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دانلود کتاب Obstetrics : normal and problem pregnancies
دانلود کتاب زنان و زایمان: بارداری های طبیعی و مشکل دار
مشخصات کتاب
Obstetrics : normal and problem pregnancies
ویرایش: 6th ed.
نویسندگان: Gabbe. Steven G.
سری:
ISBN (شابک) : 9781437719352, 143771935X
ناشر: Elsevier/Saunders
سال نشر: 2012
تعداد صفحات: 1289
زبان: English
فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود)
حجم فایل: 123 مگابایت
قیمت کتاب (تومان) : 52,000
کلمات کلیدی مربوط به کتاب زنان و زایمان: بارداری های طبیعی و مشکل دار: مامایی، بارداری -- عوارض
در صورت تبدیل فایل کتاب Obstetrics : normal and problem pregnancies به فرمت های PDF، EPUB، AZW3، MOBI و یا DJVU می توانید به پشتیبان اطلاع دهید تا فایل مورد نظر را تبدیل نمایند.
توجه داشته باشید کتاب زنان و زایمان: بارداری های طبیعی و مشکل دار نسخه زبان اصلی می باشد و کتاب ترجمه شده به فارسی نمی باشد. وبسایت اینترنشنال لایبرری ارائه دهنده کتاب های زبان اصلی می باشد و هیچ گونه کتاب ترجمه شده یا نوشته شده به فارسی را ارائه نمی دهد.
توضیحاتی در مورد کتاب زنان و زایمان: بارداری های طبیعی و مشکل دار
بسیار خوانا، به خوبی نشان داده شده، و به راحتی قابل درک است، مامایی: بارداری های طبیعی و مشکل دار انتخاب شما برای راهنمایی معتبر در مدیریت بیمار مامایی امروزی است. با انعکاس تخصص مقامات معتبر بین المللی، این مرجع پرفروش زنان و زایمان به طور کامل بازبینی شده است تا شما را در مورد همه چیز از ارزیابی سونوگرافی آناتومی و رشد جنین گرفته تا عوارض پزشکی در بارداری، تا درمان جنین و موارد دیگر به روز کند! "یک مرجع عالی برای دستیاران و همکارها در آموزش به طور یکسان" بررسی شده توسط: واحد تشخیص زنان و زایمان، بیمارستان دانشگاه لندسپیتالی/دانشگاه ایسلند تاریخ: دسامبر 2014 از دانش و تجربه کارشناسان بین المللی در زمینه زنان و زایمان بهره مند شوید. دیدگاه جدیدی در مورد طیف وسیعی از مسائل کلیدی امروز به دست آورید - همه مبتنی بر شواهد و خواندنی آسان. با پوشش جدید منشأ جنینی بیماری بزرگسالان، پزشکی مبتنی بر شواهد، ارزیابی کیفیت، تغذیه، شیوه‌های جهانی مامایی، و موارد دیگر، در جریان باشید. اطلاعات مورد نیاز خود را به سرعت با عبارات کلیدی پررنگ، جداول اضافی، نمودارهای جریان و لیست های گلوله ای برای ارجاع آسان پیدا کنید. در هر فصل "نکات کلیدی" را صفر کنید - اکنون با گنجاندن آمارهای مرتبط، مفیدتر از همیشه شده است. نوموگرام های جدید سونوگرافی را در آپاندیس مقادیر طبیعی در بارداری مشاهده کنید. در www.expertconsult.com به محتویات کامل به‌علاوه مراجع، جداول و تصاویر اختصاصی به‌صورت آنلاین دسترسی داشته باشید.
توضیحاتی درمورد کتاب به خارجی
Highly readable, well illustrated, and easy to understand, Obstetrics: Normal and Problem Pregnancies remains your go-to choice for authoritative guidance on managing today's obstetric patient. Reflecting the expertise of internationally recognized authorities, this bestselling obstetrics reference has been thoroughly revised to bring you up to date on everything from ultrasound assessment of fetal anatomy and growth, to medical complications in pregnancy, to fetal therapy...and much more! 'An excellent reference for residents and fellows in training alike' Reviewed by: Obstetrics and Prenatal Diagnosis Unit, Landspitali University Hospital/University of Iceland Date: December 2014 Benefit from the knowledge and experience of international experts in obstetrics. Gain a new perspective on a wide range of today's key issues - all evidence-based and easy to read. Stay current with new coverage of fetal origins of adult disease, evidence-based medicine, quality assessment, nutrition, global obstetric practices, and much more. Find the information you need quickly with bolded key statements, additional tables, flow diagrams, and bulleted lists for easy reference. Zero in on "Key Points" in every chapter - now made more useful than ever with the inclusion of related statistics. View new ultrasound nomograms in the Normal Values in Pregnancy appendix. Access the complete contents online, plus exclusive references, tables, and images, at www.expertconsult.com.
فهرست مطالب
Cover Copyright Contributors Preface Section I - Physiology 1 Placental Anatomy and Physiology Overview of the Delivered Placenta Placental Development The Amnion and Yolk Sac The Maternal-Fetal Relationship during the First Trimester Extravillous Trophoblast Invasion and Physiologic Conversion of the Spiral Arteries The Role of the Endometrium during the First Trimester The Topology of the Villous Trees Placental Histology The Integrity of the Villous Membrane Placental Vasculature Physiology of the Secondary Yolk Sac and Exocoelomic Cavity Placental Transport Overview of the Exchange Physiology of the Placenta and Its Development Over Gestation Bulk Flow/Solvent Drag Diffusion Transporter-Protein Mediated Processes Endocytosis/Exocytosis Placental Nutrient Supply and Intrauterine Growth Restriction Placental Endocrinology Progesterone Estrogens Human Chorionic Gonadotropin Placental Lactogen Placental Growth Hormone Key Points References 2 Placental and Fetal Physiology Placental Physiology Placental Metabolism and Growth Placental Transfer General Considerations Transfer of Individual Solutes Respiratory Gases Glucose Amino Acids Lipids Water and Ions Calcium Receptor-Mediated Endocytosis/Exocytosis Placental Blood Flow Uterine Blood Flow Umbilical Blood Flow Immunologic Properties of the Placenta Amniotic Fluid Volume Fetal Physiology Growth and Metabolism Substrates Hormones Fetal Cardiovascular System Development Fetal Heart Autonomic Regulation of Cardiovascular Function Hormonal Regulation of Cardiovascular Function Arginine Vasopressin Renin–Angiotensin II Fetal Hemoglobin Fetal Kidney Fetal Gastrointestinal System Gastrointestinal Tract Liver Fetal Adrenal and Thyroid Adrenal Thyroid Fetal Central Nervous System Summary Key Points References 3 Maternal Physiology Body Water Metabolism Osmoregulation Salt Metabolism Renin-Angiotensin-Aldosterone System Atrial and Brain Natriuretic Peptide Cardiovascular System Heart Cardiac Output Arterial Blood Pressure and Systemic Vascular Resistance Venous Pressure Central Hemodynamic Assessment Normal Changes That Mimic Heart Disease Effect of Labor and the Immediate Puerperium Respiratory System Upper Respiratory Tract Mechanical Changes Lung Volume and Pulmonary Function Gas Exchange Sleep Hematologic Changes Plasma Volume and Red Blood Cell Mass Iron Metabolism in Pregnancy Platelets Leukocytes Coagulation System Urinary System Anatomic Changes Renal Hemodynamics Renal Tubular Function/Excretion of Nutrients Alimentary Tract Appetite Mouth Stomach Intestines Gallbladder Liver Nausea and Vomiting of Pregnancy Skeleton Calcium Metabolism Skeletal and Postural Changes Endocrine Changes Thyroid Adrenal Glands Pituitary Gland Pancreas and Fuel Metabolism Glucose Proteins and Fats/Lipids Eye Key Points References 4 Maternal-Fetal Immunology Immune System Overview: Innate and Adaptive Immunity Innate Immunity: First Line of Host Defense Antimicrobial Peptides Macrophages Natural Killer Cells Toll-like Receptors Complement System Cytokines Chemokines Adaptive Immunity Major Histocompatibility Complex Humoral Immune Response: B Cells and Antibodies Antibody Isotypes T Cells Helper T Subsets Fetal Immune System Cord Blood Transplantation Maternal Tolerance of the Fetus Tolerance Through Human Leukocyte Antigens Tolerance Through Regulation of Maternal T Cells Tolerance Through Regulation of Complement and Cytokines Immunity In Infection-Associated Preterm Birth Immunity in Preeclampsia Maternal-Fetal Human Leukocyte Antigen Compatibility and Recurrent Pregnancy Loss Maternal-Fetal Cell Trafficking and Microchimerism Summary Key Points References 5 Developmental Origins of Adult Health and Disease Epigenetics and Programming Fetal Nutrition and Growth Energy Balance Programming Hepatic Programming Pancreas Programming Cardiac Programming Osteoporosis Programming Brain Programming Maternal Stress and Anxiety Glucocorticoids and Prematurity Immune Function Endocrine Programming Sexuality Programming Renal Programming Conclusion Key Points References Section II - Prenatal Care 6 Preconception and Prenatal Care: Maternal Mortality Neonatal Mortality and Morbidity Prenatal Care Risk Assessment Preconceptional Education The Initial Preconceptional or Prenatal Visit Social and Demographic Risks Medical Risk Hyperthyroidism Hypothyroidism Obstetrical Risk Physical and Laboratory Evaluation Assessment of Gestational Age Clinical Dating Ultrasound Repeat Prenatal Visits Intercurrent Problems The Prenatal Record Prenatal Education Informed Consent and VBAC Smoking Cessation Drugs and Teratogens Radiologic Studies Nutrition Weight Gain Activity and Employment Travel Immunizations Nausea and Vomiting in Pregnancy Heartburn Restless Legs Syndrome Sciatica Carpal Tunnel Syndrome Hemorrhoids Constipation Urinary Frequency and Incontinence Round Ligament Pain Syncope Backache Sexual Activity Circumcision Breastfeeding Preparation for Childbirth Signs of Labor Prepared Parenthood and Support Groups Postpartum Visit Summary Key Points References Additional References Introduction Maternal Mortality Neonatal Mortality and Morbidity Prenatal Care Risk Assessment Preconceptional Education The Initial Preconceptional or Prenatal Visit Thyroid Disorders Assessment of Gestational Age Repeat Prenatal Visits Prenatal Education 7 Nutritional Management During Pregnancy Integrating Nutrition Into the Obstetrical History Maternal Weight Gain Recommendations Low or Underweight Preconception BMI