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ACOG Pub Review > PB#105: Bariatric Surgery and Pregnancy > Flashcards

PB#105: Bariatric Surgery and Pregnancy Flashcards

1
Q

Prevalence of obesity in pregnancy

A

10-36%

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2
Q

Prevalence of obesity among all reproductive-aged women; prevalence of obesity among reproductive-aged Mexican-American pts; prevalence of obesity among reproductive-aged Black pts

A

29%; 36%; 50%

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3
Q

Effects of obesity on fertility (2)

A

Reduced fertility, less likely to respond to ovulation induction (even w/ high-dose gonadotropins)

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4
Q

Primary mechanism for reduced fertility 2/2 obesity

A

Oligo-ovulation/anovulation

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5
Q

Maternal pregnancy risks associated w/ obesity (13)

A

GDM, pre-E, C/S, infectious morbidity, operative morbidity/postop recovery complications, prolonged op times, increased blood loss, VTE, unsuccessful VTOLAC, iatrogenic PTD, need for IOL/AOL, higher doses of oxytocin, longer labor course

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6
Q

Effects of obesity on iatrogenic vs spontaneous PTD

A

Iatrogenic PTD higher in obese pts, spontaneous PTL/PTD lower in obese pts

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7
Q

Fetal/Neonatal risks associated w/ obesity in pregnancy (5)

A

Congenital anomalies, growth abnormalities, sAB, IUFD, subsequent childhood obesity

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8
Q

Most common congenital anomalies associated w/ obesity in pregnancy (3)

A

ONTDs, cardiac anomalies, facial clefting

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9
Q

RR of IUFD in obese pts compared to normal weight pts

A

2.1–4.3-fold greater

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10
Q

Effect of increasing BMI on OB US

A

Worsening visualization of congenital anomalies, though no effect on EFW calculations

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11
Q

Nonsurgical weight loss approaches (4)

A

Behavioral changes, diet, exercise, pharmacotherapy

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12
Q

Candidates for bariatric surgery

A

Pts w/ BMI >40, or pts w/ BMI >35 and other comorbidities

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13
Q

Most effective therapy for morbid obesity

A

Bariatric surgery

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14
Q

Two general approaches to bariatric surgery

A

Restrictive, restrictive-malabsorptive combo

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15
Q

Two common bariatric surgeries currently in use, and classification of each one

A

Roux-en-Y (restrictive-malabsorptive combo), adjustable gastric banding (restrictive)

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16
Q

Pathophysiology of Roux-en-Y procedure

A

Creates a roux (straight) limb connected to gastric pouch and Y-portion downstream as enteroenterostomy, w/ proximal stomach separate from remaining part of stomach w/ staples

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17
Q

Pathophysiology of gastric banding

A

Fluid-filled band is placed around stomach near fundus, reducing functional stomach volume

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18
Q

Surgically route of roux-en-Y and of gastric banding

A

Both can be performed laparoscopically or open

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19
Q

Less common bariatric procedures, and classification of each one (2)

A

Vertical banded gastroplasty (restrictive), biliopancreatic diversion (malabsorptive)

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20
Q

Effects of weight loss following bariatric surgery on fertility (4)

A

Improvement in PCOS, improvement in anovulation, improvement in irregular menses, improvement in fertility rates

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21
Q

Risk associated w/ contraception following malabsorptive surgery

A

Possibility of decreased absorption of OCPs

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22
Q

Most effective intervention to improve medical comorbidities associated w/ obesity (outside of pregnancy)

A

Weight loss

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23
Q

Percentage of pregnant pts that are still obese after bariatric surgery

A

80%

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24
Q

Pregnancy risks associated w/ hx of bariatric surgery (3)

A

Hx of C/S, GDM, need for C/S

25
Q

Does bariatric surgery improve C/S rates in obese pts?

A

No (they are comparable in pts s/p bariatric surgery compared to obese pts prior to surgery, and as high as 62%)

26
Q

Pregnancy conditions that are less likely following bariatric surgery (4)

A

HTN, pre-GDM, weight gain during pregnancy, fetal macrosomia

27
Q

Possible late complications in pregnancy following prior bariatric surgery (3)

A

Intestinal obstruction, GI hemorrhage, maternal death

28
Q

Does bariatric surgery improve rates of congenital anomalies in future pregnancies?

A

Yes (rate of congenital anomalies in pts s/p bariatric surgery is comparable to general population)

29
Q

Is maternal weight gain during pregnancy a predictor of birth weight in pts s/p bariatric surgery?

A

Yes

30
Q

Is bariatric surgery associated w/ increased risk of perinatal death?

