Antenatal Disorders for the MRCOG and Beyond

Cover
Half-title
Title page
Copyright information
Table of contents
LIst of contributors
Preface
1 Antenatal care and risk assessment
	Introduction
	What is the purpose of antenatal care?
	Antenatal risk assessment
	Who should see women at antenatal visits, and where?
	Antenatal interventions which are not routinely recommended
	Who should provide antenatal care?
	Basic principles of antenatal care
	Organization and content of the antenatal visit
		Frequency of antenatal visits
		First contact with a healthcare professional
		The booking visit
		Follow-up visits
		General lifestyle advice during pregnancy
		Pre-pregnancy counselling and care
	Key summary points
	References
2 Antepartum haemorrhage
	Introduction
	General management principles
	Placental abruption
		Pathophysiology
		Aetiology
		Clinical presentation
		Management
			Fluid management of hypovolaemia
			Coagulopathy/disseminated intravascular coagulation (DIC)
	Placenta praevia
		Aetiology and risk factors
		Diagnosis
		Clinical presentation
		Management
		Delivery
	Vasa praevia
		Clinical presentation
		Risk factors
		Diagnosis
		Management and prognosis
	Marginal bleed
	Uterine rupture
		Risk factors
		Clinical presentation
		Management
	Unexplained bleeding
		Management
	Key summary points
	References
	Further reading
3 Multiple pregnancy
	Prevalence and epidemiology
	Classification of multiple pregnancy
	Complications
		Twin-to-twin transfusion syndrome
		Discordant growth
		Monofetal death
		Selective fetal reduction
		Higher-order multiple pregnancies
	Antenatal care
	Mode and timing of delivery
	Intrapartum care
	Key summary points
	References
4 Hypertensive disorders in pregnancy
	Introduction
	Definitions (NICE 2010)
		Degrees of hypertension
		Significant proteinuria
		Measurement of blood pressure
		Measurement of proteinuria (NICE 2010)
	Why is hypertensive disease in pregnancy important?
		Maternal mortality and morbidity
		Perinatal mortality and morbidity
	Pre-conception care
	Antihypertensive medication
		Antihypertensive medication and breastfeeding
	Outpatient management of hypertensive disorders in pregnancy
	Management of chronic hypertension
	Management of gestational hypertension
		Antepartum care
		Timing of delivery
		Care in labour
		Postnatal care
	Long-term significance of hypertension in pregnancy
	Pre-eclampsia
		Aetiology and pathogenesis
		Prediction of pre-eclampsia
		Reducing the risk of pre-eclampsia
		Management of pre-eclampsia
			Maternal monitoring and management of hypertension (NICE 2010)
			Fetal monitoring
			Timing of delivery
			Management of delivery
			Seizure prophylaxis
			Postpartum care
	Eclampsia
		Management
	HELLP syndrome
		Laboratory diagnosis
		Differential diagnosis
		Complications of HELLP
		Management
	Postpartum hypertension
		Aetiology of hypertension in the postpartum
		Why detect and treat postpartum hypertension?
		Antihypertensive treatment
	Key summary points
	References
5 Prematurity
	Introduction
	Pathogenesis
	Antenatal management
		Risk assessment
		Investigations
			Cervical length scanning
			Infection screening
			Fetal fibronectin (FFN)
			Other technologies
		Preventive treatment
			Cerclage
			Progesterone
			Cervical pessary
			Bed rest
		Multiple pregnancy and preterm birth prophylaxis
	Symptomatic women
		Assessment
		Fetal fibronectin
		Actim Partus
		Cervical length scanning
		Treatment
			Tocolysis
			Steroids
			In-utero transfer
			Magnesium sulphate for fetal neuroprotection
	Management of women with PPROM
	Perinatal issues
		Parental counselling
		Mode of delivery
	Key summary points
	References
	Further reading
		RCOG Green-top Guidelines
		RCOG Scientific Impact Papers
		NICE guidance
6 Previous caesarean section
	Introduction
	Antenatal care for a woman who has had a previous caesarean delivery
		Morbidly adherent placenta
	Options for birth after previous caesarean section
	Vaginal birth after caesarean section (VBAC)
		Contraindications to VBAC
		Risks of VBAC versus elective LSCS
	Planned repeat caesarean section
	Special circumstances
		Preterm delivery
		Multiple pregnancy
		Induction and augmentation of labour
		External cephalic version (ECV) after previous LSCS
		When there is disagreement between the clinician and woman regarding mode of delivery after previous caesarean section
		Delivery after intrauterine fetal death in the second trimester, or termination of pregnancy in the second trimester, in a woman with a previous LSCS
	Reviewing local practice
	Key summary points
	References
	Further reading
7 Common medical disorders in pregnancy
	7.1 Anaemia
		Background and clinical relevance
		Treatment
			Oral iron supplements
			Parenteral iron
			Serum ferritin
			Blood transfusion
		Megaloblastic anaemias
		Key summary points
		References
	7.2 Endocrine disorders
		Diabetes
			Background
			Effect of pregnancy on diabetes
			Effect of diabetes on pregnancy
			Management of diabetic pregnancy
				Pre-pregnancy care
				Antenatal management
				Intrapartum management
			Gestational diabetes
				Screening at first antenatal visit
