دانلود کتاب Obstetrics. Normal and problem pregnancies

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Cover
Copyright
Contributors
Preface
Section I - Physiology
1 Placental Anatomy and Physiology
Overview of the Delivered Placenta
Placental Development
The Amnion and Yolk Sac
The Maternal-Fetal Relationship during the First Trimester
Extravillous Trophoblast Invasion and Physiologic Conversion of the Spiral Arteries
The Role of the Endometrium during the First Trimester
The Topology of the Villous Trees
Placental Histology
The Integrity of the Villous Membrane
Placental Vasculature
Physiology of the Secondary Yolk Sac and Exocoelomic Cavity
Placental Transport
Overview of the Exchange Physiology of the Placenta and Its Development Over Gestation
Bulk Flow/Solvent Drag
Diffusion
Transporter-Protein Mediated Processes
Endocytosis/Exocytosis
Placental Nutrient Supply and Intrauterine Growth Restriction
Placental Endocrinology
Progesterone
Estrogens
Human Chorionic Gonadotropin
Placental Lactogen
Placental Growth Hormone
Key Points
References
2 Placental and Fetal Physiology
Placental Physiology
Placental Metabolism and Growth
Placental Transfer
General Considerations
Transfer of Individual Solutes
Respiratory Gases
Glucose
Amino Acids
Lipids
Water and Ions
Calcium
Receptor-Mediated Endocytosis/Exocytosis
Placental Blood Flow
Uterine Blood Flow
Umbilical Blood Flow
Immunologic Properties of the Placenta
Amniotic Fluid Volume
Fetal Physiology
Growth and Metabolism
Substrates
Hormones
Fetal Cardiovascular System
Development
Fetal Heart
Autonomic Regulation of Cardiovascular Function
Hormonal Regulation of Cardiovascular Function
Arginine Vasopressin
Renin–Angiotensin II
Fetal Hemoglobin
Fetal Kidney
Fetal Gastrointestinal System
Gastrointestinal Tract
Liver
Fetal Adrenal and Thyroid
Adrenal
Thyroid
Fetal Central Nervous System
Summary
Key Points
References
3 Maternal Physiology
Body Water Metabolism
Osmoregulation
Salt Metabolism
Renin-Angiotensin-Aldosterone System
Atrial and Brain Natriuretic Peptide
Cardiovascular System
Heart
Cardiac Output
Arterial Blood Pressure and Systemic Vascular Resistance
Venous Pressure
Central Hemodynamic Assessment
Normal Changes That Mimic Heart Disease
Effect of Labor and the Immediate Puerperium
Respiratory System
Upper Respiratory Tract
Mechanical Changes
Lung Volume and Pulmonary Function
Gas Exchange
Sleep
Hematologic Changes
Plasma Volume and Red Blood Cell Mass
Iron Metabolism in Pregnancy
Platelets
Leukocytes
Coagulation System
Urinary System
Anatomic Changes
Renal Hemodynamics
Renal Tubular Function/Excretion of Nutrients
Alimentary Tract
Appetite
Mouth
Stomach
Intestines
Gallbladder
Liver
Nausea and Vomiting of Pregnancy
Skeleton
Calcium Metabolism
Skeletal and Postural Changes
Endocrine Changes
Thyroid
Adrenal Glands
Pituitary Gland
Pancreas and Fuel Metabolism
Glucose
Proteins and Fats/Lipids
Eye
Key Points
References
4 Maternal-Fetal Immunology
Immune System Overview: Innate and Adaptive Immunity
Innate Immunity: First Line of Host Defense
Antimicrobial Peptides
Macrophages
Natural Killer Cells
Toll-like Receptors
Complement System
Cytokines
Chemokines
Adaptive Immunity
Major Histocompatibility Complex
Humoral Immune Response: B Cells and Antibodies
Antibody Isotypes
T Cells
Helper T Subsets
Fetal Immune System
Cord Blood Transplantation
Maternal Tolerance of the Fetus
Tolerance Through Human Leukocyte Antigens
Tolerance Through Regulation of Maternal T Cells
Tolerance Through Regulation of Complement and Cytokines
Immunity In Infection-Associated Preterm Birth
Immunity in Preeclampsia
Maternal-Fetal Human Leukocyte Antigen Compatibility and Recurrent Pregnancy Loss
Maternal-Fetal Cell Trafficking and Microchimerism
Summary
Key Points
References
5 Developmental Origins of Adult Health and Disease
Epigenetics and Programming
Fetal Nutrition and Growth
Energy Balance Programming
Hepatic Programming
Pancreas Programming
Cardiac Programming
Osteoporosis Programming
Brain Programming
Maternal Stress and Anxiety
Glucocorticoids and Prematurity
Immune Function
Endocrine Programming
Sexuality Programming
Renal Programming
Conclusion
Key Points
References
Section II - Prenatal Care
6 Preconception and Prenatal Care:
Maternal Mortality
Neonatal Mortality and Morbidity
Prenatal Care
Risk Assessment
Preconceptional Education
The Initial Preconceptional or Prenatal Visit
Social and Demographic Risks
Medical Risk
Hyperthyroidism
Hypothyroidism
Obstetrical Risk
Physical and Laboratory Evaluation
Assessment of Gestational Age
Clinical Dating
Ultrasound
Repeat Prenatal Visits
Intercurrent Problems
The Prenatal Record
Prenatal Education
Informed Consent and VBAC
Smoking Cessation
Drugs and Teratogens
Radiologic Studies
Nutrition
Weight Gain
Activity and Employment
Travel
Immunizations
Nausea and Vomiting in Pregnancy
Heartburn
Restless Legs Syndrome
Sciatica
Carpal Tunnel Syndrome
Hemorrhoids
Constipation
Urinary Frequency and Incontinence
Round Ligament Pain
Syncope
Backache
Sexual Activity
Circumcision
Breastfeeding
Preparation for Childbirth
Signs of Labor
Prepared Parenthood and Support Groups
Postpartum Visit
Summary
Key Points
References
Additional References
Introduction
Maternal Mortality
Neonatal Mortality and Morbidity
Prenatal Care
Risk Assessment
Preconceptional Education
The Initial Preconceptional or Prenatal Visit
Thyroid Disorders
Assessment of Gestational Age
Repeat Prenatal Visits
Prenatal Education
7 Nutritional Management During Pregnancy
Integrating Nutrition Into the Obstetrical History
Maternal Weight Gain Recommendations
Low or Underweight Preconception BMI
Overweight and Obese Preconception BMI
Maternal Weight Gain Recommendations for Special Populations
Multiple Gestation
Adolescents
Other Groups
Laboratory Evaluation of Nutritional Status
Maternal Nutrient Needs: Current Recommendations
Energy
Protein
Omega-3 Fatty Acids
Vitamin and Mineral Supplementation Guidelines
Dietary Reference Intake
Vitamins
Vitamin A
Vitamin D
Vitamin C
Vitamin B6
Vitamin K
Folate
Folate and Neural Tube Defects
Folate Supplementation
Minerals
Iron
Calcium
Zinc
Nutrition-Related Problems in Pregnancy
Nausea and Vomiting
Heartburn and Indigestion
Constipation
Food Contamination
Pregnancy Following Bariatric Surgery
Key Points
References
additional References
Integrating Nutrition into the Obstetric History
Maternal Weight Gain Recommendations
Maternal Nutrient Needs: Current Recommendations
Vitamin and Mineral Supplementation Guidelines
Nutrition-related Problems in Pregnancy
8 Drugs and Environmental Agents in Pregnancy and Lactation:
Embryology
Basic Principles of Teratology
Genotype and Interaction with Environmental Factors
Timing of Exposure
Mechanisms of Teratogenesis
Manifestation
Agent
Dose Effect
Epidemiologic Approaches to Birth Defects
Case Reports
Descriptive Studies
Case-Control Studies
Cohort Studies
Clinical Trials
Medical Drug Use
Effects of Specific Drugs
Estrogens and Progestins
Androgenic Steroids
Spermicides
Anticonvulsants
Isotretinoin
Vitamin A
Psychoactive Drugs
Tranquilizers
Lithium (Eskalith, Lithobid)
Antidepressants
Anticoagulants
Thyroid and Antithyroid Drugs
Digoxin (Lanoxin)
Antihypertensive Drugs
Sympathetic Blocking Agents
Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
Antineoplastic Drugs and Immunosuppressants
Antiasthmatics
Terbutaline (Brethine)
Cromolyn Sodium (Intal)
Isoproterenol (Isuprel) and Metaproterenol (Alupent)
Corticosteroids
Iodide
Antiemetics
Vitamin B6
Doxylamine
Meclizine (Bonine)
Dimenhydrinate (Dramamine)
Diphenhydramine (Benadryl)
Phenothiazines
Metoclopramide
Ondansetron (Zofran)
Methylprednisolone
Ginger
Acid-Suppressing Drugs
Antihistamines and Decongestants
Antibiotics and Anti-infective Agents
Penicillins
Cephalosporins
Sulfonamides
Sulfamethoxazole with Trimethoprim (Bactrim, Septra)
Nitrofurantoin (Macrodantin)
Tetracyclines
Aminoglycosides
Antituberculosis Drugs
Erythromycin
Clarithromycin
Fluoroquinolones
Metronidazole (Flagyl)
Antiviral Agents
Lindane (Kwell)
Antiretroviral Agents
Antifungal Agents
Drugs for Induction of Ovulation
Mild Analgesics
Aspirin
Acetaminophen (Tylenol, Datril)
Other Nonsteroidal Anti-inflammatory Agents
Codeine
Sumatriptan
Drugs of Abuse
Smoking
Smoking Cessation During Pregnancy
Alcohol
Marijuana
Cocaine
Narcotics and Methadone
Caffeine
Aspartame (NutraSweet)
Drugs in Breast Milk
Drugs Commonly Listed as Contraindicated During Breastfeeding
Cytotoxic Drugs That May Interfere with Cellular Metabolism of the Nursing Infant
Drugs of Abuse for Which Adverse Effects on the Infant During Breastfeeding Have Been Reported
Radioactive Compounds That Require Temporary Cessation of Breastfeeding
Drugs for Which the Effect on Nursing Infants Is Unknown but May Be of Concern
Drugs That Have Been Associated with Significant Effects in Some Nursing Infants and Should Be Given to Nursing Mothers with Caution
