Obesity is a major health problem in the developed world and is beginning to have an impact on pregnancy (CEMACH 2004). We aimed to examine the differences in the intra-partum care of morbidly obese women compared with those of normal weight women. Intra-partum variables of labour monitoring as well as anaesthetic and neonatal variables were compared between 50 morbidly obese and 50 normal weight women. The morbidly obese group was observed to be significantly more prone to invasive fetal monitoring (27% vs 0%, p

Perimortem caesarean section (PCS) is a rare event often resulting in high mortality of mother and/or fetus. It represents a tragedy for the mother and the family and a crisis for the healthcare professionals managing such a case. This paper seeks to raise awareness of the pertinent issues surrounding PCS and challenges care providers to put in place procedures to deal with this catastrophic event. It also reviews the historical perspective of PCS, maternal physiology during cardiopulmonary resuscitation (CPR), prognostic factors for maternal and fetal wellbeing, techniques of PCS, survival for mother and baby and the medico legal aspects of PCS.

Maternal and perinatal morbidity and mortality remain major challenges in the delivery of safe maternity care worldwide. Anaemia in pregnancy is an important contributor to this dismal picture, especially where blood transfusion services are poorly developed. An early diagnosis and treatment of iron deficiency anaemia in pregnancy using the new generation dextran-free parenteral iron preparations can save lives and reduce morbidity in selected pregnancies. It is time to cast aside the fears associated with the use of the old parenteral iron preparations which were associated a high incidence of anaphylaxis, and embrace the use of new parenteral iron products which have better side effect profiles and can deliver total dose infusions without the need for test dosing. In selected women, the benefits of this treatment far outweigh any disadvantages.

Morbid obesity in pregnancy is a growing problem and is having an impact on morbidity, mortality as well as significantly increasing antenatal and intra-partum costs of pregnancy care. The incidence of morbid obesity in pregnancy in our unit was 7.5% during the study period and this was associated with statistically significant increased maternal and perinatal morbidity. It also led to increased costs because of multidisciplinary management of the pregnancies, increased investigations and hospital stay when compared with normal weight pregnant women. Looking after morbidly obese pregnant women is an expensive undertaking, as the cost of the care of one morbidly obese pregnant woman and her baby is several times that of the normal weight woman. Health planners need to factor in these costs which are set to escalate given the predicted increase in the obese population in the UK.

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