26.03.2014

Obesity and pregnancy pictures

For many women, weight management is a lifelong challenge, and planning to become pregnant can be great a motivator for adopting a healthy lifestyle. For a woman of reproductive age, obesity is correlated with subfertility, infertility and increased risk for several pregnancy complications.
Increased time to pregnancy and decrease spontaneous pregnancy rates even in ovulatory women. As part of pregnancy planning, it is our goal at Golden Gate to address the problem of obesity prior to conception if at all possible.
Monthly NewsletterEach month we send an email newsletter to our patients with useful information about pregnancy, women's health and skincare. The incidence of obesity in women of child bearing age is on the rise, and is a growing healthcare concern.
During the entire course of pregnancy, elevated body mass index (BMI) is an independent risk factor for many maternal and fetal comorbidities. An abnormality of folate metabolism is speculated to contribute to the high prevalence of neural tube defects in the fetus of the parturient woman with morbid obesity. The peripheral vascular resistance is low during pregnancy due to elevations in progesterone, which has smooth muscle relaxant properties.
Pregnancy-induced hypertension (PIH) is diagnosed in about seven percent of all pregnancies.
A prospective observational study of 427 pregnant women showed that both the number of needle passes and the time to placement from skin infiltration were increased with inadequate back flexion and failure to palpate bony landmarks. It is sensible to calculate induction agents to the lean body mass, and succinylcholine is calculated to the body weight with a maximum of 200mg for a rapid sequence induction. Labor and delivery suites should have easy access to difficult airway carts and the obstetric anesthesiologist should be proficient with video laryngoscopes and fiberoptic intubations. In patients with morbid obesity, airway loss is more frequent at the time of emergence and recovery.
Maternal hemorrhage is more common in morbidly obese parturient and blood and blood products should be readily available.
There are updated recommendations for weight gain during pregnancy from IOM which were released in May of 2009; including provisional guidelines for women pregnant with twins. CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Obesity is a growing epidemic thought to be the cause of various growing health conditions like diabetes, cardiovascular disease and premature death. Knowing the facts about excess maternal weight with its attendant health risks for moms and babies, can help inform the choices obese women make while planning pregnancy and once they have conceived.
We calculate and record your BMI at every office visit and you can calculate your BMI yourself if you know your height and weight. Vasudevan is from the Department of Anesthesia and Critical Care at Beth Israel Deaconess Medical Center and is an Instructor at Harvard Medical School, Boston, Massachusetts. The incidence of obesity is higher in women aged at least 20 years than in men of the same age. Pregnancy in women who are overweight, obese, or morbidly obese  is a major health concern. Metwally et al[5] studied the risk of miscarriage in women who were obese and women who were not obese. The risk of stillbirths and intrauterine fetal demise are increased in parturient women who are obese. Fetal macrosomia increases the risk of shoulder dystocia, clavicle fractures, nerve injuries, birth asphyxia, and depressed five-minute Apgar scores and result in increased admission to new born nurseries.
During the course of pregnancy, even women within the normal preconceptual BMI range are at a risk of developing many comorbid conditions, such as gestational diabetes, pregnancy-induced hypertension, thrombosis varicose veins, anemia, and lower-extremity edema.
A 15-year population-based cohort study by Robinson et al[15] shows that relative to women who are not obese, there was one excess case of PIH per 10 women with moderate obesity and one per seven in women who were severely obese.
Surprisingly, when women are pregnant and obese, the reduction in functional residual capacity does not appear to reduce more.[16] However, the work of breathing increases tremendously and the mismatch in oxygen supply and demand is pronounced. Progesterone is a respiratory stimulant, but despite this, women who are obese and pregnant may have symptomatic OSA.
During pregnancy, the secretion of human placental lactogen, human chorionic gonadotrophin, and steroid hormones increase the resistance of target tissues to insulin. Post-term pregnancies, or pregnancies that last 42 weeks or more, are common in women with high BMI.
Monitoring contractions and ensuring adequate strength of contractions can be  a challenge in women who are obese and in labor. A large panniculus can hinder consistent and reliable external fetal monitoring; therefore, fetal scalp monitoring may be warranted for reliable intrapartum fetal monitoring.


