Gabbe's Obstetrics: Normal and Problem Pregnancies

✍ Scribed by Mark B. Landon, Henry L. Galan, Eric R. M. Jauniaux, Deborah A. Driscoll, Vincenzo Berghella, William A. Grobman, Sarah J. Kilpatrick, Alison G. Cahill

• Publisher: Saunders, Elsevier
• Year: 2020
• Tongue: English
• Leaves: 1469
• Edition: 8
• Category: Library

✦ Synopsis

Highly readable, well-illustrated, and easy to understand, Gabbe’s Obstetrics: Normal and Problem Pregnancies is an ideal day-to-day reference or study tool for residents and clinicians. This 8th Edition of this bestselling text offers fast access to evidence-based, comprehensive information, now fully revised with substantial content updates, new and improved illustrations, and a new, international editorial team that continues the tradition of excellence established by Dr. Steven Gabbe.
Puts the latest knowledge in this complex specialty at your fingertips, allowing you to quickly access the information you need to treat patients, participate knowledgably on rounds, and perform well on exams.
Contains at-a-glance features such as key points boxes, bolded text, chapter summaries and conclusions, key abbreviations boxes, and quick-reference tables, management and treatment algorithms, and bulleted lists throughout.
Features detailed illustrations from cover to cover—many new and improved—including more than 100 ultrasound images that provide an important resource for normal and abnormal fetal anatomy.
Covers key topics such as prevention of maternal mortality, diabetes in pregnancy, obesity in pregnancy, vaginal birth after cesarean section, and antepartum fetal evaluation.
Provides access to 11 videos that enhance learning in areas such as cesarean delivery and operative vaginal delivery.

✦ Table of Contents

Cover image
Title Page
Obstetrics: Normal and Problem Pregnancies
Copyright Page
Contributors
Preface
Table Of Contents
Video Contents
1 Placental Anatomy and Physiology
Abstract
Key Words
Outline
Placental Anatomy
Overview of the Delivered Placenta
Placental Development
Amnion and Yolk Sac
Maternal-Fetal Relationship During the First Trimester
Extravillous Trophoblast Invasion and Physiologic Conversion of the Spiral Arteries
Role of the Endometrium During the First Trimester
Topology of the Villous Trees
Placental Histology
Integrity of the Villous Membrane
Placental Vasculature
Placental Physiology
Physiology of the Secondary Yolk Sac and Exocoelomic Cavity
Placental Metabolism and Growth
Placental Transport
Bulk Flow/Solvent Drag
Diffusion
Transporter Protein–Mediated Processes
Endocytosis/Exocytosis
A Selective Barrier
Substance-Specific Placental Transport
Respiratory Gases
Glucose
Amino Acids
Lipids
Water and Ions
Calcium
Placental Nutrient Supply and Intrauterine Growth Restriction
Vasomotor Control of the Umbilicoplacental Circulation
Placental Endocrinology
Progesterone
Estrogens
Human Chorionic Gonadotropin
Placental Lactogen
Placental Growth Hormone Variant
Leptin
Pregnancy-Associated Plasma Protein A
Sex Differences in Placental Function
Summary
Key Points
Acknowledgment
References
2 Fetal Development, Physiology, and Effects on Long-Term Health
Abstract
Key Words
Outline
Fetal Metabolism and Growth
Substrates
Hormones
Fetal Growth Hormone
Fetal Cardiovascular System
Development
Fetal Heart
Regulation of Cardiovascular Function
Autonomic Regulation
Fetal Hemoglobin
Amniotic Fluid Volume
Hormonal Regulation of Amniotic Fluid
Arginine Vasopressin
Renin-Angiotensin II
Fetal Kidney
Fetal Gastrointestinal System
Gastrointestinal Tract
Liver
Fetal Adrenal and Thyroid Glands
Adrenal Glands
Thyroid Gland
Fetal Central Nervous System
Fetal Programming of Adult Health and Disease
Epigenetics and Programming
DNA Methylation
Histone Modification
Noncoding RNAs
Fetal Nutrition and Growth: Effects on Programming
Programming by Environmental Agents
Organ-Specific Programming
Hepatic Programming
Pancreatic Programming
Cardiac Programming
Osteoporosis Programming
Brain Programming
Renal Programming
Immune Function
Endocrine Programming
Sexuality Programming
Mechanisms of Programmed Obesity: Appetite and Adiposity
Maternal Stress, Anxiety, and Programming
Glucocorticoids, Prematurity, and Programming
Summary
Key Points
References
3 Maternal Physiology
Abstract
Key Words
Outline
Gestational Weight Gain
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
Cardiac Rhythm
Hematologic Changes
Plasma Volume and Red Cell Mass
Iron Metabolism
Platelets
Leukocytes
Coagulation System
Respiratory System
Upper Respiratory Tract
Mechanical Changes
Lung Volume and Pulmonary Function
Gas Exchange
Sleep
Urinary System
Anatomic Changes
Renal Hemodynamics
Renal Tubular Function and Excretion of Nutrients
Body Water Metabolism
Osmoregulation
Salt Metabolism
Renin-Angiotensin-Aldosterone System
Atrial and Brain Natriuretic Peptide
Clinical Implications of Pregnancy-Related Renal and Urologic Changes
Alimentary Tract
Appetite
Mouth
Stomach
Intestines
Gallbladder
Liver
Nausea and Vomiting of Pregnancy
Endocrine Changes
Thyroid
Adrenals
Pituitary
Pancreas and Fuel Metabolism
Glucose
Proteins and Lipids
Skeleton
Calcium Metabolism
Skeletal and Postural Changes
Skin
Central Nervous System
Eyes
Breasts
Lower Reproductive Tract
Vagina
Cervix
Microbiome
Vaginal Microbiome
Gut Microbiome
Placental and Amniotic Fluid Microbiome
Summary
Key Points
References
Bibliography
Gestational Weight Gain
Cardiovascular Changes
Arterial Blood Pressure and Systemic Vascular Resistance
Labor Effects on the Cardiovascular System
Cardiac Rhythm
Hematologic Changes
Iron Metabolism
Coagulation System
Respiratory System
Sleep
Urinary System
Osmoregulation
Renin-Angiotensin-Aldosterone System
Clinical Implications of Pregnancy-Related Renal and Urologic Changes
Appetite and Mouth
Stomach
Intestines
Gallbladder
Liver
Thyroid
Adrenals
Pituitary
Pancreas and Fuel Metabolism
Skeleton: Calcium Metabolism
Skeleton: Postural Changes
Skin
Central Nervous System
Eyes
Breasts
Lower Reproductive Tract: Vagina
Lower Reproductive Tract: Cervix
Lower Reproductive Tract: Microbiome
4 Maternal-Fetal Immunology
Abstract
Key Words
Outline
Immune System Overview: Innate and Adaptive Immunity
Innate Immunity: First Line of Host Defense
Toll-like Receptors
Antimicrobial Peptides
Macrophages
Natural Killer Cells
Complement System
Cytokines
Chemokines
Adaptive Immunity
Major Histocompatibility Complex
Humoral Immune Responses: B Cells and Antibodies
Regulatory B Cells
Antibody Isotypes
T Cells
Regulatory T Cells
Helper T Cell Subsets
Fetal Immune System
Cord Blood Transplantation
Maternal Tolerance of the Fetus
Tolerance Through Regulation of Maternal T Cells
Tolerance Through Regulation of Maternal B Cells
Tolerance Through Dendritic Cells and Antigen Presentation
Tolerance Through Human Leukocyte Antigens
Tolerance Through Regulation of Complement, Chemokines and Cytokines
Fetal Rejection During Pregnancy
Immune Response to Perinatal Infections
Solid Organ Transplantation in Pregnancy
Amelioration of Rheumatoid Arthritis in Pregnancy
Summary
Key Points
Acknowledgments
References
Bibliography
Immune System Overview: Innate and Adaptive Immunity
Innate Immunity: First Line of Host Defense
Adaptive Immunity
Fetal Immune System
Maternal Tolerance of the Fetus
Immune Response to Perinatal Infections
Solid Organ Transplantation in Pregnancy
5 Preconception and Prenatal Care
Abstract
Key Words
Outline
Prenatal Care: Changing the Paradigm to Include the Life-Course Perspective
Definition and Goals of Care
Evidence and Rationale for Paradigm Shift
Components of Preconception Care and Well-Woman Visits
Reproductive Life Plan: Definition
Preconception Health Counseling
Maternal Age
Maternal Age Over 35 Years
Teen Pregnancies
Body Mass Index
Weight Gain
Overweight and Obesity
Underweight
Pregnancy After Bariatric Surgery
Infections and Immunizations
Genetic and Family History
Intimate Partner Violence
Substance Abuse and Other Hazards
Active and Passive Smoking
Alcohol
Other Substance Abuse
Mercury Exposure
Occupational Hazards and Environmental Exposures
Environmental Exposures.
