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

Questions?

www.ObsGynae.netTereza.Remesova@nhs.

net