Pregnancy is a state of physiological alteration as a result of increased oxygen demand and involves significant haemodynamic changes including sustained rises in cardiac output (CO) (by up to 30- 60%) and stroke volume (SV) (up to 30%) by virtue of increase in the blood volume This is associated with decrease in the systemic vascular resistance (SVR) and enhanced myocardial performance. When pregnancy is associated with obesity the cardiovascular system is further stressed. Obese pregnant women with a body mass index (BMI) more than 35kg/m2 pose significant health issue and are at risk for anaesthesia related maternal mortality. Several cases of sudden cardiac arrests of unexplained cause in obese pregnants have been reported. Obesity induced pathological changes have profound effects on cardiac endothelial and vascular function. Thus in pregnancy, obesity leads to further increase in blood volume and cardiac output proportionate to the amount of fat thus causing further volume overload of the heart. A study conducted with transthoracic echo showed a mean increase of around 550mls in cardiac output between obese and non-obese parturients in the third trimester. In contrast to the decrease in SVR that occurs in normal pregnancy, obesity by itself is associated with increased SVR by virtue of the increased sympathetic activity due to the effects of hormones including leptin, insulin and inflammatory mediators. This causes an increase in afterload 6, 8 thus offsetting the advantage of reduced afterload of normal pregnancy affecting the CO further. This combination of volume and pressure overload leads to systolic dysfunction. Furthermore the increase in heart rate of pregnancy in line with elevated cardiac output will decrease the diastolic interval and time for myocardial perfusion causing diastolic dysfunction. Thus obese pregnant patients may present with a systolic, diastolic or both systolic and diastolic dysfunction of the left ventricle. Associated obstructive sleep apneoa (OSA) and pulmonary hypertension may lead to right ventricular failure. These changes are further compromised in the third trimester due to aortocaval compression thus reducing cardiac output and placental perfusion. The large abdominal panniculus in obesity will further add to the uterine and vascular compression. It is thus evident that obese parturient women pose an increase in risk for cardiovascular compromise. As obesity is considered a global health care problem especially in women, anaesthetists are increasingly faced with the care of this high risk group of patients.9However there is paucity of evidence to quantify this cardiovascular compromise on obese pregnant women and guide provision of best care.