obesity in pregnancy...doubled the pre-eclampsia risk.2 obesity is also a risk factor for maternal...

Author(s)

Dr Wiece Koniman - Obstetrician and Gynaecologist Dr Sade Okutubo- Consultant anaesthetist Dr Maryam Parisaei - Obstetrician and Gynaecologist Dr Sissela Sylvan - SHO Dr Ed Dorman - Obstetrician and Gynaecologist

Version

3.1

Version Date

May 2018

Implementation/approval Date

May 2018

Review Date

May 2019

Review Body Maternity Risk Management Review Group

Policy Reference Number

108/swsh/mat/obes

Version Date Author Reason Ratification 2 February 2013 Dr Ozlem Turan, ST2 in Obstetrics

and Gynaecology Dr Sade Okutubo, Consultant anaesthetist Dr Maryam Parisaei, Consultant Obstetrician and Gynaecologist

Expired Yes

3

April 2016 Dr Wiece Koniman Dr Sade Okutubo, Dr Maryam Parisaei Dr Sissela Sylvan SHO

3.1 May 2018 Dr Ed Dorman - Obstetrician and Gynaecologist

Update

OBESITY IN PREGNANCY

Obesity in Pregnancy of 22

Contents

Section Title Page No.

1.0 Summary………………………………………………………………………3 2.0 Introduction …………………………………………………………………...3 3.0 Scope ………………………………………………………………………….3 4.0 Roles and responsibilities …………………………………………………...3 5.0 Body of Policy…………………………………………………………………4 5.1 Antenatal Care………………………………………………………………..4 5.2 On Admission to Labour Ward or Established Labour…………………………..5

5.3 Special equipment ………………………………………………………………….6 5.4 Induction of labour…………………………………………………………………..6 5.5 VTE Assessment (see thromboprophylaxis guideline)………………………….7 5.6 Assessment of availability of equipment in all care settings……………………7 6.0 Training and Awareness…………………………………………………………...10 7.0 Review……………………………………………………………………………….10 8.0 Monitoring/Audit: Measurable Policy Objective………………………………….11 9.0 References ………………………………………………………………………….12 Appendix 1 …………………………………………………………………………..13 Summary …………………………………………………………………………….14 Bibliography………………………………………………………………………….15 Appendix 2…………………………………………………………………………...16 Appendix 3…………………………………………………………………………...17 Consultation List...…………………………………………………………………..18 10.0 Equality Impact Assessment ………………………………………………………19 Document control summary ……………………………………………………….21 Signatures …………………………………………………………………………..22


1.0 Summary

Obesity in pregnancy has implications for both mother and child. Health care professionals have a responsibility to inform women of the risks, act to recognise and reduce complications, and assist women in changing behaviour.

2.0 Introduction

Obesity in pregnancy is a body mass index (BMI) of 30 or more at the first antenatal consultation. It is one of the most commonly occurring risk factors in obstetric practice. The prevalence of obesity in the general population in England has increased since the early 1990s.

In December 2010, CMACE published data on the prevalence of obesity in pregnancy between 1st March and 30th April 2009 in the UK. This report showed the UK prevalence rate of women with a known BMI of 35 or more at any point in pregnancy was 5%.1

Between January and December 2015, 18.18% of pregnant women at HUH had a BMI above 30 and 1.79% had a BMI of 40 or more.

The CMACE study found that the stillbirth rate in women with a BMI of 35 or more (8.6 per 1000 singleton births) was twice as high as the overall national stillbirth rate (3.9/1000 singleton births), and that the risk of stillbirth increases with increasing obesity.

