Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
Contraception. 2021 Aug;104(2):202-205. doi: 10.1016/j.contraception.2021.02.012. Epub 2021 Feb 28.
To determine conception rates, contraceptive use patterns, and frequency of counseling regarding pregnancy recommendations in patients undergoing bariatric surgery.
Using a database of bariatric surgery patients at our institution, we identified female patients aged 18 to 45 who underwent surgery from 2013 to 2018. Patient charts were reviewed for demographic information, documentation of counseling regarding pregnancy recommendations, conception during the postoperative period, and pre and postoperative contraception use. We examined rates of contraception use and used standard statistical tests to compare conception rates between groups.
Of the 460 patients that met inclusion criteria and did not have a history of permanent contraception, 54% (95% CI 49-58) had documented postoperative contraception use, most commonly the levonorgestrel-releasing intrauterine device followed by combination oral contraceptive pills. In the 18 months following bariatric surgery, 6% of patients (95% CI 4-8) had a documented pregnancy. Over 50% (95% CI 35-71) of pregnancies occurred in patients without documented postoperative contraception.
For bariatric surgery patients at risk of pregnancy, postoperative contraception use patterns and conception rates are not consistent with the recommendation to refrain from pregnancy for 18 months.
Individualized contraceptive counseling that includes a discussion of fertility and weight loss goals, planned bariatric procedure type, and patient preference should be implemented as part of standard preoperative care for patients at risk of pregnancy undergoing bariatric surgery.
确定接受减重手术患者的妊娠建议咨询率、避孕方式和妊娠推荐咨询频率。
利用我院减重手术患者数据库，我们筛选出了 2013 年至 2018 年间年龄在 18 至 45 岁之间接受手术的女性患者。对患者的病历进行了回顾，记录了妊娠推荐咨询情况、术后妊娠情况、术前和术后避孕措施使用情况等信息。我们分析了避孕措施使用情况，并使用标准统计检验比较了不同组别间的妊娠率。
在符合纳入标准且无永久性避孕史的 460 名患者中，54%（95%置信区间 49-58）记录了术后避孕措施使用情况，最常见的是左炔诺孕酮宫内节育器，其次是复方口服避孕药。在减重手术后的 18 个月内，6%（95%置信区间 4-8）的患者记录了妊娠。超过 50%（95%置信区间 35-71）的妊娠发生在未记录术后避孕措施的患者中。
对于有妊娠风险的减重手术患者，术后避孕方式和妊娠率与建议术后 18 个月内避免妊娠不一致。
对于有妊娠风险的接受减重手术的患者，应该实施个体化避孕咨询，包括生育和减肥目标、计划的减重手术类型以及患者偏好等方面的讨论，作为标准术前护理的一部分。
