1. Outcome of Early Pregnancy After Bariatric Surgery Outcome of Early Pregnancy After Bariatric Surgery Dr. Tereza Indrielle Remesova Lucy Jones Pratik Sufi Department of Bariatric Surgery Whittington Hospital London. UK

2. Background Increase 800 % (USA) American Society for Metabolic & Bariatric Surgery / ACOG: Women after bariatric surgery should delay conception to 12 – 18 months post operatively 150 kg 110kg 85kg 0 months 12 months 18 months

3. Our cohort 2009 - 2011 20 patients aged 22 – 42 2 gastric bands, 18 gastric bypass conceived at 1 week to 42 months after bariatric surgery

4. Methods Retrospective data collection from medical records semi-structured telephone interviews were carried out with most of the patients initial reproductive plans fertility status contraceptive method surgical outcome development of pregnancy and obstetrical and neonatal outcome

5. Results - Pregnancies 11 primiparas 4 women G3, 1 woman G4, 1 woman G5  3 not recorded 17Singleton 2Twins 1Miscarriage (6 weeks)

6. Results - Conception 16 10 patientsBefore 12 months 3 patients12 - 18 months 7 patients18 – 42 months non - intentionally9  3 pill 2 condom 1 implant removed 1 patch 2 nil Intentionally0 Non - intentionally 6 no contraception 1 pill intentionally3

7. Results - Fertility 5 patients thought to be infertile 1 not recorded 9PCOS 1Decreased infertility 9Normal fertility 9regular 5irregular 1Amenorrhoea, resolved after surgery

8. Complications 2 cases not recorded 3 cases not recorded 1 Placental abruption (38w) 1 small-sized placenta 1 Hypoglycaemia 1 low levels of vit/minerals 3 anaemia no gestational diabetes (bias?) 5 Uncomplicated pregnancy 1 not recorded 1 PPH 1 IUGR (30w) 1 hypertension 1 Anterior abdo wall haematoma 1 pneumonia 1 symptomatic gall stones 5 anaemia 1 Ca deffiniciency no gestational diabetes (bias?) 2 uncomplicated pregnancies

9. Mode of Delivery 4 cases not recorded / about to give birth C section (42 %)Emergency 4 Placental abruption Foetal distress at 42 weeks Growth failure Failed induction Elective 2 Breech Previous C section Vaginal (58 %)10

10. Neonatal outcome Average weight of the newborn was 2.94 kg (0.9 – 4 kg) and all babies were healthy at the time of the interview. NICU – twins with IUGR 130 weeks (twins) 1438 - 41 142 weeks

11. Conclusion Low fertility, increases rapidly with weight loss -> appropriate counselling Complications related to obesity and rapid weight loss Obstetrical outcome satisfactory if well monitored Neonatal outcomes satisfactory

12. Conclusion Careful monitoring, MDT approach

13. Questions? www.ObsGynae.net Tereza.Remesova@nhs.net