Bromocriptine
Ergotamine
Lithium
Maternal Medication Usually Compatible with Breastfeeding
Narcotics, Sedatives, and Anticonvulsants
Cold Preparations
Antihypertensives
Thiazides
β-Blockers
Angiotensin-Converting Enzyme Inhibitors
Calcium Channel Blockers
Anticoagulants
Corticosteroids
Digoxin (Lanoxin)
Antibiotics
Acyclovir
Antifungal Agents
Oral Contraceptives
Alcohol
Propylthiouracil
Histamine-2 Receptor Blockers
Caffeine
Smoking
Occupational and Environmental Hazards
Ionizing Radiation
Acute Exposure
Mutagenesis
Video Display Terminals
Lead
Mercury
The Obstetrician’s Role in Evaluating Drug and Reproductive Risks in and Beyond the Workplace
Summary
Key Points
References
Additional References
Teratogenesis
Epidemiology
Hormones
Anticonvulsants
Vitamin A Derivatives
Psychoactive Drugs
Anticoagulants
Thyroid and Antithyroid Drugs
Cardiac and Antihypertensive Medications
Antiasthmatics
Antiemetics
Antihistamines and Decongestants
Antibiotics and Antiinfective Agents
Ovulation Induction Medications
Mild Analgesics
Drugs of Abuse
Caffeine
Drugs in Breast Milk
Radiation
Lead
References
9 Obstetrical Ultrasound:
Biophysics of Ultrasound
Optimizing the Ultrasound Image
Power
Gain
Attenuation
Focus
Depth and Zoom
Harmonic Imaging
Special Ultrasound Modalies
M-Mode
Color and Pulse-Wave Doppler
Three-Dimensional Ultrasound
Scanning Technique
Orientation
Angle of Insonation
Using Natural Windows
First-Trimester Ultrasound
First-Trimester Normal Findings
First-Trimester Abnormal Findings
Second- and Third-Trimester Ultrasound
Types of Examinations
Qualifications for Interpreting Diagnostic Ultrasound Examinations
Components of the Examination
Cardiac Activity
Number of Fetuses
Presentation
Amniotic Fluid Volume
Placenta and Umbilical Cord
Uterus and Adnexa
Anatomic Survey
Documentation
Ultrasound for Determining Gestational Age
Standard Measurements
Gestational Age Determination
When to Use Ultrasound Dating
Assessing Fetal Growth
Estimating Fetal Weight
Diagnosing Abnormal Growth
Safety of Ultrasound
Quantifying Machine Power Output
“Entertainment” Ultrasound Examinations
Key Points
References
10 Genetic Counseling and Genetic Screening
Frequency and Etiology of Genetic Disease
Chromosomal Abnormalities
Single-Gene Disorders
Polygenic/Multifactorial Disorders
Teratogenic Disorders
Clinical Spectrum of Chromosomal Abnormalities
Autosomal Trisomy
Trisomy 21
Trisomy 13
Trisomy 18
Other Autosomal Trisomies
Autosomal Deletions or Duplications
Sex Chromosomal Abnormalities
Monosomy X (45,X)
Klinefelter Syndrome
Polysomy X in Girls (47,XXX; 48,XXXX; 49,XXXXX)
Polysomy Y in Boys (47,XYY and 48,XXYY)
Genetic History
Genetic Counseling
Communication
Nondirective Counseling
Psychological Defenses
Genetic Screening
Carrier Screening for Heritable Conditions
Ashkenazi Jewish Genetic Diseases
Hemoglobinopathies
Cystic Fibrosis
Newborn Screening
Screening for Aneuploidy
First Trimester Screening
Second Trimester Serum Screening
First and Second Trimester Screening
Factors Confounding Detection Rates
Maternal Age
Maternal Weight and Ethnicity
Multiple Gestation
Maternal Serum Alpha-Fetoprotein Screening for Neural Tube Defects
Obstetrical Significance of Unexplained Elevated Maternal Serum Alpha-Fetoprotein
Key Points
References
11 Prenatal Genetic Diagnosis
Diagnostic Procedures for Prenatal Genetic Diagnosis
Amniocentesis
Technique
Amniocentesis in Twin Pregnancies
Safety
Early Amniocentesis
Amniocentesis in Women with Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus
Chorionic Villus Sampling
Technique
Safety
Chorionic Villus Sampling in Twin Pregnancies
Fetal Blood Sampling
Technique
Safety
Indications for Prenatal Genetic Studies
Cytogenetic Disorders
Advanced Maternal Age
Previous Child with Chromosomal Abnormality
Parental Chromosomal Rearrangements
Assisted Reproduction through Intracytoplasmic Sperm Injection
Accuracy of Prenatal Cytogenetic Diagnosis
Numerical
Structural
Newer Cytogenetic Approaches
Fluorescence in Situ Hybridization
Quantitative Fluorescent Polymerase Chain Reaction
Comparative Genomic Hybridization and Chromosomal Microarrays
Mendelian Disorders
Molecular Approach to Diagnosis
Mendelian Disorders Without Known Molecular Basis
Multifactorial Disorders
Ultrasound Diagnosis of Fetal Malformations
Ultrasound as a Screening Test for Birth Defects
Ultrasound Screening for Aneuploidy
Second Trimester
First Trimester
Screening for Anomalies with the Standard Ultrasound Examination
Head and Neck
General Appearance
Neural Tube Defects
Cystic Hygroma
Cleft Lip and Palate
Micrognathia
Cerebellum and Cisterna Magna
Choroid Plexus
Lateral Ventricles
Midline Falx
Chest
Chest Masses
Four-Chamber View of the Heart
Outflow Tracts
Abdomen
Kidneys
Bladder
Umbilical Cord Insertion into the Abdomen
Number of Umbilical Cord Vessels
Spine
Extremities
Hydrops
Effect of Prenatal Ultrasound on Neonatal Outcome
Cell Free Fetal DNA and Intact Fetal Cells in Maternal Blood: Definitive Noninvasive Diagnosis
Cell Free Fetal DNA in Maternal Blood
Y-Sequences
Single Gene Disorders
Rhesus (D)
Trisomy 21
Intact Fetal Cells
Preimplantation Genetic Diagnosis
Obtaining Embryonic and Gamete DNA
Chromosomal Indications
Single Gene Disorders
Novel Indications
Avoiding Clinical Termination
Nondisclosure of Parental Genotype
Cancer and Other Adult-Onset Disorders
HLA-Compatible Embryos
Aneuploidy Testing to Improve Pregnancy Rates
Safety of Preimplantation Genetic Diagnosis
Current Utility
Key Points
References
12 Antepartum Fetal Evaluation
Defining the Problem of Perinatal Mortality
Characteristics of Fetal Death
Causes of Fetal Deaths
Timing of Fetal Death
Identifying Those at Risk
Details on Select Maternal Conditions
Potential Utility of Antepartum Fetal Testing
What Do These Tests Tell Us About the Fetus?
Fetal State
Biophysical Techniques of Fetal Evaluation
Maternal Assessment of Fetal Activity
Contraction Stress Test
Predictive Value of the Contraction Stress Test
Nonstress Test
Fetal Heart Rate Patterns Observable on the Nonstress Test
Reactive
Nonreactive
Other Nonstress Test Patterns or Findings
Sinusoidal
Bradycardia
Tachycardia
Arrhythmia
Deceleration
Predictive Value of Nonstress Test
Fetal Biophysical Profile
Predictive Value of Biophysical Profile
Modified Biophysical Profile
Doppler Ultrasound
Clinical Application of Tests of Fetal Well-Being
Evidence for Condition-Specific Testing Strategies
Assessment of Fetal Pulmonary Maturation
Tests of Fetal Pulmonary Maturity
Quantitation of Pulmonary Surfactant
Measurements of Surfactant Function
Determination of Fetal Pulmonary Maturation in Clinical Practice
Conclusions and Future Directions
Key Points
References
ADDITIONAL References
Section III - Intrapartum Care
13 Normal Labor and Delivery
Labor: Definition and Physiology
Mechanics of Labor
Uterine Activity (Powers)
The Fetus (Passenger)
The Maternal Pelvis (Passage)
Cardinal Movements in Labor
Engagement
Descent
Flexion
Internal Rotation
Extension
External Rotation
Expulsion
Normal Progress of Labor
Interventions Affecting Normal Labor Outcomes
Active Management of Labor
Second Stage of Labor
Spontaneous Vaginal Delivery
Delivery of the Placenta and Fetal Membranes
Episiotomy, Perineal Injury, and Perineal Repair
Key Points
References
14 Abnormal Labor and Induction of Labor
Diagnosis
Abnormal Labor at Term
Disorders of the Latent Phase
Disorders of the Active Phase
Electromechanical Classification
Combined Disorder
Disorders of the Second Stage
Disorders of the Third Stage
Precipitous Labor
Anesthesia Effects on Labor Progress
Management of Abnormal Labor and Delivery
Pharmacologic Augmentation
Side Effects
Uterine Overactivity
Water Intoxication
Hypotension
Uterine Rupture
Anaphylaxis of Pregnancy (Amniotic Fluid Embolism)
Induction of Labor
Indications and Contraindications
Prolonged Pregnancy
Elective Induction of Labor
Prediction of Labor Induction Success
Cervical Ripening
Failed Induction
Techniques for Cervical Ripening and Labor Induction
Oxytocin
Low-Dose Versus High-Dose Oxytocin
Oxytocin Dosing Intervals
Oxytocin Dosing Protocols
Prostaglandins
Prostaglandin E2
Prostaglandin E1
Alternative Pharmacologic Methods
Mechanical Methods
Membrane Stripping
Amniotomy
Hygroscopic Dilators
Transcervical Balloon Catheters
Extra-Amniotic Saline Infusion
Midtrimester Induction
Summary
Key Points
References
additional References
Introduction
Abnormal Labor at Term
Disorders of the Second Stage
Precipitous Labor
Anesthesia Effects on Labor Progress
Management of Abnormal Labor and Delivery
Induction of Labor
Cervical Ripening
Elective Induction of Labor
Prediction of Labor Induction Success
Techniques for Cervical Ripening and Labor Induction
Prostaglandins
Alternative Pharmocologic Methods
Mechanical Methods
Midtrimester Induction
15 Operative Vaginal Delivery
Operative Vaginal Delivery
Classification, Prerequisites, and Indications
