Clinical Obstetrics: The Fetus & Mother

Description:

From preconception care through all aspects of care of the pregnant mother and newborn infant, Clinical Obstetrics provides comprehensive, authoritative information on today’s obstetrics and maternal-fetal medicine. The fourth edition has been streamlined with concise chapters summarizing clinical content for busy practitioners. The digital provides expanded content and exciting new animations and interactive decision-making algorithms.  Together, the print and digital offer residents, trainees, and all obstetrics and maternal-fetal practitioners a comprehensive resource featuring the most up-to-date guidelines, decision algorithms, and evidence for clinical practice. 

 

Table of Contents:

 

Part I Early Pregnancy Complications

1. Early Pregnancy Loss and Fetal Death

Introduction and Definitions

Sporadic Early Pregnancy Loss

Recurrent Early Pregnancy Loss

Known or Suspected Etiologic Factors for REPL

Evaluation of Patients With REPL

Prognosis and Treatment of REPL

Lifestyle and Environmental Factors

Uterine Factors

Antiphospholipid Syndrome

Endocrine Disorders

Other Possible Etiologies

Fetal Death

Known or Suspected Etiologic Factors for Fetal Death

Evaluation of Patients With Fetal Death

Prognosis and Treatment of Subsequent Pregnancies in Cases of Prior Fetal Death

2. Thrombophilias

Introduction

The Coagulation Pathway and Physiologic Changes During Pregnancy

Screening and Diagnosis of Inherited Thrombophilias

Thrombophilia and VTE Risk Classification

Medication Regimens for VTE Prevention

Low-Risk Thrombophilias

FVL Heterozygosity

PGM Heterozygosity

Protein C Deficiency

Protein S Deficiency

Inherited High-Risk Thrombophilias

FVL Homozygosity

PGM Homozygosity

Heterozygous for FVL and PGMs

ATIII Deficiency

Antepartum and Postpartum Management of Women With Inherited Thrombophilias

Acquired Thrombophilias

Antiphospholipid Syndrome

3. Ectopic and Heterotopic Pregnancies

Ectopic Pregnancy

Incidence

Etiology and Risk Factors

Signs and Symptoms

Laboratory Assessment

Treatment of Ectopic Pregnancy

Specific Forms of Ectopic Pregnancy

Heterotopic Pregnancy

Incidence

Clinical Features and Diagnosis

Treatment of Heterotopic Pregnancy

4. Evaluation of Stillbirth

Introduction

Epidemiology

Risk Factors for Stillbirth

Classification of Stillbirth

Causes of Stillbirth

Infection

Maternal Medical Conditions

Fetal Conditions

Placental Abnormalities

Multifetal Gestations

Evaluation of Stillbirth

Delivery/Bereavement

Management of Subsequent Pregnancy

Prevention of Stillbirth

5. Multifetal Pregnancies: Epidemiology, Clinical Characteristics, and Management

Introduction

Epidemiology

Classification

Ultrasound Diagnosis and Surveillance

Determining Gestational Age

Determining Chorionicity and Amnionicity

First Trimester

Second and Third Trimesters

Complications in Multifetal Pregnancies

Maternal Complications

Fetal Complications

Vanishing Twin

Preterm Birth

Intrauterine Growth Restriction

Discordant Anomalies

Fetal Death

Placental Anomalies

MC Twin Pregnancy

The MC Placenta

Complications in MC Twins

Complications Present From the Beginning of the Gestation

Complications That Occur During Pregnancy

Triplets and Higher Order Multiple Pregnancy

Multifetal Pregnancy Reduction and Selective Fetal Termination

Timing and Mode of Delivery in Twins

6. The Normal and Abnormal Placenta

Introduction and a Historical Perspective

Anatomy and Morphology

The Placental Villus

The Chorionic and Basal Plates and Nonvillous Support

Placental Blood Flow

Placental Development

Placental Hormones and Other Signals

Progesterone

Estrogen

Human Chorionic Gonadotropin

Human Placental Lactogen

Other Hormones and Signaling Molecules

Maternal-Fetal Exchange

General Principles

Oxygen

Carbon Dioxide (CO2), Protons, and Lactate

Water

Key Cations and Anions

Glucose

Amino Acids

Lipids

Immunoglobulins

Drugs and Xenobiotics

Placental Dysfunction and Obstetrical Diseases—A Pathophysiological Approach

Histopathology of the Placenta

Placental Shape Abnormalities

Multifetal Gestation

UC Structural Abnormalities

The Morbidly Adherent Placenta

Maternal Vascular Malperfusion

Fetal Vascular Malperfusion

Perivillous Fibrinoid Deposition

Placental Infection and Inflammation

Disorders of Villous Vascular Proliferation

Gestational Trophoblastic Disease

Additional Placental Pathologies

The Placental Origins of Childhood and Adult Diseases

Part II Fetal Infections and Teratogenesis

7. Teratogens

Introduction

Basic Principles of Teratology

The Etiology of Congenital Malformations

Factors That Affect Susceptibility to Potential Teratogens

Timing of Exposure

Dose of the Exposure

Threshold Dose

Genetic Susceptibilities

Environmental Agents Resulting in Toxicity

Interpretation of Animal Study Data

Evaluating Animal Studies to Determine the Potential Risk in Humans

Evaluating and Counseling Patients About Teratogenic Risks

2015 Update to FDA Pregnancy Categories

Pharmacokinetics and Metabolism of Medications or Chemicals

Placental Transport

The Role of the Physician in Counseling Families

Clinical Evaluation

Major Teratogens

Lithium

Rubella

ACE Inhibitors

Selective Serotonin Uptake Inhibitors

Warfarin

Phenytoin (Dilantin)

