Introduction This case illustrates obstetric, logistical and financial aspects of antenatal and intrapartum management of pregnant women with BMI>80.
Case Summary A 29 year-old multiparous woman with BMI of 70.2 was booked for Consultant-led antenatal care. Her booking weight was 197kg, increasing to 242kg at term (BMI:80) despite specialist dietary input.
Given her extreme obesity, with co-morbidities including obstructive sleep apnoea, lymphoedema and heavy smoking, joint antenatal care was co-ordinated. Multidisciplinary meetings involving maternal and fetal medicine, anaesthetics and haematology identified key steps to minimise maternal and fetal complications. Manual handling assessments were made, bariatric equipment was sourced and team members underwent moving and handling training.
Conclusions Despite the rapidly increasing prevalence of obesity, our Unit's experience managing this patient has highlighted the lack of robust evidence regarding antenatal and intrapartum care of patients with super morbid obesity, let alone at such extreme levels (BMI>80).
RCOG guidelines mainly apply to women with BMI>30 and do not include active management of weight gain during the index pregnancy.1 Our literature search found only one obstetric case study for a patient with BMI>70, which principally looked at anaesthetic issues.2 UKOSS conducted cohort studies that looked at outcomes of pregnancy3 and delivery4 in women with extreme obesity but no firm management guidelines were made.
This lack of literature suggests cases such as this require an individualised approach to obstetric care. Early involvement of the multidisciplinary team, Moving and Handling Team and Estates Department is important with an awareness of increased financial implications.
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