Screening for Chronic Disease, Optimizing Care, and Managing Medication Exposure
Prenatal Care
Components of Prenatal Care
High-Tech Versus Low-Tech Care
Group Prenatal Care
Risk Assessment
Initial Prenatal Visit
Social and Demographic Risks
Medical Risk
Obstetric Risk
Physical and Laboratory Evaluation
Repeat Prenatal Visits
Intercurrent Problems
Common Patient-Centered Issues
Nutrition During Pregnancy
Activity and Employment
Travel
Nausea and Vomiting in Pregnancy
Heartburn
Backache
Sexual Activity
Prepared Parenthood and Support Groups
Prenatal Record
Prenatal Education
Postpartum Care
Components of the Postpartum Visit
Birth Spacing
Counseling Regarding Medical Conditions and Obstetric Complications
Coming Full Circle: Components of Interconception Care and Well-Woman Visits
Key Points
References
Bibliography
Prenatal Care: Changing the Paradigm to Include the Life-Course Perspective
Evidence and Rationale for Paradigm Shift
Advanced Maternal Age
Teen Pregnancy
Weight Gain
Pregnancy After Bariatric Surgery
Infections and Immunizations
Genetics and Family History
Intimate Partner Violence
Substance Abuse
Active and Passive Smoking
Alcohol
Mercury
Occupational Hazards and Environmental Exposures
Prenatal Care: Components of Prenatal Care
High-Tech Versus Low-Tech
Group Prenatal Care
Risk Assessment
Initial Prenatal Visit
Repeat Prenatal Visits
Common Patient-Centered Issues
The Prenatal Record
Prenatal Education
Postpartum Care: Components of Postpartum Visit
Birth Spacing
Counseling Regarding Medical Conditions and Obstetric Complications
Coming Full Circle: Components of Interconception Care and Well-Woman Visits
6 Nutrition During Pregnancy
Abstract
Key Words
Outline
Introduction
Integrating Nutrition Into the Obstetric History
Maternal Weight Gain Recommendations
Low or Underweight Preconception Body Mass Index
Overweight and Obese Prepregnancy Body Mass Index
Maternal Weight Gain Recommendations for Special Populations
Multiple Gestations
Adolescents
Other Groups
Maternal Nutrient Needs: Current Recommendations
Energy
Proteins
Omega-3 Fatty Acids
Vitamin and Mineral Supplementation Guidelines
Dietary Reference Intakes
Tolerable Upper Intake Level
Vitamins
Vitamin A
Vitamin D
Vitamin C
Vitamin B6
Vitamin K
Folate
Folate and Neural Tube Defects.
Folate Supplementation.
Minerals
Iron
Calcium
Zinc
Choline
Nutrition-Related Problems During Pregnancy
Nausea and Vomiting
Heartburn and Indigestion
Constipation
Food Contamination
Special Nutritional Considerations During Pregnancy
Caffeine
Vegetarian and Vegan Diets
Herbal Supplements
Key Points
References
7 Drugs and Environmental Agents in Pregnancy and Lactation
Outline
Overview
Basic Principles of Teratology
Genotype and Interaction With Environmental Factors
Timing of Exposure
Mechanisms of Teratogenesis
Manifestation
Agent
Dose Effect
Epidemiologic Studies Evaluating the Fetal Risk of Drugs and Environmental Agents
Case Reports
Descriptive Studies
Case-Control Studies
Cohort Studies
Randomized and Controlled Clinical Trials
Pharmacokinetics of Drugs Across the Placenta and Breast Tissues
Placental Transfer
Breast Milk Transfer
Prescription Drugs, Over-the-Counter Products, and Herbal Supplements
Effects of Specific Drugs in Pregnancy
Estrogens and Progestin
Androgenic Steroids
Spermicides
Antiepileptic Drugs
Isotretinoin
Vitamin A
Psychoactive Drugs
Tranquilizers.
Lithium (Eskalith, Lithobid, and Various Generic Formulations).
Antidepressants.
Anticoagulants
Thyroid and Thyroid-Blocking Drugs
Antihypertensive Drugs (See Also Chapter 31)
Sympathetic Blocking Agents.
Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers.
Antineoplastic and Immunosuppressant Drugs
Bronchodilators
Terbutaline (Brethine and Various Generic Formulations).
Cromolyn Sodium (Intal).
Isoproterenol (Isuprel) and Metaproterenol (Alupent).
Corticosteroids.
Iodide.
Antinausea and Motion Sickness Drugs
Doxylamine.
Meclizine (Bonine and Various Generic Formulations).
Dimenhydrinate (Dramamine).
Diphenhydramine (Benadryl).
Phenothiazines.
Metoclopramide.
Ondansetron (Zofran and Various Generic Formulations).
Methylprednisolone.
Ginger.
Acid-Suppressing Drugs
Antihistamines and Decongestants
Antibiotics and Antiinfective Agents
Penicillins.
Cephalosporins.
Sulfonamides.
Sulfamethoxazole With Trimethoprim (Bactrim, Septra, and Various Generic Formulations).
Nitrofurantoin (Macrodantin and Various Generic Formulations).
Tetracyclines.
Aminoglycosides.
Antituberculosis Drugs.
Erythromycin.
Clarithromycin.
Fluoroquinolones.
Metronidazole (Flagyl).
Newer Antibiotics.
Antiviral Agents
Lindane (Kwell).
Antiretroviral Agents
Antifungal Agents
Drugs for Induction of Ovulation
Analgesic Drugs
Aspirin.
Acetaminophen (Tylenol, Datril, and Various Generic Formulations).
Other Nonsteroidal Antiinflammatory Agents.
Codeine.
Sumatriptan.
Bisphosphonates.
Drugs of Abuse
Smoking and Nicotine Replacement Therapies
Alcohol
Marijuana
Cocaine
Opioids
Methamphetamine
Caffeine
Drugs in Breast Milk
Drugs Commonly Listed as Contraindicated During Breastfeeding
Cytotoxic Drugs That May Interfere With the 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 That Should Be Given to Nursing Mothers With Caution
Maternal Medications Usually Compatible With Breastfeeding
Narcotics, Sedatives, and Anticonvulsants
Cold Preparations
Antihypertensives
Anticoagulants
Corticosteroids
Antibiotic and Other Antiinfective Drugs
Antifungal Agents
Oral Contraceptives
Alcohol
Propylthiouracil
H2-Receptor Blockers
Caffeine
Smoking and Nicotine
Occupational and Environmental Hazards
Ionizing Radiation
Acute Exposure
Mutagenesis From Exposure
Video Display Terminals
Lead
Mercury in Fish
Obstetrician’s Role in Patient Assessment and Education
Key Points
References
Bibliography
Teratogenesis
Epidemiology
Pharmacokinetics
Hormones
Antiepileptic Drugs
Vitamin A Derivatives
Psychoactive Drugs
Anticoagulants
Thyroid and Antithyroid Drugs
Cardiac and Antihypertensive Medications
Bronchodilators
Antiemetics
Antihistamines and Decongestants
Antibiotics and Antiinfective Agents
Ovulation Induction Medications
Mild Analgesics
Drugs of Abuse
Caffeine
Drugs in Breast Milk
Radiation
Lead
Patient Education
8 Substance Use Disorder in Pregnancy
Abstract
Key Words
Outline
Epidemiology and Scope of the Problem
Addiction and the Chronic Disease Model
Neurobiology of Addiction
Screening, Brief Intervention, Referral to Treatment: SBIRT
Management of Pregnancies Affected by Substance Use Disorder
General Principles
Opioid Use Disorder: Heroin, Fentanyl, Oxycodone, Morphine
Pregnancy Risks
Treatment for Opioid Use Disorder
Pregnancy Management
Neonatal Abstinence Syndrome
Marijuana (Tetrahydrocannabinol [THC])
Pregnancy Risks
Treatment for Marijuana Use
Pregnancy Management
Lactation
Stimulants
Pregnancy Risks
Treatment for Pregnancies Complicated by Stimulant Use Disorder
Pregnancy Management
Lactation
Benzodiazepines
Pregnancy Risks
Treatment for Benzodiazepine Dependence
Pregnancy Management
Lactation
Key Points
References
References
9 Obstetric Ultrasound
Abstract
Key Words
Outline
Overview
Biophysics of Ultrasound
What Makes a Good Ultrasound Study?
Proper Gain and Focus
Optimal Magnification
Attenuation and Shadowing
Power Adjustment
Proper Orientation
Angle of Insonation
Special Ultrasound Modalities
M-Mode
Color and Pulse-Wave Doppler
Three-Dimensional Ultrasound
First-Trimester Ultrasound
First-Trimester Normal Findings
First-Trimester Abnormal Findings
Second- and Third-Trimester Ultrasound
Types of Examinations
Qualifications for Performing and Interpreting Diagnostic Ultrasound Examinations
Components of the Examination
Cardiac Activity
Number of Fetuses
Presentation
Amniotic Fluid Volume
Oligohydramnios
Polyhydramnios
Placenta and Umbilical Cord
Placenta Previa
Vasa Previa
Placenta Morphology
Umbilical Cord
Uterus
Cervix
Adnexae
Anatomic Survey
Documentation
Ultrasound Biometry
Standard Measurements
Gestational Age Determination
When to Use Ultrasound Dating
Using Ultrasound to Assess Fetal Growth
Estimating Fetal Weight
Diagnosing Abnormal Growth
Growth Restriction
Macrosomia
Safety of Ultrasound
Fetal Safety
Preventing Transmission of Infections
Ultrasound Diagnosis of Malformations
Accuracy of Ultrasound as a Screening Tool for Birth Defects
Screening for Aneuploidy
Screening for Anomalies With the Standard Ultrasound Examination
Head and Spine
General Appearance.
Cerebellum and Cisterna Magna.
Choroid Plexus.
Lateral Ventricles.
