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Dr. Tim, MD
Dr. Tim, MD, Board Cert. OB/GYN
Category: OB GYN
Satisfied Customers: 950
Experience:  General OB/GYN, complicated obstetrics, complicated GYN
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My daughter is 17+4 wks pregnant. She has Ehlars danloss

Customer Question

Hi my daughter is 17+4 wks pregnant. She has Ehlars danloss syndrome, had a gastric bypass 6 years ago, lost 8 stone and 14 months ago had a body lift (apronectomy plus all round the back to lift buttocks and tighten muscles etc)
She looks amazing. She also is very anaemic and suffers with deficiency of vit d and b12 requiring regular Injections.
My question is this - is it safe for her to have a natural delivery or is Caesarian safer. The registrar feels natural would be ok tho I am concerned, given how recent she was cut all way round and stretched etc) that pushing could rupture something or under all the surgeons good work. Advice please!
Submitted: 11 months ago.
Category: OB GYN
Expert:  Dr. Tim, MD replied 11 months ago.
Thank you for the question and this is a very interesting question. Here are my thoughts:1. The gastric bypass has made absorption of vitamins and iron an issue leading to anemia and a B12 deficiency - this is being managed appropriately2. I am familiar with this surgery and the incisions involved3. With regard to Ehler-Danlos (EDS) in pregnancy, these patients should have regular followup with a Cardiologist (heart ultrasound to look for valvular disease or aortic dilation) and assessment of her cervix as cervical incompetence and preterm delivery are risks. There is no recomendation for a Cesarean Section in these patients. So, in answer to your question, I do not think that the surgery, anemia or EDS taken as a whole is an indication for a Cesarean Section. The incisions related to the gastric bypass and the apronectomy should not be an issue with pushing during labor. Also, blood loss with a C-section is typically more than with a vaginal birth, making it all the more important to consider a vaginal birth. She is certainly someone that might benefit from an OB Consult, but the basic answer is that she needs closer monitoring and should shoot for a vaginal birth if possible. Dr. Tim
Expert:  Dr. Tim, MD replied 11 months ago.
Please respond if you were able to view my answer. Do you have any questions?Dr. Tim

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