Obesity

Question 1

Pregnancy considerations for obesity?

Answer 1

At risk for:
Early miscarriage
GDM
Gestational hypertension / pre-eclampsia
VTE
Anaesthetic problems
Neural tube defects
Late stillbirth and neonatal death
Fetal Macrosomia
Fetal trauma

Can have difficulty with palpation and monitoring, venous access and other procedures.

BMI> 40 should have anaesthetic referral in pregnancy

Additional maternal and fetal monitoring

Question 2

Birth considerations for obesity?

Answer 2

Risk of:
Prolonged labour
Macrosomia - should dystocia
Operative birth
Difficulty siting epidural or spinal

Fetal monitoring - use of FSE?
Avoid induction
Thromboprophylaxis if BMI >40
Venous access on admission if BMI >40

Avoid dehydration in labour - risk of VTE

Question 3

Postpartum considerations for obesity

Answer 3

May need increased analgesia post-op
Breastfeeding support
Referral for assistance to reduce weight / counselling
Repeat GTT at 6 weeks.
Combined OCP may not be effective.

INCREASED RISK OF SEPSIS if LSCS

Question 4

What are the four phases of wound healing?

Answer 4

1. Haemostasis - control of blood loss and formation of obstacle to possible bacterial attacks.
2. Inflammation - blood flow to the area
3. Proliferation - A matrix of collagen is formed. Granulation occurs within 3 days in acute wounds.
4. Maturation - starts around 21 days and can take up to 1 year. Collagen fibres strengthen and position, and vascularisation decreases turning scar from pink to white.

Question 5

What factors inhibit wound healing in obese women?

Answer 5

Adipose tissue is hypoperfused and impedes normal breathing therefore reduced circulating o2
Weight of abdomen may cause poor circulation = ischaemia

Mobility - often lower when obese - encourages blood circulation and chest ventilation. Also helps prevent VTE, pressure sores and wound dehiscence.

Poor nutrition

Comorbidities - diabetes = disorganised inflammation phase