Operative Vaginal Delivery Instruments
Forceps Instruments
“Classic” Forceps
Rotational Forceps
Other Specialized Instruments
Vacuum Extraction Devices
Stainless Steel Devices
Soft Cup Devices
Operative Vaginal Delivery Techniques
Classic Forceps: Application for Occiput Anterior and Occiput Posterior Positions
Rotational Forceps: Application for Occiput Transverse Positions
Classic Forceps
Keilland’s Forceps
Forceps Rotation: Application for the Occiput Posterior Position
Vacuum Extraction
Risks And Benefits of Operative Vaginal Delivery
Benefits of Operative Vaginal Delivery
Maternal Risks
Perineal Trauma
Urinary Incontinence
Fecal Incontinence
Fetal Risks
Craniofacial and Intracranial Injury
Cephalohematoma and Subgaleal Hemorrhage
Intracranial Hemorrhage
Neurologic and Cognitive Effects
Complex Operative Vaginal Delivery Procedures
Rotations Greater Than 45 Degrees
Midpelvic Cavity Delivery
Sequential Use of Vacuum and Forceps
Trial of Operative Vaginal Delivery
Vacuum Delivery and the Preterm Fetus
Counseling: Forceps, Vacuum, or Cesarean Delivery
Simulation and Residency Training in Operative Vaginal Delivery
Key Points
References
16 Intrapartum Fetal Evaluation
History of Fetal Monitoring
Instrumentation for Electronic Fetal Heart Rate Monitoring
Physiologic Basis of Fetal Heart Rate Monitoring
Tachycardia
Bradycardia
Variability
Periodic Changes
Decelerations
Early Decelerations
Late Decelerations
Variable Decelerations
Prolonged Decelerations
Accelerations
Sinusoidal Patterns
Additional Terminology from the NICHD Workshop
Evolution of Fetal Heart Rate Patterns
Management of Non-Reassuring Fetal Heart Rate Patterns
Interventions for Non-reassuring Fetal Status
Nonsurgical Interventions
Oxygen Administration
Lateral Positioning
Hydration
Oxytocin
Tocolytics
Amnioinfusion
Meconium
Alternatives for Evaluating the Fetus with a Non-reassuring Fetal Heart Rate Pattern
Fetal Scalp pH
Accelerations and Variability
Fetal Pulse Oximetry
ST Analysis, the STAN Technology
Computerized Interpretation of Fetal Heart Rate Patterns
Operative Intervention for Non-reassuring Fetal Status
Management of Non-Reassuring Fetal Heart Rate Patterns: a Proposed Protocol
Auscultation as an Alternative
Assessment of Fetal Condition at Birth
Risks and Benefits of Electronic Fetal Heart Rate Monitoring
Summary
Key Points
References
17 Obstetrical Anesthesia
Personnel
Pain Pathways
Effects of Pain and Stress
Analgesia for Labor
Psychoprophylaxis and Nonpharmacologic Analgesia Techniques
Systemic Opioid Analgesia
Patient-Controlled Analgesia
Meperidine (Demerol)
Nalbuphine (Nubain)
Butorphanol (Stadol)
Fentanyl
Sedatives
Placental Transfer
Neuraxial Analgesic and Anesthetic Techniques
Lumbar Epidural Analgesia and Anesthesia
Complications of Neuraxial Blocks
Hypotension
Local Anesthetic Toxicity
Allergy to Local Anesthetics
High Spinal or “Total Spinal” Anesthesia
Nerve Injury
Spinal Headache
Back Pain
Breastfeeding Issues
Effects on Labor and Method of Delivery
Study Design
Progress of Labor and Cesarean Delivery Rate
Fever
Paracervical Block
Anesthesia for Vaginal Delivery
Local Anesthesia
Pudendal Nerve Block
Monitored Anesthesia Care with Sedation
Spinal (Subarachnoid) Block
Lumbar Epidural Anesthesia
General Anesthesia
Anesthesia for Cesarean Delivery
Premedication
Antacids
Left Uterine Displacement
General Anesthesia
Preoxygenation
Induction
Muscle Relaxants
Cricoid Pressure
Intubation
Proper Tube Placement
Nitrous Oxide and Oxygen
Volatile Halogenated Agent
Postdelivery
Extubation
Aspiration
Neuraxial Anesthesia
Postoperative Care
Key Points
References
18 Malpresentations and Shoulder Dystocia
Clinical Circumstances Associated with Malpresentation
Abnormal Axial Lie
Management of A Singleton Gestation
Deflection Attitudes
Face Presentation
Mechanism of Labor
Brow Presentation
Compound Presentation
Breech Presentation
Mechanism and Conduct of Labor and Vaginal Delivery
Contemporary Management of the Term Breech
Further Discussion of Delivery for the Term Frank or Complete Breech
The Term Breech Trial
Special Clinical Circumstances and Risks: Preterm Breech, Hyperextended Head, Footling Breech
Breech Second Twin
External Cephalic Version
Shoulder Dystocia
Key Points
References
AdDITIONAL References
Face Presentation
Mechanism of Labor
Brow Presentation
Mechanism and Conduct of Labor and Vaginal Delivery
Contemporary Management of the Term Breech
Further Discussion of Delivery for the Term Frank or Complete Breech
The Term Breech Trial
Shoulder Dystocia
19 Antepartum and Postpartum Hemorrhage
Pregnancy-Related Hemodynamic Changes
Physiologic Adaptation to Hemorrhage
Classification of Hemorrhage
Antepartum Hemorrhage
Placental Abruption
Definition and Pathogenesis
Incidence
Clinical Manifestations
Risk Factors
Increasing Parity and Maternal Age
Cigarette Smoking
Cocaine Abuse
Trauma
Maternal Hypertension
Preterm Premature Rupture of Membranes
Rapid Uterine Decompression Associated with Multiple Gestation and Polyhydramnios
Thrombophilia
Uterine and Placental Factors
Prior Abruption
Diagnosis
Radiology
Laboratory Findings
Pathologic Studies
Management
Neonatal Outcome
Placenta Previa
Definition and Pathogenesis
Incidence
Clinical Manifestations
Risk Factors
Increasing Parity, Maternal Age, and Maternal Race
Cigarette Smoking and Residence at Higher Elevation
Multiple Gestations and Male Fetal Gender
Previous Placenta Previa
Prior Curettage and Prior Cesarean Delivery
Diagnosis
Radiology
Management
Outpatient Management
Expectant Management of Preterm Patients
Delivery
Associated Conditions
Placenta Accreta
Definition and Pathogenesis
Incidence and Risk Factors
Clinical Manifestations
Diagnosis
Radiology
Laboratory Findings
Pathologic Studies
Management
Vasa Previa
Definition and Pathogenesis
Incidence and Risk Factors
Clinical Manifestations
Diagnosis
Management
Postpartum Hemorrhage
Normal Blood Loss and Postpartum Hemorrhage
Postpartum Hemorrhage Etiologies
Uterine Atony
Definition and Pathogenesis
Incidence and Risk Factors
Clinical Manifestations and Diagnosis
Prevention and Management
Bimanual Uterine Massage
Uterotonic Therapy
Uterine Tamponade
Selective Arterial Embolization
Surgical Intervention
Genital Tract Lacerations
Definition and Pathogenesis
Incidence and Risk Factors
Clinical Manifestations and Diagnosis
Management
Vulvar Hematoma
Vaginal Hematoma
Retroperitoneal Hematoma
Retained Products of Conception
Definition and Pathogenesis
Incidence and Risk Factors
Clinical Manifestations and Diagnosis
Management
Uterine Rupture
Definition and Pathogenesis
Incidence and Risk Factors
Clinical Manifestations and Diagnosis
Management
Maternal and Neonatal Outcomes
Uterine Inversion
Definition and Pathogenesis
Incidence and Risk Factors
Clinical Manifestations and Diagnosis
Management
Coagulopathy
Definition and Pathogenesis
Incidence and Risk Factors
Clinical Manifestations and Diagnosis
Management
Vitamin K
Recombinant Activated Factor Viia
Fibrinogen Concentrate
Hemostatic Agents
Fluid Resuscitation and Transfusion
Volume Resuscitation
Colloid Solutions
Blood Component Therapy
Whole Blood
Packed Red Blood Cells
Platelet Concentrates
Fresh-Frozen Plasma
Cryoprecipitate
Transfusion Protocols
Transfusion Risks and Reactions
Metabolic Abnormalities and Hypothermia
Immunologic Reactions
Infection Risks
Acute Lung Injury
Blood Conservation Approaches
Autologous Donation and Transfusion
Acute Normovolemic Hemodilution
Intraoperative and Postoperative Blood Salvage
Alternative Oxygen Carriers
Hemorrhage Prevention and Protocols
Key Points
References
ADDITIONAL References
Introduction
Pregnancy-Related Hemodynamic Changes
Antepartum Hemorrhage
Antepartum Hemorrhage—Clinical Manifestations
Antepartum Hemorrhage—Risk Factors
Antepartum Hemorrhage—Management
Neonatal Outcome
Placenta Previa
Placenta Previa—Incidence
Placenta Previa—Clinical Manifestations
Placenta Previa—Risk Factors
Placenta Previa—Diagnosis
Placenta Previa—Management
Placenta Accreta
Placenta Accreta—Radiology
Placenta Accreta—Laboratory Findings
Placenta Accreta—Management
Vasa Previa
Vasa Previa—Incidence and Risk Factors
Vasa Previa—Diagnosis
Postpartum Hemorrhage
Postpartum Hemorrhage—Incidence and Risk Factors
Postpartum Hemorrhage—Prevention and Management
Genital Tract Lacerations
Retained Products of Conception—Management
Uterine Rupture
Uterine Rupture—Incidence and Risk Factors
Uterine Rupture—Clinical Manifestations and Diagnosis
Uterine Rupture—Maternal and Neonatal Outcomes
Uterine Inversion—Definition and Pathogenesis
Uterine Inversion—Incidence and Risk Factors
Uterine Inversion—Management
Coagulopathy—Recombinant Activated Factor VIIA
Coagulopathy—Transfusion Protocols
Coagulopathy—Immunologic Reactions
Coagulopathy—Infection Risks
Intraoperative and Postoperative Blood Salvage
Alternative Oxygen Carriers
Hemorrhage Prevention and Protocols
Online References
20 Cesarean Delivery
Definitions