Methotrexate

Cytomegalovirus

Tetracycline

Thalidomide

Accutane

Evaluation of Reproductive Risk or Cause of a Child’s Malformation After Environmental Exposure

8. The Effects of Illicit Drug and Alcohol Use in Pregnancy

Introduction

Alcohol

Cocaine

Pharmacology

Maternal Effects

Fetal/Neonatal Effects

Opioids

Pharmacology

Misuse, Dependence, and Addiction

Maternal Effects

Fetal/Neonatal Effects

Treatment in Pregnancy

Hallucinogens, Amphetamines, and Benzodiazapines

Tobacco and Nicotine

Caffeine

Drug Use and Lactation

9. Radiation in Pregnancy

Introduction

Types of Radiation

Radiation Effects on the Fetus

Occupational Exposures During Pregnancy

Pregnancy and Therapeutic Radiotherapy

Scope of Radiotherapy Exposure

Clinical Use of Radiation Therapy During Pregnancy

General Recommendations

10. Infectious Disease in Pregnancy

Introduction

Cytomegalovirus

Epidemiology

Transmission

Clinical Presentation

Clinical Assessment

Pharmacologic Treatment

Rubella

Epidemiology

Transmission

Clinical Presentation

Clinical Assessment

Management of Rubella Infection in Pregnancy

Varicella Zoster Virus

Epidemiology

Transmission

Clinical Presentation

Clinical Assessment

Pharmacologic Treatment and Prevention

Management of VZV in Pregnancy

Herpes Simplex Virus

Epidemiology

Clinical Manifestations

Diagnosis

Treatment

Prevention

Parvovirus B19 Infection

Epidemiology

Clinical Presentation

Clinical Assessment

Nonpharmacologic Treatment and Prevention

Toxoplasmosis

Epidemiology

Clinical Presentation

Clinical Assessment

Pharmacologic Treatment and Prevention

Measles

Epidemiology

Clinical Presentation

Clinical Assessment

Nonpharmacologic Treatment and Prevention

Part III Prenatal Diagnosis

11. Principles of Genetic Counseling in Prenatal and Perinatal Medicine

Introduction

The Genetic and Genomic Basis for Counseling

Congenital Anomalies: Definition and Causes

Genetic Disorders

Principles of Genetic Counseling

Reasons for Referral for Genetic Counseling

Counseling About Genetic Tests in the Prenatal and Perinatal Period

Principles Guiding the Delivery of Genetic Counseling

Preconception Care

12. Basic Principles of Ultrasound

Introduction

Basic Physics

Ultrasound Image and Resolution

Ultrasound Safety

Ultrasound Examination

Head

Fetal Spine

Fetal Heart

Abdomen

Extremities

Fetal Biometry

13. The First Prenatal Visit—Setting the Stage for Optimal Pregnancy Care

Introduction

Laboratory Screening

Hematologic Screening

Infectious Disease Screening

General Health Screening

First-Trimester Ultrasound

Genetic Testing

Care Dictated by Maternal History

Care Dictated by Preexisting Maternal Medical Conditions

14. Invasive Diagnostic Procedures

Introduction

Pretest Genetic Counseling

Prenatal Diagnostic Tests

Chorionic Villus Sampling

Amniocentesis

Cordocentesis

Indications for an Invasive Prenatal Diagnostic Procedure

Increased Risk of Fetal Aneuploidy

Advanced Maternal Age (>35 Years)

Assisted Reproductive Technology

Parent With a Chromosomal Structural Anomaly

Fetal Structural Abnormalities Identified by Ultrasound

Intrauterine Growth Restriction

Increased Risk of a Known Genetic Disease of the Fetus

Advanced Paternal Age

Infectious Diseases

Maternal Request

Indications for Cordocentesis

Checklist for Carrying Out Invasive Diagnostic Procedures

Invasive Procedures in Multiple Pregnancies

Techniques

Risk of Fetal Loss

15. Expanded Mendelian Screening

Introduction

Key Measures of Screening Tests: Sensitivity, Specificity, PPV, and Negative Predictive Value

Use and Misuse of Statistics

History of Screening in Obstetrics

Beginnings of Panels

Screening Guidelines

Limitations of Ethnicity-Based Guidelines

Current Guidelines for Optimal Panel ECS Design

Timing of ECS

Genetic Counseling

Anxiety and Stigmatization

Screening Technology

Partner Screening

Adult-Onset Disorders

What Will All This Look Like in 5 to 10 Years?

