Urgent help needed!

[soocalchic 1,087]

women have made it through successful pregnancies after going through a situation like yours, become your best advocate and do what you see fit.. All very scary but doable..

[mamaplumlee 58]

I have no judgements about the situation. I have heard it go both ways. The Xray has radiation which yes CAN cause defects but I know people who have had CTscans while pregnant on their tummies (my best friend) and her baby is just fine. People have surgeries while pregnant and things turn out fine too. In some cases things can go wrong but have they seen anything wrong with the levels or imaging of the baby at this point? I don't think anyone will have judgements about this situation and if they do... F--- them. It is your own person choice to make and whatever is decided is the right answer for you! Good luck and I am here if you need to vent or have questions.

[chanelle102 173]

Y

Edited January 30, 2014 by chanelle102

[1Day1Life4Now 882]

I would never tell you what to do but wanted to send you some hugs and let you know regardless of what decisions you make, all will be okay. Use the medical staff for expert opinions and use multiple resources for those opinions. Medicine is a "practice" not an exact science. Doctors can only give you their opinions, they can't predict the future.

[chanelle102 173]

[

Edited January 30, 2014 by chanelle102

[Madam Reverie 2,958]

Chanelle, my heart is going out to you.

On doing a cursory search of the academic medical journals on pregnancy after bariatric surgery (because as of yet, I have not found one which encompasses 'surgery whilst pregnant' and I concede the procedures documented do not encompass VSG), I found the following. Go straight to the abstracts/conclusions to get the gist of the research and findings. Sorry to everyone else for the information splat taking up your screens.

This is clearly not merely an issue of the fetus being exposed to radiation through an x-ray or the impact of the anesthesia on the fetus during the VSG procedure (which is not to be overlooked and if you'd like me to send you a complete article privately, I can - 'cause it's very long to post here and you'd need to read all of it to get the baseline). It is also about the severe nutritional, Vitamin and mineral deficiencies present in the first weeks after the operation which appear to have a significant impact on the progress of the fetuses growth and development in utero. A point that would need significant evaluation, monitoring and intensive hands-on care. If you would like to ask any questions on the below, please do not hesitate to contact me.

Much love x

Analgesia, Anaesthesia and Pregnancy A Practical Guide

• 3rd Edition

• By Steve Yentis
  Chelsea and Westminster Hospital, London
  
  By Surbhi Malhotra
  St Mary’s Hospital, London

• Publisher: Cambridge University Press

  Print Publication Year:2012

  Online Publication Date:December 2012

  Online ISBN:9781139012966

  Paperback ISBN:9781107601598

• Book DOI: http://dx.doi.org/10.1017/CBO9781139012966

  Subjects: Anesthesia, Intensive Care, Pain Management ,Obstetrics and Gynecology, Reproductive Medicine

Chapter 3

Anaesthesia before conception or

confirmation of pregnancy

Many women will require anaesthesia when they are pregnant and many will be unaware that

they are pregnant at the time of the anaesthetic, especially in the first 2–3 months of their

pregnancy. The thalidomide catastrophe initiated the licensing arrangements for new drugs and

their use in pregnancy; the current cautious stance of the pharmaceutical industry is reflected in

the British National Formulary’s statement that no drug is safe beyond all doubt in early

pregnancy. The anaesthetist should have a clear knowledge of the time scale of the developing

fetus in order to balance the risks and benefits of any drug given to the mother. A teratogen is a

substance that causes structural or functional abnormality in a fetus exposed to that substance.

Problems/special considerations

The possible effect of a drug can be considered against the stage of the developing fetus:

Pre-embryonic phase (0–14 days post-conception): The fertilised egg is transported down

the Fallopian tube and implantation occurs at around 7 days post-conception. The

conceptus is a ball of undifferentiated dividing cells during this time and the effect of

Downloaded from Cambridge books Online by IP 129.215.17.188 on Wed Jan 29 01:41:58 GMT 2014.

http://dx.doi.org/10.1017/CBO9781139012966.004

Cambridge books Online © Cambridge University Press, 2014

drugs on it appears to be an all-or-none phenomenon. Cell division may be slowed with

no lasting effects or the conceptus will die, depending on the severity of the cell damage.