A

No

31
Q

Pregnancy rates in adolescent pts s/p bariatric surgery

A

Doubled (12.8% vs 6.4%)

32
Q

Contraceptive considerations for adolescent pts s/p malabsorptive bariatric surgery

A

Non-PO administration methods (2/2 higher risk of OCP failure)

33
Q

Recommended delay in pregnancy s/p bariatric surgery; reasons why (2)

A

12-24 months; to avoid fetal exposure to rapid maternal weight loss, to help achieve complete weight loss goals

34
Q

Considerations if pregnancy occurs within 12-24 month window s/p bariatric surgery (2)

A

Close surveillance of maternal weight/nutritional status, additional fetal monitoring (if needed)

35
Q

Most common nutritional deficiencies after roux-en-Y (6)

A

Protein, iron, vit B12, folate, vit D, calcium

36
Q

When to evaluate for micronutrient deficiencies for pregnant pts s/p bariatric surgery

A

At FOBV

37
Q

Labs to check qtri in pregnant pts s/p bariatric surgery in absence of specific nutritional deficiency (5)

A

CBC, iron, ferritin, calcium, vit D

38
Q

Route of methods to correct nutritional deficiencies

A

Can be started PO, but parenteral forms may be indicated if no improvement

39
Q

Percentage of pts s/p bariatric surgery who continue to take the prescribed multivitamin supplement long-term

A

14-59%

40
Q

Daily recommended protein intake (regardless of bariatric surgery status)

A

60g

41
Q

In what situations is caloric/protein restriction recommended for pregnant pts s/p bariatric surgery?

A

Never (even if they continue to be obese/overweight)

42
Q

Should pregnant pts s/p bariatric surgery take a PNV, a bariatric multivitamin, or both?

A

Both

43
Q

PP considerations in pts s/p bariatric surgery

A

Close infant surveillance 2/2 risk for nutritional deficiencies when breastfed

44
Q

Can nutritional deficiencies occur after restrictive bariatric surgery; why/why not?

A

Yes; 2/2 decreased food intake and/or intolerance to certain foods because of narrowed gastric opening

45
Q

Consideration in pregnancy for pts who have gastric banding

A

Active band management (fluid from gastric band is removed/lessened)

46
Q

Benefits of active band management in pregnancy (3)

A

Allows for less gastric constriction, increased PO intake, decreased 1st tri N/V sxs

47
Q

Which consultant is recommended early in pregnancy for pts s/p bariatric surgery?

A

Bariatric surgeon

48
Q

Potential complications s/p bariatric surgery (6)

A

Anastomotic leaks, bowel obstructions, internal hernias, ventral hernias, band erosion, band migration

49
Q

Management of N/V, abdominal pain in pregnant pts s/p bariatric surgery

A

Broad workup (do not presume to be pregnancy-related)

50
Q

Syndrome that may occur s/p gastric bypass; pathophysiology of this condition

A

Dumping syndrome; ingestion of refined sugars/high glycemic carbs is followed by rapid emptying from stomach into small intestine, and fluid shifts from intravascular compartment into bowel lumen resulting in small bowel distention

51
Q

Sxs of dumping syndrome (4)

A

Cramping, bloating, N/V, diarrhea

52
Q

Downstream physiologic changes associated w/ dumping syndrome (2); sxs associated w/ downstream effects of dumping syndrome (4)

A

Hyperinsulinemia, hypoglycemia; tachycardia, palpitations, anxiety, diaphoresis

53
Q

Evaluation option for GDM for pts s/p bariatric surgery in order to avoid dumping syndrome

A

Fasting + 2h PP glucose logs x1 week (since may not tolerate 1*GTT) at 24-28wga

54
Q

Effect of malabsorptive bariatric surgery on med absorption

A

Absorptive surface of intestine is decreased, so decreased time for med absorption

55
Q

Med preparations to avoid in pts s/p malabsorptive bariatric surgery; preferred med preparations in pts s/p malabsorptive bariatric surgery (2)

A

ER formulations; PO solution, IR formulations

56
Q

Class of meds to avoid in PP pts who have had bariatric surgery; why?

A

NSAIDs; 2/2 smaller gastric pouch

57
Q

Considerations for pts who have had bariatric surgery who are taking meds that necessitate therapeutic drug level

A

More frequent/regular drug level testing

58
Q

Does uncomplicated hx of bariatric surgery alter labor management, route of delivery, or need for C/S?

A

No

59
Q

Prelabor consultation for pts w/ extensive/complicated abdominal surgery related to weight loss procedures

A

Bariatric surgeon

ACOG Pub Review (12 decks)

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