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High body mass index and outcomes in the parturient
Abstract Number: 32
Abstract Type: Original Research
Obesity carries particular risks in pregnancy for mother and fetus.This was highlighted in the CEMACH report in 2007.Following this CMACE undertook a national project on maternal obesity in the U.K.and presented its findings and key recommendations for the management of these patients.Specific recommendations include antenatal anaesthetic review of all patients with a BMI≥40 and consideration regarding the timing of the epidural for labour analgesia. This study aims to compare data from women with BMI≥40 and BMI<40 in our unit to help us counsel these women appropriately in clinic.
Case notes of 145 women attending high risk anaesthetic antenatal clinic with elevated BMI (≥40) were reviewed over a two year period. Note review identified patient demographics,comorbidities,use of epidural analgesia,mode of delivery and outcomes. The data was then analysed using 2 tailed Fishers exact test with prism graph pad statistical software.
The age range of these women was 19-40 years with a BMI range of 40-65 kg/m2 97% were of white British ethnic origin. Antenatal complications of gestational diabetes and pregnancy induced hypertension were seen in 20% of women. 6% of babies born were admitted to special care baby unit (SCBU).
Antenatal assessment including dietary counselling,monitoring co-morbidities,preparation for labour analgesia is a key feature in the management of these high risk mothers.Our data highlights the increased incidence of operative deliveries in the primiparous (51.7%)mothers with BMI≥40.Lack of resources and increasing prevalence of morbid obesity might make the anaesthetic assessment of all mothers with a BMI≥40 difficult. The GA rate for LSCS is higher in the morbidly obese group primarily due to failure to site the regional block in time. Therefore, it is important to counsel these women antenatally as epidurals may lower risks associated with delivery especially the primiparous parturient with BMI≥40 who seem to have a significantly increased incidence of delivery by Caesarean section.
1. CMACE report on obesity in pregnancy. RCOA/RCOA.. December