Abstract
Objective
This guideline will review key aspects in the pregnancy care of women with obesity.
Part I will focus on Preconception and Pregnancy Care. Part II will focus on Team
Planning for Delivery and Postpartum Care.
Intended Users
All health care providers (obstetricians, family doctors, midwives, nurses, anaesthesiologists)
who provide pregnancy-related care to women with obesity.
Target Population
Women with obesity who are pregnant or planning pregnancies.
Evidence
Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane
Library on the impact of obesity in pregnancy on antepartum and intrapartum care,
maternal morbidity and mortality, obstetric anaesthesia, and perinatal morbidity and
mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled
clinical trials, and observational studies. There were no date or language restrictions.
Searches were updated on a regular basis and incorporated in the guideline to September
2018. Grey (unpublished) literature was identified through searching the websites
of health technology assessment and health technology assessment-related agencies,
clinical practice guideline collections, clinical trial registries, and national and
international medical specialty societies.
Validation Methods
The content and recommendations were drafted and agreed upon by the authors. Then
the Maternal-Fetal Medicine Committees peer reviewed the content and submitted comments
for consideration, and the Board of the Society of Obstetricians and Gynaecologists
of Canada (SOGC) approved the final draft for publication. Areas of disagreement were
discussed during meetings at which time consensus was reached. The level of evidence
and quality of the recommendation made were described using the Evaluation of Evidence
criteria of the Canadian Task Force on Preventive Health Care.
Benefits, Harms, and Costs
Implementation of the recommendations in these guidelines may increase obstetrical
provider recognition of the issues affecting pregnant individuals with obesity, including
clinical prevention strategies, communication between the health care team, the patient
and family as well as equipment and human resource planning. It is hoped that regional,
provincial and federal agencies will assist in the education and support of coordinated
care for pregnant individuals with obesity.
Guideline Update
SOGC guideline will be automatically reviewed 5 years after publication. However,
authors can propose another review date if they feel that 5 years is too short/long
based on their expert knowledge of the subject matter.
Sponsors
This guideline was developed with resources funded by the SOGC.
Summary Statements
- 1Unfavourable cervix and induction of labour are more common with maternal obesity. The role of induction of labour and risk of Caesarean birth remains unclear (II-2).
- 2Electronic fetal monitoring is recommended for women in active labour with a body mass index >35 kg/m2. Cervical assessment, uterine monitoring, and fetal heart rate monitoring may be more challenging with higher degrees of maternal body mass index (III).
- 3Decision-to-delivery time is increased in women with obesity (II-2).
- 4Body mass index increases risk of surgical site infection and wound complications (II-2).
- 5Anaesthetic risks are increased with maternal obesity (II-2).
- 6Rates of successful breastfeeding are reduced for women with obesity (II-2).
- 7Several effective contraceptive choices are available to women with obesity (III).
- 8Women with obesity are at higher risk of postpartum depression and anxiety (II-2).
- 9Antenatal, labour and delivery, and postnatal care may be more complex in women with obesity (III).
Recommendations
- 1Electronic fetal monitoring is recommended for women in active labour with a body mass index >35 kg/m2. Intrauterine pressure catheters may assist in assessment of labour contractions. Fetal scalp electrodes may be helpful to ensure continuous fetal monitoring when indicated (III B).
- 2Women with obesity may benefit from higher dosage of preoperative antibiotics for Caesarean birth (I A).
- 3It is recommended to reapproximate the subcutaneous tissue layers at the time of Caesarean birth to reduce wound complications (II-2 A).
- 4Antenatal assessment with obstetric anaesthesia may assist in planning for safer birth for women with obesity (III A).
- 5Postoperative thromboprophylaxis is recommended, at appropriate dosing for the given body mass index, due to the greater risk of venous thromboembolism following Caesarean birth with women with obesity (II-3 A).
- 6Women with obesity should be offered lactation support in the postpartum period (III C)
- 7Women with obesity should be screened for postpartum depression and anxiety given that maternal obesity is a risk factor for these conditions (II-2 A).
- 8Counselling regarding weight management in the postpartum period is suggested in order to minimize risks in subsequent pregnancies (II-2 A).
- 9Obstetric team planning may be helpful for women with obesity to navigate the steps in antenatal, labour and delivery, and postnatal care (III-3 A).
