Improving the quality
of care in BMI >30 Pregnancies
Smith
A1,2, Eccles-Smith J2
1Mater Hospital, Queensland, Australia
2The Royal Brisbane and Women’s Hospital, Queensland Australia
Aims: Obesity is the most commonly encountered risk factor in
obstetric care associated with increased maternal and fetal morbidity and
mortality. [1] This quality improvement study aimed to assess and improve the
management of peri-conceptual, pregnant and postnatal women with a Body Mass
Index (BMI) above 30 at the Royal Brisbane and Women’s Hospital.
Methods: This project retrospectively audited a randomly selected
sample of 101 women with a BMI above 30 who delivered in a tertiary hospital
(Royal Brisbane and Women’s Hospital) from January-June 2015. The electronic
patient charts were audited against The Royal College of Obstetricians and
Gynaecologists (RCOG) guidelines. [2]
Results: At the booking in visit of these 101 obese women, 18% were
classified as morbidly obese with a BMI >40. There was 100% compliance to
the standards of a recorded BMI and oral glucose tolerance test preformed
during pregnancy. Of the morbidly obese women 77% received the recommended antenatal
anaesethic review and 61% were prescribed pharmacological thromboprophylaxis
postnatally. Direct dietician involvement was observed in only 16% of these
patients. There was one neonatal death at 29 weeks and one intrauterine fetal
death at 38 weeks.
Conclusions: This project demonstrated the burden of obesity in
pregnancy and the lack of standardisation of management. This project
recommended a two-tier improvement strategy. We recommended the development and
implementation of a ‘BMI>30 pathway’ that would be filed with the pregnancy
health record. This pathway would allow the standardisation and streaming of
the management during all stages of obstetric care in women with a BMI >30
at booking in. The second recommendation was the implementation of a specific
“high BMI clinic” involving obstetricians, midwives, dieticians, anaesthetics
and psychology to address and modify the risks and issues associated with
obesity in pregnancy.
References:
1. Galtier-Dereure F, Boegner C,
Bringer J., (2000) Obesity and Pregnancy: complications and cost, Am J Clin
Nutr. 71:5 (1242s-1248s).
2. Moder J, Fitzsimons J (2010), CMACE/RCOG Joint Guideline: Management of
Women with Obesity in Pregnancy.