This document discusses obesity in obstetrics. It defines classifications of obesity and notes that obesity prevalence is around 30-40% in men and women. Key points are that adipose tissue communicates with other tissues via adipokines, which can enhance or reduce insulin sensitivity. Obesity is associated with conditions like metabolic syndrome and nonalcoholic fatty liver disease. It also discusses obesity-related risks in pregnancy like gestational diabetes and complications during delivery. Lifestyle changes and bariatric surgery are described as treatment approaches for obesity.
Polycystic ovarian syndrome (PCOS) is a condition
of unexplained hyperandrogenic chronic anovulation
that most likely represents a heterogenous disorder.
About 10% of women in the reproductive age group
suffer from this disorder.
Pcos by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine-metabolic disorder that implies various severe consequences to female health, including alarming rates of infertility. Although its exact etiology remains elusive, it is known to feature several hormonal disturbances, including hyperandrogenemia, insulin resistance (IR), and hyperinsulinemia. Insulin appears to disrupt all components of the hypothalamus-hypophysis-ovary axis, and ovarian tissue insulin resistance results in impaired metabolic signaling but intact mitogenic and steroidogenic activity, favoring hyperandrogenemia, which appears to be the main culprit of the clinical picture in PCOS. In turn, androgens may lead back to IR by increasing levels of free fatty acids and modifying muscle tissue composition and functionality, perpetuating this IR-hyperinsulinemia-hyperandrogenemia cycle. Nonobese women with PCOS showcase several differential features, with unique biochemical and hormonal profiles. Nevertheless, lean and obese patients have chronic inflammation mediating the long term cardiometabolic complications and comorbidities observed in women with PCOS, including dyslipidemia, metabolic syndrome, type 2 diabetes mellitus, and cardiovascular disease. Given these severe implications, it is important to thoroughly understand the pathophysiologic interconnections underlying PCOS, in order to provide superior therapeutic strategies and warrant improved quality of life to women with this syndrome.
For more Info visit www.healthlibrary.com "Management of PCOS in Unani System of Medicine" by Dr. Shaikh Nikhat held on 11th June 2016.
Management of PCOS in Unani System of Medicine - Unani system have the holistic approach to treat the condition like PCOD / PCOS.
Polycystic ovarian syndrome (PCOS) is a condition
of unexplained hyperandrogenic chronic anovulation
that most likely represents a heterogenous disorder.
About 10% of women in the reproductive age group
suffer from this disorder.
Pcos by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine-metabolic disorder that implies various severe consequences to female health, including alarming rates of infertility. Although its exact etiology remains elusive, it is known to feature several hormonal disturbances, including hyperandrogenemia, insulin resistance (IR), and hyperinsulinemia. Insulin appears to disrupt all components of the hypothalamus-hypophysis-ovary axis, and ovarian tissue insulin resistance results in impaired metabolic signaling but intact mitogenic and steroidogenic activity, favoring hyperandrogenemia, which appears to be the main culprit of the clinical picture in PCOS. In turn, androgens may lead back to IR by increasing levels of free fatty acids and modifying muscle tissue composition and functionality, perpetuating this IR-hyperinsulinemia-hyperandrogenemia cycle. Nonobese women with PCOS showcase several differential features, with unique biochemical and hormonal profiles. Nevertheless, lean and obese patients have chronic inflammation mediating the long term cardiometabolic complications and comorbidities observed in women with PCOS, including dyslipidemia, metabolic syndrome, type 2 diabetes mellitus, and cardiovascular disease. Given these severe implications, it is important to thoroughly understand the pathophysiologic interconnections underlying PCOS, in order to provide superior therapeutic strategies and warrant improved quality of life to women with this syndrome.
For more Info visit www.healthlibrary.com "Management of PCOS in Unani System of Medicine" by Dr. Shaikh Nikhat held on 11th June 2016.