Overweight and Obese Preconception BMI Maternal Weight Gain Recommendations for Special Populations Multiple Gestation Adolescents Other Groups Laboratory Evaluation of Nutritional Status Maternal Nutrient Needs: Current Recommendations Energy Protein Omega-3 Fatty Acids Vitamin and Mineral Supplementation Guidelines Dietary Reference Intake Vitamins Vitamin A Vitamin D Vitamin C Vitamin B6 Vitamin K Folate Folate and Neural Tube Defects Folate Supplementation Minerals Iron Calcium Zinc Nutrition-Related Problems in Pregnancy Nausea and Vomiting Heartburn and Indigestion Constipation Food Contamination Pregnancy Following Bariatric Surgery Key Points References additional References Integrating Nutrition into the Obstetric History Maternal Weight Gain Recommendations Maternal Nutrient Needs: Current Recommendations Vitamin and Mineral Supplementation Guidelines Nutrition-related Problems in Pregnancy 8 Drugs and Environmental Agents in Pregnancy and Lactation: Embryology Basic Principles of Teratology Genotype and Interaction with Environmental Factors Timing of Exposure Mechanisms of Teratogenesis Manifestation Agent Dose Effect Epidemiologic Approaches to Birth Defects Case Reports Descriptive Studies Case-Control Studies Cohort Studies Clinical Trials Medical Drug Use Effects of Specific Drugs Estrogens and Progestins Androgenic Steroids Spermicides Anticonvulsants Isotretinoin Vitamin A Psychoactive Drugs Tranquilizers Lithium (Eskalith, Lithobid) Antidepressants Anticoagulants Thyroid and Antithyroid Drugs Digoxin (Lanoxin) Antihypertensive Drugs Sympathetic Blocking Agents Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Antineoplastic Drugs and Immunosuppressants Antiasthmatics Terbutaline (Brethine) Cromolyn Sodium (Intal) Isoproterenol (Isuprel) and Metaproterenol (Alupent) Corticosteroids Iodide Antiemetics Vitamin B6 Doxylamine Meclizine (Bonine) Dimenhydrinate (Dramamine) Diphenhydramine (Benadryl) Phenothiazines Metoclopramide Ondansetron (Zofran) Methylprednisolone Ginger Acid-Suppressing Drugs Antihistamines and Decongestants Antibiotics and Anti-infective Agents Penicillins Cephalosporins Sulfonamides Sulfamethoxazole with Trimethoprim (Bactrim, Septra) Nitrofurantoin (Macrodantin) Tetracyclines Aminoglycosides Antituberculosis Drugs Erythromycin Clarithromycin Fluoroquinolones Metronidazole (Flagyl) Antiviral Agents Lindane (Kwell) Antiretroviral Agents Antifungal Agents Drugs for Induction of Ovulation Mild Analgesics Aspirin Acetaminophen (Tylenol, Datril) Other Nonsteroidal Anti-inflammatory Agents Codeine Sumatriptan Drugs of Abuse Smoking Smoking Cessation During Pregnancy Alcohol Marijuana Cocaine Narcotics and Methadone Caffeine Aspartame (NutraSweet) Drugs in Breast Milk Drugs Commonly Listed as Contraindicated During Breastfeeding Cytotoxic Drugs That May Interfere with Cellular Metabolism of the Nursing Infant Drugs of Abuse for Which Adverse Effects on the Infant During Breastfeeding Have Been Reported Radioactive Compounds That Require Temporary Cessation of Breastfeeding Drugs for Which the Effect on Nursing Infants Is Unknown but May Be of Concern Drugs That Have Been Associated with Significant Effects in Some Nursing Infants and Should Be Given to Nursing Mothers with Caution Bromocriptine Ergotamine Lithium Maternal Medication Usually Compatible with Breastfeeding Narcotics, Sedatives, and Anticonvulsants Cold Preparations Antihypertensives Thiazides β-Blockers Angiotensin-Converting Enzyme Inhibitors Calcium Channel Blockers Anticoagulants Corticosteroids Digoxin (Lanoxin) Antibiotics Acyclovir Antifungal Agents Oral Contraceptives Alcohol Propylthiouracil Histamine-2 Receptor Blockers Caffeine Smoking Occupational and Environmental Hazards Ionizing Radiation Acute Exposure Mutagenesis Video Display Terminals Lead Mercury The Obstetrician’s Role in Evaluating Drug and Reproductive Risks in and Beyond the Workplace Summary Key Points References Additional References Teratogenesis Epidemiology Hormones Anticonvulsants Vitamin A Derivatives Psychoactive Drugs Anticoagulants Thyroid and Antithyroid Drugs Cardiac and Antihypertensive Medications Antiasthmatics Antiemetics Antihistamines and Decongestants Antibiotics and Antiinfective Agents Ovulation Induction Medications Mild Analgesics Drugs of Abuse Caffeine Drugs in Breast Milk Radiation Lead References 9 Obstetrical Ultrasound: Biophysics of Ultrasound Optimizing the Ultrasound Image Power Gain Attenuation Focus Depth and Zoom Harmonic Imaging Special Ultrasound Modalies M-Mode Color and Pulse-Wave Doppler Three-Dimensional Ultrasound Scanning Technique Orientation Angle of Insonation Using Natural Windows First-Trimester Ultrasound First-Trimester Normal Findings First-Trimester Abnormal Findings Second- and Third-Trimester Ultrasound Types of Examinations Qualifications for Interpreting Diagnostic Ultrasound Examinations Components of the Examination Cardiac Activity Number of Fetuses Presentation Amniotic Fluid Volume Placenta and Umbilical Cord Uterus and Adnexa Anatomic Survey Documentation Ultrasound for Determining Gestational Age Standard Measurements Gestational Age Determination When to Use Ultrasound Dating Assessing Fetal Growth Estimating Fetal Weight Diagnosing Abnormal Growth Safety of Ultrasound Quantifying Machine Power Output “Entertainment” Ultrasound Examinations Key Points References 10 Genetic Counseling and Genetic Screening Frequency and Etiology of Genetic Disease Chromosomal Abnormalities Single-Gene Disorders Polygenic/Multifactorial Disorders Teratogenic Disorders Clinical Spectrum of Chromosomal Abnormalities Autosomal Trisomy Trisomy 21 Trisomy 13 Trisomy 18 Other Autosomal Trisomies Autosomal Deletions or Duplications Sex Chromosomal Abnormalities Monosomy X (45,X) Klinefelter Syndrome Polysomy X in Girls (47,XXX; 48,XXXX; 49,XXXXX) Polysomy Y in Boys (47,XYY and 48,XXYY) Genetic History Genetic Counseling Communication Nondirective Counseling Psychological Defenses Genetic Screening Carrier Screening for Heritable Conditions Ashkenazi Jewish Genetic Diseases Hemoglobinopathies Cystic Fibrosis Newborn Screening Screening for Aneuploidy First Trimester Screening Second Trimester Serum Screening First and Second Trimester Screening Factors Confounding Detection Rates Maternal Age Maternal Weight and Ethnicity Multiple Gestation Maternal Serum Alpha-Fetoprotein Screening for Neural Tube Defects Obstetrical Significance of Unexplained Elevated Maternal Serum Alpha-Fetoprotein Key Points References 11 Prenatal Genetic Diagnosis Diagnostic Procedures for Prenatal Genetic Diagnosis Amniocentesis Technique Amniocentesis in Twin Pregnancies Safety Early Amniocentesis Amniocentesis in Women with Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus Chorionic Villus Sampling Technique Safety Chorionic Villus Sampling in Twin Pregnancies Fetal Blood Sampling Technique Safety Indications for Prenatal Genetic Studies Cytogenetic Disorders Advanced Maternal Age Previous Child with Chromosomal Abnormality Parental Chromosomal Rearrangements Assisted Reproduction through Intracytoplasmic Sperm Injection Accuracy of Prenatal Cytogenetic Diagnosis Numerical Structural Newer Cytogenetic Approaches Fluorescence in Situ Hybridization Quantitative Fluorescent Polymerase Chain Reaction Comparative Genomic Hybridization and Chromosomal Microarrays Mendelian Disorders Molecular Approach to Diagnosis Mendelian Disorders Without Known Molecular Basis Multifactorial Disorders Ultrasound Diagnosis of Fetal Malformations Ultrasound as a Screening Test for Birth Defects Ultrasound Screening for Aneuploidy Second Trimester First Trimester Screening for Anomalies with the Standard Ultrasound Examination Head and Neck General Appearance Neural Tube Defects Cystic Hygroma Cleft Lip and Palate Micrognathia Cerebellum and Cisterna Magna Choroid Plexus Lateral Ventricles Midline Falx Chest Chest Masses Four-Chamber View of the Heart Outflow Tracts Abdomen Kidneys Bladder Umbilical Cord Insertion into the Abdomen Number of Umbilical Cord Vessels Spine Extremities Hydrops Effect of Prenatal Ultrasound on Neonatal Outcome Cell Free Fetal DNA and Intact Fetal Cells in Maternal Blood: Definitive Noninvasive Diagnosis Cell Free Fetal DNA in Maternal Blood Y-Sequences Single Gene Disorders Rhesus (D) Trisomy 21 Intact Fetal Cells Preimplantation Genetic Diagnosis Obtaining Embryonic and Gamete DNA Chromosomal Indications Single Gene Disorders Novel Indications Avoiding Clinical Termination Nondisclosure of Parental Genotype Cancer and Other Adult-Onset Disorders HLA-Compatible Embryos Aneuploidy Testing to Improve Pregnancy Rates Safety of Preimplantation Genetic Diagnosis Current Utility Key Points References 12 Antepartum Fetal Evaluation Defining the Problem of Perinatal Mortality Characteristics of Fetal Death Causes of Fetal Deaths Timing of Fetal Death Identifying Those at Risk Details on Select Maternal Conditions Potential Utility of Antepartum Fetal Testing What Do These Tests Tell Us About the Fetus? Fetal State Biophysical Techniques of Fetal Evaluation Maternal Assessment of Fetal Activity Contraction Stress Test Predictive Value of the Contraction Stress Test Nonstress Test Fetal Heart Rate Patterns Observable on the Nonstress Test Reactive Nonreactive Other Nonstress Test Patterns or Findings Sinusoidal Bradycardia Tachycardia Arrhythmia Deceleration