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Maternal and Neonatal Outcomes After Bariatric Surgery: A Systematic Review and Meta-Analysis: Do the Benefits Outweigh the Risks?

W. Kwong,G. Tomlinson,D. Feig

Published 2019 in Obstetric Anesthesia Digest

ABSTRACT

expansion with colloids was associated with significantly lower systolic and diastolic blood pressures compared with the crystalloid or no volume expansion group, but no significant differences were found between the groups for heart rate or cardiac index. Data could not be aggregated from > 1 study to evaluate effects on systemic vascular resistance or atrial natriuretic peptide (ANP). Two studies did investigate systemic vascular resistance but with different control groups; both found a decrease in systemic vascular resistance occurred following volume expansion with a colloid. Two studies measured ANP levels and found significant increases in ANP for the colloid groups. For the other outcomes evaluated, only one or 2 studies reported on the outcome so meta-analysis could not be performed. The authors of this systematic review and metaanalysis concluded that there still remains insufficient evidence from RCTs to provide strong recommendations for a specific fluid management protocol in women with preeclampsia. They recommended management be tailored to each patient’s status and suggested a role for the use of noninvasive hemodynamic monitors to guide treatment. They did state that guidelines advocating fluid restriction in preelamptic women are likely justified, at least until more data become available. Finally, they indicated large RCTs addressing fluid management in preeclampsia are still needed to further elucidate the best fluid management strategies in this heterogenous patient group.

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