{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T06:19:45Z","timestamp":1783059585144,"version":"3.54.6"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T00:00:00Z","timestamp":1775260800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T00:00:00Z","timestamp":1775260800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Gynecol Obstet"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Obesity affects nearly 40% of reproductive-aged American women, with over 12% classified as severely obese. Higher maternal body mass index (BMI) is linked to increased cesarean rates; however, data on intraoperative hemodynamics and anesthetic management, particularly in the superobese (BMI\u2009\u2265\u200950\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), remain limited.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 2051 cesarean deliveries under neuraxial anesthesia, stratified by six BMI categories. The primary outcome was intraoperative hypotension based on serial noninvasive blood pressure (NIBP) readings. Secondary outcomes included neuraxial placement time, surgical duration, estimated blood loss (EBL), and neonatal Apgar scores. Multivariate regression, adjusted for comorbidities and neuraxial technique, assessed associations and outcome differences across BMI groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Superobese parturients exhibited a delayed yet sustained decline in mean arterial pressure (MAP) following neuraxial anesthesia, showing a late-phase, vasopressor-resistant hypotensive pattern. Time from surgical procedure start to fetal delivery increased from 11.8\u2009\u00b1\u20099.1\u00a0min in normal weight versus 17.3\u2009\u00b1\u20099.3\u00a0min in superobese (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Between BMI groups, anesthesia start to procedure start, which reflected positioning, IV optimization, and neuraxial placement, increased from 35.1\u2009\u00b1\u20099.4\u00a0min to 50.6\u2009\u00b1\u200915.9\u00a0min (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), while total procedure time increased from 57.7\u2009\u00b1\u200924.3 to 76.8\u2009\u00b1\u200927.4\u00a0min (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). EBL was significantly higher in the superobese patients: 902\u2009\u00b1\u2009294\u00a0mL versus normal BMI patients: 712\u2009\u00b1\u2009230\u00a0mL (p\u2009&lt;\u20090.0001). 1-min Apgar scores declined with higher BMI, but 5-min scores were comparable across groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Superobesity is associated with specific intraoperative negative outcomes during cesarean delivery under neuraxial anesthesia. Our study findings highlight the need for anticipatory anesthetic planning and tailored hemodynamic management strategies in high-BMI parturients to optimize maternal and neonatal outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00404-026-08408-0","type":"journal-article","created":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T10:43:24Z","timestamp":1775299404000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative hemodynamics and anesthetic implications in superobese parturients undergoing cesarean delivery: a retrospective cohort analysis"],"prefix":"10.1007","volume":"313","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3768-7371","authenticated-orcid":false,"given":"Teshi","family":"Kaushik","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Hackney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayesha","family":"Bryant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Baker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sijules","family":"Abongwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brant M.","family":"Wagener","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Arnold","family":"Fr\u00f6lich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,4]]},"reference":[{"key":"8408_CR1","doi-asserted-by":"publisher","unstructured":"Stierman B, Afful J, Carroll MD et al (2021) National Health and Nutrition Examination Survey 2017\u2013March 2020 prepandemic data files\u2014development of files and prevalence estimates for selected health outcomes. 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