History of Cesarean Delivery
Incidence
Trends in Cesarean Delivery Rates
Monitoring Cesarean Delivery Rates
Indications for Cesarean Delivery
Maternal-Fetal Indications
Fetal Indications
Maternal Indications
Cesarean Delivery on Maternal Request
Technique of Cesarean Section
Prophylactic Pre-cesarean Interventions, Including Antibiotics and Thromboprophylaxis
Site Preparation
Abdominal Incision Type and Dissection
Uterine Incision and Delivery of the Fetus
Extraction of the Fetus
Placental Extraction and Uterine Repair
Abdominal Closure
Complications of Cesarean Delivery
Intraoperative Complications
Uterine Lacerations
Bladder Injury
Ureteral Injury
Gastrointestinal Tract Injury
Uterine Atony
Placenta Accreta
Maternal Mortality
Maternal Postoperative Morbidity
Endomyometritis
Wound Infection
Thromboembolic Disease
Septic Pelvic Thrombophlebitis
Vaginal Birth after Cesarean Delivery
Trends
Candidates for Trial of Labor After Cesarean
Success Rates for Trial of Labor After Cesarean
Maternal Demographics
Prior Indication for Cesarean Delivery
Prior Vaginal Delivery
Birthweight
Labor Status and Cervical Examinations
Previous Incision Type
Multiple Prior Cesarean Deliveries
Risks of Vaginal Birth after Cesarean Delivery–Trial of Labor
Uterine Rupture
Risk Factors for Uterine Rupture
Number of Prior Cesarean Deliveries
Prior Vaginal Delivery
Uterine Closure Technique
Interpregnancy Interval
Induction of Labor
Labor Augmentation
Sonographic Evaluation of the Uterine Scar
Other Risks Associated with Vaginal Birth After Cesarean Delivery–Trial of Labor
Management of Vaginal Birth After Cesarean Delivery–Trial of Labor
Counseling for Vaginal Birth After Cesarean Delivery–Trial of Labor
Cesarean Hysterectomy
Technique and Complications
Tubal Sterilization
Modified Pomeroy
The Parkland Procedure
The Irving Procedure
The Uchida Procedure
Key Points
References
ADDITIONAL References
History of Cesarean Delivery
Trends in Cesarean Delivery Rates
Monitoring Cesarean Delivery Rates
Indications for Cesarean Delivery
Technique of Cesarean Section
Complications of Cesarean Delivery
Vaginal Birth After Cesarean Delivery
Risks of Vaginal Birth After Cesarean-Trial of Labor
Cesarean Hysterectomy (Technique and Complications)
Tubal Sterilization (Modified Pomeroy, The Irving Procedure, The Uchida Procedure)
ONLINE References
Section IV - Postpartum Care
21 The Neonate
Cardiopulmonary Transition
Pulmonary Development
The First Breaths
Fetal Breathing
Mechanics of the First Breath
Circulatory Transition
Abnormalities of Cardiopulmonary Transition
Birth Asphyxia
Delivery Room Management of the Newborn
Sequelae of Birth Asphyxia
Birth Injuries
Neonatal Thermal Regulation
Physiology
Clinical Applications
Delivery Room
Nursery
Neonatal Nutrition and Gastroenterology
Water and Electrolytes
Calories
Protein
Carbohydrate
Fat
Infant Feeding
Neonatal Hypoglycemia
Congenital Gastrointestinal Surgical Conditions
Gastrointestinal Tract Obstruction
Abdominal Wall Defects
Diaphragmatic Hernia
Necrotizing Enterocolitis
Neonatal Jaundice
Neonatal Hematology
Anemia
Polycythemia
Thrombocytopenia
Vitamin K Deficiency Bleeding of the Newborn
Perinatal Infection
Early-Onset Bacterial Infection
Respiratory Distress
Cardiovascular Causes
Pulmonary Causes
Neonatal Neurology
Intraventricular Hemorrhage and Periventricular Leukomalacia
Seizures
Classification of Newborns by Growth and Gestational Age
Nursery Care
Care of the Parents
Outcome of Neonatal Intensive Care and Threshold of Viability
The Late Preterm Infant
Key Points
References
additional References
Cardiopulmonary Transition
Abnormalities of Cardiopulmonary Transition
Birth Injuries
Neonatal Thermal Regulation
Neonatal Nutrition and Gastroenterology
Neonatal Hematology
Perinatal Infection
Respiratory Distress
Neonatal Neurology
Classification of Newborns by Growth and Gestational Age
Nursery Care
Outcome of Neonatal Intensive Care
The Late Preterm Infant
ONLINE References
22 Postpartum Care
Postpartum Involution
The Uterus
The Cervix
The Fallopian Tube
Ovarian Function
Weight Loss
Thyroid Function
Cardiovascular System, Immunity, and Coagulation
The Urinary Tract and Renal Function
Other Changes
Management of the Puerperium
Health Maintenance
Perineal Care
Delayed Postpartum Hemorrhage and Postpartum Anemia
Postpartum Infection
Maternal-Infant Attachment
Pregnancy Prevention and Birth Control
Natural Methods
Barrier Methods
Hormonal Contraceptive Medications
Intrauterine Devices
Sterilization
Postpartum Psychological Reactions
Managing Perinatal Grieving
Postpartum Posttraumatic Stress Disorder
Key Points
References
additional References
Postpartum Involution
Postpartum Ovulation
Thyroid Function
Cardiovascular System, Immunity, Coagulation
Urinary Tract and Renal Function
Management of Puerperium
Perineal Care
Birth Control
Sterilization
Postpartum Psychological Reactions
23 Lactation and Breastfeeding
Breast Anatomy and Development
The Physiology of Lactation
Stages of Lactogenesis
The Endocrinology of Lactogenesis
Milk Transfer
Breast Milk: the Gold Standard
Overview
Limitations of Breastfeeding Research
The Role of the Obstetrician and Gynecologist
Successful Management of Breastfeeding
Anatomic Abnormalities of the Breast
Labor and Delivery Management
Breast Milk Expression
Maternal Nutrition and Exercise during Lactation
Breast and Nipple Pain
Mastitis and Breast Abscess
Milk Transfer and Infant Growth
Jaundice in the Newborn
Galactogogues: Drugs to Improve Milk Production
Maternal Disease
Drugs in Breast Milk
Breast Masses during Lactation
Back-to-Work Issues
Weaning
Key Points
References
additional References
General
Breastfeeding Outcomes
Breastfeeding and Host Response
Breastfeeding Management
Lactation Physiology
Online References
Section V - Complicated Pregnancy
24 Surgery During Pregnancy
Maternal Physiology
Diagnostic Imaging
Ionizing Radiation
Ultrasound
Magnetic Resonance Imaging
Anesthesia During Nonobstetrical Surgery
Anesthesia and Teratogenicity
Anesthesia and Pregnancy Physiology
Nonobstetrical Surgery and Pregnancy Outcome
Fetal Monitoring
Laparoscopy in Pregnancy
Laparoscopic Entry Techniques in Pregnancy
Laparoscopy and Pregnancy Outcome
Adnexal Masses in Pregnancy
Obesity, Bariatric Surgery, and Pregnancy
Key Points
References
25 Trauma and Related Surgery in Pregnancy
Incidence of Trauma in Pregnancy
Anatomic and Physiologic Changes of Pregnancy
Fetal Physiology
Maternal Anatomic and Physiologic Changes
Blunt Trauma
Motor Vehicle Crashes
Falls
Domestic Violence
Specific Injuries
Fractures
Penetrating Trauma
Thermal Injuries (Burns)
Direct Fetal Injuries
Pathophysiology of Fetal Loss Resulting From Maternal Trauma
Predictors of Fetal Mortality
Management Considerations
Initial Approaches
Evaluation on Labor and Delivery
Fetal Monitoring
Laboratory Testing
Diagnostic Imaging during Pregnancy
Ultrasound
Ionizing Radiation
MRI
Contrast Agents
Suggested Guidelines for Radiologic Evaluation of Trauma
Surgery for Traumatic Injuries during Pregnancy
Uterine Rupture
Perimortem Cesarean Section
Other Considerations
Long-Term Effects of Trauma
Prevention of Trauma
Screening and Identification of Women at Risk for Domestic Violence
Key Points
References
26 Pregnancy Loss
Frequency and Timing of Pregnancy Loss
Placental Anatomic Characteritics of Successful and Unsuccessful Pregnancies
Numerical Chromosomal Abnormalities: the Most Frequent Causes of Early Pregnancy Loss
Types of Numerical Chromosomal Abnormalities
Autosomal Trisomy
Polyploidy
Sex Chromosomal Polysomy (X or Y)
Monosomy X
Relationship Between Recurrent Losses and Numerical Chromosomal Abnormalities
Expectation of Abortus Karyotype in Recurrent Abortion
Genetic Counseling for Recurrent Aneuploidy
Clinical Management of Recurrent Aneuploidy
Chromosomal Rearrangements
Translocations
Inversions
Mendelian and Polygenic/Multifactorial Etiology
Luteal Phase Defects
Thyroid Abnormalities
Diabetes Mellitus
Intrauterine Adhesions (Synechiae)
Müllerian Fusion Defects
Leiomyomas
Cervical Insufficiency
Infections
Acquired Thrombophilias
Inherited Thrombophilias
Exogenous Agents
X-Irradiation and Chemotherapeutic Agents
Alcohol
Caffeine
Contraceptive Agents
Chemicals
Cigarette Smoking
Trauma
Psychological Factors
Management of Recurrent Early Pregnancy Loss
When Is Formal Evaluation Necessary?
Recommended Evaluation
Late Pregnancy Loss (Stillbirth)
Recurrence
Genetic Factors
Polygenic/Multifactorial
Maternal Evaluation
Management in Subsequent Pregnancies
Obstetrical Outcome After Early Pregnancy Complications
Key Points
References
27 Cervical Insufficiency
The Spontaneous Preterm Birth Syndrome
The Diagnosis of Cervical Insufficiency
Cervical Competence as A Biologic Continuum
Tests for Cervical Insufficiency
Risk Factors for Cervical Insufficiency
Use of Cerclage for Risk Factors
Can Sonographic Evaluation of the Cervix Diagnose Insufficiency?
