This chapter summarizes the most commonly performed bariatric operations. It reviews the impact of pre-pregnancy bariatric surgery on the female reproductive functions and the relevant pregnancy outcome parameters. The chapter formulates recommendations for clinical care of these patients for both the postoperative as well as the prenatal period. Mixing the different types of bariatric surgery might lead to unreliable conclusions since a different outcome can be expected after the restrictive type than after the malabsorptive types. Women experiencing pregnancy after bariatric surgery have important reproductive health care needs. The specific needs of these high-risk pregnancies are best addressed by a multidisciplinary team including obstetricians, surgeons, endocrinologists, pediatricians, psychiatrists, and nutritionists. Some aspects of prenatal care in women with a history of bariatric surgery require specific attention. Pregnancy after surgery improves many pregnancy outcomes but adds new risks related to nutritional deficiencies and surgical complications, thus requiring a specialized multidisciplinary approach.

The indications for induction of labour (IOL) can be divided into fetal or maternal indications. The IOL is initiated for a specific indication, due to the associated risks. Prolonged pregnancy is the most common indication for IOL. Guidelines from the National Institute for Health and Clinical Excellence (NICE) recommend offering IOL to women between 41 and 42 weeks gestation. The main risk for women with prolonged ruptured membranes is intra-uterine infection. Maternity units throughout the UK have different policies on timing of IOL and the location where induction is commenced. Intrauterine fetal death (IUFD) may occur at any stage of pregnancy. The causes of IUFD include fetal anomalies, infection, fetal hypoxia secondary to placental insufficiency. IUFD should be confirmed by two obstetricians or ultrasonographers, and is confirmed by visualisation of the inactive fetal heart. Women with IUFD have to deal with grief and labour pain.