				Screening later in pregnancy
				Diagnosis of gestational diabetes
				Importance of gestational diabetes
			Key summary points
		Thyroid disease
			Physiology
			Hyperthyroidism
				Effect of pregnancy on hyperthyroidism
				Effect of hyperthyroidism on pregnancy
				Management of hyperthyroidism
			Hypothyroidism
				Effect of pregnancy on hypothyroidism
				Effect of hypothyroidism on pregnancy
				Management of hypothyroidism
			Key summary points
		Prolactinoma
			Effect of pregnancy on prolactinoma
			Effect of prolactinoma on pregnancy
			Management of prolactinoma
			Key summary points
		References
		Further reading
	7.3 Gastrointestinal and hepatic disease
		Physiological changes during pregnancy
		Reflux oesophagitis
		Peptic ulcer disease
		Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
		Intrahepatic cholestasis of pregnancy
		Acute fatty liver of pregnancy
		Key summary points
		References
	7.4 Haematological disorders
		Introduction
		Haemoglobinopathies
		Sickle cell disease
		Beta-thalassaemia
		Antenatal screening
		Management of sickle cell disease in pregnancy
			Pre-conception care
			Antenatal care
			Intrapartum care
			Postpartum care
		Sickle cell crisis
		Thrombocytopenia
		Immune thrombocytopenic purpura (ITP)
		Thrombotic thrombocytopenic purpura (TTP)
		Neonatal alloimmune thrombocytopenia (NAIT)
		Thrombophilia
		Key summary points
		References
	7.5 Malignancy
		Introduction
		Cervical cancer
			Previous treatment
		Breast cancer
		Ovarian cancer
		Melanoma
		Acute leukaemia
		Pregnancy following previous chemotherapy
		Gestational trophoblastic disease
		Key summary points
		References
	7.6 Obesity
		The scale of the problem
		Pre-pregnancy counselling
		Antenatal care
		Intrapartum care
		Postnatal care
		The future
		Key summary points
		References
	7.7 Kidney disease
		Physiological changes in renal function with pregnancy
		Effect of chronic kidney disease on pregnancy
		Effect of pregnancy on chronic kidney disease
		Women on dialysis and with transplant
		Management
			Pre-pregnancy
			Antepartum
			Postpartum
		Key summary points
		References
	7.8 Skin disorders
		Introduction
		Physiological changes in pregnancy
		Atopic eruption of pregnancy (AEP)
		Polymorphic eruption of pregnancy (PEP)
		Pemphigoid gestationis (PG)
		Key summary points
		References
8 Cardiac disease in pregnancy
	Introduction
	Principles of management
	Specific heart diseases
	Key summary points
	References
9 Alloimmunization in pregnancy
	Introduction
	Prediction
	Prevention
		Silent sensitization
		Consent and refusal
		Fetal genotyping
	Treatment
		Red blood cell alloimmunization
		Investigation
		Ultrasound monitoring
		Cordocentesis and intrauterine transfusion
		Planning for delivery
	Platelet alloimmunization
	Key summary points
	References
	Further reading
10 Maternal mental health disorders
	Introduction
	Psychiatric disorders in pregnancy
		Depression in pregnancy
			Incidence
			Onset
			Risk factors
			Clinical features
			Treatment
		Psychosis in pregnancy
			Clinical features
			Treatment
	Postnatal psychiatric disorders
		Postpartum blues
			Incidence
			Onset
			Clinical features
			Prognosis
			Treatment
		Postnatal depression
			Incidence
			Onset
			Risk factors
			Clinical features
			Treatment
		Postpartum (puerperal) psychosis
			Incidence
			Onset
			Risk factors
			Clinical features
			Treatment
	Conclusion
	Key summary points
	References
	Further reading
11 Drug and alcohol misuse in pregnancy
	Introduction
	What is substance misuse?
		Accepted definitions of substance misuse
	How common is substance misuse in pregnancy?
	Substances of misuse
	Effects of substances of misuse on pregnancy
		Alcohol
			Associated problems
		Cannabis
			Associated problems
		Heroin
			Associated problems
		Methadone
		Buprenorphine
		Codeine
		Benzodiazepines
			Associated problems
		Cocaine/crack cocaine, amphetamines and mephedrone
			Associated problems
		Ketamine
		Ecstasy
		Solvents
		‘Legal’ highs
	General principles of management
		Philosophy of care
		Attitude
		Holistic care
			Comorbid medical problems
			Social problems
		Engagement
		Communication
		Model of care
	Pre-conception care
	Antenatal care
		Identification of patients
		Management of substance misuse
			Assessment
			Antenatal screening and investigations
			Drug screening
			Harm reduction advice
			Facilitating change
			Safeguarding
	Obstetric care
		Venous damage and thromboembolic disease
			Management
		Blood-borne viruses and sepsis
			Management
		Placental problems and preterm delivery
			Management
		Mental health problems
			Management
		Complex social factors
			Chaos
			Management
		Family planning
			Management
	Planning intrapartum and postnatal care
		Intrapartum care
		Postnatal care
			Neonatal and infant problems
			Maternal health
	Key summary points
	References
	Further reading
12 Screening for fetal anomalies
	Introduction
	Screening for structural anomalies
		Diagnostic value of the routine scan during pregnancy
	Screening for Down’s syndrome
		The provision of Down’s syndrome screening during antenatal care
	Key summary points
	References
Index