Several interventions maybe preventive. Closure ofsubcuta tion rates (Tipton, 2011). Studies have also examined the use of higher doses of perioperative prophylactic antibiotics. Phar macokinetic studies indicate that tissue concentrations of pro phylactic antibiotics are lower with increasing BMI (Pevzner, 2011; Young, 2015). One prospective study showed that a 3-g dose of cefazolin resulted in higher tissue concentrations com pared with a 2-g dose (Swank, 2015). hat said, a retrospective analysis of 335 women with a median weight of 310 pounds found that the higher dose of cefazolin did not result in few surgical site infections (Ahmadzia, 2015). In one recent study, phylaxis had a surgical infection rate of 13.4 percent compared with a rate of 6.4 percent for those given a 2-day course of oral cephalexin and metronidazole in addition to perioperative prophylaxis (Valent, 2017).
used prophylactically (Mark, 2014). To address this, Hussamy and colleagues (2018) designed a randomized trial of NPWT going cesarean delivery. Such therapy did not signiicantly lower the postoperative wound complication rate compared with routine care-19 versus 17 percent, respectively.
To lower thromboembolic complications, graduated compression stockings, hydration, and early mobilization after cesarean delivery in obese women are recommended by the American College of Obstetricians and Gynecologists (2015). Some also recommend "mini-dose" heparin prophylaxis, but we do not routinely use this (Chap. 52, p. 1019).
Several surgical procedures are designed to treat morbid obesity either by diminishing gastric volume-restrictive, or by bypassing gastrointestinal absorption-restrictive nalabsorptive. In nonpregnant patients, these procedures improve or resolve diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea and reduce risks of myocardial infarction and death (Beamish, 2016).
Of options, the two approved laparoscopic adjustable silicone gastric banding (LASGB) procedures-LAPBAND and REALIZE-place a band 2 cm below the gastroesophageal junction to create a small stomach pouch above the ring. he ring diameter is controlled by a saline reservoir in the band.
hese procedures can have positive efects on pregnancy outcomes. For example, Dixon and colleagues (2005) compared
TABLE 8-3. Pregnancy Outcomes Following Bariatric Surgery
Outcomea (n = 651) (n = 361.) aData not reported identically-frequencies are approxi mations.
bData from Adams, 201n5; Bar-Zohar, 2006; Carelli, 201n1;
Dixon, 2005; Ducarme, 2013; Facchiano, 2012; Lapolla, 2010; Pilone, 2014; Sheiner, 2009; Skull, 2004.
(Data from Adams, 2015; Ducarme, 2013; Facchiano, 2012;
Gonzalez, 2015; Sheiner, 2009.
pregnancy outcomes in bariatric surgery patients against their preprocedural outcomes and those of a matched cohort of obese women. Following banding, the incidences of gestational hypertension-1 0 versus 45 percent-and gestational diabetes-6 versus 15 percent-were significantly lower in the bariatric surgery patients compared with their preprocedural pregnancies. The results from these and other studies are shown in Table 48-3.