Straight to theatre -- should women with a high BMI be offered caesarean section routinely?

Maternal obesity is an increasingly common risk factor for maternal morbidity and mortality. Obesity is associated with increased caesarean section rates [1] and provides a number of anaesthetic challenges. The Centre for Maternal and Child Enquiries (CMACE) and Royal College of Obstetricians and Gynaecologists (RCOG) joint guideline [2] advises that anaesthetic assessment should occur for women with a body mass index (BMI) of >40 kg.m-2 so that potential difficulties with regional or general anaesthesia can be identified. For this project we looked at maternal outcomes of women with a raised BMI to see how this can guide our practice.