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Obesity > Obesity in pregnancy > Flashcards

Obesity in pregnancy Flashcards

1
Q

BMI measurment units

A

kg/m2

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2
Q

Obesity classes

A 
I = 30-34.9
II = 35 - 39.9
III = 40 +
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3
Q

Obesity Increased fetal pregnancy risks

A
  1. stillbirth (black obese > white obese)
  2. recurrent miscarriage
  3. anomalies: cardiac, neural tube defects, hydrocephalus, orofacial, limb reduction
  4. SAB
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4
Q

Obesity maternal risks

A
  1. proteinuria
  2. PreE
  3. DM
  4. cardiovascular
  5. NASH
  6. OSA
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5
Q

Obesity cause an increased risk in spontaneous PTB?

A

Conflicting data

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6
Q

Obesity increased L&D risks

A
  1. failed induction
  2. increased risk for c/s
  3. c/s = wound dehiscence/infection
  4. VTE
  5. endometritis
  6. dystocia
  7. longer FIRST stage of labor, not second
  8. PPH due to atony s/p vaginal delivery, but not c/s
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7
Q

PP complications of obesity

A
  1. earlier d/c breastfeeding
  2. post pregnancy weight retention
  3. PP depression
  4. PP anemia
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8
Q

Childhood risks for obesity

A
  1. metabolic syndrome
  2. macrosomia
  3. IUGR
  4. childhood obesity
  5. childhood asthma
  6. Psych: development disorders, autism, ADD, developmental delay
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9
Q

Operating table typically accommodate what wt limit?

A

450lbs, some 1000 lbs

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10
Q

Preconception counseling works best in obesity

A

Motivational interviewing: pt centered, resolving ambivalence

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11
Q

Minimum Percentage of wt loss to significantly improve metabolic health

A

5-7%

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12
Q

Metformin in pregnancy, function?

A

decreases hepatic glucose production, shown to decrease gestational weight gain

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13
Q

Should obese women diet during pregnancy

A

Should not focus on weight loss during pregnancy: focus on dietary control, exercise, wt modification

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14
Q

Wt gain recs in pregnancy from IOM

A
  1. overweight: 15-25lbs

2. obese: 11-20 lbs

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15
Q

What if obese/overweight women do not gain or lose weight in pregnancy?

A

More assoc with SGA

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16
Q

How do we make sono easier in obese women

A
  1. vaginal
  2. umbilicus as window
  3. tissue harmonic imaging
  4. MRI ($$$) not rec routine screening
17
Q

When should we screen for OSA and what if pt has it?

A

Screen for OSA in first trimester, refer to sleep specialist. assoc with adverse pregnancy outcomes, anesthesia consult when in hospital early on

18
Q

OSA poses increased risk for what adverse outcomes in pregnancy?

A
  1. PreE
  2. Eclampsia
  3. Cardiomyopathy
  4. PE
  5. Mortality in hospital
19
Q

Should you increase fetal surveillance in obese pts?

A

Not routine rec, has not been shown to improve outcomes

20
Q

Obesity affect VBACS? How

A

Yes, the higher the prepregnancy BMI, the lower success of VBAC

21
Q

Epidural complications in obese women? Anesthesia in general?

A
  1. epidural failure more common
  2. Class III obesity have greater risk of hypotension
  3. spinal impairs respiratory function for 2 hrs s/p procedure
  4. Difficult intubation
22
Q

Rec dose preop prophylactic abx?

A 
2g cefazolin (80kg = 175lbs)
3g cefazolin (120kg = 265lbs)
**30-60 min prior to skin incision**
--studies conflicting/nonconclusive regarding 3g dose recommendation
23
Q

Should we use a drain in women with large subcutaneous fat?

A

Study showed that it may have potentiated wound complications, so NO.

24
Q

Vertical/pfannenstiel?

A

Multiple studies conflicting data: some show increased wound comps with vertical, some show good results with supraumbilical incision

25
Q

Sewing subcut layer greater than 2cm, does that reduce risk?

A

significantly decreases incidence of wound disruption

26
Q

VTE prophylaxis rec for obese women?

A

Pneumatic compression prior to c/s and cont PP, early ambulation PP.

27
Q

In pregnancy, what increases risk for VTE?

A
  1. PreE
  2. Increasing obesity
  3. Stat C/S
  4. Immobility
  5. IUGR
  6. Infection
28
Q

DVT prophylaxis dose? When to start PP s/p c/s?

A

LMWH (enoxaparin) 40 mg daily
Weight based (0.5mg/kg q 12 hrs)
Start 12 hrs PP

29
Q

How do you measure enoxaparin therapeutic range or not?

A

Anti-Xa concentrations

30
Q

Which works better? wt based dosing or BMI stratified dosing for enoxaparin prophylaxis?

A

STudies have shown wt based prophylaxis

31
Q

Closure of wound options, which improves wound healing times?

A

Secondary closure, secondary intention with wound vac (negative pressure dressing) improved healing times compared with secondary intention alone

32
Q

Interpregnancy weight loss decreases risk for what in next pregnancy?

A

LGA infant

33
Q

Normal caloric intake in pregnancy?

A

2200-2900kcal/day

Obesity (1 decks)

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