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HIGH RISK PREGNANCY MANAGEMENT
BMI >40
A pregnancy is
identified as “High Risk” because when the “BMI” (Body Mass Index) is 40
or greater. A normal BMI is 20-25. BMI is calculated for each
pregnant patient using a chart with a woman’s height and initial
weight. This teaching sheet outlines the increased risks pregnant women
and their babies may experience that can be related to obesity.
When an obese woman
becomes pregnant, there are increased burdens placed on her body that
can complicate a pregnancy. The main risks to mother and baby are:
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Gestational
diabetes
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High blood
pressure, and possible Pre-Eclampsia
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A large baby
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A prolonged or
difficult labor and delivery
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Increased
likelihood of Cesarean Section delivery
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Difficulty with
abdominal wound healing if you have a Cesarean Section
An obese woman’s
progress during pregnancy will be monitored more closely, and this may
involve more blood tests and longer and more frequent appointments with
her doctor. Total pregnancy weight gain should be limited to 15 pounds
or less for an obese woman, as her caloric needs are less in pregnancy
than for women of average weight. Later in pregnancy, the doctor may
wish to perform extra ultrasounds and “non-stress” testing (fetal heart
rate monitoring) to assess the baby’s growth and well being before
birth.
Labor is often longer and more
difficult for obese women. Because of this, it is important to know
what to expect during your birth experience. Internal fetal heart rate
and contraction monitors may be necessary, as the external monitors may
not be adequate for assessing how the woman and her baby are tolerating
labor. The pushing stage of labor may be longer than usual, and will
require the woman’s very best effort to deliver vaginally. It is very
important to try for a vaginal delivery, as it is safer and the recovery
process is much easier than after a Cesarean section.
Discussing a woman’s weight and weight
gain during pregnancy are very sensitive subjects. We hope that this
information will be helpful to you in understanding the special
management of obstetric care during a high-risk pregnancy.
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