Key Words
ABBREVIATIONS:
BMI (body mass index), DMPA (Medroxyprogesterone acetate), IUDs (intrauterine devices), VBAC (vaginal birth after Caesarean section), VTE (venous thromboembolism)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Obstetrics and Gynaecology CanadaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- The risk of prelabor and intrapartum cesarean delivery among overweight and obese women: possible preventive actions.Am J Obstet Gynecol. 2015; 212: 241.e1-241.e9
- Pre-pregnancy body mass index (BMI) and delivery outcomes in a Canadian population.BMC Pregnancy Childbirth. 2014; 14: 422
- Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London.Int J Obes Relat Metab Disord. 2001; 25: 1175-1182
- Maternal and perinatal outcomes of extreme obesity in pregnancy.J Obstet Gynaecol Can. 2013; 35: 606-611
- Obesity and cervical ripening failure risk.J Matern Fetal Neonatal Med. 2012; 25: 304-307
- Prostaglandin versus mechanical dilation and the effect of maternal obesity on failure to achieve active labor: a cohort study.J Matern Fetal Neonatal Med. 2017; 30: 1621-1626
- Effects of maternal obesity on duration and outcomes of prostaglandin cervical ripening and labor induction.Obstet Gynecol. 2009; 114: 1315-1321
- Nonmedically indicated induction in morbidly obese women is not associated with an increased risk of cesarean delivery.Am J Obstet Gynecol. 2017; 217: 451.e1-451.e8
- The effect of the MFM obesity protocol on cesarean delivery rates.Am J Obstet Gynecol. 2016; 215: 492.e1-492.e6
- Term elective induction of labor and perinatal outcomes in obese women: retrospective cohort study.BJOG. 2016; 123: 271-278
- Term elective induction of labor and pregnancy outcomes among obese women and their offspring.Obstet Gynecol. 2018; 131: 12-22
- The adipokine apelin and human uterine contractility.Am J Obstet Gynecol. 2012; 206: 359.e1-359.e5
- Inhibitory effect of leptin on human uterine contractility in vitro.Am J Obstet Gynecol. 2006; 195: 504-509
- Maternal body mass index and duration of labor.Eur J Obstet Gynecol Reprod Biol. 2013; 171: 49-53
- Contemporary labor patterns: the impact of maternal body mass index.Am J Obstet Gynecol. 2011; 205: 244.e1-244.e8
- Non-elective caesarean delivery due to ineffective uterine contractility or due to obstructed labour in relation to maternal body mass index.Eur J Obstet Gynecol Reprod Biol. 2009; 145: 163-166
- Morbid obesity and intra-partum care.J Obstet Gynaecol. 2008; 28: 301-304
- The impact of maternal body mass index and gestational age on the detection of uterine contractions by tocodynamometry: a retrospective study.Reprod Sci. 2016; 23: 638-643
- Monitoring contractions in obese parturients: electrohysterography compared with traditional monitoring.Obstet Gynecol. 2007; 109: 1136-1140
- Women with high BMI: should they be managed differently due to antagonising action of leptin in labour?.Med Hypotheses. 2013; 80: 767-768
- Oxytocin augmentation in spontaneously laboring, nulliparous women: multilevel assessment of maternal BMI and oxytocin dose.Biol Res Nurs. 2017; 19: 382-392
- Effect of maternal body mass index on oxytocin treatment for arrest of dilatation.J Perinat Med. 2013; 41: 517-521
- Management of spontaneous labour at term in healthy women.J Obstet Gynaecol Can. 2016; 38: 843-865
- Fetal health surveillance: Intrapartum consensus guideline.J Obstet Gynaecol Can. 2018; 40: e298-e322
- The use of intermittent auscultation in parturients of varying BMI categories: experience from a mid-sized tertiary care obstetrical unit.J Obstet Gynaecol Can. 2015; 37: 310-313
- Influence of maternal body mass index on accuracy and reliability of external fetal monitoring techniques.Acta Obstet Gynecol Scand. 2014; 93: 590-595
- Determination of fetal heart rate from abdominal signals: evaluation of beat-to-beat accuracy in relation to the direct fetal electrocardiogram.Biomed Tech (Berl). 2012; 57: 383-394
- Maternal morbid obesity and the risk of adverse pregnancy outcome.Obstet Gynecol. 2004; 103: 219-224
- Maternal prepregnancy obesity and the risk of shoulder dystocia: a meta-analysis.BJOG. 2018; 125: 407-413
- Pregnancy adverse outcomes related to pregravid body mass index and gestational weight gain, according to the presence or not of gestational diabetes mellitus: a retrospective observational study.Diabetes Metab. 2016; 42: 38-46
- Induction of labour versus expectant management for large-for-date fetuses: a randomised controlled trial.Lancet. 2015; 385: 2600-2605
- Safe prevention of the primary cesarean delivery.Am J Obstet Gynecol. 2014; 210: 179-193
Royal College of Obstetricians and Gynaecologists. Shoulder Dystocia. Green-top Guideline No. 42. 2nd Edition. March 2012.
