P115 Optimising obstetric care in high BMI patients: should we offer elective caesarean sections based on BMI?

Published Date: 01st May 2022

Publication Authors: Robinson E, John S, Singh P

Introduction
Obesity in the obstetric population is increasing. Obese patients pose obstetric and anaesthetic challenges, contributing to maternal and fetal morbidity and mortality [1]. Our maternity department is increasingly busy, with 4000 deliveries/year. More women with high BMIs are booking, and increasingly require involvement of the anaesthetic team, especially out-of-hours, when less-experienced staff may be on call.

Methods
We identified all women with a BMI >=40 kg/m2, booking between March and February 2020. Retrospective data on their demography, antenatal care, labour, delivery and pregnancyoutcome were collected from electronic records.

Result(s)
In total,141women met criteria. Patientswere excluded if lost to follow-up, pregnancy continuing or was lost - resulting in 93 live births in our study group. BMI ranged from 40 to 58.8. 24% underwent elective caesarean section (CS), 45% were induced and 31% laboured spontaneously. The emergency CS (eCS) ratewas 38%, with 85% out-of-hours. The eCS rate did not increase with BMI (41% BMI 40-44.9; 39% BMI 45-49.5; 29% BMI >50), but numbers were small in higher BMI categories (only 8 women had a booking BMI >50). A trend was seen with parity, BMI and eCS rate. Nulliparous womenwere more likely to have eCS with increasing BMI, while multiparous women had a lower eCS rate (Table). Most of patients (93%) were seen in consultant-led obstetric antenatal clinics, 36% of these by the High BMI Lead. Additionally, 71% were seen in consultant-led anaesthetic clinics. (Table Presented)

Discussion
The RCOA and RCOG recommend that woman with a BMI >40 should receive specialised antenatal care.We found high levels of consultant-led clinics in both specialities. The RCOA recommends that an anaesthetist of at least ST6 grade should be involved in the operative delivery of these high-risk patients [2]. Due to frequent out-of-hours eCS, this is often not the case. With higher eCS rates in primiparous women with high BMIs (100% when BMI > 50), perhaps this group should be offered elective CS to ensure the recommended safe care. Our obstetricians are reviewing the "High BMI Pathway". This, along with altering the timing of induction-of-labour, may improve patient care by reducing the number of out-of-hours emergencies.

 

Robinson, E; John, S; Singh, P. (2022). P.115 Optimising obstetric care in high BMI patients: should we offer elective caesarean sections based on BMI?. International Journal of Obstetric Anesthesia. 50(Suppl 1), pp.62-63. [Online]. Available at: https://doi.org/10.1016/j.ijoa.2022.103411 [Accessed 16 September 2022].

 

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