Handbook of Obesity in Obstetrics and Gynecology

1st Edition - January 12, 2023
Imprint: Academic Press
Editors: Tahir A. Mahmood, Chu Chin Lim
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 8 9 9 0 4 - 8
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 8 9 9 1 2 - 3

**Selected for Doody’s Core Titles® 2024 in Obstetrics & Gynecologyn**Handbook of Obesity in Obstetrics and Gynecology addresses all aspects of general obstetrics and gyne… Read more

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**Selected for Doody’s Core Titles® 2024 in Obstetrics & Gynecologyn**

Handbook of Obesity in Obstetrics and Gynecology addresses all aspects of general obstetrics and gynecology in obese patients, providing evidence-based guidance for the treatment and management of gynecological problems and pregnancy-related care in obese women. The book is a valuable resource for junior doctors, residents and obstetricians and gynecologists looking for a comprehensive guide that addresses the most relevant aspects of obstetric and gynecologic care that are impacted by obesity, an increasingly prevalent condition. The rising prevalence of global obesity is of public health concern, hence obese women suffer from a higher incidence of menstrual disorders, polycystic ovaries, infertility issues, and more.

In pregnancy, obesity is associated with an increased risk of early pregnancy loss, recurrent pregnancy loss, fetal developmental abnormalities, thrombo-embolic disease, gestational diabetes, dysfunctional labor, post-partum hemorrhage and difficult operative deliveries.

