Outcome of Early Pregnancy After Bariatric Surgery Outcome of Early Pregnancy After Bariatric...
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Transcript of Outcome of Early Pregnancy After Bariatric Surgery Outcome of Early Pregnancy After Bariatric...
Outcome of Early Pregnancy After Bariatric Surgery
Dr. Tereza Indrielle Remesova
Lucy JonesPratik Sufi
Department of Bariatric SurgeryWhittington Hospital London. UK
Background
Increase 800 % (USA)
American Society for Metabolic & Bariatric Surgery / ACOG:
Women after bariatric surgery should delay conception to 12 – 18 months post operatively
150 kg 110kg 85kg
0 months 12 months 18 months
Our cohort2009 - 201120 patients aged 22 – 422 gastric bands, 18 gastric
bypassconceived at 1 week to 42
months after bariatric surgery
MethodsRetrospective data collection
from medical recordssemi-structured telephone
interviews were carried out with most of the patients
• initial reproductive plans• fertility status• contraceptive method• surgical outcome• development of pregnancy and obstetrical
and neonatal outcome
Results - Pregnancies11 primiparas4 women G3, 1 woman G4, 1
woman G5 3 not recorded
17 Singleton
2 Twins
1 Miscarriage (6 weeks)
Results - Conception
16
10 patients Before 12 months
3 patients 12 - 18 months
7 patients 18 – 42 months
non - intentionally
9 3 pill 2 condom 1 implant removed 1 patch 2 nil
Intentionally 0 Non - intentionally
6 no contraception1 pill
intentionally 3
Results - Fertility5 patients thought to be infertile 1 not recorded
9 PCOS
1 Decreased infertility
9 Normal fertility
9 regular
5 irregular
1 Amenorrhoea, resolved after surgery
Complications 2 cases not recorded
3 cases not recorded
1 Placental abruption (38w)1 small-sized placenta1 Hypoglycaemia1 low levels of vit/minerals 3 anaemia
no gestational diabetes (bias?)
5 Uncomplicated pregnancy 1 not recorded
1 PPH 1 IUGR (30w)1 hypertension 1 Anterior abdo wall haematoma 1 pneumonia 1 symptomatic gall stones 5 anaemia1 Ca deffiniciency
no gestational diabetes (bias?)
2 uncomplicated pregnancies
Mode of Delivery 4 cases not recorded / about to give birth
C section (42 %) Emergency4
• Placental abruption• Foetal distress at 42
weeks• Growth failure• Failed induction
Elective2
• Breech• Previous C section
Vaginal (58 %) 10
Neonatal outcome
Average weight of the newborn was 2.94 kg (0.9 – 4 kg) and all babies were healthy at the time of the interview.
NICU – twins with IUGR
1 30 weeks (twins)
14 38 - 41
1 42 weeks
Conclusion Low fertility, increases rapidly
with weight loss -> appropriate counselling
Complications related to obesity and rapid weight loss
Obstetrical outcome satisfactory if well monitored
Neonatal outcomes satisfactory
ConclusionCareful monitoring, MDT
approach