Outcome of Pregnancy in the Morbidly Obese Woman

Background: Obesity is a growing global health problem. In South Africa; more than half of the adult women are overweight and almost 30are obese. The problems associated with obesity; such as diabetes; hypertension; thrombo-embolism and coronary heart disease; are well described in the non-pregnant population; but the condition itself holds specific risks during the ante-; intra- and postpartum periods of the pregnant woman. Of particular concern is the intrapartum period. Complications such as slow progress during labour and increased rates of caesarean section are best addressed proactively. For this reason certain sources advocate that all morbidly obese women be referred for evaluation of the pregnancy and planning of labour and delivery by an anaesthetist and a specialist obstetrician. The aim of this study was to determine whether morbidly obese women are at increased risk of adverse outcomes; compared to women with a normal body mass index (BMI). Methods: A case control study design was used. In this study a normal BMI was defined as 20-25 kg/m2 and morbid obesity as a BMI of = 40 kg/m2. The BMI was calculated from the weight and height measured at the booking visit. The cases in this study comprised the first hundred morbidly obese women seen at the Obstetric Special Care Clinic in Tygerberg Hospital (TBH); a secondary and tertiary referral centre. The controls (n = 209) were women with normal BMIs and singleton pregnancies who booked as low-risk patients at the Bishop Lavis Midwife Obstetric Unit (MOU) during the same calendar period. A minimum ratio of 2:1 controls-to-case was used; with controls also matched for primi- or multiparity. Patients booking at the MOU with significant obstetric risk factors are referred to TBH for antenatal care. These women were not considered as controls. However; low-risk women who met the inclusion criteria at booking and who subsequently developed risks or complications were included; as the selection was done according to findings at the booking visit. The main outcomes to be determined were: ante-; intra- and postpartum maternal complications; rate of epidurals; and perinatal outcomes. Results: Women in the morbidly obese group were significantly older (p 0.001) and of higher parity (p 0.001) than those with normal BMIs. There was no difference in the numbers of primigravidae. Significantly more women in the morbidly obese group had experienced at least one miscarriage (p received it. During delivery; perineal damage was more common in morbidly obese women (p 0.001) and their babies were significantly larger (p 0.001). There was one perinatal death. Conclusions: Morbidly obese women experienced increased complications during pregnancy and childbirth. Due to the high rate of caesarean sections and the potential difficulties of emergency anaesthesia among these women; epidural anaesthesia during labour should be planned and administered as often as possible

Intrauterine Deaths in High-Risk Pregnancies with Normal and Borderline Umbilical Artery Doppler Flow Velocity Waveforms

Objective. To investigate the use of a personal computer (PC)-based; continuous-wave Doppler device by a trained midwife at the fetal evaluation clinic at a tertiary hospital to assess flow velocity waveforms (FVWs) of the umbilical artery flow in referred women. Methods. Pregnant women referred for suspected poor fetal growth were evaluated from June 2002 through December 2004. The Umbiflow device (still prototype; developed by CSIR/MRC/Stellenbosch University); consisting of a Pentium 3 PC with an ultrasound transducer plugged into the USB port; was used to analyse the FVW of the umbilical artery. Pregnancies in which the resistance index (RI) was 75th percentile (P75) were not further evaluated for fetal well-being unless the clinical condition of the mother had changed. Pregnancies with an RI P75 were followed up according to a specific protocol. Primary endpoints were intrauterine death and intrauterine growth restriction. Results. Doppler FVWs were assessed in 955 pregnancies. The RI was P75 in 529 participants (55.4); between the P75 and P95 percentile in 350 (36.6) and P95 in 53 (5.5). In 23 cases (2.4) end-diastolic flow was absent or reversed (AREDF). Intrauterine death within 1 week of the test occurred in 1; 4; 0 and 2 women respectively in these four groups; and 16.7; 34.5; 54.9and 65.5respectively gave birth to infants that were small for gestational age. Conclusions. Intrauterine death; within 1 week of the test; was extremely rare when the RI was P75 (0.2). Relatively more deaths within a week of the Doppler examination occurred in the P75 - P95 group. This group should be regarded as being at high risk and needs careful antenatal surveillance

The Sexual Function and Influence of Urinary Incontinence Questionnaire (SF-IUIQ) - Assessing Sexual Function of Urinary Incontinent Women in South Africa

Objective. To develop and psychometrically validate a questionnaire that assesses sexual function of urinary incontinent women in South Africa and the influence of inconti- nence on their sexual function. Design. A prospective descriptive study. Setting. Urogynaecology and gynaecology outpatient clinics at Tygerberg Hospital; Stellenbosch University; South Africa. Subjects. All patients attending the urogynaecology or gynaecology outpatient clinic at Tygerberg Hospital; who were older than 18 years; not pregnant and could communicate in either Afrikaans or eng. Outcome measures. The content validity; reliability (internal consistency) and construct validity (convergent and discrimi- nant validity) of the Sexual Function and Influence of Urinary Incontinence Questionnaire (SF-IUIQ). Results. Of the subjects 33were not sexually active. Sexual quality of life was significantly influenced by urinary incontinence in 37.7of individuals. Leakage during sexual activity occurred in 32.Conclusions. The SF-IUIQ is a reliable and valid measure of sexual function in urinary incontinent women; and ofthe influence of urinary incontinence on sexual function