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y4 cbls > Obs&gyn: Obesity > Flashcards

Obs&gyn: Obesity Flashcards

1
Q

How to calculate BMI?

A

Body Mass Index (BMI)

Weight (kg)/ Height2 (m2)

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2
Q

BMI ranges

A
  • BMI of 25-30: Overweight
  • BMI 30-34.9: Class 1 Obesity
  • BMI 35-39.9: Class 2 Obesity
  • BMI 40+: Class 3 or Morbid Obesity
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3
Q

How does obesity may cause a disease?

A

White fat around viscera sets up inflammation and cell death and causes disease

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4
Q

What’s Leptin?

A

Leptin

  • produced by adipose tissue
  • mediates long term appetite controls
  • encourage us to eat more when fat stores are low, and less when storage is high
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5
Q

What’s Ghrelin?

A

Ghrelin

  • produced by the empty stomach
  • modulating short term appetite
  • encouraging us to eat when the stomach is empty, and stop when the stomach is stretched
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6
Q

By use of what pathways leptin and ghrelin produce their effects on appetite?

A
  • Leptin and ghrelin control the appetite through action on the central nervous system
  • Act on the paraventricular and arcuate nuclei of the hypothalamus through several pathways
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7
Q

What (3) hormones adipose cells produce?

A
  • Adiponectin → regulates fatty acid and glucose metabolism - levels are lower in obesity, which is related to insulin resistance
  • Oestrogen
  • Leptin - note levels of leptin are higher, but obesity leads to Leptin resistance
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8
Q

Complications of obesity

A
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9
Q

What BMI of >30 in pregnancy increases the risk of?

A
  • Thrombosis
  • Gestational Diabetes - 3 fold increase
  • Pre-eclampsia - with BMI of 35 the risk is double that of a woman with a BMI of 25
  • Neural tube defect
  • Miscarriage - increases from 20% to 25%
  • Increased birth weight - chances of a baby weighing more than 4kg are increased from 7% to 14%
  • Stillbirth - risk increased from 1 in 200 to 1 in 100
  • Increased risk of baby developing obesity or diabetes in later life
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10
Q

Risks of BMI >40 in pregnancy and labour

A

With a BMI of more than 40:

  • Increased risk of prematurity
  • Labour dystocia
  • Shoulder dystocia
  • Emergency caesarean section
  • Intraoperative complications, including bleeding
  • Postoperative complications, including wound infection
  • Anaesthetic complications, particularly with general anaesthesia
  • Postpartum haemorrhage
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11
Q

What advice to give for a woman of BMI of 30 or more wants to conceive?

A
  • advice on weight and lifestyle should be given to all women of childbearing age
  • support to lose weight prior to conception for all women with a BMI of 30 or more
  • BMI of 30 or more should be advised to commence 5mg Folic Acid supplementation at least a month before conception and continuing during the first trimester of pregnancy

• BMI of 30 or more should be advised to commence 10 micrograms Vitamin D supplementation daily throughout pregnancy and while breastfeeding

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12
Q

Do we need to refer a pregnant obese woman?

A

Women with a BMI of 30 or more should be referred to a consultant obstetrician

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13
Q

When during pregnancy should we measure maternal weight and height?

A
  • Weight and height should be measured and BMI recorded at booking visit
  • Re-measurement of maternal weight in the third trimester will aid planning with regard to equipment and personnel
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14
Q

Considerations for maternal BMI >35 and pre-eclampsia

A

Women with a BMI of 35 or more have an increased risk of pre-eclampsia.

Assess additional risk factors and commence low dose aspirin

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15
Q

When and for whom do we do OGTT in pregnancy?

A

Women with a BMI of 30 or more should have a 2 hour 75g oral glucose tolerance test at 24-28 weeks

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16
Q

The anaesthetic risk for women with BMI 40 or more

A

Women with a BMI of 40 and above should have an antenatal consultation with an obstetric anaesthetist to assess and discuss potential risks with IV access and regional and general anaesthesia

  • Epidural re-site and failure rates higher
  • Higher risk of gastric content aspiration, difficult intubation and postoperative atelectasis with general anaesthesia
  • Increased comorbidities including IHD and hypertension
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17
Q

Extra nursing and manual handling considerations for women with BMI of 40 or more

A

Women with a BMI of more than 40 should have:

  • a manual handling and tissue viability assessment
  • safe workloads of beds and theatre tables
  • appropriately sized TEDS or boots
  • plan for body position, repositioning, skin care and support services in women at risk of pressure sores
18
Q

Potential intrapartum complications in obese women

A
  • Slow progress
  • Shoulder dystocia
  • Emergency caesarean section
  • Increased risk of PPH
  • Vaginal Birth After Caesarean (VBAC) can be considered on an individual basis – obesity is a risk factor for uterine rupture
19
Q

Place of birth for obese women

A

Women with a BMI of 35 or more should give birth on a consultant led unit with appropriate neonatal services – babies are 1.5 times more likely to require admission to special care

•Duty anaesthetist should be informed when a woman with a BMI of 40 or more is admitted if delivery/theatre is anticipated. Early epidural may be advisable if required

20
Q

What (extra) interventions woman with BMI of 40 or more may require during labour?

