Introduc)on

•  Obesity rates have dramatically increased in the last 20 years and are set to double by 2050.

•  The prevalence of obesity in women of childbearing age increased from 12% in 1993 to 20% in 2010.

•  The prevalence of obesity in the first trimester has more than doubled in the last 20 years. As it stands, 2 % of women are morbidly obese at booking.

•  Well-established associations exist between obesity and pregnancy complications, namely:

o  Hypertensive disorderso  Gestational diabeteso  Fetal anomalieso  Fetal growth abnormalitieso  Venous thrombo-embolismo  Stillbirtho  IOL and augmentation of labouro  Caesarean section and instrumental deliverieso  Preterm labour

Objective to analyse the effects of morbid obesity (class III; BMI≥40) on pregnancy outcomes in a tertiary unit teaching hospital and to compare our outcomes to women with a normal BMI and to current literature

Materialsandmethods•  All cases of women with a BMI greater than or equal to

40kg/m2 who booked at our unit (a London tertiary teaching hospital) between 01/01/10 and 31/11/15 were included (n 512).

•  2000 randomised cases of women with normal BMI (20-25) over the same time period were obtained.

•  The groups were matched for parity, pervious caesarean section and age. 449 morbidly obese women were compared with 1359 normal BMI women.

•  The outcome data collected were: •  maternal and fetal complications •  gestation at deliver•  mode of delivery•  onset of labour•  blood loss at delivery•  actual birth weight

Referenceso  Health & Social Care information Centre (HSCIC) statistics on Obesity, Physical

Activity and Diet England 2015). 2016. o  Morgan K, Rahman M, Macey S, Atkinson M, Hill R, Khanom A et al. Obesity in

pregnancy: a retrospective prevalence-based study on health service utilisation and costs on the NHS. BMJ Open. 2014;4(2):e003983- e003983.

o  Cedergren M. Maternal Morbid Obesity and the Risk of Adverse Pregnancy Outcome. Obstetrical & Gynecological Survey. 2004;59(7):489-491.

o  Sebire N, Jolly M, Harris J, Wadsworth J, Joffe M, Beard R et al. Maternal obesity and pregnancy outcome: a study of 287 213 pregnancies in London. Int J Obes Relat Metab Disord. 2001;25(8):1175-1182.

o  Usha Kiran T, Hemmadi S, Bethel J, Evans J. Outcome of pregnancy in a woman with an increased body mass index. BJOG: An International Journal of Obstetrics and Gynaecology. 2005;112(6):768-772. :112.

  Conclusiono  Some of the well accepted risks associated with morbid obesity

are supported in this analysis of our obese populationo  However, macrosomia, shoulder dystocia, IUGR, VTE and

stillbirth are no more likely to occur in our obese women o  The reason behind these encouraging results may be explained

by the dedicated specialist clinic care that we are able to offer

DiscussionIt is possible that some risks associated with morbid obesity in pregnancy are unavoidable for example fetal anomalies, Hypertensive disorders, and to a lesser extent, GDM may also fall into this categoryThe reduced rates of some of the complications may be explained by morbidly obese women being seen in a consultant lead dedicated specialist clinic, where management includes:

•  Strict information on reduced fetal movements and growth scans routinely at 36/40 thus potentially reducing the stillbirth rate in this group

•  Early and on-going strict management of VTE prophylaxis with LMWH antenatally and 6 weeks postpartum

•  Educating women on healthy eating choices, may benefit their long-term health and the future health of their offspring

•  Detailed intrapartum plans including active management of the third stage and the early recognition of risk factors possibly reducing our rates of MOH

•  Use of Cervical-ripening balloon/ Propess IOL for women who opt for VBAC and STAN monitoring in labour possibly leading to reduced interventions such as emergency caesarean section

This specialist clinic is the ideal opportunity to engage patients prior to future pregnancies and minimise pregnancy complications. We also provide information to our women on weight loss diet/ bariatric surgery and organise postpartum referrals to our bariatric surgical team if women wishes to be informed further. Also we believe pre-pregnancy public health education is essential to improve pregnancy outcomes and the health of the offspring

Pregnancy outcomes of women with morbid obesity at a tertiary teaching hospital: A case-control study

Kelly Hepburne Scott1, Berrin Tezcan1

1 - St George’s University Hospitals NHS Foundation Trust, Department of Obstetrics, Blackshaw Road, Tooting, London, SW17 0QT

Demographics 

Antenatal complications of higher incidence in women with BMIs ≥ 40:

o  PET and PIH requiring treatment 8 x more commono  GDM 12 x more commono  Fetal anomalies 3 x more common

Antenatal complications not of higher incidence in women with BMIs ≥ 40:

o  Macrosomiao  IUGRo  Venous Thromboembolismo  Stillbirth

Labour and Delivery complications of higher incidence in women with BMI ≥ 40:

o  Induction of labour 2.6 x more common o  Reduced rate of spontaneous labour 41%o  Emergency caesarean section 1.5 times commono  Haemorrhage greater than 1000mls 1.6 times more

common

Results

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% BMI >40

% BMI <40

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BMI >40

BMI 20-25

Labour and delivery complications not of higher incidence in women with BMIs ≥40:

o  Normal vaginal delivery rate o  Elective caesarean section rateo  Instrumental deliveries o  If instrumental deliveries did occur they were more

likely to be forcepso  Preterm delivery < 37/50 and <34/40o  MOH greater than 2000mls. o  Shoulder dystocia

VaginalBirthA<erCaesareanSec)ono  No differences in successful VBAC, 68.96%. o  No differences in attempted VBAC, 46.7%

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80

Attempted VBAC Successful VBAC Total Overall VBAC success

BMI >40

BMI 20-25

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