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.
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.
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.
Classification & conservative surgeries for prolapseIndraneel Jadhav
Stage 0
no prolapse
- Aa,Ba,Ap,Bp are all at -3
- C or D between tvl and < tvl -2
Stage I
most distal portion > 1cm above level of hymen
Stage II
<1cm proximal to or distal to the plane of hymen
Stage III
>1cm below the plane of the hymen
Stage IV
complete eversion, distal portion at least (tvl -2 cm)
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
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.
Classification & conservative surgeries for prolapseIndraneel Jadhav
Stage 0
no prolapse
- Aa,Ba,Ap,Bp are all at -3
- C or D between tvl and < tvl -2
Stage I
most distal portion > 1cm above level of hymen
Stage II
<1cm proximal to or distal to the plane of hymen
Stage III
>1cm below the plane of the hymen
Stage IV
complete eversion, distal portion at least (tvl -2 cm)
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
to download this presentation from this link
https://mohmmed-ink.blogspot.com/2020/12/obesity.html
obesity, causes, diagnosis, complications, treatment, prevention.
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.
This is a very simple and informative presentation about obesity in obstetrics and gynecology including the cause, classification, the effects of obesity on women from gynecologic and then obstetric point of view and then how we can manage these patients.
Definition
Incidence
Types
Diabetogenic effect of pregnancy
Metabolic changes during pregnancy
Risk of uncontrolled DM on pregnancy
Diagnosis and evaluation
Medical management
Nursing management
Definition of Diabetes mellitus:It is inability to metabolize glucose properly. It is a chronic systemic disease, manifesting metabolic and vascular changes affecting every organ in the body.
a. Pregestational (preexisting) diabetes
Occurs when have type 1 or type 2 diabetes before becoming pregnant.
1-Type I Insulin-dependent (IDDM) (Insulin deficient).
2-Type II Non-Insulin dependent (NIDDM) (Insulin resistant).
b. Gestational diabetes mellitus (GDM).
Occurs diabetes when becoming pregnant.
a. Pregestational (preexisting) diabetes
Occurs when have type 1 or type 2 diabetes before becoming pregnant.
1-Type I Insulin-dependent (IDDM) (Insulin deficient).
2-Type II Non-Insulin dependent (NIDDM) (Insulin resistant).
b. Gestational diabetes mellitus (GDM).
Occurs diabetes when becoming pregnant.
Diabetes may appear only during pregnancy due to :-
1-Increased levels of antiinsulinas (estrogen, progesteron, human placental lactogen, and prolactine).
2-Decreased renal threshold for glucose (glucose loss in urine).
During early stage of pregnancy: Maternal hypoglycemia.
After the fourth month: increase glucose level in the blood due to placental hormones
During labor: liability to hypoglycaemia.
After delivery: glucose level return to prepregnant state.
Gestational Diabetes
Risk Factors
Maternal age >25
Family history
Glucosuria
Prior macrosomia
Previous unexplained stillbirth
Risk of uncontrolled diabetes on pregnancy
A- Maternal effect:
On pregnancy On labor On puerperium
-Abortion - premature -puerperal sepsis
-PET labor -PPH
-Polyhydramnios - Inertia - Abnormal
-Pressure symptom - Operative lactation
-Infection delivery
-Retinopathy
Risk of uncontrolled diabetes on fetus
1- Abortion
2- Congenital anomalies
Open neural defect, CHD, renal anomaly, sacral agenesis, small left colon syndrome(Approximately 40% to
50% of infants with this disorder have diabetic mothers, almost all of whom are insulin dependent , , imperforated anus.
3- Macrosomia
Fetal hyperglycaemia causes increase insulin secretion and lead to increase fetal fat deposition
Open neural defect
sacral agenesis
Macrosomia
Macrosomia
Macrosomia
Risk of uncontrolled diabetes on fetus
4- Intrauterine fetal death due to:
Congenital malformation, ketoacedosis, hypoglycaemia, superimposed PET.
5- Neonatal hypoglycemia
After delivery, glucose concentration fail, while neonatal insulin level remain high lead to neonatal hypoglycemia (Tremors, pallor, apnea, cyanosis)
Risk of uncontrolled diabetes on fetus
7- Hyperbilirubinaemia
Due to immature liver
8- Neonatal death due to:
Congenital anomalies
Please find the power point on Gestational Diabetes Mellitus (GDM) . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Pregestational diabetes a major obstetrical problem now a days. These PPT contains modern as well as Ayurveda aspect for preventing a pregnant women & her baby from developing complications.
Gestational diabetes Mellitus is defined as:
“Glucose intolerance of any severity with onset or first recognition during pregnancy”
This definition is applicable irrespective of whether the condition resolves after delivery or not.
It does not exclude the possibility that diabetes could have antedated pregnancy.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
- 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
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Obesity it’s effect in obstetrics & gynaecology
1. OBESITY --IT’S EFFECT IN
OBSTETRICS & GYNAECOLOGY
Prof. M.C.Bansal.