Intrapartum stillbirth rates were three times higher than the national average for women with BMI of 35 or more with only 55% of women giving birth naturally. Obesity in pregnancy is associated with an increased risk of a number of serious adverse outcomes including miscarriage, fetal congenital anomaly, thromboembolism, gestational diabetes, pre-eclampsia,,dysfunctional labour, postpartum haemorrhage, wound infections, stillbirth, neonatal death, increased rates of caesareans and lower breastfeeding rates. A systematic review of risk factors for pre-eclampsia found that a high BMI at booking was associated with a 50% increase in the risk of developing pre-eclampsia, while a booking BMI >35 doubled the pre-eclampsia risk.2

Obesity is also a risk factor for maternal death. The MBRRACE report in 2015 reporting on maternal deaths in the 2011-2013 triennium showed that 30% of mothers who died were obese and 22% were overweight. .3

3.0 Scope

This policy applies to all those working in the Trust, and offers guidance to those who provide care and advice for women of reproductive age in primary care.

4.0 Roles and Responsibilities

This policy applies to all health care professionals that care for women in pregnancy, including midwives, general care practitioners, obstetricians and anaesthetists.


5.0 Body of Policy

5.1 Antenatal care

All women must have a height and weight recorded, and a BMI calculated at booking and documented on the EPR system. A VTE score should be calculated to assess their risk of developing thromboembolism (see 5.5).

Recommendations:

If BMI >30

5mg Folic acid from 1 month before conception until 14 weeks gestation

10mcg Vitamin D during pregnancy and breastfeeding

Random blood glucose every visit. If this is ≥7, a GTT (glucose tolerance test) is required

Discuss the increased risks of gestational diabetes, pre eclampsia, DVT and PE (thrombosis), unsuccessful VBAC (increased risk of uterine rupture and neonatal morbidity), anaesthetic and operative complications during caesarean, postpartum haemorrhage

Weigh in the third trimester if they are keen for delivery on the Birth Centre. This is to ensure there has been no excessive weight gain

Give Patient Information Leaflet (Appendix 1)

If BMI > 35




Discuss the increased risks of gestational diabetes, pre eclampsia, DVT and PE (thrombosis), unsuccessful VBAC (increased risk of uterine rupture and neonatal morbidity), anaesthetic and operative complications during caesarean, postpartum haemorrhage

Advise to deliver on the consultant led delivery suite. Not suitable for the Birth Centre

Weigh in the third trimester.



Monitoring for pre-eclampsia (BP and urine) is required at a minimum of 3 weekly intervals between 24 and 32 weeks gestation, and 2 weekly intervals from 32 weeks to delivery, if they have no other risk factors for pre-eclampsia

If BMI >40




Discuss the increased risks of gestational diabetes, pre eclampsia, DVT and PE (thrombosis), unsuccessful VBAC (increased risk of uterine rupture and neonatal morbidity), anaesthetic and operative complications during caesarean, postpartum haemorrhage.

Advise to deliver on the consultant led delivery suite. Not suitable for the Birth Centre

Monitoring for pre-eclampsia (BP and urine) is required at a minimum of 3 weekly intervals between 24 and 32 weeks gestation, and 2 weekly intervals from 32 weeks to delivery, if they have no other risk factors for pre-eclampsia


Risk Assessment Form to be completed if necessary (Appendix 2)

Document and offer an appointment for “Wednesday Club Clinic” to be seen by a Consultant Obstetrician, a Consultant Obstetric Anaesthetist a consultant midwife and a dietician


5.2 On Admission to Labour Ward or Established Labour Recommendations: If BMI >30

If BMI > 35

If BMI> 40

Active management of third stage


Active management of third stage and 40 IU Syntocinon over 4 hours

Anaesthetic (Appendix 3) and Obstetric Registrars need to both be informed, to review the patient. This referral needs to be documented by the midwife looking after the patient

At onset of established labour, IV line should be sited as this can often be difficult. Blood should be sent for a full blood count (FBC) and a Group and Save. Regular oral ranitidine (150mg) and metoclopromide (10mg) is recommended

On K2 Guardian the BMI checklist should be completed on admission in labour. This can be found in the actions drop box menu under patient care.