Summary

16. Preimplantation Genetic Diagnosis in Assisted Reproductive Technology

History of PGT

Testing Platforms

Preimplantation Genetic Testing for Monogenic Disorders

Clinical Management Issues in Preimplantation Diagnosis

Low Embryo Yields

Embryo Mosaicism

No Results

Costs of PGT

Risks to the Fetus and Baby

Ethical Conundrums

Future Directions

Acknowledgment

Part IV Methods of Evaluation of Fetal Development and Well-being

17. Embryonic Development

Introduction

Embryonic Disk Folding

Pharyngeal Apparatus

The Face

The Palate

The Respiratory System

The Digestive System

The Urinary System

The Genital System

The Cardiovascular System

The Nervous System

The Musculoskeletal System

18. Prenatal Diagnosis of Deviant Fetal Growth

Introduction

Fetal Growth Restriction

Definition

Etiologies and Risk Factors

Classification of IUGR

Diagnosis of FGR

Doppler in FGR

Antenatal Surveillance

Optimal Time of Delivery in FGR

Preventing FGR

Macrosomia

Neonatal and Maternal Outcomes of Macrosomia

Diagnosis of Macrosomia

Prevention

Induction of Labor and Cesarean Delivery for Macrosomia

19. Three- and Four-Dimensional Ultrasound and Magnetic Resonance Imaging in Pregnancy

Introduction

Three-Dimensional and Four-Dimensional Ultrasound

Main Principles of the 3D and 4D Ultrasound

Clinical Applications of the 3D and 4D Ultrasound in Pregnancy

Comparison of 3D/4D Ultrasound With 2D Ultrasound

Magnetic Resonance Imaging

General Considerations and Safety

Fetal MRI

MRI and Placenta Accreta Spectrum

20. Doppler Ultrasonography and Fetal Well-being

Introduction

Physics of Doppler

Doppler Indices

Fetal Circulation

Arterial Doppler Measurements

Uterine Artery Doppler

Umbilical Artery Doppler

Middle Cerebral Artery

Venous Doppler Assessment

Ductus Venosus

Umbilical Vein

Doppler Ultrasound in Normal Pregnancies

First-Trimester Screening for Chromosomal Abnormalities and Congenital Heart Defects

Early Screening for Preeclampsia and FGR

Screening for Adverse Perinatal Outcomes Using the Cerebroplacental Ratio

Doppler Ultrasound in Abnormal Pregnancies

Fetal Anemia

Fetal Growth Restriction

Fetal Hydrops

Complicated Monochorionic Twins

21. Antepartum and Intrapartum Surveillance of the Fetus and the Amniotic Fluid

Introduction

Antepartum Surveillance Techniques (Fetus and Amniotic Fluid)

Fetal Movement Monitoring

Contraction Stress Test

Nonstress Test

Vibroacoustic Stimulation

Biophysical Profile

Amniotic Fluid Volume Assessment

Intrapartum Fetal Surveillance Techniques

Fetal Heart Rate Monitoring

Fetal Acid-Base Evaluation

Fetal Stimulation Techniques

Fetal Pulse Oximetry

Fetal Electrocardiogram ST Segment Automated Analysis

Part V Fetal Therapy

22. Maternal Alloimmunization and Fetal Hemolytic Disease

Introduction

History

Red Blood Cell Antigens

Rh Antigen System Nomenclature

Diversity and Ethnicity

Immunology

Rh Functionality

PATHOGENESIS OF MATERNAL ALLOIMMUNIZATION

Transplacental Hemorrhage

Maternal Response

Rh Immune Response

Antibody Detection and Measurement Methods

Prevalence of Rh Immunization

PATHOGENESIS OF FETAL HEMOLYTIC DISEASE

Degrees of Rh Hemolytic Disease

Monitoring the Mother and Fetus at Risk

PREDICTING THE SEVERITY OF RH HEMOLYTIC DISEASE

Medical History

Rh Antibody Titers

Fetal Blood Sampling

Ultrasound

Cell-Mediated Maternal Antibody Functional Assays

MANAGEMENT OF THE RH-IMMUNIZED WOMAN AND HER FETUS

Nonsensitized Women (First Affected Pregnancy)