There should be early and clear interdisciplinary communication regarding the management of parturient women who are morbidly obese.
Continuous epidural analgesia, patient-controlled epidural analgesia, and combined spinal epidurals are frequently used to deliver safe labor analgesia. In parturient women who are obese or morbidly obese, many factors contribute to the technical difficulties in establishing epidural catheter placements and labor analgesia. Even in emergent situations, the obstetric and anesthesia team need to have clear communication, and if regional anesthesia is deemed feasible, then a spinal anesthesia or continuous spinal anesthesia should be performed. Video laryngoscopes are proven to improve visualization of the vocal cords in patients with morbid obesity and in patients meeting criteria for predicted difficult intubations.[42,43] Therefore, though there are no published data of the use of video laryngoscopes in pregnant women, they will play an important role in the management of an anticipated difficult intubation. In patients with morbid obesity, the height of the spinal block may be difficult to predict as the cephalad spread of even epidurally administered bupivacaine is higher than in parturient women who are not obese.[44] This may be due to compression of the thecal sac by the extra weight.
Inadequate preoxygenation, suboptimal patient position, inadequate access to the patient’s airway, and urgency can all contribute a failed intubation. Residual effect of anesthetic agents, extubation during Stage 2 of anesthesia, opioids, obstructive sleep apnea, and poor oxygen reserve are the usual contributory factors.
The risk of endometritis and wound infection are more frequent in patients with morbid obesity.
Adequate prepregnancy counseling and ideal prepregnancy body weight are the best way to improve the outcomes from this disease.[52] Obesity has a multitude of adverse effects on the mother and the fetus. Though pre-pregnancy BMI does not reflect on the pattern of weight gain in pregnancy, it is a valid assessment tool. Early onset of obesity in young women can result in irregular menstruation with erratic ovulation.
Their study included both women who had conceived naturally and those who had required ART.
This association is strong, even when controlling for comorbidities, such as hypertension and diabetes.
When obesity or morbid obesity is superimposed on pregnancy, the risk of developing a comorbid condition is significantly higher. Cardiac output increases 30 to 35 percent during the first trimester, and during the third trimester and postpartum period, the cardiac output can increase 50 to 70 percent, compared to the pre-pregnant state.
The combination of increased cardiac output and elevated afterload contributes to left ventricular hypertrophy. Early in pregnancy, the alveolar ventilation is increased and pregnant women have a  sense of dyspnea. Thus, women who are obese and pregnant have minimal to absent pulmonary reserve and are prone to develop hypoxemia easily.
As weight gain is the norm during pregnancy, the maternal benefits from the weight loss surgery may be limited. With reasonable weight loss, obesity-related comorbid conditions improve, with a reduction in the maternal and fetal adverse comes. Manual palpations and external tocometry may be unreliable and use of intrauterine pressure catheters can be advantageous.
The success of VBAC is quoted to be about 80 percent.[29] Suspected macrosomia,   maternal diabetes, multiple gestation, and maternal obesity are not contraindications for offering a trial of labor.
The longer duration may be due to difficulty in moving the bed and the patient, the establishment of anesthesia, and difficulty with surgical exposure. The obstetrician should be aware of the high risk of failed intubation and more time that may be required to establish regional anesthesia.
Polley et al[32] found an association between increasing BMI and increasing distance of the epidural space from the skin. Obesity has been identified as a contributory factor for increasing the anesthesia-related complications. Patients with morbid obesity and obstructive sleep apnea or who are at risk for sleep apnea should be monitored closely. The anesthetic complications can be fatal, and it is essential to have a multidisciplinary management plan that includes the obstetrician, anesthesiologist, and neonatologist to help avoid emergent interventions. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002.
The effect of gestational weight gain by body mass index on maternal and neonatal outcomes.
The impact of maternal obesity on the incidence of adverse pregnancy outcomes in high-risk term pregnancies. Pregnancy following gastric bypass for morbid obesity: effect of surgery-to-conception interval on maternal and neonatal outcomes.
Maternal and obstetric complications of pregnancy are associated with increasing gestational age at term.


