The Acute Abdomen in Pregnant Women After Roux-en-Y Gastric Bypass: Encouraging Results from a National Referral Centre

Abstract

Background

Pregnant women with a history of bariatric surgery (BS) may develop acute abdominal pain related to this surgery, especially after Roux-en-Y gastric bypass. Studies showed alarming results regarding maternal and foetal morbidity and mortality. The aim of this study was to analyse these outcomes for pregnant women and their offspring.

Methods

Single-centre retrospective cohort study in a tertiary referral centre for bariatric complications during pregnancy. Pregnant women with a history of BS referred between September 2015 and November 2019 with acute abdominal pain suspected for a bariatric complication were included. Data were retrospectively collected from the patient files, and a questionnaire was sent regarding the postoperative course and childbirth.

Results

Fifty women were included. At presentation, mean maternal age was 31 (± 4) years, and median gestational age was 28+4 (25+4, 30+5) weeks. Thirteen women were treated conservatively. Thirty-seven women underwent surgery for, among others, internal herniation (n = 26) and intussusception (n = 6). Six women required small bowel resection. Two women underwent an emergency caesarean section shortly after the surgery due to foetal distress. Eight women delivered preterm of whom five infants required respiratory support. There was one intrauterine foetal death. Surgery > 48 h after the onset of the symptoms was not associated with an increase in small bowel resections or preterm birth.

Conclusion

Acute abdominal pain in pregnant women may be related to a bariatric complication. Further awareness of bariatric complications within the obstetric care and transferal to specialized care to prevent diagnostic delay may improve maternal and neonatal outcome.

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Correspondence to Daniëlle S. Bonouvrie.

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Appendix

Appendix

Questionnaire: Bariatric Complication During Pregnancy

  1. 1.

    What was your pre-pregnancy weight?

  2. 2.

    How long (hours) did the acute abdominal pain exist before you were admitted to the emergency department of Maxima Medical Centre?

  3. 3.

    What was you gestational age when you were admitted to the emergency department of Maxima Medical Centre?

  4. 4.

    Could you tell us, as precise as possible, how your abdominal pain started, where the pain was located and if there was anything that could reduce or worsen the pain?

  5. 5.

    Was the pain absent after you were discharged from the hospital? Yes/No* (*strike out whichever option does not apply to you). In case No applies to you, could you describe the pain?

  6. 6.

    Did any problems occur during the pregnancy or the childbirth after discharge from the hospital?

  7. 7.

    What was you gestational age when you delivered your child?

  8. 8.

    What was the type of your childbirth? Vaginal delivery/caesarean delivery* (*strike out whichever option does not apply to you).

In case of a vaginal delivery ➔ continue to question 9 and skip question 12 and 13.

In case of a caesarean delivery ➔ continue to question 12

  1. 9.

    Was your childbirth induced? Yes/No* (*strike out whichever option does not apply to you). In case yes applies to you, what was the reason for the induction?

  2. 10.

    What was the position of your baby? Head/breech* (*strike out whichever option does not apply to you).

  3. 11.

    How was the delivery? Without assistance/forceps/vacuum* (*strike out whichever option does not apply to you).

  4. 12.

    Which type of C-section applies? Elective C-section/emergency C-section (*strike out whichever option does not apply to you). What was the reason for the C-section?

  5. 13.

    Did any complications occur during childbirth? Yes/No* (*strike out whichever option does not apply to you). In case of yes, which complication(s) and how was this treated?

  6. 14.

    Did their occur any complications regarding the health of your child(ren) in the first couple of days after the childbirth? Yes/No* (*strike out whichever option does not apply to you). In case of yes, which complication(s) and how was this treated?

  7. 15.

    What was the length of your baby at childbirth?

  8. 16.

    What was the body weight of your baby at childbirth?

In case you gave birth to twins ➔

  1. 17.

    What was the length of your second baby at childbirth?

  2. 18.

    What was the body weight of your second baby at childbirth?

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Bonouvrie, D.S., van der Woude, D.A.A., Uittenbogaart, M. et al. The Acute Abdomen in Pregnant Women After Roux-en-Y Gastric Bypass: Encouraging Results from a National Referral Centre. OBES SURG 30, 4029–4037 (2020). https://doi.org/10.1007/s11695-020-04833-5

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Keywords

  • Bariatric surgery
  • Roux-en-Y gastric bypass
  • Pregnancy
  • Abdominal pain
  • Complication
  • Internal herniation
  • Intussusception