Management of PCOS in Unani System of Medicine - Unani system have the holistic approach to treat the condition like PCOD / PCOS.
Treatment of poly-cystic ovary syndrom (PCOS)indiajpsingh
Poly-cystic ovary syndrome (PCOS) is a Gynecological problem that can affect woman's: Menstrual cycle, Difficulty to be pregnant, Hormonal imbalances, Skin and hair problems.
I would like to suggest an invented procedure to treat the same very easily and successfully.
Role of life style modification in pcosPoonam Loomba
changing diet ,eating habits,regular exercise yoga aerobics swimming can help in weight loss.Psychological counselling helps in managing stress.Life style modifications are first linee management of adolescent pcos
PANEL DISCUSSION
MANAGEMENT OF PCOS - WOMB to TOMB
MODERATOR : Sharda Jain
PANELISTS : Dr.Chitra setia
Dr Puneet Arora
Dr. Ila Gupta
Dr. Rupam Arora
Dr. Archana Sharma
Dr. Sangeeta Gupta
Dermatologists
Dr. V.K. Upadhyay
Dr. S. Kandhari
PCOS IS THE THIEF OF WOMENHOOD........an enigmatic condition must be understood and managed according to the age it presents.......contact dr jaideep at jaideep malhotraagra@gmail.com for CME AND WORKSHOPS IN YOUR CITY
Secondary amenorrhoea by dr alka mukherjee dr apurva mukherjeealka mukherjee
The first step in the evaluation of any patient with secondary amenorrhea is a urine pregnancy test. Every contraceptive method has a failure rate, and anyone who is menstruating is potentially fertile, regardless of age. [5][6]
If the pregnancy test is negative, consider the clinical picture: hirsutism, acne, and a long history of infrequent and irregular menses suggest polycystic ovarian syndrome. By the Rotterdam criteria, a patient may be diagnosed with PCOS if she has two of the following: clinical or chemical hyperandrogenism, oligo- or amenorrhea, or polycystic ovaries on ultrasound. So if a patient has evidence of hirsutism and oligo- or amenorrhea, she can be diagnosed with PCOS without further laboratory testing or imaging.
If history and physical exam are not consistent with PCOS, a TSH should be ordered. Both hyper- and hypothyroidism can lead to menstrual dysfunction.
If TSH is normal, check a serum prolactin. Elevated serum prolactin suggests prolactinoma.
Treatment of poly-cystic ovary syndrom (PCOS)indiajpsingh
Poly-cystic ovary syndrome (PCOS) is a Gynecological problem that can affect woman's: Menstrual cycle, Difficulty to be pregnant, Hormonal imbalances, Skin and hair problems.
I would like to suggest an invented procedure to treat the same very easily and successfully.
Role of life style modification in pcosPoonam Loomba
changing diet ,eating habits,regular exercise yoga aerobics swimming can help in weight loss.Psychological counselling helps in managing stress.Life style modifications are first linee management of adolescent pcos
PANEL DISCUSSION
MANAGEMENT OF PCOS - WOMB to TOMB
MODERATOR : Sharda Jain
PANELISTS : Dr.Chitra setia
Dr Puneet Arora
Dr. Ila Gupta
Dr. Rupam Arora
Dr. Archana Sharma
Dr. Sangeeta Gupta
Dermatologists
Dr. V.K. Upadhyay
Dr. S. Kandhari
PCOS IS THE THIEF OF WOMENHOOD........an enigmatic condition must be understood and managed according to the age it presents.......contact dr jaideep at jaideep malhotraagra@gmail.com for CME AND WORKSHOPS IN YOUR CITY
Secondary amenorrhoea by dr alka mukherjee dr apurva mukherjeealka mukherjee
The first step in the evaluation of any patient with secondary amenorrhea is a urine pregnancy test. Every contraceptive method has a failure rate, and anyone who is menstruating is potentially fertile, regardless of age. [5][6]
If the pregnancy test is negative, consider the clinical picture: hirsutism, acne, and a long history of infrequent and irregular menses suggest polycystic ovarian syndrome. By the Rotterdam criteria, a patient may be diagnosed with PCOS if she has two of the following: clinical or chemical hyperandrogenism, oligo- or amenorrhea, or polycystic ovaries on ultrasound. So if a patient has evidence of hirsutism and oligo- or amenorrhea, she can be diagnosed with PCOS without further laboratory testing or imaging.