MBBS. M.S. FICOG. MICOG.
Founder Principal & Controller ;
Jhalwar Medical College And Hospital, Jhalwar.
Ex. Principal & Controller ;
Mahatma Gandhi Medical College & hospital;
Sitapura , Jaipur.
Dr. Ridhi Kathuria
PG Student (NIMS MEDICAL COLLEGE, JAIPUR)
2.
3. Obesity
• Body weight more than 20% the normal
weight for his or her optimal height of an
individual .
• Body mass index (BMI) is weight in KG divided
by height in meters squared. (weight in Kg /
Height in square meter e.g. surface area of
body ).
7. Epidomology
• Obesity is rapidly increasing all over the world , more
so in developed countries and in effluent society of
developing countries like India too., owing to over
eating . Fast food , soft drinks and marked decrease in
physical activities .
• 5% population in India is suffering from Morbid
Obesity. 15% women are obese in India.
• Obesity is more common in young women .
• Child of normal weight has 10% chances of developing
obesity.
• If both parents are obese than there are 80% chances if
obesity development.
11. Physiology of Adipose Tissue
• Part of “Obesity"
• Adipose tissue serves three general functions:
• Adipose tissue is a storehouse of energy.
• Fat serves as a cushion from trauma.
• Adipose tissue plays a role in the regulation of
body heat.
12.
13. >obesity is a consequence of the fat imbalance inherent in high-calorie
diets.
>The mechanism for mobilizing energy from fat involves various
enzymes and neurohormonal agents.
>Following ingestion of fat and its breakdown by gastric and pancreatic
lipases, absorption of long-chain triglycerides and free fatty acids takes
place in the small bowel.
>Chylomicrons (microscopic particles of fat) transferred through lymph
channels into the systemic venous circulation are normally removed by
hepatic parenchymal cells where a new lipoprotein is released into the
circulation.
> When this lipoprotein is exposed to adipose tissue, lipolysis takes
place through the action of lipoprotein lipase, an enzyme derived from
the fat cells themselves.
>The fatty acids that are released then enter the fat cells where they are
reesterified with glycerophosphate into triglycerides.
>Because alcohol diverts fat from oxidation to storage, body weight is
directly influenced
21. Metabolic Syndrome and Pregnancy
• Pregnant women with metabolic syndrome
having Glucose intolerance develop Frank
Type 2 diabetes; superimposed PIH ? HEllP
syndrome / eclampsia at early mid trimester
and need early evaluation , investigations and
appropriate / optimal control.
• These women need pre conception counseling
for weight loss/ modification of life style
, balanced low calorie diet and regular
exercise.
22.
23. Adult Treatment Panel III (ATP III): Criteria for
Diagnosis of the Metabolic Syndrome
Patients with three or more of the following:
1.Abdominal obesity: waist circumference > 88 cm (34.7 in) in
women or > 102 cm (40.2 in) in men
2.Hypertriglyceridemia: 150 mg/dL
3.High-density lipoprotein (HDL): < 50 mg/dL in women or <
40 mg/dL in men
4.High blood pressure: 130/85 mm Hga
5.High fasting glucose: 110 mg/dLa
24.
25. Causes of Obesity
• Familial.
• Hyperinsulinism .
• Hyper adrenocorticism.
• Hypogonadism .
• Hypothyroidism
• Abnormal Eating Behaviour ---Hormones which
control eating are –ghrelin from stomach, Insulin
from pancreas; leptin from fat , PYY-3-36 from
colon ; satiety center in hypothalamus control
satiety .
26.
27.
28.
29.
30.
31.
32.
33.
34. Complications Of Obesity during pregnancy
• General – difficulty in work
, Fatigue, backache, Depression.
• Surgical Problems– Ventral Hernia, Incisional Hernia
, gallstones , burst abdomen , Fat necrosis , delayed
recovery from anaesthesia, difficulty in intra tracheal
intubation, difficulty in positioning for spinal / epidural
anesthesia
• Obstetrical – miscarriage, stillbirths , PIH, type 2
Diabetes ,IUGR/ large & over weight baby, Preterm
baby, Dystocia / prolong labor / increased operative
deliveries/ LSCS.
• New Born– Birth trauma , NTDs , pre term
birth ,early neonatal deaths
35. Obesity And Pregnancy
• Marked obesity is equivocally
hazardous to the pregnant
women and her fetus.
38. Pre conception Treatment
• Counseling –psychoanalysis and
psychotherapy, modification in life style .
• Diet – low calorie balanced diet- as per advise
o f dietician and proper monitoring for gradual
weight loss without developing mal nutrition.
• Regular exercise to burn fat.
• Drug treatment ;
• Weight loosing Surgery.
39. Most legitimate non surgical methods
are fraught with frequent failures
;Legitimate weight loss approaches
include behavioral pharmacological
and surgical techniques.
40.
41.
42.
43. Ante Natal Check Ups
• She is a case of high risk pregnancy.
