Developing a clinical care pathway for obese pregnant women: A quality improvement project |
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| Authors: | Shanna Fealy Alexis Hure Graeme Browne Carol Prince |
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| Institution: | 1. Port Macquarie Base Hospital, Wrights Road, NSW, Australia;2. The University of Newcastle, University Drive, Callaghan, NSW, Australia;1. University of Western Sydney, School of Nursing and Midwifery, Locked Bag 1797, Penrith South DC, NSW 2751, Australia;2. Royal Hospital for Women, Barker Street, Randwick, NSW 2031, Australia;1. Etlik Zubeyde Hanim Women''s Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey;2. Recep Tayyip Erdogan University School of Medicine, Department of Obstetrics and Gynecology, Rize, Turkey;3. Gulhane Military Medical Academy, Department of Epidemiology, Ankara, Turkey;4. St. Luke''s Roosevelt Hospitals, Department of Obstetrics and Gynecology, New York, NY, United States;1. Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, United States;2. College of Nursing, University of Tennessee, Knoxville, 1200 Volunteer Boulevard, Knoxville, TN 37996, United States;1. Department of Women''s and Children''s Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden;2. Breastfeeding Promotion Network of India (BPNI), New Delhi, India;3. Department of Paediatrics, University College of Medical Sciences & Guru Tegh Bahadur (GTB) Hospital, New Delhi, India |
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| Abstract: | ProblemObesity in pregnancy is associated with an increased incidence of maternal and foetal morbidity and mortality, from conditions like preeclampsia, gestational diabetes, preterm birth and stillbirth. Between 20% and 25% of pregnant women in Australia are presenting to their first antenatal appointment with a body mass index (BMI) ≥30 kg/m2, defined as obesity in pregnancy. These figures are concerning for midwifery and obstetric staff directly involved in the clinical care of these women and their families. In the absence of national or state clinical practice guidelines for managing the risks for obese pregnant women, a local quality improvement project was conducted.AimTo plan, implement, and evaluate the impact of an alternative clinical care pathway for pregnant women with a BMI ≥ 35 kg/m2 at their first antenatal visit.Project settingThe project was undertaken in the antenatal clinic of a rural referral hospital in NSW, Australia.SubjectsEighty-two women with a BMI ≥ 35 kg/m2 were eligible for the alternative care pathway, offered between January and December 2010.InterventionThe alternative care pathway included the following options, in addition to usual care: written information on obesity in pregnancy, referral to a dietitian, early plus repeat screening for gestational diabetes, liver and renal function pathology tests, serial self-weighing, serial foetal growth ultrasounds, and a pre-labour anaesthetic consultation.FindingsDespite being educated on the risk associated with obesity in pregnancy, women did not take up the offers of dietetic support or self-weighing at each antenatal visit. Ultrasounds were well received and most women underwent gestational diabetes screening. |
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| Keywords: | Obesity Pregnancy Risks Management Implementation Science |
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