Active management of third stage and 40 IU Syntocinon over 4 hours

Anaesthetic (Appendix 3) and Obstetric Registrars need to both be informed, to review the patient. This referral needs to be documented by the midwife looking after the patient

At onset of established labour, IV line should be sited as this can often be difficult. Blood should be sent for a full blood count (FBC) and a Group and Save. Regular oral ranitidine (150mg) and metoclopromide (10mg) is recommended


5.3 Special Equipment

It is recommended that the Hovercraft device will be used to transfer patients from operating theatre bed if >125 kgs.

For anyone with BMI>35 it is recommended Lloyd Davies stirrups to be used in theatre.

The theatre co-ordinator should be contacted on admission of anyone to Delivery Suite above 125kg.

The theatre bed in obstetric theatre caters for up to 225 kg. If any patient weighs more than this the theatre co-ordinator should be contacted on admission to the labour ward as the Alpha Star Plus bed (up to 400kg) will need to be made available.

Patients for elective caesarean section whose BMI>35, should be weighed in ANC as part of pre clerking and their weight be added in the public comments on the elective caesarean section list so appropriate equipment can be available.

5.4 Induction of labour Higher maternal BMI in the first trimester and a greater change in BMI during pregnancy are associated with longer gestation and an increased risk of postdates pregnancy. Higher maternal BMI during the first trimester is also associated with decreased likelihood of spontaneous onset of labour at term and increased likelihood of complications. 5

Maximum chances should be given to women to labour spontaneously to reduce the risk of failed induction of labour and increased likelihood of instrumental deliveries and emergency Caesarean sections. However, with increased risk of stillbirth associated with maternal obesity and post dates as two independent factors and reduced likelihood of onset of spontaneous labour at term consideration should be given for induction of labour at 40/40 for mothers with booking BMI >40, especially for those with additional risk factors such as medical co morbidities or advanced maternal age. Women with a high BMI should be seen by a Consultant at 38 weeks to discuss delivery before the due date. Planned delivery between 39 and 40 weeks has been shown to reduce complications in these circumstances for mother and baby.

On K2 Guardian the BMI checklist should be completed on admission to labour. This can be found in the actions drop box menu under patient care.

An obstetrician (Specialty Trainee year 6 and above) andan anaesthetist shouldbe informed and be available if necessary for the labour and delivery, including attending any operative vaginal or abdominal delivery. The patient must be included in ward rounds


Caesarean Section

Women who have more than 2cm subcutaneous fat during caesarean section are recommended to have suturing of the subcutaneous tissue space in order to reduce the risk of wound infection and wound separation.

5.5 VTE Assessment (see thromboprophylaxis guideline) If BMI over 30 and 2 risk factors - consider thromboprophylaxis in pregnancy from 28 weeks until 6 weeks postpartum. If BMI over 30 and 1 risk factor - offer thromboprophylaxis after delivery for 10 days. If 2 risk factors or persisting – consider extending length of thromboprophylaxis

If BMI over 40 offer thromboprophylaxis for 10 days regardless of mode of delivery

ANTENATAL AND POSTNATAL DOSE OF LMWH

5.6 Assessment of availability of equipment in all care settings:

Equipment

Quantity Location Comments

Maquet Operating Table

1 Main operating theatre (Theatre 4)

Maximum weight capacity 225kg

Hovermatt

2 Main operating theatre

Wheelchairs

At least 2 at all times Delivery suite Capacity 200kg

Large Blood Pressure cuffs

Antenatal clinic 8 (1 extra large) Antenatal ward 1 Postnatal ward 2 (including OAU)

Weight <50 kg 20mg enoxaparin daily Weight 50-90 kg 40mg enoxaparin daily Weight 91-130 kg 60mg enoxaparin daily Weight 131-170 kg 80mg enoxaparin daily Weight > 170 kg 0.6mg/kg/day enoxaparin


Delivery Suite 4 Main operating theatre 4

Large Spinal and Epidural needles

Main operating theatre (Theatre 4)

Maximove Arjo Electronic hoist

1 Priestley ward Maximum capacity 190 kg

Hill –Rom affinity Delivery beds

14 Delivery Suite rooms Maximum capacity 227kg

Alpha star plus bed 1 Main theatres if required

Maximum capacity 400kg

Lloyds Davies Stirrups Pair

Main Theatres

Equipment

Quality Location Comments

Scales 1 set in each community antenatal clinic

2 sets available in community offices if needed for home bookings

Community Antenatal clinic

Community Midwifery Offices

Team Leaders to monitor mums

Community Midwifery Administrator to monitor every 6 months

Height Measurement A height measurement to be available in each community antenatal clinic.

