This primaegravida has morbid obesity. There is increase risk of morbidity and mortality to the mother and the fetus. Proper dating of pregnancy is required as early intervention may be required. Abdominal and pelvic examination may be difficult and uninformative because of obesity. Abdominal ultrasound [uss] may also be difficult. She may need detailed uss in a tertiary unit as serum tests for anomaly risk is difficult to interpret in obese patients.
She is at increased risk of pregnancy induced hypertension [PIH], gestational diabetes millets[GDM] thromboembolismic disease[TED] macrosomia & operative delivery. Large size cuff is needed to measure BP GTT to detect GDM, urine dipsticks. USS is needed for presentation viability as per abdomen may be difficult as well as uss for growth after 28 weeks every 4 weeks. Weight reduction is not advised during pregnancy but referral to dietician for advice on healthy food is needed Intravenous access may be difficult as well as anesthesia, arrange for anaesthesitist review..Operative risk is increased with obesity.
This is high risk pregnancy and should be followed in consultant led unit. Screen for PIH, GDM and TED. Follow .up growth by serial uss. Bp check with proper size cuff as well as urine dipstick. With macrosomia a consultant may advice induction of labour at 37-38 weeks
Intrapartum advice epidural analgesia as there is increase risk of operative delivery. Advice mobilization and good hydration as well as graduated stocking. Estimate TED risk. Abdominal CTG may not detect the fetal heart trace so scalp electrode should be applied. Apartogram to follow up progress of labour Senior obstetrician & midwife supervision is needed. Anticipate shoulder dystocia Do active management of the third stage of labour.
Postnatal watch for hydration early mobilization Advice graduating stocking Encourage breast feeding. Hormonal contraception is not advised in this patient but mirena or IUCD can be advised .advise weight reduction. Support group. Written information on long term risks