Cover image
Title page
Table of Contents
Copyright
Dedication
List of contributors
Preface
Section 1: Gynaecology
1. Obesity, the onset of adolescence and menstrual disorders
Abstract
1.1 Role of BMI charts
1.2 Aetiology
1.3 Summary
Reference
Further reading
2. Polycystic ovary syndrome
Abstract
2.1 Introduction
2.2 Diagnosis
2.3 Obesity, polycystic ovary syndrome, and related indices
2.4 Comorbidities
2.5 Other contraception consideration
Further reading
3. Hirsutism
Abstract
3.1 Clinical features and symptoms
3.2 Examination
3.3 Summary
Further reading
4. Contraception for obese and super obese women
Abstract
4.1 Risks associated with obesity during pregnancy
4.2 Classification of obesity
4.3 Metabolic disorders associated with obesity in nonpregnant obese
4.4 Mechanisms by which obesity could potentially affect contraceptive efficacy
4.5 Potential concerns with obesity and contraception
4.6 Methods of sterilisation
Further reading
5. Contraception after bariatric surgery
Abstract
5.1 Introduction
5.2 Obesity and contraception issues
5.3 Progestogen-only pill
Further reading
6. Obesity and sexual health
Abstract
6.1 Sexual behaviour
6.2 Obesity and sexual function
6.3 Obesity and sexual health outcomes
6.4 Managing sexuality issues of young obese women
Reference
Further reading
7. Obesity: male and female infertility
Abstract
7.1 Introduction
7.2 Epidemiology
7.3 Female infertility
7.4 Treatment options
7.5 Male infertility
7.6 Conclusion
Further reading
8. Obesity—recurrent miscarriage
Abstract
8.1 Introduction
8.2 Obesity and miscarriage
8.3 Obesity and recurrent miscarriage
8.4 Aetiologies of recurrent miscarriage
8.5 Polycystic ovarian syndrome
8.6 Ovarian dysfunction
8.7 Endometrial changes in obesity
8.8 Immunological factors
8.9 Management of recurrent miscarriage
8.10 Conclusion
Further reading
9. Obesity and assisted conceptionion
Abstract
9.1 Introduction
9.2 Conclusion
10. Medical and surgical interventions to improve fertility outcomes
Abstract
10.1 Introduction
10.2 Lifestyle interventions
10.3 Medical interventions
10.4 Surgical Interventions to improve fertility potential in obese men and women
10.5 Conclusion
Further reading
11. Heavy menstrual bleeding
Abstract
11.1 Introduction
11.2 Polyp
11.3 Adenomyosis
11.4 Leiomyoma
11.5 Malignancy and hyperplasia
11.6 Ovulatory dysfunction
11.7 Endometrial
11.8 Structured history taking in women with AUB
11.9 Assessment of women presenting with HMB
11.10 Investigations
11.11 Management of women with HMB/AUB
11.12 Nonsteroidal anti-inflammatory drugs
11.13 Hormonal options
11.14 Conclusion
Further reading
12. Obesity, incontinence, and pelvic floor dysfunction
Abstract
12.1 Urinary incontinence
12.2 Obesity and stress urinary incontinence
12.3 Anal incontinence
12.4 Pelvic floor dysfunction
12.5 Conclusion
13. Obesity and pelvic organ prolapse
Abstract
13.1 Introduction
13.2 Obesity as risk factor for pelvic organ prolapse
13.3 Weight loss and the effects upon pelvic organ prolapse
13.4 Prolapse surgery in the obese woman
13.5 Recurrence of pelvic organ prolapse
13.6 Conclusion
Key points
14. Obesity and chronic pelvic pain
Abstract
14.1 Introduction
14.2 Obesity and pain physiology
14.3 Genetics of obesity and pelvic pain
14.4 Psychological impact of obesity and chronic pain
14.5 Impact of obesity on assessment of chronic pelvic pain
14.6 Impact of obesity on treatment of women with chronic pelvic pain
14.7 Impact of obesity on surgical management of women with chronic pelvic pain
14.8 Obesity and endometriosis
14.9 Obesity and adenomyosis
14.10 Obesity and abdominal myofascial pain syndrome
14.11 Obesity and nongynecological causes of chronic pelvic pain
14.12 Conclusion
Further reading
15. Obesity and clinical psychosomatic women’s health
Abstract
15.1 Introduction
15.2 Psychosomatic aspect of menstrual problems and obesity
15.3 Psychosomatic insights into menstrual problems in the obese
15.4 Clinical psychosomatic approach to menstrual disorder
15.5 Clinical psychosomatic approach to premenstrual syndrome
15.6 Psychosomatic aspect of infertility and obesity
15.7 Psychosomatic aspect of gender violence and obesity
15.8 Psychosomatic aspect of severe pelvic/perineal dysfunction and obesity
15.9 Psychosomatic aspect of gynaecological tumours and obesity
15.10 Conclusions
Further reading
16. Obesity and cancer
Abstract
16.1 Overview
16.2 Epidemiological evidence for links between obesity and cancer
16.3 Cancers unique to or more common in women
16.4 Potential mechanisms for oncogenesis
16.5 Clinical implications for prevention and treatment of cancer in obese patients
16.6 Ongoing needs for research
16.7 Endometrial cancer
16.8 Breast cancer
16.9 Ovarian cancer
16.10 Cervical cancer
16.11 Mechanisms relating obesity to female malignancies
16.12 Effect of obesity on management of female malignancies
16.13 Oncogenetics
16.14 Future directions
Further reading
17. Obesity and breast cancer
Abstract
17.1 Epidemiology
17.2 Pathogenic mechanisms
17.3 Diagnosis
17.4 Therapy
17.5 Prognosis
Further reading
18. Female obesity and osteoporosis
Abstract
18.1 Introduction
18.2 Normal bone metabolism
18.3 Epidemiology of osteoporosis and obesity
18.4 Relationship between fat and bone: epidemiologic and clinical observations