Embryonic phase (3–8 weeks post-conception): Differentiation of cells into the organs and

tissues occurs during this phase and drugs administered to the mother may cause

considerable harm. The type of abnormality that is produced depends on the exact stage

of organ and tissue development when the drug is given.

Fetal phase (9 weeks to birth): At this stage, most organs are fully formed, although

the cerebral cortex, cerebellum and urogenital tract are still developing. Drugs

administered during this time may affect the growth of the fetus or the functional

development within specific organs.

Management options

The anaesthetist should always consider the possibility of pregnancy in any woman of child-

bearing age who presents for surgery, whether elective or emergency, and should specifically

enquire in such cases. If there is doubt, a pregnancy test should be offered. If pregnancy is

suspected, the use of nitrous oxide is now generally considered acceptable, despite its effects

on methionine synthase and DNA metabolism, as there is little evidence that it is harmful

clinically. Similarly, although the volatile agents have been implicated in impairing embryonic

development, clinical evidence is lacking. Some drugs cross the placenta and exert their effect

on the fetus, e.g. warfarin, which may cause bleeding in the fetus.

Key points

The possibility of pregnancy should be considered in any woman of childbearing age.

No drug is safe beyond all doubt in pregnancy.

Further reading

Allaert SE, Carlier SP, Weyne LP, et al. First trimester anesthesia exposure and fetal outcome.

A review. Acta Anaesthesiol Belg 2007; 58: 119–23.

6 Section 1: Preconception and conception

Pregnancy shortly after bariatric surgery.

Transliterated Title: Svangerskap like etter fedmeoperasjon. Authors: Skogøy K; kristin.skogoy@nordlandssykehuset.no
Laurini R
Aasheim ET Source: Tidsskrift For Den Norske Lægeforening: Tidsskrift For Praktisk Medicin, Ny Række [Tidsskr Nor Laegeforen] 2009 Mar 12; Vol. 129 (6), pp. 534-6. Publication Type: Case Reports; English Abstract; Journal Article Language: Norwegian Journal Info: Publisher: Norske Laegeforening Country of Publication: Norway NLM ID: 0413423 Publication Model: Print Cited Medium: Internet ISSN: 0807-7096 (Electronic)Linking ISSN: 00292001 NLM ISO Abbreviation: Tidsskr. Nor. Laegeforen. Subsets: MEDLINE Imprint Name(s): Publication: Oslo : Norske Laegeforening
Original Publication: Chistiania : Alb. Cammermeyer, 1880- MeSH Terms: Bariatric Surgery/*adverse effects
Pregnancy Complications/*etiology
Adult ; Bariatric Surgery/methods ; Duodenum/surgery ; Female ; Fetal Development ; HELLP Syndrome/etiology ; Humans ; Infant, Newborn ; Infant, Small for Gestational Age ; Obesity, Morbid/metabolism ; Obesity, Morbid/surgery ; Pregnancy ; Pregnancy Complications/metabolism ; Pregnancy Outcome ; Risk Factors; Time Factors ; Ultrasonography, Prenatal ; Weight Loss

Abstract: Bariatric surgery is increasingly used to treat morbidly obese patients. Fertility in women may be enhanced after these procedures, owing to substantial weight loss and possibly a decreased absorption of oral contraceptives. We report a pregnancy that occurred two months after biliopancreatic diversion with duodenal switch in a 32-year-old woman. She subsequently developed haemolysis, elevated liver enzymes and low platelets count (HELLP) syndrome and had a weight loss of 43 kg (from the bariatric procedure) until the infant was delivered preterm by caesarean section (due to low activity). The infant was small in relation to the gestational age, with a weight of less than 50 % of the expected (780 g at 29.6 weeks). Histological examination demonstrated a small placenta with insufficient spiral artery trophoblast infiltration, possibly caused either by severe preeclampsia or by maternal nutritional deficiencies. Severe metabolic aberrations may complicate pregnancies after malabsorptive bariatric surgery. Patient preparations before weight-loss operations should include information on fertility and birth control in the postoperative period. Protocols for monitoring of patients that become pregnant after bariatric surgery are needed.

