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Published byEmmeline Gilbert Modified over 9 years ago
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Outcome of Early Pregnancy After Bariatric Surgery Outcome of Early Pregnancy After Bariatric Surgery Dr. Tereza Indrielle Remesova Lucy Jones Pratik Sufi Department of Bariatric Surgery Whittington Hospital London. UK
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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
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Our cohort 2009 - 2011 20 patients aged 22 – 42 2 gastric bands, 18 gastric bypass conceived at 1 week to 42 months after bariatric surgery
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Methods Retrospective data collection from medical records semi-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
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Results - Pregnancies 11 primiparas 4 women G3, 1 woman G4, 1 woman G5 3 not recorded 17Singleton 2Twins 1Miscarriage (6 weeks)
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Results - Conception 16 10 patientsBefore 12 months 3 patients12 - 18 months 7 patients18 – 42 months non - intentionally9 3 pill 2 condom 1 implant removed 1 patch 2 nil Intentionally0 Non - intentionally 6 no contraception 1 pill intentionally3
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Results - Fertility 5 patients thought to be infertile 1 not recorded 9PCOS 1Decreased infertility 9Normal fertility 9regular 5irregular 1Amenorrhoea, resolved after surgery
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Complications 2 cases not recorded 3 cases not recorded 1 Placental abruption (38w) 1 small-sized placenta 1 Hypoglycaemia 1 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 anaemia 1 Ca deffiniciency no gestational diabetes (bias?) 2 uncomplicated pregnancies
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Mode of Delivery 4 cases not recorded / about to give birth C section (42 %)Emergency 4 Placental abruption Foetal distress at 42 weeks Growth failure Failed induction Elective 2 Breech Previous C section Vaginal (58 %)10
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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 130 weeks (twins) 1438 - 41 142 weeks
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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
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Conclusion Careful monitoring, MDT approach
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Questions? www.ObsGynae.net Tereza.Remesova@nhs.net
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