Tape measures x 2 to be available for home bookings.

Community Antenatal clinic

Community Midwifery Offices

Team Leaders to monitor every 6 months.

Community Midwifery Administrator to monitor every 6 months

Blood Pressure Cuffs All community midwives to have medium & large cuff sized

Extra large cuffs x 3

Included in midwives equipment

Community Midwifery Office

Team leaders to monitor every 6 months

Equipment record maintained by CMU admin & to monitor this every 6 months.


6.0 Training and Awareness

This policy will be made available to all staff working in women’s health and anesthetics.

7.0 Review

This policy will be reviewed in 3years. Earlier review may be required in response to exceptional circumstances, organisational change or relevant changes in legislation or guidance.


8.0 Monitoring/Audit :Measurable Policy Objective

Measurable Policy Objective

Monitoring/Audit

Frequency of monitoring

Responsibility for performing the monitoring

Monitoring reported to which groups/committees, inc responsibility for reviewing action plans

Calculation of BMI in the health records and on EPR

Review of notes and EPR

12 months Maternity Department

Maternity Risk Management Review Group

Women booked with a BMI of equal to or more than 30 are booked in accordance with policy requirements




Women with BMI of equal to or more than 35 are being advised to deliver in an obstetric led unit




Women with a BMI of equal to or more than 40 are managed in accordance with local policy requirements




Women with a BMI of equal to or more than 30 are managed in accordance with local policy requirements.




Equipment is available in all care settings




Proportion of women with BMI over 30 who are recommended to take 5mg folic acid




Proportion of women with BMI over 30 who are recommended to take 10mcg Vitamin D





9.0 References

1. Centre for Maternal and Child Health (CMACE). Maternal obesity in the UK: Findings from a national project. London: CMACE, 2010

2. Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review ofcontrolled studies. British Medical Journal 2005;330(7491):549-550.

3. Centre for Maternal and Child Health (CMACE). Saving Mothers’ Lives 2006-2008 report: Reviewing maternal deaths to make motherhood safer.London: CMACE March 2011

4. Heslehurst N, Ells LJ, Simpson H, Batterham A, Wilkinson J, Summerbell CD. Trends in maternal obesity incidence rates, demographic predictors, and health inequalities in 36,821 women over a 15-year period. BJOG: An International Journal of Obstetrics and Gynaecology 2007;114(2):187-94.

5. Kanagalingam MG, Forouhi NG, Greer IA, Sattar N. Changes in booking body mass index over a decade: retrospective analysis from a Glasgow Maternity Hospital. BJOG: An International Journal of Obstetrics and Gynaecology 2005;112(10):1431-3

6. Maternal obesity, length of gestation, risk of post dates pregnancy and spontaneous onset of labour at term. British Journal of Obstetrics & Gynaecology: An International Journal of Obstetrics & Gynaecology.Volume 115, Issue 6, Date: May 2008, Pages: 720 to 725. FC Denison, J Price, C Graham, S Wild, WA Liston.


Appendix 1

Information for Pregnant Women with a High Body Mass Index (BMI)

One of our aims of care during pregnancy is to identify those women who may need extra surveillance during pregnancy and help delivering their baby. One thing that makes this more likely is a high body mass index – BMI. (Body mass index is a relationship between your height and your weight, and is a way of working out how overweight you are.) If your BMI is ≥ 40 you will have been offered an appointment for the Wednesday Club Clinic at Homerton University Hospital where you have an opportunity to meet with an Anaesthetic Consultant, Obstetric Consultant and a midwife. If your BMI is above 30 you are recommended to take 5mg of folic acid starting at least at one month before conception and continue until 12 weeks of pregnancy. You should also consider taking Vitamin D supplementation during pregnancy and whilst breastfeeding as there is some evidence that women with higher BMI and their babies may be more likely to be Vitamin D deficient. Ultrasound scans are more difficult to perform in women of higher BMI, and as a result it may not be possible to completely exclude abnormalities in your baby at the anomaly scan. You have an increased chance of developing:

Diabetes in pregnancy, so if your BMI is ≥ 30 you will be offered a blood test at each visit, and if this is abnormal you will be referred for a Glucose Tolerance Test.