Predictive Value of Nonstress Test Fetal Biophysical Profile Predictive Value of Biophysical Profile Modified Biophysical Profile Doppler Ultrasound Clinical Application of Tests of Fetal Well-Being Evidence for Condition-Specific Testing Strategies Assessment of Fetal Pulmonary Maturation Tests of Fetal Pulmonary Maturity Quantitation of Pulmonary Surfactant Measurements of Surfactant Function Determination of Fetal Pulmonary Maturation in Clinical Practice Conclusions and Future Directions Key Points References ADDITIONAL References Section III - Intrapartum Care 13 Normal Labor and Delivery Labor: Definition and Physiology Mechanics of Labor Uterine Activity (Powers) The Fetus (Passenger) The Maternal Pelvis (Passage) Cardinal Movements in Labor Engagement Descent Flexion Internal Rotation Extension External Rotation Expulsion Normal Progress of Labor Interventions Affecting Normal Labor Outcomes Active Management of Labor Second Stage of Labor Spontaneous Vaginal Delivery Delivery of the Placenta and Fetal Membranes Episiotomy, Perineal Injury, and Perineal Repair Key Points References 14 Abnormal Labor and Induction of Labor Diagnosis Abnormal Labor at Term Disorders of the Latent Phase Disorders of the Active Phase Electromechanical Classification Combined Disorder Disorders of the Second Stage Disorders of the Third Stage Precipitous Labor Anesthesia Effects on Labor Progress Management of Abnormal Labor and Delivery Pharmacologic Augmentation Side Effects Uterine Overactivity Water Intoxication Hypotension Uterine Rupture Anaphylaxis of Pregnancy (Amniotic Fluid Embolism) Induction of Labor Indications and Contraindications Prolonged Pregnancy Elective Induction of Labor Prediction of Labor Induction Success Cervical Ripening Failed Induction Techniques for Cervical Ripening and Labor Induction Oxytocin Low-Dose Versus High-Dose Oxytocin Oxytocin Dosing Intervals Oxytocin Dosing Protocols Prostaglandins Prostaglandin E2 Prostaglandin E1 Alternative Pharmacologic Methods Mechanical Methods Membrane Stripping Amniotomy Hygroscopic Dilators Transcervical Balloon Catheters Extra-Amniotic Saline Infusion Midtrimester Induction Summary Key Points References additional References Introduction Abnormal Labor at Term Disorders of the Second Stage Precipitous Labor Anesthesia Effects on Labor Progress Management of Abnormal Labor and Delivery Induction of Labor Cervical Ripening Elective Induction of Labor Prediction of Labor Induction Success Techniques for Cervical Ripening and Labor Induction Prostaglandins Alternative Pharmocologic Methods Mechanical Methods Midtrimester Induction 15 Operative Vaginal Delivery Operative Vaginal Delivery Classification, Prerequisites, and Indications Operative Vaginal Delivery Instruments Forceps Instruments “Classic” Forceps Rotational Forceps Other Specialized Instruments Vacuum Extraction Devices Stainless Steel Devices Soft Cup Devices Operative Vaginal Delivery Techniques Classic Forceps: Application for Occiput Anterior and Occiput Posterior Positions Rotational Forceps: Application for Occiput Transverse Positions Classic Forceps Keilland’s Forceps Forceps Rotation: Application for the Occiput Posterior Position Vacuum Extraction Risks And Benefits of Operative Vaginal Delivery Benefits of Operative Vaginal Delivery Maternal Risks Perineal Trauma Urinary Incontinence Fecal Incontinence Fetal Risks Craniofacial and Intracranial Injury Cephalohematoma and Subgaleal Hemorrhage Intracranial Hemorrhage Neurologic and Cognitive Effects Complex Operative Vaginal Delivery Procedures Rotations Greater Than 45 Degrees Midpelvic Cavity Delivery Sequential Use of Vacuum and Forceps Trial of Operative Vaginal Delivery Vacuum Delivery and the Preterm Fetus Counseling: Forceps, Vacuum, or Cesarean Delivery Simulation and Residency Training in Operative Vaginal Delivery Key Points References 16 Intrapartum Fetal Evaluation History of Fetal Monitoring Instrumentation for Electronic Fetal Heart Rate Monitoring Physiologic Basis of Fetal Heart Rate Monitoring Tachycardia Bradycardia Variability Periodic Changes Decelerations Early Decelerations Late Decelerations Variable Decelerations Prolonged Decelerations Accelerations Sinusoidal Patterns Additional Terminology from the NICHD Workshop Evolution of Fetal Heart Rate Patterns Management of Non-Reassuring Fetal Heart Rate Patterns Interventions for Non-reassuring Fetal Status Nonsurgical Interventions Oxygen Administration Lateral Positioning Hydration Oxytocin Tocolytics Amnioinfusion Meconium Alternatives for Evaluating the Fetus with a Non-reassuring Fetal Heart Rate Pattern Fetal Scalp pH Accelerations and Variability Fetal Pulse Oximetry ST Analysis, the STAN Technology Computerized Interpretation of Fetal Heart Rate Patterns Operative Intervention for Non-reassuring Fetal Status Management of Non-Reassuring Fetal Heart Rate Patterns: a Proposed Protocol Auscultation as an Alternative Assessment of Fetal Condition at Birth Risks and Benefits of Electronic Fetal Heart Rate Monitoring Summary Key Points References 17 Obstetrical Anesthesia Personnel Pain Pathways Effects of Pain and Stress Analgesia for Labor Psychoprophylaxis and Nonpharmacologic Analgesia Techniques Systemic Opioid Analgesia Patient-Controlled Analgesia Meperidine (Demerol) Nalbuphine (Nubain) Butorphanol (Stadol) Fentanyl Sedatives Placental Transfer Neuraxial Analgesic and Anesthetic Techniques Lumbar Epidural Analgesia and Anesthesia Complications of Neuraxial Blocks Hypotension Local Anesthetic Toxicity Allergy to Local Anesthetics High Spinal or “Total Spinal” Anesthesia Nerve Injury Spinal Headache Back Pain Breastfeeding Issues Effects on Labor and Method of Delivery Study Design Progress of Labor and Cesarean Delivery Rate Fever Paracervical Block Anesthesia for Vaginal Delivery Local Anesthesia Pudendal Nerve Block Monitored Anesthesia Care with Sedation Spinal (Subarachnoid) Block Lumbar Epidural Anesthesia General Anesthesia Anesthesia for Cesarean Delivery Premedication Antacids Left Uterine Displacement General Anesthesia Preoxygenation Induction Muscle Relaxants Cricoid Pressure Intubation Proper Tube Placement Nitrous Oxide and Oxygen Volatile Halogenated Agent Postdelivery Extubation Aspiration Neuraxial Anesthesia Postoperative Care Key Points References 18 Malpresentations and Shoulder Dystocia Clinical Circumstances Associated with Malpresentation Abnormal Axial Lie Management of A Singleton Gestation Deflection Attitudes Face Presentation Mechanism of Labor Brow Presentation Compound Presentation Breech Presentation Mechanism and Conduct of Labor and Vaginal Delivery Contemporary Management of the Term Breech Further Discussion of Delivery for the Term Frank or Complete Breech The Term Breech Trial Special Clinical Circumstances and Risks: Preterm Breech, Hyperextended Head, Footling Breech Breech Second Twin External Cephalic Version Shoulder Dystocia Key Points References AdDITIONAL References Face Presentation Mechanism of Labor Brow Presentation Mechanism and Conduct of Labor and Vaginal Delivery Contemporary Management of the Term Breech Further Discussion of Delivery for the Term Frank or Complete Breech The Term Breech Trial Shoulder Dystocia 19 Antepartum and Postpartum Hemorrhage Pregnancy-Related Hemodynamic Changes Physiologic Adaptation to Hemorrhage Classification of Hemorrhage Antepartum Hemorrhage Placental Abruption Definition and Pathogenesis Incidence Clinical Manifestations Risk Factors Increasing Parity and Maternal Age Cigarette Smoking Cocaine Abuse Trauma Maternal Hypertension Preterm Premature Rupture of Membranes Rapid Uterine Decompression Associated with Multiple Gestation and Polyhydramnios Thrombophilia Uterine and Placental Factors Prior Abruption Diagnosis Radiology Laboratory Findings Pathologic Studies Management Neonatal Outcome Placenta Previa Definition and Pathogenesis Incidence Clinical Manifestations Risk Factors Increasing Parity, Maternal Age, and Maternal Race Cigarette Smoking and Residence at Higher Elevation Multiple Gestations and Male Fetal Gender Previous Placenta Previa Prior Curettage and Prior Cesarean Delivery Diagnosis Radiology Management Outpatient Management Expectant Management of Preterm Patients Delivery Associated Conditions Placenta Accreta Definition and Pathogenesis Incidence and Risk Factors Clinical Manifestations Diagnosis Radiology Laboratory Findings Pathologic Studies Management Vasa Previa Definition and Pathogenesis Incidence and Risk Factors Clinical Manifestations Diagnosis Management Postpartum Hemorrhage Normal Blood Loss and Postpartum Hemorrhage Postpartum Hemorrhage Etiologies Uterine Atony Definition and Pathogenesis Incidence and Risk Factors Clinical Manifestations and Diagnosis Prevention and Management Bimanual Uterine Massage Uterotonic Therapy Uterine Tamponade Selective Arterial Embolization Surgical Intervention Genital Tract Lacerations Definition and Pathogenesis Incidence and Risk Factors Clinical Manifestations and Diagnosis Management Vulvar Hematoma Vaginal Hematoma Retroperitoneal Hematoma Retained Products of Conception Definition and Pathogenesis Incidence and Risk Factors Clinical Manifestations and Diagnosis Management Uterine Rupture Definition and Pathogenesis Incidence and Risk Factors Clinical Manifestations and Diagnosis Management Maternal and Neonatal Outcomes Uterine