If history and physical exam are not consistent with PCOS, a TSH should be ordered. Both hyper- and hypothyroidism can lead to menstrual dysfunction.
If TSH is normal, check a serum prolactin. Elevated serum prolactin suggests prolactinoma.
This presentation was delivered at Puri on 10th january 2015
on the occasion of annual Rotary District Conference along with IMA Puri. It highlights on metabolic syndrome and its surgical solution.
DEFINITION AND MEASUREMENT Obesity is a state of excess adipose tissue mass. Although often viewed as equivalent to increased body weight, this need not be the case—lean but very muscular individuals may be overweight by numerical standards without having increased adiposity.
Body mass index (BMI), which is equal to weight/height2 (in kg/m2 )
Body weights are distributed continuously in populations, so that choice of a medically meaningful distinction between lean and obese is somewhat arbitrary. Obesity is therefore defined by assessing its linkage to morbidity or mortality
Obesity in Adolescent- Right Time to InterveneSujoy Dasgupta
Invited lecture by Dr Sujoy Dasgupta in a Webinar by Food, Drugs and Medicosurgical Equipment Committee of FOGSI (Federation of Obstetric and Gynaecological Societies of India) on “Adolescent Nutrition: Challenges and Way Forward” held in November, 2021.
NON-ALCOHOLIC FATTY LIVER DISESEppt.pptxSangram Das
Always stay happy because with age beauty fades but inner charecter shines forever so always maintain your BMI and BMR also check fasting blood sugar every month.
Obesity refers to the condition of having an excessive amount of body fat.
This ppt contains a concise content regarding obesity for students of final year. I hope it will suffice you in your studies. Thank you spending your precious time in referring the same.
For more notes: Join Us on Telegram: https://t.me/OBGYN_Note_Book Or Facebook: https://www.facebook.com/obgyn.books
Slideshare: https://www.slideshare.net/bjlomsecond
* These are Dr Gebresilassie's Amazing Notes.
* If you have feedback, contact me on https://t.me/Hanybal2021
* For further OBGYN notes - join us on telegram https://t.me/OBGYN_Note_Book
Obstetric analgesia and anesthesia 2021OBGYN Notes
* These are Dr Gebresilassie's Amazing Notes.
* If you have feedback, contact me on https://t.me/Hanybal2021
* For further OBGYN notes - join us on telegram https://t.me/OBGYN_Note_Book
* These are Dr Gebresilassie's Amazing Notes.
* If you have feedback, contact me on https://t.me/Hanybal2021
* For further OBGYN notes - join us on telegram https://t.me/OBGYN_Note_Book
This is a clinically oriented maternal anatomy, prepared by Dr Gebresilassie Andualem
You can get more books from our Telegram channel:
https://t.me/OBGYN_Note_Book
This Note is Prepared by A OBGYN resident @ SPHMMC, Addis Ababa, Ethiopia (March 2019)
For further notes, you can join us on our Telegram group @obgynsphmmc2019
Tel: +251920257863
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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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.