Rh-immunized Women With a Previously Affected Fetus or Infant

Treatment

PREVENTION OF RH IMMUNIZATION

Rh Immunoglobulin

RhIG Mechanism of Action

Antenatal Rh Prophylaxis

Postpartum Rh Prophylaxis

Rh Prophylaxis Problems

Reactions to Intramuscular RhIG—Newer Forms of RhIG

SUMMARY OF RECOMMENDATIONS FOR RH PROPHYLAXIS

NON-RhD BLOOD GROUP IMMUNIZATION

ABO Hemolytic Disease

Hemolytic Disease Caused by Atypical Blood Group Antibodies

AREAS FOR FUTURE RESEARCH

23. Fetal Neonatal Alloimmune Thrombocytopenia

Introduction

Etiology

Biologic Activity of Human Platelet Antigens

Diagnosis

Antenatal Management and Screening

Universal Screening

Screening by Antibody Titers

Screening by HLA DRB3*0101 Typing

Postnatal Management

Subsequent Pregnancy Management

24. Fetal Surgical Interventions

Introduction

Fetal Interventions for Monochorionic Twin Pregnancy Complications

Treatment of TTTS

Serial Amniocentesis

Laser Therapy

Twin Anemia-Polycythemia Sequence

Definition

Pathophysiology and Staging

Treatment of TAPS and Outcomes

Selective Intrauterine Growth Restriction

Incidence

Definition of sIUGR

Classification of sIUGR

Etiology

Management

Twin Reverse Arterial Perfusion Sequence

Treatment

Discordant (Obligate Lethal) Anomalous Twins

DEVELOPMENTAL STRUCTURAL ABNORMALITIES

Fetal Lung Masses

Thoracic Space-Occupying Lesions

Congenital Diaphragmatic Hernia

Cystic Adenomatoid Malformation/Congenital Pulmonary Airway Malformation

Bronchopulmonary Sequestration

Lower Urinary Tract Obstruction

Clinical Assessment

Treatment

Amniotic Band Syndrome

Clinical Assessment

Clinical Presentation

Treatment

Spina Bifida Repair

Postnatal Treatment of OSB

Rationale for Prenatal Treatment

Prenatal Repair of OSB

Fetoscopic Techniques

Part VI Maternal Diseases Complicating Pregnancy

25. Critical Care Obstetrics

Introduction

Initial General Management of Shock in Pregnancy

Screening

Nonpharmacologic Treatment

Hemorrhagic (Hypovolemic) Shock

Management of Hemorrhagic Shock in Pregnancy

Nonpharmacologic and Pharmacologic Treatments

Distributive Shock

Anaphylactic Shock

Septic Shock

Cardiogenic Shock

Clinical Presentation

Management of Cardiogenic Shock in Pregnancy

Nonpharmacologic and Pharmacologic Treatment

Acute Respiratory Distress Syndrome

Trauma

Management of Trauma in Pregnancy

Cardiopulmonary Resuscitation

Electronic Fetal Heart Rate Monitoring During Maternal Resuscitation

26. Anesthesia in the Normal and High-Risk Patient

Introduction

Anesthesia for Labor and Delivery in a Patient With a Routine Pregnancy

Anesthesia for Labor and Delivery in a Patient With a High-Risk Pregnancy

General Principles

Obesity

Cardiac Disease

Preeclampsia

Neurologic Disease

Substance Abuse

27. Hypertensive Diseases in Pregnancy

Introduction

Clinical Presentation

Classification of Hypertensive Disorders in Pregnancy

Preeclampsia

Clinical Assessment

Etiology

Eclampsia

Clinical Presentation

Etiology

Clinical Assessment

HELLP Syndrome

Clinical Presentation

Clinical Assessment

Chronic Hypertension

Screening

Clinical Presentation

Etiology

CHTN With Superimposed Preeclampsia

Clinical Presentation

Gestational Hypertension

Clinical Presentation

Management of Hypertension in Pregnancy

Antepartum Management

Intrapartum Management

Condition-Specific Management

Pharmacologic Treatment

Antiseizure Medications in Preeclampsia

Antihypertensive Therapy

Alpha- and Beta-Blocking Agents

Calcium Channel Blockers

Hydralazine

Sodium Nitroprusside

Diuretics

Angiotensin-Converting Enzyme Inhibitors

Aspirin

28. Cardiac Diseases in Pregnancy

Introduction

Clinical Assessment of the Cardiac Patient During Pregnancy

Specific Maternal Cardiac Diseases Affecting Pregnancy

Arrhythmias

Congenital Cardiac Diseases

Acquired Valvular Disease

Peripartum Cardiomyopathy

Hypertrophic Cardiomyopathy

Marfan Syndrome

Vascular Ehlers-Danlos Syndrome

Pregnancy-Associated MI

Use of Anticoagulation Therapy in Pregnancy

29. Maternal Pulmonary Disorders Complicating Pregnancy

Introduction

Clinical Assessment of the Pregnant Pulmonary Patient

Screening

Effects of Pulmonary Disorders on Pregnancy

Asthma

Aspiration in Pregnancy

Infectious Pulmonary Diseases in Pregnancy

Amniotic Fluid Embolus Syndrome

Pulmonary Hypertension

Respiratory Failure in Pregnancy

30. Diabetes Mellitus in Pregnancy

Introduction

CLINICAL PRESENTATION

Etiology

Metabolic Changes in Diabetic Pregnancies

Maternal Complications

GESTATIONAL DIABETES MELLITUS

Screening and Clinical Assessment

Long-Term Maternal and Fetal Outcomes

PREEXISTING DIABETES MELLITUS IN PREGNANCY

Screening and Clinical Assessment

Short- and Long-Term Fetal Outcomes

Prevention of Fetal Anomalies

MANAGEMENT OF DIABETES DURING PREGNANCY

Nonpharmacologic Management

Pharmacologic Management

ANTEPARTUM ASSESSMENT

Maternal Assessment

Fetal Surveillance

TIMING AND MODE OF DELIVERY

Preterm Labor

Management During Labor and Delivery

31. Endocrine Disorders in Pregnancy

Introduction

Endocrine Changes Associated With a Normal Pregnancy

Pituitary

Cortisol Physiology in Pregnancy

Salt and Water Metabolism

Calcium Metabolism

Thyroid

Placental/Fetal Hormones Affecting the Maternal Endocrine System

Human Chorionic Gonadotropin

Thyrotropin-Releasing Hormone

Human Placental Lactogen (Human Chorionic Somatomammotropin)

