Green top Guideline Flashcards
What is the percentage of obesity in antenatal population?
21,3 % obese
43 % BMI in the normal range
In the review into maternal death, what is the percentage of obese women?
30 % of women who died were obese
22 % of women who died were overweight
When a woman with obesity should seek prepregnancy counseling?
If BMI > 30
What is the classification of adults according to BMI?
Underweight < 18,5
Normal range 18,5 - 24,99
Overweight > = 25
Preobese 25 - 29,99
Obesity class 1 30 - 34,99
Obesity class 2 35 - 39,99
Obesity class 3 >= 40
What are the informations that should be provided preconceptually to women with high BMI?
🚩Weight loss reduces the risk of stillbirth, hypertension , fetal macrosomia
🚩Weight loss increases the chance of successful vaginal birth after CS ( VBAC)
What are the maternal risks that can be associated with obesity?
1- ⬆️ risk of miscarriage
2- GDM
3- PET
4- VTE
5- induced labour/ prolonged labour
6 - CS / anaesthetic complications
7- PPH
8 - less likely to maintain breastfeeding
9- wound infection/ mortality
What are the fetal risks that can be associated with obesity?
1- congenital anomalies
2- stillbirth
3- prematurity
4- macrosomia/ neonatal death
5- increased risk of developing obesity and metabolic disorders in childhood.
What nutritional supplements should be recommended to women with obesity who wish to become pregnant?
❤ BMI > 30 👉 5mg / d folic acid 1 month before conception
* routine vit D:( uncertain evidence)
[ at high risk of vitD deficiency]
What is the risk increased by calcium & vitD combinations?
Preterm birth
In women with obesity:
- when the need of multidisciplinary team antenatally
- when to deliver in a consultant led unit
- BMI> 30 👉 MDT antenatally
- BMI > 35 👉 CLU at delivery
When to assess the moving & handling risk( around delivery) in the 3rd trimester in a woman with obesity?
If BMI > 40
When to calculate BMI in pregnancy?
At booking
🚩 in obese women: at booking + at the 3rd trimester
What is acceptable gestational weight gain in obese women?
Lack of consensus on optimal gestational weight gain
What is the role of anti obesity drugs in pregnancy?
NOT recommended in pregnancy
Orlistat as anti obesity drug , is it allowed in pregnancy?
No,
orlistat is a lipase inhibitor
( no increase in major malformation risk was seen)
What is the risk of using phentermine/ topiramate ( anti obesity drug ) in pregnancy?
( promotes appetite)
Increase the risk of oral cleft in exposure in 1st trimester.
6 times more
What is the risk of taking lorcaserin in pregnancy ?
( serotonin receptor antagonist)
Exposure in late pregnancy result lower birth weight of offspring which persist to adulthood.
👉 contraindicated in pregnancy.
What specific risk assessment are required for anaesthetics?
1- BMI> 40 👉 referral to obstetric anesthetist for antenatal assessment
2- assess: venous access +regional & general anaesthesia difficulties
3- MDT: if any potential difficulties
What specific risk assessments are required for prevention of pressure sores?
BMI > 40 + IMMOBILITY are:
risk factors of pressure sores
👉 document risk assessment in 3rd trimester 👉 plans for for skin care & repositioning frequency.
Above what BMI a woman should be screened for gestational diabetes?why?
BMI > 30
obese women with diabetes have 3 fold increased risk of congenital anomalies.
Above what BMI obese women have increased risk of preeclampsia?
Class 2 and more ( BMI > 35)
What are the moderate risk factors for preeclampsia that MAY benefit from aspirin in pregnancy?
MORE THAN 1 OF:
1- BMI > 35
2- First pregnancy
3- maternal age > 40
4- family history of PET
5- multiple pregnancy
👉 150 mg aspirin from 12w of pregnancy
What are the maternal diseases that should be screened in pregnancy in women with obesity?
1- GDM BMI> 30
2- hypertension BMI > 35
3- VTE BMI > 30
4- mental health problems BMI >30
( depression- anxiety)
What are the structural anomalies that the fetuses of obese women at high risk of?
1- spina bifida
2- NTD
3- hydrocephaly
4- Cardiovascular anomalies
Above what BMI the higher fetal loss rate after amniocentesis?
BMI > 40
If BMI < 40 👉 don’t have increased risk of fetal loss.
What special considerations about NIPT in screening obese pregnant women ?
Free DNA fractions shown to be decreased in maternal serum with increasing maternal weight
👉 NIPT less effective in obese women
How & when should the fetus of obese women be monitored antenatally?
🚩 BMI< 35 👉 Symphysis fundal height SFH at each visit from 24w
🚩BMI > 35 👉 serial US to detect SGA
How should the fetus of obese women be monitored during labour?
In accordance with NICE
Obese women are at increased risk of prolonged pregnancy, what is the risk of the fetus in that case?
Stillbirth
BMI >35👉4 times more normal BMI
[ despite that No routine monitoring of post dates pregnancy]
What should be discussed with women with maternal obesity regarding labour &birth?
1- low risk + multiparty 👉 MLUs
2- high risk 👉 CLUs + MDT
3- ACTIVE MANAGEMENT OF 3rd STAGE: to reduce the risk of PPH
What are the potential intrapartum complications in women with maternal obesity?
1- labour induction
2- argumentation of labour
3- intrapartum CS
4- shoulder dystocia
5- additional analgesia during labour
Is maternal obesity an indication for induction of labour?
Discussion should be made
On individual basis:
📌 elective induction at term in obese women reduce the chance of CS without increasing the risk of adverse outcomes.
Maternal obesity is associated with fetal overgrowth, what is the overall OR?
2.4 for LGA more than 90th centile
How much the incidence of CS is increased in women with overweight & obese women?
🚩The risk of CS is increased by 50 % in overweight women
🚩More than doubled in obese women
What are the benefits of induction labour at term for fetal macrosomia irrespective of maternal BMI?
Reduction in the risk of shoulder dystocia & fetal fractures
Fetuses from induction of labour group were at increased risk of what?
1-Raised bilirubin
2- High rates of Phototherapy
What is the success rate of VBAC in general population ?
In obese women?
In general population 73%
In obese women 54 %
👉 obesity is a risk factor for unsuccessful VBAC
What is the risk associated with trial of labour after CS in obesity class 3 ?
Uterine rupture
What specific surgical techniques are recommended for CS on obese women?
🚩BMI>30 👉 Prophylactic antibiotics at the time of surgery
🚩> 2 cm subcutaneous fat 👉 should have suturing of subcutaneous space.
🚩No routine use of negative pressure dressing therapy or subcutaneous drains ( lack of evidence)
📒 What is the period of time a woman undergone a bariatric surgery is recommended before attempting pregnancy?
12 - 18 months
And should have CL antenatal care
+ referral to dietitian for advice
In comparison between class 3 obesity & bariatric surgery in the pregnancy outcomes?
Better overall obstetric outcomes after bariatric surgery
