Carolyn Chiswick

Improving pregnancy outcome in obese women.

The global pandemic of maternal obesity presents a major challenge for healthcare providers, and has significant short- and long-term implications for both maternal and fetal health. Currently, the evidence-base underpinning many of the interventions either currently in use or recommended to improve pregnancy outcome in obese women is limited. The nature and timing of these interventions vary widely, ranging from simple advice to more intensive dietary and exercise programmes, cognitive behavioural therapy and drug trials. In addition, a growing number of very severely obese women now enter pregnancy having had surgical interventions. Although surgical interventions such as gastric bypass or banding may be associated with improved pregnancy outcomes, these women have particular nutritional requirements, which need to be addressed to optimise pregnancy outcome. Until the outcomes of ongoing current trials are reported and provide a firm evidence base on which to base future intervention strategies and guide evidence based care for obese pregnant women, pregnancy outcome is best optimised by high-risk antenatal care delivered by healthcare providers who are experienced in supporting these high-risk women.

Efficacy of metformin in pregnant obese women: a randomised controlled trial

Introduction Increasing evidence suggests obesity has its origins prior to birth. There is clear correlation between maternal obesity, high birthweight and offspring risk of obesity in later life. It is also clear that women who are obese during pregnancy are at greater risk of adverse outcomes, including gestational diabetes and stillbirth. The mechanism(s) by which obesity causes these problems is unknown, although hyperglycaemia and insulin resistance are strongly implicated. We present a protocol for a study to test the hypothesis that metformin will improve insulin sensitivity in obese pregnant women, thereby reducing the incidence of high birthweight babies and other pregnancy complications. Methods and analysis The Efficacy of Metformin in Pregnant Obese Women, a Randomised controlled (EMPOWaR) trial is a double-masked randomised placebo-controlled trial to determine whether metformin given to obese (body mass index >30 kg/m2) pregnant women from 16 weeks’ gestation until delivery reduces the incidence of high birthweight babies. A secondary aim is to test the mechanism(s) of any effect. Obese women with a singleton pregnancy and normal glucose tolerance will be recruited prior to 16 weeks’ gestation and prescribed study medication, metformin or placebo, to be taken until delivery. Further study visits will occur at 28 and 36 weeks’ gestation for glucose tolerance testing and to record anthropometric measurements. Birth weight and other measurements will be recorded at time of delivery. Anthropometry of mother and baby will be performed at 3 months postdelivery. As of January 2014, 449 women had been randomised across the UK. Ethics and dissemination The study will be conducted in accordance with the principles of Good Clinical Practice. A favourable ethical opinion was obtained from Scotland A Research Ethics Committee, reference number 10/MRE00/12. Results will be disseminated at conferences and published in peer-reviewed journals. Trial registration number ISRCTN51279843.

Fat necrosis of the abdominal pannus following caesarean section in patients with morbid obesity.

glandular lesions look like MDA, based not only on the chief clinical symptom (a large amount of a watery discharge), but also on the radiologic and histologic findings [4]. Most articles describing radiologic features of MDA were published in early 1990s, whereas LEGH was described in 1999. Therefore, a significant number of lesions reported as MDA might represent LEGH rather than true MDA. Because MDA has an extremely poor prognosis and the patient with MDA needs to undergo a radical hysterectomy, benign pseudoneoplastic glandular lesions should be differentiated from MDA, especially in young women to avoid unnecessary hysterectomies. LEGH, as one of the pseudoneoplastic glandular lesions, was first proposed by Nucci et al. in 1999 and characterized by prominent proliferation of endocervical glands with a lobular arrangement [5]. Nara et al. reported that surgical treatment should be considered for LEGH with a width 1.8 cm, even if malignant findings are not noted because LEGH may represent a pre-cancerous condition for Fig. 1. Radiologic, gross and histologic findings of lobular endocervical glandular hyp intensity (arrow), suggesting possible minimal deviation adenocarcinoma or other ps simple trachelectomy

Induction of Labour in Obese Women

Induction of labour is one of the most commonly performed obstetric interventions. Obese women are more likely to require induction of labour for a variety of reasons. They are also less likely to achieve an uncomplicated vaginal delivery following the process. Much of the aetiology remains poorly understood, and there is a paucity of evidence to guide the clinician caring for obese women who require induction of labour. There is a need for further research to help define the mechanisms responsible and devise an evidence-based care plan for obese women who require induction of labour for whatever the reason.