An observational study of the relationship between lumbar epidural space depth and body mass index in michigan parturients.
Anaesthesia chapter from saving mothers’ lives: reviewing maternal deaths to make pregnancy safer.
Failed obstetric tracheal intubation and postoperative respiratory support with the proseal laryngeal mask airway. Expected difficult tracheal intubation: a prospective comparison of direct laryngoscopy and video laryngoscopy in 200 patients.
A 5-year audit of accidental dural punctures, postdural puncture headaches, and failed regional anesthetics at a tertiary-care medical center. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail. Each of these mechanisms must occur at just the right time and in just the right way for a healthy pregnancy from start to finish. We recommend a medically supervised weight loss program for women who need extra assistance, and we have worked well with the team of experts at JumpstartMD who provide women with the nutritional guidance and emotional support necessary to achieve and maintain more healthy weights. The altered physiology, the clinical implications, and the anesthetic and obstetric management are discussed in this article.
Rasmussen et al[7] found that maternal obesity is associated with a 1.7-fold increase in risk of neural tube defects and with maternal morbid obesity, the risk increased greater than 3-fold.
The structures less well seen on ultrasound of women with increasing BMI are fetal heart, spine, kidneys, diaphragm, and umbilical cord. Therefore, the magnitude of this association is profound in women who are pregnant and overweight or obese. In a retrospective study, Caughey et al[22,23] showed that obesity was a modifiable risk factor that increased the risk of post-term pregnancies by nearly 1.5 times.
The anesthesiologist should evaluate parturient women who are obese and have an assessment and anesthetic plan in place. The pattern of fat distribution in individuals who are obese can vary and neuraxial techniques can be surprisingly easy in some.
The increased incidence of inadequate neuraxial block, multiple attempts at the technique, and higher risk for having the epidural replaced may all contribute to the increased incidence of unplanned dural taps in individuals who are obese. Lifting the pannus off the mother vertically is a better option for both vertical and transverse incisions. Getting it right prior to conception and after delivery sets the stage for healthier moms and kids for many years to come! The increase in blood volume, fetus, placenta, amniotic fluid, and increase in body fat stores are some of the factors that contribute to the weight gain. As the uterus enlarges, the residual volume and expiratory reserve volume reduce and, by term, the functional residual capacity is 15 to 20 percent below the nonpregnant state. The risk of developing gestational diabetes mellitus (GDM) is about two, four, and eight times higher among overweight, obese, and severely obese women, respectively.[18] The potential adverse effects from GDM are higher risk of adverse infant outcome, higher risk of mother developing diabetes later in life, and higher risk of diabetes and overweight in the child. Patients who are obese have higher gastric residual volumes, are more likely to have lower esophageal sphincter tone, and have a higher risk for regurgitation of gastric content. With such focus on obesity in terms of general health and the disease process, researchers wanted to learn more about the potential role of inflammation associated with obesity on the mechanisms of pregnancy. It is essential to recognize that weight gain during pregnancy in women with a normal BMI is different from the allowable weight gain in women with an elevated or low BMI (Table 2). The residual gastric volume appears to be higher in women who are obese and in labor than women who are in labor and not obese. The spinal needle is then removed and an epidural catheter is threaded through the epidural needle. LMA ProSeal® (LMA North America, Inc., San Diego, California) has the ability to empty the stomach and has been used to maintain oxygenation in patients with failed intubation for an emergency Cesarean section. The incidence of complications, such as epidural failures and unintended dural puncture, appear to be lower than with the epidural analgesia alone.
Further study revealed inflammation and obesity can cause increased risk of preeclampsia – affecting the mother and child by causing increased blood pressure, increased risk of premature delivery and increased risk of death.
As more and more children are diagnosed with diseases that once affected only adults, researchers are finding a link between obesity, inflammation and increased risk of disease in both the fetus and children born to obese mothers.




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