Obesity in pregnancy Flashcards
1
Q
What are the risks to the mother of obesity in pregnancy?
A
- Miscarriage
- Gestational diabetes
- Pre-eclampsia
- VTE/PE
- Post-partum haemorrhage
- Instrumental delivery
- Emergency c-section
2
Q
What are the risks to the baby of obesity in pregnancy?
A
- Stillbirth
- Premature birth
- Foetal abnormality (eg. spina bifida)
- Hyperglycaemia
- Premature mortality during adulthood
- Large baby
3
Q
How should a mum with a BMI of 30-34.9 be managed?
A
- Reweigh at 38 weeks
- Patient education
- Screen for gestational diabetes (24-28 weeks) with an oral GTT
4
Q
How should a mum with a BMI of 35-39.9 be managed?
A
- Consultant led care
- Monthly check ups after 24 weeks (growth scans etc)
- Calculate BMI at each check-up
- Thromboprophylaxis (if obese + 2 risk factors –> give clexane)
- Aspirin (due to risk of pre-eclampsia)
NB if >40 have all of the above but also:
- Anaesthetic management plan for labour at meeting
- Postnatal thromboprophylaxis
5
Q
Should an obese mother be offered an induction of labour?
A
NOT on the basis of induction alone
6
Q
What is the definition of a macrosomic baby?
A
> 90th percentile of gestational age, so about >4500g (9lb 15oz)
7
Q
What causes macrosomia?
A
- Obesity/weight gain through pregnancy
- Gestational diabetes
- Postdates
- Ethnicity
8
Q
What are the complications of macrosomia?
A
- Prolonged vaginal delivery time
- Shoulder dystocia (increased risk of cerebral palsy)
- Post-partum haemorrhage
- Perineal tears
- Uterine rupture
- Neonatal hypoglycaemia
- Jaundice
- Childhood obesity/metabolic syndrome
9
Q
How should large babies be managed?
A
Delivery:
- Consider induction/instrumental/c-section
- Monitor baby BM after delivery
