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Vaginal birth after cesarean section versus elective
repeat cesarean delivery: Weight-based outcomes.
Carroll CS Sr, Magann EF, Chauhan SP, Klauser CK, Morrison JC.
Department of Obstetrics and Gynecology, University of Mississippi Medical
Center, Jackson, USA.
OBJECTIVE: The study was undertaken to compare infectious morbidity and
trial of labor (TOL) success stratified by weight in women. STUDY DESIGN:
Vaginal birth after cesarean section (VBAC) candidates were divided into
groups based on prepregnancy weight: group I, 70 (<200 pounds); group II,
70 (200-300 pounds); and group III, 69 (>300 pounds). RESULTS: The TOL
success rate was 81.8% in group I compared with 57.1% in group II and
13.3% in group III (P =.001). The overall infectious morbidity was
significantly greater in the obese women 39% (P =.001) compared with the
average women at 11.4% and the lean women at 5.7%. CONCLUSION: Infectious
morbidity is increased and VBAC success is reduced in patients who weigh
more than 300 pounds.
PMID: 12824987 [PubMed - indexed for MEDLINE]
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Transrectal scanning: an alternative when transvaginal
scanning is not feasible.
Timor-Tritsch IE, Monteagudo A, Rebarber A, Goldstein SR, Tsymbal T.
Division of Obstetric and Gynecological Ultrasound, Department of
Obstetrics and Gynecology, NYU School of Medicine, New York, USA.
Ilan.Timor@med.nyu.edu
OBJECTIVE: In scanning the female pelvis the clear images of transvaginal
sonography (TVS) result from placing the transducer close to the region of
interest. The advantages of TVS over transabdominal sonography (TAS) and
transperineal sonography are well documented. Transrectal scanning is
proposed mostly for ultrasound guidance in draining a pelvic abscess. Our
aim was to investigate the applicability of transrectal scanning (TRS) for
cases in which TVS is impossible. METHODS: Forty-two patients with an
absolute or a relative contraindication to TVS were scanned
transabdominally and transrectally. The TRS was performed using a
transvaginal probe, which was lubricated and slowly advanced into the
rectum. The technique used was similar to that of TVS. Images were
compared for resolution and quality. RESULTS: All scans were completed
without significant patient discomfort or complaints. TRS was clearly
superior to TAS in 31 cases. In nine cases TAS furnished some clinical
information but TRS yielded better images. Only in one such case was TAS
similar in quality to TRS. In four obese patients TAS did not reveal
sufficient pelvic anatomy to generate a clinical diagnosis, whereas TRS
revealed two sets of normal ovaries and two patients with ovarian cysts.
In the two cases with vaginal agenesis TRS revealed the diagnosis of
Rokitansky-Kuster syndrome. In three of the four patients with ruptured
membranes the cervix could be measured precisely. CONCLUSION: Transrectal
scanning should be used liberally after proper patient selection and
counseling. The images obtained are superior to TAS and comparable to
those obtained by TVS. Copyright 2003 ISUOG. Published by John Wiley &
Sons, Ltd.
PMID: 12768560 [PubMed - indexed for MEDLINE]
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Obesity as an independent risk factor for infectious
morbidity in patients who undergo cesarean delivery.
Myles TD, Gooch J, Santolaya J.
Department of Obstetrics and Gynecology, Texas Tech Health Sciences Center
at Amarillo, Amarillo, Texas, USA. mylesth@slucare1.sluh.edu
OBJECTIVE: Our purpose was to evaluate obesity (body mass index greater
than 30.0) as an independent risk factor for infectious morbidity in women
having elective or nonelective cesarean deliveries. METHODS: Charts of 611
patients undergoing cesarean were reviewed. After exclusion of those with
pre-existing chorioamnionitis, 574 cases were separated into two groups
(elective or nonelective cesarean) and then subdivided based on the
presence or not of postdelivery infectious morbidity. Estimated blood
loss, operative time, number of vaginal examinations, labor length, use of
internal monitors, body mass index (BMI), and obesity (BMI greater than
30.0) were then recorded. Student t test, chi(2), multivariate analysis,
and receiver operating characteristics curves were used where appropriate
(significance: P <.05). RESULTS: The mean gestational age at delivery was
38.3 weeks. Three hundred sixty patients had nonelective cesareans, and
214 had elective cesareans. Prophylactic antibiotics were used for 86.6%
of the nonelective group and 75.2% of the elective group. In the
nonelective group and after multivariate analysis, significant risk
factors for postoperative infections were as follows: labor length (18.4
hours versus 10.9, P <.003), number of vaginal examinations (6.1 versus
4.5, P <.001), BMI (36.6 versus 32.3, P <.001), and obesity (81.8% versus
57.3%, P <.001). For the elective group, a higher BMI (38.9 versus 32.2, P
<.003), and black race (63.2% versus 11.5%, P <.001) were found to be
significant. CONCLUSION: Our data suggest that obesity is a independent
risk factor for postcesarean infectious morbidity and endomyometritis,
even if the cesarean is elective and prophylactic antibiotics are given.
PMID: 12423861 [PubMed - indexed for MEDLINE]
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Necrotizing fasciitis in gynecologic and obstetric
patients: a surgical emergency.
Gallup DG, Freedman MA, Meguiar RV, Freedman SN, Nolan TE.
Department of Obstetrics and Gynecology, Mercer University School of
Medicine, Savannah, Memorial Health University Medical Center, Georgia,
USA.
OBJECTIVE: We reviewed the cases of 23 patients who were admitted to the
hospital with a primary diagnosis of histopathologically confirmed
necrotizing fasciitis in the lower abdomen or pelvis. Rapid demise of a
healthy postpartum women piqued our interest in trying to identify the
early signs and symptoms that may lead to earlier diagnosis and treatment
of this often fatal disease. STUDY DESIGN: A retrospective analysis of
charts of all patients who were admitted to the gynecology and obstetrics
services of our hospital systems with a diagnosis of necrotizing fasciitis
for the past 14 years was performed. Age, comorbid factors, precipitating
events, weight, symptoms and signs, microbiologic factors, radiographs,
surgical therapy, and morbidity were correlated. RESULTS: Definitive
operation was accomplished within 48 hours of the diagnosis of necrotizing
fasciitis in all but 3 patients. Of the 17 patients who were not
puerperal, 88% of the women were obese; 65% of the women were
hypertensive, and 47% of the women were diabetic. Of the total 23
patients, 70% of the women complained of severe pain, and 35% of the women
had radiographic diagnostics for necrotizing fasciitis ("gas"). Four
patients had diverting colostomies, and 39% of the patients had flaps or
synthetic grafts. Three patients died (mortality rate, 13%). One patient
who was puerperal died of a severe rapid septicemia; the 2 late deaths
were the result of systemic candidiasis. CONCLUSION: Necrotizing fasciitis
is a rapidly progressive, often lethal, infectious disease process that
requires early aggressive debridement. Any patient with inordinate pain
and unilateral edema in the pelvis, especially in the puerperium, should
be suspected of having this disease. Radiographic studies are often
diagnostic of this condition. The triad of pelvic pain, edema, and any
sign of septicemia carries an extremely grave prognosis and mandates
immediate surgical intervention.
