1
Q
WHO defines obesity as
A
BMI >30kg
2
Q
class 1 obesity
A
BMI between 30-39.9
3
Q
class 2 morbid obesity
A
BMI between 40-49.9kg
4
Q
class 3 super obesity
A
BMI >50kg
5
Q
% of aus women over 18 were overweight or obese
A
60
6
Q
why are women obese
A
- Gender
- Socioeconomic status – rates of obesity increase
- Diet and lifestyle
- Mental wellbeing
- Sedentary work
- Genetics
- Ethnicity
- Emotional reasons
7
Q
complications of obesity
A
- Metabolic (type 2 diabetes)
- Circulatory (CV disease)
- Degenerative (osteoarthritis)
- Usually associated with AMA
- Increases risk of gynae complications e.g endometrial cancer, infertility and menorrhagia through menstrual disturbances and ovulation disorders
8
Q
is obesity a disability
A
- Disability discrimination act identified
- Physical – affects a person’s mobility or dexterity
9
Q
legislation
A
Disability discrimination act 1992
10
Q
Against the law in NSW to treat people unfairly or harass them because they have a disability
A
- a disability the person has now;
- a disability that someone thinks the person has now
- a disability a person had in the past
- a disability that a person will get in the future,
- a disability that relatives, friends, work colleagues or associates of the individual has now, had in the past or will get in the future
11
Q
A/N issues and pregnancy management
A
- review at booking in
- obesity clinics
- diet and lifestyle interventions increase folic acid
- screening and management of comorbidities (diabetes, hypertension, skeletal, bone and ligament, miscarriage and stillbirth)
- anaesthetic review before or at term (analgesia and general physical assessment)
- sensitive approach to engage women in their care
12
Q
labour and birth issues
A
- location
- ambulation
- water birth
- WHS issues
- Higher induction and LSCS
- Fetal monitoring issues
- Early and more epidurals
- Limited real choices
13
Q
postnatal issues
A
- Ambulation post birth
- Increased general morbidity
- Breast size and feeding issues
- Increased LSCS rates and associated issues : infection, mobility, thrombotic events
14
Q
neonatal and infant issues
A
- Macrosomia
- Hypoglycaemia and hypothermia
- Higher scn/nicu management for jaundice and respiratory distress
- Increased infant and child morbidity and the continuing obesity cycle
15
Q
perinatal complications associated with obesity
A
- Fetal anomaly
- GDM
- Hypertensive disorders (pre-eclampsia)
- LGA
- Macrosomic babies and stillbirth
- Longer labour
- IOL
- Premature labour
- PPH
- Internal fetal surveillance
- X5 likely for LSCS
- Experience difficult anaesthetic procedures
16
Q
care of women who are obese
A
- higher doses of folic acid in early pregnancy,
- a wide range of surveillance methods for congenital abnormalities
- regular ultrasound growth scans with customised growth charts because accurate growth assessment by palpation is often difficult
- early glucose tolerance testing for gestational diabetes and increased number of visits to monitor blood pressure, and attend anaesthetic and obstetric referrals
- more likely to have longer labours, caesarean section and postpartum haemorrhage is thought to be due to the myometrium of the uterus not contracting efficiently
17
Q
- obesity is a factor in …% of maternal deaths and has a significant influence on pregnancy
A
35
18
Q
obesity definition
A
- defined as the excessive accumulation of fat within the fat cells as a result of discrepancy between energy intake and energy expenditure
19
Q
non-pregnancy treatment and care
A
- attain steady weight loss until the BMI is within the normal range
- increasing overall muscle mass
- producing a sense of wellbeing
- depressing appetite
- increasing the overall metabolic rate
20
Q
pre-conception care and issues
A
- support and advice should be available for all women with a BMI>30 in order to achieve a normal BMI
- bariatric surgery does improve fertility
- encourage all women with obesity to take 5mg of folic acid supplementation
21
Q
pregnancy issues
A
- early miscarriage
- GDM and preeclampsia
- Venous thromboembolism
- Anaesthetic problems
- Neural tube defects
- Late stillbirth
- Fetal macrosomia
- Fetal trauma
- NICU admissions
22
Q
medical management and care
A
- Women with a BMI >40 antenatal anaesthetic referral screen
- 10mg of vit D supplement throughout pregnancy and BF
23
Q
midwifery management and care
A
- BMI ≥30 should be referred to a consultant to discuss intrapartum risks and management strategies4 * Women with a BMI ≥35 should be booked in a consultant-led environment
- Moderate exercise should be encouraged, unless the woman is experiencing other signs or symptoms
- Individualised advice, especially options for fetal anomaly screening, is important, taking into account the effects of weight on biochemical results
- Careful observation of the maternal and fetal status is important during pregnancy to detect complications; community monitoring for preeclampsia at least every 3 weeks between 24 and 32 weeks for women with a BMI ≥35 is recommended
24
Q
labour issues medical management
A
Increased rates of prolonged labour
- * Risks associated with macrosomia, e.g. shoulder dystocia
- * Increased rates of operative birth especially for primigravida
- * Difficulties in undertaking instrumental and operative procedures
- * Difficulty siting an epidural or spinal for labour or caesarean section
25
midwifery management
- Effective midwifery support in labour is important; women with a BMI ≥40 should receive continuous midwifery care in labour
- * Encourage changes in maternal position throughout labour
- * Avoid dehydration in labour (risk of venous thrombo-embolism)
- * Observe progress – use the partogram carefully throughout labour
- * Fetal scalp electrode for difficulty with abdominal auscultation of the fetal heart
26
postpartum issues
- Venous thrombo-embolism; obesity in the presence of two other persisting risk factors should prompt the need for thrombo-prophylaxis for 3–5 days
- * Longer post-operative recovery and increased rates of post-operative complications, e.g. infections of wound and urinary tract
- * Women who are obese during pregnancy tend to retain fat centrally on their abdomen postnatally, which may result in increased morbidity and mortality in later life
- * Lower rates of breast-feeding
- * Contraceptive choices will be influenced by the presence of complications
27
medical management postpartum
- Multidisciplinary approach to the management of associated conditions
- * Encourage women to lose excess weight to achieve a healthy BMI prior to any subsequent pregnancy
28
midwifery management postpartum
- May need increased post-operative analgesia
- * Early mobilisation ; continue thrombo-embolic prophylaxis until fully mobile
- * Encourage and support breast-feeding to help mobilise fat stores: tailor breast-feeding advice to meet individual needs; suggest underarm positioning at the breast * Review postpartum weight at the 6–8 week check and consider referral to the MDT for support and advice regarding weight reduction and moderate exercise
- * Consider referral for cognitive and behavioural therapy and consider providing extended midwifery postnatal care
- * The combined contraceptive pill may not be as effective in obese women
- * Repeat GTT at 6 weeks postnatal if GDM diagnosed during pregnancy
Complex care 2
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Decks in class (9)
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