- Sonographic fetal weight estimation in normal and overweight/obese healthy term pregnant women by gestation-adjusted projection (GAP) method.Arch Gynecol Obstet. 2016; 293: 775-781
- Influence of maternal body mass index on sonographic fetal weight estimation prior to scheduled delivery.J Obstet Gynaecol Res. 2015; 41: 1556-1561
- Emergency Caesarean section in obese parturients: is a 30-minute decision-to-incision interval feasible?.J Obstet Gynaecol Can. 2015; 37: 988-994
- Does obesity complicate regional anesthesia and result in longer decision to delivery time for emergency cesarean section?.Acta Anaesthesiol Scand. 2017; 61: 609-618
- Impact of obesity on incision-to-delivery interval and neonatal outcomes at cesarean delivery.Am J Obstet Gynecol. 2013; 209: 386.e1-386.e6
- Associations between maternal size and health outcomes for women undergoing caesarean section: a multicentre prospective observational study (The MUM SIZE Study).BMJ Open. 2017; 7e015630
- Extreme obesity and postcesarean maternal complications.Obstet Gynecol. 2014; 124: 227-232
- Maternal obesity and risk of post-cesarean wound complications.Am J Perinatol. 2014; 31: 299-304
- Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section.Cochrane Database Syst Rev. 2014; 10CD007482
- No. 247-Antibiotic prophylaxis in obstetric procedures.J Obstet Gynaeol Can. 2017; 39: e293-e2e9
- Pharmacokinetics of cefazolin prophylaxis in obese gravidae at time of cesarean delivery.Am J Obstet Gynecol. 2015; 213: 541.e1-541.e7
- Increased 3-gram cefazolin dosing for cesarean delivery prophylaxis in obese women.Am J Obstet Gynecol. 2015; 213: 415.e1-415.e8
- Effect of post-cesareandelivery oral cephalexin and metronidazole on surgical site infection among obese women: a randomized clinical trial.JAMA. 2017; 318: 1026-1034
- Cesarean section in morbidly obese parturients: practical implications and complications.N Am J Med Sci. 2012; 4: 13-18
- Vertical skin incisions and wound complications in the obese parturient.Obstet Gynecol. 2003; 102: 952-956
- Abdominal incision selection for cesarean delivery of women with class III obesity.Am J Perinatol. 2016; 33: 547-551
- Supra-umbilical vertical midline abdominal incision in morbidly obese gynaecological oncology patients.J Obstet Gynaecol. 2013; 33: 505-507
- Cesarean section in morbidly obese women: supra or subumbilical transverse incision?.Acta Obstet Gynecol Scand. 2009; 88: 1049-1052
- The Problem of the pannus: physician preference survey and a review of the literature on cesarean skin incision in morbidly obese women.Am J Perinatol. 2016; 33: 463-472
- Operating on the obese woman—a review.BJOG. 2006; 113: 1167-1172
- Suture closure of subcutaneous fat and wound disruption after cesarean delivery: a meta-analysis.Obstet Gynecol. 2004; 103: 974-980
- Wound drainage for caesarean section.Cochrane Database Syst Rev. 2013; 12CD004549
- Suture versus staples for skin closure after cesarean: a metaanalysis.Am J Obstet Gynecol. 2015; 212 (621.e1–10)
- Comparison of staples vs subcuticular suture in class III obese women undergoing cesarean: a randomized controlled trial.Am J Obstet Gynecol. 2018; 218: 451.e1-451.e8
- Prophylactic wound vacuum therapy after cesarean section to prevent wound complications in the obese population: a randomized controlled trial (the ProVac study).Am J Perinatol. 2017; 34: 1125-1130
- Prophylactic negative pressure wound therapy for obese women after cesarean delivery: a systematic review and meta-analysis.Obst Gynecol. 2017; 130: 969-978
- Cost-effectiveness analysis alongside a pilot study of prophylactic negative pressure wound therapy.J Tissue Viability. 2017; 26: 79-84
- Prophylactic negative-pressure wound therapy after cesarean is associated with reduced risk of surgical site infection: a systematic review and meta-analysis.Am J Obstet Gynecol. 2018; 218 (200–10.e1)
- Systematic review and meta-analysis of wound dressings in the prevention of surgical site infections in surgical wounds healing by primary intention.Br J Surg. 2012; 99: 1185-1194
- The impact of maternal obesity and weight gain on vaginal birth after cesarean section success.Am J Obstet Gynecol. 2004; 191: 954-957
- Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery.Obstet Gynecol. 2006; 108: 125-133