Inversion Definition and Pathogenesis Incidence and Risk Factors Clinical Manifestations and Diagnosis Management Coagulopathy Definition and Pathogenesis Incidence and Risk Factors Clinical Manifestations and Diagnosis Management Vitamin K Recombinant Activated Factor Viia Fibrinogen Concentrate Hemostatic Agents Fluid Resuscitation and Transfusion Volume Resuscitation Colloid Solutions Blood Component Therapy Whole Blood Packed Red Blood Cells Platelet Concentrates Fresh-Frozen Plasma Cryoprecipitate Transfusion Protocols Transfusion Risks and Reactions Metabolic Abnormalities and Hypothermia Immunologic Reactions Infection Risks Acute Lung Injury Blood Conservation Approaches Autologous Donation and Transfusion Acute Normovolemic Hemodilution Intraoperative and Postoperative Blood Salvage Alternative Oxygen Carriers Hemorrhage Prevention and Protocols Key Points References ADDITIONAL References Introduction Pregnancy-Related Hemodynamic Changes Antepartum Hemorrhage Antepartum Hemorrhage—Clinical Manifestations Antepartum Hemorrhage—Risk Factors Antepartum Hemorrhage—Management Neonatal Outcome Placenta Previa Placenta Previa—Incidence Placenta Previa—Clinical Manifestations Placenta Previa—Risk Factors Placenta Previa—Diagnosis Placenta Previa—Management Placenta Accreta Placenta Accreta—Radiology Placenta Accreta—Laboratory Findings Placenta Accreta—Management Vasa Previa Vasa Previa—Incidence and Risk Factors Vasa Previa—Diagnosis Postpartum Hemorrhage Postpartum Hemorrhage—Incidence and Risk Factors Postpartum Hemorrhage—Prevention and Management Genital Tract Lacerations Retained Products of Conception—Management Uterine Rupture Uterine Rupture—Incidence and Risk Factors Uterine Rupture—Clinical Manifestations and Diagnosis Uterine Rupture—Maternal and Neonatal Outcomes Uterine Inversion—Definition and Pathogenesis Uterine Inversion—Incidence and Risk Factors Uterine Inversion—Management Coagulopathy—Recombinant Activated Factor VIIA Coagulopathy—Transfusion Protocols Coagulopathy—Immunologic Reactions Coagulopathy—Infection Risks Intraoperative and Postoperative Blood Salvage Alternative Oxygen Carriers Hemorrhage Prevention and Protocols Online References 20 Cesarean Delivery Definitions History of Cesarean Delivery Incidence Trends in Cesarean Delivery Rates Monitoring Cesarean Delivery Rates Indications for Cesarean Delivery Maternal-Fetal Indications Fetal Indications Maternal Indications Cesarean Delivery on Maternal Request Technique of Cesarean Section Prophylactic Pre-cesarean Interventions, Including Antibiotics and Thromboprophylaxis Site Preparation Abdominal Incision Type and Dissection Uterine Incision and Delivery of the Fetus Extraction of the Fetus Placental Extraction and Uterine Repair Abdominal Closure Complications of Cesarean Delivery Intraoperative Complications Uterine Lacerations Bladder Injury Ureteral Injury Gastrointestinal Tract Injury Uterine Atony Placenta Accreta Maternal Mortality Maternal Postoperative Morbidity Endomyometritis Wound Infection Thromboembolic Disease Septic Pelvic Thrombophlebitis Vaginal Birth after Cesarean Delivery Trends Candidates for Trial of Labor After Cesarean Success Rates for Trial of Labor After Cesarean Maternal Demographics Prior Indication for Cesarean Delivery Prior Vaginal Delivery Birthweight Labor Status and Cervical Examinations Previous Incision Type Multiple Prior Cesarean Deliveries Risks of Vaginal Birth after Cesarean Delivery–Trial of Labor Uterine Rupture Risk Factors for Uterine Rupture Number of Prior Cesarean Deliveries Prior Vaginal Delivery Uterine Closure Technique Interpregnancy Interval Induction of Labor Labor Augmentation Sonographic Evaluation of the Uterine Scar Other Risks Associated with Vaginal Birth After Cesarean Delivery–Trial of Labor Management of Vaginal Birth After Cesarean Delivery–Trial of Labor Counseling for Vaginal Birth After Cesarean Delivery–Trial of Labor Cesarean Hysterectomy Technique and Complications Tubal Sterilization Modified Pomeroy The Parkland Procedure The Irving Procedure The Uchida Procedure Key Points References ADDITIONAL References History of Cesarean Delivery Trends in Cesarean Delivery Rates Monitoring Cesarean Delivery Rates Indications for Cesarean Delivery Technique of Cesarean Section Complications of Cesarean Delivery Vaginal Birth After Cesarean Delivery Risks of Vaginal Birth After Cesarean-Trial of Labor Cesarean Hysterectomy (Technique and Complications) Tubal Sterilization (Modified Pomeroy, The Irving Procedure, The Uchida Procedure) ONLINE References Section IV - Postpartum Care 21 The Neonate Cardiopulmonary Transition Pulmonary Development The First Breaths Fetal Breathing Mechanics of the First Breath Circulatory Transition Abnormalities of Cardiopulmonary Transition Birth Asphyxia Delivery Room Management of the Newborn Sequelae of Birth Asphyxia Birth Injuries Neonatal Thermal Regulation Physiology Clinical Applications Delivery Room Nursery Neonatal Nutrition and Gastroenterology Water and Electrolytes Calories Protein Carbohydrate Fat Infant Feeding Neonatal Hypoglycemia Congenital Gastrointestinal Surgical Conditions Gastrointestinal Tract Obstruction Abdominal Wall Defects Diaphragmatic Hernia Necrotizing Enterocolitis Neonatal Jaundice Neonatal Hematology Anemia Polycythemia Thrombocytopenia Vitamin K Deficiency Bleeding of the Newborn Perinatal Infection Early-Onset Bacterial Infection Respiratory Distress Cardiovascular Causes Pulmonary Causes Neonatal Neurology Intraventricular Hemorrhage and Periventricular Leukomalacia Seizures Classification of Newborns by Growth and Gestational Age Nursery Care Care of the Parents Outcome of Neonatal Intensive Care and Threshold of Viability The Late Preterm Infant Key Points References additional References Cardiopulmonary Transition Abnormalities of Cardiopulmonary Transition Birth Injuries Neonatal Thermal Regulation Neonatal Nutrition and Gastroenterology Neonatal Hematology Perinatal Infection Respiratory Distress Neonatal Neurology Classification of Newborns by Growth and Gestational Age Nursery Care Outcome of Neonatal Intensive Care The Late Preterm Infant ONLINE References 22 Postpartum Care Postpartum Involution The Uterus The Cervix The Fallopian Tube Ovarian Function Weight Loss Thyroid Function Cardiovascular System, Immunity, and Coagulation The Urinary Tract and Renal Function Other Changes Management of the Puerperium Health Maintenance Perineal Care Delayed Postpartum Hemorrhage and Postpartum Anemia Postpartum Infection Maternal-Infant Attachment Pregnancy Prevention and Birth Control Natural Methods Barrier Methods Hormonal Contraceptive Medications Intrauterine Devices Sterilization Postpartum Psychological Reactions Managing Perinatal Grieving Postpartum Posttraumatic Stress Disorder Key Points References additional References Postpartum Involution Postpartum Ovulation Thyroid Function Cardiovascular System, Immunity, Coagulation Urinary Tract and Renal Function Management of Puerperium Perineal Care Birth Control Sterilization Postpartum Psychological Reactions 23 Lactation and Breastfeeding Breast Anatomy and Development The Physiology of Lactation Stages of Lactogenesis The Endocrinology of Lactogenesis Milk Transfer Breast Milk: the Gold Standard Overview Limitations of Breastfeeding Research The Role of the Obstetrician and Gynecologist Successful Management of Breastfeeding Anatomic Abnormalities of the Breast Labor and Delivery Management Breast Milk Expression Maternal Nutrition and Exercise during Lactation Breast and Nipple Pain Mastitis and Breast Abscess Milk Transfer and Infant Growth Jaundice in the Newborn Galactogogues: Drugs to Improve Milk Production Maternal Disease Drugs in Breast Milk Breast Masses during Lactation Back-to-Work Issues Weaning Key Points References additional References General Breastfeeding Outcomes Breastfeeding and Host Response Breastfeeding Management Lactation Physiology Online References Section V - Complicated Pregnancy 24 Surgery During Pregnancy Maternal Physiology Diagnostic Imaging Ionizing Radiation Ultrasound Magnetic Resonance Imaging Anesthesia During Nonobstetrical Surgery Anesthesia and Teratogenicity Anesthesia and Pregnancy Physiology Nonobstetrical Surgery and Pregnancy Outcome Fetal Monitoring Laparoscopy in Pregnancy Laparoscopic Entry Techniques in Pregnancy Laparoscopy and Pregnancy Outcome Adnexal Masses in Pregnancy Obesity, Bariatric Surgery, and Pregnancy Key Points References 25 Trauma and Related Surgery in Pregnancy Incidence of Trauma in Pregnancy Anatomic and Physiologic Changes of Pregnancy Fetal Physiology Maternal Anatomic and Physiologic Changes Blunt Trauma Motor Vehicle Crashes Falls Domestic Violence Specific Injuries Fractures Penetrating Trauma Thermal Injuries (Burns) Direct Fetal Injuries Pathophysiology of Fetal Loss Resulting From Maternal Trauma Predictors of Fetal Mortality Management Considerations Initial Approaches Evaluation on Labor and Delivery Fetal Monitoring Laboratory Testing Diagnostic Imaging during Pregnancy Ultrasound Ionizing Radiation MRI Contrast Agents Suggested Guidelines for Radiologic Evaluation of Trauma Surgery for Traumatic Injuries during Pregnancy Uterine Rupture Perimortem Cesarean Section Other Considerations Long-Term Effects of Trauma Prevention of Trauma Screening and Identification of Women at Risk for