Effects of Maternal Morbid Obesity on Fetal Health and Hospital Staff Safety

Abstract

In a large, free-standing women’s hospital, staff and physicians care for a variety of obstetric patients, including those with morbid obesity. When caring for patients who are morbidly obese, there is potential for harm, patient and/or staff injuries, fetal compromise, surgical site infections, and strained staff resources. Of the patients served in 2017 at Sharp Mary Birch Hospital for Women & Newborns, 18.5% of patients had a body mass index (BMI) that was greater than 35. The need to improve nursing care for this patient population was identified. The case involved a 32-year-old, gravida 5, para 1 woman, with a BMI of 61 at time of hospital admission. Her pregnancy was complicated by poorly controlled type II diabetes, severe preeclampsia, and macrosomia of the fetus. Before admission to the hospital for the birth process, the woman had multiple triage visits and a stay on the antepartum unit. It was difficult for nurses to find fetal heart tones due to the woman’s obesity, and she was noncompliant with diet orders. She signed a waiver that she was aware of the risks, including death, if she ate when “nothing by mouth” was ordered and an emergency cesarean was performed. The neonate was born at 35 weeks and 3 days and was admitted to the NICU and intubated for respiratory distress. During the postpartum course, the patient required regular and neutral protamine Hagedorn insulin before meals, insulin aspart sliding scale for postmeal coverage during the hospital stay, as well as magnesium sulfate administration postdelivery. Blood sugars ranged from 254–252 mg/dl, and the highest blood pressure recorded was 176/94. Because of time-consuming comorbidities of this patient, the nurse providing postpartum care found it difficult to provide the same level of care to other patients in the assignment. Physical therapy and the diabetic nurse educator were used to assist in care of this patient. Nurses who care for bariatric patients should be aware of the potential for injuries, the resources needed and available for this population, and the potential complications that can arise. Staffing assignments should be adjusted so that the nurse may provide adequate care for this complicated patient population. A resource binder has since been developed to assist in caring for this patient population.