Placental Growth Hormone

Insulin-Like Growth Factor

Endocrine Disorders of Pregnancy

Thyroid Disorders

Pituitary Disorders

Adrenal Gland Disorders

Disorders of Calcium Metabolism

Summary

32. Obesity in Pregnancy

Introduction

Definition

Epidemiology

Pathogenesis

Clinical Presentation

Antepartum

Maternal Complications

Fetal Assessment

Management of Labor and Delivery

Timing of Delivery

Intrapartum

Cesarean Delivery Technique

Postpartum

Preconception and Pregnancy Interval Counseling

33. Gastrointestinal Diseases Complicating Pregnancy

Introduction

GI Alterations During Normal Pregnancy

Differential Diagnosis of Abdominal Pain During Pregnancy

Nonobstetric Causes of Abdominal Pain

Clinical Presentation and Etiology

Clinical Assessment

Acute, Life-Threatening Conditions

Bowel Obstruction

Perforated Peptic Ulcers

Ruptured Aneurysm

Nausea, Vomiting, and Hyperemesis Gravidarum

Clinical Presentation

Clinical Assessment

Etiology

Management of Nausea, Vomiting, and HG in Pregnancy

Diffuse Abdominal Pain

Colonic Pseudoobstruction (Ogilvie Syndrome)

