Dr Jade Eccles-Smith
The Royal Brisbane and Women's Hospital 


Improving the quality of care in BMI >30 Pregnancies
Smith 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. [1] 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. [2]

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.