Main Article Content
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.
Rasmussen SA, Chu SY, Kim SY, Schmid CH, Lau J. Maternal obesity and risk of neural tube defects: A meta analysis. American Journal of Obstetrics and Gynecology. 2008;198(6):611-619.
Villamor E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: A population-based study. The Lancet. 2006;368(9542):1164-1170.
Knight-Agarwal CR, Williams LT, Davis D, Davey R, Cochrane T, Zhang H, Rickwood P. Association of BMI and interpregnancy BMI change with birth outcomes in an Australian obstetric population: a retrospective cohort study. BMJ Open. 2016;6(5):e010667.
Chu SY, Kim SY, Schmid CH, Dietz PM, Callaghan WM, Lau J, et al. Maternal obesity and risk of Cesarean delivery: A meta-analysis. Obesity Reviews. 2007; 8(5):385-94.
Neumann K, Indorf I, Härtel C, Cirkel C, Rody A, Beyer DA. C-section prevalence among obese mothers and neonatal hypoglycemia: A cohort analysis of the Department of Gynecology and Obstetrics of the University of Lübeck. Geburtshilfe und Frauenheilkunde. 2017;77(05):487-94.
Denison FC, Aedla NR, Keag O, Hor K, Reynolds RM, Milne A, Diamond A, Royal College of obstetricians and gynaeco-logists. Care of women with obesity in pregnancy: Green‐top Guideline No. 72. BJOG: An International Journal of Obstetrics & Gynaecology. 2019;126(3): e62-106.
National Institute of Health and Care Excellence. Obesity: Identification, assessment and management. Clinical guideline 189. London: NICE; 2014.
Kither H, Whitworth MK. The implications of obesity on pregnancy. Obstetrics, Gynaecology & Reproductive Medicine. 2012;22(12):362-7.
Mehasseb MK, Shafi MI. Supra-umbilical vertical midline abdominal incision in morbidly obese gynaecological oncology patients. Journal of Obstetrics and Gynaecology. 2013;33(5):505-7.
Viegas CM, Viegas OA. Preventing a surgical complication during cesarean delivery in a morbidly obese patient: A simple apparatus to retract the abdominal panniculus. Medscape General Medicine. 2006;8(1):52.