Brain Cysts.
Midline Falx.
Cystic Hygroma.
Cleft Lip and Palate.
Micrognathia.
Anencephaly and Encephalocele.
Spine
Chest
Diaphragmatic Hernia.
Lung Masses.
Heart and Outflow Tracts.
Abdomen
Abdominal Wall Defects.
Urinary Tract
Kidneys.
Bladder.
Skeletal
Hydrops
Fetal MRI to Supplement Ultrasound
Clinical Value of Prenatal Diagnosis of Birth Defects
Key Points
References
10 Genetic Screening and Diagnosis
Abstract
Key Words
Outline
Genetic History
Genetic Counseling
Chromosome Abnormalities
Autosomal Trisomy
Trisomy 21
Trisomy 13
Trisomy 18
Other Autosomal Trisomies
Autosomal Deletions and Duplications
Sex Chromosome Abnormalities
Monosomy X (45,X)
Klinefelter Syndrome
Polysomy X in Girls (47,XXX; 48,XXXX; 49,XXXX)
Polysomy Y in Boys (47,XYY and 48,XXYY)
Screening for Aneuploidy
Cell-Free DNA Analysis
First-Trimester Screening
Second-Trimester Serum Screening
First- and Second-Trimester Screening
Aneuploidy Screening in Multiple Gestation
Ultrasound Screening for Aneuploidy
Diagnostic Strategy for Detecting Chromosome Abnormalities
Indications for Prenatal Cytogenetic Testing
Previous Child With a Chromosome Abnormality.
Parental Chromosome Rearrangements.
Assisted Reproduction Through Intracytoplasmic Sperm Injection.
Cytogenetic/Cytogenomic Testing.
Chromosome Microarrays.
Fluorescence in Situ Hybridization.
Quantitative Fluorescent Polymerase Chain Reaction.
Accuracy of Prenatal Cytogenetic Diagnosis
Mosaicism.
Implications of de Novo Structural Abnormalities.
Single-Gene or Mendelian Disorders
Carrier Screening for Heritable Disorders
Ashkenazi Jewish Genetic Diseases
Hemoglobinopathies
Cystic Fibrosis
Spinal Muscular Atrophy
Fragile X Syndrome
Newborn Screening
Molecular Approach to Prenatal Diagnosis of Single-Gene Disorders
Whole Exome Sequencing
Mendelian Disorders Without Known Molecular Basis
Multifactorial and Polygenic Disorders
Screening for Neural Tube Defects
Obstetric Significance of Unexplained Elevated Maternal Serum Alpha-Fetoprotein
Indications for Prenatal Genetic Testing
Procedures for Prenatal Genetic Diagnosis
Amniocentesis
Amniocentesis in Twin Pregnancies
Safety of Amniocentesis
Chorionic Villus Sampling
Safety of Chorionic Villus Sampling
Chorionic Villus Sampling in Twin Pregnancies
Invasive Diagnostic Testing in Women With Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus
Fetal Blood Sampling
Preimplantation Genetic Testing
Obtaining Embryonic and Gamete DNA
Novel Indications Addressed Only by Preimplantation Genetic Testing
To Avoid Pregnancy Termination
Nondisclosure of Parental Genotype
Human Leukocyte Antigen–Compatible Embryos for Umbilical Cord Blood Stem Cell Transplantation
Preimplantation Genetic Testing for Chromosomal Indications
Methodology.
Numeric Chromosome Abnormalities.
Structural Chromosome Abnormalities.
Preimplantation Genetic Diagnosis for Single-Gene Disorders
Safety of Preimplantation Genetic Diagnosis
Intact Fetal Cells
Key Points
References
11 Normal Labor and Delivery
Abstract
Key Words
Outline
Overview
Labor: Definition and Physiology
Mechanics of Labor
Uterine Activity (Powers)
Fetus (Passenger)
Maternal Pelvis (Passage)
Cardinal Movements in Labor
Engagement
Descent
Flexion
Internal Rotation
Extension
External Rotation
Expulsion
Normal Progress of Labor
First Stage of Labor
Second Stage of Labor
Factors Affecting Normal Labor Progress
Interventions to Promote Labor Progress
Active Management of Labor
Spontaneous Vaginal Delivery
Third Stage of Labor
Episiotomy and Perineal Injury Repair
Ultrasound in Labor and Delivery
Key Points
References
References
12 Induction of Labor
Abstract
Key Words
Outline
Induction of Labor: Definition/Epidemiology
Indications/Contraindications
Hypertensive Disorders
Prolonged Pregnancy
Non–medically Indicated (Elective) Induction
Prediction of Labor Induction Success/Failure
Cervical Ripening and Induction Methods
Pharmacologic Methods of Cervical Ripening
Prostaglandins
Prostaglandin E2.
Prostaglandin E1.
Mechanical Methods of Cervical Ripening
Intracervical Balloon Catheter
Balloon Catheter Inflation Amounts.
Single Versus Double-Balloon Catheter.
Membrane Stripping
Oxytocin for Induction
Oxytocin Dosing Intervals and Protocols
Combination Methods for Induction/Cervical Ripening
Alternative Induction Methods
Amniotomy
Nipple Stimulation
Failed Induction of Labor
Other
Premature Rupture of Membranes
Midtrimester Induction
Outpatient Induction
Key Points
References
References
13 Operative Vaginal Delivery
Abstract
Key Words
Outline
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
Kielland Forceps
Forceps Rotation: Application for the Occiput Posterior Position
Vacuum Extraction
Benefits and Risks 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.
Vacuum Versus Forceps
Operative Vaginal Delivery Versus Second-Stage Cesarean Delivery
Complex Operative Vaginal Delivery Procedures
Rotations Greater Than 45 Degrees
Midpelvic Cavity Delivery
Sequential Use of Vacuum and Forceps
Vacuum Delivery and the Preterm Fetus
Counseling
Simulation Training for Operative Vaginal Delivery
Key Points
References
References
14 Shoulder Dystocia
Abstract
Key Words
Outline
Defining Shoulder Dystocia
Risk Factors and Associations
Prophylactic Cesarean Delivery
Maternal and Neonatal Complications of Shoulder Dystocia
Shoulder Dystocia Management
Simulation Training for Shoulder Dystocia
Mechanisms of Fetal Injury
Key Points
References
15 Intrapartum Fetal Evaluation
Abstract
Key Words
Outline
Background
Fetal Heart Rate Monitoring
Normal Physiologic Control of the Fetal Heart Rate
Intermittent Auscultation
Electronic Fetal Monitoring
Electronic Fetal Monitoring Technology
External Monitors
Internal Monitors
Nomenclature
Current Terminology
Terms No Longer Used
Uterine Activity
Other Nomenclature
Intermittent Monitoring
Electronic Fetal Monitoring Patterns Associated With Acidemia and Clinical Outcomes
Newer Considerations
Periodic Change
Clinical Factors Affecting Electronic Fetal Monitoring Patterns and Interpretation
Magnesium Sulfate
Meconium-Stained Amniotic Fluid
Small-for-Gestational-Age Infants
Additional Technologies
Fetal Blood Sampling
Fetal Pulse Oximetry
ST-Segment Analysis
Computerized Interpretation of Electronic Fetal Monitoring
Diagnosis and Interventions
Differential Diagnosis
Position Change
Maternal Oxygen Supplementation
Intravenous Fluids
Tocolysis
Amnioinfusion
Fetal Scalp Stimulation
Clinical Algorithms
Trial of Labor After Cesarean Considerations
Consideration for Fetal Abnormalities
Umbilical Cord Gas Analysis
Considerations for Electronic Fetal Monitoring: Review
Minimizing Errors
Summary
Key Points
References
16 Obstetric Anesthesia
Abstract
Key Words
Outline
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)
Fentanyl
Remifentanil
Sedatives
Inhaled Nitrous Oxide
Placental Transfer
Neuraxial Analgesic and Anesthetic Techniques
Lumbar Epidural Analgesia/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
Fever.
Paracervical Block
Anesthesia for Instrumented Vaginal Delivery or Perineal Repair
Local Anesthesia
Pudendal Nerve Block
Monitored Anesthesia Care Using Sedation
Spinal (Subarachnoid) Block
Anesthesia for Cesarean Delivery
Premedication
Aspiration and Aspiration Prophylaxis
Left Uterine Displacement
General Anesthesia
Preoxygenation
Induction
Intubation
Failed Intubation.
Intraoperative Anesthetic Agents
Nitrous Oxide and Oxygen.
Volatile Halogenated Agent.
After Delivery
Extubation
Neuraxial Anesthesia
Postoperative Care
Key Points
References
17 Malpresentations and Malposition
Abstract
Key Words
Outline
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
Term Breech Trial
Selection of Candidates for Vaginal Breech Delivery
Special Clinical Circumstances and Risks: Preterm Breech, Hyperextended Head, and Footling Breech
Breech Second Twin
External Cephalic Version
Abnormalities of Position; Occiput Posterior and Occiput Transverse
Diagnosis of Occiput Posterior
Prevention of Persistent Occiput Posterior
Key Points
References
References
18 Antepartum and Postpartum Hemorrhage
Abstract
Key Words
Outline
Pregnancy-Related Hemodynamic Changes
Maternal Adaptation to Hemorrhage
Classification of Hemorrhage
Antepartum Hemorrhage
Placental Abruption (Box 18.1)
Definition and Pathogenesis
Incidence
Clinical Manifestations
Risk Factors
Prior Abruption.
