The 2003–2005 CEMACH report in the UK highlighted obesity as a significant risk for maternal death, morbid obesity being a particular high risk group. The UK obstetric surveillance survey collected data on women with body mass index (BMI) >50 and estimated an incidence of 0.87/1000.
The University Hospital of North Durham is a DGH with 3000 deliveries per annum. A retrospective audit of the case notes was carried out for women with BMI >50 delivering over a 26 month period, standards set using specific guidelines for BMI >50.
There were 30 cases of women with BMI >50 in pregnancy. All women were referred for consultant-led care. 80% women had documentation that there had been dietary/exercise advice given but only 50% were offered a dietician referral. 100% had a glucose tolerance test at booking and 26 weeks. Only 60% had an anaesthetist referral. Thromboprophylaxis risk assessments was carried out for only 57% women during their antenatal care and 60% postdelivery all having 6 weeks of postnatal anticoagulation.
The incidence of extreme obesity was 1 in 200 that is, five times as many cases as expected from the UKOSS study and questions whether the incidence of extreme obesity in the UK is much higher than originally thought which has implications for service provision. The audit demonstrated that the guidelines were not being adhered to, particularly for anaesthetic assessment and VTE risk. The importance of pregnancy management to improve the outcome for these women and babies is paramount.
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