Improving the quality
of care in BMI >30 Pregnancies
A1,2, Eccles-Smith J2
1Mater Hospital, Queensland, Australia
2The Royal Brisbane and Women’s Hospital, Queensland Australia
Aims: Obesity is the most commonly encountered risk factor in
obstetric care associated with increased maternal and fetal morbidity and
mortality.  This quality improvement study aimed to assess and improve the
management of peri-conceptual, pregnant and postnatal women with a Body Mass
Index (BMI) above 30 at the Royal Brisbane and Women’s Hospital.
Methods: This project retrospectively audited a randomly selected
sample of 101 women with a BMI above 30 who delivered in a tertiary hospital
(Royal Brisbane and Women’s Hospital) from January-June 2015. The electronic
patient charts were audited against The Royal College of Obstetricians and
Gynaecologists (RCOG) guidelines. 
Results: At the booking in visit of these 101 obese women, 18% were
classified as morbidly obese with a BMI >40. There was 100% compliance to
the standards of a recorded BMI and oral glucose tolerance test preformed
during pregnancy. Of the morbidly obese women 77% received the recommended antenatal
anaesethic review and 61% were prescribed pharmacological thromboprophylaxis
postnatally. Direct dietician involvement was observed in only 16% of these
patients. There was one neonatal death at 29 weeks and one intrauterine fetal
death at 38 weeks.
Conclusions: This project demonstrated the burden of obesity in
pregnancy and the lack of standardisation of management. This project
recommended a two-tier improvement strategy. We recommended the development and
implementation of a ‘BMI>30 pathway’ that would be filed with the pregnancy
health record. This pathway would allow the standardisation and streaming of
the management during all stages of obstetric care in women with a BMI >30
at booking in. The second recommendation was the implementation of a specific
“high BMI clinic” involving obstetricians, midwives, dieticians, anaesthetics
and psychology to address and modify the risks and issues associated with
obesity in pregnancy.
1. Galtier-Dereure F, Boegner C,
Bringer J., (2000) Obesity and Pregnancy: complications and cost, Am J Clin
Nutr. 71:5 (1242s-1248s).
2. Moder J, Fitzsimons J (2010), CMACE/RCOG Joint Guideline: Management of
Women with Obesity in Pregnancy.