1.10 Obesity in Obstetric

Question 1

Complications obesity in pregnancy

Answer 1

1. Antenatal:
Risk comorbs
GDM
PIH
PET
VTE

2. Perinatal
3. Postnatal
4. Post op infection - wound or chest
5. VTE
6. Cardioresp complication
   - Pulm oedema
   - pp cardiomyopathy
   - hypoxia

Question 2

Perinatal

Answer 2

1. Increase chance of Caesarean section and instrument
   more difficult - risk prolonged surgery
2. Difficulty with IV access
3. More challenging epidural/ SAB placement
   poor landmarks
4. Unilateral / Failed / High Regional block
   - altered spread d/t fat compressions
5. Difficulty est. LBW
   Drug doses
6. Complicates an already difficult airway
   Faster desat time on apnoea
   Increased aspiration risk
7. Risk to staff mobilising patients
8. Equipment issues - max weight supported by beds

Question 3

Advice give regarding analgesia for labour and delivery

Answer 3

1. Emphasis risk abnormal labour and difficulty siting epi
2. Advantage epi:
   Analgesia
   easier tolerate tocolytics
   Risk DVT less
3. Emphasis early siting
   - allow time difficulty
4. Exam back @ same time
   ?ID difficult anatomy
5. Potential to avoid GA
6. Options if Epi FAILS
   - Remi PCA
   assess airway

Question 4

Advice regarding analgesia during labour and delivery

Answer 4

7. Complications of epidural
hypotension
motor blockade
Possible effects on labour - 
relative increase instruments

8. GA v RA and relative benefits of RA
   Avoid GA complications
   Aspiration / intubation / hypoxia
9. RIsk effects GA fetus
   requiring neonatal intervention and resus

10 Regional tech discussed
complications

Question 5

Advice regarding analgesia during labour and delivery

Answer 5

11. Consider CSE
    added benefit manipulating block for section
    dermatomes difficulty to assess
    duration surgery often longer
12. Discuss method ensuring adequate block and managing pai
    Epidural top up if CSE
    IV bolus if fentanyl
    Entonox via FM
13. Possible conversion GA if unable to produce adequate block
14. That touch and pressure are normal during a working regional block