Increasing Parity and Maternal Age.
Maternal Substance Abuse.
Trauma.
Maternal Diseases.
Preterm Premature Rupture of Membranes and Chorioamnionitis.
Rapid Uterine Decompression Associated With Multiple Gestations and Polyhydramnios.
Uterine, Placental, and Fetal Factors.
Diagnosis
Radiology.
Laboratory Findings.
Pathologic Studies.
Management
Neonatal Outcome
Placenta Previa (Box 18.3)
Definition and Pathogenesis
Incidence
Clinical Manifestations
Risk Factors
Prior Placenta Previa.
Prior Cesarean Delivery And Uterine Surgery.
Intrinsic Maternal Factors.
Extrinsic Maternal Factors.
Fetal Factors.
Diagnosis
Radiology.
Management
Asymptomatic Placenta Previa.
Bleeding placenta previa.
Delivery.
Associated Conditions
Placenta Accreta Syndrome (Box 18.5)
Definition and Pathogenesis.
Incidence and Risk Factors.
Clinical Manifestations.
Diagnosis.
Radiographic Techniques.
Laboratory Findings.
Pathologic Studies.
Management.
Vasa Previa (Box 18.6)
Definition and Pathogenesis.
Incidence and Risk Factors.
Clinical Manifestations.
Diagnosis.
Management.
Postpartum Hemorrhage
Normal Blood Loss and Postpartum Hemorrhage
Postpartum Hemorrhage: Etiologies and Treatment
Uterine Atony (Box 18.8)
Definition and Pathogenesis.
Incidence and Risk Factors.
Clinical Manifestations and Diagnosis.
Prevention and Management.
Bimanual uterine massage.
Uterotonic therapy.
Tranexamic acid.
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 (Box 18.10)
Definition and Pathogenesis.
Incidence and Risk Factors.
Clinical Manifestations and Diagnosis.
Management.
Uterine Inversion (Box 18.11)
Definition and Pathogenesis.
Incidence and Risk Factors.
Clinical Manifestations and Diagnosis.
Management.
Coagulopathy (Box 18.12)
Definition and Pathogenesis.
Incidence and Risk Factors.
Clinical Manifestations and Diagnosis.
Management.
Tranexamic acid.
Recombinant activated factor VII.
Fibrinogen concentrate.
Prothrombin complex 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.
Massive transfusion protocols.
Transfusion Risks and Reactions
Metabolic abnormalities and hypothermia.
Immunologic reactions.
Infection risks.
Transfusion-associated circulatory overload and transfusion-related acute lung injury.
Blood Conservation Approaches
Preoperative Autologous Blood Donation and Transfusion
Acute Normovolemic Hemodilution
Intraoperative Blood Salvage
Alternative Oxygen Carriers
Hemorrhage Prevention and Protocols
Key Points
References
19 Cesarean Delivery
Abstract
Key Words
Outline
Definitions
History of Cesarean Delivery
Incidence
Indications for Cesarean Delivery
Maternal-Fetal Indications
Fetal Indications
Maternal Indications
Cesarean Delivery on Maternal Request
Technique of Cesarean Delivery
Family-Friendly Cesarean Delivery
Precesarean Antibiotics
Precesarean Thromboprophylaxis
Steroids for Pulmonary Maturity
Other Prophylactic Precesarean Interventions
Site Preparation
Abdominal Skin Incision and Abdominal Entry
Bladder Flap
Uterine Incision
Delivery of the Fetus
Prevention of Postpartum Hemorrhage
Placental Delivery
Uterine Repair
Abdominal Closure
Immediate Postcesarean Care
Complications of Cesarean Delivery
Intraoperative Complications
Uterine Lacerations
Bladder Injury
Ureteral Injury
Gastrointestinal Tract Injury
Uterine Atony
Placenta Previa and Placenta Accreta
Maternal Mortality
Maternal Postoperative Morbidity
Infections
Endomyometritis
Wound Infection
Thromboembolic Disease
Septic Pelvic Thrombophlebitis
Tubal Sterilization
Modified Pomeroy
Salpingectomy
Parkland Procedure
Irving Procedure
Uchida Procedure
Key Points
References
References
20 Vaginal Birth After Cesarean Delivery
Abstract
Key Words
Outline
Vaginal Birth After Cesarean Delivery
Trends
Candidates for a Trial of Labor After Cesarean
Success Rates for a Trial of Labor After Cesarean
Maternal Demographics
Prior Indication for Cesarean Delivery
Prior Vaginal Delivery
Birthweight
Labor Status and Cervical Examinations
Previous or Unknown Incision Type
Multiple Prior Cesarean Deliveries
Postterm Pregnancy
Twin Gestation
Risks Associated With a Trial of Labor After Cesarean
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 a Trial of Labor After Cesarean Delivery
Management of a Trial of Labor After Cesarean
Counseling Women for a Trial of Labor After Cesarean
Cost-Effectiveness of a Trial of Labor After Cesarean
Key Points
References
21 Placenta Accreta Spectrum
Abstract
Key Words
Outline
Pathogenesis
Epidemiology
Placenta Previa Accreta
Other Risk Factors
Diagnosis
Ultrasound Imaging
Magnetic Resonance Imaging
Management
Surgical Management
Conservative Management
Additional Procedures
Reproductive Outcomes Following Placenta Accreta Spectrum
Summary
Key Points
References
22 Patient Safety and Quality Measurement in Obstetric Care
Abstract
Key Words
Outline
Patient Safety
Overview
Frequency of Preventable Obstetric Adverse Events
Factors That Contribute to Preventable Adverse Events
Approaches to Improve Obstetric Safety
Checklists and Protocols
Simulation
Shoulder Dystocia
Eclampsia
Other Obstetric Events
Enhancement of Communication
Multifaceted Approaches
Summary
Measurement of Obstetric Quality of Care
Overview
Quality Measures
Access Measures
Patient Experience
Data Sources
Quality Improvement
Key Points
References
23 The Neonate
Abstract
Key Words
Outline
Cardiopulmonary Transition
Pulmonary Development
First Breaths
Fetal Breathing
Mechanics of the First Breath
Circulatory Transition
Abnormalities of Cardiopulmonary Transition
Birth Asphyxia
Delivery Room Management of the Newborn
Cord Clamping
Sequelae of Birth Asphyxia
Birth Injuries
Neonatal Thermal Regulation
Physiology
Clinical Applications
Delivery Room
Nursery
Neonatal Nutrition and Gastroenterology
Infant Feeding
Neonatal Hypoglycemia
Congenital Gastrointestinal Surgical Conditions
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
Classification of Newborns by Growth and Gestational Age
Nursery Care
Care of the Parents
Kangaroo Care
Outcome of Neonatal Intensive Care and Threshold of Viability
Late Preterm Infant
Key Points
References
Bibliography
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
24 Postpartum Care and Long-Term Health Considerations
Abstract
Key Words
Outline
Overview
Postpartum Involution
Uterus
Cervix
Fallopian Tubes
Ovarian Function
Weight Loss
Thyroid Function
Cardiovascular System, Immunity, and Coagulation
Urinary Tract and Renal Function
Other Changes
Management of the Puerperium
Health Maintenance
Perineal and Pelvic Care
Delayed Postpartum Hemorrhage and Postpartum Anemia
Postpartum Infection
Maternal-Infant Attachment
Pregnancy Prevention and Birth Control
Long-Acting Reversible Contraception
Injectable Contraception
Combined Hormonal Contraception
Progestin-Only Oral Contraception
Emergency Contraception
Sterilization
Barrier Methods
Natural Family Planning Methods
Postpartum Psychologic Reactions
Managing Perinatal Grieving
Postpartum Posttraumatic Stress Disorder
Key Points
References
References
Bibliography
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
25 Lactation and Breastfeeding
Abstract
Key Words
Outline
Epidemiology
Breast Anatomy and Development
Physiology of Lactation
Stages of Lactogenesis
Endocrinology of Lactogenesis
Milk Transfer
Transfer of Medications and Drugs to the Breastfeeding Child
Breast Milk: the Gold Standard
Breastfeeding: Better Maternal and Child Outcomes
Role of the Obstetrician and Gynecologist
Focused Issues in the Successful Management of Breastfeeding
Anatomic Abnormalities of the Breast
Previous Breast Surgeries
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
Galactogogues: Drugs to Improve Milk Production
Maternal Disease
Breast Masses During Lactation
Back-to-Work Issues
Conclusions
Key Points
References
References
26 Pregnancy as a Window to Future Maternal and Child Health
Abstract
Key Words
Outline
Pregnancy as a Stress Test
Pregnancy-Related Conditions Associated With Later Chronic Disease
Infertility
Parity
Gestational Diabetes Mellitus
Hypertensive Disease of Pregnancy
Spontaneous Preterm Birth
Fetal Growth Restriction
Placental Abruption
Management in the Postpartum Period and Beyond
Lactation Support
Lifestyle Modification
Health Screening
Summary
Key Points
References
27 Antepartum Fetal Evaluation
Abstract
Key Words
Outline
Defining the Problem of Perinatal Mortality
Characteristics of Fetal Death
Causes of Fetal Death
Timing of Fetal Death
Identifying Those at Risk
Select Antenatal Conditions That May Contribute to Increased Risk of Fetal Death
Maternal Characteristics
Maternal Age
Maternal Race and Ethnicity
Socioeconomic Factors, Prenatal Care, and Substance Abuse
Maternal Comorbidities
Obesity
Diabetes Mellitus
Hypertensive Disorders
Thrombophilia
Intrahepatic Cholestasis
Renal Disease and Systemic Lupus Erythematosus
Obstetric Factors
Fertility History and Assisted Reproductive Technology
Multiple Gestations.