Domestic Violence Key Points References 26 Pregnancy Loss Frequency and Timing of Pregnancy Loss Placental Anatomic Characteritics of Successful and Unsuccessful Pregnancies Numerical Chromosomal Abnormalities: the Most Frequent Causes of Early Pregnancy Loss Types of Numerical Chromosomal Abnormalities Autosomal Trisomy Polyploidy Sex Chromosomal Polysomy (X or Y) Monosomy X Relationship Between Recurrent Losses and Numerical Chromosomal Abnormalities Expectation of Abortus Karyotype in Recurrent Abortion Genetic Counseling for Recurrent Aneuploidy Clinical Management of Recurrent Aneuploidy Chromosomal Rearrangements Translocations Inversions Mendelian and Polygenic/Multifactorial Etiology Luteal Phase Defects Thyroid Abnormalities Diabetes Mellitus Intrauterine Adhesions (Synechiae) Müllerian Fusion Defects Leiomyomas Cervical Insufficiency Infections Acquired Thrombophilias Inherited Thrombophilias Exogenous Agents X-Irradiation and Chemotherapeutic Agents Alcohol Caffeine Contraceptive Agents Chemicals Cigarette Smoking Trauma Psychological Factors Management of Recurrent Early Pregnancy Loss When Is Formal Evaluation Necessary? Recommended Evaluation Late Pregnancy Loss (Stillbirth) Recurrence Genetic Factors Polygenic/Multifactorial Maternal Evaluation Management in Subsequent Pregnancies Obstetrical Outcome After Early Pregnancy Complications Key Points References 27 Cervical Insufficiency The Spontaneous Preterm Birth Syndrome The Diagnosis of Cervical Insufficiency Cervical Competence as A Biologic Continuum Tests for Cervical Insufficiency Risk Factors for Cervical Insufficiency Use of Cerclage for Risk Factors Can Sonographic Evaluation of the Cervix Diagnose Insufficiency? Cerclage for Cervical Sonographic Indications Patient Selection for Cerclage Acute Cervical Insufficiency Cerclage Technique History-Indicated (a.k.a. Prophylactic) and Ultrasound-Indicated Cerclage Physical Examination–Indicated (a.k.a. Emergent) Cerclage Risks of Cerclage Alternative Treatments to Cervical Cerclage Summary Key Points References 28 Preterm Birth Definitions Frequency of Preterm and Low Birth Weight Delivery Outcomes for Infants Born Preterm Perinatal Mortality Infant Mortality Perinatal Morbidity Long-term Outcomes Epidemiology of Preterm Birth Clinical Risk Factors for Spontaneous Preterm Birth Host Factors Medical Infections Periodontal Disease Genitourinary Tract Factors Cervical Length Cervical Procedures Congenital Abnormalities of the Uterus Behavioral Smoking and Substance Abuse Physical Activity Nutritional Factors Demography, Stress, and Social Determinants of Health African Americans Genetic Contributors to Preterm Birth Past Pregnancy History Current Pregnancy Risks Bleeding and Vanishing Twins Multifetal Gestation and Uterine Distention Scoring Systems Pathophysiology of Spontaneous Preterm Birth Cervical Changes (Ripening) Increased Uterine Contractility Decidual Membrane Activation Fetal Participation in the Onset of Labor The Preterm Parturition Syndrome Intrauterine Infection Frequency of Intrauterine Infection in Spontaneous Preterm Birth Intrauterine Infection as a Chronic Process Infection, Preterm Labor, and Neonatal Outcomes Gene-Environment Interactions Uteroplacental Ischemia/Decidual Hemorrhage Uterine Overdistention Abnormal Allograft Reaction Allergy-Induced Preterm Labor Cervical Insufficiency Endocrine Disorders Summary of the Preterm Parturition Syndrome Clinical Care for Women in Preterm Labor Diagnosis of Preterm Labor Diagnostic Tests for Preterm Labor Amniocentesis for Women with Preterm Labor Goals of Treatment for Women in Preterm Labor Maternal Transfer Antibiotics Antenatal Corticosteroids Fetal Effects Other Fetal Effects of Glucocorticoids Maternal Effects Duration of Benefit Risks of Antenatal Corticosteroid Treatment Other Antenatal Treatments to Reduce Fetal/Neonatal Morbidity Respiratory Distress Neurologic Morbidity Treatment Protocol Tocolysis Efficacy Choosing a Tocolytic Agent Pharmacology Contraindications to Tocolysis Calcium Channel Blockers Maternal Effects Fetal Effects Treatment Protocol Summary of Treatment with Calcium Channel Blockers Magnesium Sulfate Maternal Effects Neonatal Effects Summary of Treatment with Magnesium Sulfate Cyclo-oxygenase Inhibitors Maternal Effects Fetal and Neonatal Effects Treatment Protocol Protocol for Indomethacin Tocolysis Summary of Treatment with Indomethacin β-Mimetic Tocolytics Side Effects and Complications of β-Mimetic Tocolysis Cardiopulmonary Complications of β-Mimetics. Metabolic Complications. Neonatal Effects. Summary of Treatment with β-Mimetic Tocolysis Other Tocolytic Agents Clinical Use of Tocolytic Drugs Persistent Contractions Care After Acute Treatment for Preterm Labor Maintenance Tocolytic Treatment Conduct of Labor and Delivery for the Preterm Infant Intrapartum Assessment of the Preterm Fetus Labor and Delivery Cesarean Delivery Prevention of Preterm Birth Secondary Prevention of Preterm Birth Before Pregnancy During Pregnancy Modification of Maternal Activity Nutritional Supplements Enhanced Prenatal Care Periodontal Care Antibiotic Treatment Progesterone Cervical Cerclage Clinical Use of Progesterone and Cerclage to Prevent Preterm Birth Late Preterm Birth Primary Prevention of Preterm Birth Public Educational Interventions Public and Professional Policies Social Determinants of Health Summary Key Points References additional References Introduction and Epidemiology Host Factors—Maternal-Congenital Abnormalities of the Uterus Host Factors—Maternal-Behavioral Smoking and Substance Abuse Physical Activity Nutritional Factors Demography, Stress, and Social Determinants of Health Genetic Contributors to Preterm Birth Past Pregnancy History Pregnancy Termination Current Pregnancy Risks Bleeding and Vanishing Twins Multifetal Gestation and Uterine Distention Scoring Systems Pathophysiology of Spontaneous Preterm Birth Cervical Changes (Ripening) Increased Uterine Contractility Decidual Membrane Activation Fetal Participation in the Onset of Labor Preterm Parturition Syndrome Intrauterine Infection Frequency of Intrauterine Infection in Spontaneous Preterm Birth Intrauterine Infection as a Chronic Process Infection, Preterm Labor, and Neonatal Outcomes Gene-Environment Interactions Uteroplacental Ischemia/Decidual Hemorrhage Uterine Overdistention Abnormal Allograft Rejection Allergy-Induced Preterm Labor Endocrine Disorders Clinical Care for Women in Preterm Labor Diagnosis of Preterm Labor Diagnostic Tests for Preterm Labor Maternal Transfer Antibiotics Antenatal Corticosteroids Maternal Effects Duration of Benefit Risks of Antenatal Cortcosteroid Treatment Other Antenatal Treatments to Reduce Fetal/Neonatal Morbidity Neurologic Morbidity Tocolysis Calcium Channel Blockers Magnesium Sulfate Cyclooxygenase Inhibitors Beta-Mimetic Tocolytics Other Tocolytic Agents Clinical Use Of Tocolytic Drugs Maintenance Tocolytic Treatment Intrapartum Assessment of the Preterm Fetus Labor and Delivery Cesarean Delivery Prevention of Preterm Birth Modification Of Maternal Activity Nutritional Supplements Enhanced Prenatal Care Periodontal Care Antibiotic Treatment Progesterone Cervical Cerclage Late Preterm Birth Primary Prevention of Preterm Birth 29 Premature Rupture of the Membranes Fetal Membrane Anatomy and Physiology Etiology of Premature Rupture of the Membranes Prediction and Prevention of Preterm Premature Rupture of the Membranes Clinical Course after Premature Rupture of the Membranes Risks OF Premature Rupture of the Membranes Maternal Risks Fetal and Neonatal Risks Diagnosis of Premature Rupture of the Membranes Management of Premature Rupture of the Membranes General Considerations Management of Premature Rupture of the Membranes at Term Management of Preterm Premature Rupture of the Membranes Near Term (32 to 36 Weeks) Management of Premature Rupture of the Membranes Remote from Term (23 to 31 weeks) Corticosteroid Administration Antibiotic Administration Tocolysis Cervical Cerclage Herpes Simplex Virus Management of Previable Premature Rupture of the Membranes Summary Key Points References 30 Multiple Gestations Zygosity and Chorionicity Distribution and Causes of Dizygotic Versus Monozygotic Twinning Diagnosis of Multiple Gestations Determination of Chorionicity Determination of Zygosity Maternal and Fetal Risks of Multiple Gestation Maternal Adaptation to Multifetal Gestation Maternal Morbidity and Mortality Perinatal Morbidity and Mortality Fetal Anomalies Issues and Complications Unique to Multiple Gestations “Vanishing Twin” “Appearing Twin” First-Trimester Multifetal Pregnancy Reduction Discordance for Anomalies Selective Termination of an Anomalous Fetus Cord Occlusion for Selective Termination in Monochorionic Twins Intrauterine Fetal Death of One Twin Twin–Twin Transfusion Syndrome Etiology Diagnosis and Staging Management Serial Amnioreduction Septostomy Laser Therapy Outcomes after Laser Therapy Monoamniotic Twins Twin Reversed Arterial Perfusion Sequence Conjoined Twins Antepartum Management of Multifetal Pregnancy Maternal Nutrition and Weight Gain Spontaneous Preterm Birth Bedrest and Hospitalization Cerclage Tocolysis Progesterone Antenatal Testing Fetal Growth Surveillance Discordant Growth Specialized Twin Clinics Timing of Delivery in Multiple Gestations Monochorionic, Diamniotic Twins: Special Considerations