Pre-eclampsia, so if your BMI is ≥ 35 your blood pressure and urine should be checked at least every 3 weeks between 24 and 32 weeks of pregnancy, and 2 weekly from 32 weeks to delivery.

During labour:

You will be offered care on the consultant led delivery suite if your BMI ≥ 35 and are not suitable for the Birth Centre.

You should keep well hydrated

It may be difficult to monitor your baby’s heart beat with an abdominal probe and other ways of monitoring your baby’s well-being such as using a scalp electrode may be discussed with you.

Your labour may progress slower than normal and you may be offered a drip of hormones to help with this.

Senior midwives and obstetricians will be available on the delivery suite in the rare circumstance of any problems such as shoulder dystocia. (When the baby’s head has been born but one of the shoulders becomes stuck behind the mother’s pelvic bone, preventing the birth of the baby’s body).

You have increased chance of being delivered by an emergency caesarean section and this is why anaesthetic input is important in intrapartum care.

You have an increased risk of bleeding after delivery, and to help prevent this it is recommended for you to have an intravenous cannula inserted, and the be given extra hormones once your baby is born.

If you do have a caesarean section in most cases it is better for you to have a regional anaesthetic (a spinal or an epidural). This means the injection is given into your back (either by injection into the spine or through a tube placed into your back) to make the lower part of the body numb. With a regional anaesthetic you stay awake during the operation, and this is the usual, preferred technique. Being awake has many advantages for you and your baby during and after the


operation. There are times when we need to deliver a baby as quickly as possible. If you have an epidural during labour that is working well, we can often use it for either a caesarean section or if we need to deliver your baby using special equipment, for example forceps or ventouse (a suction cup). If you have a high BMI, this can makeanaesthetic procedures more difficult. It may be harder to find the correct place to put the needle in to give the anaesthetic and be more difficult to get the anaesthetic to work properly straight away. It may also be hard to find your veins for taking blood and putting up drips (intravenous cannulae). A high BMI may also cause problems with general anaesthesia during and after the operation (if you have a general anaesthetic, you will be asleep during the operation). Pain relief and anaesthetic choices for your labour and delivery will be discussed at the Wednesday Club. It is easier to do this in relaxed surroundings, rather than trying to explain things when you are having labour pains. Things can happen very quickly during labour and the more information you have, the more prepared you will be.

If labour is not straightforward, you should think about having an epidural early during labour rather than later because it might take longer than usual to give you a spinal or epidural anesthetic.

The anaesthetist may encourage you to have an epidural in labour so that you can avoid a general anesthetic if you need a Caesarean section.

When you are admitted to the labour ward you may be seen by the obstetric and anesthetic team. This will allow the anesthetist and obstetrician on duty to go over the plan suggested by the consultants who you saw during your pregnancy. We will give you an antacid tablet (such as ranitidine) and a tablet to decrease chance of nausea and vomiting throughout labour. It is also best not to eat any solid or fatty food when you are in labour. After you have had your baby we might need to give you heparin injections. This thins the blood and is to try to prevent blood clots forming in your legs or chest. This problem is more common during and after pregnancy and is even more likely in women with a high BMI. Patient information leaflets (“Pain relief in labour”, “Your anesthetic for Caesarean section” and “High Body Mass Index BMI”) from the Obstetric Anesthetists’ Association (OAA) can be downloaded free of charge in several different languages from the following website: http://www.oaaformothers.info Summary

If your BMI is above 35, you are more likely to need some sort of help with the delivery of your baby than someone with a lower BMI.

