Alex C. VIDAEFF

Alex C. VIDAEFF |Clyto Access

Maternal-Fetal Medicine Baylor College of Medicine, USA

Keynote Speaker

Expertise: Maternal-Fetal Medicine

Biography:

Dr. Alex Vidaeff received his MD degree from the University of Bucharest in 1977. In 1983, he was accepted into the United States as a political refugee and resumed training initially in Pathology at Lenox Hill Hospital in New York, and then in ob/gyn. He graduated from the ob/gyn residency at Temple University in Philadelphia in 1991 and subsequently moved to Boston. After 10 years as Clinical Instructor and then Assistant Clinical Professor at Harvard Medical School, he decided to complete a Maternal-Fetal Medicine fellowship at the University of Texas – Houston Medical School. Upon completion of his fellowship in 2003, he stayed on the faculty and moved up the academic ranks to full Professor of Ob/Gyn. In 2011, Dr. Vidaeff joined the faculty at Baylor College of Medicine in Houston. In 2015, he became the Program Director for the Maternal-Fetal Medicine Fellowship at Baylor.

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Presentation:

Title: Cesarean delivery in the obese parturient

Abstract:

The rate of obesity has increased dramatically in the United States, presently with 20.5% of women being obese as they begin pregnancy. Of all parturients, 4-6% have morbid obesity and it has been estimated that 200,000 morbidly obese women give birth per year in the United States. Cesarean delivery is the most common major surgical procedure in the United States, but women with BMI >35 have a double risk of cesarean delivery and about 60% of women with BMI > 50 undergo cesarean delivery. Caring for obese patients often requires modification of techniques and practices in order to improve care and safety.

The purpose of this presentation is to discuss the following clinical questions: 1. What technical surgical aspects should be considered at cesarean delivery?
2. Are there adjustments necessary in perioperative antibiotic prophylaxis?
3. What particular anesthesia considerations are applicable?
4. What are the post operative considerations relative to thromboprophylaxis?
We will review and challenge current practices surrounding the delivery of obese women and will outline what evedence-based improvements can be adopted in practice.

There is little evidence to establish whether elective cesarean delivery is preferable to planned vaginal delivery in morbidly obese women. Older literature seemed to indicate a significantly higher rate of emergency cesarean delivery in morbidly obese women compared to normal weight controls. Anxiety about the need for emergency intrapartum cesarean delivery in technically difficult conditions has undoubtedly contributed to the higher rate of prelabor cesarean deliveries. More recent data, however, indicate that these emergency occurrences are rare, especially in multiparous women, not justifying elective cesarean delivery in obese multiparous women and calling for a change in practice. Given the well documented risks associated with cesarean delivery in obese women, consideration should be given to developing preventive strategies for reducing the cesarean delivery rate in obese patients. When deciding on route of delivery in morbidly obese women, the implications of an emergent cesarean delivery in technically difficult conditions and the possibility of neonatal birth injury with attempted vaginal delivery should be considered. Outcome differences between nulliparous and parous women should also be taken into account, with available evidence suggesting that labor induction in obese nulliparous women and elective cesarean delivery in obese multiparous women may not be justified.

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