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Essay No. 194 REPLY(Please check it Dr Paul),Thanks

Essay No. 194 REPLY(Please check it Dr Paul),Thanks Posted by Rishit H.
r Paul,
I am sending my answer for the first time. Kindly correct it and give your valuable advice to improve in future.
Thanking You,


Thanking You,



This patient, by the virtue of her obesity, is at an increased risk of complications antenatally, intrapartum and postpartum. These complications are
both foetal and maternal.In order to improve the outcome of her pregnancy,
preventive measures and steps for early recognition and treatment along
with skilled care is a must. This can be best acheived wihin a team of
obstetrician, midviwes, her general practitioner and a dietician.
First and foremost clinical diagnosis may be difficult, it may be
difficult to establish viablity and dating of the pregnancy without a transvaginal
scanning.As the pregnancy proceeds, it may be difficult to evaluate the
size of the foetus, determine the prenting part, detect foetal heart rate or
recognize the presence or absence of hydroamnios.Hence this may neccesitate serial growth scans. There is increased risk of foetus to be large for gestational age, for which ultrasound would be of immense help.
Dietary advice is of help ,so refferal to a dietician is appropriate.Diet restriction may cause growth restriction,So is not advisable.Maternal complications as preeclampsia, gestational diabetes and thromboembolic phenomenon may develop during pregnancy.Blood pressure measurement using standard cuff may give erroneously high reading ,appropriate size cuff should be used. A screening for gestational diabetes to be done at 26 weeks gestation. During labour chances of prolonged labour, intrumental vaginal delivery and caesarian section are high. Initially it may be difficult to site an infusion in a fat limb and to site an epidural cannula.If anticipated ,should be placed well in time.If caesarian section required it should be done by a senior obstetrician and a senior anaesthetist, as intubatipon may be hazardous. If macrosomia anticipated , adequate trained staff and protocols for shoulder dystocia should be performed. Obesity is a risk factor for thromboembolism. Early ambulation postdelivery should be encouraged. If surgery performed ,thromboprophylaxis should be considered.Stockings would be added help. Delayed wound healing and haematoma is common, so adequate sepsis and haemostasis, prophylactic antibiotics and adequate hygiene is mandatory.The newborn with low apgar score and problems due to macrosomia are more frequent so neonatologist should be informed in time , to plan adequate care of the baby.Advice regarding control over diet before next pregnancy to be given. Oral combined contraceptives are relative contraindications. Written information regarding support group like weight watchers and continual of dietary advice should be given.