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Complex care 2 > Module 7 > Flashcards

Module 7 Flashcards

1
Q

WHO defines obesity as

A

BMI >30kg

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2
Q

class 1 obesity

A

BMI between 30-39.9

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3
Q

class 2 morbid obesity

A

BMI between 40-49.9kg

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4
Q

class 3 super obesity

A

BMI >50kg

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5
Q

% of aus women over 18 were overweight or obese

A

60

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6
Q

why are women obese

A
  • Gender
  • Socioeconomic status – rates of obesity increase
  • Diet and lifestyle
  • Mental wellbeing
  • Sedentary work
  • Genetics
  • Ethnicity
  • Emotional reasons
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7
Q

complications of obesity

A
  • Metabolic (type 2 diabetes)
  • Circulatory (CV disease)
  • Degenerative (osteoarthritis)
  • Usually associated with AMA
  • Increases risk of gynae complications e.g endometrial cancer, infertility and menorrhagia through menstrual disturbances and ovulation disorders
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8
Q

is obesity a disability

A
  • Disability discrimination act identified
    1. Physical – affects a person’s mobility or dexterity
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9
Q

legislation

A

Disability discrimination act 1992

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10
Q

Against the law in NSW to treat people unfairly or harass them because they have a disability

A
  • a disability the person has now;
  • a disability that someone thinks the person has now
  • a disability a person had in the past
  • a disability that a person will get in the future,
  • a disability that relatives, friends, work colleagues or associates of the individual has now, had in the past or will get in the future
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11
Q

A/N issues and pregnancy management

A
  • review at booking in
  • obesity clinics
  • diet and lifestyle interventions increase folic acid
  • screening and management of comorbidities (diabetes, hypertension, skeletal, bone and ligament, miscarriage and stillbirth)
  • anaesthetic review before or at term (analgesia and general physical assessment)
  • sensitive approach to engage women in their care
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12
Q

labour and birth issues

A
  • location
  • ambulation
  • water birth
  • WHS issues
  • Higher induction and LSCS
  • Fetal monitoring issues
  • Early and more epidurals
  • Limited real choices
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13
Q

postnatal issues

A
  • Ambulation post birth
  • Increased general morbidity
  • Breast size and feeding issues
  • Increased LSCS rates and associated issues : infection, mobility, thrombotic events
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14
Q

neonatal and infant issues

A
  • Macrosomia
  • Hypoglycaemia and hypothermia
  • Higher scn/nicu management for jaundice and respiratory distress
  • Increased infant and child morbidity and the continuing obesity cycle
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15
Q

perinatal complications associated with obesity

A
  • Fetal anomaly
  • GDM
  • Hypertensive disorders (pre-eclampsia)
  • LGA
  • Macrosomic babies and stillbirth
  • Longer labour
  • IOL
  • Premature labour
  • PPH
  • Internal fetal surveillance
  • X5 likely for LSCS
  • Experience difficult anaesthetic procedures
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16
Q

care of women who are obese

A
  • higher doses of folic acid in early pregnancy,
  • a wide range of surveillance methods for congenital abnormalities
  • regular ultrasound growth scans with customised growth charts because accurate growth assessment by palpation is often difficult
  • early glucose tolerance testing for gestational diabetes and increased number of visits to monitor blood pressure, and attend anaesthetic and obstetric referrals
  • more likely to have longer labours, caesarean section and postpartum haemorrhage is thought to be due to the myometrium of the uterus not contracting efficiently
17
Q
  • obesity is a factor in …% of maternal deaths and has a significant influence on pregnancy
A

35

18
Q

obesity definition

A
  • defined as the excessive accumulation of fat within the fat cells as a result of discrepancy between energy intake and energy expenditure
19
Q

non-pregnancy treatment and care

A
  • attain steady weight loss until the BMI is within the normal range
  • increasing overall muscle mass
  • producing a sense of wellbeing
  • depressing appetite
  • increasing the overall metabolic rate
20
Q

pre-conception care and issues

A
  • support and advice should be available for all women with a BMI>30 in order to achieve a normal BMI
  • bariatric surgery does improve fertility
  • encourage all women with obesity to take 5mg of folic acid supplementation
21
Q

pregnancy issues

A
  • early miscarriage
  • GDM and preeclampsia
  • Venous thromboembolism
  • Anaesthetic problems
  • Neural tube defects
  • Late stillbirth
  • Fetal macrosomia
  • Fetal trauma
  • NICU admissions
22
Q

medical management and care

A
  • Women with a BMI >40 antenatal anaesthetic referral screen
  • 10mg of vit D supplement throughout pregnancy and BF
23
Q

midwifery management and care

A
  • BMI ≥30 should be referred to a consultant to discuss intrapartum risks and management strategies4 * Women with a BMI ≥35 should be booked in a consultant-led environment
  • Moderate exercise should be encouraged, unless the woman is experiencing other signs or symptoms
  • Individualised advice, especially options for fetal anomaly screening, is important, taking into account the effects of weight on biochemical results
  • Careful observation of the maternal and fetal status is important during pregnancy to detect complications; community monitoring for preeclampsia at least every 3 weeks between 24 and 32 weeks for women with a BMI ≥35 is recommended
24
Q

labour issues medical management

A

Increased rates of prolonged labour
- * Risks associated with macrosomia, e.g. shoulder dystocia
- * Increased rates of operative birth especially for primigravida
- * Difficulties in undertaking instrumental and operative procedures
- * Difficulty siting an epidural or spinal for labour or caesarean section

25
Q

midwifery management

A
  • Effective midwifery support in labour is important; women with a BMI ≥40 should receive continuous midwifery care in labour
    • Encourage changes in maternal position throughout labour
    • Avoid dehydration in labour (risk of venous thrombo-embolism)
    • Observe progress – use the partogram carefully throughout labour
    • Fetal scalp electrode for difficulty with abdominal auscultation of the fetal heart
26
Q

postpartum issues

A
  • Venous thrombo-embolism; obesity in the presence of two other persisting risk factors should prompt the need for thrombo-prophylaxis for 3–5 days
    • Longer post-operative recovery and increased rates of post-operative complications, e.g. infections of wound and urinary tract
    • Women who are obese during pregnancy tend to retain fat centrally on their abdomen postnatally, which may result in increased morbidity and mortality in later life
    • Lower rates of breast-feeding
    • Contraceptive choices will be influenced by the presence of complications
27
Q

medical management postpartum

A
  • Multidisciplinary approach to the management of associated conditions
    • Encourage women to lose excess weight to achieve a healthy BMI prior to any subsequent pregnancy
28
Q

midwifery management postpartum

A
  • May need increased post-operative analgesia
    • Early mobilisation ; continue thrombo-embolic prophylaxis until fully mobile
    • Encourage and support breast-feeding to help mobilise fat stores: tailor breast-feeding advice to meet individual needs; suggest underarm positioning at the breast * Review postpartum weight at the 6–8 week check and consider referral to the MDT for support and advice regarding weight reduction and moderate exercise
    • Consider referral for cognitive and behavioural therapy and consider providing extended midwifery postnatal care
    • The combined contraceptive pill may not be as effective in obese women
    • Repeat GTT at 6 weeks postnatal if GDM diagnosed during pregnancy

Complex care 2 (9 decks)

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