1. The Health Roundtable Management of Rising BMI in Pregnancy Presenter: Kay Kurth Hospital Code Name: Cougar3 Innovation Poster Session HRT1104b – Maternity March 10-11 2011

2. The Health Roundtable KEY PROBLEM  Pregnant women presenting to Sandringham to have their baby’s with elevated BMI.  No clear management.  Anaesthetists unhappy.  Difficulties with management in labour ie. Monitoring, epidurals

3. The Health Roundtable AIM OF THIS INNOVATION  Develop a plan to identify at risk patients.  Provide support and education  Liaise with multidisciplinary team in the care of patients with BMI>35

4. The Health Roundtable BASELINE DATA  Survey in 2008 to 2009  Identified 20 patients >BMI 35  NVB 27%  C/S 61%  PPH 20%  Transferred to Tertiary hospital 10%

5. The Health Roundtable KEY CHANGES IMPLEMENTED  A multidisciplinary team meeting to decide on most appropriate plan in 2009.  Changes decided upon & implemented  Target group BMI 35 – 37 with no co-morbidities and committed to being involved in planned hospital management during their pregnancy.  Guideline developed to outline care and management.  Target group require review by anaesthetic clinic.  Antenatal care to be with Obstetrician.  Early GTT to be considered &/ GCT @ 26/40.  Consultation with dietician & lifestyle change coaching.  Mid-trimester fetal morphological assessment @ 20-21/40 & a repeat scan @ 28-34/40 to be considered.  Due to increased risk of complications antenatal visits are scheduled at least fortnightly from 28/40.  Repeat anaesthetic review @ 34/40.  If caesarean section required, theatre to be aware of elevated BMI. Prophylactic administration of antibiotic of 2GM Cephazolin at operation & thromboprophylaxis to be considered.  Consideration given to management in birth suite, all staff to be aware of any documented plan. Anaesthetic staff to be informed of admission. All staff to be aware of OH&S issues & provide appropriate equipment.  If fetal monitoring required, an internal scalp electrode may be needed.  Breast feeding to be encouraged. 

6. The Health Roundtable OUTCOMES SO FAR  Survey 2009 -2010  Identified 36 women BMI 35-37  NVB 50%  C/S 31%  PPH 14%  Transferred to tertiary hospital 5.7%

7. The Health Roundtable LESSONS LEARNT  Providing obese pregnant women with education and support during their pregnancy significantly improves outcomes.