Early Pregnancy Markers
Amniotic Fluid Abnormalities
Fetal Growth Restriction
Postterm Pregnancy
Fetal Malformations and Aneuploidies
Conclusions
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 Pattern.
Bradycardia.
Tachycardia.
Arrhythmia.
Deceleration.
Predictive Value of the Nonstress Test
Fetal Biophysical Profile
Predictive Value of the Biophysical Profile
Modified Biophysical Profile
Doppler Ultrasound
Clinical Application of Tests of Fetal Well-Being
Evidence for Condition-Specific Testing
Assessment of Fetal Pulmonary Maturation
Tests of Fetal Pulmonary Maturity
Determination of Fetal Pulmonary Maturation in Clinical Practice
Summary
Key Points
References
Bibliography
28 Amniotic Fluid Disorders
Abstract
Key Words
Outline
Amniotic Fluid Volume
Ultrasound Assessment 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
Bibliography
Amniotic Fluid
Amniotic Fluid Volume Assessment
Oligohydramnios
Polyhydramnios
29 Late- and Postterm Pregnancy
Abstract
Outline
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
30 Fetal Growth Restriction
Abstract
Key Words
Outline
Regulation of Fetal Growth
Definition and Patterns of Fetal Growth Restriction
Etiologies of Intrauterine Growth Restriction
Maternal and Fetal Manifestations of Fetal Growth Restriction
Maternal Impacts
Fetal Impacts
Diagnostic Tools in Fetal Growth Restriction
Fetal Biometry
Reference Ranges That Define 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
Integrated Approach to Screening
Preventive Strategies
Management in Clinical Practice
Therapeutic Options
Assessment of Fetal Well-Being
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
Timing of Delivery
General Considerations
Between 24 and 30 Weeks’ Gestation
Between 30 and 34 Weeks’ Gestation
Between 34 and 37 Weeks’ Gestation
Beyond 37 Weeks’ Gestation
Delivery
Outcome
Short-Term Outcomes
Long-Term Outcomes
Key Points
References
Bibliography
31 Surgery During Pregnancy
Abstract
Key Words
Outline
Maternal Physiology
Diagnostic Imaging
Ionizing Radiation
Ultrasound
Magnetic Resonance Imaging
Contrast in Pregnancy
Anesthesia During Nonobstetric Surgery
Anesthesia and Pregnancy Physiology
Anesthesia and Teratogenicity
General Anesthesia and Neurodevelopmental Outcomes
Nonobstetric 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
Cardiac Surgery in Pregnancy
Neurosurgery in Pregnancy
Nephrolithiasis Management in Pregnancy
Key Points
References
References
32 Trauma and Related Surgery in Pregnancy
Abstract
Key Words
Outline
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 and Intimate Partner 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 Approach
Evaluation on Labor and Delivery
Fetal Monitoring
Laboratory Assessment
Diagnostic Imaging
Ultrasound
Ionizing Radiation
Magnetic Resonance Imaging
Contrast Agents
Suggested Guidelines for Radiologic Evaluation of Trauma
Exploratory Surgery for Traumatic Injuries During Pregnancy
Uterine Rupture
Implications of Cardiac Arrest and Perimortem Cesarean Section
Other Considerations
Medical and Legal Implications After Maternal Trauma
Long-Term Effects of Trauma
Prevention of Trauma
Screening and Identification of Women at Risk for Domestic Violence
Key Points
References
33 Pregnancy Loss
Abstract
Key Words
Outline
Frequency and Timing of Pregnancy Loss
Placental Anatomic Characteristics of Successful and Unsuccessful Pregnancies
Numerical Chromosomal Abnormalities
Types of Numerical Chromosomal Abnormalities
Autosomal Trisomy
Polyploidy
Sex Chromosomal Polysomy (X or Y)
Monosomy X
Relationship Between Recurrent Early Pregnancy Loss and Numerical Chromosomal Abnormalities
Expectation of Karyotype in Recurrent Early Pregnancy Loss
Genetic Counseling for Recurrent Aneuploidy
Clinical Management of Recurrent Aneuploidy
Chromosomal Rearrangements
Translocations
Inversions
Mendelian and Polygenic/Multifactorial Etiology
Luteal Phase Defects
Thyroid Function Abnormalities
Diabetes Mellitus
Intrauterine Adhesions (Synechiae)
Müllerian Fusion Defects
Leiomyomas
Infections
Thrombophilias
Acquired Thrombophilias
Inherited Thrombophilias
Other Causes of Early Pregnancy Losses
Cervical Insufficiency
Exogenous Agents
X-Irradiation and Chemotherapeutic Agents
Alcohol
Caffeine
Common Medications and Contraception
Chemicals
Cigarette Smoking
Hyperprolactinemia
Psychological Factors
Management of Recurrent Early Pregnancy Loss
When Is Formal Evaluation Necessary?
Recommended Evaluation
Treating Unexplained Recurrent Early Pregnancy Loss
Late Pregnancy Loss
Risk Factors
Recurrence
Genetic Factors
Polygenic/Multifactorial
Maternal Evaluation
Management in Subsequent Pregnancies
Obstetric Outcome After Early Pregnancy Complications
Key Points
References
References
34 Stillbirth
Key Words
Outline
Risk Factors
Classification of Stillbirth
Etiology
Infection
Maternal Medical Conditions
Hypertensive Disorders
Diabetes Mellitus
Thyroid Disease
Systemic Lupus Erythematosus
Intrahepatic Cholestasis of Pregnancy
Inherited and Acquired Thrombophilias
Fetal Conditions
Genetic Abnormalities
Fetal Structural Anomalies
Fetomaternal Hemorrhage
Fetal Growth Abnormalities
Placental Abnormalities
Umbilical Cord Abnormalities
Multifetal Gestation
Intrapartum Stillbirth
Evaluation of Stillbirth
Pathologic and Histologic
Genetic
Laboratory
Delivery of the Stillbirth
Bereavement and Psychosocial Issues
Management of Subsequent Pregnancy
Prevention
Key Points
References
35 Cervical Insufficiency
Abstract
Key Words
Outline
Cervical Insufficiency: a Distinct Entity or Evidence of Preterm Parturition?
Short Cervix
Risk Factors for Cervical Insufficiency
Tests for Cervical Insufficiency
Clinical Diagnosis of Cervical Insufficiency
Patient History
Sonographic Diagnosis of Cervical Insufficiency
Diagnosis of Cervical Insufficiency on Physical Examination
Treatment: Vaginal Cerclage
Vaginal Cerclage Technique
History-Indicated Cerclage
Transabdominal Cerclage in Case of Failed Vaginal Cerclage
Ultrasound-Indicated Cerclage
Physical Examination–Indicated Cerclage
Indications for Cerclage Removal
Cerclage and Preterm Labor
Cerclage and Preterm Membrane Rupture
Other Risks of Cerclage
Cerclage Effectiveness Based on Evidence
History-Indicated Cerclage
Ultrasound-Indicated Cerclage
Physical Examination–Indicated Cerclage
Cerclage in Multiple Gestations
Alternative Treatments to Cervical Cerclage
Activity Restriction
Pessary
Progesterone
Comparative Trials of Treatment of Cervical Insufficiency
The Case for Multiple Therapies for Cervical Insufficiency
Summary
Key Points
References
References
Bibliography
36 Preterm Labor and Birth
Abstract
Key Words
Outline
Definitions
Frequency of Preterm and Low-Birthweight 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
Maternal 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
Black Race.
Genetic Contributors to Preterm Birth
Pregnancy History
Current Pregnancy Risks
Bleeding and Vanishing Twins
Multifetal Gestation and Uterine Distension
Risk-Scoring Systems
Pathophysiology of Spontaneous Preterm Birth
Cervical Changes: Softening and 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 and Decidual Hemorrhage
Uterine Overdistension
Breakdown of Fetal-Maternal Tolerance
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
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
Sequelae of Antenatal Treatments to Reduce Fetal/Neonatal Morbidity
Respiratory Distress
Neurologic Morbidity
Treatment Protocol.
Tocolysis in Preterm Labor
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.
Cyclooxygenase Inhibitors.
Maternal effects.
Fetal and neonatal effects.
Treatment 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.
Atosiban and 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
Delayed Cord Clamping
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.
Progestogens.
