Mx - Obesity in pregnancy

Question 1

Obesity in pregnancy poses risks to the mother and fetus, which are

Answer 1

Antenatal -
medical complications - GDM and PET
DVT
OSA
difficult abdominal palpation and USS of baby
pregnancy loss

Intrapartum
Difficult monitoring
Prolonged labour - risk of PPH
Difficult delivery and risk of shoulder dystocia
Failure to progress
CS
Anaesthetic - difficult epidural and difficult airway

Post-partum
Increased ICU requirement
Poor wound healing and infection
Difficult breastfeeding
Post natal depression

Question 2

What are the key antenatal mx points for an obese patient?

Answer 2

1) Encourage healthy diet and exercise - consider referral to dietician
2) Advise higher dose of folic acid supplement 5mg to prevent NTD, and consider 150 microg iodine supplementation
3) Document BMI and advise about recommended GWG (5-9kg for obese women)
4) Consider screening for pre-existing diabetes, and offer early OGTT for GDM with repeat testing at 28 weeks
5) Pre-eclampsia surveillance - monitor BP
5) Anaesthetic assessment

Question 3

What are the key intrapartum mx points for an obese patient?

Answer 3

1) Place IV cannula on admission to labour ward

2) Be aware of increased risk of shoulder dystocia and PPH

Question 4

What are the key postpartum mx points for an obese patient?

Answer 4

1) VTE prophylaxis - obese women are at higher risk!
2) Wound surveillance post C/S
3) Breastfeeding support
4) Follow-up diet and exercise advice with view to weight reduction or minimising further weight gain.