• Early diagnosis, Thorough History taking , general
physical , systemic and obstetrical examination with
special care for early detection of HT/ PIH / Hyper
glycaemia/ Type 2 diabetes , not to allow weight loss as
well as excessive weight gain through out the
pregnancy.
• Diet monitoring.
• Appropriate exercise –brisk walking, swimming
, bicycling , yoga and deep breathing exercise are
permitted.
• regular fetal monitoring with USG, color Doppler
, laboratory Tests and bio physical profile of fetus in
utero as and when needed.
45. Intra Partum Management
• Avoid Prematurity as well as post datism.
• Mode / timing of delivery is to be decided by considering following points
----
Age and Parity.
Previous Obstetrical history –bad ?/ Good.
Present complications .
Appropriate time to conduct delivery is when 37 weeks are completed (as
far as possible ).
Active management of labor by observing universal aseptic technique ; if
Vaginal delivery Decided ( no trial of labor ); possibility of shoulder
dystocia should always be anticipated.
LSCS if decided on obstetrical grounds with definite indication should be
done liberally by experienced obstetrician in presence of senior
anesthesiologist and pediatrician.
post delivery 24 -48 hours are crucial when complication like diabetes, PIH ,
pre/post term delivery, PROM , LSCS anemia or PPH occur.
Early breast feeding , neonatal care in NICU may be needed.
early mobilization of patient to avoid Complications of DVTand Pulmonary
embolism etc.
46.
47.
48.
49.
50. Gynaecological problems with obesity
• Early onset of menarche .
• Adoloscent menstrual problems ---PCOD, oligo-hypo
menorrhea, amenorrhoea, DUB ( metropathia type), Hirsuitism.
• Infertility—PCOD , Anovulation , delayed marriage , Often partner is also
obese., flowr seminis.Subfertilty in obese woman is due to increased
insulin resistance .impaired fecundity in woman with BMI >30Kg/ sq
meter---in IVF and ICSI has been reported
• Endometrial hyperplasia– carcinoma.
• Hyperestrogenic state--- increased DVT, HT, OCP;s side effects are more.
• Delayed onset of Menopause ---post menopausal bleeding ---endometrial
polyps ; hyperplasia; carcinoma situ .
• Ovarian , vulval malignancy ,
• Infertile fat female is prone to have more incidence of fibroids.
• Vaginitis , vulvo-vaginitis ---pre diabetic or frank diabetic women.
• UTI.
53. Treatment of Obesity
• General --- counseling for diet and exercise .
• Drugs --- oristat( selective inhibitor of gastric and
pancreatic lipase that inhibits absorption of
lipids in intestine) , Sibuttraminen
(non adrenaline and 5HT reuptake inhibitor
acts as appetite inhibitor ).Metformin.
• Surgery ---(Bariatric Surgery )
1. Restrictive --- vertical banded gastroplasty
, laparoscopic adjustable gastric banding , jaw wiring .
2. Malabsorptive – Bilo pancreative diversion ; bilo
pancreatic diversion with duodenal switch .
3. Combine –Jejuno-ileal by pass--- roux-en – Y
gastric by pass by open method / by laparoscopy.
57. When To Plan” Weight loosing surgery”?
• Morbid obese women have failed to bring down their
BMI with Medical Management.
• It is absolutely contra indicated in Pregnancy.
• Weight loosing surgery should be done well (at least 1
year ) before planning Pregnancy .
• If BMI returns to normal range and if there is no
element of mal nutrition the obstetrical out come in
terms of maternal and fetal morbidity and mortality
also returns to that in normal gravid women .
• If early pregnancy occurs and maternal weight loss
continues ---- adverse effect on intra uterine fetal
growth --- poor / bad Fetal outcome .
62. PNMR in obese pregnant women
• 1.6-2.6 fold increase in still births.
• Early neonatal deaths are nearly doubled in
Primi gravida ---IUFD rate increase as BMI
increase .
• Over all PNMR is 2 times more in obese
women as compared to non obese pregnant
women .
63. fetal morbidity
• 3.5 fold increase in NTDs.
• 2-3 fold increase in omphalocoele , heart defects and
other multiple anomalies .
• Associated hypertension and diabetes are to main
contributory factors for these anomalies.
• Maternal Obesity and childhood obesity in offspring --
-- Children of such mothers have obesity
, hyperglycemia, hyper lipidaemia(HDL) and insulin
resistance ; the definite criteria of having developed
metabolic syndrome.
64. Contraception & future Pregnancy
• After present delivery / miscarriage obese woman should
be advised to continue the weight loosing / maintenance
therapy as before., as future conception when planned will
give better results.
• Birth spacing for 1-2 years is advisable.
• OCs carry high rate of side effects( DVT,PE, HT , deranged
glucose and lipid profile ; cardio vascular accidents
, gallstones, intra hepatic cholestasis etc ) as well as failure
rates directly proportional to increased BMI.
• Progestin bearing IUCD are safe and effective method of
contraception as compared to barrier methods.
• After completion of family size husband can go for
vasectomy.