The death of an obese woman and her unborn child underscores the concern many health professionals have about the risks of pregnancy so soon after having gastric bypass surgery. The deaths, reported two years ago, were the first suffered by a woman and an unborn child due to complications from such surgery.

The big concern: Women make up the majority of the 110,000 people who have gastric bypass surgery, largely during their child-bearing years.

The 41-year-old woman was brought to Boston's Brigham and Women's Hospital after she spent two days in another hospital that had misdiagnosed the cause of the sudden pain in her upper stomach. Doctors did emergency surgery after an infection was found. Most of the woman's small intestine slid through a tear in an adjacent membrane, a problem that can remain after these organs are moved during bypass surgery. The hole eventually stopped the flow of blood to the intestines turning them gangrenous.

Although surgeons repaired the woman's intestines, the damage was already done. Her unborn baby was already dead and the woman died shortly after surgery.

At the time of death, the woman weighed 440 pounds.

Despite this tragic "first," some gastric bypass experts contend recent studies showed the mortality rate for the morbidly obese was five times lower if they opted for the surgery -- as well as fewer complications for women during pregnancy -- compared to those who didn't.

More number-crunching behind gastric bypass:

• About 20 percent of the patients who choose gastric bypass surgery will suffer complications
• An estimated 1 to 4 out of every 200 patients will die from those complications
• Eighty-five percent of all gastric bypass surgeries are done on women, primarily during their childbearing years
• Tears or hernias weren't uncommon, experts say, and could happen up to five years after surgery

Because the surgery lessens the number of nutrients available to a fetus and can lead to serious infections, many physicians prescribe contraceptives for two years after the surgery to avoid pregnancy until a woman's weight stabilizes. Also more common are pregnancies a year after the surgery because fertility rises with a major weight loss.

How gastric bypass surgery works: The surgeon separates a small pouch at the top of the stomach with staples from the rest. He or she then cuts the bottom segment of the small intestine and attaches it to the newly stapled pouch. The upper part of the stomach that holds digestive juices is reattached to the lower part.

Because the "new" pouch holds just a few ounces of food, calories and nutrients aren't absorbed into the small intestine, meaning people lose weight. But they also have to take supplements and protein to guard against malnutrition.

Because three more patients in Massachusetts have died due to gastric bypass complications in the past 20 months, the state is considering new safety guidelines.

Springfield News-Leader August 24, 2004