Anesthesia for Delivery in Pregnant Women With Excess Body Weight: A Clinical Review

Purpose The increasing prevalence of maternal obesity presents significant challenges for obstetric anesthesia. This clinical review aims to provide current evidence on the anesthetic management of obese parturients, focusing on antenatal assessment, anesthesia techniques, and the roles of midwives and nurses within the multidisciplinary team.Design Clinical review METHODS: A structured literature search was performed using PubMed, Scopus, CINAHL, and Web of Science databases, covering publications from January 2015 to April 2026. Inclusion criteria included original research articles, systematic reviews, meta-analyses, clinical guidelines, consensus statements, and international guidelines related to the anesthetic management of pregnant women with obesity.Findings Parturients with obesity face complex physiological and technical risks, including difficult airway management, increased neuraxial failure, and higher perioperative complications. Early antenatal anesthetic consultation is strongly recommended, with a preference for neuraxial over general anesthesia. Ultrasound guidance has been shown to improve the success of neuraxial techniques in difficult cases. Midwives and nurses are essential in anticipating complications, monitoring high-risk patients, and supporting recovery, but they need structured training and resources to ensure safety.Conclusions The anesthetic management of pregnant women with obesity requires early antenatal assessment, individualized planning, and multidisciplinary collaboration. Neuraxial anesthesia remains the preferred approach, whereas general anesthesia should be reserved for selected or rescue situations. Standardized risk-stratification pathways, structured post-cesarean care, and targeted training for midwives and nurses are needed to improve maternal safety and promote consistent, patient-centered care across clinical settings.