- Mode of delivery for the morbidly obese with prior cesarean delivery: vaginal versus repeat cesarean section.Am J Obstet Gynecol. 2001; 185: 349-354
- Do obese women receive the necessary interventions to achieve vaginal birth after Cesarean?.Am J Perinatol. 2016; 33: 991-997
- Trial of labor compared with cesarean delivery in superobese women.Obstet Gynecol. 2017; 130: 994-1000
- Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology.Anesthesiology. 2016; 124: 270-300
- Managing anesthesia for cesarean section in obese patients: current perspectives.Local Reg Anesth. 2016; 9: 45-57
- Epidural catheter placement in morbidly obese parturients with the use of an epidural depth equation prior to ultrasound visualization.ScientificWorldJournal. 2013; 2013695209
- Impact of morbid obesity on epidural anesthesia complications in labor.Am J Obstet Gynecol. 2011; 205: 370.e1-370.e6
- Maternal outcomes in pregnancies complicated by obesity.Obstet Gynecol. 2005; 106: 1357-1364
- Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta‐analysis.Obes Rev. 2009; 10: 194-203
- Maternal obesity, mode of delivery, and neonatal outcome.Obstet Gynecol. 2013; 122: 50-55
- The impact of body mass index on maternal and neonatal outcomes: a retrospective study in a UK obstetric population, 2004-2011.BJOG. 2013; 120: 932-939
- Association between prepregnancy body mass index and severe maternal morbidity.JAMA. 2017; 318: 1777-1786
- Risk of adverse pregnancy outcomes by prepregnancy body mass index: a population-based study to inform prepregnancy weight loss counseling.Obstet Gynecol. 2015; 125: 133-143
- ACOG practice bulletin no 156: obesity in pregnancy.Obstet Gynecol. 2015; 126: e112-e126
- Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery.Obstet Gynecol. 2002; 100: 959-964
- Complications of cesarean delivery in the massively obese parturient.Am J Obstet Gynecol. 2010; 203: 271.e1-271.e7
- Pulmonary embolism in pregnancy.Lancet. 2010; 375: 500-512
- Deep vein thrombosis and pulmonary embolism in pregnancy: diagnosis, complications, and management.Clin Obstet Gynecol. 2010; 53: 345-359
- Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database.BJOG. 2001; 108: 56-60
- Risk of a thrombotic event after the 6-week postpartum period.N Engl J Med. 2014; 370: 1307-1315
- Postpartum venous thromboembolism: incidence and risk factors.Obstet Gynecol. 2014; 123: 987-996
- Impact of risk factors on the timing of first postpartum venous thromboembolism: a population-based cohort study from England.Blood. 2014; 124: 2872-2880
- Practice bulletin no. 123: thromboembolism in pregnancy.Obstet Gynecol. 2011; 118: 718-729
- Risk factors for pregnancy-associated venous thromboembolism: a review.J Perinat Med. 2014; 42: 417-425
- Pre-pregnancy BMI, delivery BMI, gestational weight gain and the risk of postpartum venous thrombosis.Thromb Res. 2016; 145: 151-156
- VTE, thrombophilia, antithrombotic therapy, and pregnancy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines.Chest. 2012; 141: e691S-e736S
- Enoxaparin dosing after cesarean delivery in morbidly obese women.Obstet Gynecol. 2015; 125: 1371-1376
- High prepregnant body mass index is associated with early termination of full and any breastfeeding in Danish women.Am J Clin Nutr. 2007; 86: 404-411
- Prepregnant overweight and obesity diminish the prolactin response to suckling in the first week postpartum.Pediatrics. 2004; 113: e465-e471
- Effect of maternal obesity on lactation: systematic review.Nutr Hosp. 2011; 26: 1266-1269
- Predictors of breastfeeding in overweight and obese women: data from Active Mothers Postpartum (AMP).Matern Child Health J. 2011; 15: 367-375
- Maternal obesity and breastfeeding intention, initiation, intensity and duration: a systematic review.Matern Child Nutr. 2014; 10: 166-183
- Reduced breastfeeding rates among obese mothers: a review of contributing factors, clinical considerations and future directions.Int Breastfeed J. 2015; 10: 21
- Breastfeeding intention and early post-partum practices among overweight and obese women in Ontario: a selective population-based cohort study.J Matern Fetal Neonatal Med. 2013; 26: 611-615
- Contraceptive use by diabetic and obese women.Womens Health Issues. 2005; 15: 167-173