Hemoperitoneum

Hereditary Angioedema

Substance Abuse

Vasoocclusive Crises

Right Upper Quadrant Pain

Gallbladder Disease

Hepatitis

Left Upper Quadrant Pain

Spleen

Upper Abdominal Pain

Acute Pancreatitis

Hiatal Hernias

Pneumonia

Epigastric Pain

Lower Abdominal Pain

Oral Cavity Complications of Pregnancy

Clinical Presentation

Dental Caries

Pregnancy Gingivitis

Granuloma Gravidarum

Sialorrhea Gravidarum

Management of Oral Cavity Complications in Pregnancy

GI Reflux

Clinical Presentation

Management of GERD in Pregnancy

Peptic Ulcer Disease

Clinical Presentation

Clinical Assessment

Pharmacologic Treatment

Nonpharmacologic Treatment: GI Endoscopy During Pregnancy

Acute Appendicitis

Clinical Presentation

Clinical Assessment

Nonpharmacologic Treatment

Acute Intestinal Obstruction

Clinical Presentation

Clinical Assessment

Nonpharmacologic Treatment

Inflammatory Bowel Disease

Clinical Presentation

Clinical Assessment

Management of IBD in Pregnancy

Irritable Bowel Syndrome

Clinical Presentation

Clinical Assessment

Pharmacologic and Nonpharmacologic Treatment

Celiac Disease

Clinical Presentation and Etiology

Clinical Assessment

Management of CD in Pregnancy

Constipation

Clinical Assessment

Nonpharmacologic Treatment

Diarrhea

Clinical Presentation and Assessment

Hemorrhoids

Clinical Presentation

Pharmacologic and Nonpharmacologic Treatment

Complications After Surgery for Morbid Obesity

Clinical Presentation

Management of Complications Post–Bariatric Surgery in Pregnancy

Total Parenteral Nutrition in Pregnancy

Summary and Recommendations

34. Liver Disease in Pregnancy

Introduction

Physiological Changes in Liver in Normal Pregnancy

Liver Diseases Unique to Pregnancy

Hyperemesis Gravidarum

Intrahepatic Cholestasis of Pregnancy

Liver Involvement in Hypertensive Disorders of Pregnancy

Preeclampsia

HELLP Syndrome

Hepatic Infarction, Hematoma, and Rupture

Acute Fatty Liver of Pregnancy

Liver Disease Concurrent to Pregnancy

Biliary Disease

Viral Hepatitis in Pregnancy

Autoimmune Hepatitis

Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis

Budd-Chiari Syndrome

Cirrhosis With PH

Liver Transplantation

35. Pregnancy Complicated by Renal Disorders

Introduction

Renal Physiology in Pregnancy

Clinical Assessment of Renal Function in Pregnancy

Chronic Kidney Disease and Pregnancy

Impact of CKD on pregnancy outcomes

Impact of pregnancy on CKD

Pregnancy in End-Stage Renal Disease

Principles of Management of Pregnancy Complicated by CKD

Acute Kidney Injury

Common Causes of AKI During Pregnancy

Urinary Tract Infections

Conclusions

36. Neurological Disorders in Pregnancy

Introduction

Stroke

Etiology and Risk Factors for Pregnancy-Related Stroke

Management of Ischemic Stroke in Pregnancy and Postpartum

Prevention of Ischemic Stroke in Pregnancy

Cerebral Hemorrhage in Pregnancy

Etiology and Risk Factors for Intracerebral Hemorrhage in Pregnancy

Clinical Presentation of ICH in Pregnancy

Clinical Assessment and Management of ICH in Pregnancy

Prevention of ICH in Pregnancy

Subarachnoid Hemorrhage in Pregnancy

Clinical Presentation of SAH in Pregnancy

Pharmacologic Management of SAH in Pregnancy

Cerebrovascular Conditions Associated With Hemorrhage in Pregnancy

Reversible Cerebral Vasoconstriction Syndrome

Posterior Reversible Encephalopathy Syndrome

Cerebral Vein Thrombosis

Eclampsia

Pituitary Apoplexy

Headache Syndromes in Pregnancy

Tension Headaches

Migraine Headaches

Idiopathic Intracranial Hypertension

Neuromuscular Disorders in Pregnancy

Bell Palsy

Carpal Tunnel Syndrome

Acute Inflammatory Demyelinating Polyneuropathy

Myasthenia Gravis

Other Neuromuscular Disorders

Epilepsy

Etiology and Risk Factors of Epilepsy

Clinical Management of Epilepsy in Pregnancy

Long-Term Outcomes of Epilepsy in Pregnancy

Movement Disorders in Pregnancy

Chorea Gravidarum

Restless Leg Syndrome

Parkinson Disease

Management of PD in Pregnancy

Tremor

Neuroradiology Considerations

37. Thromboembolic Disorders of Pregnancy

Introduction

Pregnancy and the Hemostatic System: Clot Formation, Thrombin Regulation, and Fibrinolysis

Clinical Presentation

Clinical Risk Factors for VTE in Pregnancy

Hemostatic Changes in Pregnancy

Acquired Thrombophilia

Inherited Thrombophilias

Screening

Clinical Assessment

Diagnosis of Venous Thromboembolism

Diagnosis of Acute Pulmonary Embolus

Radiation Exposure in Diagnosis of Thromboembolic Disorders of Pregnancy

Pharmacologic Treatment

Anticoagulation Therapy

Management of Venous Thromboembolism in Pregnancy

Special Considerations

Postpartum Management

Summary

38. Hematological Disorders of Pregnancy

Introduction

Anemia

Etiology

Incidence and Risk Factors

Effects of Anemia on Pregnancy

Clinical Assessment of Anemia in Pregnancy

Microcytic Anemias

Hemoglobin C and E

Normocytic Anemias

Macrocytic Anemias

Coagulation Disorders in Pregnancy

Pregnancy Changes in Coagulation Factors

Laboratory Workup of Coagulation

Thrombocytopenia

Other Platelet Disorders

Thrombophilias in Pregnancy (See Comprehensive Discussion in Chapter 40)

