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Obstetrics > RANZCOG guideline Obesity in pregnancy > Flashcards

RANZCOG guideline Obesity in pregnancy Flashcards

1
Q

What are the risks that a woman with a BMI >30 should be told about at pre-conception regarding obesity in pregnancy

A
  • subfertility
  • increased risk of miscarriage
  • increased risk of NTD therefor higher dose of folic acid (800mcg –>5mg)
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2
Q

How does obesity impact on NIPT

A
  • ‘No result’ more likely (?less fetal fraction)
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3
Q

What is the definition of obesity?

A 
BMI >30
Obese class I - 30-35
Obese class II - 35-40
Obese class III > 40
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4
Q

List 10 problems associated with obesity antenatally in pregnancy

A

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
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5
Q

List 7 intra-partum problems associated with obesity in pregnancy?

A
  • 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
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6
Q

List 3 problems associated with anaesthetics in labour and obesity

A
  • difficult or failed regional anaesthetic (epidural, spinal)
  • increased risk of maintaining adequate airway control
  • increased risk of need for ICU post operatively
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7
Q

List 5 postpartum problems associated with obesity in pregnancy

A
  • Depression
  • wound healing
  • VTE
  • breast feeding difficulties
  • Long term neonatal consequence (neonatal body composition, infant weight gain, obesity)
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7
Q

List 5 postpartum problems associated with obesity in pregnancy

A
  • Depression
  • wound healing
  • VTE
  • breast feeding difficulties
  • Long term neonatal consequence (neonatal body composition, infant weight gain, obesity)
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8
Q

regarding bariatric surgery and. pregnancy (2 points)

A
  • 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
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9
Q

what nutritional requirements would you expect for a woman who has undergone gastric bypass surgery?

A 
May be deficient in:
- Vitamins A, D and B 12
- calcium
- iron
-selenium
- zinc
- copper
protein intake >60g/day
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10
Q

what is dumping syndrome?

A
  • 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
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11
Q

How can you avoid dumping syndrome (in someone who has had gastric bypass surgery)

A
  • small, frequent meals of complex carbohydrates
  • delaying liquid for 30 mins after a meal
  • lying down for 30 mins after a meal
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12
Q

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

A
  • small bowel obstruction
  • hernia
  • gastric band erosion
  • cholelithiasis
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13
Q

What is the basic dietary advice you would give a pregnant woman

A

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

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14
Q

what is the ideal weight gain in pregnancy for a woman under BMI of 18?

A

12-18kg of weight gain

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15
Q

what is the ideal weight gain for a woman with a BMI of 18.5-24.9?

A

11.5 - 16kg

16
Q

What is the ideal weight gain for a woman with a BMI of 25-29.9 in pregnancy?

A
  • 6.8-11.3kg
17
Q

What is the ideal weight gain for a women with BMI of >30 in pregnancy

A

5-9kg

18
Q

What is the rate of a ‘no result’ NIPT test based on obesity class I vs Class II?

A 
5% and rising to 10% 
higher for class III
19
Q

List 3 practical requirements for an obese >40 women antenatally?

A
  • anaesthetic referral
  • aspirin and calcium supplementation
  • serial growth scans
20
Q

If an obese woman class III asks to attempt VBAC what extra pieces of information would you give during counselling?

A
  • 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
21
Q

What is the incidence of emergency Caesarean section for women with Class III obesity?

A

40%

22
Q

What are the pharmacological measures you should consider for a woman with class III obesity?

A
  • folic acid 5mg
  • calcium and aspirin
  • clexane antenatally and postnatally 50-90kg = 40mg, 90-130kg = 60mg, >130kg = 80mg
  • prophylactic antibiotics = 3g cefazolin if >120kg
23
Q

What measures should be taken if a woman with Class III obesity presents in labour?

A
  • 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

Obstetrics (28 decks)

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