Background High body mass index (BMI) is a major risk factor for developing maternal complications such as thromboembolism (TE) and pressure sores. More than half of all mothers who died have a high BMI.1 Most complications are preventable by robust risk assessments during the perinatal period.

Aim To audit standards of perinatal care for women with BMI≥35.

Methods Maternity records for all women with BMI≥35 who delivered at Sunderland Royal Hospital over seven weeks from 1 December 2009 (n=52) were audited. Data collected included referral to Obstetric Anaesthetic clinic, fetal presentation scan, continuous electronic fetal monitoring (EFM) in labour, documentation of risk assessments for TE and pressure sores.

Results 69% of women with a BMI≥40 were offered an appointment at the Obstetric Anaesthetic clinic. For women who delivered at term, only 33% had a scan for fetal presentation from 35 weeks gestation. 65% had continuous EFM in labour. High rate of risk assessment documentation for TE and pressure sores was achieved on admission (both 79%), which decreased to 50% and 70%, respectively in the postnatal period.

Conclusions There was poor implementation of the anaesthetic referral pathway. Most women did not have fetal presentation scan. There was incomplete documentation of risk assessments especially in the postnatal period.

Recommendations Specific pathways of perinatal care for women with high BMI should be introduced and effective implementation audited. Staff should be trained on importance of accurate perinatal risk assessment.