PMID: 12193917 [PubMed - indexed for MEDLINE]
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Relationship of urodynamic parameters and obesity in
women with stress urinary incontinence.
Bai SW, Kang JY, Rha KH, Lee MS, Kim JY, Park KH.
Department of Obstetrics and Gynecology, College of Medicine, Yonsei
University, 134, Sinchon-dong, Seodaemun-gu, Seoul, Korea 120-752.
swbai@yumc.yonsei.ac.kr
OBJECTIVE: To identify the relationship of obesity and stress urinary
incontinence and of obesity and urodynamic parameters in patients with
stress urinary incontinence (SUI). STUDY DESIGN: The study included 98
women who were clinically diagnosed as having stress urinary incontinence
and 102 women, the control group, who had no stress urinary incontinence.
We compared body mass index (BMI) as a parameter of obesity between the
two groups. BMI was defined as weight (in kilograms) divided by height (in
square meters). All patients with SUI underwent urodynamic tests, and we
determined the relationship between BMI and urodynamic parameters by using
the Pearson correlation coefficient. RESULTS: There was no difference in
age between the two groups. However, BMI was significantly higher in women
with SUI than in the control group. There were more vaginal deliveries and
higher parity in women with SUI than in the control group. BMI was
significantly higher in women with SUI than in the control group only in
the younger group, while parity and number of vaginal deliveries were
higher in the SUI group than control group among all age groups. The
coefficient of multiple logistic regression between obesity and SUI was
.131 (r = .131). There was no relationship between BMI and urodynamic
parameters among patients with SUI. The average intraabdominal pressure
was significantly increased in the obese group over that in the nonobese
group. Correlation between BMI and intraabdominal pressure showed a close
relationship. CONCLUSION: BMI was higher in the SUI group than control
group. Obesity may be an important etiologic factor in SUI but did not
influence urodynamic parameters, and there was no relationship between BMI
and urodynamic parameters.
PMID: 12170533 [PubMed - indexed for MEDLINE]
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Maternal medical disease: risk of antepartum fetal
death.
Simpson LL.
Department of Obstetrics and Gynecology, New York Presbyterian Hospital,
Columbia University College of Physicians and Surgeons, NY 10032, USA.
ls731@columbia.edu
Although certain maternal medical conditions increase the risk of
antepartum fetal death, improvements in medical and obstetric care have
decreased the likelihood of stillbirth. This article examines the current
stillbirth rates reported in pregnancies complicated by common medical
diseases. The reported stillbirth rates are expressed as the number of
stillbirths occurring at > or = 20 weeks of gestation per 1,000 births in
patients with the condition. Overall, about 10% of all fetal deaths are
related to maternal medical illnesses such as hypertension, diabetes,
obesity, systemic lupus erythematosus, chronic renal disease, thyroid
disorders, and cholestasis of pregnancy. The early recognition of maternal
medical diseases provides an opportunity for increased surveillance and
interventions that may lead to more favorable pregnancy outcomes.
Publication Types:
PMID: 11876567 [PubMed - indexed for MEDLINE]
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Influence of maternal and fetal glucokinase mutations
in gestational diabetes.
Spyer G, Hattersley AT, Sykes JE, Sturley RH, MacLeod KM.
Department of Diabetes and Vascular Medicine, School of Postgraduate
Medicine, Royal Devon and Exeter Hospital, Barrack Road, Exeter, UK.
We report 2 insulin-treated pregnancies in a mother with hyperglycemia
resulting from a glucokinase gene mutation. The inheritance of a
glucokinase mutation in 1 child reduced his intrauterine growth (birth
weight less than first percentile) by reducing fetal insulin secretion. We
discuss the implications for obstetric management of patients with
glucokinase mutations.
PMID: 11483936 [PubMed - indexed for MEDLINE]
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Pregnancy after Lap-Band surgery: management of the
band to achieve healthy weight outcomes.
Dixon JB, Dixon ME, O'Brien PE.
Monash University Department of Surgery, Alfred Hospital, Melbourne,
Victoria, Australia. john.dixon@med.monash.edu.au
BACKGROUND: Severely obese women have higher obstetric risks and poorer
neonatal outcomes. Weight loss reduces obstetric risk. The introduction of
a laparoscopically-placed adjustable gastric band, a safe and effective
method of weight loss, has given us the ability and responsibility to
adjust the band in relation to pregnancy. OBJECTIVE: Our aim was to devise
a safe management plan to achieve healthy maternal weight gain (Institute
of Medicine 1990) during pregnancy. METHODS: In a cohort group of 650
patients to have a Lap-Band placement for severe obesity, we have reviewed
the management of the band and pregnancy outcomes of all women (n=20) to
complete a pregnancy (n=22) with a band in-situ. RESULTS: All 22
pregnancies were singleton, with no primary caesarean sections (3 for
recurring indications). The mean maternal weight gain was 8.3 kg compared
with 15.2 kg for the 15 previous pregnancies of women in this group
(p<0.05). There was no difference in birth weights. Obstetric
complications were minimal, and there were no premature or low birth
weight infants. 11 of 15 subjects with active management of the band
achieved a maternal weight gain within the advised range compared with
only 2 of 7 prior to this. CONCLUSION: The ability to adjust gastric
restriction allows optimal control of maternal weight change in pregnancy
and should help avoid the risks of excessive weight change.
PMID: 11361170 [PubMed - indexed for MEDLINE]
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[Effect of growth hormone on the outcome of ovulation
induction in patients with polycystic ovary syndrome]
[Article in Chinese]
Wang Y, Li M, Yang C.
Department of Obstetric and Gynecology, Third Hospital, Peking University,
Beijing 100083, China.
OBJECTIVE: To study the effect of growth hormone (GH) on the outcome of
ovulation induction in patients with polycystic ovary syndrome (PCOS).
METHODS: We examined serum sex hormone, GH and insulin like growth
factor-II (IGF-II) basal levels by radioimmunoassay in 130 PCOS patients
and 107 normal women. In addition, we observed the effect of GH on the
outcome of ovulation induction in 7 poor responders to human menopausal
gonadotropin (hMG) treatment. RESULTS: The mean serum GH level is (2.50
+/- 1.33) micrograms/L and (1.04 +/- 0.47) micrograms/L respectively in
nonobese and obese PCOS patients which were significantly lower than those
in controls [(5.30 +/- 2.26) micrograms/L, (2.95 +/- 1.49) micrograms/L
respectively, P < 0.05]. The mean serum IGF-II level is (136 +/- 27)
nmol/L in the obese PCOS patients, significantly greater than those in
nonobese PCOS and controls (P < 0.05). When we used GH with hMG in 7 poor
responders, the total amount of hMG required decreased from 1 to 12 amples
and the duration of treatment shortened as compared with hMG alone.
CONCLUSION: There is abnormal GH secretion in patients with PCOS, GH may
improve the outcome of ovulation induction by gonadotropin.
PMID: 11778543 [PubMed - indexed for MEDLINE]
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Obesity-related complications of pregnancy vary by
race.
Steinfeld JD, Valentine S, Lerer T, Ingardia CJ, Wax JR, Curry SL.