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
Bibliography
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
Pregnancy History
Pregnancy Termination
Current Pregnancy Risks: Mode of Conception
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
Bacterial Vaginosis
Uteroplacental Ischemia/Decidual Hemorrhage
Uterine Overdistension
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
37 Premature Rupture of the Membranes
Abstract
Key Words
Outline
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 Newborn Risks
Diagnosis of Premature Rupture of the Membranes
Management of Premature Rupture of the Membranes
General Considerations (Fig. 37.1)
Management of Premature Rupture of the Membranes at Term
Management of Preterm Premature Rupture of the Membranes at 320/7 to 366/7 Weeks’ Gestation (Fig. 37.2)
Management of Preterm Premature Rupture of the Membranes at 230/7 to 316/7 Weeks’ Gestation (Fig. 37.3)
Corticosteroid Administration
Antibiotic Administration
Magnesium Sulfate for Neuroprotection
Tocolysis
Special Circumstances Impacting the Management of Preterm Premature Rupture of the Membranes
Cervical Cerclage
Herpes Simplex Virus
Management of Previable Premature Rupture of the Membranes (Before 230/7 Weeks’ Gestation [Fig. 37.4])
Summary
Key Points
References
References
38 Preeclampsia and Hypertensive Disorders
Outline
Definitions
Gestational Hypertension
Severe Hypertension
Proteinuria
Edema
Preeclampsia and Eclampsia
Criteria for Preeclampsia or Gestational Hypertension With Severe Features
Chronic Hypertension
Chronic Hypertension With Superimposed Preeclampsia
Gestational Hypertension
Severe Gestational Hypertension
Preeclampsia
Atypical Preeclampsia
Capillary Leak Syndrome: Facial Edema, Ascites and Pulmonary Edema, and Gestational Proteinuria
Gestational Proteinuria
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
Antiplatelet Agents Including Low-Dose Aspirin
Heparin or Low-Molecular-Weight Heparin
Vitamins C and E
Metformin and Pravastatin
Folic Acid Supplementation
Laboratory Abnormalities in Preeclampsia
Renal Function
Hepatic Function
Hematologic Changes
Hemolysis, Elevated Liver Enzymes, and Low Platelets 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 Gestational Hypertension–Preeclampsia
Gestational Hypertension.
Hospitalization.
Bedrest.
Blood Pressure Medications.
Fetal and Maternal Surveillance.
Recommended Management.
Hypertension or preeclampsia without severe features.
Preeclampsia with severe features.
Expectant Management
Recommended Management of Preeclampsia With Severe Features
Intrapartum Management
Prevention of Eclamptic Seizures
Control of Severe Hypertension
Mode of Delivery
Postpartum Management
Maternal and Perinatal Outcomes in Preeclampsia
Counseling Women Who Have Had Preeclampsia in Prior Pregnancies
Remote Prognosis
Eclampsia
Pathophysiology
Diagnosis
Time of Onset of Eclampsia
Cerebral Pathology
Differential Diagnosis
Maternal and Perinatal Outcome
Is Eclampsia Preventable?
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 of Eclampsia
Postpartum Management of Eclampsia
Subsequent Pregnancy Outcomes and Remote Prognosis
Chronic Hypertension
Definition and Diagnosis
Etiology and Classification
Maternal and 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
References
Bibliography
Prevention
Renal Function
Hepatic Function
Hematologic Changes
HELLP Syndrome
Hemodynamics
Management
Counseling Women
Eclampsia
Chronic Hypertension
39 Multiple Gestations
Abstract
Key Words
Outline
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
Role of Twin Chorionicity in Risk of Maternal Complications
Perinatal Morbidity and Mortality
Fetal Anomalies
Cardiac Anomalies
Issues and Complications Unique to Multiple Gestations
“Vanishing Twin”
Outcomes in Pregnancies With Vanishing Twin
First-Trimester Multifetal Pregnancy Reduction
Discordance for Anomalies
Selective Termination
Dichorionic Twins
Monochorionic Twins
Intrauterine Fetal Demise of One Twin
Twin-Twin Transfusion Syndrome
Etiology
Diagnosis and Staging
Management
Serial Amnioreduction.
Laser Therapy.
Outcomes after laser therapy.
Neurologic outcomes after laser for twin-twin transfusion syndrome.
Stage I twin-twin transfusion syndrome.
Selective Intrauterine Growth Restriction in Monochorionic Twin Pregnancies
Twin Anemia-Polycythemia Sequence
Monoamniotic Twins
Twin-Twin Transfusion Syndrome in Monoamniotic Twin Gestations
Twin Reversed Arterial Perfusion Sequence
Conjoined Twins
Triplet Pregnancy: Impact of Chorionicity
Effect of Obstetric History of Risk of Twin Spontaneous Preterm Birth
Risk of Spontaneous Preterm Birth of Multiples in Patients With a Prior Singleton Spontaneous Preterm Birth
Risk of Spontaneous Preterm Birth in Subsequent Singletons After a Spontaneous Preterm Birth of Twins
Antepartum Management of Multifetal Pregnancy
Maternal Nutrition and Weight Gain
Spontaneous Preterm Birth
Bed Rest and Activity Restriction
Tocolysis
Progesterone
Intramuscular 17-Hydroxyprogesterone Caproate.
Vaginal Progesterone.
Cerclage
Pessary
Antenatal Testing
Fetal Growth Surveillance
Discordant Growth
Timing of Delivery in Multiple Gestations
Monochorionic Diamniotic Twins: Special Considerations Regarding Delivery Timing
Timing of Delivery With 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
Conclusions
Key Points
References
References
40 Red Cell Alloimmunization
Abstract
Key Words
Outline
Historic 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
Cordocentesis
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
Duffy
Kidd
Kell
Key Points
References
References
41 Maternal Mortality
Abstract
Key Words
Outline
Maternal Health and the Burden of Death and Disability
Where Mothers Die
Adolescent Girls
Lifetime Risk of Maternal Death
Global
United States of America
Mothers Who Survive: Severe Maternal Morbidity
Babies Who Die
Why Mothers Die
Clinical Causes
Health System Factors
Vulnerability and Underlying Social Determinants
Causes of the Causes
Access to Sexual and Reproductive Health
Family Planning
Unsafe Abortion
Improving Maternal and Reproductive Health for All WOMEN in Future
Life-Threatening Obstetric Complications
Postpartum Hemorrhage
Preeclampsia/Eclampsia
Sepsis
Obstructed Labor and Obstetric Fistula
Human Immunodeficiency Virus and Malaria
Acknowledgments
Key Points
References
42 Heart Disease in Pregnancy
Outline
Maternal Hemodynamics
Blood Volume
Diagnosis and Evaluation of Heart Disease
General Care
Risk Scoring Strategies
Valvular Disease
Mitral Stenosis
Mitral Regurgitation
Aortic Stenosis
Aortic Regurgitation
Prosthetic Valves
First Trimester
Second and Third Trimester
Labor and Delivery
Postpartum
Congenital Heart Disease
Isolated Septal Defects
Patent Ductus Arteriosus
Tetralogy of Fallot
Transposition of the Great Arteries
Fontan Procedure
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
Bibliography
General Care
Diagnosis and Evaluation of Heart Disease
Valvular Disease
Congenital Heart Disease
Cardiomyopathy
Myocardial Infarction
Marfan Syndrome
Pulmonary Hypertension
Critical Care: Hemodynamic Monitoring and Management
43 Respiratory Disease in Pregnancy
Abstract
Key Words
Outline
Pneumonia in Pregnancy
Bacterial Pneumonia
Viral Pneumonias
Pneumocystis Jirovecii Pneumonia
Tuberculosis in Pregnancy
Diagnosis
Prevention
Treatment
Asthma in Pregnancy
Diagnosis
Effects of Pregnancy on Asthma
Effects of Asthma on Pregnancy
Management of Asthma
Management of Asthma Exacerbations
Obstetric Considerations
Acute Respiratory Distress Syndrome
Transfusion-Related Acute Lung Injury
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
References
44 Renal Disease in Pregnancy
Abstract
Key Words
Outline
Renal System in Normal Pregnancy
Asymptomatic Bacteriuria and Acute Urinary Tract Infection
Pyelonephritis
Kidney Stones
Acute Kidney Injury
Diagnostic Criteria
Prerenal Acute Kidney Injury
Acute Tubular Necrosis
Preeclampsia
HELLP Syndrome
Atypical Hemolytic Uremic Syndrome
Postrenal Acute Kidney Injury
Proteinuria
Nephrotic Syndrome
Chronic Kidney Disease
Diagnostic Considerations in Pregnancy
Effect of Pregnancy on Chronic Kidney Disease
Effect of Chronic Kidney Disease on Pregnancy
Disorders Associated With Chronic Kidney Disease
Diabetic Nephropathy
Lupus Nephritis
Glomerulonephritis
Polycystic Kidney Disease
Vesicoureteral Reflux
Renal Artery Stenosis
Management Considerations for Chronic Kidney Disease
Hypertension
Anemia
Hemodialysis
Renal Transplant
Key Points
References
References
45 Diabetes Mellitus Complicating Pregnancy
Abstract
Key Words
Outline
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 (Class F)
Retinopathy
Coronary Artery Disease
Early Screening for Overt Diabetes and Detection 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 Benefit in Treating 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
References
Bibliography
Pathophysiology
Diabetes Mellitus
Perinatal Morbidity and Mortality
Maternal Classification and Risk Assessment
Detection and Significance of Gestational Diabetes Mellitus
Detection and Significance of Gestational Diabetes: Early Screening for Overt Diabetes and Detection of Gestational Diabetes
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 Gestational Diabetes Mellitus
Prepregnancy Counseling of Women With Preexisting Diabetes Mellitus
Contraception
46 Obesity in Pregnancy
Abstract
Key Words
Outline
Defining Obesity
Epidemiology
Prenatal Care
Counseling
Maternal Risk
Long-Term Maternal Complications
Fetal and Neonatal Risks
Long-Term Risks to the Offspring
Gestational Weight Gain
Management of the Obese Gravida
Preconception Counseling
Identification of Common Obesity-Related Comorbidity
Ultrasound
Genetic Screening
Intrapartum Management
Timing of Delivery
Delivery Site
Fetal Monitoring
Facilities Considerations
Labor Management
Induction of Labor
Elective Induction of Labor
Labor Curves
Modes of Delivery
Vaginal Delivery
Vaginal Birth After Cesarean
Cesarean Delivery
Cesarean Delivery Technical Aspects
Preparation for Surgery
Surgical Technique
Hysterotomy.