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
3. 3
Keys points
Definitions
Prevalence
Adipose Pathophysiology
Metabolic Syndrome
Nonalcoholic Fatty Liver Disease -
Obesity-Associated Morbidity
Obesity Treatment
• Underweight: <18.5 kg/m2
• Normal: 18.5 to 24.9
• Overweight: 25.0 to 29.9
• Obese ≥ 30 kg/m2
– C I: 30 – 34.9,
– CII: 35-39.9
– CIII: ≥40
o Supermorbid obesity: ≥50 kg/m2
• slightly more women than men were
designated obese—36 versus 34 percent
• common among all socioeconomic levels,
the overall severity advances with
increasing poverty
• Genetic predisposition has been identified
from several gene loci
4. • Many fattissue cells communicate with all
other tissues via endocrine and paracrine
factors, which are cytokines specifically termed
adipocytokines (adipokines)
• Adipokines that enhances insulin sensitivity
– Adiponectin
– It enhances insulin sensitivity, blocks hepatic
glucose release, and has cardioprotective effects
on circulating plasma lipids
– adiponectin deficit → diabetes, hypertension,
endothelial cell activation, and cardiovascular
disease
– adiponectin has antiinflammatory and insulin-
sensitizing roles and is negatively regulated by fat
mass
• Adipokines that enhance insulin resistance
– inflammatory cytokines
– leptin, resistin,TNF-α, and IL-6
– higher during pregnancy
• type 2 diabetes, dyslipidemia, and hypertension
• Criteria for Diagnosis of the Metabolic
Syndrome
– Waist circumference is the preferred
measurement for screening
4
5. • visceral adiposity correlates with hepatic fat content
• With obesity, excessive fat accumulates in the liver -
hepatic steatosis (nonalcoholic fatty liver
disease (NAFLD))
• In persons with the metabolic syndrome, steatosis
can progress to nonalcoholic steatohepatitis (NASH)
and cirrhosis, as well as hepatocellular carcinoma
• Cause ¼ of CLD cases worldwide
• strongly associated with both fatal and nonfatal
cardiovascular disease
• glucose intolerance, hypertension, dyslipidemia, and
metabolic syndrome
• Insulin resistance and metabolic syndrome
– cardiovascular disease: myocardial infarction, atrial
fibrillation, heart failure, and stroke
– structural cerebral changes and lower executive
functioning and memory in adults
5
• Waist circumference positively correlates with
abdominal fat content, which is a risk factor
for poor health outcomes
• Waist circumference is measured at the level
of the iliac crests at the end of normal
expiration
– Values > 35 inches (88 cm) are considered elevated
6. • weight loss in obese adult women
– behavioral, pharmacological, and surgical
techniques
• Dietary changes and exercise
– reduce weight and rates of the associated
metabolic syndrome
– When used in conjunction with bariatric surgery,
glucose control in those with type 2 diabetes is
improved
• In both surgical and medical interventions are
associated with appreciable long-term failure
rates—up to 50% in patients with type 2
diabetes undergoing bariatric surgery
• a 10% weight loss within 6 months is realistic
– AHA: suitable options
– 1200 to 1500 kcal/day or diets that incorporate a
500 or 750-kcal/d deficit
– No single diet plan is gold standard, but ideal
regimen is one that can be adhered to
• when weight loss is the desired goal, a calorie-
restricted diet should be combined with less
sedentary time and increased physical activity;
the activity should be gradually increased over
time as tolerated
Orlistat (Xenical)
– is a reversible inhibitor of gastric and pancreatic
lipases and leads to a 30% blockage of dietary at
absorption
• 120-mg capsule PoTID taken with meals
– Associated malabsorption can lead to deficiencies
of the fat-soluble vitamins A, D, E, and K
– So all patients should receive a daily supplement
enriched with these vitamins
Lorcaserin (Belviq)
– is a serotonin 2C receptor agonist used to
suppress appetite
– One 10-mg tablet Po – BID
– Phentermine and topiramate
6
7. – Rx
• Life style and dietary changes
• Pharmacologic for those
1. with known CVD,
2. with LDL cholesterol ≥ 190 mg/dL,
3. aged 40 to 75 years with diabetes & LDL
cholesterol ≥ 70 mg/dL and an estimated
10-year risk of a cardiovascular event that is
at least 7.5%
7
Dyslipidemia
• is an abnormal amount of lipids (e.g.