Department of Obstetrics and Gynecology, Hartford Hospital, Connecticut,
USA. jsteinfe@lij.edu
OBJECTIVE: To evaluate racial effects on obstetric complications in obese
gravidas. METHODS: The obstetric database was reviewed for the period
6/1/94 to 3/31/97. All clinic patients delivering singletons were
included. Obesity was defined as a body mass index (BMI) of 29 kg/m2 or
more, or a pre-pregnancy weight of 200 pounds or more. Complications
studied included hypertension, diabetes, cesarean delivery, and fetal
macrosomia. RESULTS: Of 2,424 eligible subjects, 168 were obese (6.9%).
Obese patients had higher rates of chronic hypertension and pregestational
diabetes, as well as increased rates of preeclampsia, gestational
diabetes, fetal macrosomia, cesarean delivery, and operative vaginal
delivery compared to nonobese patients. Of the obese patients, 105 (63%)
were Hispanic, 39 (23%) were African American, and 24 (14%) were White; no
Asian or Mixed/Other patients were obese. Mean BMIs of the obese subgroups
did not differ (P = 0.14), but prepregnancy weights were greater in Whites
than Hispanics (P < 0.002). Obese Hispanics had an increased rate of
gestational diabetes (P = 0.04) and of infant weight > or =4,500 g (P
=.03). Obese Hispanic and African American women were more likely than
obese Whites to deliver by cesarean (P = 0.03). CONCLUSION: Racial
differences affect the complication rates in obese gravidas, and may
influence prenatal counseling and pregnancy management.
PMID: 11048836 [PubMed - indexed for MEDLINE]
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Increasing maternal weight: a risk factor for
preeclampsia/eclampsia but apparently not for HELLP syndrome.
Martin JN Jr, May WL, Rinehart BK, Martin RW, Magann EF.
Department of Obstetrics and Gynecology and Preventive Medicine,
University of Mississippi Medical Center, Jackson 39216-4505, USA.
BACKGROUND: Maternal obesity is a risk factor for severe preeclampsia. We
sought to ascertain whether a similar relationship exists between maternal
weight and HELLP syndrome (hemolysis, elevated liver enzymes, and low
platelets) as an atypical form of severe preeclampsia. METHODS: In this
retrospective investigation, 434 patients with HELLP syndrome were
assigned to one of four study groups according to maternal weight and were
analyzed in relation to selected maternal and perinatal data reflective of
disease severity. RESULTS: We found no significant associations between
maternal weight and parameters of HELLP syndrome severity, race, delivery
mode, gestational age, or perinatal outcome. Significantly associated with
increasing maternal weight were maternal age, parity, admission mean
arterial pressure, peak peripartum systolic blood pressures, concurrent
essential hypertension, and the interval between admission and delivery.
Inversely associated were eclampsia and the interval between delivery and
discharge. CONCLUSIONS: Severity and complications attendant with HELLP
syndrome appear unrelated to maternal weight. Paradoxically, eclampsia
occurs most commonly in the lighter gravida with HELLP syndrome.
PMID: 10923957 [PubMed - indexed for MEDLINE]
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Benefits associated with harmonic tissue imaging in the
obstetric patient.
Treadwell MC, Seubert DE, Zador I, Goyert GL, Wolfe HM.
Division of Maternal-Fetal Medicine, Department of Obstetrics and
Gynecology, Hutzel Hospital/Wayne State University, Detroit, MI 48201,
USA. mtread@med.wayne.edu
OBJECTIVE: We sought to determine the impact of harmonic tissue imaging on
image resolution and visualization of fetal structures during obstetric
ultrasonography. STUDY DESIGN: Patients with singleton second- or
third-trimester fetuses were recruited. Prospective comparisons of
conventional fundamental imaging and harmonic tissue imaging were made.
Visualization rates and frequencies of improvement in resolution were
calculated. Discriminate function analysis evaluated determinants of
improved visualization. RESULTS: Harmonic tissue imaging improved
resolution of at least one fetal structure in 51.4% of patients studied.
Differences were most marked for 4-chamber views of the heart with
improvement in resolution in 30.5% of patients and change in ability to
visualize in 9.5%. Maternal weight and gestational age had a significant
influence on whether improvements were noted with harmonic tissue imaging,
accounting for 27% of the variance. CONCLUSIONS: Harmonic tissue imaging
offers significant improvements over fundamental imaging in image
resolution and structure visualization in obese patients during the second
trimester of pregnancy.
PMID: 10871487 [PubMed - indexed for MEDLINE]
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[Remifentanil in anesthesia and intensive care]
[Article in Italian]
Mastronardi P, Cafiero T, De Cillis P.
Dipartimento di Scienze Chirurgiche, Anestesiologiche e dell'Emergenza,
Universita degli Studi Federico II, Napoli.
Remifentanil (R) is a novel short-acting mu-receptor opioid. R is in the
same structural family as fentanyl and the other phenylpiperidines, but it
differs from fentanyl because of its pharmacokinetic profile and its
metabolism: R undergoes extrahepatic metabolism by blood and tissue
nonspecific esterases. For these reasons the time required for decreases
of any percentage plasmatic concentrations of R after termination of the
infusion is independent of infusion duration. The pharmacokinetic profile
of R is organ-independent and the dosing regimen must be regulated in
elderly patients by reducing the bolus and infusion doses, and in obese
subjects by calculating the intravenous dosages as a function of age and
lean body mass. The placental transfer of R doesn't affect the newborn as
recently described in literature but further and wider clinical
experiences are needed for assessing the use of R in obstetric anesthesia.
R causes either a reduction in the MAC of volatile anesthetics or a
decrease in propofol requirements but it cannot be used as a sole
anesthetic agent. R can be utilized to facilitate tracheal intubation
without using muscle relaxants, to manage analgesia and sedation also in
association with midazolam and/or propofol, furthermore as analgesic agent
for monitored anesthesia care, for the critical patient in ICU and for the
postoperative analgesia if a proper analgesic strategy had not been
planned.
Publication Types:
PMID: 10965728 [PubMed - indexed for MEDLINE]
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Maternal obesity and pregnancy outcome.
Michlin R, Oettinger M, Odeh M, Khoury S, Ophir E, Barak M, Wolfson M,
Strulov A.
Department of Obstetrics and Gynecology, Western Galilee Medical Center,
Nahariya, Israel. meting@naharia.health.gov.il
BACKGROUND: Obesity, a common condition in developed countries, is
recognized as a threat to health. OBJECTIVES: To describe the distribution
of weight in pregnant women and evaluate the influence of obesity on
pregnancy outcome in a high parity northern Israeli population. METHODS:
The study included 887 women who gave birth in the Western Galilee Medical
Center during the period August to November 1995. The patients were
classified as underweight, normal weight, overweight, or obese according
to body mass index. Maternal demographic, obstetric, and perinatal
variables were compared. A control group of 167 normal weight women were
matched with the obese group for maternal age, parity, and gestational
age. RESULTS: Obese mothers had a higher incidence of gestational diabetes
and pregnancy-induced hypertension compared to normal weight mothers (5.4%
vs. 1.8%, and 7.2% vs. 0.6% respectively, P < 0.01), a higher rate of
labor induction (20.4% vs. 10.2%, P < 0.01), and a higher cesarean section
rate (19.6% vs. 10.8%, P < 0.05). There was also a significant difference
in the prevalence of macrosomia in the offspring (16.8% vs. 8.4%, P <
0.05). CONCLUSION: Obese pregnant women are at high risk for complications
during delivery and therefore need careful pre-conception and prenatal
counseling, as well as perinatal management.
