الفهرس 
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Abstract
besity is an epidemic not only in the United States and developed countries but also in the developing world.
The world is getting fatter. Over last three decades, rates of obesity have risen.
The rise in obesity among pregnant women goes hand in hand with the upward trend of obesity in the general population. In addition, the percentage of women gaining excessive weight during pregnancy has also increased.
The obstetric complications of maternal obesity are generally related to issues of maternal pre-gravid obesity rather than excessive weight gain during gestation that results in a non-obese women becoming obese.
The problems relating to the management of obesity in pregnancy are many. There are both short-and long-term complications and implications for both mother and fetus.
Several systematic reviews and meta-analyses confirm the association of pre-pregnancy & early pregnancy overweight/ obesity with labour outcomes.
Furthermore, there were important gaps in the literature to appear effect of overweight/obesity at time of birth on labour outcome.
So we conduct this study to explore various maternal and fetal outcomes of labour which were influenced by maternal obesity in comparison to those of normal weight women at time of birth.
The most widely applied of various anthropometric measures used to calculate and classify adiposity is the Body Mass Index (BMI), calculated by dividing weight (kilograms) by square of height (metres). BMI is the most simple practical tool for adiposity classification.
In this study one hundred ninety two (192) pregnant women were included in prospective observational comparative (cohort) study.
They were divided into 3 groups based on their body mass index (BMI) at term pregnancy:
(1) group A: 96 pregnant women with normal weight (BMI < 25 kg/m2).
(2) group B: 60 pregnant women who are overweight (BMI 25-34.9 kg/m2).
(3) group C: 36 pregnant women who are obese (BMI ≥ 35 kg/m2).
The study was in reception room & delivery suite of Obstetrics and Gynecology Hospital of Ain Shams University.
Verbal informed consent & full history were taken from the pregnant women who were included in the study according to the inclusion & exclusion criteria of that study. Then they were followed up during labour by partogram to assess the effect of obesity on the progress of labour.
The influence of obesity on maternal and fetal outcomes was compared between the 3 groups regarding mode of delivery, reason of delivery mode, duration of labour stages (first, second, third) as a primary outcome and maternal birth injuries, primary postpartum haemorrhage, macrosomia, shoulder dystocia, birth asphyxia as a secondary outcomes.
Our study found several complications during labour in obese women; the rate of cesarean deliveries was significantly increased with the increase in BMI, arrested progress of labour was the most common indication for CS in obese group.
The duration of the 1st stage & 3rd stage of labour was significantly longer in the obese group, whereas Obese women who progress to the second stage of labour are just as likely to birth vaginally as women with normal BMIs.
Also that study appeared that as regard primary postpartum Hge, macrosomia & shoulder dystocia failed to reach significance but as regard maternal birth injury & birth asphyxia were statistically significant.
Many studies have demonstrated that obesity in pregnancy is associated with a wide spectrum of adverse labour outcomes. At parturition the obese patient is at an increased risk of cesarean delivery and associated complications of anesthesia, wound disruption, infection, and deep venous thrombophlebitis. For the fetus there are short-term risks of fetal macrosomia, more specifically obesity, and long-term risks of adolescent components of the metabolic syndrome.
This study, like any other observational study of its kind suffers from several limitations which made its results to be different in comparison with other studies. firstly, Weight and height were measured to pregnant women at time of labour unlike previous studies that dependent on that pre-pregnancy measurements. Secondly, this study used data collected over 6 months; a short duration to have large sample size like other studies. The third limitation was using of BMI alone as the method to detect obesity regardless on the lack of standard definitions of overweight and obesity which made comparison of findings across studies difficult.
Obesity engenders obesity and the need to put an end to this vicious cycle is imperative. Nutritional counseling for establishment of a healthy and balanced diet, physical exercise and close monitoring of maternal weight preconceptionally and throughout pregnancy can be useful weapons in our battle against the current epidemic of obesity.
The primary objective in the management of obesity during pregnancy is prevention. Having obese women lose weight with lifestyle changes and achieve a normal BMI before conception and preserve on it during pregnancy by healthy nutrition & suitable exercise program till the time of labour would be the ideal goal