Compare and contrast the physiological changes in the cardiovascular system in
pregnancy at term and morbid obesity (BMI > 30).
The question was very specific for the cardiovascular system and therefore answers that
described respiratory changes and airway modulation failed to score marks. This answer leant
itself to a tabular format. Candidates are reminded to ensure they document the facts in the
correct column i.e. obesity facts in the obesity column. The cardiovascular changes associated
with term pregnancy are well described in various texts. Those associated with morbid obesity
required some integration from various sources and would include a structured series of
comments such as heart rate (unchanged), blood pressure (tendency for hypertension), stoke
volume (increased), cardiac output (increased), blood volume (increased – although perhaps
decreased on a ml/kg basis), systolic function (preserved or increased), LV wall thickness
increased. The pathological changes seen with the diseases associated with obesity are difficult
to tease out and better answers identified this. Morbid obesity has a specific definition and
stating this aided focus of the answers.