Cerclage for Cervical Sonographic Indications
Patient Selection for Cerclage
Acute Cervical Insufficiency
Cerclage Technique
History-Indicated (a.k.a. Prophylactic) and Ultrasound-Indicated Cerclage
Physical Examination–Indicated (a.k.a. Emergent) Cerclage
Risks of Cerclage
Alternative Treatments to Cervical Cerclage
Summary
Key Points
References
28 Preterm Birth
Definitions
Frequency of Preterm and Low Birth Weight Delivery
Outcomes for Infants Born Preterm
Perinatal Mortality
Infant Mortality
Perinatal Morbidity
Long-term Outcomes
Epidemiology of Preterm Birth
Clinical Risk Factors for Spontaneous Preterm Birth
Host Factors
Medical
Infections
Periodontal Disease
Genitourinary Tract Factors
Cervical Length
Cervical Procedures
Congenital Abnormalities of the Uterus
Behavioral
Smoking and Substance Abuse
Physical Activity
Nutritional Factors
Demography, Stress, and Social Determinants of Health
African Americans
Genetic Contributors to Preterm Birth
Past Pregnancy History
Current Pregnancy Risks
Bleeding and Vanishing Twins
Multifetal Gestation and Uterine Distention
Scoring Systems
Pathophysiology of Spontaneous Preterm Birth
Cervical Changes (Ripening)
Increased Uterine Contractility
Decidual Membrane Activation
Fetal Participation in the Onset of Labor
The Preterm Parturition Syndrome
Intrauterine Infection
Frequency of Intrauterine Infection in Spontaneous Preterm Birth
Intrauterine Infection as a Chronic Process
Infection, Preterm Labor, and Neonatal Outcomes
Gene-Environment Interactions
Uteroplacental Ischemia/Decidual Hemorrhage
Uterine Overdistention
Abnormal Allograft Reaction
Allergy-Induced Preterm Labor
Cervical Insufficiency
Endocrine Disorders
Summary of the Preterm Parturition Syndrome
Clinical Care for Women in Preterm Labor
Diagnosis of Preterm Labor
Diagnostic Tests for Preterm Labor
Amniocentesis for Women with Preterm Labor
Goals of Treatment for Women in Preterm Labor
Maternal Transfer
Antibiotics
Antenatal Corticosteroids
Fetal Effects
Other Fetal Effects of Glucocorticoids
Maternal Effects
Duration of Benefit
Risks of Antenatal Corticosteroid Treatment
Other Antenatal Treatments to Reduce Fetal/Neonatal Morbidity
Respiratory Distress
Neurologic Morbidity
Treatment Protocol
Tocolysis
Efficacy
Choosing a Tocolytic Agent
Pharmacology
Contraindications to Tocolysis
Calcium Channel Blockers
Maternal Effects
Fetal Effects
Treatment Protocol
Summary of Treatment with Calcium Channel Blockers
Magnesium Sulfate
Maternal Effects
Neonatal Effects
Summary of Treatment with Magnesium Sulfate
Cyclo-oxygenase Inhibitors
Maternal Effects
Fetal and Neonatal Effects
Treatment Protocol
Protocol for Indomethacin Tocolysis
Summary of Treatment with Indomethacin
β-Mimetic Tocolytics
Side Effects and Complications of β-Mimetic Tocolysis
Cardiopulmonary Complications of β-Mimetics.
Metabolic Complications.
Neonatal Effects.
Summary of Treatment with β-Mimetic Tocolysis
Other Tocolytic Agents
Clinical Use of Tocolytic Drugs
Persistent Contractions
Care After Acute Treatment for Preterm Labor
Maintenance Tocolytic Treatment
Conduct of Labor and Delivery for the Preterm Infant
Intrapartum Assessment of the Preterm Fetus
Labor and Delivery
Cesarean Delivery
Prevention of Preterm Birth
Secondary Prevention of Preterm Birth
Before Pregnancy
During Pregnancy
Modification of Maternal Activity
Nutritional Supplements
Enhanced Prenatal Care
Periodontal Care
Antibiotic Treatment
Progesterone
Cervical Cerclage
Clinical Use of Progesterone and Cerclage to Prevent Preterm Birth
Late Preterm Birth
Primary Prevention of Preterm Birth
Public Educational Interventions
Public and Professional Policies
Social Determinants of Health
Summary
Key Points
References
additional References
Introduction and Epidemiology
Host Factors—Maternal-Congenital Abnormalities of the Uterus
Host Factors—Maternal-Behavioral
Smoking and Substance Abuse
Physical Activity
Nutritional Factors
Demography, Stress, and Social Determinants of Health
Genetic Contributors to Preterm Birth
Past Pregnancy History
Pregnancy Termination
Current Pregnancy Risks
Bleeding and Vanishing Twins
Multifetal Gestation and Uterine Distention
Scoring Systems
Pathophysiology of Spontaneous Preterm Birth
Cervical Changes (Ripening)
Increased Uterine Contractility
Decidual Membrane Activation
Fetal Participation in the Onset of Labor
Preterm Parturition Syndrome
Intrauterine Infection
Frequency of Intrauterine Infection in Spontaneous Preterm Birth
Intrauterine Infection as a Chronic Process
Infection, Preterm Labor, and Neonatal Outcomes
Gene-Environment Interactions
Uteroplacental Ischemia/Decidual Hemorrhage
Uterine Overdistention
Abnormal Allograft Rejection
Allergy-Induced Preterm Labor
Endocrine Disorders
Clinical Care for Women in Preterm Labor
Diagnosis of Preterm Labor
Diagnostic Tests for Preterm Labor
Maternal Transfer
Antibiotics
Antenatal Corticosteroids
Maternal Effects
Duration of Benefit
Risks of Antenatal Cortcosteroid Treatment
Other Antenatal Treatments to Reduce Fetal/Neonatal Morbidity
Neurologic Morbidity
Tocolysis
Calcium Channel Blockers
Magnesium Sulfate
Cyclooxygenase Inhibitors
Beta-Mimetic Tocolytics
Other Tocolytic Agents
Clinical Use Of Tocolytic Drugs
Maintenance Tocolytic Treatment
Intrapartum Assessment of the Preterm Fetus
Labor and Delivery
Cesarean Delivery
Prevention of Preterm Birth
Modification Of Maternal Activity
Nutritional Supplements
Enhanced Prenatal Care
Periodontal Care
Antibiotic Treatment
Progesterone
Cervical Cerclage
Late Preterm Birth
Primary Prevention of Preterm Birth
29 Premature Rupture of the Membranes
Fetal Membrane Anatomy and Physiology
Etiology of Premature Rupture of the Membranes
Prediction and Prevention of Preterm Premature Rupture of the Membranes
Clinical Course after Premature Rupture of the Membranes
Risks OF Premature Rupture of the Membranes
Maternal Risks
Fetal and Neonatal Risks
Diagnosis of Premature Rupture of the Membranes
Management of Premature Rupture of the Membranes
General Considerations
Management of Premature Rupture of the Membranes at Term
Management of Preterm Premature Rupture of the Membranes Near Term (32 to 36 Weeks)
Management of Premature Rupture of the Membranes Remote from Term (23 to 31 weeks)
Corticosteroid Administration
Antibiotic Administration
Tocolysis
Cervical Cerclage
Herpes Simplex Virus
Management of Previable Premature Rupture of the Membranes
Summary
Key Points
References
30 Multiple Gestations
Zygosity and Chorionicity
Distribution and Causes of Dizygotic Versus Monozygotic Twinning
Diagnosis of Multiple Gestations
Determination of Chorionicity
Determination of Zygosity
Maternal and Fetal Risks of Multiple Gestation
Maternal Adaptation to Multifetal Gestation
Maternal Morbidity and Mortality
Perinatal Morbidity and Mortality
Fetal Anomalies
Issues and Complications Unique to Multiple Gestations
“Vanishing Twin”
“Appearing Twin”
First-Trimester Multifetal Pregnancy Reduction
Discordance for Anomalies
Selective Termination of an Anomalous Fetus
Cord Occlusion for Selective Termination in Monochorionic Twins
Intrauterine Fetal Death of One Twin
Twin–Twin Transfusion Syndrome
Etiology
Diagnosis and Staging
Management
Serial Amnioreduction
Septostomy
Laser Therapy
Outcomes after Laser Therapy
Monoamniotic Twins
Twin Reversed Arterial Perfusion Sequence
Conjoined Twins
Antepartum Management of Multifetal Pregnancy
Maternal Nutrition and Weight Gain
Spontaneous Preterm Birth
Bedrest and Hospitalization
Cerclage
Tocolysis
Progesterone
Antenatal Testing
Fetal Growth Surveillance
Discordant Growth
Specialized Twin Clinics
Timing of Delivery in Multiple Gestations
Monochorionic, Diamniotic Twins: Special Considerations Regarding Delivery Timing
Fetal Lung Maturity in Twins
Timing of Delivery in Triplets
Mode of Delivery in Multiple Gestations
Vertex-Vertex Twins
Nonvertex-Presenting Twin
Vertex-Nonvertex Twins
Triplets
Intrapartum Management of Twin Vaginal Delivery
Time Interval Between Deliveries
Conclusion
Key Points
References
31 Intrauterine Growth Restriction
Regulation of Fetal Growth
Definition and Patterns of Fetal Growth Restriction
Etiologies of Intrauterine Growth Restriction
Maternal and Fetal Manifestations of Intrauterine Growth Restriction
Maternal Impacts
Fetal Impacts
Diagnostic Tools in Fetal Growth Restriction
Fetal Biometry
Fetal Body Composition
Reference Ranges Defining Fetal Growth
Fetal Anatomic Survey
Amniotic Fluid Assessment
Doppler Velocimetry
Invasive Testing
Screening and Prevention of Fetal Growth Restriction
Maternal History
Maternal Serum Analytes
Clinical Examination
Maternal Doppler Velocimetry
First Trimester Integrated Screening
Preventive Strategies
Management in Clinical Practice
Therapeutic Options
Assessment of Fetal Well-Being (See Chapter 12)
Maternal Monitoring of Fetal Activity
Fetal Heart Rate Analysis
