Obesity in pregnancy, bariatric surgery, Misc Flashcards
What are the pregnancy effects of obesity?
- SAB
- Congenital anomalies
- IUFD
- macrosomia
- Childhood obesity, asthma
What are the antepartum maternal effects of obesity in pregnancy?
- GDM
- VTE
- Preeclampsia
- Fatty liver disease
- OSA
- Excessive weight gain
What are the intrapartum maternal effects of obesity in pregnancy?
- Increased risk of CD
- Failed TOLAC
- Postpartum hemorrhage
- Infection
- Prolonged labor
- VTE
What are the postpartum maternal effects of obesity in pregnancy?
- Surgical site infection
- VTE
- Weight retention
What is the best way to reduce complications for obesity in pregnancy?
Weight loss prior to pregnancy
What is the recommended management for obesity in pregnancy?
- Diet
- Exercise
- Behavior modification
Who should get an early GDM screen?
- BMI>30
- History of GDM
- History of glucose intolerance
When is antenatal testing indicated for obesity in pregnancy?
BMI 35-39= 37 weeks
BMI=/> 40= 34 weeks
What antepartum things should you counsel patient on and consider for obesity in pregnancy?
- Cell free DNA fetal fraction low and results more likely to be uninterpretable
- Lower detection of congenital anomalies
- Early anesthesia consult
What intrapartum things should you consider for obesity in pregnancy?
- Allow a longer first stage of labor before CD
- Consider high dose of ppx antibiotics for c-section
- Close subcutaneous layer with> 2cm
- No subcutaneous drains due to increase risk of infection
What postpartum things should you consider for obesity in pregnancy?
- Mechanical thromboprophylaxis before and after c-section
- For very high risk VTE you can add lovenox 12hrs post c-section
How long should you delay pregnancy after bariatric surgery?
12-14 months
You want to see the major weight loss and make sure weight loss has stabilized
What labs should be monitored with Roux-en-Y bariatric procedure in pregnancy?
Folate
B12
Vitamin D
Calcium
Protein
Iron
What glucose testing should be done with patients with previous bariatric surgery in pregnancy?
Avoid OGTT and due fasting and postprandial checks x 1 week due to risk of dumping syndrome
What is the fetal blood volume?
80ml/kg
What are the effects of smoking in pregnancy?
- Increase risk of SAB
- Increased risk of SIDS
- Increased risk of abruption
- Increased risk of IUGR
- Increased risk of infertility
- Increased risk of PTD
- Increased risk of stillbirth
- Increased risk of ectopic pregnancy
When is TDAP vaccine indicated?
27-36 weeks gestation
What vaccines are acceptable during pregnancy?
- Influenza
- COVID
- Pneumococcus
- TDAP
- Hepatitis A
- Hepatitis B
What vaccines are contraindicated during pregnancy?
- MMR
- Varicella
- HPV
- Intranasal flu vaccine
What are the imaging studies of choice in pregnancy?
Ultrasound and MRI
What are potential causes of oligohydramnios?
ROM
IUGR
SGA
TORCH infections
Renal agenesis
Idiopathic
What are potential causes of polyhydramnios?
Idiopathic
Maternal diabetes
Esophageal atresia
Duodenal atresia
Genetic anomalies
Syphillis, TORCH infections
Hydrops
What are treatment options for polyhydramnios?
Expectant management
Amnioreduction
How do you perform an amnioreduction?
Remove 500cc/hr to a total of 1500cc
Repeat every 1-2 weeks
How long does corpus luteal persist in pregnancy?
Up to 12 weeks
What is the recommendation for management of adnexal masses in pregnancy?
Expectant management
How long does ACOG recommend breastfeeding?
At least 6 months
What are contraindications to breastfeeding?
Substance abuse
HIV
Untreated TB or varicella
HSV on breast
What is the management for mastitis?
Continuing breastfeeding or express
dicloxacillin 500mg q6hrs x 10 days
What is the level for an epidural?
L2/3 or L3/4
What are complications of epidural placement?
Maternal hypotension
Spinal headache
At what gestational age should you not use vacuum for delivery?
Prior to 34 weeks gestation
