Introduction Maternal obesity is associated with adverse pregnancy outcomes. We routinely see women with a BMI >45 to discuss antenatal and intrapartum care including an early epidural recommendation.

Methods Retrospective analysis of women with a booking BMI >45 between January 2009 and October 2013.

Aims To compare delivery outcomes against the UKOSS study findings and to look at neonatal and anaesthetic outcomes.

Results

• 158 patients were analysed (mean BMI 49).

• 68% of all patients were either induced or required labour augmentation (background rate of 39%). 64% of these women achieved a vaginal delivery, increasing to 70% if no induction or augmentation.

• 71% of multiparous women who spontaneously laboured and had previously achieved a vaginal delivery, delivered vaginally again.

• Half of primiparous women requiring induction or labour augmentation had an emergency caesarean.

• 49% had intrapartum regional anaesthetic. 42% required multiple attempts, 19% needed an epidural re-site or spinal for theatre.

Conclusion These results mirror the UKOSS study findings. Higher maternal BMI is associated with an increased incidence of induction and augmentation of labour. Despite this the vaginal delivery rate is high. Primiparous women requiring induction or augmentation of labour were most susceptible to obstetric intervention. Excluding macrosomia, intrapartum and neonatal complications reflect background population rates.

Our data suggests counselling for an early epidural needs individualising, particularly for multiparous women in spontaneous labour having previously achieved a vaginal delivery.

Reference

1. Knight M, Kurinczuk J, et al. Extreme obesity in pregnancy in the United Kingdom. Obstet Gynecol 2010;115(5):989–97