Background Obesity is one of the biggest challenges facing maternity services today. Women with obesity have significant higher complication rates and these can potentially be reduced with good quality clinical care.
Objectives To compare current practise at Royal Derby Hospital with the RCOG/CEMACE guideline on management of pregnant women with morbid obesity.
Methods A retrospective case-note audit of all women delivered at RDH between 01/09/2011 and 31/08/2012 with booking BMI ≥ 40.
Results There were 6252 deliveries at RDH with 140(2.24%) patients with BMI ≥ 40. We analysed 134 case notes. Glucose tolerance test was performed in 96.2% of patients at 28 weeks gestation and 55.2% had an anaesthetic review. 47.1% of women laboured spontaneously, 36.5% of labours were induced and 16.4% had elective caesarean section (CS). 67.8% of women had a normal vaginal delivery, the instrumental delivery and Emergency CS rate were 9.0% and 23.2% respectively. 89.6% of operative deliveries were either performed or supervised by ST6 and above. 96.2% had active management of 3rd stage and major postpartum haemorrhage occurred in 8.2% of women. For term deliveries the birth weights ranged from 2620 g to 5080 g (21.6% greater than 4000 g). 47.3% had postnatal thromboprophylaxis with 81.4% on sufficient thromboprophylaxis for weight.
Conclusion The audit demonstrated that the guidelines were not being adhered to, particularly for anaesthetic assessment and venous thromboembolism risk. Review of our local guideline with more training for healthcare professionals involved in the care of this group of high risk patients is required to improve maternal and neonatal outcomes.
CMACE/RCOG Joint Guideline on ‘Management of Women with Obesity in Pregnancy’ - March 2010
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