Obstetrics and gynecology clinics of North America
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The incidence of obesity is increasing rapidly, and it affects a greater proportion of women than men. Unfortunately, obesity has a negative impact on women's reproductive health, including increased adverse perinatal outcomes. ⋯ A woman who becomes pregnant after bariatric surgery usually has an uncomplicated pregnancy but requires special attention to some complications that can occur after these procedures. This article reviews the perinatal outcomes and provides recommendations for care regarding the unique issues that arise during a pregnancy after bariatric surgery.
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Although renal disease in pregnancy is uncommon, it poses considerable risk to maternal and fetal health. This article discusses renal physiology and assessment of renal function in pregnancy and the effect of pregnancy on renal disease in patients with diabetes, lupus, chronic glomerulonephritis, polycystic kidney disease, and chronic pyelonephritis. Renal diseases occasionally present for the first time in pregnancy, and diagnoses of glomerulonephritis, acute tubular necrosis, hemolytic uremic syndrome, and acute fatty liver of pregnancy are described. Finally, therapy of end-stage renal disease in pregnancy, dialysis, and renal transplantation are reviewed.
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Venous thrombosis and embolism (VTE) is one of the most common, serious complications associated with pregnancy, and now ranks as a leading cause of maternal morbidity and mortality in developed countries. Information regarding the association of VTE with acquired and heritable thrombophilias has greatly expanded in the last 20 years, adding a new layer of complexity to decisions about thromboprophylaxis. The objective of this review is to detail which patients are at clinically important increased risk for VTE, are candidates for thrombophilia screening, and warrant thromboprophylaxis. Recommended management regimens for use in specific patient subgroups are also provided.