Comments: Comment in: Tidsskr Nor Laegeforen. 2009 Mar 12;129(6):536-7. (PMID: 19291887) Entry Date(s): Date Created: 20090317 Date Completed: 20090319 Latest Revision: 20110330 Update Code: 20131125 DOI: 10.4045/tidsskr.09.34019 PMID: 19291886 Database: MEDLINE with Full Text

The risk of adverse pregnancy outcome after bariatric surgery:

a nationwide register-based matched cohort study

Mette Mandrup Kjær, MD; Jeannet Lauenborg, MD, PhD; Birger Michael Breum, MD; Lisbeth Nilas, DMSc

OBJECTIVE: The aim of this study was to describe the risk of adverse

obstetric and neonatal outcome after bariatric surgery.

STUDY DESIGN: Nationwide register-based matched cohort study of

singleton deliveries after bariatric surgery during 2004-2010. Data

were extracted from The Danish National Patient Registry and The Med-

ical Birth Register. Each woman with bariatric surgery (exposed) was in-

dividually matched with 4 women without bariatric surgery (unexposed)

on body mass index, age, parity, and date of delivery. Continuous vari-

ables were analyzed with the paired t test and binary outcomes were

analyzed by logistic regression.

RESULTS: We identied 339 women with a singleton delivery after bari-

atric surgery (84.4% gastric bypass). They were matched to 1277 un-

exposed women. Infants in the exposed group had shorter mean gesta-

tional age (274 vs 278 days; P .001), lower mean birthweight (3312

vs 3585 g; P .001), lower risk of being large for gestational age (ad-

justed odds ratio, 0.31; 95% condence interval, 0.15– 0.65), and

higher risk of being small for gestational age (SGA) (adjusted odds ratio,

2.29; 95% condence interval, 1.32–3.96) compared with infants in

the unexposed group. No statistically signicant difference was found

between the groups regarding the risk of gestational diabetes mellitus,

preeclampsia, labor induction, cesarean section, postpartum hemor-

rhage, Apgar score less than 7, admission to neonatal intensive care

unit or perinatal death.

CONCLUSION: Infants born after maternal bariatric surgery have lower

birthweight, lower gestational age, 3.3-times lower risk of large for ges-

tational age, and 2.3-times higher risk of SGA than infants born by a

matched group of women without bariatric surgery. The impact on SGA

was even higher in the subgroup with gastric bypass.

Key words: adverse pregnancy outcome, bariatric surgery, gastric

bypass, pregnancy

Pregnancy after bariatric surgery: a current view of maternal,

obstetrical and perinatal challenges

Ronis Magdaleno Jr • Belmiro Gonc¸ alves Pereira •

Elinton Adami Chaim • Egberto Ribeiro Turato

Received: 6 May 2011 / Accepted: 14 December 2011 / Published online: 29 December 2011

Ó Springer-Verlag 2011

Abstract With the increase in the number of bariatric

surgeries being performed in women of childbearing age,

physicians must have concerns regarding the safety of

pregnancy after bariatric surgery. The aim of this review is

to summarize the literature reporting on maternal, obstet-

rical and perinatal implications of pregnancy following BS.

Methods English, Spanish and Portuguese-language arti-

cles were identied in a PUBMED search from 2005 to

February 2011 using the keywords for pregnancy and

bariatric surgery or gastric bypass or gastric banding.

Results The studies show improved fertility and a

reduced risk of gestational diabetes, pregnancy-induced

hypertension and pre-eclampsia, macrosomia in pregnant

women after bariatric surgery. The incidence of intrauter-

ine growth restriction and small for gestational age are

increased. No conclusions can be drawn concerning the

risk for cesarean delivery and the best surgery- to-conception interval. Deciencies in Iron, Vitamin A,

vitamin B12, Vitamin K, folate and Calcium can result in

maternal and fetal complications.

Conclusions Pregnancy outcome of women who deliv-

ered after BS, as compared to obese populations, is better

and safer and comparable to the general population. Close

supervision before, during and after pregnancy following

bariatric surgery and nutrient supplementation adapted to

the patient’s individual requirements can prevent nutrition-

related complications and improve maternal and fetal

health.

