Background Obesity is arguably the biggest challenge facing maternity services today. Complication rates for women with obesity are substantially higher and these can potentially be reduced with quality clinical care.

Objectives To compare routine practices at St Thomas' Hospital with the local trust guidelines on management of obesity in pregnancy.

Methods All women delivered at STH between 01/01/2011 and 28/02/2011 with BMI ≥30 were included in this audit. Data was collected retrospectively from patients' notes.

Results There were 1103 deliveries at STH with 165 (15%) patients with high BMIs. We analysed 152 case notes. The majority of patients had Class I BMI (73%), were 30-39 years of age (49%) and were multiparous (72%). There was a higher LSCS rate among the obese patients as compared to the general population (39% vs. 28%). Obese patients were more likely to have babies with a birth weight >4kg (16% vs. 9%). 52% of all obese patients had a consultant review before 24 weeks. Glucose tolerance test was performed in 12% of patients at booking, and 61% at 26 weeks gestation. Only 4% had BMI reassessment at 34 weeks gestation. Among patients with Class III BMI, 69% had aspirin antenatally, 54% had an anaesthetic referral and 69% had postnatal thromboprophylaxis.

Summary There is room for improvement in providing higher quality care for obese patients. This could be due to inadequate awareness of trust guidelines. More training is required for midwives and junior doctors involved in the care of this group of high risk patients.