BACKGROUND

1. . Evaluation of the antenatal care and obstetric outcome of obese pregnant women and those with a healthy BMI at a district general hospital in the UK Armstrong S, McDermott L, Lambert J Department of Obstetrics and Gynaecology, Great Western Hospital (GWH), Swindon, UK RESULTS BACKGROUND METHOD CONCLUSION The UK is witnessing an ever-increasing rise in the number of obese preganant women. Obesity is the most commonly occuring risk factor in Obstetric practice and is linked to an increased risk of antenatal (gestarional diabetes, pregnancy-induced hypertension, pre-eclampsia), intrapartum (increased caesarean and instrumental delivery rate) and postnatal complications (post-partum haemorrhage, wound infection etc). It is vital that GWH develop robust processes to manage these risks to provide optimal care. Obesity in pregnancy is defined as a Body Mass Index (BMI) of 30 kg/m2 or greater. There are three different categories of obesity: BMI 30-34.9 (class 1); 35-39.9 (class 2); and BMI 40 or over (class 3 or morbid obesity) • A retrospective analysis 150 patient notes was performed. • Women who delivered within a pre-determined time frame (01/01/2011 – 31/01/2011) were recruited. Notes were randomly selected by the hospital audit department. • Those within BMI ranges 20-25 and 30-35 at booking were selected for scrutiny. The BMI of pregnant women booking at GWH is not currently electronically recorded, and therefore each set of notes was reviewed and only those women whose BMI fell within the pre-determined ranges were examined closely. Data was entered onto an excel spreadsheet. • The following data was collected: • maternal age and smoking status • antenatal complications (hypertension, anaemia, development of urinary tract infection) • glucose tolerance testing (GTT) – antenatal and postnatal • nutritional supplementation (folic acid, vitamin D) thromboembolic risk assessment at booking • delivery details (Induction of labour, Mode of delivery, use of regional anaesthesia, baby weight) • postnatal complications (post-partum haemorrhage, perineal trauma and baby admissions to Special Care Baby Unit (SCBU) • It is difficult make reliable comparisons regarding antenatal complications between the BMI groups from our date due to the small sample sizes. • The rate of delivery by caesarean section was higher in the obese category (see below). • The average birth weight born to both BMI categories was similar at approximately 3300g • The number of postnatal complications in our sample size were too small to draw comparison (see below) • Our findings correlate with current understanding of the increased risks associated with being obese in pregnancy. • Due to the small number of women audited within the BMI range 30-35, it is difficult to draw any statistically significant conclusions on BMI in relation to antenatal care and obstetric outcome. In order to improve the audit, a greater number of obese women should be captured in the audit, GWH should electronically record the BMI of women at booking. This is a CNST and RCOG requirement. • Since performing this work, new maternity notes have been introduced at GWH which include a VTE risk assessment to be completed at booking • A review of current guidelines is recommended. Clearly, not every recommendation set out by professional organisations will be practical/economically viable in a district hospital, but a review of referral for GTT criteria may be beneficial and viable. • Current guidance on antenatal dietary advice and nutritional supplementation should be imparted to GPs who care for obese women planning to start a family. OBJECTIVES To compare the antenatal care and obstetric outcome of mothers with a healthy BMI (20-25) to women with a raised BMI (30-35). We also compared RCOG (Royal College of Obstericians and Gynaecologists) CNST (Clinical Negligence Scheme for Trusts) and NICE (National Institiute of Clinical Excellence) guidelines with current practice at GWH to see if improvements can be made. DESIGN RESULTS A retrospective audit • Of the 150 sets of notes reviewed, 14 fell into the class 1 obesity category (BMI 30-35). 32 sets of notes were reviewed with a normal BMI (BMI 20-25). • Key findings: • The average age of obese women was higher than women with a normal BMI (32.9 vs 30.1 years) • A large proportion on the women who smoked were in the obese category (71.4% of smokers were obese) (see opposite) • Poor rate of screening for gestational diabetes amongst obese women. Currently GWH only offer GTT to women with BMI >38 despite RCOG recommendation that it should be offered to all obese mothers • No evidence of antenatal VTE (venous thromboembolism) risk assessment or documented evidence of advice regarding folic acid and vitamin D supplementation for obese mothers despite RCOG recommendations. SETTING Great Western Hospital (GWH). A District General Hospital, Swindon, UK. Current maternity guidelines exist so that only women with a BMI of 38 or greater are referred to a consultant-led antental clinic; therefore a large proportion of obese mothers are never seen by an Obstetrician References Management of Women with Obesity in pregnancy. CMACE/RCOG joint guideline March 2010 CNST Maternity Clinical Risk Management Standards, January 2011 www.nice.org.uk