[Morbid obesity: a risk factor for obstetric complications].
In a primipara, 28 years of age and with a BMI of 44 kg/m2, a Zavanelli manoeuvre was performed. Due to uterine atony she had to undergo a hysterectomy. A multipara, 39 years of age and with a BMI of 66 kg/m2, experienced that her weight exceeded the limits of the beds and that local anaesthesia was hard to perform; she suffered from a lesion of the lumbosacral plexus caused by a shoulder dystocia. In the end, both mothers and their babies could go home in a moderate condition. Obesity is becoming more prevalent and brings with it an increase in obstetric risks. During pregnancy and delivery, morbidly obese patients should be monitored by a gynaecologist. Special interest should focus on screening for (gestational) diabetes, hypertension and foetal growth. Ultrasound may detect congenital malformations early; however, the sensitivity of ultrasound is lower in morbidly obese patients. When macrosomia is expected, a clear plan should be made regarding the mode of delivery. It is useful to make a treatment protocol for morbidly obese patients.
Poots
S
S
Erasmus Medisch Centrum, afd. Verloskunde en Vrouwenziekten, Postbus 2040, 3000 CA Rotterdam.
Logmans
A
A
Duvekot
J J
JJ
Steegers
E A P
EA
D000328:Adult; D015992:Body Mass Index; D036861:Delivery, Obstetric / Q000379:methods; D016640:Diabetes, Gestational / Q000150:complications; D005260:Female; D005320:Fetal Macrosomia / Q000150:complications; D006801:Humans; D009767:Obesity, Morbid / Q000150:complications* / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000517:prevention & control; D011256:Pregnancy Outcome; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000592:standards