Avaliação da vitalidade fetal e resultados perinatais em gestações após gastroplastia com derivação em Y de Roux

Abstract

Nomura rmY et al. 670Rev Assoc Med Bras 2010; 56(6): Incidence and prevalence of morbid obesity have increased and bariatric surgery has emerged as a treatment option for this disease. Amongst patients who undergo bariatric surgery, many are women of childbearing age and, after surgery, there is significant improvement in fertility, with normal hormone levels and menstrual cycles, which promotes the occurrence of pregnancy. 1 The benefits of bariatric surgery consist of reduction in body weight and mitigation of risks related to associated comorbidities. However, there are major drawbacks caused by the nutritional deficits that are triggered by malabsorption of nutrients induced by the gastric bypass.Pregnancy in obese women is associated with higher rates of maternal and perinatal complications as compared to pregnancies in women with normal body mass index (BMI). There is increased incidence of diabetes, hypertension, cesarean delivery, fetal macrosomia, and anesthetic complications. 2-5 Nevertheless, studies involving pregnant women who underwent previous bariatric surgery have not demonstrated a significant impact on perinatal outcomes. [6][7][8][9] On the other hand, regarding the effects on the maternal compartment in patients with morbid obesity, most studies have reported encouraging results after bariatric surgery. Some Results. Thirty pregnancies after Roux-en-Y gastric bypass were identified and 24 of them had fetal well-being assessed. All patients had normal results on cardiotocography, fetal biophysical profile, and umbilical artery Doppler velocimetry. There was one case of oligohydramnios. The main complication was maternal anemia (Hb < 11.0 g/dL, 86.7%). Twenty-one patients had cesarean section (70%). Delivery-related complications included one case of adherence, one of hematoma and uterine wall infection, and one of postpartum hysterectomy because of uterine fibroids and atony. The rate of small for gestational age infants was 23.3%. Conclusion.There was no impairment of fetal well-being in pregnancies after Roux-en-Y gastric bypass. The main maternal complication was anemia and these patients need specific nutritional counseling including broad assessment of micronutrient deficiencies since the early stages of pregnancy.

Influence of Roux-en-Y Gastric Bypass on the Nutritional Status of Vitamin A in Pregnant Women: a Comparative Study

“…Weight loss induced by surgery in this group promotes significant improvement in fertility, with normalization of hormone levels and menstrual cycle, favoring the occurrence of pregnancy [4,5].…”

An overview of recently published medical papers in Brazilian scientific journals

“…But survival rates were similar in both groups. Nomura et al9 studied fetal vitality assessed in pregnancies after gastroplasty with Roux-en-Y gastric bypass to check for maternal complications and perinatal results and conclude that fetal vitality was not compromised in pregnancies after the procedure. The main complication was anemia, requiring specific nutritional counseling and a broad evaluation for micronutrient deficiencies at early pregnancy.…”

Efeitos da cirurgia bariátrica nos resultados perinatais em gestações classificadas como alto risco

“…Comparando-se o tipo de parto, há variações de índices de cesariana conforme a literatura, de 61,5 a 70%. Com relação aos recém nascidos pequenos para a idade gestacional, também tem-se variações de 11,5 a 23,3% (15,16) .…”