PMID: 10892363 [PubMed - indexed for MEDLINE]
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Perinatal outcome in grand and great-grand multiparity:
effects of parity on obstetric risk factors.
Babinszki A, Kerenyi T, Torok O, Grazi V, Lapinski RH, Berkowitz RL.
Division of Maternal-Fetal Medicine, Department of Obstetrics, Sinai
School of Medicine, New York, NY, USA.
OBJECTIVE: We sought to compare obstetric and neonatal complications among
great-grand multiparous, grand multiparous, and multiparous women. STUDY
DESIGN: One hundred thirty-three great-grand multiparas, 314 grand
multiparas, and 2195 multiparas who were delivered of their infants
between 1988 and 1998 were selected for the study. To facilitate
comparison, the patients were all >35 years old and had similar
socioeconomic characteristics. RESULTS: The incidence of malpresentation
at the time of delivery, maternal obesity, anemia, preterm delivery, and
meconium-stained amniotic fluid increased with higher parity, whereas the
rate of excessive weight gain and cesarean delivery decreased. Compared
with grand multiparas, great-grand multiparas had significantly elevated
risks for abnormal amounts of amniotic fluid, abruptio placentae, neonatal
tachypnea, and malformations but lower rates of placenta previa (P <.05).
The incidence of postpartum hemorrhage, preeclampsia, placenta previa,
macrosomia, postdate pregnancy, and low Apgar scores was significantly
higher in grand multiparas than in multiparas, whereas the proportion of
induction, forceps delivery, and total labor complications was
significantly lower than in the multiparous group (P <.05). Similar
frequency of maternal diabetes, infection, uterine wall scar rupture,
variations in fetal heart rate, fetal death, and neonatal mortality was
found in the 3 groups. CONCLUSION: Both high-parity groups have their own
risk factors, but the rate of some complications decreases with higher
parity. In addition, perinatal mortality remains low in these patients,
and therefore, under satisfactory socioeconomic and health care
conditions, high parity should not be considered dangerous.
PMID: 10486482 [PubMed - indexed for MEDLINE]
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Shoulder dystocia: an obstetric emergency.
Bennett BB.
Department of Obstetrics and Gynecology, University of Florida College of
Medicine, Gainesville, USA.
Shoulder dystocia is one of the most dreaded complications of vaginal
delivery encountered by the obstetrician. Although risk factors for
shoulder dystocia exist, approximately 50% of cases do not demonstrate the
classic predisposing signs. Obstetricians can help patients decrease their
risk for fetal macrosomia by frequent attention to weight gain, nutrition,
and exercise during pregnancy and by aggressive management of diabetes.
All obstetricians must be familiar with the maneuvers used to effect
delivery of impacted shoulders and must be prepared to institute these
maneuvers immediately in a crisis situation.
Publication Types:
PMID: 10472064 [PubMed - indexed for MEDLINE]
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Obesity and related pregnancy complications in an
inner-city clinic.
Bowers D, Cohen WR.
Department of OB/GYN, Sinai Hospital of Baltimore, Baltimore, MD 21215,
USA.
OBJECTIVE: The study was designed to determine the prevalence of obesity
and related pregnancy complications in an inner-city prenatal clinic.
STUDY DESIGN: A retrospective review was conducted of the medical records
of 281 women with no chronic diseases and who delivered singleton term
babies during a 1-year period. The frequencies of various pregnancy
complications, including pregnancy-induced hypertension, preeclampsia,
gestational diabetes, shoulder dystocia, postpartum hemorrhage, fourth
degree laceration, intrauterine growth restriction, and macrosomia, were
compared among groups of patients stratified by body mass index (BMI).
RESULTS: Thirty-four percent of patients had a reported prepregnancy BMI
of > 26 kg/m2. Fifty-two percent of patients were obese (BMI > 26 kg/m2)
when they registered for prenatal care, and 82% of patients had a BMI > 26
kg/m2 at the time of delivery. The incidence of birth weights of > 4 kg
was significantly higher in women with a registration BMI > 26 kg/m2 (p =
0.026). Most of these macrosomic babies had mothers with a BMI > 29 kg/m2.
Patients who required cesarean delivery had significantly higher BMI than
those who were delivered vaginally (p < 0.001). CONCLUSION: Obesity was
more common in our inner-city population than has previously been reported
and was associated with an increased risk of fetal macrosomia and
operative delivery.
PMID: 10685225 [PubMed - indexed for MEDLINE]
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Simplified abdominal wall-lifting device for gasless
laparoscopy.
Tintara H, Leetanaporn R, Getpook C, Suntharasaj T.
Faculty of Medicine, Department of Obstetrics and Gynecology, Prince of
Songkla University, Thailand.
OBJECTIVE: To develop a simplified abdominal wall-lifting device for
gasless laparoscopy. METHODS: The device is composed of an electric-power
actuator, sliding arm and abdominal wall-retractor. All parts of the
device are reusable. The device provides planar displacement of the
anterior abdominal wall to enable space for laparoscopy. The valveless
ports and conventional instruments, as well as laparoscopic instruments,
were used without a gas leak problem. RESULTS: After preliminary success
in the laboratory testing, a petition was made to the hospital's Ethic
Committee. Since then we have performed 40 gasless laparoscopic procedures
including 13 salpingo-oophorectomies, 10 diagnostic laparoscopies, five
tubal ligations, five ovarian cystectomies, four salpingectomies, two
removals of pelvic IUDs and one laparoscopic hysterectomy. There were no
surgical complications, including no abdominal wall trauma. The operative
field was almost the same as that of the pneumoperitoneum technique, with
the exception of morbidly obese patients. CONCLUSIONS: This preliminary
experience demonstrates the efficiency of the simplified abdominal
wall-lifting device and the potential advantages of gasless laparoscopy.
Continued modifications and applications are necessary to delineate the
full range of benefits of this device and technique, especially in
developing countries.
PMID: 9639221 [PubMed - indexed for MEDLINE]
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Anti-aspiration prophylaxis in New Zealand: a national
survey.
Kluger MT, Willemsen G.
Department of Anaesthesia, Auckland Hospital, New Zealand.
