SYNOPSIS Obesity is associated with multiple adverse reproductive outcomes, but the mechanisms involved are largely unknown. Public health scientists studying obesity and its effects on health outcomes have referred to obesity as a “complex system”, defined as a system of heterogeneous parts interacting in nonlinear ways to influence the behavior of the parts as a whole1,22. By this definition, human reproduction is also a complex system which may explain some of the difficulty in identifying the mechanisms linking obesity and adverse reproductive function. Despite the difficulties, research on obesity and reproduction is important as there is an epidemic of obesity among reproductive age women with associated consequences for future generations. In this review we discuss the adverse reproductive outcomes associated with obesity and data from translational studies of the mechanisms involved. We conclude with a brief discussion of public health policy as it relates to the treatment of infertility in obese women.

Obesity is associated with serious reproductive sequelae. Given its prevalence among reproductive age women, much recent attention has focused on the mechanisms by which obesity affects female reproductive function and fertility. In the following review, we summarize literature investigating the epidemiology and pathophysiology of obese reproduction, and we propose research strategies that may help inform approaches to improve reproductive function and outcomes among obese women.

Background Renal forniceal rupture is a lesser-known cause of acute abdomen in pregnancy. The ureteral compression by the gravid uterus places pregnant women at a higher risk. Sequelae in pregnancy could include intractable pain, acute kidney injury, and preterm birth. Case A 22-year-old primigravida with no prior medical history presented with an acute abdomen in her second trimester. The diagnosis of renal forniceal rupture was made by a radiologist using MRI. A percutaneous nephrostomy catheter was placed, and the patient's pain was relieved. She subsequently delivered at term. Conclusion Upon presentation of an acute abdomen in pregnancy, providers may not include renal forniceal rupture in their differential as readily as obstetric or gynecologic causes, resulting in delayed diagnosis, unnecessary invasive interventions, and potentially adverse maternal and neonatal outcomes. Increasing provider awareness could result in improved outcomes.

Mesothelioma in situ has been proposed as a precursor to malignant mesothelioma arising in the pleura or peritoneum. We report a case of malignant peritoneal mesothelioma which progressed from mesothelioma in situ over a 10-mo period in a 24-yr-old woman with stage IV endometriosis. Initial surgery showed deeply infiltrative endometriosis with progestin effect. Postoperatively the patient had intractable pelvic pain and vaginal discharge. Imaging studies were negative. Repeat laparoscopy 10 mo later revealed vesicular lesions on the omentum and pinpoint white lesions studding the small bowel, appendix, and pelvic peritoneum. A diagnosis of epithelioid mesothelioma was established on biopsy of the omentum and confirmed by immunohistochemistry showing complete loss of BRCA1-associated protein-1 (BAP1) nuclear staining. Retrospectively, BAP1 loss was identified in the cytologically bland, single-layer surface mesothelium of the prior resection specimen, consistent with mesothelioma in situ. The patient underwent genetic testing and was found to have a pathogenic germline mutation in BAP1.

The use of robotic-assisted laparoscopic surgery has continued to grow since the Food and Drug Administration approval for robotic-assisted gynecologic surgery in 2005. However, despite this growth in utilization, the data supporting its use in benign gynecologic surgery has not strongly supported its advantages over conventional laparoscopy. Controversy exists between supporters of robotic-assisted laparoscopic surgery and conventional laparoscopy. This article discusses the current literature regarding the use of robotic-assisted surgery in benign gynecologic surgery.