IN the modern world
obesity is one of the biggest problems. However the medical world has found a
solution to it. They perform special types of surgical procedures to overcome
this. These are called Bariatric surgery. There are 3 such operations, gastric banding,
Ry gastric bypass, and Gastric sleeve by pass. After these women can lose up to
38 kgms. Eating decreases extra care is required to keep the nutrition good. Fertility,
PCOS blood pressure, and diabetes improves .Women should wait for12 to18 months
after bariatric surgery before getting pregnant. This time is necessary for
them to establish their weight loss and nutrition.
During pregnancy
the risk for preeclampsia, gestational diabetes, decrease. However risk of
hyperemesis, intestinal obstruction, internal hernias, and cholelithiasis
increases. Often an adjustment to gastric banding is required. There is risk of
premature labor, lower risk of forceps delivery, caesarian section, epidural anesthesia
labor dystocia, fetal distress, peripartum[Ma1]
sphincter injury ,
large babies ,and post-partum bleeding on the fetal side there is no increase in fetal malformation , neonatal
intensive care admissions neonatal
deaths and stillbirths increased.
During pregnancy
special care is required both for mother’s nutrition and growth of the baby.
The pregnancy complications are minimized however they are not completely
eliminated. Normal pregnancy tests are all performed, glucose tolerance test is
modified. In women after bariatric surgery threshold for diagnosis of GDM is a
fasting more than5.3mmol/L, one hour after a meal7.8mmols/L 2hours more than
6.7 mmol/L is considered as GDM.
This subject needs to be studied a bit more by
all concerned surgeons for new techniques ,nutrionalists[Ma2] and above all obstetrician who need to manage these women .