Closure.
Anesthesia
Postoperative Management
Postpartum Management
Breastfeeding
Contraception
Interpregnancy Care
Bariatric Surgery
Key Points
References
References
47 Thyroid and Parathyroid Diseases in Pregnancy
Abstract
Key Words
Outline
Parathyroid Diseases
Calcium Homeostasis During Pregnancy
Hyperparathyroidism
Hypercalcemia
Therapy
Hypoparathyroidism
Pseudohypoparathyroidism
Vitamin D Deficiency
Osteoporosis
Thyroid Diseases
Thyroid Function Tests
Thyroid-Stimulating Hormone Receptor Antibodies
Prepregnancy Counseling
Maternal-Placental-Fetal Interactions
Hyperthyroidism
Gestational Hyperthyroidism
Transient Hyperthyroidism of Hyperemesis Gravidarum
Subclinical Hyperthyroidism
Graves Disease
Treatment of Thyroid Storm
Fetal Hyperthyroidism
Neonatal Hyperthyroidism
Neonatal Central Hypothyroidism
Resistance to Thyroid Hormone Syndrome
Hypothyroidism
Etiology and Classification of Hypothyroidism
Subclinical Hypothyroidism.
Neurologic development and 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
References
References
Bibliography
Calcium Metabolism, Parathyroid, Calcitonin, Bone
Parathyroid Diseases
Vitamin D
Osteoporosis
Thyroid Diseases
Iodine
Maternal-Fetal Physiopathology
Human Chorionic Gonadotropin and Thyrotoxicosis
Hyperthyroidism
Antithyroid Drug Therapy
Fetal and Neonatal Pathology
Thyroxine Resistance Syndrome
Hypothyroidism
Screening
Chronic or Hashimoto Thyroiditis
Goiter, Thyroid Nodules, and Cancer
Postpartum Thyroiditis
48 Pituitary and Adrenal Disorders in Pregnancy
Abstract
Key Words
Outline
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 Aldosteronism
Pheochromocytoma
Key Points
References
References
49 Hematologic Complications of Pregnancy
Abstract
Key Words
Outline
Pregnancy-Associated Thrombocytopenia
Gestational Thrombocytopenia
Immune Thrombocytopenic Purpura
Thrombotic Thrombocytopenic Purpura and Hemolytic Uremic Syndrome
Platelet Storage Pool Disease
Evaluation of Thrombocytopenia During Pregnancy 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 Disease
Key Points
References
References
Bibliography
Thrombocytopenia
Anemias (Iron, Folate, Vitamin B12)
Hemoglobinopathies
Von Willebrand Disease
50 Thromboembolic Disorders in Pregnancy
Abstract
Key Words
Outline
Background and Historic Notes
Diagnoses and Definitions
Epidemiology and Incidence
Genetics
Physiology of Hemostasis
Vasoconstriction and Platelet Action
Coagulation Cascade
Anticoagulant System
Clot Lysis and Fibrinolysis
Pathophysiology of Thrombosis in Pregnancy
Antiphospholipid Syndrome
Inherited Thrombophilias
Risk Factors and Associations
Complications
Considerations in the Management of Pregnant Women
Diagnosis of Venous Thromboembolism
Deep Venous Thrombosis
Clinical signs and symptoms.
Risk scoring system.
Imaging.
d-Dimer and other laboratory assays.
Workup of patients with suspected deep venous thrombosis.
Pulmonary Embolus
Clinical signs and symptoms.
Nonspecific studies.
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 From Diagnostic Procedures
Fetal Exposure.
Maternal Exposure.
Management of Venous Thromboembolism
Prevention
Perioperative prevention.
Preconception counseling.
Therapy
Unfractionated heparin.
Low-molecular-weight heparin.
Fondaparinux.
Coumarin.
Treatment of Acute Deep Venous Thrombosis or Pulmonary Embolus.
Prophylactic anticoagulation recommendations for low-, moderate-, and high-risk groups.
Inferior vena cava filters.
Delivery and anesthesia concerns.
Postpartum Breastfeeding.
Key Points
References
References
51 Collagen Vascular Diseases in Pregnancy
Abstract
Key Words
Outline
Systemic Lupus Erythematosus
Background and Clinical Manifestations
Diagnosis
Systemic Lupus Erythematosus in Pregnancy: Concerns and Complications
Lupus Flare and Pregnancy
Lupus Nephritis and Pregnancy
Pregnancy Loss.
Intrauterine Growth Restriction.
Preterm Birth.
Hypertensive Disorders of Pregnancy.
Neonatal Lupus Erythematosus
Management of Pregnancies Complicated by Systemic Lupus Erythematosus
Antiphospholipid Syndrome
Background and Clinical Manifestations
Diagnosis
Definite Antiphospholipid Syndrome
Possible or Probable Antiphospholipid Syndrome and Equivocal Cases
Antiphospholipid Syndrome in Pregnancy: Concerns and Complications
Recurrent Early Miscarriage.
Fetal Death.
Preterm Birth for Preeclampsia or Placental Insufficiency
Management of Pregnancies Complicated by Antiphospholipid Syndrome
Refractory and High-Risk Obstetric Antiphospholipid Syndrome
Pregnancy Complications and Surveillance
Rheumatoid Arthritis
Background and Clinical Manifestations
Diagnosis
Rheumatoid Arthritis in Pregnancy: Concerns and Complications
Management of Pregnancies Complicated by Rheumatoid Arthritis
Treatment of Rheumatoid Arthritis During Pregnancy
Systemic Sclerosis
Background and Clinical Manifestations
Diagnosis
Systemic Sclerosis in Pregnancy: Concerns and Complications
Management of Pregnancies Complicated by Systemic Sclerosis
Sjögren Syndrome
Key Points
References
52 Hepatic Disorders During Pregnancy
Abstract
Key Words
Outline
Physiologic Effects of Pregnancy and Assessment of Liver Disease
Differential Diagnosis of Hepatobiliary Symptoms and Conditions During Pregnancy
Maternal Jaundice
Right Upper Quadrant Abdominal Pain
Nausea and Vomiting
Pruritus
Hepatic Lesions
Ascites
Abdominal Imaging During Pregnancy
Therapeutic Endoscopy During Pregnancy
Endoscopy With Variceal Sclerotherapy or Banding
Endoscopic Retrograde Cholangiopancreatography
Liver Biopsy
Common Liver Diseases Incidental to Pregnancy
Acute Viral Hepatitis A, B, and C
Hepatitis D
Hepatitis E
Chronic Hepatitis B
Chronic Hepatitis C
Wilson Disease
Autoimmune Hepatitis
Herpes Simplex Hepatitis
Liver Masses in Pregnancy
Hepatic Hemangiomas
Focal Nodular Hyperplasia
Hepatic Adenomas
Hepatic Cysts
Hepatocellular Carcinoma and Hepatic Metastases
Budd-Chiari Syndrome
Cirrhosis and Portal Hypertension
Acute Intermittent Porphyria
Nonalcoholic Fatty Liver Disease
Alcoholic Liver Disease
Intrahepatic Cholestasis of Pregnancy
Maternal and Fetal Outcomes
Treatment
Acute Fatty Liver of Pregnancy
Cholestatic Liver Diseases
Primary Biliary Cirrhosis
Maternal and Fetal Outcomes
Primary Sclerosing Cholangitis
Maternal and Fetal Outcomes
Pregnancy After Liver Transplantation
Pancreatobiliary Disease
Cholelithiasis and Cholecystitis
Choledocholithiasis
Acute Pancreatitis
Clinical Presentation
Laboratory Blood Work
Imaging
Perinatal Outcomes
Choledochal Cysts
Summary
Key Points
References
References
53 Gastrointestinal Diseases in Pregnancy
Abstract
Key Words
Outline
Physiologic Changes During Pregnancy
Diagnostic Considerations During Pregnancy
Changes to the Physical Exam During Pregnancy
Changes to Laboratory Assessments During Pregnancy
Endoscopy During Pregnancy
Esophagogastroduodenoscopy
Colonoscopy
Flexible Sigmoidoscopy
Video Capsule Endoscopy
Deep Enteroscopy
Upper Gastrointestinal Disorders During Pregnancy
Nausea and Vomiting of Pregnancy
Hyperemesis Gravidarum
Gastroesophageal Reflux Disease
Peptic Ulcer Disease
Hiatal Hernia
Achalasia
Celiac Disease
Lower Gastrointestinal Disorders During Pregnancy
Appendicitis
Inflammatory Bowel Disease
Etiology
Presentation
Diagnosis
Fertility and Surgery
Effect of Pregnancy on Inflammatory Bowel Disease and the Effect of Inflammatory Bowel Disease on Pregnancy
Preconception Counseling
Medications (Table 53.2)
5-Aminosalicylates and Sulfasalazine.
Immunomodulators.
Biologics.
Steroids.
Antibiotics.