Regarding Delivery Timing Fetal Lung Maturity in Twins Timing of Delivery in Triplets Mode of Delivery in Multiple Gestations Vertex-Vertex Twins Nonvertex-Presenting Twin Vertex-Nonvertex Twins Triplets Intrapartum Management of Twin Vaginal Delivery Time Interval Between Deliveries Conclusion Key Points References 31 Intrauterine Growth Restriction Regulation of Fetal Growth Definition and Patterns of Fetal Growth Restriction Etiologies of Intrauterine Growth Restriction Maternal and Fetal Manifestations of Intrauterine Growth Restriction Maternal Impacts Fetal Impacts Diagnostic Tools in Fetal Growth Restriction Fetal Biometry Fetal Body Composition Reference Ranges Defining Fetal Growth Fetal Anatomic Survey Amniotic Fluid Assessment Doppler Velocimetry Invasive Testing Screening and Prevention of Fetal Growth Restriction Maternal History Maternal Serum Analytes Clinical Examination Maternal Doppler Velocimetry First Trimester Integrated Screening Preventive Strategies Management in Clinical Practice Therapeutic Options Assessment of Fetal Well-Being (See Chapter 12) Maternal Monitoring of Fetal Activity Fetal Heart Rate Analysis Amniotic Fluid Volume Biophysical Parameters Doppler Ultrasound Invasive Fetal Testing Anticipating the Progression to Fetal Compromise The Timing of Delivery Delivery Outcome Short-Term Outcomes Long-Term Outcomes Key Points References ADDITIONAL References Regulation of Growth Definition and Patterns of Growth Restriction Etiologies of Intrauterine Growth Restriction Maternal and Fetal Manifestations of Intrauterine Growth Restriction Diagnostic Tools in Fetal Growth Restriction Screening and Prevention of Fetal Growth Restriction Management in Clinical Practice Assessment of Fetal Well-Being The Timing of Delivery Outcomes 32 Red Cell Alloimmunization Nomenclature Historical Perspectives Incidence Pathophysiology Rhesus Alloimmunization and Fetal/Neonatal Hemolytic Disease of the Newborn Genetics Prevention of RhD Hemolytic Disease in the Fetus and Newborn History Preparations Indications Diagnostic Methods Maternal Antibody Determination Fetal Blood Typing Amniocentesis to Follow the Severity of Hemolytic Disease of the Fetus and Newborn Fetal Blood Sampling Ultrasound Clinical Management First Affected Pregnancy Previously Affected Fetus or Infant Intrauterine Transfusion Technique Complications and Outcome Neonatal Transfusions Neurologic Outcome Other Treatment Modalities Future Therapeutic Options Hemolytic Disease of the Fetus and Newborn Due to Non-RhD Antibodies Rhc RhC, RhE, and Rhe M Duffy Kidd Kell Key Points References 33 Amniotic Fluid Disorders Normal Amniotic Fluid Volume Ultrasound Measurement of Amniotic Fluid Volume Amniotic Fluid Formation Fetal Urine Lung Liquid Amniotic Fluid Removal Fetal Swallowing Intramembranous Absorption Oligohydramnios Evaluation and Treatment of Oligohydramnios Oligohydramnios in Labor Polyhydramnios Evaluation and Treatment of Polyhydramnios Key Points References 34 Prolonged and Postterm Pregnancy Definition Incidence Etiology Diagnosis Perinatal Morbidity and Mortality Oligohydramnios Fetal Growth Postmaturity Meconium Maternal Complications Management Antenatal Surveillance Expectant Management Versus Induction of Labor Labor Induction Long-Term Neonatal Outcomes Multiple Gestation Key Points References Section VI - Pregnancy and Coexisting Disease 35 Hypertension Definitions Gestational Hypertension Preeclampsia and Eclampsia Chronic Hypertension Chronic Hypertension with Superimposed Preeclampsia Gestational Hypertension Preeclampsia Atypical Preeclampsia Capillary Leak Syndrome: Facial Edema, Ascites and Pulmonary Edema, and Gestational Proteinuria Gestational Proteinuria Preeclampsia-Eclampsia at Less Than 20 Weeks’ Gestation Risk Factors for Preeclampsia Pathophysiology Uterine Vascular Changes Vascular Endothelial Activation and Inflammation Genetics and Genetic Imprinting Changes in Prostanoids Lipid Peroxide, Free Radicals, and Antioxidants Diagnosis of Preeclampsia Prediction of Preeclampsia Prevention of Preeclampsia Calcium Supplementation Antithrombotic Agents Vitamins C and E Laboratory Abnormalities in Preeclampsia Renal Function Hepatic Function Hematologic Changes HELLP Syndrome Laboratory Criteria for Diagnosis Clinical Findings Differential Diagnosis Management of HELLP Syndrome Expectant Management of HELLP Syndrome Corticosteroids to Improve Pregnancy Outcome in Women with HELLP Syndrome Maternal and Perinatal Outcome Recommended Management Intrapartum Management Postpartum Management Hepatic Complications in HELLP Syndrome Hepatic Infarction Hepatic Hematoma and Rupture Liver Transplantation for Intractable Hemorrhage Hemodynamic Monitoring in Preeclampsia Antepartum Management of Mild Hypertension-Preeclampsia Gestational Hypertension Hospitalization Bedrest Blood Pressure Medications Fetal and Maternal Surveillance Recommended Management Mild Hypertension or Preeclampsia Severe Hypertension in Preeclampsia Expectant Management Recommended Management of Severe Hypertension-Preeclampsia Intrapartum Management Prevention of Eclamptic Seizures Control of Severe Hypertension Mode of Delivery Postpartum Management Maternal and Perinatal Outcome with Preeclampsia Counseling Women Who Have Had Preeclampsia in Prior Pregnancies Remote Prognosis Eclampsia Pathophysiology Diagnosis Time of Onset Cerebral Pathology Differential Diagnosis Maternal and Perinatal Outcome Is Eclampsia Preventable? Maternal Transport of the Eclamptic Patient Treatment of Eclamptic Convulsions Prevention of Maternal Injury During the Convulsions Prevention of Recurrent Convulsions Control of Severe Hypertension Intrapartum Management Postpartum Management of Eclampsia Subsequent Pregnancy Outcome and Remote Prognosis Incidence of Chronic Hypertension Definition and Diagnosis Etiology and Classification Maternal-Perinatal Risks Goals of Antihypertensive Therapy in Pregnancy Safety of Antihypertensive Drugs in Pregnancy Recommended Management of Chronic Hypertension in Pregnancy Evaluation and Classification Low-Risk Hypertension High-Risk Hypertension Postpartum Management Hypertensive Emergencies in Chronic Hypertension Hypertensive Encephalopathy Treatment of Hypertensive Encephalopathy Lowering Blood Pressure in Hypertensive Encephalopathy Sodium Nitroprusside Nitroglycerin Key Points References ADDITIONAL References Prevention Renal Function Hepatic Function Hematologic Changes HELLP SYNDROME Hemodynamics Management Counseling Women Eclampsia Chronic Hypertension 36 Heart Disease Maternal Hemodynamics Blood Volume Diagnosis and Evaluation of Heart Disease General Care Valvular Disease Mitral Stenosis Mitral Regurgitation Aortic Stenosis Aortic Regurgitation Prosthetic Valves Congenital Heart Disease Isolated Septal Defects Patent Ductus Arteriosus Tetralogy of Fallot Transposition of the Great Vessels Fontan Repair Eisenmenger Syndrome Coarctation of the Aorta Summary Cardiomyopathy Myocardial Infarction Marfan Syndrome Pulmonary Hypertension Other Conditions Critical Care: Hemodynamic Monitoring and Management Hemodynamic Monitoring Hemodynamic Management Key Points References ADDITIONAL References Valvular Disease General Care Diagnosis and Evaluation of Heart Disease Congenital Heart Disease Cardiomyopathy Myocardial Infarction Marfan Syndrome Pulmonary Hypertension Critical Care: Hemodynamic Monitoring and Management 37 Respiratory Diseases in Pregnancy Pneumonia in Pregnancy Bacteriology Bacterial Pneumonia Viral Pneumonias Influenza Virus Varicella Virus Pneumocystis jiroveci Pneumonia Tuberculosis in Pregnancy Diagnosis Prevention Treatment Summary Asthma in Pregnancy Diagnosis Effects of Pregnancy on Asthma Effects of Asthma on Pregnancy Asthma Management Objective Measures for Assessment and Monitoring Patient Education Avoidance or Control of Asthma Triggers Pharmacologic Therapy Step Therapy Inhaled Corticosteroids Inhaled β2-Agonists Omalizumab Theophylline Leukotriene Moderators Oral Corticosteroids Management of Allergic Rhinitis and Gastroesophageal Reflux Antenatal Management Home Management of Asthma Exacerbations Hospital and Clinic Management of Asthma Exacerbations Labor and Delivery Management Breastfeeding Summary Restrictive Lung Disease Sarcoidosis Cystic Fibrosis Effect of Pregnancy on Cystic Fibrosis Counseling Patients with Cystic Fibrosis in Pregnancy Management of the Pregnancy Complicated by Cystic Fibrosis Key Points References 38 Renal Disease Introduction Altered Renal Physiology in Pregnancy Asymptomatic Bacteriuria Pyelonephritis Acute Renal Disease in Pregnancy Urolithiasis Glomerulonephritis Acute Renal Failure in Pregnancy Hemolytic Uremic Syndrome Polycystic Kidney Disease Vesicoureteral Reflux Renal Artery Stenosis Nephrotic Syndrome Chronic Renal Disease in Pregnancy Effect of Pregnancy on Renal Function Effect of Chronic Renal Disease on Pregnancy Management of Chronic Renal Disease in Pregnancy Hemodialysis in Pregnancy Renal Transplant Key Points References 39 Diabetes Mellitus Complicating Pregnancy Pathophysiology Normal Glucose Tolerance Glucose Metabolism Diabetes Mellitus Type 1 Diabetes Mellitus Type 2 Diabetes and Gestational Diabetes Amino Acid Metabolism Lipid Metabolism Maternal Weight Gain and Energy Expenditure Perinatal Morbidity and Mortality Fetal Death Congenital Malformations Fetal Macrosomia Hypoglycemia