Amniotic Fluid Volume
Biophysical Parameters
Doppler Ultrasound
Invasive Fetal Testing
Anticipating the Progression to Fetal Compromise
The Timing of Delivery
Delivery
Outcome
Short-Term Outcomes
Long-Term Outcomes
Key Points
References
ADDITIONAL References
Regulation of Growth
Definition and Patterns of Growth Restriction
Etiologies of Intrauterine Growth Restriction
Maternal and Fetal Manifestations of Intrauterine Growth Restriction
Diagnostic Tools in Fetal Growth Restriction
Screening and Prevention of Fetal Growth Restriction
Management in Clinical Practice
Assessment of Fetal Well-Being
The Timing of Delivery
Outcomes
32 Red Cell Alloimmunization
Nomenclature
Historical Perspectives
Incidence
Pathophysiology
Rhesus Alloimmunization and Fetal/Neonatal Hemolytic Disease of the Newborn
Genetics
Prevention of RhD Hemolytic Disease in the Fetus and Newborn
History
Preparations
Indications
Diagnostic Methods
Maternal Antibody Determination
Fetal Blood Typing
Amniocentesis to Follow the Severity of Hemolytic Disease of the Fetus and Newborn
Fetal Blood Sampling
Ultrasound
Clinical Management
First Affected Pregnancy
Previously Affected Fetus or Infant
Intrauterine Transfusion
Technique
Complications and Outcome
Neonatal Transfusions
Neurologic Outcome
Other Treatment Modalities
Future Therapeutic Options
Hemolytic Disease of the Fetus and Newborn Due to Non-RhD Antibodies
Rhc
RhC, RhE, and Rhe
M
Duffy
Kidd
Kell
Key Points
References
33 Amniotic Fluid Disorders
Normal Amniotic Fluid Volume
Ultrasound Measurement of Amniotic Fluid Volume
Amniotic Fluid Formation
Fetal Urine
Lung Liquid
Amniotic Fluid Removal
Fetal Swallowing
Intramembranous Absorption
Oligohydramnios
Evaluation and Treatment of Oligohydramnios
Oligohydramnios in Labor
Polyhydramnios
Evaluation and Treatment of Polyhydramnios
Key Points
References
34 Prolonged and Postterm Pregnancy
Definition
Incidence
Etiology
Diagnosis
Perinatal Morbidity and Mortality
Oligohydramnios
Fetal Growth
Postmaturity
Meconium
Maternal Complications
Management
Antenatal Surveillance
Expectant Management Versus Induction of Labor
Labor Induction
Long-Term Neonatal Outcomes
Multiple Gestation
Key Points
References
Section VI - Pregnancy and Coexisting Disease
35 Hypertension
Definitions
Gestational Hypertension
Preeclampsia and Eclampsia
Chronic Hypertension
Chronic Hypertension with Superimposed Preeclampsia
Gestational Hypertension
Preeclampsia
Atypical Preeclampsia
Capillary Leak Syndrome: Facial Edema, Ascites and Pulmonary Edema, and Gestational Proteinuria
Gestational Proteinuria
Preeclampsia-Eclampsia at Less Than 20 Weeks’ Gestation
Risk Factors for Preeclampsia
Pathophysiology
Uterine Vascular Changes
Vascular Endothelial Activation and Inflammation
Genetics and Genetic Imprinting
Changes in Prostanoids
Lipid Peroxide, Free Radicals, and Antioxidants
Diagnosis of Preeclampsia
Prediction of Preeclampsia
Prevention of Preeclampsia
Calcium Supplementation
Antithrombotic Agents
Vitamins C and E
Laboratory Abnormalities in Preeclampsia
Renal Function
Hepatic Function
Hematologic Changes
HELLP Syndrome
Laboratory Criteria for Diagnosis
Clinical Findings
Differential Diagnosis
Management of HELLP Syndrome
Expectant Management of HELLP Syndrome
Corticosteroids to Improve Pregnancy Outcome in Women with HELLP Syndrome
Maternal and Perinatal Outcome
Recommended Management
Intrapartum Management
Postpartum Management
Hepatic Complications in HELLP Syndrome
Hepatic Infarction
Hepatic Hematoma and Rupture
Liver Transplantation for Intractable Hemorrhage
Hemodynamic Monitoring in Preeclampsia
Antepartum Management of Mild Hypertension-Preeclampsia
Gestational Hypertension
Hospitalization
Bedrest
Blood Pressure Medications
Fetal and Maternal Surveillance
Recommended Management
Mild Hypertension or Preeclampsia
Severe Hypertension in Preeclampsia
Expectant Management
Recommended Management of Severe Hypertension-Preeclampsia
Intrapartum Management
Prevention of Eclamptic Seizures
Control of Severe Hypertension
Mode of Delivery
Postpartum Management
Maternal and Perinatal Outcome with Preeclampsia
Counseling Women Who Have Had Preeclampsia in Prior Pregnancies
Remote Prognosis
Eclampsia
Pathophysiology
Diagnosis
Time of Onset
Cerebral Pathology
Differential Diagnosis
Maternal and Perinatal Outcome
Is Eclampsia Preventable?
Maternal Transport of the Eclamptic Patient
Treatment of Eclamptic Convulsions
Prevention of Maternal Injury During the Convulsions
Prevention of Recurrent Convulsions
Control of Severe Hypertension
Intrapartum Management
Postpartum Management of Eclampsia
Subsequent Pregnancy Outcome and Remote Prognosis
Incidence of Chronic Hypertension
Definition and Diagnosis
Etiology and Classification
Maternal-Perinatal Risks
Goals of Antihypertensive Therapy in Pregnancy
Safety of Antihypertensive Drugs in Pregnancy
Recommended Management of Chronic Hypertension in Pregnancy
Evaluation and Classification
Low-Risk Hypertension
High-Risk Hypertension
Postpartum Management
Hypertensive Emergencies in Chronic Hypertension
Hypertensive Encephalopathy
Treatment of Hypertensive Encephalopathy
Lowering Blood Pressure in Hypertensive Encephalopathy
Sodium Nitroprusside
Nitroglycerin
Key Points
References
ADDITIONAL References
Prevention
Renal Function
Hepatic Function
Hematologic Changes
HELLP SYNDROME
Hemodynamics
Management
Counseling Women
Eclampsia
Chronic Hypertension
36 Heart Disease
Maternal Hemodynamics
Blood Volume
Diagnosis and Evaluation of Heart Disease
General Care
Valvular Disease
Mitral Stenosis
Mitral Regurgitation
Aortic Stenosis
Aortic Regurgitation
Prosthetic Valves
Congenital Heart Disease
Isolated Septal Defects
Patent Ductus Arteriosus
Tetralogy of Fallot
Transposition of the Great Vessels
Fontan Repair
Eisenmenger Syndrome
Coarctation of the Aorta
Summary
Cardiomyopathy
Myocardial Infarction
Marfan Syndrome
Pulmonary Hypertension
Other Conditions
Critical Care: Hemodynamic Monitoring and Management
Hemodynamic Monitoring
Hemodynamic Management
Key Points
References
ADDITIONAL References
Valvular Disease
General Care
Diagnosis and Evaluation of Heart Disease
Congenital Heart Disease
Cardiomyopathy
Myocardial Infarction
Marfan Syndrome
Pulmonary Hypertension
Critical Care: Hemodynamic Monitoring and Management
37 Respiratory Diseases in Pregnancy
Pneumonia in Pregnancy
Bacteriology
Bacterial Pneumonia
Viral Pneumonias
Influenza Virus
Varicella Virus
Pneumocystis jiroveci Pneumonia
Tuberculosis in Pregnancy
Diagnosis
Prevention
Treatment
Summary
Asthma in Pregnancy
Diagnosis
Effects of Pregnancy on Asthma
Effects of Asthma on Pregnancy
Asthma Management
Objective Measures for Assessment and Monitoring
Patient Education
Avoidance or Control of Asthma Triggers
Pharmacologic Therapy
Step Therapy
Inhaled Corticosteroids
Inhaled β2-Agonists
Omalizumab
Theophylline
Leukotriene Moderators
Oral Corticosteroids
Management of Allergic Rhinitis and Gastroesophageal Reflux
Antenatal Management
Home Management of Asthma Exacerbations
Hospital and Clinic Management of Asthma Exacerbations
Labor and Delivery Management
Breastfeeding
Summary
Restrictive Lung Disease
Sarcoidosis
Cystic Fibrosis
Effect of Pregnancy on Cystic Fibrosis
Counseling Patients with Cystic Fibrosis in Pregnancy
Management of the Pregnancy Complicated by Cystic Fibrosis
Key Points
References
38 Renal Disease
Introduction
Altered Renal Physiology in Pregnancy
Asymptomatic Bacteriuria
Pyelonephritis
Acute Renal Disease in Pregnancy
Urolithiasis
Glomerulonephritis
Acute Renal Failure in Pregnancy
Hemolytic Uremic Syndrome
Polycystic Kidney Disease
Vesicoureteral Reflux
Renal Artery Stenosis
Nephrotic Syndrome
Chronic Renal Disease in Pregnancy
Effect of Pregnancy on Renal Function
Effect of Chronic Renal Disease on Pregnancy
Management of Chronic Renal Disease in Pregnancy
Hemodialysis in Pregnancy
Renal Transplant
Key Points
References
39 Diabetes Mellitus Complicating Pregnancy
Pathophysiology
Normal Glucose Tolerance
Glucose Metabolism
Diabetes Mellitus
Type 1 Diabetes Mellitus
Type 2 Diabetes and Gestational Diabetes
Amino Acid Metabolism
Lipid Metabolism
Maternal Weight Gain and Energy Expenditure
Perinatal Morbidity and Mortality
Fetal Death
Congenital Malformations
Fetal Macrosomia
Hypoglycemia
Respiratory Distress Syndrome
Calcium and Magnesium Metabolism
Hyperbilirubinemia and Polycythemia
Cardiomyopathy
Maternal Classification and Risk Assessment
Nephropathy
Retinopathy
Coronary Artery Disease
Detection and Significance of Gestational Diabetes Mellitus
Treatment of the Patient with Type 1 or Type 2 Diabetes Mellitus
Ketoacidosis
Antepartum Fetal Evaluation
Timing and Mode of Delivery
Glucoregulation during Labor and Delivery
Management of the Woman with Gestational Diabetes
Is There a Benefit to the Treatment of Gestational Diabetes Mellitus?
