RANZCOG guideline Obesity in pregnancy Flashcards
What are the risks that a woman with a BMI >30 should be told about at pre-conception regarding obesity in pregnancy
- subfertility
- increased risk of miscarriage
- increased risk of NTD therefor higher dose of folic acid (800mcg –>5mg)
How does obesity impact on NIPT
- ‘No result’ more likely (?less fetal fraction)
What is the definition of obesity?
BMI >30 Obese class I - 30-35 Obese class II - 35-40 Obese class III > 40
List 10 problems associated with obesity antenatally in pregnancy
Increased risk of:
- miscarriage and recurrent miscarriage
- congenital anomalies
- HTN and PET
- diabetes
- stillbirth
- VTE
- Sleep apnoea
- pre term birth
- maternal death
- depression
- fetal growth restriction
List 7 intra-partum problems associated with obesity in pregnancy?
- labour dystocia
- shoulder dystocia
- increased difficulty with heart rate monitoring
- increased rate of instrumental vaginal delivery
- increased risk of CS
- increased risk of PPH
- increased risk of perinatal deathL
List 3 problems associated with anaesthetics in labour and obesity
- difficult or failed regional anaesthetic (epidural, spinal)
- increased risk of maintaining adequate airway control
- increased risk of need for ICU post operatively
List 5 postpartum problems associated with obesity in pregnancy
- Depression
- wound healing
- VTE
- breast feeding difficulties
- Long term neonatal consequence (neonatal body composition, infant weight gain, obesity)
List 5 postpartum problems associated with obesity in pregnancy
- Depression
- wound healing
- VTE
- breast feeding difficulties
- Long term neonatal consequence (neonatal body composition, infant weight gain, obesity)
regarding bariatric surgery and. pregnancy (2 points)
- refer anyone with obese category >II for bariatric surgery ( in Australia presumably)
- consider the nutritional and supplement requirement of women who have had bariatric surgery in prengnacy
what nutritional requirements would you expect for a woman who has undergone gastric bypass surgery?
May be deficient in: - Vitamins A, D and B 12 - calcium - iron -selenium - zinc - copper protein intake >60g/day
what is dumping syndrome?
- the rapid transit of food particularly sugar through the stomach to the duodenum
- results in rapid movements of fluid with resultant osmotic induced diarrhoea etc
- results in hypoglycemia
How can you avoid dumping syndrome (in someone who has had gastric bypass surgery)
- small, frequent meals of complex carbohydrates
- delaying liquid for 30 mins after a meal
- lying down for 30 mins after a meal
List 4 surgical differential diagnoses that need to be considered for a woman who has undergone bariatric surgery and presents with abdominal pain in pregnancy
- small bowel obstruction
- hernia
- gastric band erosion
- cholelithiasis
What is the basic dietary advice you would give a pregnant woman
the extra dietary requirement in pregnancy is 300 calories today = half a sandwich or a glass of skim milk
avoid processed food
base meal around salad or veggies with side of carbohydrates and lean proteins
what is the ideal weight gain in pregnancy for a woman under BMI of 18?
12-18kg of weight gain
what is the ideal weight gain for a woman with a BMI of 18.5-24.9?
11.5 - 16kg
What is the ideal weight gain for a woman with a BMI of 25-29.9 in pregnancy?
- 6.8-11.3kg
What is the ideal weight gain for a women with BMI of >30 in pregnancy
5-9kg
What is the rate of a ‘no result’ NIPT test based on obesity class I vs Class II?
5% and rising to 10% higher for class III
List 3 practical requirements for an obese >40 women antenatally?
- anaesthetic referral
- aspirin and calcium supplementation
- serial growth scans
If an obese woman class III asks to attempt VBAC what extra pieces of information would you give during counselling?
- higher failure rate (requirement for Em CS)
- more difficult attempt for epidural/spinal in labour
- more dangerous GA in labour if regional anaesthetic does not work
What is the incidence of emergency Caesarean section for women with Class III obesity?
40%
What are the pharmacological measures you should consider for a woman with class III obesity?
- folic acid 5mg
- calcium and aspirin
- clexane antenatally and postnatally 50-90kg = 40mg, 90-130kg = 60mg, >130kg = 80mg
- prophylactic antibiotics = 3g cefazolin if >120kg
What measures should be taken if a woman with Class III obesity presents in labour?
- ensure anaesthetist aware
- encourage early epidural
- ensure adequate theatre staffing and equipment for obese patient
- continuous fetal monitoring required (often with FSE)
- preparation for shoulder dystocia and PPH