Respiratory Distress Syndrome Calcium and Magnesium Metabolism Hyperbilirubinemia and Polycythemia Cardiomyopathy Maternal Classification and Risk Assessment Nephropathy Retinopathy Coronary Artery Disease Detection and Significance of Gestational Diabetes Mellitus Treatment of the Patient with Type 1 or Type 2 Diabetes Mellitus Ketoacidosis Antepartum Fetal Evaluation Timing and Mode of Delivery Glucoregulation during Labor and Delivery Management of the Woman with Gestational Diabetes Is There a Benefit to the Treatment of Gestational Diabetes Mellitus? Randomized Treatment Trials for Gestational Diabetes Mellitus Treatment of the Woman with Gestational Diabetes Mellitus Postpartum Follow-Up of Women with Gestational Diabetes Mellitus Long-Term Effects of Glucose Intolerance on Mother and Fetus Prepregnancy Counseling of Women with Preexisting Diabetes Mellitus Contraception Key Points References ADDITIONAL References Pathophysiology Diabetes Mellitus Perinatal Morbidity and Mortality Maternal Classification and Risk Assessment Detection and Significance of Gestational Diabetes Mellitus Treatment of the Patient with Type 1 or Type 2 Diabetes Mellitus Antepartum Fetal Evaluation Timing and Mode of Delivery Glucoregulation During Labor and Delivery Management of the Woman with Gestational Diabetes Postpartum Follow-Up of Women with GDM Prepregnancy Counseling of Women with Preexisting Diabetes Mellitus Contraception 40 Thyroid and Parathyroid Diseases in Pregnancy Parathyroid Diseases Calcium Homeostasis During Pregnancy Hyperparathyroidism Differential Diagnosis of Hypercalcemia Therapy Hypoparathyroidism Pseudohypoparathyroidism Vitamin D Deficiency Osteoporosis Thyroid Diseases Thyroid Function Tests Prepregnancy Counseling Maternal-Placental-Fetal Interactions Hyperthyroidism Gestational Hyperthyroidism Transient Hyperthyroidism of Hyperemesis Gravidarum Graves’ Disease Treatment of Thyroid Storm Neonatal Hyperthyroidism Fetal Hyperthyroidism Neonatal Central Hypothyroidism Resistance to Thyroid Hormone Syndrome Hypothyroidism Etiology and Classification of Hypothyroidism Subclinical Hypothyroidism Clinical Hypothyroidism Isolated Hypothyroxinemia Universal versus Selective Screening for Thyroid Disease Euthyroid Chronic or Hashimoto Thyroiditis Treatment of Hypothyroidism Single Nodule of the Thyroid Gland Patients with Known Thyroid Cancer before Pregnancy Postpartum Thyroid Dysfunction Key Points Acknowledgment References additional References Calcium Metabolism, Parathyroid, Calcitonin, Bone Parathyroid Diseases Vitamin D Osteoporosis Thyroid Diseases Iodine Maternal-Fetal Physiopathology hCG and Thyrotoxicosis Hyperthyroidism Antithyroid Drug Therapy Fetal and Neonatal Pathology Thyroxine Resistance Syndrome Hypothyroidism Screening Chronic or Hashimoto’s Thyroiditis Goiter, Thyroid Nodules, and Cancer Postpartum Thyroiditis 41 Pituitary and Adrenal Disorders in Pregnancy Anterior Pituitary Anterior Pituitary Hormone Changes in Pregnancy Pituitary Tumors Prolactinoma Acromegaly Thyrotropin-Secreting Tumors Clinically Nonfunctioning Adenomas Hypopituitarism Sheehan Syndrome Lymphocytic Hypophysitis Posterior Pituitary Diabetes Insipidus Adrenals Cushing Syndrome Adrenal Insufficiency Primary Hyperaldosteronism Pheochromocytoma Key Points References 42 Hematologic Complications of Pregnancy Pregnancy-Associated Thrombocytopenia Gestational Thrombocytopenia Immune Thrombocytopenic Purpura Thrombotic Thrombocytopenic Purpura and Hemolytic Uremic Syndrome Evaluation of Thrombocytopenia During Pregancy and the Puerperium Therapy of Thrombocytopenia During Pregnancy Gestational Thrombocytopenia Immune Thrombocytopenic Purpura Management of Thrombotic Thrombocytopenic Purpura and Hemolytic Uremic Syndrome Fetal/Neonatal Alloimmune Thrombocytopenia Iron Deficiency Anemia Megaloblastic Anemia Hemoglobinopathies Hemoglobin S Hemoglobin SC Disease Thalassemia Von Willebrand’s Disease Key Points References additional References Thrombocytopenia Anemias (Iron, Folate, Vitamin B12) Hemoglobinopathies Von Willebrand’s Disease 43 Thromboembolic Disorders Epidemiology Risk Factors Physiology of Hemostasis Vasoconstriction and Platelet Action Coagulation Cascade Anticoagulant System Clot Lysis and Fibrinolysis Pathophysiology of Thrombosis in Pregnancy Antiphospholipid Antibody Syndrome Inherited Thrombophilias Diagnosis of Venous Thromboembolism Deep Venous Thrombosis Clinical Signs and Symptoms Risk Scoring System Imaging D-Dimer Assays Workup of Patients with Suspected Deep Venous Thrombosis Pulmonary Embolus Clinical Signs and Symptoms Nonspecific Studies Pulmonary Arteriography Ventilation-Perfusion Scanning Spiral Computed Tomographic Pulmonary Angiography Ventilation-Perfusion Scanning Versus Computed Tomographic Pulmonary Angiography Magnetic Resonance Angiography D-Dimer Assays Lower Extremity Evaluation Workup of Patients with Suspected Pulmonary Embolus Radiation Exposure in Pregnancy Fetal Exposure Maternal Exposure Treatment of Thromboembolism in Pregnancy Unfractionated Heparin Low-Molecular-Weight Heparin Fondaparinux Coumarin Treatment of Acute Deep Venous Thrombosis or Pulmonary Embolus Prophylactic Applications and Dosing Other Considerations of Therapy and Prevention Perioperative Prevention Inferior Vena Cava Filters Key Points References additional References 44 Collagen Vascular Diseases Systemic Lupus Erythematosus Epidemiology and Etiology Clinical Manifestations Diagnosis Clinical Features Laboratory Findings Systemic Lupus Erythematosus and Pregnancy Risk for Systemic Lupus Erythematosus Exacerbation (Flare) Lupus Nephritis and Pregnancy Pregnancy Loss Preeclampsia Intrauterine Growth Restriction Preterm Birth Neonatal Lupus Erythematosus Drug Therapy and Systemic Lupus Erythematosus in Pregnancy Nonsteroidal Anti-inflammatory Drugs Glucocorticoids Antimalarials Azathioprine Cyclosporine Drugs with Moderate to High Risk for Fetal Harm Obstetrical Management Antiphospholipid Syndrome Epidemiology Pathophysiology Clinical Manifestations Diagnosis Laboratory Findings Pregnancy in Women with Antiphospholipid Syndrome Treatment of Antiphospholipid Syndrome in Pregnancy Rheumatoid Arthritis Pathophysiology Clinical Manifestations and Laboratory Findings Rheumatoid Arthritis and Pregnancy Obstetrical Complications Obstetrical Management Antirheumatic Medications Systemic Sclerosis Pathogenesis Clinical Manifestations and Diagnosis Systemic Sclerosis and Pregnancy Effects of Pregnancy on Systemic Sclerosis Effects of Systemic Sclerosis on Pregnancy Obstetrical Management Sjögren Syndrome Key Points References 45 Hepatic and Gastrointestinal Diseases Hepatic Disorders During Pregnancy Physiologic Effects of Pregnancy and Assessment of Liver Disease Differential Diagnosis of Hepatobiliary Symptoms and Conditions during Pregnancy Jaundice Right Upper Quadrant Abdominal Pain Nausea and Vomiting Pruritus Hepatic Lesions Ascites Abdominal Imaging during Pregnancy Therapeutic Endoscopy during Pregnancy Therapeutic Endoscopic Retrograde Cholangiopancreatography Endoscopic Variceal Sclerotherapy or Banding Pancreatobiliary Disease Acute Pancreatitis Cholelithiasis and Cholecystitis Choledocholithiasis Choledochal Cysts Common Liver Diseases Incidental to Pregnancy Acute Viral Hepatitis A, B, and C Wilson’s Disease Autoimmune Hepatitis Hepatic Hemangiomas, Cysts, and Abscesses Hepatocellular Carcinoma and Hepatic Metastases Liver Diseases Significantly Affected by Pregnancy Hepatitis E Chronic Hepatitis B Chronic Hepatitis C Hepatic Adenomas Acute Intermittent Porphyria Sickle Cell Hemoglobinopathies Portal Hypertension Budd-Chiari Syndrome Pregnancy After Liver Transplantation Liver Disease Strongly Related or Unique to Pregnancy Alcoholism During Pregnancy Hepatic Involvement in Hyperemesis Gravidarum Herpes Simplex Hepatitis Intrahepatic Cholestasis of Pregnancy Preeclampsia and Eclampsia Hemolysis, Elevated Liver Function Tests, and Low Platelet Count (HELLP) Syndrome Management of Preeclampsia, Eclampsia, and HELLP Syndrome Hepatic Hemorrhage and Rupture Acute Fatty Liver of Pregnancy Key Points References additional References Physiologic Effects of Pregnancy and Assessment of Liver Disease Abdominal Imaging During Pregnancy Therapeutic Endoscopy During Pregnancy Pancreatobiliary Disease Common Liver Disease Incidental to Pregnancy Liver Diseases Significantly Affected by Pregnancy Liver Diseases Strongly Related or Unique to Pregnancy Gastrointestinal Disorders During Pregnancy Physiologic Effects of Pregnancy on Abdominal Disorders Differential Diagnosis and Evaluation of Gastrointestinal Symptoms during Pregnancy Abdominal Pain Upper Gastrointestinal Symptoms Nausea and Vomiting Dyspepsia or Pyrosis Hematemesis Dysphagia Lower Gastrointestinal Symptoms Diarrhea Constipation Rectal Bleeding Diagnostic Testing during Pregnancy Radiologic Imaging Endoscopy during Pregnancy Gastrointestinal Disorders Predominantly Upper Gastrointestinal Disorders Hyperemesis Gravidarum Gastroesophageal Reflux and Peptic Ulcer Disease Diaphragmatic Rupture Predominantly Lower Gastrointestinal Disorders Acute Appendicitis Intestinal Obstruction Intestinal Pseudo-obstruction Colon Cancer Inflammatory Bowel Disease Hemorrhoids Mesenteric Ischemia and Infarction Irritable Bowel Syndrome Splenic Artery Aneurysm Rupture Key Points References additional