- U.S. medical eligibilitycriteria for contraceptive use, 2016.MMWR Recomm Rep. 2016; 65: 1-103
- Canadian contraception consensus (part 3 of 4): chapter 8–progestin-only contraception.J Obstet Gynaecol Can. 2016; 38: 279-300
- No. 329-Canadian contraception consensus part 4 of 4 chapter 9: combined hormonal contraception.J Obstet Gynaecol Can. 2017; 39 (229–68.e5)
- Impact of obesity on oral contraceptive pharmacokinetics and hypothalamic-pituitary-ovarian activity.Contraception. 2009; 80: 119-127
- Pharmacokinetics of a combined oral contraceptive in obese and normal-weight women.Contraception. 2010; 81: 474-480
- Ovarian suppression in normal-weight and obese women during oral contraceptive use: a randomized controlled trial.Obstet Gynecol. 2010; 116: 275-283
- Contraceptive use by obese women 1 year postpartum.Contraception. 2009; 80: 463-468
- Postpartum care and contraception in obese women.Clin Obstet Gynecol. 2016; 59: 204-215
- Condom use to aid cervical visualization during speculum examination.Can Fam Physician. 2018; 64: 297-298
- Contraceptive efficacy and safety of DMPA-SC.Contraception. 2004; 70: 269-275
- Follicular development and ovulation in extremely obese women receiving depo-medroxyprogesterone acetate subcutaneously.Contraception. 2010; 81: 487-495
- A 3-year multicentre randomized controlled trial of etonogestrel- and levonorgestrel-releasing contraceptive implants, with non-randomized matched copper-intrauterine device controls.Hum Reprod. 2015; 30: 2527-2538
- Contraceptive efficacy and cycle control with the Ortho Evra/Evra transdermal system: the analysis of pooled data.Fertil Steril. 2002; 77: S13-S18
- Contraceptive failures in overweight and obese combined hormonal contraceptive users.Obstet Gynecol. 2013; 121: 585-592
- Contraceptive failures in overweight and obese combined hormonal contraceptive users.Obstet Gynecol. 2013; 122: 158-159
- Combined oral contraceptives and body weight: do oral contraceptives cause weight gain? A primate model.Hum Reprod. 2011; 26: 330-336
- Combination contraceptives: effects on weight.Cochrane Database Syst Rev. 2014; 1CD003987
- Bariatric surgery: a systematic review and meta-analysis.JAMA. 2004; 292: 1724-1737
- ACOG practice bulletin no. 105: bariatric surgery and pregnancy.Obstet Gynecol. 2009; 113: 1405
- 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society.J Am Coll Cardiol. 2014; 63: 2985-3023
- Obesity and reproduction: a committee opinion.Fertil Steril. 2015; 104: 1116-1126
- Changes in prepregnancy body mass index between pregnancies and risk of primary cesarean delivery.Am J Obstet Gynecol. 2007; 197: 376.e1-376.e7
- Changes in prepregnancy body mass index between the first and second pregnancies and risk of large-for-gestational-age birth.Am J Obstet Gynecol. 2007; 196: 530.e1-530.e8
- The impact of interpregnancy weight change on birthweight in obese women.Am J Obstet Gynecol. 2013; 208: 205.e1-205.e7
- Interpregnancy body mass index change and success of term vaginal birth after cesarean delivery.Am J Obstet Gynecol. 2014; 210: 330.e1-330.e7
- Weight change between successive pregnancies and risks of stillbirth and infant mortality: a nationwide cohort study.Lancet. 2016; 387: 558-565
- Weight change and the risk of gestational diabetes in obese women.Epidemiology. 2004; 15: 733-737
- Gestational weight gain and long-term postpartum weight retention: a meta-analysis.Am J Clin Nutr. 2011; 94: 1225-1231
- Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy.Am J Clin Nutr. 2008; 87: 1750-1759
- The effects of physical activity and physical activity plus diet interventions on body weight in overweight or obese women who are pregnant or in postpartum: a systematic review and meta-analysis of randomized controlled trials.Prev Med. 2013; 56: 351-364
- O-glycoside biomarker of apolipoprotein C3: responsiveness to obesity, bariatric surgery, and therapy with metformin, to chronic or severe liver disease and to mortality in severe sepsis and graft vs host disease.J Proteome Res. 2009; 8: 603-612
- Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials.Obes Rev. 2011; 12: 709-723
- Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study.Am J Clin Nutr. 2011; 93: 772-779
- Diet quality and weight change among overweight and obese postpartum women enrolled in a behavioral intervention program.J Acad Nutr Diet. 2013; 113: 54-62