Keywords Bariatric surgery

Pregnancy Pregnancy

complications

Morbid obesity Weight loss

Vitamin A Deficiency in Pregnancy: Perspectives after Bariatric Surgery

Cristiane Barbosa Chagas^{1, 2}, Cláudia Saunders^{3, 4, 5}, Silvia Pereira^{1, 6, 2}, Jacqueline Silva^{7, 2},Carlos Saboya^{8, 9, 6, 2} and Andréa Ramalho^{3, 10, 11}

(1)

Clinical Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

(2)

Center for Research on Micronutrients, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

(3)

FIOCRUZ, Rio de Janeiro, Brazil

(4)

Nutrition and Dietetics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

(5)

Research Group in Maternal and Child Health (GPSMI), Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

(6)

Clínica Cirúrgica Carlos Saboya, Rio de Janeiro, Brazil

(7)

Human Nutrition, Center for Research on Micronutrients, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

(8)

Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil

(9)

Brazilian Society for Bariatric and Metabolic Surgery, São Paulo, Brazil

(10)

Social Applied Nutrition Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

(11)

Instituto de Nutrição Josué de Castro, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, 373. Edifício dos Institutos Bloco J, 2° andar, sala 26, Ilha do Fundão, 21941-590 Rio de Janeiro, Brazil

Andréa Ramalho

Email: aramalho.rj@gmail.com

Published online: 12 December 2012

Abstract

This study aims to describe the clinical consequences of Vitamin A deficiency (VAD) in pregnant women after bariatric surgery. Included are studies on VAD during pregnancy and after bariatric surgery conducted in humans from 1993 to 2011. There are few investigations on the relationship between pregnancy and bariatric surgery and on the damage to the binomial mother–child resulting from VAD in this relationship. The high percentage of VAD in the postoperative period is a cause for concern, especially considering the function of this vitamin in certain biological moments and in moments of intense nutritional demand. This vitamin serum evaluation is recommended during the prenatal period.

Keywords

Pregnancy Vitamin A Vitamin A deficiency Obesity Bariatric surgery Retinol Beta carotene Night blindness

Edited January 29, 2014 by Madam Reverie

[BellaHugz 331]

All I can say is contact your doctor who did you surgery, then contact your Obgyn see what you should do next based on the knowledge of wht the professionals say. Then talk with your hubby and find peace with your decesion. Praying for you to find peace and knowledge during this time in your life.

[Bronco0605 135]

Sometimes when you are going through a complicated medical situation it is find to find someone with the exact same condition. I have had lots of experience with complicated medical things. I had a stroke at 28, 3 surgeries for pelvic tumors. Maybe we can offer better support if we know what the main struggle is.

What is your biggest concern?

Is it facing a pregnancy with the sleeve so early on?

Is it the possible birth defects?

Is not being prepared for another child?

Is it not being able to nourish the baby?

[Blondiee 278]

Do what you feel in your heart Chanelle and seek a second opinion. Sending you a great big E-hug!

Congratulations Soocalchic!

[chanelle102 173]

Y

Edited January 30, 2014 by chanelle102

[woo woo 872]

MESSAGE TO ALL I WASN'T SEEKING AN ANSWER TO TERMINATE MY PREGNANCY I WAS SEEKING TO SEE IF ANYONE HAS BEEN THROUGH THIS AND WHAT WAS THERE OUTCOME!!! I DONT NEED ANYONE'S HELP WHEN IT COMES TO MSKING A DECISION THAT WONT EFFECT ANYONE BUT MY FAMILY AND I!!! JUST WAS HOPING THAT THERE WAS SOMEONE OUT THERE WHO WENT THROUGH THIS!!

THANKS

Well this is nasty isn't it? I'm sure everyone who took the time to enter a heartfelt reply will really appreciate it.

[chanelle102 173]

Y

Edited January 30, 2014 by chanelle102

[Madam Reverie 2,958]

So now I'm stuck with a dilemma!!! My gym advised I terminate the pregnancy because I had X-rays under anesthesia during surgery which there's a 80 percent chance the fetus has birth defects!!! She set me up with a doctor the doctor won't do it bc it's to high risk!!! So now I'm lost with what to do with this

I'm just nervous and don't know what to do this is why I turned to this forum for help!!! I'm lost my gyn advised to terminate

I'm just stressing and looking for insight on this matter!!

Chanelle, it is for the above reasons, that people were offering you empathy for your predicament.

[chanelle102 173]

I

Edited January 30, 2014 by chanelle102

[ualaw08 270]

So the answer is no. No one has gone through this. Best of luck to you.