Obesity - Maternal medicine Module part2

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A woman with a BMI of 42 seen in antenatal clinic at 37 weeks. A plan is being made for
induction of labour at 39/40 weeks.


A woman with a BMI of 35 who, at 36/40 week scan, shows estimated fetal weight of greater
than the 98th centile.

A 22-year-old primigravida attends for post-dates induction of labour at 41+5 weeks of gestation.
At booking her BMI was 32 (weight 95 kg). There is no significant past medical history and she has
been well antenatally. Following induction with prostaglandins and syntocinon she had a normal
vaginal birth, although the placenta was not delivered for 50 minutes. The blood loss was estimated
to be 1300 ml.

3) What is the most appropriate postnatal thromboprophylaxis method for this woman?

4) Not true about obesity and pregnancy


are at increased risk of mental health problems and should therefore be screened for these in


Regarding folic acid supplementation in pregnancy for women having BMI 30 kg/m2 or greater,
true statement is


A woman with a BMI of 30 seen for her anomaly scan at 20/40 weeks. She had a gastric band
procedure 2 years previous and lost 20% of her bodyweight.

A 29-year-old para 1 with a booking BMI of 42 (121 kg) attends at 39+1 weeks of gestation with a
history of regular contractions and spontaneous rupture of the membranes. Her first baby was born
three years ago by emergency caesarean section for suspected fetal compromise when the cervix was
7 cm dilated. In this pregnancy, the antenatal course has been uncomplicated and she is aiming for a
vaginal birth. On examination, the cervix is 5 cm dilated and the liquor is clear.

8) What would be the most appropriate management?

A 20-year-old para 1 is seen for booking at 12 weeks gestation. In her first pregnancy she had a
spontaneous vaginal birth at 38 weeks. She has a BMI of 33 (weight 85 kg) and smokes 10 cigarettes
per day. She is otherwise fit and well and is not on any medication other than folic acid 5 mg which
was prescribed by her GP.

9) What would be the most appropriate management for her pregnancy?


During antenatal consultations, women with a BMI greater than 30 should be informed of which
of the following antenatal risks:

A 28-year-old woman with a BMI of 40 at booking and weighing 120 kg, had a Neville Barnes
forceps birth with an episiotomy and is requesting an early discharge. She had an uncomplicated
pregnancy and does not like staying in hospital.

11) How would you advise this woman?


A 30 years old woman books in the antenatal clinic at 12 week of gestation with a BMI of 40.This
is her first pregnancy and she is fit and well with no family history of note. With regard to her BMI
which complication of pregnancy is the highest risk compared to women with a normal BMI ?

13) A woman with a BMI of 40 booking at 12/40 weeks in her first pregnancy


likely to have inaccurate SFH measurements and should be referred for serial assessment of fetal
size using ultrasound.

15) All are true regarding pregnancy following bariatric surgery except;


should have venous access established early in labour and consideration should be given to the
siting of a second cannula.


A woman with a BMI of 37 is 41 weeks pregnant. The baby has demonstrated normal growth on
scans and she declines induction of labour.

18) should be referred to an obstetric anaesthetist for consideration of antenatal assessment.


A 31-year-old primigravida with BMI of 40 attends her community midwife at 8 weeks of
gestation for her booking visit. What information should she be given on her options regarding
screening for chromosomal anomalies?


should have a moving and handling risk assessment carried out in the third trimester of
pregnancy to determine any requirements for labour and birth.

21) With regard to reproduction in obese woman; which of the following statement is correct;

A 36/40 weeks pregnant woman in her second pregnancy, and with a BMI of 41 at booking,
presents in the antenatal clinic to discuss the mode of birth. Her scan today shows a normal size baby.
She had an emergency Caesarean section 3 years ago with her first baby at full dilatation with no
subsequent complications.

22) What would be the most appropriate advice at this point in her management?

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