Obesity in pregnancy is a substantial public health problem with potentially dire consequences on pregnancy outcome for the mother and the neonate. Objective: To determine the prevalence and care of morbidly obese women (BMI > 40 kg/m2) in our obstetric population over one year against standards and criteria set by the Royal College of Obstetricians and Gynaecologists (RCOG) in the Green-top Guideline No. 72 “Care of women with Obesity in pregnancy”. Methods: This was a retrospective longitudinal cohort study conducted at the obstetrics department of Great Western Hospital NHS Foundation Trust UK. Data were collected from patients’ records on Medway Maternity software and hospital notes of women with BMI > 40 kg/m2 who delivered between 1st December 2017 and 31st December 2018. Data were analyzed using Epi info version 7.0. Results were presented in tables and charts. Results: During the period of the audit, there were a total of 4198 deliveries. The number of morbidly obese women was 145, giving a prevalence of 3.45%. Majority of the women (42) had no prepregnancy complications. Complications before pregnancy were previous miscarriages, polycystic ovarian syndrome, disc pro-lapse, diabetes, previous IUGR and hyperprolactinaemia. Antenatally, most patients had no complications. Gestational hypertension was the most common complication (9), followed by gestational diabetes (7), intrauterine growth restriction (1), placenta praevia (1), and severe preeclampsia (1). None of the patients had intrapartum complications in this study. Majority of the patients (46) had no postpartum complications, 11 had postpartum haemorrhage, 2 had postpartum hypertension, and one had wound infection and dehiscence. Compliance with care was 92.67%. Conclusion: This audit revealed that morbidly obese women in our obstetric population were at risk of some of the complications of obesity in pregnancy, labour, delivery and postpartum. The care for these women was within recommended standards with room for improvement.
Cite this paper
Ekanem, E. and Lalrinawmi, L. (2020). Audit of Obstetric Outcome in Morbidly Obese Women at Great Western Hospital NHS Foundation Trust UK. Open Access Library Journal, 7, e6298. doi: http://dx.doi.org/10.4236/oalib.1106298.
Shah, P.K., Chaudhari, H.K. and Garg, S. (2018) Comparative Study of Obstetric Outcome in Overweight and Obese Pregnant Women. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 7, 3199.
https://doi.org/10.18203/2320-1770.ijrcog20183317
Denison, F.C., Aedla, N.R., Keag, O., Hor, K., Reynolds, R.M., Milne, A., et al. (2019) Care of Women with Obesity in Pregnancy: Green-Top Guideline No. 72. BJOG: An International Journal of Obstetrics and Gynaecology, 126, 62-106.
https://doi.org/10.1111/1471-0528.15386
Ma, R.C.W., Schmidt, M.I., Tam, W.H., McIntyre, H.D. and Catalano, P.M. (2016) Clinical Management of Pregnancy in the Obese Mother: Before Conception, during Pregnancy, and Post Partum. The Lancet Diabetes and Endocrinology, 4, 1037- 1049. https://doi.org/10.1016/S2213-8587(16)30278-9
Thanoon, O., Gharaibeh, A. and Mahmood, T. (2015) The Implications of Obesity on Pregnancy Outcome. Obstetrics, Gynaecology and Reproductive Medicine, 25, 102-105. https://doi.org/10.1016/j.ogrm.2015.01.008
Lumsden, M.A. and Hor, K. (2015) Impact of Obesity on the Health of Women in Midlife. The Obstetrician & Gynaecologist, 17, 201-208.
https://doi.org/10.1111/tog.12199
Stewart, F.M., Ramsay, J.E. and Greer, I.A. (2009) Obesity: Impact on Obstetric Practice and Outcome. The Obstetrician & Gynaecologist, 11, 25-31.
https://doi.org/10.1576/toag.11.1.25.27465
Chodankar, R., Middleton, G., Lim, C. and Mahmood, T. (2018) Obesity in Pregnancy. Obstetrics, Gynaecology and Reproductive Medicine, 28, 53-56.