39. Maternal Infections, Sexually Transmitted Infections, and Human Immunodeficiency Virus Infection in Pregnancy

Introduction

Pathophysiology of Infection

Immunization of Adult Women

Maternal Infections

Urinary Tract Infections

Respiratory Tract Infections

Listeria

Hepatitis E Virus

Tick-Borne Illnesses

STIs in Pregnancy

Epidemiology and Risk Factors

Syphilis

Chlamydia

Gonorrhea

Trichomoniasis

Herpes Simplex Virus

HIV in Pregnancy

Etiology and Risk Factors

Clinical Assessment in Pregnancy

Clinical Management in Pregnancy

Prevention of Infection

Prevention of Transmission

Summary

40. Rheumatologic and Connective Tissue Disorders in Pregnancy

Introduction

Systemic Lupus Erythematosus

Assessment of SLE in Pregnancy

Effects of Pregnancy on SLE

Effects of SLE on Pregnancy

Antiphospholipid Syndrome

Neonatal Lupus Syndrome

Clinical Management of SLE in Pregnancy

Pharmacologic Management

Scleroderma

Rheumatoid Arthritis

Assessment of RA in Pregnancy

Pharmacologic Management of RA During Pregnancy

Ankylosing Spondylitis

Laboratory Evaluation of AS

Effect of AS on Pregnancy

Management of AS During Pregnancy

Sjögren Syndrome

41. Dermatologic Disorders During Pregnancy

Introduction

Physiologic Cutaneous Changes During Pregnancy

Pigmentary Changes

Connective Tissue Changes

Adnexal Changes

Vascular Changes

Specific Dermatoses of Pregnancy

Polymorphic Eruption of Pregnancy

Atopic Eruption of Pregnancy

Pemphigoid Gestationis

Intrahepatic Cholestasis of Pregnancy

Summary

42. Cancer and Other Neoplasms in Pregnancy

Introduction

Benign Masses in Pregnancy

Uterine Myomas

Clinical Presentation

Adnexal Masses in Pregnancy

Cancers in Pregnancy

Incidence

Screening

Management of Cancer in Pregnancy

Nonpharmacologic Treatment

Pharmacologic Treatment

Cervical Cancer

Microinvasive Cancer of the Cervix

Breast Cancer

Ovarian Cancer

Sex Cord-Stromal Tumors

Hodgkin Disease

Non-Hodgkin Lymphoma

Acute Leukemia

Chronic Myelocytic Leukemia

Melanoma

Gastrointestinal Cancer

Gynecologic Malignancies

Endocrine Tumors

Urinary Tract Malignancies

Central Nervous System Tumors

43. Psychiatric Problems During and After Pregnancy

Introduction

Changes in Approaches to Maternal Mental Illness

The Risks of Psychiatric Illness for the Mother and Fetus

Design Challenges in Research on Maternal Mental Illness

Future Challenges

Psychiatric Illness in the Perinatal Period

Mood Disorders

Anxiety Disorders

Chronic Psychotic Disorders

Eating Disorders

Psychiatric Emergencies

Acute Psychosis and Mania During Pregnancy

Postpartum Psychosis

Delirium

Suicidality

Homicidality

Part VII Obstetric and Peripartal Events

44. Normal and Abnormal Labor

Introduction

Normal Cervical Dilation

Latent Phase

Active Phase

Normal Fetal Descent

Uterine Activity in Labor

Abnormal Labor

Latent Phase Dysfunction

Active Phase Dysfunction

The Second Stage of Labor

Cephalopelvimetry

Duration

Summary

45. Operative Vaginal Delivery

Introduction

History

Training

Case Selection and Choice of Instrument

Technique

Forceps

Vacuum Extraction (VE)

Episiotomy

Maternal and Perinatal Outcomes After Operative Vaginal Delivery

Maternal Morbidity

Neonatal Morbidity

Operative Vaginal Delivery Versus Cesarean Delivery

Summary

46. Fetal Malpresentation

Introduction

Terminology and Etiology

SINGLETON PREGNANCY MALPRESENTATIONS

Breech Presentation

External Cephalic Version

Candidate Selection and Preparation for ECV

Performing ECV

Complementary and Alternative Methods of Cephalic Version

Breech Vaginal Delivery

Candidate Selection and Preparation for Breech Vaginal Delivery

Performing Breech Vaginal Delivery

Clinician Training in Vaginal Breech Delivery

Shoulder Presentation

Face, Brow, and Compound Presentations

Face Presentation

Brow Presentation

Compound Presentation

MULTIFETAL PREGNANCIES

Cephalic/Cephalic Twins

Cephalic/Noncephalic Twins

Breech/Any Position Twins

Triplets

47. Placental Abruption

Introduction

Definition

Clinical Significance

Incidence

Risk Factors

Pathophysiology

Clinical Presentation

Clinical Assessment

Ultrasound in the Diagnosis of Abruption

The Kleihauer-Betke Test

Complications of Placental Abruption

Fetal Complications

Neonatal Complications

Maternal Complications

Management of Placental Abruption in Pregnancy

Timing of Delivery in Cases Managed Expectantly

Tocolysis in the Setting of Abruption

Abruption Found Incidentally on Ultrasound

Management of Placental Abruption in Subsequent Pregnancies

Summary

48. Cervical Insufficiency

Introduction

Etiology

Epidemiology

Pathogenesis

Risk Factors (Table 48.1)

Clinical Assessment

History-Defined Cervical Insufficiency

Ultrasound-Defined Cervical Insufficiency

Physical Examination–Defined Cervical Insufficiency

Adjunctive Measures for Diagnosis

Treatment

History-Indicated Cerclage

Ultrasound-Indicated Cerclage

Physical Examination–Indicated Cerclage

Management

Cerclage Contraindications

Limits of Gestational Age for Cerclage

Pericerclage Procedures

Postcerclage Follow-up

Cerclage Complications

Removal of Cerclage

Cerclage Techniques

Summary

49. Spontaneous Preterm Labor and Delivery

Introduction

Definitions

Epidemiology

CLINICAL PRESENTATION

Risk Factors for PTB

Underlying Mechanisms of Preterm Parturition Syndrome

PERINATAL MORTALITY AND MORBIDITY

Perinatal Mortality

Perinatal Morbidity

Long-Term Consequences of Preterm Delivery

DIAGNOSIS OF PTL

Sonographic Measurement of Cervical Length

Fetal Fibronectin Assessment

Determining the Etiology of Suspected PTL

MANAGEMENT OF PTL

Corticosteroid Administration

Magnesium Sulfate Administration

Tocolytic Therapy

Antibiotics

Treatment Following Arrest of PTL

Intrapartum Management of Preterm Delivery

Management Decisions at the Lower End of Viability

PREVENTION OF SPONTANEOUS PTB

Nonmedically Indicated Late-Preterm/Early-Term Birth

Cerclage Placement

Use of Fertility Treatments

Progesterone Supplementation

Pessary Placement

Clinical Care Implications

LONG-TERM MATERNAL CONSEQUENCES OF PTB

50. Prelabor Rupture of Membranes

Definitions

Frequency, Timing, and Site of Membrane Rupture

Frequency

Timing: When Do Membranes Normally Rupture?

