Pregnancy outcomes and nutritional indices after 3 types of bariatric surgery performed at a single institution

BackgroundNutritional status during pregnancy and the effects of nutritional deficiencies on pregnancy outcomes after bariatric surgery is an important issue that warrants further study. The objective of this study was to investigate pregnancy outcomes and nutritional indices after restrictive and malabsorptive procedures.MethodsWe investigated pregnancy outcomes of 113 women who gave birth to 150 children after biliopancreatic diversion (BPD), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) between June 1994 and December 2011. Biochemical indices and pregnancy outcomes were compared among the different types of surgery and to overall 20-year hospital data, as well as to 56 presurgery pregnancies in 36 women of the same group.ResultsAnemia was observed in 24.2% and 15.6% of pregnancies after BPD and RYGB, respectively. Vitamin B₁₂ levels decreased postoperatively in all groups, with no further decrease during pregnancy; however, low levels were observed not only after BPD (11.7%) and RYGB (15.6%), but also after SG (13.3%). Folic acid levels increased. Serum albumin levels decreased in all groups during pregnancy, but hypoproteinemia was seen only after BPD. Neonates after BPD had significantly lower average birth weight without a higher frequency of low birth weight defined as<2500 g. A comparison of neonatal data between babies born before surgery and siblings born after surgery (AS) showed that AS newborns had lower average birth weight with no significant differences in body length or head circumference and no cases of macrosomia.ConclusionOur study showed reasonably good pregnancy outcomes in this sample population after all types of bariatric surgery provided nutritional supplement guidelines are followed. Closer monitoring is required in pregnancies after malabsorptive procedures especially regarding protein nutrition.     

抚触对巨大儿生长发育影响的研究

目的　观察抚触对巨大儿生长发育的影响。方法　 6 3例足月剖宫产出生的巨大儿随机分为抚触组 31例与对照组 32例。从出生 2 4h后开始对抚触组巨大儿进行抚触 ,2次 /d ,15～2 0min/次 ,坚持抚触至少 4个月 ,对照组常规护理不进行抚触。 1岁时对 2组巨大儿的体重、身长进行测量 ,并应用SM社会生活能力量表对 2组巨大儿在 1岁时的智能发育进行测定 ,同时统计 2组巨大儿由出生至 1岁时门诊看病次数及住院次数 (呼吸系统疾病及腹泻为主 )。结果　抚触组巨大儿体格正常发育例数及智能发育得分均显著优于对照组 ;患病率明显低于对照组 ,3项统计结果均为P <0 .0 5。结论　抚触对巨大儿体格的正常发育及智能发育均有良好的促进作用。     

Tracheal rupture in complicated delivery: A case report and review of the literature

A case of distal tracheal rupture is described, literature review reveals two previously reported cases of neonatal distal tracheal rupture, as well as 14 cases of anterior subglottic rupture. All patients had shoulder dystocia, and 59% had associated brachial plexus injury. Delayed diagnosis (>3 days) was common in the distal tracheal group (66%), compared to 0% in the anterior subglottic group. The 2 distal tracheal rupture patients were initially managed conservatively, but ultimately required open repair. Distal tracheal rupture is exceedingly rare and more difficult to diagnose and manage than the more common anterior subglottic rupture.     

巨大儿的产前预测及对母婴结局的影响

目的观察分析巨大儿产期预测对母婴结果的影响。方法选取我院从2011年3月至2012年3月收治的巨大儿共120例。随机将患者分为预测组和非预测组。其中预测组患者共55例产妇,非预测组共65例产妇。结果预测组产妇的剖宫产率为41.8%,明显要低于未预测组的53.8%,两组对比有显著性差异(P<0.01)。另外,两组产妇在分娩过程中,预测组发生的并发症明显要少于未预测组,其中预测组发生胎儿宫内窘迫、肩难产、产后出血以及产后尿潴留等均明显要少于未预测组产妇,两组对比有显著性差异(P<0.01)。结论产期预测能有效减少剖宫产率,防止分娩过程中母婴发生各种的并发症,减少非产妇以及胎儿的影响。     

妊娠期糖尿病巨大儿106例临床分析

目的探讨妊娠期糖尿病（GDM）巨大儿发生情况及母婴结局。方法对本院分娩单胎1166例GDM孕妇及新生儿资料进行回顾性统计分析,106例分娩的巨大儿及孕妇作为研究组,其余1060例为对照组,比较孕妇年龄、身高、孕期增重、孕期增加BMI、产前BMI、孕周、孕产次、妊娠及围产儿并发症的情况。结果研究组孕妇身高、孕期增重、孕期增加BMI、产前BMI、孕周和产次均明显高于对照组（P〈0.01）;孕妇软产道损伤发生率高于对照组（P〈0.05）,羊水过多发生率明显多于对照组（P〈0.01）;围产儿结局研究组死胎、产伤及新生儿肺炎发生率高于对照组（P〈0.05）,尤其肺炎发生率差异极显著（P〈0.01）;比较两组至少发生一项母婴并发症,显示GDM孕妇分娩巨大儿主要影响围产儿结局（P〈0.01）,而对妊娠并发症影响无统计学意义（P〉0.05）。结论确诊为妊娠期糖尿病的孕妇应适当控制孕期增重,积极预防巨大儿的发生,减少相关母婴并发症。     

胰岛素泵和"双C"疗法治疗妊娠期糖尿病的护理和疗效比较

目的 观察胰岛素泵和"双C"疗法对妊娠期糖尿病惠者血糖控制情况和巨大儿出生率的影响.方法 将120例妊娠期糖尿病患者随机均分为两组,胰岛素泵组采用胰岛素泵输入治疗,双C治疗组佩戴动态血糖监测系统(CGMS)24 h后置入胰岛素泵,根据监测结果调整剂量.两组分别行相关护理,观察患者血糖情况和各组巨大儿出生率.结果 两组患者治疗后空腹、餐后、睡前、凌晨血糖均较治疗前降低(P＜0.05或P＜0.01);两组巨大儿出生率控制较好,双C治疗组更好,但组间无明显差异(P＞0.05).结论 胰岛素泵治疗法和"双C"治疗法都是控制妊娠期糖尿病患者血糖安全、有效的方法.     

巨大儿127例临床分析

目的:探讨巨大儿的分娩方式及分娩并发症.方法:对我院127例巨大儿的临床资料进行回顾性分析,并与127例正常新生儿作对照.结果:127例巨大儿难产比例显著高于对照组(P＜0.05).巨大儿组产妇在分娩过程中,产后出血、产道裂伤、新生儿窒息、头盆不称、胎儿窘迫与对照组存在显著性差异.巨大儿组新生儿发生新生儿窒息、低血糖症、产伤的发生率也显著增高.但两组在分娩过程中均无围生儿死亡.结论:对于巨大胎儿应根据不同的临床情况选择合适的分娩方法,尽可能减少母婴损伤,并可适当放宽剖宫产指征.     

个体化医学营养治疗应用于妊娠糖尿病患者的效果分析

目的探讨个体化医学营养治疗在妊娠糖尿病治疗中的效果。方法将226例妊娠期糖尿病孕妇分成观察组118例和对照组108例,比较两组胰岛素使用率、巨大儿和早产儿发生率的差异。结果观察组的胰岛素使用率以及巨大儿和早产儿的发生率较对照组明显降低（P〈0．05）。结论对妊娠期糖尿病患者进行个体化的医学营养治疗,有利于减少并发症和提高孕妇和胎儿的健康水平。