Extreme obesity as a patient safety risk during labor and birth.

摘要

You've just been notified that a pregnant woman weighing over 600 pounds will be giving birth in your unit next week. What plans should be underway to make sure this birth is as safe as possible? Key issues to consider for women with extreme obesity (body mass index > 40) are (a) the nurse-to-patient ratio, (b) maternal and fetal assessment, (c) pain management, (d) necessary equipment, and (e) possible emergent cesarean birth. Advance planning is critical to safe care during labor and birth for women with extreme obesity. Ideally, each perinatal unit has established protocols for these pregnant women that include advance notification from providers by 34 weeks gestation. Although an estimated maternal weight can be useful for planning purposes, maternal weight should be confirmed on admission if at all possible because an accurate weight determines the type of bed that is required. If a woman is ambulatory and there is no scale that can provide an accurate weight for patients over 300 pounds (accuracylimit of most scales), it may be necessary to escort her to a scale that the hospital normally uses to weigh freight or laundry. This can be embarrassing for the woman, and the situation should be handled in a manner most sensitive to her situation.