Mode of Delivery
Irritable Bowel Syndrome
Hemorrhoids
Colorectal Cancer
Intestinal Obstruction
Intestinal Pseudo-obstruction
Mesenteric Ischemia and Infarction
Rupture of Splenic Artery Aneurysm
Nutritional Support During Pregnancy
Enteral Nutrition
Parenteral Nutrition
Differential Diagnosis of Nonobstetric Conditions for Common Gastrointestinal Complaints
Key Points
References
References
54 Neurologic Disorders in Pregnancy
Abstract
Key Words
Outline
Epilepsy
Epilepsy and Fertility
Teratogenic Effects of Antiseizure Drugs
Valproate
Carbamazepine
Lamotrigine
Levetiracetam
Phenytoin
Phenobarbital
Topiramate
Other Antiseizure Drugs
Effect of Antiseizure Drug Dose
Polytherapy
Other Therapies
Effects of Pregnancy on Antiseizure Medications
Pregnancy and Seizure Frequency
Obstetric and Neonatal Outcomes
Preconception Counseling for Women With Epilepsy
Genetic Counseling
Folic Acid Supplementation
Care of the Patient During Pregnancy
Labor and Delivery
New Onset of Seizures in Pregnancy and in the Puerperium
Breastfeeding and the Postpartum Period
Postpartum Safety
Multiple Sclerosis
Multiple Sclerosis and Fertility
Effect of Pregnancy on Multiple Sclerosis
Effect of Multiple Sclerosis on Pregnancy Outcomes
Disease-Modifying Agents and Pregnancy
Injectables
Interferon β
Oral Agents
Infusions
Prepregnancy Counseling for Patients With Multiple Sclerosis
Management of Multiple Sclerosis During Pregnancy
Relapse Risk During Pregnancy
Management of a Relapse During Pregnancy
Labor and Delivery
Breastfeeding and the Postpartum Period
Headache
Migraine
Secondary Headache in Pregnancy
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
Cerebral Venous Thrombosis
Subarachnoid Hemorrhage
Reversible Cerebral Vasoconstriction
Stroke
Ischemic Stroke
Hemorrhagic Stroke
Key Points
References
References
Bibliography
Epilepsy
MS
Headache
Stroke
55 Malignant Diseases and Pregnancy
Abstract
Key Words
Outline
Surgery and Anesthesia
Radiation Therapy
Chemotherapy During Pregnancy
Pharmacology of Chemotherapy During Pregnancy
Classification of Chemotherapy Agents
Antimetabolites
Alkylating Agents
Antitumor Antibiotics
Vinca Alkaloids
Platinum Agents
Taxane Agents
Targeted Therapies
Drug Effects on the Embryo, Fetus, and Neonate
Cancer During Pregnancy
Breast Cancer
Diagnosis and Staging
Treatment
Prognosis
Lactation and Breast Reconstruction
Hematologic Malignancies
Hodgkin Lymphoma
Non-Hodgkin Lymphoma
Acute Leukemia
Chronic Leukemia
Melanoma
Gynecologic Malignancies
Cervical Cancer
Early-Stage Disease.
Locally Advanced Disease.
Advanced Disease.
Method of Delivery.
Ovarian Cancer
Postoperative Adjuvant Therapy.
Vulvar and Vaginal Cancer
Endometrial Cancer
Miscellaneous Tumors
Upper Gastrointestinal Cancers
Colon and Rectal Cancer
Urinary Tract Cancers
Central Nervous System Tumors
Lung Cancer
Fetal-Placental Metastasis
Pregnancy Following Cancer Treatment
Gestational Trophoblastic Disease and Pregnancy-Related Issues
Complete Hydatidiform Mole
Invasive Mole (Chorioadenoma Destruens)
Partial Hydatidiform Mole
Placental Site Trophoblastic Tumor and Epithelioid Trophoblastic Tumor
Choriocarcinoma
Key Points
References
56 Skin Disease and Pregnancy
Abstract
Outline
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 (Dermatitis) and Other Dermatitides
Acne Vulgaris
Other Inflammatory Skin Diseases
Autoimmune Progesterone Dermatitis
Impetigo Herpetiformis
Cutaneous Manifestations of Autoimmune Disorders
Bullous Disorders
Skin Tumors
Malignant Melanoma
Pruritus in Pregnancy
Specific Dermatoses of Pregnancy
Pemphigoid (Herpes) Gestationis
Polymorphic Eruption of Pregnancy
Atopic Eruption of Pregnancy
Prurigo of Pregnancy
Pruritic Folliculitis of Pregnancy
Key Points
References
57 Maternal and Perinatal Infection in Pregnancy
Outline
Human Immunodeficiency Virus
Virology
Epidemiology
Clinical Manifestations
Diagnosis
Rapid Intrapartum Testing
Ethics and Evolution of HIV Infection and Treatment
Preconception Counseling
Management During Pregnancy
Initial Evaluation
Counseling and Coordination of Care
Treatment
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors.
Integrase Strand Transfer Inhibitors.
Protease Inhibitors.
Nonnucleoside Reverse Transcriptase Inhibitors.
Ongoing Management
Genetic Testing
Immunization
Human Immunodeficiency Virus/Hepatitis B Virus Coinfection
Human Immunodeficiency Virus/Hepatitis C Virus Coinfection
Acute Infection
Serodiscordant Couples
Delivery Planning
Intrapartum Therapy
Intrapartum Management
Postpartum Care of the Human Immunodeficiency Virus Infected Woman
Infant Feeding
Infant Prophylaxis, Screening and Diagnosis
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 Hepatitis B Virus Infection During Pregnancy
Hepatitis C
Virology/Epidemiology
Diagnosis
Preconceptual Counseling
Hepatitis C Virus in Pregnancy
Antepartum Hepatitis C Virus Treatment: Reproductive Justice
Hepatitis D
Hepatitis E
Coxsackie Virus
Human Papillomavirus
Epstein-Barr Virus
Smallpox
Zika Virus
Virology/Epidemiology
Clinical Manifestations
Diagnosis
Preventing Zika Exposure
Management of Zika in Pregnancy
Ebola
Virology/Epidemiology
Clinical Manifestations
Diagnosis
Management of Ebola in Pregnancy
Key Points
References
References
Bibliography
Human Immunodeficiency Virus
Influenza
Parvovirus
Measles
Rubella
Cytomegalovirus
Herpes Simplex Virus
Varicella
Hepatitis
Human Papillomavirus
58 Maternal and Perinatal Infection in Pregnancy
Abstract
Key Words
Outline
Bacterial Infections
Epidemiology
Chlamydial Infection
Pathogenesis
Diagnosis
Treatment
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
Maternal, Fetal, and Neonatal Complications
Management
Neonatal Prognosis
Short-Term Outcome.
Long-Term Outcome.
Puerperal Endometritis
Epidemiology
Clinical Presentation and Diagnosis
Management
Prevention of Puerperal Endometritis
Serious Sequelae of Puerperal Infection
Wound Infection
Pelvic Abscess
Septic Pelvic Thrombophlebitis
Severe Sepsis
Other Important Infections
Listeriosis
Epidemiology and Pathogenesis
Clinical Manifestations
Diagnosis
Treatment
Syphilis
Pathogenesis
Congenital Syphilis
Diagnosis
Toxoplasmosis
Epidemiology
Clinical Manifestations
Diagnosis
Congenital Toxoplasmosis
Management
Key Points
References
References
59 Mental Health and Behavioral Disorders in Pregnancy
Abstract
Key Words
Outline
Mood Disorders
Major Depressive Episode
Diagnosis and Prevalence During Pregnancy and Postpartum
Natural History Across Childbearing
Treatment of Major Depressive Disorder During Pregnancy
Selective Serotonin Reuptake Inhibitor Exposure and Reproductive Outcomes
Miscarriage and Stillbirth.
Birth Defects.
Preterm Birth.
Neonatal Effects.
Neurobehavioral Development.
Dosage Requirements Across Pregnancy.
Integrative Treatments.
Treatment of Postpartum Major Depressive Disorder
Prevention of Postpartum Major Depressive Disorder.
Treatment During Breastfeeding.
Suicide Risk.
Bipolar Disorder
Diagnosis and Prevalence
Natural History Across Childbearing
Impact of Bipolar Disorder on Pregnancy Outcomes
Treatment of Bipolar Disorder During Childbearing
Lithium.
Valproic Acid.
Carbamazepine and Oxcarbazepine.
Lamotrigine.
Atypical Antipsychotics.
Alternative and Supplemental Treatment Options.
Prevention of Bipolar Disorder Recurrence Postpartum
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
Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Schizophrenia
Diagnosis and Prevalence
Natural History of Schizophrenia Across Childbearing
Antipsychotic Drug Use in Pregnancy
Congenital Malformations
Adverse Pregnancy Outcomes
Child Development
Individual Atypical Antipsychotics
Antipsychotic Drugs During Breastfeeding
Key Points
References
Bibliography
Mood Disorders
Bipolar Disorder
Anxiety Disorders
Eating Disorders
Schizophrenia
Online Resources
Appendix I Normal Values in Pregnancy and Ultrasound Measurements
Appendix II Anatomy of the Pelvis
Key Points
Suggested Readings
Appendix III Glossary of Key Abbreviations

✦ Subjects

Obstetrics; Pregnancy; Maternal-Fetal Medicine; Gynecology; Women’s Health