post on the pregnant women and fetus.

[Guest guest]

this is the story on that.

An obese Massachusetts woman and her 8-month-old fetus died of

complications 18 months after stomach-stapling surgery, an apparent

first that is leading to warnings about the risks of pregancy soon

after the surgery.

The deaths raise concerns because most of the 110,000 people who

have gastric, or stomach, bypass surgery each year in this country

are women in their child-bearing years, say doctors at Brigham and

Women's Hospital in Boston who tried to save the mother and baby.

They reported on the case in a letter in Thursday's New England

Journal of Medicine.

Brigham surgeon Dr. E. Whang cared for the 41-year-old woman

nearly two years ago, when she was brought to their emergency

department after two days at another hospital, where the cause of

sudden pain in her upper stomach was misdiagnosed.

" She was nearly dead, " said Whang, who noted the woman had the

gastric bypass and prenatal care at other hospitals.

After tests and symptoms indicated a massive infection, Whang did

emergency surgery. He found most of the woman's small intestine had

slid through a hernia, or tear, in an adjacent membrane, a defect

sometimes left after the intestines are rearranged in the bypass

operation. The hole choked off blood to the stretch of intestines,

and the tissue turned gangrenous.

By then the fetus had died. Whang repaired the intestine, but the

woman died within a few hours. She still weighed 440 pounds; her

original weight was not available.

" This is a tragic case, but you need to look at the overall risk-

benefit of the surgery, " said Dr. Harvey Sugerman, president of the

American Society for Bariatric Surgery, an educational group for

obesity surgeons.

Sugerman said three studies show extremely obese patients have death

rates as much as four or five times lower if they undergo gastric

bypass surgery, compared with those who don't, and other research

shows lower rates of pregnancy complications after the weight-loss

surgery.

Sugerman estimated more than 110,000 gastric bypasses will be done

in the United States this year. Complications strike as many as 1 in

5 patients, and it is believed that for every 200 patients, 1 to 4

will die.

Sugerman and other doctors said they know of no other mother-baby

deaths after the operation.

But Whang said about 85 percent gastric bypasses are performed on

women, most of childbearing age. He advised any pregnant patients

with sudden pain to see a bypass expert quickly.

" Most doctors recommend contraceptives for two years after the

surgery " to avoid pregnancy until the woman's weight stabilizes,

said Dr. Sattar Hadi, who runs the high-risk obesity clinic at

Vanderbilt University's Center for Human Nutrition.

Hadi said it's unclear whether the Massachusetts woman's hernia was

due solely to the surgery " or the fetus pushing onto the intestines. "

Dr. Mark Tucker, director of bariatric surgery at the University of

Medicine and Dentistry of New Jersey in Stratford, said such hernias

are not uncommon and can happen up to five years after the surgery.

Because fertility increases with major weight loss, he said, reports

of pregnancies within a year of surgery are becoming more common.

In the standard type of gastric bypass surgery performed on this

woman, a small pouch at the stomach's top is separated from the rest

using staples. Moving down the small intestine a few feet, the

surgeon then cuts it in two, pulls the bottom segment up and

attaches it to the new pouch. The dangling upper segment, which

carries digestive juices, is then reattached to the lower segment.

Patients then lose weight because the new pouch holds a few ounces

of food at a time, and some calories and nutrients are not absorbed

because the food bypasses much of the stomach and small intestine.

Patients must take protein and vitamin supplements to avoid

malnutrition.

Since the start of 2003, three other Massachusetts patients have

died after gastric bypass, and the state is developing guidelines to

increase safety.

The federal Medicare program has paid for stomach bypass surgeries

for a few years, but only in people with related medical conditions

such as diabetes. It covered 7,801 operations in 2003, about double

the number in 2001.

Dr. Steve Phurrough of the Centers for Medicare and Medicaid

Services said the agency recently ruled obesity can be considered an

illness on its own, so an advisory panel this fall is to recommend

whether Medicare should cover the surgery in people without related

conditions. He expects the panel will urge waiting until there's

more research on the surgery on the elderly.

" We have significant concerns about the risks, " Phurrough

said. " People die from this procedure. "