| Efecto del IMC materno sobre la evolución del embarazo y del recién nacido |
Effect of maternal body mass index on pregnancy outcome and newborn weight.
Yazdani S, Yosofniyapasha Y, Nasab BH, Mojaveri MH, Bouzari Z.
Department of Anesthesia, Babol University of Medical Sciences, Babol, Iran. bahmanh2002@yahoo.com.
BMC Res Notes. 2012 Jan 17;5:34.
Abstract
BACKGROUND: Maternal obesity has been associated with adverse pregnancy outcomes, such as pre-eclampsia, eclampsia, pre- and post-term delivery, induction of labor, macrosomia, increased rate of caesarean section, and post-partum hemorrhage. The objective of this study was to determine the effect of maternal Body Mass Index (BMI) on pregnancy outcomes. METHODS: 1000 pregnant women were enrolled in the study. In order to explore the relationship between maternal first trimester Body Mass Index and pregnancy outcomes, participants were categorized into five groups based on their first trimester Body Mass Index. The data were analyzed using Pearson Chi-square tests in SPSS 18. Differences were considered significant if p < 0.05. RESULTS: Women with an above-normal Body Mass Index had a higher incidence of pre-eclampsia, induction of labor, caesarean section, pre-term labor, and macrosomia than women with a normal Body Mass Index (controls). There was no significant difference in the incidence of post-term delivery between the control group and other groups. CONCLUSION: Increased BMI increases the incidence of induction of labor, caesarean section, pre-term labor and macrosomia. The BMI of women in the first trimester of pregnancy is associated with the risk of adverse pregnancy outcome.
http://www.biomedcentral.com/content/pdf/1756-0500-5-34.pdf |
| DE(50) y DE(95) de bupivacaína intratecal en obesas mórbidas sometidas a parto por cesárea |
ED(50) and ED(95) of intrathecal bupivacaine in morbidly obese patients undergoing cesarean delivery.
Carvalho B, Collins J, Drover DR, Atkinson Ralls L, Riley ET.
Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94305, USA. bcarvalho@stanford.edu
Anesthesiology. 2011 Mar;114(3):529-35.
Abstract
BACKGROUND: It has been suggested that morbidly obese parturients may require less local anesthetic for spinal anesthesia. The aim of this study was to determine the effective dose (ED(50)/ED(95)) of intrathecal bupivacaine for cesarean delivery in morbidly obese patients. METHODS: Morbidly obese parturients (body mass index equal to or more than 40) undergoing elective cesarean delivery were enrolled in this double-blinded study. Forty-two patients were randomly assigned to receive intrathecal hyperbaric bupivacaine in doses of 5, 6, 7, 8, 9, 10, or 11 mg (n = 6 per group) coadministered with 200 μg morphine and 10 μg fentanyl. Success (induction) was defined as block height to pinprick equal to or more than T6 and success (operation) as success (induction) plus no requirement for epidural supplementation throughout surgery. The ED(50)/ED(95) values were determined using a logistic regression model. RESULTS: ED(50) and ED(95) (with 95% confidence intervals) for success (operation) were 9.8 (8.6-11.0) and 15.0 (10.0-20.0), respectively, and were similar to corresponding values of a nonobese population determined previously using similar methodology. We were unable to measure ED(50)/ED(95) values for success (induction) because so few blocks failed initially, even at the low-dose range. There were no differences with regard to secondary outcomes (i.e., hypotension, vasopressor use, nausea, and vomiting). CONCLUSIONS: Obese and nonobese patients undergoing cesarean delivery do not appear to respond differently to modest doses of intrathecal bupivacaine. This dose-response study suggests that doses of intrathecal bupivacaine less than 10 mg may not adequately ensure successful intraoperative anesthesia. Even when the initial block obtained with a low dose is satisfactory, it will not guarantee adequate anesthesia throughout surgery.
http://journals.lww.com/anesthesiology/pages/articleviewer.aspx?year=2011&issue=03000&article=00016&type=abstract |
| Imagen y obesidad: una perspectiva durante el embarazo |
Imaging and obesity: a perspective during pregnancy.
Maxwell C, Glanc P.
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto, ON, Canada.
AJR Am J Roentgenol. 2011 Feb;196(2):311-9.
Abstract
OBJECTIVE: Obesity is a rapidly growing global pandemic that has surpassed all other risk factors in obstetric care, converting 40% of pregnant women into a high-risk category, with the attendant increased burden on our health care systems. This article will review the role of the imaging specialist in understanding the determinants of poor pregnancy outcome in the mother and her baby. We will also review how obesity affects the quality of patient care in terms of the limitation in completion of fetal anatomic surveys, ergonomic risks to the imaging specialist, and techniques that may improve imaging quality and ensure patient safety. We urgently need refinement in our ability to detect those fetuses at greatest risk for stillbirth and growth restriction, macrosomia, and congenital anomalies, and to understand the potentially multigenerational impact of maternal obesity on the incidence of obesity and the metabolic syndrome for the future. Utilization of emerging technologies such as laser Doppler, evolving MRI technology, and expanded roles for ultrasound such as ultrasound guidance for placement of labor anesthesia will become increasingly important. CONCLUSION: The far-reaching implications of obesity on the mother and her children will continue have a progressive impact on our health care systems and resources.
http://www.ajronline.org/content/196/2/311.full.pdf |
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