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Managing obesity in pregnancy
  1. K Navaratnam,
  2. M Akhtar,
  3. M Davies
  1. Southport and Ormskirk Hospital NHS Trust, Southport, UK

Abstract

Aims To identify the proportion of obese women booking for obstetric care. Audit compliance with local and CMACE guidance,1 and assess labour outcomes for these women.

Background Maternal obesity is a common obstetric risk factor, with 4.99% UK prevalence.2 A body mass index (BMI) ≥35 confers moderate obstetric risk, a BMI≥40 confers high obstetric risk.2 In the 2003–2005 CEMACH report, 28% of mothers who died were obese.3 A pregnancy complicated by obesity increases the risk of preeclampsia, gestational diabetes mellitus (GDM), dysfunctional labour, operative intervention and postpartum haemorrhage 2.

Methods A 12-month retrospective case-note audit of women booking with a BMI≥35.

Results 62 women identified with a BMI≥35, 34 women had a BMI≥40. 76% had an anaesthetic review, 94% had a glucose tolerance test, 69% had fetal growth estimated by ultrasound. 79% of women laboured, 35% of labours were induced. 60% of women had a normal delivery, 6% had instrumental delivery, 15% had an emergency caesarean section (CS), 19% had an elective CS. 29% had an estimated blood loss ≥500 ml at delivery. Venous thromboembolic (VTE) risk was poorly assessed, with insufficient thromboprophylaxis for weight. Antenatally, no women had high VTE risk, 21% had intermediate risk. Postnatally 5% had high VTE risk, 71% had intermediate risk.

Conclusion Pre-pregnancy and antenatal risk counselling is vital, with surveillance for preeclampsia in addition to GDM. Standardised VTE risk assessment should be introduced, with weight-appropriate thromboprophylaxis. Normal birth should be promoted, to reduce obstetric interventions in this high risk group.

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