Prepregnancy body mass index in a first uncomplicated pregnancy and outcomes of a second pregnancy

Tabet, Maya; Flick, Louise H.; Tuuli, Methodius G.; Macones, George A.; Chang, Jen Jen

doi:10.1016/j.ajog.2015.06.031

Cited by 23 publications

(15 citation statements)

References 39 publications

(60 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The risk of cesarean delivery is increased in obese parturients, which is most relevant to this article. In a study involving 121,092 nulliparous women stratified by prepregnancy BMI, Tabet et al7 reported that the odds ratio (95% confidence interval) for cesarean delivery among overweight and obese women was 1.50 (1.41, 1.59) and 2.06 (1.91, 2.21) respectively 7. Similar findings were reported in other large cohorts 8,9…”

Section: Introductionmentioning

confidence: 53%

Managing anesthesia  for cesarean section in obese patients: current perspectives

Lamon¹,

Habib²

2016

LRA

View full text Add to dashboard Cite

Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging. An existing labor epidural catheter can be topped up for cesarean delivery. In patients who do not have a well-functioning labor epidural, a combined spinal epidural technique might be preferred over a single-shot spinal technique since it is technically easier in obese parturients and allows for extending the duration of the block as required. A continuous spinal technique can also be considered. Studies suggest that there is no need to reduce the dose of spinal bupivacaine in the obese parturient, but there is little data about spinal dosing in super obese parturients. Intraoperatively, patients should be placed in a ramped position, with close monitoring of ventilation and hemodynamic status. Adequate postoperative analgesia is crucial to allow for early mobilization. This can be achieved using a multimodal regimen incorporating neuraxial morphine (with appropriate observations) with scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Thromboprophylaxis is also important in this patient population due to the increased risk of thromboembolic complications. These patients should be monitored carefully in the postoperative period, since there is increased risk of postoperative complications in the morbidly obese parturients.

show abstract

Section: Introductionmentioning

confidence: 53%

Managing anesthesia  for cesarean section in obese patients: current perspectives

Lamon¹,

Habib²

2016

LRA

View full text Add to dashboard Cite

show abstract

“…In this period, ORs have been estimated to be in favor of FD vs VD for avulsion, and ranged between 3.42 and 10.0. However, when LAM avulsion rates were compared after the first year postpartum, values ranged from 55% to 89% after FD and 18% to 41% after VD; ORs were higher for FD and ranged from 5.3 to 11.4. These LAM avulsion rates decreased when FD and VD were compared 10 years after delivery, as did the ORs (4.2–5.0).…”

Section: Discussionmentioning

confidence: 95%

Malmström vacuum or Kielland forceps: which causes more damage to pelvic floor?

García‐Mejido

Martín‐Martinez

González-Díaz

et al. 2020

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

Objective To determine whether differences exist in the rate of levator ani muscle (LAM) avulsion between women who had undergone either Malmström vacuum delivery (MVD) or Kielland forceps delivery (KFD), allowing for potential confounding factors. Methods This was a prospective observational study of nulliparous women undergoing instrumental delivery using Malmström vacuum extractor or Kielland forceps, at two hospital centers in Spain. Fetal head position (anterior, posterior or transverse) and fetal head station (low or mid) were assessed by ultrasound and digital examination, respectively. Avulsion was defined on tomographic ultrasound imaging as an abnormal insertion of the LAM in the three central slices from the plane of minimal hiatal dimensions. Results In total, 414 patients were included in the study (212 MVD and 202 KFD). We observed a higher rate of LAM avulsion in the KFD group (KFD 49.5% vs MVD 32.5%; P = 0.001). When the results were evaluated according to fetal head position and station, we observed no differences in LAM avulsion. The crude odds ratio (OR) for the difference in avulsion between women in the KFD and MVD groups was 2.03 (95% CI, 1.36–3.03). However, when adjusted for duration of second stage of labor, fetal head circumference and fetal head station, the OR was no longer statistically significant (OR, 2.14 (95% CI, 0.95–4.85); P = 0.068). Conclusion When potential confounding factors are taken into account, the rate of LAM avulsion does not differ between women according to whether they have undergone KFD or MVD. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

show abstract

“…A recent study found that suboptimal pre-gravid BMI increases the risk of adverse maternal and fetal outcomes in a subsequent pregnancy, suggesting that suboptimal BMI is not only important for an index pregnancy but also carries considerable long-term consequences of public health implications into future conceptions [9] . Thus, the pre-pregnancy BMI is of importance because it is one of the pre-gestational factors (like obesity) that might be managed by timely dietary intervention.…”

Section: Discussionmentioning

confidence: 99%

Perinatal Advantages and Disadvantages of Being Underweight before Pregnancy: A Population-Based Study

Bregar

Blickstein

Šimenc

et al. 2016

Gynecol Obstet Invest

View full text Add to dashboard Cite

Aims: To evaluate the advantages and disadvantages of being underweight before pregnancy. Methods: Cohort study of a large population-based dataset of singleton births was used to compare maternal and neonatal outcomes of pre-gravid underweight body mass index (BMI <18.5 kg/m²) women with pre-gravid normal weight controls (BMI 18.5-24.9 kg/m²). Results: A total of 10,995 pre-gravid underweight and 146,155 pre-gravid normal weight mothers were compared. The mean maternal age and gestational age were not different but lean mothers were significantly and more frequently primiparous, had a higher incidence of births at <36 and <32 weeks' gestation, and had a significantly higher incidence of low and very low birth weight infants. Lean mothers had a significantly lower incidence of birth weights >4,000 g, less cesarean births and a lower incidence of gestational diabetes and hypertensive disorders. Conclusions: A tradeoff exists between the advantages of being lean before pregnancy in terms of less maternal morbidity in return for gaining a more advanced gestational age and higher birth weight.

show abstract

Prepregnancy body mass index in a first uncomplicated pregnancy and outcomes of a second pregnancy

Cited by 23 publications

References 39 publications

Managing anesthesia  for cesarean section in obese patients: current perspectives

Managing anesthesia  for cesarean section in obese patients: current perspectives

Malmström vacuum or Kielland forceps: which causes more damage to pelvic floor?

Perinatal Advantages and Disadvantages of Being Underweight before Pregnancy: A Population-Based Study

Contact Info

Product

Resources

About

Prepregnancy body mass index in a first uncomplicated pregnancy and outcomes of a second pregnancy

Cited by 23 publications

References 39 publications

Managing anesthesia &nbsp;for cesarean section in obese patients: current perspectives

Managing anesthesia &nbsp;for cesarean section in obese patients: current perspectives

Malmström vacuum or Kielland forceps: which causes more damage to pelvic floor?

Perinatal Advantages and Disadvantages of Being Underweight before Pregnancy: A Population-Based Study

Contact Info

Product

Resources

About

Managing anesthesia for cesarean section in obese patients: current perspectives

Managing anesthesia for cesarean section in obese patients: current perspectives