When you go onto the labour ward to have your baby, tell the midwives that you need to see the anaesthetist and obstetrician on duty if your BMI≥ 40.

When you are in labour it is best not to eat any solid or fatty foods.

It can be more difficult and take longer to do epidurals and spinals than in women with a lower BMI.

It may be better to have an epidural early in labour rather than later, in case you need a Caesarean section or we need to deliver your baby quickly using forceps or ventouse.

If you have a Caesarean section it is generally better for you and the baby to stay awake than have a general anaesthetic.

If you need a general anaesthetic, this may be more difficult than for women with a lower BMI, and the anaesthetists need to plan for this.

http://www.oaaformothers.info/


Patient information anaesthetic leaflets can be downloaded in several different languages from: http://www.oaaformothers.info

This booklet has been adapted from the OAA High BMI leaflet and edited for Homerton University Hospital patients. Bibliography CMACE/RCOG Joint Guideline. Management of Women with Obesity in Pregnancy. March 2010

Confidential Enquiry into Maternal and Child Health’s report on maternal deaths in 2003–2005

NICE Clinical Guideline No. 13. Caesarean Section. April 2004

Obstetric Anaesthetists’ Association.Information for Women leaflet – High BMI. Cited 20/11/10. URL: http://www.oaa-anaes.ac.uk/content.asp?ContentID=322

http://www.oaaformothers.info/

http://www.oaa-anaes.ac.uk/content.asp?ContentID=322


Appendix 2

Raised BMI Risk Assessment

Complete and place in patients notes Patient Details Name Date of Risk Assessment

Place patient details sticker Date of birth Expected Date of Delivery

Hospital Number Planned Mode of Delivery Surgical / Vaginal

Weight at booking (kgs) Height at booking (m2) Calculated BMI (wt/ht2)

Existing Co morbidities?(Tick as many as apply) Asthma BMI >45 Cardiac Failure Diabetes Gestational Insulin dep Gastro Esophageal Reflux Previous problems with Anaesthesia Previous Back Surgery Respiratory Problems Sleep Apnoea on BIPAP Action Plan: Given Lifestyle and Well Being advice/ leaflet re pregnancy and obesity To inform Anaesthetist on call on patient’s arrival to hospital in labour

Advised to bring in CPAP/BIPAP machine

Book appointment to see in High Risk Anaesthesia Clinic (only if 2 or more co morbidities)

Assessors Name : Signature

Assessors Position:


Appendix 3

High BMI Anaesthesia Action Checklist For patients with a BMI > 35 in established labour, on call registrar for anaesthesia please complete this check list, and carry out actions as required.

At least one 16 gauge intravenous access obtained

Bloods sent for FBC, group and save

Metoclopramide 10mg and ranitidine 150mg 8 hourly prescribed

Advice/ Consent patient for epidural/spinal documented in patients notes

Site epidural for analgesia once in established labour

Anticipate and make a plan for managing massive blood loss at delivery

Inform theatres of need for the following special equipment, as required o Bariatric operating table if > 225kgs o Lloyd Davies stirrups if BMI > 35 o Hovercraft o Extra length neuraxial needles o Pannus ‘lifting’ manoeuvres o Bariatric ward bed if > 250kgs

Inform Consultant Anaesthetist & on call team covering Obstetrics

Review/ Re assess patient progress 4 hourly

Attend in room / be on standby for vaginal delivery

Ensure patient is handed over to incoming Anaesthesia team

Anaesthetists name……………………………………………………..…… Grade………………………………………………………………………….. Signature………………………………………………………………………. Date and Time of assessment (24hr clock)………………………………...


List of all staff consulted as part of guideline development

First and Second Consultation

All Obstetric Consultants

Guideline Development Group

Supervisor of Midwives

Head of Midwifery

O & G Middle grade Doctors

All Midwives

Final Consultation

Supervisors of Midwives

Head of midwifery

Obstetric Consultants

Audit Midwife

Risk management Team

Delivery Suite Matron


10.0 Equality Impact Assessment

This checklist should be completed for all new Corporate Policies and procedures to understand their potential impact on equalities and assure equality in service delivery and employment.

