OBESITY IN PREGNANCY
Source
*Obesity in pregnancy is a double edged sword. Number of indicies are used for calculating grade of obesity.But the most covienent and widely used index is BMI.
Body mass index (BMI), expressed as weight (Kg) divided by square of height in metres (m2).
Ideal BMI should be between 20 and < 25. Arbitrary cut off points of BMI > 25 kg/m2 for overweight & > 30 kg/m2
obese are stated.
As i mentiomed above, it is a double edged sword.Risks of obesity summate with that of pregnancy and complicate the situation.
Effects of obesity obstetric performances is mentiomed below:-
Effects on pregnancy
(1) Patients feel uncomfortable and become dyspneic on exertion.
(2) Medical complications like hypertension both essential and pregnancy induced are increased and so also gestational diabetes; (3) There is difficulty in diagnosis of presentation and in hearing the FHS because of abdominal fat obscuring transmission of sound..
(4) Fetal macrosomia
(5) As such, there is more need for sonography because clinical findings are not so evident as that of non obese pregananr mothers..
(6) Increased risk of fetal malformations specially neural tube defects.
Effects on labor
(1) There is increased incidence of abnormal uterine contraction and prolonged labor.
(2) Operative interference is increased and so also difficulty in caesarean section.
(3) Shoulder dystocia is likely and.
(4) Anaesthetic hazards are high.
Puerperium
There is increased chance of puerperal urinary tract infection, PPH, venous thrombosis and lactation failure.
Management—The cases are considered as “high risk” group. They require adequate antenatal supervision and mandatory
hospital delivery.
Fat and carbohydrate should be curtailed in the diet. As these are major proximate principles which are contributory.
Obese women should limit weight gain to < 8 kg (weight gain in normal pregnancy is near about 11 kgs) and there is no need of weight loss during pregnancy.
During labor, shoulder dystocia should be kept in mind by obstetrician (macrosomia).
There is increased risk of cessarean delivery.
Other risks are—Post-term pregnancy.
Source:William's Book of Obstetrics.DC Dutta textbook of obstetrics. Shaw's text Book Obstetrics
