jueves, 17 de octubre de 2013

Embarazo y obesidad/Pregnancy and obesity

Retos anestesiológicos y obstétricos en cesárea de obesas mórbidas. Estudio en el Sureste de Nigeria  
Anaesthetic and obstetric challenges of morbid obesity in caesarean deliveries--a study in South-eastern Nigeria.
Okafor UV, Efetie ER, Nwoke O, Okezie O, Umeh U.
Department of Anaesthesia, University of Nigeria, Enugu campus, Nigeria. uvkafor@yahoo.com
Afr Health Sci. 2012 Mar;12(1):54-7.
BACKGROUND: Morbid obesity of parturient has become very important in perinatal medicine because of a worldwide obesity epidemic. Morbid obesity of parturient is reportedly associated with severely increased anaesthetic and obstetric risk. OBJECTIVE: To determine the prevalence rate, anaesthetic and obstetric complications in morbidly obese parturient that had caesarean delivery in a Nigerian tertiary care centre. METHODS: The obstetric theatre records and case files were reviewed for caesarean deliveries in the University of Nigeria Teaching Hospital, Enugu, Nigeria from May 2008 to December 2010. A sample size of 250 patients, calculated based on a prevalence rate of 19%, confidence interval of 95% , a power of 80% and a finite population of zero was used to determine the prevalence rate of morbid obesity (Body Mass Index of greater than or equal to 35 kg/m(2)). RESULTS:There were thirty-one patients with morbid obesity (12.4%). The average Body Mass Index (BMI) was 38.3 kg/m(2)(SD ± 2.99). Other findings included macrosomia (7 or 25.8%), gestational diabetes (13%) and pregnancy induced hypertension (7 or 22.5%).There were two neonatal deaths but no maternal deaths.
CONCLUSION: The prevalence rate of morbid obesity is about 10% in Nigerian women of child bearing age. This mirrors a World Health Organisation report published in the World Health Organisation Global Information Base.
KEYWORDS: anaesthetic, morbid obesity, obstetric 
Operación cesárea en parturientas con obesidad mórbida. Implicaciones prácticas y complicaciones
Cesarean section in morbidly obese parturients: practical implications and complications.
Machado LS.
Departments of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Al-Khod, Muscat, Sultanate of Oman.
N Am J Med Sci. 2012 Jan;4(1):13-8. doi: 10.4103/1947-2714.92895.
The prevalence of obesity has reached pandemic proportions across nations. Morbid obesity has a dramatic impact on pregnancy outcome. Cesarean section in these women poses many surgical, anesthetic, and logistical challenges. In view of the increased risk of cesarean delivery in morbidly obese women, the practical implications and complications are reviewed in this article. A Medline search was conducted to review the recent relevant articles in english literature on cesarean section in morbidly obese women. The types of incisions and techniques used during cesarean delivery, intra-operative and postpartum complications, anesthetic and logistical issues, maternal morbidity and mortality were reviewed. Morbidly obese women with a body mass index (BMI >40 kg/m(2) are at increased risk of pregnancy complications and a significantly increased rate of cesarean delivery. Low transverse skin incisions and transverse uterine incisions are definitely superior and must be the first option. Closure of the subcutaneous layer is recommended, but the placement of subcutaneous drains remains controversial. Thromboprophylaxis adjusted to body weight and prophylactic antibiotics help in reducing postpartum morbidity. Morbidly obese women are at increased risk of postpartum infectious morbidity. Weight reduction in the postpartum period and thereafter must be strongly encouraged for optimal future pregnancy outcomes and well-being.
KEYWORDS: Anesthesia, Cesarean section, Morbid obesity, Postoperative complications, Postpartum morbidity, Pregnancy
Cambios en la distribución del tejido adiposo durante el embarazo con sobrepeso y obesidad comparada con la mujer con peso normal     
Changes in adipose tissue distribution during pregnancy in overweight and obese compared with normal weight women.
Straughen JK, Trudeau S, Misra VK.
Department of Family Medicine and Public Health Sciences, Division of Population Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA.
Nutr Diabetes. 2013 Aug 26;3:e84. doi: 10.1038/nutd.2013.25.
OBJECTIVE: Differences in body fat distribution contribute to the metabolic abnormalities associated with overweight and obesity; however, such differences have not been adequately explored during pregnancy. Our aim was to compare longitudinal trends in maternal abdominal adipose tissue deposition during pregnancy in overweight/obese compared with normal weight women. STUDY sound  CONCLUSIONS: Adipose tissue is preferentially deposited in the more metabolically active visceral compartment as pregnancy progresses. However, this process differs in normal weight compared with overweight/obese women and may contribute to metabolic differences between these groups. Our study is a step toward a more refined description of obesity and its consequences during pregnancy.
Anestesiología y Medicina del Dolor
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