This document discusses the effects of obesity on reproduction. It notes that obesity can affect menstruation, sexual function, fertility, and pregnancy in both males and females. It outlines specific ways that obesity impacts menstruation, sexual desire and function, semen quality, testicular volume, hormone levels, and risk of infertility in males. In females, it discusses how obesity can contribute to irregular cycles, PCOS, impaired sexual function, poor response to fertility treatments, and increased risk of complications during pregnancy and delivery. The document provides recommendations for managing obesity both before and during pregnancy to help mitigate risks.
Ovulation Induction - Simplified - Dr Dhorepatil BharatiBharati Dhorepatil
What are factors to be considered
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of FSH & LH
Trigger
Luteal phase support
Pregnancy rate/cycle
Individualizing Ovarian Stimulation Protocols for IVFSherInstitute
Have you experienced poor response to IVF medications? Been told you had "Empty Follicle Syndrome?" Had lots of eggs retrieved but very few fertilized? Experienced Ovarian Hyperstimulation Syndrome? All of these issues can be tied to or affected by your protocol of stimulation. Dr. Geoffrey Sher presents his approach to customizing ovarian stimulation based on 30 years' experience in the IVF field. He outlines a number of his stimulation protocols and discusses the factors that can cause IVF failure due to improper stimulation protocols.
Ovulation Induction - Simplified - Dr Dhorepatil BharatiBharati Dhorepatil
What are factors to be considered
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of FSH & LH
Trigger
Luteal phase support
Pregnancy rate/cycle
Individualizing Ovarian Stimulation Protocols for IVFSherInstitute
Have you experienced poor response to IVF medications? Been told you had "Empty Follicle Syndrome?" Had lots of eggs retrieved but very few fertilized? Experienced Ovarian Hyperstimulation Syndrome? All of these issues can be tied to or affected by your protocol of stimulation. Dr. Geoffrey Sher presents his approach to customizing ovarian stimulation based on 30 years' experience in the IVF field. He outlines a number of his stimulation protocols and discusses the factors that can cause IVF failure due to improper stimulation protocols.
Obesity has many deleterious effects for women of reproductive age.
In the first place, obese women are more likely to encounter problems becoming pregnant and they are more likely to miscarry
They are at greater risk of developing pregnancy complications and problems associated with labour and delivery.
Finally, obese women are more at risk of postpartum complications .
Taken all together, maternal mortality and morbidity is significantly elevated for obese women .
Maternal obesity is also dangerous for the fetus and the newborn.The management of obesity requires a multidisciplinary approach.
Stepwise programmes with realistic time-related goals are required, starting with modification of lifestyle, progressing to pharmacotherapy and ultimately obesity surgery.
Weight loss interventions do not appear to be common practice among fertility centres& pre-pregnancy clinics in spite of clear evidence as to the benefits.
Women should be referred to a nutritionist in cases where clinicians lack the knowledge and/or time to provide adequate counselling.
the objective is to clarify the problem of recurrent implantation failure , regarding the definition, the caused, diagnosis, and management in cases of IVF
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
Obesity has many deleterious effects for women of reproductive age.
In the first place, obese women are more likely to encounter problems becoming pregnant and they are more likely to miscarry
They are at greater risk of developing pregnancy complications and problems associated with labour and delivery.
Finally, obese women are more at risk of postpartum complications .
Taken all together, maternal mortality and morbidity is significantly elevated for obese women .
Maternal obesity is also dangerous for the fetus and the newborn.The management of obesity requires a multidisciplinary approach.
Stepwise programmes with realistic time-related goals are required, starting with modification of lifestyle, progressing to pharmacotherapy and ultimately obesity surgery.
Weight loss interventions do not appear to be common practice among fertility centres& pre-pregnancy clinics in spite of clear evidence as to the benefits.
Women should be referred to a nutritionist in cases where clinicians lack the knowledge and/or time to provide adequate counselling.
the objective is to clarify the problem of recurrent implantation failure , regarding the definition, the caused, diagnosis, and management in cases of IVF
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
Obesity in pregnancy is now rampant and bringing about concern because of the associated morbidity and mortality both to the mother and child. All hands must be on deck to prevent and manage this condition and associated sequel.
Dr Anil Arora address the liver diseases that are specific during pregnancy. The presentation contains case discussions on diagnosis, treatments & take home messages
IVF Pregnancy -Is it different? A presentation by Dr Laxmi Shrikhande the leading IVF specialist in India
IVF (In Vitro Fertilization) pregnancy can be both similar to and different from natural conception in several ways. In IVF, fertilization of the egg occurs outside the body in a laboratory setting, typically involving the extraction of eggs from the ovaries and combining them with sperm in a petri dish. Once fertilization is successful, the resulting embryos are transferred to the uterus for implantation
This presentation focuses on common obstetrics emergencies. These include early pregnancy complications such as miscarriages and ectopic pregnancy. As well as abdominal pain. Other include haemorrhage, hypertensive state, and sepsis.