A postal questionnaire was sent on two occasions to specialist
anaesthetists within New Zealand. Questions were related to fasting
status, anti-aspiration prophylaxis, incidence of aspiration, definition
of high risk groups for aspiration pneumonitis, and identification of
departmental guidelines. Two-hundred-and-twenty-three replies were
received (72% response rate). Most adults, children and infants were
fasted for 6 hours for solids, whilst the majority fasted for 2 to 4 hours
for liquids. Two-thirds indicated that they would delay emergency surgery
(not life/limb threatening) to optimize gastric emptying. Histamine type 2
receptor antagonists, metoclopramide and cricoid pressure were used
commonly, more so in the obstetric population compared to non-obstetric
surgery. Preinduction nasogastric intubation and suction were used
infrequently. Anti-aspiration prophylaxis was deemed important in morbidly
obese patients, those in the third trimester of pregnancy and those with a
hiatus hernia, whilst diabetes mellitus, sepsis and renal failure were not
considered risk factors for aspiration pneumonitis. 71% of respondents had
at least one episode of aspiration (range 0-10), with an overall mortality
rate of 5%. Half of these cases of aspiration were deemed to be
preventable by the respondent.
PMID: 9513672 [PubMed - indexed for MEDLINE]
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Maternal weight and fetal injury at birth: data
deriving from medico-legal research.
Sama JC, Iffy L.
Institute of Forensic Medicine Novi Sad.
The relationships among maternal weight, gestational weight gain, fetal
birth weight and birth injuries have been investigated in connection with
62 cases of shoulder dystocia that involved permanent impairment of the
newborn or neonatal demise. A high prevalence of > 13.5 kgs. gestational
weight increase between the first and last office visits (62%) obesity
expressed as > or = 87 kg. body weight at term (64.1%) and > or = 4000 gm.
birth weight (80%) was found in this group of patients. The results
indicate that the relationship between excessive maternal and fetal body
weights and shoulder dystocia related fetal or neonatal impairment is
closer than previous studies have suggested. These results underline the
importance of appropriate and intensive nutritional counselling of the
mother throughout pregnancy, noting that arrest of the shoulders is only
one of those obstetric complications that are closely related to maternal
obesity. The findings underline the usefulness of medico-legal reviews in
clinical research.
PMID: 9646593 [PubMed - indexed for MEDLINE]
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Anaesthetic management of high-risk obstetric patients.
Schneider MC.
Department of Anaesthesia, Kantonsspital Basel/University Women's
Hospital, Basel, Switzerland.
PMID: 9420997 [PubMed - indexed for MEDLINE]
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[Delivery of the overweight woman. Analysis of 115
patients]
[Article in French]
Giacalone PL, Dayrolle S, Boulot P, Hedon B, Laffargue F.
Services de Gynecologie et Obstetrique, Hopital A. de Villeneuve,
Montpellier.
OBJECTIVE: Our purpose was to assess the effect of weight gain during
pregnancy on labor and delivery. Abnormal pregnancies were excluded from
the study to avoid interaction with the management of labor. POPULATION
AND METHODS: A retrospective monocentric case-control study was carried
out. We analysed 115 pregnancies delivered in our institution between June
1994 and November 1994. The course of labor was studied in 2 groups of
patients: a group of overweight patients and a control group. RESULTS: In
the overweight patients, the frequency of induction of labor (25%) and of
obstetrical analgesia (82%) was significantly higher than in the control
group (respectively 7% and 64%), as well as the average duration of labour
and the average duration of the rupture of the membranes. The rate of
cesarean section was higher in the overweight patient group (16.7%) than
in the control group (3.7%). The difference was not significant because of
the small number of patients. CONCLUSION: These results show a more
frequent requirement of induction of labour, analgesia, and cesarean
section in overweight patients. This led us to propose a multidisciplinary
management of overweight patients to minimize these different obstetrical
risks during labor.
PMID: 9265051 [PubMed - indexed for MEDLINE]
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Comment in:
Sciatic nerve palsy following childbirth.
Silva M, Mallinson C, Reynolds F.
Department of Neurology, St Thomas' Hospital, London.
Two cases are reported of sciatic nerve palsy after delivery by Caesarean
section in primigravidae. One mother was slender and had an emergency
Caesarean section for failure to progress with a breech presentation.
Epidural analgesia during labour was extended for operative delivery. The
other mother was obese, mildly hypertensive, had a large baby with a high
head and was delivered by elective Caesarean section under epidural
anaesthesia. She experienced severe intrapartum hypotension. Both patients
suffered right sided sciatic nerve palsy. The aetiologies of obstetric
palsies and those following regional block are reviewed and the importance
of careful diagnosis and of avoiding peripheral nerve compression during
regional block are emphasised.
Publication Types:
PMID: 9038451 [PubMed - indexed for MEDLINE]
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Effect of pregnancy on maternal oxygen saturation
values: use of reflectance pulse oximetry during pregnancy.
Van Hook JW, Harvey CJ, Anderson GD.
Department of Obstetrics and Gynecology, University of Texas Medical
Branch at Galveston 77555-0587, USA.
Our objective was to evaluate the usefulness of pulse oximetry monitoring
in a large population of pregnant patients. We designed our study to
measure pulse oximetry saturation in a cross section of 952 obstetric
inpatients and outpatients. A group of 366 patients identified as normal
were compared with abnormal subgroups. A subgroup of 64 patients with
saturation measurements less than 96% were further evaluated. Our results
indicated that oxygen saturation values did not change appreciably during
the course of pregnancy in normal patients. Hypoxemia (saturation
measurement less than 96%) was associated with smoking, and hypoxemia with
preterm labor occurred more frequently in patients who smoked. Obesity and
magnesium sulfate use appeared to be synergistic in the presence of
hypoxemia. We concluded that the routine use of pulse oximetry during
pregnancy may not be justified. Smoking, obesity, and magnesium sulfate
use have some effect on oximetry in pregnant patients.
PMID: 8969354 [PubMed - indexed for MEDLINE]
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Audit of sphincter repair. Factors associated with poor
outcome.
Nikiteas N, Korsgen S, Kumar D, Keighley MR.
University Department of Surgery, Queen Elizabeth Hospital, Birmingham,
United Kingdom.
PURPOSE: This study was designed to critically analyze the outcome of
sphincter repair and, if possible, to identify high-risk factors. METHODS:
Clinical and physiologic assessment was made of all sphincter repairs (42
patients) performed in one unit by two surgeons during five years.
RESULTS: Forty-two patients (10 men, 32 women) underwent sphincter repair.
Only three of five men with anterior defects of the anorectum from
perineal trauma were rendered continent. Only three of five men with
defects from fistula operations became continent, but one improved by
later graciloplasty. All six women with fistula-related injuries
eventually achieved continence, but two required repeat sphincter repairs
because of early breakdown from sepsis. The worst results were in 26 women
with third-degree obstetric injuries, of whom 11 remain incontinent; poor
results in this group were associated with gross perineal descent,
obesity, and age older than 50 years; two or more of these factors
indicated a poor outcome. Preoperative anorectal physiology did not
identify a poor-risk group. CONCLUSIONS: Poor results were identified in
women with anterior defects from obstetric trauma, especially if they were
obese, older than 50 years of age, and had perineal descent.
PMID: 8831535 [PubMed - indexed for MEDLINE]
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Neonatal outcome and obstetric complications in women
with gestational diabetes: effects of maternal body mass index.
Di Cianni G, Benzi L, Bottone P, Volpe L, Orsini P, Murru S, Casadidio
I, Clemente F, Navalesi R.
Department of Metabolic Disease, Institute of Clinical Medicine II,
University of Pisa, Italy.