triglycerides, cholesterol and/or fat phospholipids)
in the blood
• Hypercholesterolemia
– LDL is the primary atherogenic agent
• HDL versus LDL cholesterol
– two main types of cholesterol
– HDL - “good cholesterol”
• transports cholesterol to → helps in
removal of excess cholesterol
– LDL - “bad cholesterol”
• takes cholesterol to your arteries, where
it may collect in artery walls
• If excess → atherosclerosis
8. Reproductive disadvantages
• difficulty in achieving pregnancy
• early and recurrent pregnancy loss
• preterm delivery
• Several obstetrical, medical, and surgical
complications with pregnancy, labor, delivery,
and the puerperium
• oral contraceptive failure may be more likely in
overweight women
– contraceptive patch (OrthoEvra) is less effective in
those weighing > 90 kg
– Last, due to its risk for associated weight gain,
depot medroxyprogesterone acetate (Depo-
Provera) may be an unpopular choice in women
trying to lose weight
• Infants & later, adult children of obese mothers
have correspondingly higher morbidity rates
Super-morbid obesity
• ↑rates of maternal and neonatal complications
– preeclampsia, fetal overgrowth, and cesarean
delivery
– meconium aspiration, ventilator support, and
neonatal death
• obesity & metabolic syndrome → insulin
resistance, which causes low-grade
inflammation and endothelial activation ➔ play
a central role in preeclampsia
8
9. NAFLD
• ↑ preeclampsia, preterm birth, low-
birthweight neonates, cesarean
delivery, and gestational diabetes
• LDL-III predominance is a hallmark of
ectopic liver fat accumulation that is
typical of NAFLD
Perinatal Mortality
• ↑ Stillbirths
• weight loss between pregnancies for
overweight women lowers this risk
Perinatal Morbidity
• ↑ fetal and neonatal complications
Long-Term Offspring Morbidity
• Obese women beget obese children
• central obesity, elevated systolic blood
pressure, increased insulin resistance,
and lipid abnormalities
• fetal programming ?
• epigenetics
9
10. MaternalWeight Gain
10
Prepregnancy BMI Total weight gain in kg
Mean (range) in
kg/week – 2nd
& 3rd
tm
Underweight (<18.5
kg/m
2
)
12.5 to 18 0.51 (0.44 to 0.58)
Normal weight (18.5 to
24.9 kg/m
2
)
11.5 to 16 0.42 (0.35 to 0.50)
Overweight (25.0 to 29.9
kg/m
2
)
7 to 11.5 0.28 (0.23 to 0.33)
Obese (≥30.0 kg/m
2
) 5 to 9 0.22 (0.17 to 0.27)
Dietary Intervention
• lifestyle interventions and physical activity
– Maternal and neonatal outcomes did not differ between
groups
– Cochrane database analysis suggests that lifestyle
interventions confer only a modest reduction in maternal
weight gain, and their benefits for fetal overgrowth,
cesarean delivery rate, and adverse neonatal outcome are
not significant
• Regarding neonatal outcomes, the poor success of
lifestyle interventions during pregnancy
– early gene expression within the placenta has already
been programmed
Prenatal Care
• early signs of diabetes or hypertension
• Accurate fetal growth surveillance in obese women
usually requires serial sonographic assessment
11. Labor Induction
• BMI >30 kg/m2 had a longer duration of and slower
early progression in first-stage labor
• twice as likely to experience a failed induction
Anesthesia Risks
• anesthesia challenges that include difficult epidural
and spinal analgesia placement and complications
from failed or difficult intubations.