E. Atypical HUS (aHUS)
1. Epidemiology. aHUS is much less common than STEC-HUS.
2. Etiology
a. Drugs (e.g., oral contraceptives, cyclosporine, tacrolimus) or pregnancy may cause
aHUS.
b. Inherited aHUS occurs with both autosomal dominant and autosomal recessive
inheritance patterns, although not all patients have identifiable mutations. These
genetic mutations cause chronic, excessive activation of complement, which also
leads to platelet activation, endothelial cell damage, and systemic thrombotic
microangiopathy.
3. Clinical features. Clinical findings are similar to those of STEC-HUS. Diarrhea may also
be present, and severe proteinuria and hypertension are more consistently found. The
clinical course is generally more severe with multiorgan damage.
4. Management. Treatment is supportive. Inciting medications, if any, must be stopped
immediately.
5. Prognosis. Some patients have a chronic relapsing course (recurrent HUS). All patients
with aHUS have a higher risk of progression to ESRD than patients with STEC-HUS.
Obesity in pregnancy by dr alka mukherjee dr apurva mukherjee nagpur m.s. indiaalka mukherjee
Obesity among pregnant women is becoming one of the most important women's health issues. Obesity is associated with increased risk of almost all pregnancy complications: gestational hypertension, preeclampsia, gestational diabetes mellitus, delivery of large-for-GA infants, and higher incidence of congenital defects all occur more frequently than in women with a normal BMI. Evidence shows that a child of an obese mother may suffer from exposure to a suboptimal in utero environment and that early life adversities may extend into adulthood.
The evidence available on short- and long-term health impact for mother and child currently favors actions directed at controlling prepregnancy weight and preventing obesity in women of reproductive ages. More randomized controlled trials are needed to evaluate the effects of nutritional and behavioral interventions in pregnancy outcomes. Moreover, suggestions that maternal obesity may transfer obesity risk to child through non-Mendelian (e.g. epigenetic) mechanisms require more long-term investigation.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
6. •Obesity can affect every aspect of reproductive
life, whether
Metabolic,
Clinical or
Technical
•Obesity can affect
I. Menstruation
II. Sexual function: Female & Male
III. Fertility: Female & Male
IV. Pregnancy
ABOUBAKR ELNASHAR
7. The cost of management obese pregnant is
5 times higher than the average
(Ramsay et al, 2006).
Increased use of US: for difficult anomaly scans & fetal
assessment
Increased risk of:
Hospital admission for complications: PET
Operative delivery
Postpartum complications: infection, haemorrhage, DVT
Neonatal admission
ABOUBAKR ELNASHAR
9. Critical body weight of 47.8 Kg
(Frisch hypothesis).
A greater percentage of body fat (16% to 23.5%) may
serve as initiating signal.
Moderately obese: earlier menarche.
Morbid obesity: delayed menarche
Leptin:
a peptide secreted by adipose tissues
acts on CNS neurons, regulating eating behavior &
energy balance.
Higher levels: earlier menarche.
ABOUBAKR ELNASHAR
11. Male Female Best position
Thin Obese Side to side
Obese Thin Female
superior
Obese Obese Rear entry
Difficulty of performance
Obese women reported more
impairment in sexual quality of life
than obese men
(Kolotkin et al, 2005).
ABOUBAKR ELNASHAR
12. Female:
•FSFI strongly correlated with BMI
(Esposito et al, 2007).
Of the 6 sexual function parameters, desire and
pain did not correlate with BMI
•Arousal, lubrication, orgasm& satisfaction
did.
•Obese women: significant impairment of
desire, arousal, lubrication, orgasm, and
satisfaction
(Kolotkin et al, 2005; Assimakopoulos et al, 2006)
ABOUBAKR ELNASHAR
13. Male:
•ED
40-70 yrs: 50%.
increased in obese men,
{complications of metabolic syndrome}.
Management of obesity: reduced risk for ED.
ABOUBAKR ELNASHAR
15. Female:
PCOS:
• Insulin resistance:
an integral part, especially in obese women.
Hyperinsulinaemia revealed by excess wt gain
promotes ovarian androgen secretion & abnormal
follicular development: ovarian& menstrual
dysfunction.
•Androgens
are carried in the circulation bound to SHBG.
Conditions of high androgen & insulin concentrations:
lower levels of SHBG: high free androgen activity.
•Clinical manifestation: 2 of 3
1. Irregular or absent ovulation
2. Hyperandrogenism (clinical or biochemical) &/or
3. Polycystic ovaries.
ABOUBAKR ELNASHAR
17. •DVT
{Medications that contain E (COCs) or
resulting in high levels of endogenous E (ovulating
drugs)}
The combined effect of obesity & COCs: 10-fold
increase of DVT
ABOUBAKR ELNASHAR
18. •Poor outcome from Gnt ov induction
The most clinically useful predictors:
obesity & insulin resistance.
ABOUBAKR ELNASHAR
19. Male:
1. Reduced testicular vol
2. Reduced semen quality
In both extremes of BMI (< 19 or > 30 kg/m2)
suggesting impairment of spermatogenesis
(Jensen et al, 2004).
