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Obstructive sleep apnea (OSA) is characterized by upper airway collapse and obstruction during sleep. It is estimated to affect nearly 5% of the general female population. Obesity is often associated with OSA. The physiological changes associated with pregnancy may increase the severity of OSA with a higher risk of maternal and fetal morbidity. However, very few parturients are diagnosed during pregnancy. These undiagnosed parturients pose great challenge to the attending anaesthesiologist during the perioperative period. Parturients at risk should be screened for OSA, and if diagnosed, treated. This review describes the anaesthetic concerns in obese parturients at risk for OSA presenting to the labor and delivery unit.

Chronic renal failure is rare in pregnancy and often results in significant maternal and neonatal morbidity. When possible, preoperative dialysis is useful to optimize fluid and electrolyte balance. We describe the perioperative management of a parturient who persistently refused dialysis, had an uneventful cesarean delivery under graded epidural anesthesia.