https://doi.org/10.1016/j.ogrm.2017.11.003
Crane, J.M.G., Murphy, P., Burrage, L. and Hutchens, D. (2013) Maternal and Perinatal Outcomes of Extreme Obesity in Pregnancy. Journal of Obstetrics and Gynaecology Canada, 35, 606-611. https://doi.org/10.1016/S1701-2163(15)30879-3
Scott-Pillai, R., Spence, D., Cardwell, C.R., Hunter, A. and Holmes, V.A. (2013) The Impact of Body Mass Index on Maternal and Neonatal Outcomes: A Retrospective Study in a UK Obstetric Population, 2004-2011. BJOG: An International Journal of Obstetrics and Gynaecology, 120, 932-939. https://doi.org/10.1111/1471-0528.12193
Cedergren, M.I. (2004) Maternal Morbid Obesity and the Risk of Adverse Pregnancy Outcome. Obstetrics and Gynecology, 103, 219-224.
https://doi.org/10.1097/01.AOG.0000107291.46159.00
Mission, J.F., Marshall, N.E. and Caughey, A.B. (2015) Pregnancy Risks Associated with Obesity. Obstetrics and Gynecology Clinics of North America, 42, 335-353.
https://doi.org/10.1016/j.ogc.2015.01.008
Davies, G.A.L., Maxwell, C. and McLeod, L. (2018) Obesity in Pregnancy. Journal of Obstetrics and Gynaecology Canada, 40, 630-639.
https://doi.org/10.1016/j.jogc.2018.05.018
Dutton, H., Borengasser, S.J., Gaudet, L.M., Barbour, L.A. and Keely, E.J. (2018) Obesity in Pregnancy: Optimizing Outcomes for Mom and Baby. Medical Clinics of North America, 102, 87-106. https://doi.org/10.1016/j.mcna.2017.08.008
Gunatilake, R.P. and Perlow, J.H. (2011) Obesity and Pregnancy: Clinical Management of the Obese Gravida. American Journal of Obstetrics and Gynecology, 204, 106-119. https://doi.org/10.1016/j.ajog.2010.10.002
Lashen, H., Fear, K. and Sturdee, D.W. (2004) Obesity Is Associated with Increased risk of First Trimester and Recurrent Miscarriage: Matched Case-Control Study. Human Reproduction, 19, 1644-1646. https://doi.org/10.1093/humrep/deh277
Roman, H., Robillard, P., Hulsey, T.C., Laffitte, A., Kouteich, K., Marpeau, L., et al. (2007) Obstetrical and Neonatal Outcomes in Obese Women. West Indian Medical Journal, 56, 421-426.
Rayis, D.A., Abbaker, A.O., Salih, Y. and Adam, I. (2011) Obesity and Pregnancy Outcome in Khartoum, Sudan. International Journal of Gynecology and Obstetrics, 113, 160-161. https://doi.org/10.1016/j.ijgo.2010.12.008
Rowlands, I., Graves, N., de Jersey, S., McIntyre, H.D. and Callaway, L. (2010) Obesity in Pregnancy: Outcomes and Economics. Seminars in Fetal and Neonatal Medicine, 15, 94-99. https://doi.org/10.1016/j.siny.2009.09.003
Bianchi, C., de Gennaro, G., Romano, M., Aragona, M., Battini, L., Del Prato, S., et al. (2018) Pre-Pregnancy Obesity, Gestational Diabetes or Gestational Weight Gain: Which Is the Strongest Predictor of Pregnancy Outcomes? Diabetes Research and Clinical Practice, 144, 286-293. https://doi.org/10.1016/j.diabres.2018.08.019
Vaswani, P.R. and Balachandran, L. (2013) Pregnancy Outcomes in a Population with High Prevalence of Obesity: How Bad Is It? Clinical Epidemiology and Global Health, 1, 5-11. https://doi.org/10.1016/j.cegh.2012.11.006
Counseling, W.L., Schummers, L., Hutcheon, J.A. and Bodnar, L.M. (2015) Risk of Adverse Pregnancy Outcomes by Prepregnancy Body Mass Index: A Population- Based Study to Inform Prepregnancy. Obstetrics & Gynecology, 125, 133-143.
https://doi.org/10.1097/AOG.0000000000000591
Aviram, A., Hod, M. and Yogev, Y. (2011) Maternal Obesity: Implications for Pregnancy Outcome and Long-Term Risks: A Link to Maternal Nutrition. International Journal of Gynecology and Obstetrics, 115, S6-S10.
https://doi.org/10.1016/S0020-7292(11)60004-0