OBJECTIVE: To evaluate in a selected population the clinical
characteristics (time of diagnosis, different treatment, metabolic
parameters, etc.) of gestational diabetes in relation to prepregnancy body
mass index (BMI) and the influence of BMI on neonatal outcome. DESIGN:
This study was retrospectively led using a computerized data system for
all deliveries that occurred at the Departments of Obstetrics and
Gynecology of the University of Pisa (Italy) from 1 January 1987 to 31
December 1992. SUBJECTS: 93 women with GDM and 110 control subjects
divided into three groups according to their pre-pregnancy BMI: normal
weight (Nw), overweight (Ow) and obese (Ob). MEASUREMENTS: Time of
diagnosis, mode of treatment and metabolic control of GDM; time and mode
of delivery, neonatal outcome (macrosomia, respiratory distress syndrome,
hyperbilirubinemia, hypoglycemia, polycythemia, hypocalcemia). RESULTS:
GDM was diagnosed earlier in Ow and Ob than in Nw (p < 0.01) and insulin
treatment was used in 86% of Ob-GDM, 91% of Ow-GDM and in 77% of Nw-GDM
women (p < 0.001). Preterm deliveries and cesarean sections resulted
significantly increased in all BMI categories of GDM patients with respect
to matched normal controls. Prevalence of neonatal macrosomia was higher
in GDM patients (44.6%) compared with normal controls (15.4%) and
correlated (p > 0.01) with prepregnancy BMI in both groups. The body
weight increase during pregnancy was not associated with neonatal
macrosomia. CONCLUSIONS: The degree of overweight is associated with an
earlier diagnosis of GDM; prepregnancy BMI is more predictive of
macrosomia than weight gain, both in control and GDM women; GDM seems to
play the most important role in increasing the possibility of the
occurrence of macrosomia.
PMID: 8696423 [PubMed - indexed for MEDLINE]
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Abdominal pain in the postpartum: role of imaging.
Van Hoe L, Gryspeerdt S, Amant F, Marchal G, Baert AL, Spitz B.
Department of Radiology, University Hospitals, Leuven, Belgium.
The post-delivery evaluation of the obstetric patient presenting with
severe abdominal pain can be a challenge to the obstetrician, the
internist, and the radiologist. Besides non-pregnancy-related causes of
abdominal pain, several pregnancy-related complications should be included
in the list of differential diagnoses. Based on pathogenesis, these
conditions can be divided in four categories: thromboembolic disease,
infectious complications, mechanical complications, and complications of
preeclampsia. Most disease processes can be adequately visualized with
sonography. CT can be indicated for the evaluation of the extent of
ovarian vein thrombosis and for depiction of deep abdominal collections in
obese patients or in cases of abundant overlying abdominal gas. MRI can be
useful to provide the specific diagnosis of hemorrhagic liver infarction
in the clinical setting of a HELLP syndrome.
Publication Types:
PMID: 7592284 [PubMed - indexed for MEDLINE]
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Comment in:
Parturient's posture during epidural puncture affects
the distance from skin to epidural space.
Hamza J, Smida M, Benhamou D, Cohen SE.
Department of Anesthesia and Intensive Care, Hopital Antoine Beclere,
Clamart, France.
STUDY OBJECTIVE: To assess the factors affecting the distance from skin to
epidural space. DESIGN: Prospective observational study of consecutive
cases over a 2-year period. SETTING: Inpatient obstetric unit in a French
university hospital. PATIENTS: 2,123 consecutive term parturients who
received epidural anesthesia for cesarean section or epidural analgesia
for labor and vaginal delivery. INTERVENTIONS: At the time of epidural
puncture, the interspace used and the patient's posture (sitting or left
lateral decubitus) were recorded, and the distance from the skin to the
epidural space (DS-ES) was measured to the nearest 0.5 cm using a marked
epidural needle. MEASUREMENTS AND MAIN RESULTS: The relationship between
patient factors [height, weight, body mass index (BMI; weight/height2),
presence of scoliosis] and technical factors (interspace, patient's
posture at puncture) versus DS-ES was investigated using multiple
regression analysis. DS-ES correlated positively with the parturient's
weight and BMI. In addition, DS-ES was significantly greater when epidural
puncture was performed in the lateral position as compared with the
sitting position. CONCLUSION: Both the patient's weight and position
during epidural needle placement are important factors influencing DS-ES.
A change from the sitting to the lateral position may increase DS-ES,
causing catheter dislodgment and consequent inadequate analgesia. Clinical
studies relating DS-ES to inadequate analgesia must take these factors
into account.
PMID: 7772351 [PubMed - indexed for MEDLINE]
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[Influence of body weight in pregnancy and the
perinatal results]
[Article in Spanish]
Robinovich J T, Rubio E L, Saez J C, Ramirez M I.
Servicio y Departamento de Obstetricia y Ginecologia Hospital San
Borja-Arriaran, Universidad de Chile.
Between 1988-1922, data of the nutritional status of pregnant women seen
in the Santiago Metropolitan Health Service were analyzed. Underweight
(22.2%), normal weight (47.2%), overweight (19.7%) and Obese (15.4%). Four
thousand five hundred fifty five pregnant women were studied. Underweight
1136, normal weight 1219, overweight 1100 and obese 1100. Underweight was
significantly more frequent in the patients less than 20 years old while
overweight and obese was significantly more frequent in the patients over
30 years old. Hypertension (2.6%) was the only significant morbidity
factor in the obese group. The overweight and obese groups had earlier
menarche, while the obese group had shorter periods. The obese group were
associated most frequently with higher parity (75.1%), stillbirth (4.6%),
spontaneous abortion (19.5%), induced abortion (3.1%) and high obstetric
risk (33.2%). In the normogram used, the underweight patients are
abnormally represented at the start of pregnancy. The obese group gained
less weight proportionally during pregnancy (overweight and obese 42.8%,
underweight and normal 34.7%). The obese group presented more frequently
with hypertension (20.4%) and diabetes (0.7%), while the obstetric
complications occurred more frequently in the underweight (6.3%). The
underwent group had more anemia (45.4%) and premature labor (12.3%).
Cesarean section was performed more frequently in the obese group (33.1%
versus 21.3% of all the other groups combined. The neonatal birthweight
was in direct proportion to the maternal weight, measured by various
methods. It is worth noting the importance of microelements in the milk
ingestion of the pregnant patients and the influence on their weight.
PMID: 8728743 [PubMed - indexed for MEDLINE]
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Nutritional risk factors and breast cancer in Jewish
and Arab women.
Henquin N, Trostler N, Horn Y.
Department of Oncology, Assaf Harofeh Medical Center, Zerifin, Israel.