18.5 Hormonal effect of obesity and osteoporosis
18.6 Adipocyte hormones
18.7 Obesity of the bone
18.8 Clinical and diagnostic implication of the concept obesity of the bone
18.9 Treatment implications of the concept obesity of the bone
18.10 Bariatric surgery and bone health
18.11 Management after Roux-en-Y gastric bypass
18.12 Pragmatic approach for obese women
18.13 Conclusion
Further reading
19. Menopause and hormone replacement therapy
Abstract
19.1 Introduction
19.2 Oestrogens and menopausal obesity
19.3 Lifestyle intervention and hormone replacement therapy
19.4 Healthy lifestyle
19.5 Progesterone
19.6 Emerging therapies
19.7 Conclusion
Further reading
20. Intraoperative care during gynaecology surgery
Abstract
20.1 Introduction
20.2 Decision-making about surgery
20.3 Physiological changes in obese women
20.4 Preoperative evaluation
20.5 Equipment and general considerations
20.6 Anaesthetic challenges
20.7 Thromboprophylaxis
20.8 Sepsis prophylaxis
20.9 Intraoperative challenges
20.10 Open abdominal surgery
20.11 Postoperative issues
20.12 Conclusion
Further reading
Section 2: Obstetrics
21. Pathological basis of effects of obesity on pregnancy outcome
Abstract
21.1 Introduction
21.2 Classification of body mass index
21.3 Increased disease burden secondary to obesity
21.4 Other comorbidities
21.5 Physiological changes during pregnancy in normal weight women
21.6 First and second trimester of pregnancy
21.7 Third trimester
21.8 In normal weight women fat distribution
21.9 Amino acid metabolism in normal weight women
21.10 Pathological changes in obese women during pregnancy
21.11 There is increased mass of metabolic reactive visceral adipose tissue
21.12 Hyperlipidaemia
21.13 Low-grade chronic inflammation
21.14 Adiposity and pregnancy-specific insulin resistance
21.15 Glucose metabolism in obese women
21.16 Amino acid metabolism in obese women
21.17 Visceral adiposity as modulator for proinflammatory–prothrombotic state
21.18 Raised serum leptin
21.19 InterLeukin-6
21.20 Plasminogen activator inhibitor-1
21.21 TNF-α
21.22 Angiotensinogen
21.23 Ghrelin
21.24 Bone health
21.25 Long-term changes in cardiac function induce
21.26 Smoking, obesity, and cardiovascular disease risk
21.27 Preeclampsia
21.28 Maternal obesity and in-utero programming
21.29 Human studies have shown
21.30 Various hypotheses of transmission of intergenerational obesity are as follows
21.31 Summary
Further reading
22. Preconception care for obese women
Abstract
Further reading
23. Weight optimisation strategies in pregnant obese women
Abstract
23.1 Guidelines on maternal weight gain during pregnancy
23.2 Antenatal consequences of increased gestational weight gain
23.3 Postpartum consequences of increased gestational weight gain
23.4 Consequences of increased gestational weight gain for the child
23.5 Consequences of low gestational weight gain
23.6 Strategies for weight management
23.7 Exercise in pregnancy
23.8 Summary of weight optimisation in pregnancy
Further reading
24. Early pregnancy and obesity
Abstract
24.1 Management
Further reading
25. Ultrasound scanning in early pregnancy and foetal abnormality screening in obese women
Abstract
25.1 Introduction
25.2 Ultrasound scanning in early pregnancy
25.3 Conclusion
Conflict of interests
Funding source
Further reading
26. Antenatal care for obese women
Abstract
26.1 Introduction
26.2 According to the WHO (2016) report
26.3 Antepartum care of obese women
26.4 Prepregnancy counselling
26.5 Antenatal care
26.6 The first antenatal visit
26.7 Measuring weight and height for risk stratification
26.8 Diet and lifestyle modifications
26.9 Weight gain in pregnancy
26.10 Overview of antenatal tests appointments and scans
26.11 Mode and timing of delivery
26.12 Planning for delivery
26.13 Post delivery
Further reading
27. Management of pregnancy in elderly obese women
Abstract
27.1 Prevalence
27.2 Pregnancy outcomes in relation to advanced maternal age
27.3 Late pregnancy complications
27.4 Intrapartum and postpartum complications
27.5 Management
27.6 Antenatal
Further reading
28. Novel viruses and pregnancy
Abstract
28.1 Introduction
28.2 Virus and pathogenesis
28.3a Ebola virus (EBV) (Filoviridae: 1976–2021)
28.3b Zika virus (Flavivirus: 2015—current)
28.3c MERS-CoV (2012–current)
28.3d HIN1 virus (Ortho-myxovirus: 2009–2010)
28.3e Coronavirus—SARS-CoV-2 (COVID-19)
Further reading
29. Infections during pregnancy
Abstract
29.1 Immunology of pregnancy
29.2 In nonpregnant state
29.3 In pregnancy
29.4 Effect of obesity on the immunology
29.5 How to interpret the screening tests when there is a suspicion of infection?
29.6 Urinary tract infection
29.7 Group B Streptococcus (Streptococcus agalactiae)
29.8 Management of positive group B streptococcus result
29.9 Managing women in labour with positive group B streptococcus screening
29.10 Genital herpes
29.11 Classical features of primary herpes simplex virus infection are
29.12 Treatment is influenced by
29.13 Chlamydia trachomatis
29.14 Chicken pox (varicella zoster virus)
29.15 Exposure to chicken pox in adulthood
29.16 The features of foetal varicella syndrome
29.17 Labour management and neonatal varicella
29.18 Rubella
29.19 Toxoplasmosis
29.20 Parvovirus B19
29.21 Cytomegalovirus infection
29.22 Malaria
29.23 Presentation
29.24 Risks during pregnancy
