Complications of Obesity in Cesarized Parturients in the Teaching Centers of Cotonou

This survey had the objective to determine the frequency of the obesity at the parturient, to value the impact of the obesity on the childbirth by Caesarean and the complications postoperative immediate in the teaching hospitals of Cotonou. Patients and Method: We did a prospective, comparative and analytic survey from January 13 to April 13, 2012. Eight hundred ninety-one consecutive parturients having had a Caesarean were included. We studied the anesthetic techniques, the techniques of control of the aerial ways, the number of necessary tests for the tracheal intubation, the complications and aftercare of the first 48 hours. A comparison has been made according to the BMI. The obesity has been defined by a BMI ≥ 30 kg/m. The parturient has been classified in two groups: Non-obese: BMI ≤ 30 kg/m, obese: BMI ≥ 30. Results: There were 703 (78.90%) Caesareans in emergency and 188 (21.09%) programmed Caesareans. The obesity which has been recovered at 286 parturient is 32.10%. The obese parturient also required more frequently several lumbar punctures (p < 0.001) at the time of the spinal anesthesia and more of conversion of the spinal anesthesia into a general anesthesia (p = 0.008). The postoperative complications: laryngeal pain, back pain and suppuration of the wound were more frequent at the obese parturient. Conclusion: Many changes led by pregnancy are added to those of the obesity to drive to functional changes, a reduction of the physiological reserve and finally to an inHow to cite this paper: Hode, A.K., Zoumenou, E., Hounkpatin, B., Mewanou, S., Tchaou, B. and Chobli, M. (2018) Complications of Obesity in Cesarized Parturients in the Teaching Centers of Cotonou. Open Journal of Endocrine and Metabolic Diseases, 8, 137-144. https://doi.org/10.4236/ojemd.2018.86014 Received: May 5, 2018 Accepted: June 25, 2018 Published: June 28, 2018 Copyright © 2018 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access A. Kerekou Hode et al. DOI: 10.4236/ojemd.2018.86014 138 Open Journal of Endocrine and Metabolic Diseases creased anesthetic and obstetric risk. The obesity is frequent at the parturient in Benin. The post-operative complications are more frequent after the Caesarean at the obese parturient.


Introduction
According to a WHO's report, more than a third of the women and a quarter of the men in Africa are in overweight, and these proportions should increase to 41% and 30% respectively during the next ten years. The recent tendencies in the urbanization of the developing countries and the internationalization of the food market contribute to changing the behavior of people and their style of life.
These changes of lifestyle, bound to the nutrition, transition of the traditional to the modern habits, have driven to the emergence of the overweight and the obesity [1] [2]. A hospitable survey led to Cotonou returns a prevalence of overweight of 35.3% and the one of the obesity to 27.3% with a feminine predominance: 16.9% at the men vs 36% at the women [3]. The morbidity townships of the obesity at the women are the complications of pregnancy, the dystocia, and the childbirths by Caesarian procedure [4] [5] [6].
This survey had the objective to determine the frequency of the obesity at the parturient, to value the impact of the obesity on the childbirth by Caesarean and the complications postoperative immediate in the teaching hospitals of Cotonou.

Patient and Method
Our survey took place in the service of anesthesia resuscitation, the operative blocks, to the intensive care, the delivery rooms, the services of hospitalization, the neonatology service of two academic motherhoods of Benin,. We did a prospective, comparative and analytic survey of January 13 to April 13, 2012.
After the favorable opinion of the local ethics committee and the consent of the parturient. We collected the data by a standardized questionnaire. The information we collected included age, height, weight, BMI, Co-morbidities, gestational and parity, anesthetic technique, complications, indications for Caesarean section, cesarean section modalities , the satisfaction of the parturient. All parturients who had a Caesarian procedure during this study period were included either Eight hundred ninety-one parturients. We studied the anesthetic techniques, the techniques of control of the aerial ways, the number of necessary

