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Abstract
The CMACE/RCOG joint guideline recommend in their management of women with obesity in pregnancy guideline that pregnant women with a booking BMI > 40 should have an antenatal consultation with an obstetric anaesthetist. We compare the pregnancy outcome data in our morbidly obese population from both before and after the introduction of our specialist obesity obstetric anaesthetic clinic.
We performed a retrospective audit, comparing pregnancy outcomes in the first six months of 2009 pre-clinic, and the first six months of 2011 post clinic establishment, in the morbidly obese, looking at; anaesthetic type, estimated blood loss, cord pH < 7.1, cord pH < 7.0, and APGARs at 1, 5 and 10 minutes. The results are reviewed in the context of mode of delivery, induction, preterm delivery and birth weight.
Results The type of anaesthetic for elective section was 12/12 (100%) spinal in 2009 v 10/11 (90.9%) spinal +1/11 (9.1%) epidural in 2011. For emergency section the type of anaesthetic was 3/12 (25%) epidural + 9/12 (75%) spinal in 2009 v 10/15 (66.7%) epidural with one conversion to general anaesthetic (6.7%) +5/15 (33.3%) spinal in 2011. Estimated blood loss in 2011 appeared higher than in 2009, but was not significantly so. Comparing EBL in 2009 v 2011; 23/46 (50%) v35/70 (50%) had <500 ml, 20/46 (43.3%) v25/70 (35.7%) had 500–999 ml, 1/46 (2.1%) v 4/70 (5.7%) lost 1000–1499 ml, 2/46 (4.3%) v 5/70 (7.1%) lost >1500 ml. Cord pH below 7.0 occurred in 1/46 (2.1%) in 2009 v 1/70 (1.4%) in 2011. APGARS below 8 at 1, 5 and 10 minutes were 3/46 (6.5%), 1/46 (2.1%) and 1/46 (2.1%) respectively in 2009 and 13/70 (18.6%), 2/70 (2.8%) and 0/70 (0%) respectively in 2011.
There were no obvious improvements in our outcome measures following the introduction of a consultant obstetric anaesthetist clinic for those with morbid obesity.