Policy/Service Name:

Obesity in Pregnancy

Authors: Dr Koniman, Miss Parisaei, Dr Okutubo, Dr Sylvan

Role: As above

Directorate: SWSH

Date May 2016

Equalities Impact Assessment Question

Yes No Comment

1. How does the attached policy/service fit into the trusts overall aims?

Complies NICE, RCOG, CMACE

2. How will the policy/service be implemented?

Systems and training already in place to facilitate implementation

3. What outcomes are intended by implementing the policy/delivering the service?

Ensure guideline is observed to facilitate safe care

4. How will the above outcomes be measured?

Documentation compliance (page 9)

5. Who are they key stakeholders in respect of this policy/service and how have they been involved?

All staff involved in care of mother and through the consultation process (appendix 2)

6. Does this policy/service impact on other policies or services and is that impact understood?

No

7. Does this policy/service impact on other agencies and is that impact understood?

No

8. Is there any data on the policy or service that will help inform the EqIA?

No

9. Are there are information gaps, and how will they be addressed/what additional information is required?

No


10. Does the policy or service development have an adverse impact on any particular group?

No

11. Could the way the policy is carried out have an adverse impact on equality of opportunity or good relations between different groups?

No

12. Where an adverse impact has been identified can changes be made to minimise it?

No

13. Is the policy directly or indirectly discriminatory, and can the latter be justified?

No

14. Is the policy intended to increase equality of opportunity by permitting Positive Action or Reasonable Adjustment? If so is this lawful?

No

EQUALITIES IMPACT ASSESSMENT FOR POLICIES AND PROCEDURES

1. If any of the questions are answered ‘yes’, then the proposed policy is likely to be relevant to

the Trust’s responsibilities under the equalities duties. Please provide the ratifying committee with information on why ‘yes’ answers were given and whether or not this is justifiable for clinical reasons. The author should consult with the Director of HR & Environment to develop a more detailed assessment of the Policy’s impact and, where appropriate, design monitoring and reporting systems if there is any uncertainty.

2. A copy of the completed form should be submitted to the ratifying committee when

submitting the document for ratification. The Committee will inform you if they perceive the Impact to be sufficient that a more detailed assessment is required. In this instance, the result of this impact assessment and any further work should be summarised in the body of the Policy and support will be given to ensure that the policy promotes equality.


Document Control Summary

Document Control Summary

Document Title


Author (s) and Grade (s)

Dr Koniman, SpR in Obstetrics and Gynaecology Miss Parisaei Consultant Obstetrician and Gynaecologist Dr Okutubo Consultant Anaesthetist Dr Sissela Sylvan SHO

Department

Maternity

Date of Production

April 2016

Planned implementation date:

May 2016

Purpose/Aim of Document

Inform women of the risks of obesity, act to recognise and reduce complications, and assist women in changing behaviour and compliance with health and safety

Circulated to

See appendix 4

Status

Update Frequency

3 yearly

Next Review Date

May 2019

Approved By

Maternity Rick Management Review Group

Archiving of earlier versions of guidelines

Yes

Document Checklist to be filled in by Ratifying Committee

Is the Document using the correct Template? Yes

Is the Circulation List Representative? Yes

Is there an Evidence Base (where required)? Yes

Is it signed off at the appropriate level? Yes

Does it have an Equalities Impact Assessment that is satisfactory?

Yes

Does it need to go to other committees for ratification?

Yes


This guideline has been signed off by the Maternity Risk Management Group

(For guidelines with Trust wide scope.) These guidelines have been approved by the Chair of the Trusts Clinical Governance Committee

Signed: Date: Shelia Adam Director of Nursing and Quality


obesity in pregnancy...doubled the pre-eclampsia risk.2 obesity is also a risk factor for maternal...

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