Obesity GTG

Question 1

What % of antenatal are obese?

Answer 1

21%

Only 47% have BMI in normal range.

Question 2

BMI Overweight?

Answer 2

> 25

Question 3

BMI
Pre-obese
Obese Class 1
Obese Class 2
Obese Class 3

Answer 3

Pre-obese: 25-29.9
Obese Class 1 30-35
Obese Class 2 35-40
Obese Class 3 >40

Question 4

Risk per 10,000 for severe morbidity and mortality in pregnancy for
Obese Class 1
Obese Class 2
Obese Class 3

Answer 4

Obese Class 1 25
Obese Class 2 35
Obese Class 3 60

Question 5

How much more likely to suffer VTE in pregnancy if BMI >30?

Answer 5

9 times

Question 6

How much more likely to suffer GDM in pregnancy if BMI >30?

Answer 6

3 times

Question 7

How much more likely to suffer PIH-PET in pregnancy if BMI >30?

Answer 7

2-3 times

Question 8

How much more likely to have C/S, stillbirth or PPH in pregnancy if BMI >30?

Answer 8

2 times

Question 9

If BMI > 30 what additional care should be provided?

Answer 9

• Advice pre-pregnancy weight loss
• Folic acid 5mg 1 month before until end of 1st trimester
• Screen for GDM
• VTE 1 RF
• Active 3rd stage
• Specialist breast feeding support
• Offer nutritional advice post op

Question 10

If BMI > 35 what additional care (including that of >BMI 30) should be provided?

Answer 10

• Deliver on consultant led unit
• Moderate PET RF (Give aspirin if Fhx, P0, Age >40, multiple preg)
• Serial USS

Question 11

If BMI > 40 what additional care (including that of >BMI 30+35) should be provided?

Answer 11

• Moving and handling assessment
• AN anaesthetic review, inform anaesthetics when on LW
• Risk assessment 3rd trimester for tissue viability
• VTE 2 point

Question 12

If obese and GDM, what is the increased risk for congenital abnormality?

Answer 12

3 fold

Question 13

What is the success rate of IOL in obese women
i) For primip
ii) For multip

Answer 13

Primip: 60%
Multiple: 90%

Question 14

What are the success rates for VBAC and IOL?

Answer 14

54%
BMI >40 increased risk uterine rupture

Question 15

How long should someone wait after bariatric surgery before coming pregnant?

Answer 15

12-18 months

Question 16

If vomiting after bariatric surgery, what should be considered?

Answer 16

Internal hernia or gastric band

Question 17

Risk to mother if BMI >30 in pregnancy

Answer 17

Women with a booking BMI > / =30 kg/m2 are at increased risk of
Miscarriage
gestational diabetes
pre‐eclampsia
VTE
induced labour
dysfunctional or prolonged labour
caesarean section
anaesthetic complications
PPH
wound infections
mortality
Also less likely to initiate and maintain breastfeeding

Question 18

Risk for Infants to mothers who BMI > 30 includes:

Answer 18

Infants of obese mothers are at increased risk of

congenital anomalies (including neural tube defects)
stillbirth
prematurity
macrosomia
neonatal death
Increased risk of developing obesity and metabolic disorders in childhood

Question 19

What patient leaflets can be offered?

Answer 19

RCOG- why your weight matters during pregnancy and after birth

NHS choices - Overweight and pregnancy