A 41-year-old woman with a history of morbid obesity underwent BPD according to the Scopinaro technique in 2000.
After hospital admission deficit due to anastomosis of 50 kg during the first year of surgery, its weight stenosis was triggered in 67-71 kg. In 2005 and 2006, it required due to severe gastrointestinal sepsis associated with severe protein malnutrition.
In 2004 she had her first pregnancy complicated with severe anemia and the delivery was term with a healthy low birth weight newborn (2030 g).
In August 2007, on the 24th week of her second pregnancy, she was admitted to the obstetrics service due to maternal anemia.
The ultrasound performed confirmed the existence of a severe and early symmetric intrauterine growth retardation together with ascites and generalized hydrops fetalis.
The approximate weight of the fetus was 500 g.
The Doppler study showed absence of diastolic flow in the umbilical artery, middle cerebral artery and ductus.
The suspicion of maternal malnutrition as the etiology of fetal growth retardation was requested assessment in our nutrition unit.
The patient reported occasional vomiting, generalized asthenia and decreased vision in the dark.
Physical examination revealed a weight of 75 kg, BMI 30.4 kg/m2, weight prior to pregnancy 72.5 kg, pale skin and mucous membranes and significant lower limb edema.
From the beginning of pregnancy her nutritional treatment consisted of a low-fat diet together with 200 ml of a hyperproteic supplement, 120 mg of zinc sulfate, 2,000 mg of calcium, 6400 IU of non-mineral vitamin D tablets.
An analytical study was requested that included the main nutritional parameters and the results are shown in Table I. The exploration revealed a xerophthalmia.
Treatment was initiated with concentrates and total parenteral nutrition.
The intakes of vitamins and trace elements were administered intravenously in TPN together with oral supplementation.
The daily dose of vitamin A was 16,000 IU.
The ultrasound performed 15 days later showed complete disappearance of hydrops and fetal ascites, as well as normalization of the Doppler study.
The patient also started a clear progressive improvement in her clinical symptoms and nutritional status.
At the time of hospital discharge, the patient was 33 weeks pregnant and her fetal weight was 1,500 g.
1.
At 36 weeks of gestation, delivery is induced due to lack of fetal growth in the previous 15 days.
The delivery was spontaneous vaginally and the newborn was a woman with a birth weight of 2040 g (P5-P10), a length of 42 cm (< P5), (< 9 Apgar P/105) and test 30.6 cm.
Physical examination revealed generalized hypotonia, microcephalia and no response to acoustic stimuli.
In the irlogical study performed, an ophthalmia was observed together with a bilateral giant papillary coloboma accompanied by a bilateral inferior coloboma.
The complementary tests performed showed the existence of a mild pulmonary hypoplasia and hypoplasia of both kidneys that triggered renal failure.
The infant died at 6 months of age.
