Obesity in pregnancy Flashcards
BMI measurment units
kg/m2
Obesity classes
I = 30-34.9 II = 35 - 39.9 III = 40 +
Obesity Increased fetal pregnancy risks
- stillbirth (black obese > white obese)
- recurrent miscarriage
- anomalies: cardiac, neural tube defects, hydrocephalus, orofacial, limb reduction
- SAB
Obesity maternal risks
- proteinuria
- PreE
- DM
- cardiovascular
- NASH
- OSA
Obesity cause an increased risk in spontaneous PTB?
Conflicting data
Obesity increased L&D risks
- failed induction
- increased risk for c/s
- c/s = wound dehiscence/infection
- VTE
- endometritis
- dystocia
- longer FIRST stage of labor, not second
- PPH due to atony s/p vaginal delivery, but not c/s
PP complications of obesity
- earlier d/c breastfeeding
- post pregnancy weight retention
- PP depression
- PP anemia
Childhood risks for obesity
- metabolic syndrome
- macrosomia
- IUGR
- childhood obesity
- childhood asthma
- Psych: development disorders, autism, ADD, developmental delay
Operating table typically accommodate what wt limit?
450lbs, some 1000 lbs
Preconception counseling works best in obesity
Motivational interviewing: pt centered, resolving ambivalence
Minimum Percentage of wt loss to significantly improve metabolic health
5-7%
Metformin in pregnancy, function?
decreases hepatic glucose production, shown to decrease gestational weight gain
Should obese women diet during pregnancy
Should not focus on weight loss during pregnancy: focus on dietary control, exercise, wt modification
Wt gain recs in pregnancy from IOM
- overweight: 15-25lbs
2. obese: 11-20 lbs
What if obese/overweight women do not gain or lose weight in pregnancy?
More assoc with SGA
How do we make sono easier in obese women
- vaginal
- umbilicus as window
- tissue harmonic imaging
- MRI ($$$) not rec routine screening
When should we screen for OSA and what if pt has it?
Screen for OSA in first trimester, refer to sleep specialist. assoc with adverse pregnancy outcomes, anesthesia consult when in hospital early on
OSA poses increased risk for what adverse outcomes in pregnancy?
- PreE
- Eclampsia
- Cardiomyopathy
- PE
- Mortality in hospital
Should you increase fetal surveillance in obese pts?
Not routine rec, has not been shown to improve outcomes
Obesity affect VBACS? How
Yes, the higher the prepregnancy BMI, the lower success of VBAC
Epidural complications in obese women? Anesthesia in general?
- epidural failure more common
- Class III obesity have greater risk of hypotension
- spinal impairs respiratory function for 2 hrs s/p procedure
- Difficult intubation
Rec dose preop prophylactic abx?
2g cefazolin (80kg = 175lbs) 3g cefazolin (120kg = 265lbs) **30-60 min prior to skin incision** --studies conflicting/nonconclusive regarding 3g dose recommendation
Should we use a drain in women with large subcutaneous fat?
Study showed that it may have potentiated wound complications, so NO.
Vertical/pfannenstiel?
Multiple studies conflicting data: some show increased wound comps with vertical, some show good results with supraumbilical incision
Sewing subcut layer greater than 2cm, does that reduce risk?
significantly decreases incidence of wound disruption
VTE prophylaxis rec for obese women?
Pneumatic compression prior to c/s and cont PP, early ambulation PP.
In pregnancy, what increases risk for VTE?
- PreE
- Increasing obesity
- Stat C/S
- Immobility
- IUGR
- Infection
DVT prophylaxis dose? When to start PP s/p c/s?
LMWH (enoxaparin) 40 mg daily
Weight based (0.5mg/kg q 12 hrs)
Start 12 hrs PP
How do you measure enoxaparin therapeutic range or not?
Anti-Xa concentrations
Which works better? wt based dosing or BMI stratified dosing for enoxaparin prophylaxis?
STudies have shown wt based prophylaxis
Closure of wound options, which improves wound healing times?
Secondary closure, secondary intention with wound vac (negative pressure dressing) improved healing times compared with secondary intention alone
Interpregnancy weight loss decreases risk for what in next pregnancy?
LGA infant
Normal caloric intake in pregnancy?
2200-2900kcal/day
