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The aim of our retrospective study is to report on our experience using the Prevena™ wound system in obese patients undergoing caesarean section delivery. A total of 26 cases were identified from July 2012 to October 2013. The median BMI of these women was 45.3 kg/m(2). Elective caesarean sections were performed in 20 women (77%). There were four cases (15%) of superficial dehiscence. Factors associated with wound breakdown were wound infection (p = 0.03), increasing BMI (p < 0.001) and emergency LSCS (p = 0.04). In a logistic regression model the presence of infection was the only factor which remained associated with wound breakdown. Wound disruption is a major cause of morbidity following caesarean section in morbidly obese patients. The wound complication rate in our experience was low with the Prevena™ dressing with no cases of sheath dehiscence, and no patient required a second operation. The presence of infection is the most important factor in wound breakdown and should be the focus for management protocols.

Obese women are more likely to require general anaesthesia for an obstetric intervention than non-obese. Difficult tracheal intubation and oxygen desaturation is more common in pregnancy. Failed tracheal intubation has been associated with an increase in neck circumference (NC). We studied the relationship between maternal obesity and NC as pregnancy advanced in women attending a standard antenatal clinic. Of the 96 women recruited, 13.5% were obese. The mean NC was 36.8cm (SD 1.9) in the obese women compared with 31.5cm (SD 1.6) in women with a normal BMI (p0.001) at 18-22 weeks gestation. In the obese women it increased on average by 1.5cm by 36-40 weeks compared with an increase of 1.6 cm in women with a normal BMI. The antenatal measurement of NC is a simple, inexpensive tool that is potentially useful for screening obese women who may benefit from an antenatal anaesthetic assessment.

We compared the incidence of the hypertensive disorders of pregnancy in obese women with women of a normal body mass index (BMI).Prospective observational study in which BMI was calculated accurately early in pregnancy. Women were enrolled after a sonographic confirmation of an ongoing pregnancy. To reduce confounding variables the study was confined to white European women with a singleton pregnancy.Incidence of pre-eclampsia and gestational hypertension.In 2230 women, 16.8% were obese. Pre-eclampsia was diagnosed in 3.3% (n=74) and gestational hypertension in 3.0% (n=67). Both pre-eclampsia (p=0.01) and gestational hypertension (p0.01) were common in obese women compared with normal weight women. Overall 13.1% of obese women developed a hypertensive disorder during pregnancy. When analysed by parity pre-eclampsia occurred in 2.1% of primigravidas and 0.3% of multigravidas. Pre-eclampsia was increased in obese multigravidas (p=0.001), but not obese primigravidas, suggesting that parity is more influential than obesity in the development of pre-eclampsia.Obese multigravidas are more likely to develop hypertensive disorders in pregnancy and obese primigravidas are more likely to develop gestational hypertension. This is important in clinical practice because maternal weight, unlike parity, is potentially modifiable before or during pregnancy.

Background Hypertension in pregnancy is an important cause of pregnancy complications for both mother and baby in about 8% of pregnancies. Epidemiological reviews have reported an association between pre-eclampsia and maternal obesity, based on a body mass index (BMI) > 29.9 kg/m2. However, BMI measurements were usually based on self-reporting of maternal weight and height which has been shown to be inaccurate, particularly in pregnancy and in obese women. The purpose of this prospective cross-sectional study was to compare the incidence of pre-eclampsia in the different WHO BMI categories in both primigravidas and multigravidas. Methods Women were recruited at their convenience in the first trimester. Height and weight were measured digitally and BMI calculated. Pre-eclampsia was defined as hypertension (a systolic blood pressure of ≥140 mm Hg and/or a diastolic blood pressure of ≥90 mm Hg) measured on at least two separate occasions at least 6 h apart with proteinuria (≥300 mg over 24 h) after 20 weeks. Results Of the 2230 women, the mean age was 28.2 years and mean parity was 1.0. The mean gestation at recruitment was 11.2 weeks and the mean BMI was 25.6 kg/m2. The incidence of obesity was 17.4%. The incidence of pre-eclampsia analysed by BMI category is show in table 1. In both primigravidas and multigravidas, there was no increase in pre-eclampsia with obesity (p=0.23, p=0.07). Conclusions When maternal BMI is calculated accurately in early pregnancy, contrary to previous reports, there is no association between maternal obesity and pre-eclampsia.