29.25 Summary
Further reading
30. Weight management during pregnancy
Abstract
30.1 Introduction
30.2 Weight gain guidelines
30.3 Risks of inappropriate weight gain
30.4 Should women be weighed during antenatal period?
30.5 Exercise
30.6 Diet
30.7 Achieving healthy lifestyles
30.8 Postpartum
30.9 Conclusion
Recommendations for further reading
31. Management of pregnancy in women with history of weight loss surgery
Abstract
31.1 Introduction
31.2 Types of bariatric surgery
Further reading
32. Challenges of third trimester scanning in obese women
Abstract
32.1 Introduction
32.2 Why do obese pregnant women need a third trimester scan?
32.3 Challenges in third trimester screening
Further reading
33. Screening for gestational diabetes mellitus
Abstract
33.1 Prepregnancy risk factors include
33.2 Effect of gestational diabetes mellitus on both mother and baby
33.3 Long-term impact
33.4 Screening methods
33.5 Should all pregnant women be tested for hyperglycaemia in pregnancy?
33.6 Should all women be tested by a 75 g oral glucose tolerance test?
33.7 Postpartum follow-up after gestational diabetes
33.8 Interventions for prevention of gestational diabetes mellitus
Further reading
34. Management of obese pregnant women with pre-diabetes and type 1 and 2 diabetes mellitus
Abstract
34.1 Background
34.2 Treatment of gestational diabetes mellitus
34.3 Treatment of preexisting diabetes during pregnancy
34.4 Additional tips for caring for women with pregestational diabetes during pregnancy
34.5 Treatment of newly diagnosed, ‘overt’ diabetes during pregnancy
34.6 Monitoring foetal well-being
34.7 Timing and mode of delivery
34.8 Intrapartum control of glucose
34.9 Postpartum care
References
35. Drug interactions for women with diabetes and obesity during pregnancy
Abstract
35.1 Diabetes during pregnancy
35.2 Obesity and pregnancy
Further reading
36. Short- and long-term effects of gestational diabetes and foetal outcomes
Abstract
36.1 Maternal diabetes and insulin resistance
36.2 Short-term risks
36.3 Short-term clinical consequences of increased foetal size include
36.4 Long-term (foetal)
36.5 Long-term maternal risks
36.6 Short-term maternal risks
36.7 Evidence for preventing type 2 diabetes after gestational diabetes
36.8 Implications for the obstetrician and primary care provider
Further reading
37. Obesity and preeclampsia
Abstract
37.1 Introduction
37.2 Definitions
37.3 Predisposition to preeclampsia
37.4 Pathophysiological basis of pregnancy induced hypertension (PIH) during pregnancy
37.5 The placenta
37.6 Risk of miscarriage
37.7 Chronic hypertension
37.8 Effect of obesity-associated PIH on pregnancy outcomes
37.9 Care during pregnancy
37.10 Place of delivery
37.11 Postpartum
37.12 Long-term implications
37.13 Practical consideration for obesity and pregnant women
37.14 Conclusion
Further reading
38. Venous thromboembolism in obese mother
Abstract
38.1 Introduction
38.2 Pathophysiology
38.3 Other contributory factors
38.4 Symptoms of venous thromboembolism
38.5 Prevention of venous thromboembolism in obese pregnant women
38.6 Agents for thromboprophylaxis
38.7 Investigation for venous thromboembolism
38.8 Management of venous thromboembolism in obese pregnant women
38.9 Intrapartum care in obese pregnant women with regard to venous thromboembolism
38.10 Postnatal care in obese pregnant women
38.11 Contraception in obese women with a history of venous thromboembolism
38.12 Future advice in obese pregnant women with history of venous thromboembolism in index pregnancy
Further reading
39. Induction of labour in obese pregnancies
Abstract
39.1 Indications of induction of labour
39.2 Counselling for induction of labour
39.3 Methods of induction of labour
Further reading
40. Intrapartum care for obese women
Abstract
40.1 Introduction
40.2 The impact of obesity in labour
40.3 Labour management
40.4 Summary
Further reading
41. Assisted vaginal delivery in obese women
Abstract
41.1 Introduction
41.2 Indications
41.3 Prerequisites
41.4 Contraindications
41.5 Specific considerations in obese women
41.6 Summary
Further reading
42. Sepsis in obese pregnant women (concise version)
Abstract
42.1 Introduction
42.2 Epidemiology of obesity and sepsis
42.3 Immunology
42.4 Specific infections
42.5 Viral infections
42.6 Sepsis
42.7 Intrapartum care
42.8 Operative issues
42.9 Caesarean sections
42.10 Preoperative considerations
42.11 Antibiotic prophylaxis
42.12 Incision
42.13 Closure
42.14 Postoperative care
42.15 Care in wound dehiscence
42.16 Patient education
References
43. Immediate postnatal care in obese women
Abstract
43.1 Historical background
43.2 Implications of obesity in planning of postnatal care
43.3 Postpartum care plan
43.4 Thromboembolism (venous thrombosis)
43.5 Sepsis risk
43.6 Postpartum haemorrhage
43.7 Preeclampsia
43.8 Breast feeding initiation and maintenance
43.9 Care plan for other health risks
Further reading
44. Postpartum weight management and future pregnancy planning
Abstract
44.1 Complications of obesity
44.2 Complications of weight stigma
44.3 Outcomes of obesity and its effects on future pregnancies
44.4 General postpartum management
44.5 Weight loss management strategy
44.6 Obesity, weight loss, and future fertility planning
44.7 Planning for future pregnancies
References
Index

