返回Google圖書搜尋

Management of the Obese Obstetric Patient

出版	2017
URL	http://books.google.com.hk/books?id=KU-4zQEACAAJ&hl=&source=gbs_api

註釋Background and Goal of Study: In the United Kingdom obesity is increasing. Over the last 20 years numbers of obese pregnant women have doubled. Complications from obesity during pregnancy have significant implications for the mother and newborn, and women who die during pregnancy are more likely to be obese.1Accurate booking BMIs must be calculated as self-reported weight is often underestimated, especially in obese women. The CMACE/RCOG joint guideline recommends that obese women be re-weighed in the third trimester to enable appropriate planning and management.1We prospectively audited practice within Royal Hampshire County Hospital (RHCH) for calculating booking BMI's, weighing patients on admission and informing the anaesthetist about obese patients.Materials and methods: Patients admitted to labour ward were randomly selected between June and July 2015. Information was collected on their booking weight, booking BMI, admission weight and whether the duty anaesthetist had been informed following their admission. Results and discussion: Data was obtained on 42 women in labour. All had a booking weight recorded and 39 (93%) had their BMI calculated from this. 81% of booking weights were recorded in kilograms. However 19% were recorded in imperial measurements, requiring conversion to metric units for drug dosing, particularly enoxaparin, introducing room for error. It also indicated that weights were possibly estimated by women themselves. Obese women with BMI > 40 may not be identified. 11 (26%) women were obese (6 had a BMI >30 and 5 BMI >40). Of patients whose BMI was >40, the anaesthetist was informed following admission about 4 (80%).Only 8 women were re-weighed following admission. Average weight gain was 10.5kg (2.7kg-23kg).The largest increase in weight was 23kg. Similar weight gains during pregnancy may have been missed. This could affect obstetric and anaesthetic management. Evidence is lacking on which weight should be used for drug dosing, which could lead to significant under-dosing.Conclusion(s): We recommend accurate height and weight is taken during booking appointments using appropriate (metric) equipment to calculate an accurate BMI. If BMI is over 30, weight should be repeated following admission. The duty anaesthetist should be informed when a parturient with a BMI >40 is admitted. Consensus opinion on which weight to use for drug dosing is needed.References: 1 Modder J, Fitzsimons K. CMACE/RCOG Joint Guideline. 2010.