Morbid Obesity in Pregnancy

Abstract

Aim: Changing lifestyle and late age of conception has led to rising incidence of obesity in pregnancy. We present a case report of perioperative management of a morbidly obese pregnant woman and the problems we faced during its management. Case Presentation: A 35 years old, morbidly obese, unbooked, gravida 3 para 2 living 2, with post-dated pregnancy presented in labour. On investigation it was found that she was hypothyroid, diabetic, hypoproteinemic and moderately anaemic. She underwent Caesarean section due to fetal distress. Operation was difficult and an additional assistant was recruited at the operation table to retract the panniculus of anterior abdominal wall which extended to approximately 10 cm from mons veneris. She had one episode of sudden hypotension on second post-operative day which was managed conservatively. On day nine she developed a 5 x 4 cm sloughed area in the pannus near stitch-line. Wound debridement and healing occurred with secondary intention. Discussion: Morbid obesity presents several challenges but our case highlights the additional problems due to unbooked and uninvestigated state with post-dated term pregnancy in labour. Here, Obstetrician is the first point of contact and has to deal with all the associated problems that are present and also has to envisage the complications that can ensue. In our case we had to deal with post-dated pregnancy, macrosomia, diabetes, anemia, hypoproteinemia on top of obesity. Conclusion: Our case highlights the importance creating awareness in people for prenatal, routine antenatal visits, and importance of having institutional delivery. It also highlights unprecedented problems that can be faced by Obstetricians in dealing with such cases.