ABSTRACT
AIMS: To compare pregnancy care, maternal and neonatal outcomes of women with Body Mass Index (BMI) >30 enrolled in a Weight Intervention Group versus other models of antenatal care. METHODS: Retrospective, case-control study of mothers with BMI >30 managed with a specialised programme versus age-matched women enrolled in standard models of care. RESULTS: One thousand, one hundred and fifteen of 9954 pregnant women with singleton pregnancies, had a BMI >30, of whom 9.6% enrolled in the intervention group. Compared to controls, the intervention group had superior implementation of local high BMI guidelines, including; nutritional /weight gain advice (86% vs. 46%, p < 0.001), regular weighing (80% vs. 33%, p < 0.001), lactation consultant referrals (8% vs. 1%, p = 0.02), third trimester anaesthetic review and ultrasound (50% vs. 20.9%, p = 0.04 and 55% vs. 43%). Initiation of breastfeeding was higher in the intervention group (100% vs. 90%, p = 0.001). No significant difference was noted in Caesarean rate (30% vs 32%) and birthweight (3538 g vs 3560 g). CONCLUSIONS: Women with high BMI enrolled in a specialised antenatal management programme received increased care, and had superior breastfeeding initiation rates. However, engagement was poor, and no significant differences were noted in antenatal or postnatal complications, mode of birth or neonatal outcome.
ABSTRACT
BACKGROUND: Shortness of breath is a common physiological pregnancy presentation, secondary to both hormonal and mechanical effects. Its pathological causes are common (asthma exacerbation or infection); new-onset cardiac pathology is rarely considered. CASE: JC, a 39-year old G4P2T1, presented at 34 weeks' gestation with shortness of breath unrelieved by salbutamol. History included asthma, poly-drug abuse and smoking. Initial presentation was consistent with asthma exacerbation and she was treated as such. There was deterioration of symptoms and on re-examination raised jugular venous pressure was noted with bibasal lung crepitations and cardiac systolic murmur. Echocardiogram showed severe cardiomyopathy (left ventricular ejection fraction 20%). JC was commenced on diuretics, digoxin and fluid restricted. Labour was induced at 35 weeks' gestation, with birth of a healthy female infant (BW 2475 g) by elective assisted vaginal delivery. Cardiac function improved in subsequent weeks, confirming peripartum cardiomyopathy. CONCLUSION: Peripartum cardiomyopathy affects 1 in 2500-4000 live births. Over 90% of women regain normal cardiac function postpartum with optimal medical management. Peripartum cardiomyopathy presents a diagnostic conundrum as its primary symptoms mimic not only those of normal pregnancy but also a number of other, more common conditions. It is important to consider cardiac causes of shortness of breath initially, and vital to revisit an initial non-cardiac shortness of breath diagnosis if there is no sustained improvement with treatment. In this case, asthma history and initial wheeze on examination impeded correct diagnosis; however, the situation was re-evaluated and correct diagnosis made when the patient's shortness of breath deteriorated. Subsequent multidisciplinary management and birth in an appropriate setting facilitated the best outcome for both mother and baby.