A

Women with BMI of 40 or more should have:

  • continuous midwifery care
  • continuous fetal monitoring by CTG recommended, and fetal scalp electrode may be required to adequately monitor baby’s heart rate pattern
  • IV access in labour
  • Active management of 3rd stage due to increased risk of PPH
21
Q

How do we manage wound infection risk in women with BMI 30 or more?

A

Increased risk of wound infection at caesarean with BMI of 30 or more

  • prophylactic Abx and consideration of dressing type and use of fat stitch during abdominal closure
22
Q

Who to test for gestational diabetes?

A

Screen for GDM at 24-28 weeks with 75g OGTT if any of the following are present:

  • BMI above 30 kg/m2
  • Previous macrosomic baby weighing 4.5 kg or above
  • Previous gestational diabetes (although most units advise BG monitoring from around 14 weeks
  • Family history of diabetes (first‑degree relative with diabetes)
  • Minority ethnic family origin with a high prevalence of diabetes
  • Test opportunistically if Glycosuria of 2+ or above on 1 occasion or 1+ or above on 2 or more occasions during routine antenatal checks
23
Q

Positive result renges of OGTT in pregnancy

A

Positive 75g OGTT:

•Fasting plasma glucose level of 5.6 mmol/l

•2‑hour plasma glucose level of 7.8 mmol/l

24
Q

Management of gestational diabetes

A
  • Advise capillary glucose testing pre-meal and 1 hour postprandial
  • refer to Obstetrician and Diabetes team (usually a joint clinic)
  • Intervention includes diet control, medication and/or insulin
25
Q

Chronic hypertension vs gestational hypertension

(definitions)

A
  • Chronic hypertension is present at booking or before 20 weeks or if already being treated for hypertension prior to pregnancy
  • Gestational hypertension is new hypertension presenting after 20 weeks without significant proteinuria
26
Q

Pre-eclampsia vs severe pre-eclampsia

(definitions)

A
  • Pre-eclampsia is new hypertension presenting after 20 weeks with significant proteinuria, or superimposed on chronic hypertension
  • Severe pre-eclampsia is pre-eclampsia with severe hypertension with significant proteinuria and/or with symptoms, and/or biochemical and/or haematological impairment
27
Q

What’s HELLP syndrome?

A

HELLP syndrome:

  • haemolysis
  • elevated liver enzymes
  • low platelet count
  • It’sconsidered a severe variant of pre-eclampsia
28
Q

What’s eclampsia?

A

Eclampsia is a convulsive condition associated with pre-eclampsia

29
Q

Mild HTN in pregnancy ranges

A
30
Q

Moderate HTN in pregnancy - ranges

A
31
Q

Severe HTN in pregnancy - ranges

A
32
Q

Symptoms of pre-eclampsia

A
  • severe headache
  • problems with vision, such as blurring or flashing before the eyes
  • severe pain just below the ribs
  • vomiting
  • sudden swelling of the face, hands or feet

*make pregnant women aware of these symptoms and that they should seek immediate medical attention

33
Q

What’s defined as significant proteinuria?

A
  • Urinary protein:creatinine ratio is greater than 30 mg/mmol (preferred method)
  • Validated 24-hour urine collection result shows greater than 300 mg protein
34
Q

Aspirin prophylaxis for women at high risk of pre-eclampsia

A

women at high risk of pre-eclampsia to take 75 mg of aspirin daily from 12 weeks until the birth of the baby

35
Q

What places a woman in high risk of pre-eclampsia category?

A
  • Hypertensive disease during a previous pregnancy
  • Chronic kidney disease
  • Autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome
  • Type 1 or 2 diabetes
  • Chronic hypertension
36
Q

Aspirin prophylaxis for woman with moderate risk of pre-eclampsia category

A

More than one moderate risk factor for pre-eclampsia:

take 75 mg of aspirin daily from 12 weeks until the birth of the baby

37
Q

Moderate risk for pre-eclampsia

A
  • First pregnancy
  • Age 40 years or older
  • Pregnancy interval of more than 10 years
  • Body mass index (BMI) of 35 kg/m2 or more at first visit
  • Family history of pre-eclampsia
  • Multiple pregnancy
38
Q

Obesity increases the risks of which gynaecological cancers?

A
  • Increased BMI reduces risk of premenopausal breast cancer
  • Increased risk of ovarian and endometrial cancers
  • Increased risk of postmenopausal breast cancer
  • 30% of endometrial cancers in the UK are due to overweight and obese BMIs
  • Risk of endometrial cancer is increased by x 2-3 (x 6 if morbidly obese)
  • Physical activity can reduce endometrial cancer risk by up to 20-30%
  • PCOS women have an increased x 4 risk of endometrial cancer pre-menopause related to obesity
39
Q

What gynaecological conditions early-onset obesity is associated with?

A

Early onset obesity is associated with:

  • Oligomenorrhoea
  • Menstrual irregularity
  • Anovulation
  • Subfertility
  • Miscarriage
  • Polycystic Ovarian Syndrome
40
Q

Surgical considerations for obese women

A
  • Laparotomy and Laparoscopy technically more difficult
  • Consider robotic surgery in morbidly obese women
  • Anaesthetic risks
  • Wound infection
  • Thromboembolism
41
Q

Obesity and contraceptive methods

A
42
Q

Emergency contraception in obese women

A

Emergency contraceptives can be used:

  • in women of any weight or body mass index (BMI)
  • obesity is not a contraindication to any of these methods

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