Randomized Treatment Trials for Gestational Diabetes Mellitus
Treatment of the Woman with Gestational Diabetes Mellitus
Postpartum Follow-Up of Women with Gestational Diabetes Mellitus
Long-Term Effects of Glucose Intolerance on Mother and Fetus
Prepregnancy Counseling of Women with Preexisting Diabetes Mellitus
Contraception
Key Points
References
ADDITIONAL References
Pathophysiology
Diabetes Mellitus
Perinatal Morbidity and Mortality
Maternal Classification and Risk Assessment
Detection and Significance of Gestational Diabetes Mellitus
Treatment of the Patient with Type 1 or Type 2 Diabetes Mellitus
Antepartum Fetal Evaluation
Timing and Mode of Delivery
Glucoregulation During Labor and Delivery
Management of the Woman with Gestational Diabetes
Postpartum Follow-Up of Women with GDM
Prepregnancy Counseling of Women with Preexisting Diabetes Mellitus
Contraception
40 Thyroid and Parathyroid Diseases in Pregnancy
Parathyroid Diseases
Calcium Homeostasis During Pregnancy
Hyperparathyroidism
Differential Diagnosis of Hypercalcemia
Therapy
Hypoparathyroidism
Pseudohypoparathyroidism
Vitamin D Deficiency
Osteoporosis
Thyroid Diseases
Thyroid Function Tests
Prepregnancy Counseling
Maternal-Placental-Fetal Interactions
Hyperthyroidism
Gestational Hyperthyroidism
Transient Hyperthyroidism of Hyperemesis Gravidarum
Graves’ Disease
Treatment of Thyroid Storm
Neonatal Hyperthyroidism
Fetal Hyperthyroidism
Neonatal Central Hypothyroidism
Resistance to Thyroid Hormone Syndrome
Hypothyroidism
Etiology and Classification of Hypothyroidism
Subclinical Hypothyroidism
Clinical Hypothyroidism
Isolated Hypothyroxinemia
Universal versus Selective Screening for Thyroid Disease
Euthyroid Chronic or Hashimoto Thyroiditis
Treatment of Hypothyroidism
Single Nodule of the Thyroid Gland
Patients with Known Thyroid Cancer before Pregnancy
Postpartum Thyroid Dysfunction
Key Points
Acknowledgment
References
additional References
Calcium Metabolism, Parathyroid, Calcitonin, Bone
Parathyroid Diseases
Vitamin D
Osteoporosis
Thyroid Diseases
Iodine
Maternal-Fetal Physiopathology
hCG and Thyrotoxicosis
Hyperthyroidism
Antithyroid Drug Therapy
Fetal and Neonatal Pathology
Thyroxine Resistance Syndrome
Hypothyroidism
Screening
Chronic or Hashimoto’s Thyroiditis
Goiter, Thyroid Nodules, and Cancer
Postpartum Thyroiditis
41 Pituitary and Adrenal Disorders in Pregnancy
Anterior Pituitary
Anterior Pituitary Hormone Changes in Pregnancy
Pituitary Tumors
Prolactinoma
Acromegaly
Thyrotropin-Secreting Tumors
Clinically Nonfunctioning Adenomas
Hypopituitarism
Sheehan Syndrome
Lymphocytic Hypophysitis
Posterior Pituitary
Diabetes Insipidus
Adrenals
Cushing Syndrome
Adrenal Insufficiency
Primary Hyperaldosteronism
Pheochromocytoma
Key Points
References
42 Hematologic Complications of Pregnancy
Pregnancy-Associated Thrombocytopenia
Gestational Thrombocytopenia
Immune Thrombocytopenic Purpura
Thrombotic Thrombocytopenic Purpura and Hemolytic Uremic Syndrome
Evaluation of Thrombocytopenia During Pregancy and the Puerperium
Therapy of Thrombocytopenia During Pregnancy
Gestational Thrombocytopenia
Immune Thrombocytopenic Purpura
Management of Thrombotic Thrombocytopenic Purpura and Hemolytic Uremic Syndrome
Fetal/Neonatal Alloimmune Thrombocytopenia
Iron Deficiency Anemia
Megaloblastic Anemia
Hemoglobinopathies
Hemoglobin S
Hemoglobin SC Disease
Thalassemia
Von Willebrand’s Disease
Key Points
References
additional References
Thrombocytopenia
Anemias (Iron, Folate, Vitamin B12)
Hemoglobinopathies
Von Willebrand’s Disease
43 Thromboembolic Disorders
Epidemiology
Risk Factors
Physiology of Hemostasis
Vasoconstriction and Platelet Action
Coagulation Cascade
Anticoagulant System
Clot Lysis and Fibrinolysis
Pathophysiology of Thrombosis in Pregnancy
Antiphospholipid Antibody Syndrome
Inherited Thrombophilias
Diagnosis of Venous Thromboembolism
Deep Venous Thrombosis
Clinical Signs and Symptoms
Risk Scoring System
Imaging
D-Dimer Assays
Workup of Patients with Suspected Deep Venous Thrombosis
Pulmonary Embolus
Clinical Signs and Symptoms
Nonspecific Studies
Pulmonary Arteriography
Ventilation-Perfusion Scanning
Spiral Computed Tomographic Pulmonary Angiography
Ventilation-Perfusion Scanning Versus Computed Tomographic Pulmonary Angiography
Magnetic Resonance Angiography
D-Dimer Assays
Lower Extremity Evaluation
Workup of Patients with Suspected Pulmonary Embolus
Radiation Exposure in Pregnancy
Fetal Exposure
Maternal Exposure
Treatment of Thromboembolism in Pregnancy
Unfractionated Heparin
Low-Molecular-Weight Heparin
Fondaparinux
Coumarin
Treatment of Acute Deep Venous Thrombosis or Pulmonary Embolus
Prophylactic Applications and Dosing
Other Considerations of Therapy and Prevention
Perioperative Prevention
Inferior Vena Cava Filters
Key Points
References
additional References
44 Collagen Vascular Diseases
Systemic Lupus Erythematosus
Epidemiology and Etiology
Clinical Manifestations
Diagnosis
Clinical Features
Laboratory Findings
Systemic Lupus Erythematosus and Pregnancy
Risk for Systemic Lupus Erythematosus Exacerbation (Flare)
Lupus Nephritis and Pregnancy
Pregnancy Loss
Preeclampsia
Intrauterine Growth Restriction
Preterm Birth
Neonatal Lupus Erythematosus
Drug Therapy and Systemic Lupus Erythematosus in Pregnancy
Nonsteroidal Anti-inflammatory Drugs
Glucocorticoids
Antimalarials
Azathioprine
Cyclosporine
Drugs with Moderate to High Risk for Fetal Harm
Obstetrical Management
Antiphospholipid Syndrome
Epidemiology
Pathophysiology
Clinical Manifestations
Diagnosis
Laboratory Findings
Pregnancy in Women with Antiphospholipid Syndrome
Treatment of Antiphospholipid Syndrome in Pregnancy
Rheumatoid Arthritis
Pathophysiology
Clinical Manifestations and Laboratory Findings
Rheumatoid Arthritis and Pregnancy
Obstetrical Complications
Obstetrical Management
Antirheumatic Medications
Systemic Sclerosis
Pathogenesis
Clinical Manifestations and Diagnosis
Systemic Sclerosis and Pregnancy
Effects of Pregnancy on Systemic Sclerosis
Effects of Systemic Sclerosis on Pregnancy
Obstetrical Management
Sjögren Syndrome
Key Points
References
45 Hepatic and Gastrointestinal Diseases
Hepatic Disorders During Pregnancy
Physiologic Effects of Pregnancy and Assessment of Liver Disease
Differential Diagnosis of Hepatobiliary Symptoms and Conditions during Pregnancy
Jaundice
Right Upper Quadrant Abdominal Pain
Nausea and Vomiting
Pruritus
Hepatic Lesions
Ascites
Abdominal Imaging during Pregnancy
Therapeutic Endoscopy during Pregnancy
Therapeutic Endoscopic Retrograde Cholangiopancreatography
Endoscopic Variceal Sclerotherapy or Banding
Pancreatobiliary Disease
Acute Pancreatitis
Cholelithiasis and Cholecystitis
Choledocholithiasis
Choledochal Cysts
Common Liver Diseases Incidental to Pregnancy
Acute Viral Hepatitis A, B, and C
Wilson’s Disease
Autoimmune Hepatitis
Hepatic Hemangiomas, Cysts, and Abscesses
Hepatocellular Carcinoma and Hepatic Metastases
Liver Diseases Significantly Affected by Pregnancy
Hepatitis E
Chronic Hepatitis B
Chronic Hepatitis C
Hepatic Adenomas
Acute Intermittent Porphyria
Sickle Cell Hemoglobinopathies
Portal Hypertension
Budd-Chiari Syndrome
Pregnancy After Liver Transplantation
Liver Disease Strongly Related or Unique to Pregnancy
Alcoholism During Pregnancy
Hepatic Involvement in Hyperemesis Gravidarum
Herpes Simplex Hepatitis
Intrahepatic Cholestasis of Pregnancy
Preeclampsia and Eclampsia
Hemolysis, Elevated Liver Function Tests, and Low Platelet Count (HELLP) Syndrome
Management of Preeclampsia, Eclampsia, and HELLP Syndrome
Hepatic Hemorrhage and Rupture
Acute Fatty Liver of Pregnancy
Key Points
References
additional References
Physiologic Effects of Pregnancy and Assessment of Liver Disease
Abdominal Imaging During Pregnancy
Therapeutic Endoscopy During Pregnancy
Pancreatobiliary Disease
Common Liver Disease Incidental to Pregnancy
Liver Diseases Significantly Affected by Pregnancy
Liver Diseases Strongly Related or Unique to Pregnancy
Gastrointestinal Disorders During Pregnancy
Physiologic Effects of Pregnancy on Abdominal Disorders
Differential Diagnosis and Evaluation of Gastrointestinal Symptoms during Pregnancy
Abdominal Pain
Upper Gastrointestinal Symptoms
Nausea and Vomiting
Dyspepsia or Pyrosis
Hematemesis
Dysphagia
Lower Gastrointestinal Symptoms
Diarrhea
Constipation
Rectal Bleeding
Diagnostic Testing during Pregnancy
Radiologic Imaging
Endoscopy during Pregnancy
Gastrointestinal Disorders
Predominantly Upper Gastrointestinal Disorders
Hyperemesis Gravidarum
Gastroesophageal Reflux and Peptic Ulcer Disease
Diaphragmatic Rupture
Predominantly Lower Gastrointestinal Disorders
Acute Appendicitis
Intestinal Obstruction
Intestinal Pseudo-obstruction
Colon Cancer
Inflammatory Bowel Disease
Hemorrhoids
Mesenteric Ischemia and Infarction
Irritable Bowel Syndrome
Splenic Artery Aneurysm Rupture
Key Points
References
additional References
Physiologic Effects of Pregnancy on Abdominal Pain
Differential Diagnosis and Evaluation of Gastrointestinal Symptoms During Pregnancy
Diagnostic Testing During Pregnancy
Gastrointestinal Disorders
46 Neurologic Disorders
Seizure Disorders
Effects of Epilepsy on Reproductive Function
