Author: Davies J.E.; Frias-Jimenez C.
Abstract: The prevalence of obesity in pregnancy is increasing, and is a significant risk factor for anaesthetic related maternal mortality [1]. The CMACE/RCOG guidelines recommend that pregnant women with a booking BMI >40 have a consultation with an obstetric anaesthetist to enable potential difficulties to be identified and formation of a management plan [2]. Methods All letters from the anaesthetic antenatal clinic for 2010 were retrospectively reviewed and data collected on: reason for referral, coexisting medical problems, and BMI. Information on anaesthetic involvement during delivery in those seen with morbid obesity was collected using computer records and the theatre logbook. A telephone satisfaction survey was done on 10% of patients. To compare our clinic with the surrounding hospitals in Merseyside, similar data was collected from 4 district general hospitals (DGH) and the tertiary obstetric unit. Results The anaesthetic
antenatal clinic at WUTH saw 211 patients in 2010, which corresponds to 6% of the obstetric population in our area; this is higher in comparison to surrounding units (2.9-4.6%). A much greater proportion of referrals were due to obesity at our clinic (74%), compared to surrounding hospitals where rates were between 40-58%, despite similar BMI thresholds for clinic referral. All of the hospitals in the area with the exception of one DGH had a threshold for referral set at BMI 40 or below. The average BMI of those referred for obesity was 40-44, which was similar throughout the region. Coexisting medical conditions were present in 74 (47%) of those referred for obesity, the commonest being asthma and diabetes. Anaesthetic involvement in labour occurred in 59 (53%) of the obese referrals, of which 30% had an epidural. The telephone satisfaction survey revealed that 90% found the consultation helpful with 76% feeling more confident about delivery afterwards. Failure to attend rates ranged across the region between 7-20%. Discussion WUTH has 3544 deliveries annually, and serves an area with wide health inequalities; life expectancy for women in the most deprived areas of the Wirral is 9.7 years lower in comparison to the least deprived [3]. This data suggests there is a greater proportion of obesity in the obstetric population in Wirral compared to
surrounding units in Merseyside. A re audit is planned to monitor the changes within the clinic, if obesity rates continue to rise this will impact on the number of clinic sessions required. With 53% of morbid obese parturients having anaesthetic involvement in labour, and rising obesity rates nationwide, there is a significant impact on obstetric and anaesthetic services.
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