Based on a lower reported incidence of breast cancer in the Arab
population in Israel, nutritional levels were evaluated in a case-control
study of 33 Jewish and 10 Arab patients with breast cancer all matched
with a first-degree family-related control. Demographic, gynecologic,
obstetric, anthropometric, genetically tumor-related, and nutritional data
were ascertained through interviews, tests, and questionnaires. Food
consumption, calories, protein, fat, and fiber intake, and anthropomorphic
measures were calculated. The following results were obtained: 1. Calories
of food consumption were significantly higher in Jewish and Arab patients
than in their controls. 2. Jewish patients consumed significantly higher
levels of monounsaturated fat; Arab patients consumed significantly higher
levels of dietary fiber. 3. Animal protein intake was elevated in patients
of both ethnic origins as compared with controls. 4. Vegetable fat and
monounsaturated fatty acids were elevated in Arab patients as compared
with Jewish patients. 5. Body weight of both Arab and Jewish patients was
not significantly higher when compared with their controls. 6. Energy
consumption and obesity were higher in breast cancer patients than in the
controls. This supporting evidence suggests an association between obesity
and breast cancer occurrence.
PMID: 7954380 [PubMed - indexed for MEDLINE]
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Comment in:
Risk factors for severe preeclampsia.
Stone JL, Lockwood CJ, Berkowitz GS, Alvarez M, Lapinski R, Berkowitz
RL.
Department of Obstetrics, Gynecology, and Reproductive Science, Mount
Sinai Medical Center, New York, New York.
OBJECTIVE: To identify risk factors associated with severe preeclampsia
and to determine whether these factors are similar in nulliparous and
multiparous patients. METHODS: Patients whose pregnancies were complicated
by severe preeclampsia (n = 70) were compared retrospectively to 18,964
non-preeclamptic controls. Information on maternal demographic factors;
medical, obstetric, and family histories; and neonatal outcome was
retrieved and analyzed by univariate and multivariate analysis. RESULTS:
By logistic regression, the only risk factors associated with the
development of severe preeclampsia were severe obesity in all patients
(adjusted odds ratio 3.5, 95% confidence interval [CI] 1.68-7.46) and a
history of preeclampsia in multiparous patients (adjusted odds ratio 7.2,
95% CI 2.74-18.74). CONCLUSION: Severe obesity and a history of
preeclampsia are the only maternal risk factors identified for the
development of severe preeclampsia.
PMID: 8127525 [PubMed - indexed for MEDLINE]
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Obstetric challenges of massive obesity complicating
pregnancy.
Isaacs JD, Magann EF, Martin RW, Chauhan SP, Morrison JC.
Department of Obstetrics and Gynecology, University of Mississippi Medical
Center, Jackson 39216-4505.
This study examined the effects of massive maternal obesity on medical
complications, mode of delivery, postpartum complications, and hospital
confinement. In this retrospective case control study, women weighing >
300 pounds delivering from January 1, 1986, to November 1, 1991, were
matched for age, race, parity, and height with lean parturient women (mean
weight 160 +/- 21 pounds). Among massively obese women there was a greater
incidence of chronic hypertension (p < 0.05) and diabetes (p < 0.05) than
in the control group. Primary cesarean section was more frequent (p <
0.05), as was the postoperative complication of endometritis when obese
patients were compared with lean women (p < 0.05). Cephalopelvic
disproportion was the only indication for primary cesarean section, which
occurred with greater frequency in the obese group. The postpartum
hospital confinement was also significantly longer in the obese study
group (p < 0.05). The gestation of a massively obese parturient woman is
more frequently complicated by chronic hypertension and diabetes.
Abdominal delivery for cephalopelvic disproportion is more likely, and
this mode of birth is more often followed by endometritis, which results
in longer hospital stays.
PMID: 8169671 [PubMed - indexed for MEDLINE]
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Anesthetic and obstetric outcome in morbidly obese
parturients.
Hood DD, Dewan DM.
Department of Anesthesia, Wake Forest University Medical Center,
Winston-Salem, North Carolina 27157-1009.
BACKGROUND: Large studies reporting anesthetic outcome for morbidly obese
parturients are lacking. This study compares the anesthetic and obstetric
outcome in morbidly obese parturients and matched control parturients.
METHODS: Anesthesia records were prospectively collected for all patients
delivering between September 1978 and November 1989 whose weight exceeded
136.4 kg (300 pounds) at the time of delivery. A retrospective control
patient group was collected by matching the first patient weighing less
than 136.4 kg, delivered in the same month by the same obstertrician, to
the corresponding morbidly obese parturient. Anesthetic and obstetric
outcome variables were extracted from medical records and analyzed.
RESULTS: Sixty-two percent of 117 morbidly obese women underwent cesarean
section, while only 24% of control patients delivered abdominally (P <
0.05). Forty-eight percent of all laboring morbidly obese parturients
required emergency cesarean section, compared with 9% of control laboring
parturients (P < 0.05). Epidural anesthesia was used successfully for
labor and cesarean delivery in 74 of 79 morbidly obese women and 66 of 67
control patients. When compared with control patients, initial epidural
anesthesia failure was significantly more likely in morbidly obese women,
requiring epidural catheter replacement. Difficult tracheal intubation
occurred in 6 of 17 morbidly obese women, compared with 0 of 8 control
women (P = 0.06). Morbidly obese women had increased incidences of
antepartum medical disease, prolonged cesarean section operation times,
serious postoperative complications, and increased hospital stays.
CONCLUSIONS: The high incidences of antepartum medical disease and
emergency cesarean section complicate anesthetic care in the morbidly
obese parturients. Epidural anesthesia is feasible; however, the high
initial failure rate necessitates early catheter placement, critical block
assessment and catheter replacement when indicated, and provision for
alternative airway management.
PMID: 8267196 [PubMed - indexed for MEDLINE]
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The influence of obesity on the relationship between
body mass index and the distance to the epidural space from the skin.
Watts RW.
The Investigator Clinic, Port Lincoln, South Australia.
This study confirms that distance to the epidural space from the skin at
the L3-4 interspace is only moderately correlated with body mass index in
obstetric patients. A similar moderate linear correlation was found in the
non-obstetric patients. However, in obese patients (BMI > 25), distance to
epidural space from the skin correlated poorly with body mass index.
PMID: 8342760 [PubMed - indexed for MEDLINE]
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[The biochemical changes in overweight pregnant women
during the pregnancy]
[Article in Bulgarian]
Krusteva M, Malinova M, Vulcheva Z, Milchev N, Grozdanov G.
The degree of weight gain during pregnancy as a risk factor for a mother
and her newborn is a disputable problem. Most of the studies have shown,
that maternal overweight gain has a bad effect on labor delivery outcome.
The present study included 108 pregnant women, subdivided into three
groups, according to weight gain during pregnancy: Group I(32) - < 12 kg,
Group II(42) - 12 < - < 20 kg. Group III(34) - > 20 kg. The patients were
estimated according to their age, parity, pregnancy induced hypertension
and mode of delivery. The authors investigated biochemical indicators of
protein, lipid and electrolyte balance. The results illustrate the
influence of prenatal overweight gain on the pregnancy complication, mode
of delivery and some biochemical changes.
PMID: 8037320 [PubMed - indexed for MEDLINE]
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The role of the endocrine factors and obesity in
hormone-dependent gynecological neoplasias.
Maggino T, Pirrone F, Velluti F, Bucciante G.
Gynaecologic Obstetric Institute, University of Padua.