Effect of Pregnancy on Epilepsy
Effects of Pregnancy on the Disposition of Anticonvulsant Medications
Effect of Epilepsy on Pregnancy
Effects of Anticonvulsant Medications on the Fetus
Preconceptional Counseling for the Reproductive-Age Woman with a Seizure Disorder
Care of the Patient During Pregnancy
Labor and Delivery
New Onset of Seizures in Pregnancy and the Puerperium
Postpartum Period
Migraine
Cerebrovascular Diseases
Arterial Occlusion
Cerebral Vein Thrombosis
Subarachnoid Hemorrhage
Diagnosis and Treatment
Multiple Sclerosis
Carpal Tunnel Syndrome
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
Key Points
References
additional References
Epilepsy
Effect of Pregnancy on Epilepsy
Effect of Pregnancy on Disposition of Medications
Effect of Epilepsy on Pregnancy
Effects of Anticonvulsant Medications on the Fetus
Care of Patient during Pregnancy
New Onset of Seizures in Pregnancy and Puerperium
Postpartum Period
Migraine
Cerebrovascular Diseases
Multiple Sclerosis
Carpal Tunnel Syndrome
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
References
47 Malignant Diseases and Pregnancy
Chemotherapy during Pregnancy
Pharmacology of Chemotherapy During Pregnancy
Drug Effects on the Fetus
Classification of Chemotherapy Agents
Antimetabolites
Alkylating Agents
Antitumor Antibiotics
Vinca Alkaloids
Platinum Agents
Miscellaneous
Targeted Therapies
National Registry
Radiation Therapy
Surgery and Anesthesia
Pregnancy Following Cancer Treatment
Cancer during Pregnancy
Breast Cancer
Diagnosis and Staging
Treatment
Local Therapy
Pregnancy Termination
Chemotherapy
Prognosis
Subsequent Pregnancy
Lactation and Breast Reconstruction
Lymphoma
Hodgkin’s Lymphoma
Non-Hodgkin’s Lymphoma
Acute Leukemia
Chronic Leukemia
Melanoma
Cervical Cancer
Microinvasion
Invasive, Early-Stage Disease
Invasive, Locally Advanced Disease
Invasive, Distant Metastasis
Method of Delivery
Survival
Ovarian Cancer
Postoperative Adjuvant Therapy
Vulvar and Vaginal Cancer
Endometrial Cancer
Gastrointestinal Cancers
Upper Gastrointestinal Cancers
Colon and Rectal Cancer
Urinary Tract Cancers
Central Nervous System Tumors
Miscellaneous Tumors
Fetal-Placental Metastasis
Gestational Trophoblastic Disease and Pregnancy- Related Issues
Hydatidiform Mole (Complete Mole)
Invasive Mole (Chorioadenoma Destruens)
Partial Hydatidiform Mole
Placental Site Trophoblastic Tumor
Choriocarcinoma
Key Points
References
48 Skin Disease in Pregnancy and Puerperium
Physiologic Skin Changes Induced by Pregnancy
Pigmentary Changes
Vascular Changes
Connective Tissue Changes
Glandular Changes
Hair and Nail Changes
Preexisting Skin Diseases and Tumors Affected by Pregnancy
Atopic Eczema and Dermatitis
Acne Vulgaris
Other Inflammatory Skin Conditions
Autoimmune Progesterone Dermatitis
Impetigo Herpetiformis
Cutaneous Manifestations of Autoimmune Disorders
Bullous Disorders
Skin Tumors
Malignant Melanoma
Pruritus in Pregnancy
Specific Dermatoses of Pregnancy
Herpes (Pemphigoid) Gestationis
Pruritic Urticarial Papules and Plaques of Pregnancy
Prurigo of Pregnancy
Pruritic Folliculitis of Pregnancy
Key Points
References
49 Maternal and Perinatal Infection:
Epidemiology
Chlamydia
Gonorrhea
Syphilis
Congenital Syphilis
Pathogenesis
Endocervical Infections
Chlamydia
Gonorrhea
Systemic Infection
Diagnosis
Chlamydia and Gonorrhea
Syphilis
Treatment
Chlamydia
Gonorrhea
Syphilis
Key Points
References
50 Maternal and Perinatal Infection—Viral
Human Immunodeficiency Virus
Virology
Epidemiology
Screening, Diagnosis, and Staging
Clinical Manifestations and Staging
Management During Pregnancy
Initial Evaluation
Ethical Considerations
Treatment of HIV Infection During Pregnancy
Nuceloside Reverse Transcriptase Inhibitors
Non-nucleoside Reverse Transcriptase Inhibitors
Protease Inhibitors
Opportunistic Infection Prophylaxis
Summary
Ongoing Management
Antenatal Karyotype Determination
Intrapartum Management of HIV
Intrapartum Testing
Spontaneous Rupture of Membranes (SROM)
Untreated Women
Elective Cesarean Delivery
Postpartum Care of the HIV-Infected Woman
Infant Screening and Diagnosis
Factors Influencing Transmission
Preconception Counseling for HIV-Infected Women
HIV Discordant Couples
Counseling
Influenza
Virology/Epidemiology
Clinical Manifestations
Diagnosis
Management of Influenza During Pregnancy
Parvovirus
Virology/Epidemiology
Clinical Manifestations
Diagnosis
Management of Parvovirus During Pregnancy
Measles
Virology/Epidemiology
Clinical Manifestations
Diagnosis
Management of Measles During Pregnancy
Rubella
Virology/Epidemiology
Clinical Manifestations
Diagnosis
Management of Rubella Infection During Pregnancy
Congenital Infection
Cytomegalovirus Infection
Virology/Epidemiology
Clinical Manifestations
Diagnosis
Management of Cytomegalovirus During Pregnancy
Congenital Infection
Herpesvirus
Virology/Epidemiology
Clinical Manifestations
Diagnosis
Management of Herpesvirus During Pregnancy
Neonatal Herpes Infection
Varicella
Virology/Epidemiology
Clinical Manifestations
Diagnosis
Management of Varicella During Pregnancy
Congenital Infection
Hepatitis
Hepatitis A
Hepatitis B
Virology/Epidemiology
Diagnosis
Management of HBV Infection during Pregnancy
Hepatitis C
Virology/Epidemiology
Diagnosis
HCV in Pregnancy
Hepatitis D
Hepatitis E
West Nile Virus
Coxsackie Virus
Human Papillomavirus
Epstein-Barr Virus
Smallpox
Key Points
References
51 Maternal and Perinatal Infection—Bacterial
Group B Streptococcal Infection
Epidemiology
Maternal Complications
Diagnosis
Prevention of Group B Streptococcal Infection
Urinary Tract Infections
Acute Urethritis
Asymptomatic Bacteriuria and Acute Cystitis
Acute Pyelonephritis
Upper Genital Tract Infections
Chorioamnionitis
Epidemiology
Diagnosis
Management
Puerperal Endometritis
Epidemiology
Clinical Presentation and Diagnosis
Management
Prevention of Puerperal Endometritis
Serious Sequelae of Puerperal Infection
Wound Infection
Pelvic Abscess
Septic Pelvic Thrombophlebitis
Septic Shock
Toxoplasmosis
Epidemiology
Clinical Manifestations
Diagnosis
Congenital Toxoplasmosis
Management
Listeriosis
Key Points
References
52 Mental Health and Behavioral Disorders in Pregnancy
Mood Disorders
Major Depressive Episode
Diagnosis and Prevalence During Pregnancy and Postpartum
Natural History Across Childbearing
Treatment of MDE During Pregnancy
Treatment of MDE in the Postpartum Period
Bipolar Disorder
Diagnosis and Prevalence
Natural History Across Childbearing
Treatment of Bipolar Disorder During Childbearing
Prevention of Bipolar Episode Recurrence After Delivery
Breastfeeding for Women with Bipolar Disorder
Anxiety Disorders
Diagnosis and Prevalence
Natural History Across Childbearing
Effects of Anxiety During Childbearing
Treatment of Anxiety Disorders
Eating Disorders
Diagnosis and Prevalence
Natural History Across Childbearing
Treatment of Eating Disorders
Treatment of Anorexia Nervosa
Treatment of Bulimia Nervosa
Schizophrenia
Diagnosis and Prevalence
Natural History of Schizophrenia Across Childbearing
Treatment Interventions for Women with Schizophrenia
Antipsychotic Drugs During Pregnancy
Antipsychotic Drugs During Breastfeeding
Substance-Related Disorders
Diagnosis and Prevalence
Obtaining a Substance Use History
Specific Drugs of Abuse: Impact and Treatment Approaches
Alcohol and Sedative Hypnotics
Smoking
Cannabis
Cocaine
Methamphetamine
Opioids
Acute Pain Management for Women on Maintenance Opioids
Personality Disorders
Diagnosis and Prevalence
Clinical Implications
Build a Working Alliance
Structure the Relationship
Respect Patient Autonomy
Find Something to Validate in the Patient’s Response
Physician Self-Regulation
Suicide
Infanticide and Neonaticide
Postpartum Psychosis
Neonaticide
Pseudocyesis
Final Comment
Additional Resources
Key Points
References
additional References
Mood Disorders
Bipolar Disorder
Anxiety Disorders
Eating Disorders
Schizophrenia
Substance-Related Disorders
Personality Disorders
Suicide
References
Section VII - Legal and Ethical Issues in Perinatology
53 Patient Safety and Quality Measurement in Obstetrical Care
Patient Safety
Overview
Frequency of Preventable Obstetrical Adverse Events
Factors Contributing to Preventable Adverse Events
Approaches to Improve Obstetrical Safety
Checklists and Protocols
Simulation
Shoulder Dystocia
Eclampsia
Other Obstetrical Events
Enhancement of Communication in General
Multifaceted Approaches
Summary
Measurement of Obstetrical Quality of Care
Overview
Type of Quality Measures
Attempts to Establish Quality Measures
Traditional Measures
Newer Approaches to Measures
Data Sources
Quality Improvement
Summary
Key Points
References
54 Legal and Ethical Issues in Obstetrical Practice
Reproductive Liberty*
Abortion Politics and National Health Insurance Reform*
Human Embryonic Stem Cell Research Funding*
Genetic Counseling, Screening, and Prenatal Diagnosis
Genetic Screening*
Forced Cesarean Delivery
Key Points
References
Appendix I Normal Values in Pregnancy
Appendix II Anatomy of the Pelvis
Key Points
Suggested Reading
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
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T
U
V
W
X
Y
Z