Day care surgery for termination of pregnancy under general
anaesthesia: experience of managing patients with body mass index (BMI) of 35
and above
E. J. Oloto (1), D. Bose (2), S. Rowlands (3)
Contraception, Sexual
& Reproductive Health Services, University Hospitals of Leicester NHS Trust,
Leicester, UK (1); Department of Anaesthetics, Warwick Hospital, Warwick, UK
(2); British Pregnancy Advisory Service, Austy Manor, Henley in Arden, UK (3)
Introduction: Obesity in Western Europe is high and rising, and presents a
considerable anaesthetic and surgical challenges. It is not unusual in most
hospitals to use or reserve in-patient beds for patients with BMI of 35 and
above prior to day care surgery with obvious cost implications.
Objectives: To
evaluate the safety of day care surgery for termination of pregnancy under
general anaesthesia for women with BMI of 35 and above. Setting: Private
abortion service provider located about 20 kilometres away from the nearest
access to in-patient beds.
Design & Methods: A designated theatre, supported
by a consultant gynaecologist, a consultant anaesthetist and a team of
experienced nurses, is used for the management of these patients. All patients
were seen and assessed by the team immediately before surgery. Assessments
included ultrasound scan to date pregnancy, cervical preparation with
prostaglandin for gestations of 12 weeks and above and pre-medication with
antacids.
Results: Experience of managing this group of patients is continuing
and we expect to have managed over 200 cases before the congress. Analysis of
the first 127 cases revealed that 65 (51%) had BMI of between 35 and 39 while 62
(49%) were morbidly obese with BMI of between 40 and 45. The age range was 17–45
years; parity range was 0–7; and the range of gestation was 6– 17 weeks. One
hundred and eleven patients (87.4%) had suction termination, 15 patients (11.8%)
and one failed dilatation of the cervix (0.8%) for which the procedure was
abandoned. There were no complications in 120 patients (94%), 3 patients
complained of post-op pain, one felt faint, one passed blood clot and the failed
dilatation had medical TOP.
Conclusion: Obesity in the population is high and
rising. It poses considerable anaesthetic and surgical challenge. However, day
care surgery is safe in experienced hands within appropriate setting and may
represent efficient use of resources for the National Health Service.
