Pregnancy outcome following bariatric surgery Flashcards
What proportion of women who die in pregnancy are overweight/obese
50%
Prevalence of obesity in reproductive age
28%
Risks of obesity in pregnancy
Spont abortion
Gestational DM
HTN
EMCS
VTE
Wound infection
PPH
Congenital anomalies
Macrosomia
Shoulder dystocia
Admission neonatal unit
Stillbirth
When is biatric surgery offered
BMI >40 and lifestyle/,medications ineffective
What proportion of bariatric surgery are women childbearing age
50^
3 main type og biatric surgery
Restrictive (reduce caloric intake by reduce gastric capacity)
Malabsorptive
Mixture
Most common type procedures
Laparoscopic adjustable gastric banding (restrictive)
Roux-en-Y bypass (mixed)
Complications rates of procedures
5%
Consequents of gastric band
Band adjustment used to regulate weight gain
Complications - gastric prolapse, Somali obstruction, puch dilatation, gastric erosion, necrosis
What is a sleeve gastrectomy?
Irreversible
Involves removing most of stomach leaving sleeve shaped cylinder of stomach with reduced capacity
Which procedure has most extreme malabsorption
Biliopancreastic diversion
Malasorbative - low iron calcium, folate, thiamine, B12 and fat solum vitamins deficiency
Which surgery has highest risk of mortality
Jejunoileal bypass
Hepatic and renal failure
Complication of Roux-en-Y gastric bypass (RYGB)
Dumping syndrome experience by ingestion large quantities of carbohydrate
Coms stomal stenosis, ices, intestinal hernia, nutrient deficiency
How long to wait after weight loss surgery before pregnancy
1 year - rapid weight loss, nutritional deficiency
Pregnancy associations if < 1 year between surgery and pregnancy
Preterm delivery
?Miscarriage
No difference IUGR< CS, PIH or GDM
What is optimal weight gain for pregnancy
7-11KG
How does intestinal obstruction present
Epigastric pain and vomiting
Consider CT to exploratory laparotomy
Effect of weight loss surgery on risk PIH and PET
Recued
Rates of CS in post weight loss surgery
30%
Pre-conception are following bariatric surgery
Contraceptive counselling (non oral)
Nutritionist/dietician
Folic acid/b12/calcium/iron
AN Care
MDT - inform bariatric surgery
Nutrition status - blood
Refulat weight
Inform anaesthetics/paeds
BM monitoring to Ix GDM
Screen neural tube defects
Consider complications
Assess VTE
If considering cosmtomic surgery when should be performed
After completed family