• Evaluation of super-morbidly obese gravidas by the
anesthesiologist is recommended during prenatal
care or upon arrival to the labor unit
• Regional analgesia for morbidly obese women is
associated with longer neuraxial procedure times
and more failed placement attempts
• But, spinal analgesia in obese women for cesarean
delivery does not appear to have benefits over
combined spinal-epidural
• If regional analgesia is complicated by relative
hypotension
– delayed delivery ➔ neonatal acidemia
↑ Cesarean Delivery
• overweight (34 percent), class I (38 percent), class II
(43 percent), and class III (50 percent)
• Abdominal incision
– vertical incision – preferred
– low transverse abdominal incision, with or without
rostral taping of the pendulous abdomen
• wound infections
– Preventive
– Closure of subcutaneous tissue ≥ 2 cm deep
– higher doses of perioperative prophylactic antibiotics: 3-g
dose of cefazolin
– Prophylactic Negative-pressure wound therapy (NPWT) -
did not significantly lower
• lower thromboembolic complications
– Graduated compression stockings,
– Hydration
– Early mobilization
– Some also recommend “mini-dose” heparin prophylaxis,
but we do not routinely
11
12. • Initial treatment
– Comprehensive lifestyle intervention
– Dietary therapy
– Exercise
– Behavior modification
• Subsequent treatment
– Drug therapy
– Devices: Intragastric balloon therapy
• soft saline- or gas-filled balloon in the stomach to
promote a feeling of satiety and restriction
– Bariatric surgery
Bariatric surgery
• Indications
– BMIs > 40 or
– BMIs > 35 + other co-morbid conditions
(hypertension, impaired glucose tolerance, diabetes
mellitus, dyslipidemia, sleep apnea)
12
I. Restrictive Surgeries (limit intake)
– Laparoscopic adjustable silicone gastric banding (LASGB)
procedures: LAPBAND and REALIZE
• place a band 2 cm below the gastroesophageal junction to create
a small stomach pouch above the ring
• Deflation during pregnancy has higher risk
– sleeve gastrectomy partitions of the lateral stomach by a
staple line
II. Bypass surgery: promotes malabsorptive weight
loss
– Serious complications are uncommon
– however, upper abdominal pain is frequent in pregnancy
and often associated with internal herniation, which is
protrusion of the bowel through a mesentery defect
• Upper abdominal pain complicated 46 percent, and a third of
these had internal herniation
• Bowel obstruction is notoriously difficult to diagnose
– popular, and many women subsequently become pregnant
13. Roux-en-Y gastric bypass
• proximal stomach is completely transected to leave a 30-mL
pouch
• proximal end of the distal jejunum is then connected to the
small pouch
• At a site 60 cm distal to this gastrojejunostomy, a Roux-en-
Y enteroenterostomy is also completed to allow drainage of
secretions from the unused stomach and duodenum
13
• In nonpregnant patients, these procedures improve or
resolve diabetes, hyperlipidemia, hypertension, and
obstructive sleep apnea and reduce risks of myocardial
infarction and death
• Pregnancy Outcomes Following Bariatric Surgery
14. • women who have undergone bariatric surgery be assessed for
vitamin and nutritional sufficiency
– When indicated, vitamins B12 and D, folic acid, and calcium
supplementation are given
– Vitamin A deficiency is also possible
– Women with a gastric band should be monitored by their bariatric
team during pregnancy because adjustments of the band may be
necessary.
– Finally, special vigilance is appropriate for signs of internal herniation
with intestinal obstruction
14
15. • Super morbid obesity is:
– BMI ≥ 50 kg/m2
• What percentage of women are obese? 36%
• Which of the following does not cause insulin
resistance?
– a. IL-6 b. Leptin c.TNF-α d.Adiponectin
• Which of the following is not a constituent of the
metabolic syndrome?
– a. Dyslipidemia
– b. Hypertension
– c.Type 2 diabetes
– d. Chronic renal disease
• To diagnose metabolic syndrome, a patient must
have at least 3 diagnostic criteria.Which of the
following is not one of the criteria?