- Antenatal and postnatal depression in women with obesity: a systematic review.Arch Womens Ment Health. 2017; 20: 569-585
- Perinatal weight and risk of prenatal and postpartum depressive symptoms.Ann Epidemiol. 2017; 27: 695-700.e1
- Obesity and mental disorders during pregnancy and postpartum: a systematic review and meta-analysis.Obstet Gynecol. 2014; 123: 857-867
- An overview of links between obesity and mental health.Curr Obes Rep. 2015; 4: 303-310
- Body image mediates the depressive effects of weight gain in new mothers, particularly for women already obese: evidence from the Norwegian Mother and Child Cohort Study.BMC Public Health. 2016; 16: 664
- “The burden of pregnancy”; heavier for the heaviest? The changes in health related quality of life (HRQoL) assessed by the 15D instrument during pregnancy and postpartum in different body mass index groups: a longitudinal survey.Acta Obstet Gynecol Scand. 2017; 96: 352-358
- Complications of neuraxial anesthesia in an extreme morbidly obese patient for Cesarean section.Int J Obstet Anesth. 2007; 16: 139-144
- Fatal shoulder dystocia: a review of 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy.BJOG. 1998; 105: 1256-1261
- Decreased rates of shoulder dystocia and brachial plexus injury via an evidence‐based practice bundle.Int J Gynaecol Obstet. 2017; 136: 162-167
- Successfully reducing newborn asphyxia in the labour unit in a large academic medical centre: a quality improvement project using statistical process control.BMJ Qual Saf. 2018; 27: 633-642
- Evidence-based bundles and cesarean delivery surgical site infections: a systematic review and meta-analysis.Obstet. 2017; 130: 735-746
- Barriers to the use of assistive devices in patient handling.Workplace Health Saf. 2018; 66: 41-48
- Work-related repetitive strain injuries amongst practitioners of obstetric and gynaecological ultrasound worldwide.Arch Gynecol Obstet. 2012; 286: 353-356
- Weight bias reduction in health professionals: a systematic review.Clin Obes. 2016; 6: 175-188
- People-first language.Obesity Action Coalition, Tampa, FL2018 (Available at:)http://www.obesityaction.org/weight-bias-and-stigma/people-first-language-for-obesityDate accessed: April 21, 2019
- Mechanisms underlying weightstatus and healthcare avoidance in women: a study of weight stigma, body-related shame and guilt, and healthcare stress.Body Image. 2018; 25: 139-147
Article info
Publication history
No. 392, November 2019 (Replaces No. 239, February 2010)
Footnotes
This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well-documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the publisher.
All people have the right and responsibility to make informed decisions about their care in partnership with their health care providers. In order to facilitate informed choice, patients should be provided with information and support that is evidence-based, culturally appropriate, and tailored to their needs.
This guideline was written using language that places women at the centre of care. The SOGC is committed to respecting the rights of all people—including transgender, gender non-binary, and intersex people—for whom the guideline may apply. We encourage health care to engage in respectful conversation with patients regarding their gender identity as a critical part of providing safe and appropriate care. The values, beliefs, and individual needs of each patient and their family should be sought and the final decision about the care and treatment options chosen by the patient should be respected.
Identification
Copyright
© 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Correction to Guideline 392Journal of Obstetrics and Gynaecology Canada Vol. 42Issue 3
- PreviewThe authors of the guideline “Guideline No. 392-Pregnancy and Maternal Obesity Part 2: Team Planning for Delivery and Postpartum Care”1 would like to revise their recommendation on electronic fetal monitoring for women with a BMI 35 kg/m2to reflect the current guidelines on fetal health surveillance.2 Guidance has been amended to reflect that electronic fetal monitoring “can be considered” rather than “is recommended” for women in active labour with a body mass index >35 kg/m2.
- Full-Text
- Preview
