Endocrine Abstracts

Introduction: It is rare for patients with morbid obesity to become pregnant without assisted reproductive support. Spontaneous conception of triplets and their successful delivery by caesarean section is hitherto unreported. We report the case of world’s heaviest mother to undergo caesarean section with good outcome for mother and the babies.

Case history: A 24 year old lady was seen in the antenatal clinic at 11 weeks of pregnancy. She weighed 140 kg at this point and her BMI was 47. An ultrasound scan confirmed triplet pregnancy. Soon after patient was seen by an obstetrician with special interest in high risk pregnancies who advised the patient for selective foetal reduction procedure, however patient declined. Apart from hypothyroidism and obesity patient reported herself to be in ‘good health’ and active. Despite dietary advice and close follow up she gained a further 98 kg weighing 238 kilos at the time of caesarean section. The recommended weight gain during pregnancy for women with BMI >30 is more than 6 k. Her babies were delivered by elective caesarean section by a team comprising 5 obstretricians, 4 anaesthetists, 6 midwives and nurses, paediatricians and 3 theatre assistants. All 3 babies survived. She was seen in the morbid obese clinic 2 months post partum and her weight had come down to 180 kg.

Conclusion: Spontaneous pregnancy and successful delivery of even triplets are possible in extremely obese patients. Rapid and excessive weight gain during pregnancy can occur in morbidly obese patients. This patient is the heaviest mother to conceive triplets spontaneously. There are no reported cases of patients with BMI of 80 where triplets are delivered by caesarean section. Her massive weight gain during pregnancy and weight loss in the post natal period is also unusual.