Not really. If the fetal growth has been unsatisfactory during the pregnancy, then continuous electronic monitoring of the fetus will be necessary. Of course, intrauterine growth restriction increases the possibility of intervention in labour and delivery by caesarean section. Apart from this, the labour will be treated as any other.

Will there be any special measures after delivery?
The management of the underlying causes of the problem will most likely need to continue beyond delivery.

Is obesity a risk factor in pregnancy?
Obesity is, without doubt a risk factor, as far as various pregnancy complications are concerned. These include an increased risk of hypertensive disorders (including pre-­eclampsia), gestational diabetes, large babies with consequent difficult delivery, postpartum haemorrhage (PPH) and urinary tract infections.
There is some evidence, albeit inconclusive, that the risk of thrombosis and thrombo­-phlebitis may also be increased.

What about pregnancy care with obesity?
It is a fact that examining an obese pregnant woman's abdomen can be quite difficult. it may even be impossible to make out what you are feeling. Naturally this means there is an increased likelihood of missing potentially risky situations such as a breech presentation or reduced fluid around the baby. It may also create anxiety on the part of the mother, especially if the midwife or doctor spends what appears to be an eternity searching for the baby's heartbeat, always a reassuring sound to any prospective mother.

Unfortunately, yes. When there is marked obesity, the image on ultrasound can be very poor and the ultrasonographer or doctor may fail to get all the required information - a situation which can cause anxiety because of questions left unanswered.

What about delivery?
Obese women, because of an increase in antenatal problems, are at increased risk of ending up with a caesarean delivery. This is not a simple matter of an alternative method of delivery. Overweight women are more risky anaesthetic subjects. Inducing anaesthesia - both general and spinal or epidural - is more difficult.

Moreover, such potentially serious post-operative complications as thrombosis are more likely to occur among those who are significantly overweight.

Even when all seems to pass off without a hitch, excess weight still has a sting in the tail. Wound infection following surgery is much more common among the obese.

Should an overweight woman booking for antenatal care be encouraged to lose weight?
Not at all. If a woman conceives while overweight the issue of losing weight should and must be put on hold until after delivery. Of course, she may be overweight because of poor eating habits in the first place, in which case dietary advice will be given. Sensible exercise, not to lose weight but to keep healthy, will be encouraged as well.

It is important for the service providers (i.e. midwife or doctor) to be aware of potential problems associated with obesity in pregnancy and to look for them. Surveillance for raised blood pressure, urinary tract infection (UTI) and diabetes will be meticulously maintained.

In case of a caesarean delivery, preventative antibiotics - and heparin, to try to prevent thrombosis - will be administered. Heparin will normally continue until the mother is on her feet again; getting up and walking about will be actively encouraged.