References Physiologic Effects of Pregnancy on Abdominal Pain Differential Diagnosis and Evaluation of Gastrointestinal Symptoms During Pregnancy Diagnostic Testing During Pregnancy Gastrointestinal Disorders 46 Neurologic Disorders Seizure Disorders Effects of Epilepsy on Reproductive Function Effect of Pregnancy on Epilepsy Effects of Pregnancy on the Disposition of Anticonvulsant Medications Effect of Epilepsy on Pregnancy Effects of Anticonvulsant Medications on the Fetus Preconceptional Counseling for the Reproductive-Age Woman with a Seizure Disorder Care of the Patient During Pregnancy Labor and Delivery New Onset of Seizures in Pregnancy and the Puerperium Postpartum Period Migraine Cerebrovascular Diseases Arterial Occlusion Cerebral Vein Thrombosis Subarachnoid Hemorrhage Diagnosis and Treatment Multiple Sclerosis Carpal Tunnel Syndrome Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) Key Points References additional References Epilepsy Effect of Pregnancy on Epilepsy Effect of Pregnancy on Disposition of Medications Effect of Epilepsy on Pregnancy Effects of Anticonvulsant Medications on the Fetus Care of Patient during Pregnancy New Onset of Seizures in Pregnancy and Puerperium Postpartum Period Migraine Cerebrovascular Diseases Multiple Sclerosis Carpal Tunnel Syndrome Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) References 47 Malignant Diseases and Pregnancy Chemotherapy during Pregnancy Pharmacology of Chemotherapy During Pregnancy Drug Effects on the Fetus Classification of Chemotherapy Agents Antimetabolites Alkylating Agents Antitumor Antibiotics Vinca Alkaloids Platinum Agents Miscellaneous Targeted Therapies National Registry Radiation Therapy Surgery and Anesthesia Pregnancy Following Cancer Treatment Cancer during Pregnancy Breast Cancer Diagnosis and Staging Treatment Local Therapy Pregnancy Termination Chemotherapy Prognosis Subsequent Pregnancy Lactation and Breast Reconstruction Lymphoma Hodgkin’s Lymphoma Non-Hodgkin’s Lymphoma Acute Leukemia Chronic Leukemia Melanoma Cervical Cancer Microinvasion Invasive, Early-Stage Disease Invasive, Locally Advanced Disease Invasive, Distant Metastasis Method of Delivery Survival Ovarian Cancer Postoperative Adjuvant Therapy Vulvar and Vaginal Cancer Endometrial Cancer Gastrointestinal Cancers Upper Gastrointestinal Cancers Colon and Rectal Cancer Urinary Tract Cancers Central Nervous System Tumors Miscellaneous Tumors Fetal-Placental Metastasis Gestational Trophoblastic Disease and Pregnancy- Related Issues Hydatidiform Mole (Complete Mole) Invasive Mole (Chorioadenoma Destruens) Partial Hydatidiform Mole Placental Site Trophoblastic Tumor Choriocarcinoma Key Points References 48 Skin Disease in Pregnancy and Puerperium Physiologic Skin Changes Induced by Pregnancy Pigmentary Changes Vascular Changes Connective Tissue Changes Glandular Changes Hair and Nail Changes Preexisting Skin Diseases and Tumors Affected by Pregnancy Atopic Eczema and Dermatitis Acne Vulgaris Other Inflammatory Skin Conditions Autoimmune Progesterone Dermatitis Impetigo Herpetiformis Cutaneous Manifestations of Autoimmune Disorders Bullous Disorders Skin Tumors Malignant Melanoma Pruritus in Pregnancy Specific Dermatoses of Pregnancy Herpes (Pemphigoid) Gestationis Pruritic Urticarial Papules and Plaques of Pregnancy Prurigo of Pregnancy Pruritic Folliculitis of Pregnancy Key Points References 49 Maternal and Perinatal Infection: Epidemiology Chlamydia Gonorrhea Syphilis Congenital Syphilis Pathogenesis Endocervical Infections Chlamydia Gonorrhea Systemic Infection Diagnosis Chlamydia and Gonorrhea Syphilis Treatment Chlamydia Gonorrhea Syphilis Key Points References 50 Maternal and Perinatal Infection—Viral Human Immunodeficiency Virus Virology Epidemiology Screening, Diagnosis, and Staging Clinical Manifestations and Staging Management During Pregnancy Initial Evaluation Ethical Considerations Treatment of HIV Infection During Pregnancy Nuceloside Reverse Transcriptase Inhibitors Non-nucleoside Reverse Transcriptase Inhibitors Protease Inhibitors Opportunistic Infection Prophylaxis Summary Ongoing Management Antenatal Karyotype Determination Intrapartum Management of HIV Intrapartum Testing Spontaneous Rupture of Membranes (SROM) Untreated Women Elective Cesarean Delivery Postpartum Care of the HIV-Infected Woman Infant Screening and Diagnosis Factors Influencing Transmission Preconception Counseling for HIV-Infected Women HIV Discordant Couples Counseling Influenza Virology/Epidemiology Clinical Manifestations Diagnosis Management of Influenza During Pregnancy Parvovirus Virology/Epidemiology Clinical Manifestations Diagnosis Management of Parvovirus During Pregnancy Measles Virology/Epidemiology Clinical Manifestations Diagnosis Management of Measles During Pregnancy Rubella Virology/Epidemiology Clinical Manifestations Diagnosis Management of Rubella Infection During Pregnancy Congenital Infection Cytomegalovirus Infection Virology/Epidemiology Clinical Manifestations Diagnosis Management of Cytomegalovirus During Pregnancy Congenital Infection Herpesvirus Virology/Epidemiology Clinical Manifestations Diagnosis Management of Herpesvirus During Pregnancy Neonatal Herpes Infection Varicella Virology/Epidemiology Clinical Manifestations Diagnosis Management of Varicella During Pregnancy Congenital Infection Hepatitis Hepatitis A Hepatitis B Virology/Epidemiology Diagnosis Management of HBV Infection during Pregnancy Hepatitis C Virology/Epidemiology Diagnosis HCV in Pregnancy Hepatitis D Hepatitis E West Nile Virus Coxsackie Virus Human Papillomavirus Epstein-Barr Virus Smallpox Key Points References 51 Maternal and Perinatal Infection—Bacterial Group B Streptococcal Infection Epidemiology Maternal Complications Diagnosis Prevention of Group B Streptococcal Infection Urinary Tract Infections Acute Urethritis Asymptomatic Bacteriuria and Acute Cystitis Acute Pyelonephritis Upper Genital Tract Infections Chorioamnionitis Epidemiology Diagnosis Management Puerperal Endometritis Epidemiology Clinical Presentation and Diagnosis Management Prevention of Puerperal Endometritis Serious Sequelae of Puerperal Infection Wound Infection Pelvic Abscess Septic Pelvic Thrombophlebitis Septic Shock Toxoplasmosis Epidemiology Clinical Manifestations Diagnosis Congenital Toxoplasmosis Management Listeriosis Key Points References 52 Mental Health and Behavioral Disorders in Pregnancy Mood Disorders Major Depressive Episode Diagnosis and Prevalence During Pregnancy and Postpartum Natural History Across Childbearing Treatment of MDE During Pregnancy Treatment of MDE in the Postpartum Period Bipolar Disorder Diagnosis and Prevalence Natural History Across Childbearing Treatment of Bipolar Disorder During Childbearing Prevention of Bipolar Episode Recurrence After Delivery Breastfeeding for Women with Bipolar Disorder Anxiety Disorders Diagnosis and Prevalence Natural History Across Childbearing Effects of Anxiety During Childbearing Treatment of Anxiety Disorders Eating Disorders Diagnosis and Prevalence Natural History Across Childbearing Treatment of Eating Disorders Treatment of Anorexia Nervosa Treatment of Bulimia Nervosa Schizophrenia Diagnosis and Prevalence Natural History of Schizophrenia Across Childbearing Treatment Interventions for Women with Schizophrenia Antipsychotic Drugs During Pregnancy Antipsychotic Drugs During Breastfeeding Substance-Related Disorders Diagnosis and Prevalence Obtaining a Substance Use History Specific Drugs of Abuse: Impact and Treatment Approaches Alcohol and Sedative Hypnotics Smoking Cannabis Cocaine Methamphetamine Opioids Acute Pain Management for Women on Maintenance Opioids Personality Disorders Diagnosis and Prevalence Clinical Implications Build a Working Alliance Structure the Relationship Respect Patient Autonomy Find Something to Validate in the Patient’s Response Physician Self-Regulation Suicide Infanticide and Neonaticide Postpartum Psychosis Neonaticide Pseudocyesis Final Comment Additional Resources Key Points References additional References Mood Disorders Bipolar Disorder Anxiety Disorders Eating Disorders Schizophrenia Substance-Related Disorders Personality Disorders Suicide References Section VII - Legal and Ethical Issues in Perinatology 53 Patient Safety and Quality Measurement in Obstetrical Care Patient Safety Overview Frequency of Preventable Obstetrical Adverse Events Factors Contributing to Preventable Adverse Events Approaches to Improve Obstetrical Safety Checklists and Protocols Simulation Shoulder Dystocia Eclampsia Other Obstetrical Events Enhancement of Communication in General Multifaceted Approaches Summary Measurement of Obstetrical Quality of Care Overview Type of Quality Measures Attempts to Establish Quality Measures Traditional Measures Newer Approaches to Measures Data Sources Quality Improvement Summary Key Points References 54 Legal and Ethical Issues in Obstetrical Practice Reproductive Liberty* Abortion Politics and National Health Insurance Reform* Human Embryonic Stem Cell Research Funding* Genetic Counseling, Screening, and Prenatal Diagnosis Genetic Screening* Forced Cesarean Delivery Key Points References Appendix I Normal Values in Pregnancy Appendix II Anatomy of the Pelvis Key Points Suggested Reading Index A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
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