#105 Bariatric Surgery and Pregnancy Flashcards
What prepregnancy BMI or weight in pounds can be used to stratify risk during pregnancy (increased risk vs not at increased risk)?
BMI of more than 30 or a prepregnancy weight of more than 200lbs
How do you calculate BMI?
Weight in kg divided by height in meters squared
Does obesity affect ferility? If yes, in what way(s)?
Decreases fertility primarily as a result of oligo-ovulation and anovulation
Are obese women more or less likely to respond to ovulation induction?
Less likely even with higher doses of gonadotropins
In pregnancy, what additional maternal risks occur in obese patients?
Increased risks for gestational diabetes, preeclampsia, cesarean delivery, infectious morbidity, less likely to have VBAC, higher incidence of preterm birth (indicated, less likely to have spontaneous preterm labor).
Are obese patients more likely to have spontaneous preterm labor?
No
What are increased risks regarding cesarean section with obese patients?
Difficulty in establishing and recovery from region and general anesthesia, prolonged operating times, increased blood loss, higher risk of thromboembolism
What effects can maternal obesity have on the fetus?
Increased risks of congenital anomalies, growth anomalies, miscarriage, and stillbirth
What are the most common types of obesity-associated birth defects?
Neural tube, cardiac systems, and facial clefting
Are pregnancies affected by maternal obesity more likely to have SGA or LGA infants?
Most studies report an increase in LGA and macrosomic infants
What is the risk for stillbirth in the obese population compared to normal weight women?
Risk for stillbirth is 2.1-4.3 fold greater
Is maternal obesity associated with increased risk of subsequent childhood obesity?
Yes
What qualifies a patient for bariatric surgery?
BMI of 40 or more or those with a BMI of 35 or more and other comorbidities
What is the most effective therapy available for morbid obesity?
Bariatric surgery, results in improvement or complete resolution of comorbidities and improved quality of life
What are the two primary categories of bariatric surgery?
Either restrictive or combination of restrictive and malabsorptive operations
What are the two type of bariatric surgeries performed (names of procedures)?
Roux-en-Y gastric bypass (restrictive or malabsorptive) and adjustable gastric banding (restrictive)