– a. Elevated waist circumference
– b. HDL >50 mg/dL in females
– c. Fasting glucose ≥100 mg/dL
– d. Systolic blood pressure ≥130 mm Hg
• Up to 50% of patients with type 2 diabetes who
undergo bariatric surgery fail to maintain the weight
loss long term?
• Obesity increases the risk for maternal death by 4X
• Which of the following is not associated with
nonalcoholic fatty liver disease?
– a. Preeclampsia
– b. Preterm birth
– c. Hypoglycemia
– d. Low birthweight
• What is the prevalence of wound infection in obese
(BMI > 30 kg/m2) pregnant women? 1%
• What is the odds ratio for preeclampsia in obese
(body mass index >30 kg/m2) pregnant women? 3
• What is the highest ranking modifiable risk factor
for stillbirth?
– a. Obesity
– b. Cocaine use
– c. Mental illness
– d.Vitamin deficiencies
• Why have lifestyle interventions such as exercise in
obese pregnant women not been shown to
significantly improve neonatal outcomes?
– Early gene expression within the placenta has
already been programmed
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16. • You are following a 28-year-old G3P2 pregnant woman. She
has a body mass index of 55 kg/m2.You question the
accuracy of the fundal heights you are measuring.What is
the best management plan to ensure appropriate fetal
growth?
– a. Serial ultrasounds for rate of growth
– b. Do not measure fundal heights and instead perform weekly
NSTs
– c. Measure the fundal height three times each visit and average the
results
– d. Follow the change in fundal height each visit instead of the
absolute number
• Obese women are twice as likely to have a failed
induction
• Which of the following statements about anesthesia in
obese women is true?
– a. Spinal is better than combined spinal-epidural
– b. Combined spinal-epidural is better than spinal
– c. General anesthesia is better than regional anesthesia
– d. Combined spinal-epidural and spinal anesthesia can be
placed with equal expediency and function
• What is the likely reason that obese pregnant women who
become hypotensive from anesthesia more frequently have
acidotic neonates than normal weight pregnant women?
– Delayed delivery
• What is the optimal location for
placement of the skin incision for cesarean
section in a morbidly obese pregnant
woman? B
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17. • What is the increase in risk for wound infection in
supermorbidly obese pregnant women compare to nonobese
pregnant women? 3-fold
• You are going to perform a cesarean section on a woman with
a body mass index of 40 kg/m2.You want to minimize her risk
for wound infection.Which of the following interventions has
not been shown to help with this?
– a. Exercising good sterile technique
– b. Prophylactic negative-pressure wound therapy
– c. Increasing perioperative prophylactic antibiotics
– d. Closing subcutaneous tissue when it is ≥ 2 cm deep
• All except which of the following is associated with lower
rates when comparing Roux-en-Y gastric bypass to gastric
banding?
– a. Hypertension
– b. Cesarean section
– c. Low birthweight
– d. Gestational diabetes
• Compared to maintenance of an inflated gastric band during
pregnancy, full deflation of a gastric band results in all except
which of the following?
– a. Increased macrosomia
– b. Increased birthweight
– c. Increased mean weight gain
– d. Increased fetal cerebral hemorrhage
• What is the most common procedure for gastric restriction
and selective malabsorption?
– a. REALIZE
– b. LAPBAND
– c. Gastric sleeve
– d. Roux-en-Y gastric bypass
• Roux-en-Y gastric is frequently associated with which of the
following symptoms in pregnancy?
– a. Headache
– b. Constipation
– c. Lower abdominal pain
– d. Upper abdominal pain
• In women hoping to become pregnant after bariatric surgery,
counseling should include all except which of the following
points?
– a. Fertility rates are increased.
– b. Obstetric complications are reduced.
– c. Large-for-gestational-age neonates are less common.
– d. Rates of small-for-gestational-age neonates remain the
same.
• Which of the following vitamins is of least concern in pregnant
women who have undergone bariatric surgery?
– a. Folic acid
– b.Vitamin D
– c.Vitamin C
– d.Vitamin B12
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