Results
There were 703 (78.90%) Caesareans in emergency and 188 (21.09%) programmed Caesareans. The obesity has been recovered at 286 parturient is 32.10%. Among the 286 obese, 57.69% (165) had an obesity moderates; 28.32% (81) had a stern obesity, 13% (37) had a morbid obesity and 1.04% (3) were terrific obese. The obese parturient had a more elevated middle gravidity to 3.03 and a more elevated middle parity to 1.56. The high BP, OSAS and the burrs were the co-morbidities the more frequently recovered at the obese parturient (Table 1). The spinal anesthesia and the general anesthesia was practiced with the same frequency at the obese parturient as non-obese ( Table 3). The obese parturient had a score of Mallampati more frequently therefore superior to 2 were more susceptible to present some difficulties the intubation. These parturient required several laryngoscopies more frequently before the intubation ( Table 3). The obese parturient also required more frequently several lumbar punctures (p < 0.001) at the time of the spinal anesthesia and more of conversion of the spinal anesthesia into an anesthesia general p = 0.008 (Table 3).
The postoperative complications: laryngeal pain, back pain and suppuration of the wound were more frequent at the obese parturient (

Discussion
This survey permitted to determine the prevalence of the obesity at the parturient that benefitted from the Caesarean in the academic hospitals of Cotonou, and to determine the impact of the obesity on the complications of the Caesa-

rean. Open Journal of Endocrine and Metabolic Diseases
The prevalence of the obesity at these parturient was of 32.10%. It was superior to the 10.73% of the general population in the Benin [8]. Although the WHO defined the obesity for a BMI ≥ 30 Kg/m 2 ; at the parturient it is necessary to take account of the supplementary weight contained in the uterus, of the Sodium retention and the supplementary greasy mass of due to the pregnancy. The obesity would be defined then at the parturient for a BMI ≥ 35 Kg/m 2 [9]. The prevalence of the obesity at the parturient would be then of 24.80%. It remained superior to the 14.52% recovered in the urban population by Gary et al. [7].
Our survey was only carried on the parturient having benefitted a Caesarean and no on the set of the parturient. We could not define the frequency of Caesarean among the obese parturient in relation to the non-obese parturient. The obesity at the parturient is associated to affections as: the arterial hypertension, the diabetes, the asthma, the pre-eclampsia and the OSAS [10]. In our survey this association was meaningful for the arterial hypertension, the nocturnal burrs and the OSAS. At the obese pregnant women, the OSAS is even more frequent and the episodes of arterial desaturation in oxygen that can occur during the syndrome of apnea of the sleep are a threat for the mother and the fetus [11].
Many changes led by pregnancy are added to those of the obesity to drive to functional changes, a reduction of the physiological reserve and finally to an increased anesthetic and obstetric risk [12]. The oedema of the aerial ways, the greasy deposits to the level of the soft cloths of the aerial ways, the short neck and the volume of the breasts contribute to the difficulty of the intubation. The obese parturient had a score of Mallampati more 3 and 4 in relation to the non-obese parturient. The difficulty of intubation has been observed at 12.59% of the parturient obese vs 7.11% at the non-obese parturient. The impact of the failures of the intubation is the order of 1/280 at the parturient against 1/2230 in the general population of the patients operated [13] [14] [15]. The failure of the intubation was observed at 1.40% of the parturient obese vs 0.99% of the non-obese parturient. The spinal anesthesia is recommended therefore especially at the obese parturient [16]. The spinal anesthesia was preferentially the technique the more used (80.80%) for the Caesarean in our survey as well at the obese parturient that non obese. This technique associated the bupivacaine to the fentanyl and/or to morphine. The difficulty of the lumbar puncture was more frequent (67.13% vs 47.93% of multiple puncture) at the obese parturient. This tendency has been returned by Vricella et al. [10].
The laryngeal pains were more frequent at the obese that the non-obese. It explains itself comfortably by the number more raised of laryngoscopy. In the same way, there was more back pain at the obese that the non-obese. This result is only a consequence of the multiple lumbar punctures. The suppuration of the operative wound was observed solely at the obese parturient. What joins the observations of Lebuffe et al. [17]. The thickness of the adipose tissue plays an important role in the intervening of this complication. The adipose tissue is hypoperfused what makes hypoxic the sub-cutaneous tissue at the obese and delay the skinning.

Conclusion
Our survey reveals that the obesity's frequency increased depending on the number of pregnancy and childbirth. Obesity increased the risk of occurred hypertension, apnea sleep syndrome and snoring. It increased the difficulties of lumbar puncture at a spinal anesthesia with an important risk of using the general anesthesia. Immediate complications due to obesity were postoperative wound suppurations and long-term back pain.