Between September 1990 and February 1992, we studied 70 women of
post-menopausal age, of whom 33 were affected by hormone-dependent
gynecologic tumors and 37 by other pathologies, measuring estrogens,
androgens, SHBG and also measuring excess fat and its distribution. The
aim of our research was to ascertain what relation there was between
adipose tissue, taking account central or peripheric localization, the
levels of sex steroids and the onset of endometrial and breast cancer. In
the group of tumor patients, we found a quantity of fat mass greater than
in the control group (p < 0.05); there was, beside, in the first group, an
inverse proportional correlation between the SHBG levels and BMI, and
between SHBG and the fat mass (P < 0.05). We also observed an inverse
relation between the levels of testosterone and SHBG (P < 0.05). These
findings confirm the role that the adipose tissue and androgens would have
on the globulin production, which in turn would reflect on the percentage
of potentially active steroids in endometrial and mammary tissues. We also
wished to ascertain if the distribution of fatty tissue (prevalently
abdominal or prevalently gluteo-femoral) could have different
endocrine-metabolic consequences. We found a directly proportional
relation between an index of central obesity, the T/L Ratio, and the
levels of DHA-S (P < 0.05), but the significance of this relation is not
clear, inasmuch as DHA-S is one of the least active of the
androgens.(ABSTRACT TRUNCATED AT 250 WORDS)
PMID: 8500493 [PubMed - indexed for MEDLINE]
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Obstetric and birthweight differences between
Vietnam-born and Australian-born women.
Henry OA, Guaran RL, Petterson CD, Walstab JE.
University of Melbourne, Mercy Hospital for Women, East Melbourne, VIC.
OBJECTIVES: To measure the frequency of obstetrical complications and
assess the outcome of pregnancies in Vietnam-born mothers; to compute
birthweight percentile charts for their infants; and to compare these
parameters in Vietnam-born women with those of a control group of
Australian-born women. DESIGN: A retrospective study of all pregnancies in
Vietnam-born and Australian-born mothers managed in the Mercy Hospital for
Women over a 10-year period, 1979-1988 inclusive. SETTING: The Mercy
Hospital for Women provides primary and secondary obstetric care to public
and private patients. PATIENTS: All women born in Australia or Vietnam who
delivered in the Mercy Hospital for Women, Melbourne, over the 10-year
period and their infants. Twins, stillborn babies and infants with
congenital malformations were not included in the calculation of
birthweight percentiles. RESULTS: Gestational diabetes (7.3% v. 4.3%, P
less than 0.0001) and low oestriol excretion (14.4% v. 10.8%, P less than
0.0001) were more common whereas essential hypertension (0.3% v. 1.2%, P
less than 0.001) and pre eclampsia (3.7% v. 8.6%, P less than 0.0001) were
less common among Vietnam-born mothers. Intervention for labour and
delivery was less common among Vietnam-born mothers: induction of labour
(7.1% v. 24.7%, P less than 0.0001) and forceps delivery (17.8% v. 21.9%,
P less than 0.001); caesarean section rates were similar. Infants of
Vietnam-born mothers were significantly lighter than those of
Australian-born; percentile charts for birthweight and gestational age are
presented. CONCLUSIONS: Pregnancies among Vietnam-born women migrants in
Australia were associated with few complications in spite of a higher
incidence of gestational diabetes and a low oestriol excretion. The
infants were lighter than those born to Australian-born mothers. Our
percentile charts for birthweight relative to gestational age will provide
a more accurate assessment of intrauterine growth for these infants.
PMID: 1588863 [PubMed - indexed for MEDLINE]
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[Pregnancy and obesity. A case control study of 140
cases]
[Article in French]
Le Thai N, Lefebvre G, Stella V, Vauthier D, Sfoggia D, Goulon V,
Darbois Y.
Service de Gynecologie et d'Obstetrique, CHU Pitie-Salpetriere, Paris.
A retrospective study of 70 fat women and 70 women of normal weight was
carried out to compare their obstetric performance. The patients were
assessed before pregnancy for corpulence by estimating the body mass index
(IMC). Obesity was defined by having an index of 30 or above. The mean
weight of the obese patients at delivery was 142 kgs and of the controls
65.4 kgs. The main risk in obese patients is a raised blood pressure
(34%); and in spite of this no child showed intrauterine growth
retardation. The mean weight of the newborn infants was 3.7 kgs against a
mean weight of 3.2 kgs in the control group. Eighteen infants born to
obese mothers were very heavy (25%). The increase in fetal weight explains
why the caesarean section rate was three times as high in the obese
patients as in the control due to disproportion (25%). These differences
are statistically significant. Neonatal morbidity was similar in the two
groups. It is debatable whether a slimming diet was worthwhile. All the
same calorie intake reduced slightly to about 1.800 calories a day
together with vitamin supplements is advisable. It does not have any ill
effect on the fetus.
PMID: 1401773 [PubMed - indexed for MEDLINE]
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Gynecologic-obstetric changes after loss of massive
excess weight following bariatric surgery.
Deitel M, Stone E, Kassam HA, Wilk EJ, Sutherland DJ.
Department of Nutritional Sciences, University of Toronto, Ont. Canada.
A clinical study was undertaken to assess gynecologic-obstetric changes in
morbidly obese women who lost greater than or equal to 50% of their excess
weight with bariatric surgery. The 138 females (109 of reproductive age),
age 35 +/- 9 SD yr, weighed 124 +/- 23 kg before surgery and 79 +/- 13 kg
after weight loss had stabilized. Menstrual irregularities were present in
40.4% of premenopausal patients preoperatively; after massive weight loss,
cycles were abnormal in 4.6% (p less than 0.001). Infertility problems
were present preoperatively in 29.3% Of these, nine tried to conceive
after weight loss and were successful. During past pregnancies, medical
complications were frequent (hypertension 26.7%, pre-eclampsia 12.8%,
diabetes 7.0%, and deep vein thrombosis 7.0%). After weight-loss
stabilization, these obstetric complications did not occur. Incidence of
urinary stress incontinence decreased from 61.2% to 11.6% (p less than
0.001). Gynecologic-obstetric changes tended to normalize after loss of
massive body weight.
PMID: 3361039 [PubMed - indexed for MEDLINE]
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[Study on pregnancy, delivery, and nutritional
education of obese patients]
[Article in Japanese]
Suzuki H, Takehara M, Tsuji M, Nakatani K, Takahama H.
PMID: 3650351 [PubMed - indexed for MEDLINE]
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Pseudotumor cerebri and pregnancy.
Digre KB, Varner MW, Corbett JJ.
Pseudotumor cerebri (PTC) is most commonly seen in obese women of
reproductive age. We studied 109 women with PTC between ages 16 and 44
years. In 11, PTC started during pregnancy. Thirteen women with previous
diagnosis of PTC, including two of the aforementioned 11, had an
additional 17 documented pregnancies. Patients were matched by age and
parity with controls. Obstetric complications occurred more frequently in
the controls. Visual loss occurred with the same frequency in pregnant and
nonpregnant patients. Treatment of PTC patients in pregnancy should be the
same as for nonpregnant PTC patients, except that calorie restriction and
diuretic use are contraindicated. Obstetric management is no different
from that of normal pregnancy.
PMID: 6539432 [PubMed - indexed for MEDLINE]
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