Site of Membrane Rupture

Fetal Membranes and Biophysical/Biochemical Changes That Lead to PROM

Changes in Fetal Membranes During Spontaneous Rupture

Risk Factors for PROM

Previous Preterm PROM

Vaginal Bleeding

Smoking

Ethnicity

Sexual Intercourse

Vitamin C and Trace Elements

Elevated Maternal Serum Alpha-Fetoprotein Concentration

Previous Operations on the Genital Tract

Pelvic Examinations and PROM

Colonization and Infection of the Lower Genital Tract With Selective Microorganisms

Genetic Factors

Illicit Drug Use

Low Body Mass Index

Social Determinants of Health

Biophysical and Biochemical Properties of Membranes That Rupture Prematurely

Biophysical Properties

Biochemical Studies

Rupture of Membranes as an Obstetrical Syndrome

Mechanisms of Disease Implicated in Preterm PROM

Clinical Consequences of Preterm PROM

Preterm Labor and Delivery

Infection

Abruptio Placentae

Pulmonary Hypoplasia

Fetal Compression Syndrome

Fetal Growth Restriction

Fetal Death

Maternal Death

Diagnosis of PROM

Presenting Symptoms

Vaginal Examination

Initial Assessment of Patients Presenting With Preterm PROM

Ultrasound in the Evaluation of Patients With Preterm PROM

Diagnosis of Intrauterine Infection in Preterm PROM

Assessment of Fetal Well-Being

Management of Patients With Preterm PROM

Does a Digital Examination Increase the Risk of Infection?

Preterm PROM in Maternal Genital Herpes Simplex Virus Infection

Preterm PROM in Maternal HIV Infection

Previable PROM (<24 Weeks of Gestation)

Midtrimester ROM After Amniocentesis

Preterm PROM

Term PROM

Novel Treatment Techniques

Amniopatch

Fibrin Tissue Sealant

Absorbable Gelatin Sponge

Immunological Supplements

Physical Barrier to Stop Leakage

Acknowledgment

51. Prolonged Pregnancy

Introduction

Definitions

Incidence

Etiology

Risk Factors

Maternal Risks

Fetal and Neonatal Risks

Fetal Macrosomia

Management

Pregnancy Dating

Induction Versus Expectant Management

Induction of Labor

Summary

Part VIII Postpartum and Beyond

52. Puerperium and Lactation: Physiology of the Reproductive System

Introduction

Reproductive System

Cervix and Vagina

Hormonal Regulation

Urinary System

Lactation

Mammary Development

Onset of Milk Production and Early Lactation Failure

Regulation of Milk Volume

Weaning and Involution of the Mammary Gland

Composition of Human Milk

Maternal Diet and Milk Composition

Contaminants in Human Milk

Exercise and Calorie Restriction Diets During Lactation

Prenatal and Perinatal Practices and Conditions That Affect Breastfeeding

Maternal Health Problems

Lactation Support Strategies for Mother and Infant

Intrapartum Influences

Labor Induction and Delivery Method

Maternal-Infant Contact

Common Problems in Postpartum Care

Mastitis

Low Milk Production

Contraception

53. The Fourth Trimester

Introduction

Redefining the Fourth Trimester

Postpartum Care Planning

Common Postpartum Symptomatology

Shivering

Lochia

Hormonal Changes

Hair, Skin, and Muscle Changes

Pain and Discomfort

Breast Engorgement

Breastfeeding

Contraception

Common Postpartum Complications

Mastitis

Prolonged Bleeding/Retained Products

Wound Complications and Infections

Anxiety, Depression, and Mental Health Disorders

Urinary Retention and Incontinence

Dyspareunia/Sexual Dysfunction

Timing of Postpartum Visits

Health Disparities and Policy

54. Health Inequities in the Postpartum Period/Pregnancy Interval Care

Introduction

Racism

Common Barriers to Care

Healthcare Insurance Coverage

Socioeconomic Status and Postpartum Care

HIV Status

Immigrant Status

Intimate Partner Violence

Health Behaviors

Postpartum Care

Tobacco Use

Breastfeeding

Postpartum Health Screening

Opportunities to Reduce Disparities

WIC Program

Breastfeeding Support

Screening for Diabetes Postpartum

Contraception

Use of Technology in the Postpartum Period

Doula, Community Health Worker, and Patient Navigator Support Programs

Index

 

An aparitie	25 Jun. 2021
Autor	E. Albert Reece MD, PhD, MBA, Dr. Gustavo F. Leguizamón, George A. Macones, Arnon Wiznitzer
Dimensiuni	17.78 x 25.4 cm
Editura	LWW
Format	Hardcover
ISBN	9781975141462
Limba	Engleza
Nr pag	680
Versiune digitala	DA