The rate of association of each descriptor with each of the adverse outcomes or conditions was expressed as number and percentage. To compare the proportion of positive associations between each traditional descriptor and the adverse outcomes and conditions compared with the positive associations between BMI and the adverse outcomes and conditions, we constructed a series of two-by-two tables. The significances of associations from these two-by-two tables were based on χ2 test or the Fisher exact probability test. From these tables, we also derived the odds ratio and 95% confidence interval for each association, with BMI as the referent descriptor. Because all associations were planned a priori, none of the associations was corrected for multiple comparisons.
The primary finding of this study is that BMI is most frequently associated with combined obstetric and gynecologic adverse outcomes and conditions compared with other descriptors used in the past in the opening statement of the history of present illness. This finding is important, given the fact that most industrialized countries are currently experiencing an epidemic of obesity. Recent statistics indicate that more than one-third of women in the United States are obese,2 and that the prevalence of obesity is continuing to increase. As a result, the prevalence of obesity during pregnancy has dramatically increased and is now associated with an array of adverse obstetric and perinatal outcomes. The literature on obesity and its adverse effects on pregnancy outcome has expanded over the past 12 years. A Google search using the key words “obesity and pregnancy” resulted in 25,400,000 hits (performed May 16, 2012). Similarly, a Google search using the words “gynecology and obesity” resulted in 3,600,000 hits (performed May 23, 2012). There have been thousands of reports of associations of obesity with almost every adverse outcome. Because there is a documented linear dose--response relationship between frequently seen adverse outcomes, such as preeclampsia,68 it makes sense to use the specific BMI number in our communications rather than using the BMI categories. Despite these strong and associations, BMI is not currently included in the brief list of descriptors accompanying the opening statement of the history of present illness or in the “situation” part of the situation, background, assessment, and recommendation communication.
Currently, residents in obstetrics and gynecology at Winthrop University Hospital, Mineola, New York, are taught to include BMI in the opening statement of the history of present illness, as well as in all hand-off communications. The Joint Commission on Accreditation of Hospitals considers “standardized communication” as a prerequisite for patient safety and recommends situation, background, assessment, and recommendation communication as the best practice.69 The situation, background, assessment, and recommendation communication technique includes four components: situation (description of the patient by name, age, sex, gravidity, parity, ethnicity, hopefully BMI, and the reason for report); background (presenting symptom and a brief summary of the medical history); assessment (vital signs and clinical impression); and recommendation (specific action to be taken and urgency). The need for accurate communication among health care providers occurs constantly under a variety of settings such as emergency room, labor and delivery suite, or during changing shifts when specific patient information is passed from one caregiver to another. To ensure safe and effective care, the situation, background, assessment, and recommendation communication should provide the most consistent and precise exchange of patient information by using information-rich descriptors. In our view, BMI is the most informative descriptor, as compared with the other traditional descriptors that we use in everyday practice in obstetrics and gynecology. Given the recent obesity epidemic, it is prudent to include BMI along with our other traditional markers in the situation part of the situation, background, assessment, and recommendation communications. Our management should be drastically altered when a “36-year-old, white female, G3P1Ab1, BMI 42” presents for medical care as compared with a “36-year-old, white female, G3P1Ab1” with the same symptoms.
It is certain that similar convincing arguments can be made for BMI to be included in the history of present illness, as well as in the situation portion of the situation, background, assessment, and recommendation communication, in all communications regarding patients of other medical specialties. However, it is important for the obstetricians and gynecologists to lead this effort. Therefore, it will be prudent for all health care providers in obstetrics and gynecology to be encouraged to include BMI, along with the other typical descriptors, at the start of their communications to enhance awareness of potential complications and their prevention. This can only lead to improvement in women’s health care.
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