Tahir A. Mahmood

Tahir Mahmood, CBE, MD, FRCPI, FFRSH, MBA, FACOG, FRCPE, FEBCOG, FRCOG Consultant Gynecologist and Clinical Director Women , Children and Clinical Services Directorate , Victoria Hospital, NHS Fife, Kirkcaldy, Scotland, UK Past Vice-President Standards, Royal College of Obstetricians and Gynecologists (2007-2010); President, European Board and College of Obstetrics and Gynecology (EBCOG, 2014-2017); Past President of Edinburgh Obstetrical Society ( 2012-2014); Past President of the Northern Obstetrical and Gynaecological Society of Scotland ( 1999-2011), National Lead for Heavy Menstrual Bleeding Audit in England and Wales (2010-2015), FIGO Hyperglycaemia in Pregnancy Working Group ( 2014-2016); and is currently International UNFPA Consultant for EECA Region, Chair of EBCOG Standards of Care and Position Statements Group, and Life Trustee Lindsay Stewart R&D Foundation of the Royal College of Obstetrician and Gynaecologists. In the recent past, he has held honorary senior Clinical Lectureships at the Universities of Edinburgh, Dundee and St. Andrews in Scotland. He has edited 10 manuscripts and has published more than 200 research papers and chapters. He was appointed as Commander of the order of the British Empire (CBE) in the New Year’s honours list (2012) by Her Majesty Queen Elizabeth, the 2nd

Affiliations and expertise

Consultant Obstetrician and Gynaecologist, Victoria Hospital, Kirkcaldy and Clinical Senior Lecturer, University of St. Andrews, UK

Chu Chin Lim

Dr Lim graduated from Queens University, Belfast, in 1992. He completed his training program in Northern Ireland and higher specialty training in Ninewells hospital, Dundee University, and also completed a Fellow training program in University of Otago, New Zealand, in Urogynecology. Dr Lim was appointed as Consultant Obstetrician and Gynecologist to NHS Fife in 2004 and currently is committee member for Clinical Governance Group for British Society of Urogynecology. His research interests include minimal access surgery and well-being of obese women both in obstetrics & gynecology.

Affiliations and expertise

Consultant Obstetrician and Gynaecologist, Victoria Hospital, UK

Life Sciences

Physical Sciences & Engineering

Social Sciences & Humanities

Health