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Effects of maternal over Weight in labor on both Mother and fetus

Author: 
Dr. Bashar Mohammed Zaki, Dr. Faten Mohammed Basheer and Dr. Ammar Myasar Zaidan
Subject Area: 
Health Sciences
Abstract: 

Background: Excessive weight has become one of the major health problems worldwide, especially with the globally increasing prevalence and the wide range of accompanying health problems, including metabolic syndrome, cardiovascular diseases and hypertension, liver and gall bladder diseases. During pregnancy, obesity is associated with increased maternal and perinatal morbidity, and sometimes mortality. Body Mass Index (BMI) is the most commonly used method to estimate the degree of obesity. Objectives: The aim of the study is to correlate between high maternal BMI at delivery and adverse pregnancy outcome (maternal and fetal). Patients and methods: This study is a prospective comparative study based on women attending labor ward at Al-khansaa Maternity Teaching Hospital in Mosul city conducted from the 1st of June 2017 to 30th of December 2017. A total of 200 patients were included, all of them had term, singleton pregnancy, with cephalic presentation and all underwent a trail of vaginal delivery. The patients were classified according to their BMI (calculated after delivery) to control group with normal BMI and case group with high BMI. Case group was further subdivided to three groups (overweight, obese, and severely obese) to find if any of the comparison parameters has linear association with the degree of obesity. Case and control group were compared for maternal and fetal complications during and after labor. Maternal complications included hypertension, gestational edema, gestational diabetes, ante partum or intrapartum hemorrhage, delivery mode, perineal tears and postpartum hemorrhage. Fetal complications included fetal distress during labor, large for gestational age, birth trauma, low apgar score, congenital abnormality, and admission to neonatal intensive care unit. Results: By comparing case and control groups, results showed that case group were statistically at more risk of having hypertension (OR=3.81), prolonged pregnancy (OR=2.68), lack of progression of labor (OR=7.98), emergency cesarean section (OR=3.57), and postpartum hemorrhage (OR=5.71), with the susceptibility to the first four factors increased linearly with the increase of maternal BMI. A strong association have also been found between maternal obesity and gestational edema (OR=6.74). Although more cases of gestational diabetes mellitus were recorded in case than control group but this difference was not statistically significant. The same was observed regarding the incidence of instrumental vaginal delivery, and deep perineal tears. Regarding fetal and neonatal outcomes, case group had statistically higher susceptibility to have large for gestational age babies (OR=4.94), abnormal fetal heart rate during labor (OR=2.52), low apgar score at 1 minute (OR=5.72). Statistically no significant increase in meconium stained liquor, congenital abnormality, birth trauma and admission to NICU. Conclusion: Delivery while having high BMI is considered a high risk condition, and requires special attention for early detection and appropriate management of complications and those ladies need more care during and after labor.

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