Key recommendations( management of obesity during pregnancy) 16-Women with a booking BMI _35 have an increased risk of pre-eclampsia and should have surveillance during pregnancy in accordance with the Pre-eclampsia Community Guideline(evidence -B) 17-The duty anaesthetist covering labour ward should be informed when a woman with a BMI _40 is admitted to the labour ward if delivery or operative intervention is anticipated. This communication should be documented by the attending midwife in the notes.( evidence -D) 18-Operating theatre staff should be alerted regarding any woman whose weight exceeds 120kg and who is due to have an operative intervention in theatre.(evidence -D) 19-An obstetrician and an anaesthetist at Specialty Trainee year 6 and above, or with equivalent experience in a non-training post, should be informed and available for the care of women with a BMI _40 during labour and delivery, including attending any operative vaginal or abdominal delivery and physical review during the routine medical ward round.( evidence -D) 20-Women with a BMI _40 who are in established labour should receive ontinuous midwifery care.( evidence -D) 21-Women with a BMI _40 should have venous access established early in labour (evidence -D) 22-All women with a BMI _30 should be recommended to have active management of the third stage of labour. This should be documented in the notes.( evidence -B) 23-Women with a BMI _30 having a caesarean section have an increased risk of wound infection, and should receive prophylactic antibiotics at the time of surgery, as recommended by the NICE Clinical Guideline No. 13(evidence -B) 24-As recommended by the NICE Clinical Guideline No. 13 (Caesarean Section, April 2004), women undergoing caesarean section who have more than 2cm subcutaneous fat, should have suturing of the subcutaneous tissue space in order to reduce the risk of wound infection and wound separation (evidence -A) 25-Obesity is associated with low breastfeeding initiation and maintenance rates. Women with a booking BMI _30 should receive appropriate specialist advice and support antenatally and postnatally regarding the benefits, initiation and maintenance of breastfeeding (evidence -B) 26-Women with a booking BMI _30 should continue to receive nutritional advice following childbirth from an appropriately trained professional, with a view to weight reduction(evidence -C ) 27-All women with a booking BMI _30 who have been diagnosed with gestational diabetes should have a test of glucose tolerance approximately 6 weeks after giving birth.( evidence -D) 28-Women with a booking BMI _30 and gestational diabetes who have a normal test of glucose tolerance following childbirth, should have regular follow up with the GP to screen for the development of type 2 diabetes.( evidence -B) 29-All women with a booking BMI _30 who have been diagnosed with gestational diabetes should have annual screening for cardio-metabolic risk factors, and be offered lifestyle and weight management advice.( evidence -B)
Posted on: Sun, 06 Jul 2014 10:44:18 +0000
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