the health roundtable management of rising bmi in pregnancy presenter: kay kurth hospital code name:...
TRANSCRIPT
The Health Roundtable
Management of Rising BMIin PregnancyPresenter: Kay Kurth
Hospital Code Name: Cougar3
Innovation Poster SessionHRT1104b – MaternityMarch 10-11 2011
The Health Roundtable
KEY PROBLEM
Pregnant women presenting to Sandringham to have their baby’s with elevated BMI.
No clear management. Anaesthetists unhappy. Difficulties with management in labour ie.
Monitoring, epidurals
The Health Roundtable
AIM OF THIS INNOVATION
Develop a plan to identify at risk patients. Provide support and education Liaise with multidisciplinary team in the care of
patients with BMI>35
The Health Roundtable
BASELINE DATA
Survey in 2008 to 2009 Identified 20 patients >BMI 35 NVB 27% C/S 61% PPH 20% Transferred to Tertiary hospital 10%
The Health Roundtable
KEY CHANGES IMPLEMENTED
A multidisciplinary team meeting to decide on most appropriate plan in 2009. Changes decided upon & implemented Target group BMI 35 – 37 with no co-morbidities and committed to being involved in
planned hospital management during their pregnancy. Guideline developed to outline care and management. Target group require review by anaesthetic clinic. Antenatal care to be with Obstetrician. Early GTT to be considered &/ GCT @ 26/40. Consultation with dietician & lifestyle change coaching. Mid-trimester fetal morphological assessment @ 20-21/40 & a repeat scan @ 28-
34/40 to be considered. Due to increased risk of complications antenatal visits are scheduled at least
fortnightly from 28/40. Repeat anaesthetic review @ 34/40. If caesarean section required, theatre to be aware of elevated BMI. Prophylactic
administration of antibiotic of 2GM Cephazolin at operation & thromboprophylaxis to be considered.
Consideration given to management in birth suite, all staff to be aware of any documented plan. Anaesthetic staff to be informed of admission. All staff to be aware of OH&S issues & provide appropriate equipment.
If fetal monitoring required, an internal scalp electrode may be needed. Breast feeding to be encouraged.
The Health Roundtable
OUTCOMES SO FAR
Survey 2009 -2010 Identified 36 women BMI 35-37 NVB 50% C/S 31% PPH 14% Transferred to tertiary hospital 5.7%
The Health Roundtable
LESSONS LEARNT
Providing obese pregnant women with education and support during their pregnancy significantly improves outcomes.