3. Reduced T/E2 & Decreased sperm
concentration:
{Excessive conversion of T into E2 by
aromatase enzyme in peripheral body fat
[Fejes et al, 2006].
Disturbed testicular thermoregulation
(Baker, 1998). }
ABOUBAKR ELNASHAR
20. 4. Infertility
A dose–response relationship
Association between BMI & infertility was similar
for older & younger men, suggesting that ED in
older men does not explain the association
(Sallmen et al, 2006)
ABOUBAKR ELNASHAR
22. •Intrapartum
Failure to progress
Failure VBAC
Shoulder dystocia
CS
Operative problems
Anesthetic problems
•Postpartum
Hge
Infection
DVT
•Foetal
Macrosomia
Birth injury
PNM/ PNM
V. Labour
ABOUBAKR ELNASHAR
23. Fetal anomalies
Spina bifida or omphalocele: 3 times
Heart defect or multiple anomalies:
Twice
Miscarriage:
•3 times more.
•Encourage wt loss to maximize the
chance of a successful pregnancy
before treatment of infertility.
ABOUBAKR ELNASHAR
24. PIH
2-3 fold increase
US in morbidly obese:
difficult.
{Adipose tissue
attenuates the US signal}.
ABOUBAKR ELNASHAR
25. Diabetes
4 fold increase in risk of GDM.
•Appropriate management:
reduce f macrosomia & perinatal morbidity.
•Women with GDM
much more likely to develop diabetes, and this risk
is greatest in obese women.
•Therefore,
1. Wt loss & exercise.
2. Regular screening for T2DM.
ABOUBAKR ELNASHAR
26. Venous thromboembolism.
•Pregnancy
prothrombotic state {increase in coagulation factors
decrease in natural anticoagulants
inhibition of fibrinolysis}.
•Obesity
treble the risk of thrombosis: pul embolism
{Obese individuals: higher levels of factor VIII &
factor IX}
ABOUBAKR ELNASHAR
27. Increased rates of intrapartum complications
•Increased rate of CS:
Anaesthesia services need to be effective.
•Failure of VBAC:
Success < 15% .
ABOUBAKR ELNASHAR
28. Fetal macrosomia
is a risk factor for:
1. lower Apgar score at 1 min
2. lower umbilical artery pH level
3. Severe injuries to the baby.
Morbidity is increased by 8%.
ABOUBAKR ELNASHAR
29. Admission to a NICU
Significantly higher
{increased rates of
antenatal complications
complications secondary to macrosomia}.
Breast feeding
less likely.
ABOUBAKR ELNASHAR
30. Management of obese pregnant
I. Before pregnancy
1. Healthy lifestyle, healthy diet , exercise, lose
weight, folic acid supplements, to use
contraception while aiming for target wt
Gynecology & Prepregnancy clinics.
2. Surgical treatment of obesity in young women
have been suggested by some authors.
ABOUBAKR ELNASHAR
31. BMI Lean
<20
Normal
20-25
Over weight
25-30
Obese
>30
Weight gain, Kg 12-18 12-16 7-12 7
II. During pregnancy
1. Exercise in pregnancy:
a. Exercise that uses upper or lower extremity ms while
recumbent do not increase ut contractions, PTL or poor Apgar
scores
(de Veciana & Mason, 2000).
b. Gentle aerobic exercise
c. Walking
(Homko et al, 1998).
• Significantly higher birth wt.
Reduce pregnancy complications e.g. GDM
2. Healthy diet, avoid excess wt gain
ABOUBAKR ELNASHAR
33. 3.Thromboprophylaxis
if needed (graduated compression stockings,
hydration, early mobilization, heparin)
4. low dose aspirin
in the presence of additional risk factors (obesity is
associated with increased risk of PET)
5. Screening for congenital abnormality:
anomaly scan, serum
6. Screening for GDM
ABOUBAKR ELNASHAR
34. III. During labour
1. Anaesthetic consultation before delivery
2. Plan delivery to allow optimum management by
experienced obstetricians
ABOUBAKR ELNASHAR
35. VI. Postpartum
1. Prophylactic antibiotics
if delivery is complicated
2.Thromboprophylaxis if indicated
Consider extended thromboprophylaxis after
discharge
3. Postnatal review at 6w
Discuss: any problems
future intervention
Best targeted at women with BMI > 35.
ABOUBAKR ELNASHAR
37. •Effects
1. No adverse
on perinatal outcome
2. Complications are less:
GDM, PIH, macrosomia,CS
3. Deficiency
of iron, vit B12, folate,
calcium
LAPAROSCOPICADJUSTABLEGASTRIC BANDING
ABOUBAKR ELNASHAR
38. Counseling
Before pregnancy
1. Unexpected pregnancy can occur after wt
loss following surgery
2.Delay pregnancy for 12-18 ms {avoid
pregnancy during the rapid wt loss phase}
During pregnancy
1.Surgical monitoring {adjustment of the
band may be necessary}
2.Evaluate nutritional deficiencies: vitamins
supplementation when necessary
ABOUBAKR ELNASHAR