Birth asphyxia during general anesthesia for a morbidly obese parturient with gestational diabetes mellitus undergoing cesarean section--a case report.

A 26-year-old pregnant woman with a body mass index of 60 was scheduled for cesarean section at 36 weeks' gestation. She was found having affected with gestational diabetes mellitus and hypertension at 17 weeks of pregnancy. The blood glucose level as controlled by subcutaneous injection of insulin was maintained at the level of 110-140 mg/dL. Hypertension was also controlled by methyldopa and hydralazine with the systolic pressure maintaining at 140-180 mmHg during the pregnancy. Abnormal perfusion of umbilical artery without compromise of placental function was found twice by Doppler prenatal examination at gestation of 33 and 34 weeks respectively. The operation was performed under general anesthesia. However, apnea and low Apgar score of the neonate were noted. General anesthesia was thought as the root cause of this event at first. After a series of examination and management, hypoglycemia and uteroplacental perfusion insufficiency were considered as the causes of this morbidity. The neonate's condition was improved in 48 hr after close care.