BOOK
Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice E-Book
Robert K. Creasy | Robert Resnik | Jay D. Iams | Charles J. Lockwood | Thomas Moore | Michael F Greene
(2013)
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Book Details
Abstract
Minimize complications with Creasy and Resnik's Maternal-Fetal Medicine. This medical reference book puts the most recent advances in basic science, clinical diagnosis, and management at your fingertips, equipping you with the up-to date evidence-based guidelines and knowledge you need to ensure the best possible outcomes in maternal-fetal medicine.
- Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability.
- Apply today’s best practices in maternal-fetal medicine with an increased emphasis on evidence-based medicine.
- Find dependable, state-of-the-art answers to any clinical question with comprehensive coverage of maternal-fetal medicine from the foremost researchers and practitioners in obstetrics, gynecology and perinatology.
- Take advantage of the most recent diagnostic advances with a new section on Obstetrical Imaging, complemented by online ultrasound clips as well as cross references and links to genetic disorder databases.
- Stay on top of rapidly evolving maternal-fetal medicine through new chapters on Recurrent Spontaneous Abortion, Stillbirth, Patient Safety, Maternal Mortality, and Substance Abuse, as well as comprehensive updates on the biology of parturition, fetal DNA testing from maternal blood, fetal growth, prenatal genetic screening and diagnosis, fetal cardiac malformations and arrhythmias, thyroid disease and pregnancy, management of depression and psychoses during pregnancy and the puerperium, and much more.
- Access the complete contents online at Expert Consult.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Expert Consult ad | IFC2 | ||
| Creasy and Resnik's Maternal-Fetal Medicine, 7/e | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| Preface | xvii | ||
| Table Of Contents | xix | ||
| Video Contents | xxiii | ||
| 1 Scientific Basis of Perinatal Biology | 1 | ||
| 1 Human Basic Genetics and Patterns of Inheritance | 3 | ||
| Impact of Genetics and the Human Genome Project on Medicine in the 21st Century | 3 | ||
| What Is a Gene? | 3 | ||
| Chemical Nature of Genes | 3 | ||
| Biochemistry of Gene Function | 5 | ||
| Information Transfer | 5 | ||
| Quality Control in Gene Expression | 5 | ||
| Mutations | 6 | ||
| Chromosomes in Humans | 7 | ||
| Cell Cycle, Mitosis, and Meiosis | 7 | ||
| Cell Cycle | 7 | ||
| Mitosis | 7 | ||
| Meiosis and the Meiotic Cell Cycle | 8 | ||
| Stages of Meiosis. | 8 | ||
| Sex Differences in Meiosis. | 9 | ||
| Males. | 9 | ||
| Females. | 9 | ||
| Fertilization. | 10 | ||
| Clinical Significance of Mitosis and Meiosis. | 10 | ||
| Analysis of Human Chromosomes | 10 | ||
| Chromosome Banding | 11 | ||
| Molecular Cytogenetics: Fluorescence in Situ Hybridization and Multicolor Karyotyping | 11 | ||
| Copy Number Variation and Array-Based Technologies | 12 | ||
| Characteristics of the More Common Chromosome Aberrations in Humans | 13 | ||
| Abnormalities in Chromosome Number | 13 | ||
| Aneuploidy. | 13 | ||
| Polyploidy. | 14 | ||
| Alterations of Chromosome Structure | 14 | ||
| Deletions and Duplications. | 14 | ||
| Autosomal Deletion and Duplication Syndromes | 17 | ||
| Insertions and Inversions. | 17 | ||
| Translocations. | 18 | ||
| Reciprocal Translocation. | 18 | ||
| Robertsonian Translocation. | 19 | ||
| Isochromosomes. | 20 | ||
| Clinical and Biologic Considerations of the Sex Chromosomes | 20 | ||
| Turner Syndrome | 20 | ||
| Klinefelter Syndrome | 21 | ||
| Prevalence of Chromosome Disorders in Humans | 21 | ||
| Chromosome Abnormalities in Abortuses and Stillbirths | 22 | ||
| Summary of Maternal-Fetal Indications for Chromosome Analysis | 22 | ||
| Abnormal Phenotype in a Newborn Infant | 23 | ||
| Unexplained First-Trimester Spontaneous Abortion with No Fetal Karyotype | 23 | ||
| Stillbirth or Neonatal Death | 23 | ||
| Fertility Problems | 23 | ||
| Neoplasia | 23 | ||
| Detection of Fetal Aneuploidy | 23 | ||
| Patterns of Inheritance | 24 | ||
| Autosomal Dominant Mode of Inheritance | 25 | ||
| Criteria for Autosomal Dominant Inheritance | 25 | ||
| Other Characteristics | 25 | ||
| Variable Expressivity. | 25 | ||
| Penetrance. | 25 | ||
| New Mutations. | 25 | ||
| Autosomal Recessive Mode of Inheritance | 25 | ||
| Sex-Linked Mode of Inheritance | 26 | ||
| Multifactorial Inheritance | 27 | ||
| Heritability | 27 | ||
| Recurrence Risk | 27 | ||
| Twin Studies | 27 | ||
| Complex Inheritance | 27 | ||
| Characteristic Features of Complex Traits | 28 | ||
| Regression to the Mean. | 28 | ||
| Heritability. | 28 | ||
| Threshold Traits. | 28 | ||
| Penetrance, Probability, and Severity. | 28 | ||
| Increased Risk across Diagnostic Categories. | 28 | ||
| Rarer Forms Show Increased Relative Risk. | 28 | ||
| Common Disorders with Multifactorial Inheritance | 28 | ||
| Cleft Lip and Cleft Palate. | 28 | ||
| Cleft Palate. | 29 | ||
| Neural Tube Defects. | 29 | ||
| Pyloric Stenosis. | 29 | ||
| Celiac Disease. | 29 | ||
| Inflammatory Bowel Disease (Crohn Disease). | 29 | ||
| Hirschsprung Disease. | 30 | ||
| Congenital Heart Defects. | 30 | ||
| Mitochondrial Inheritance | 30 | ||
| Dynamic Mutations and Trinucleotide Repeats | 31 | ||
| Imprinting | 31 | ||
| Genetic Testing and DNA Diagnostics | 32 | ||
| Methods Used in Genetic Testing | 32 | ||
| Hybridization-Based Methods | 32 | ||
| Polymerase Chain Reaction | 33 | ||
| DNA Sequencing | 34 | ||
| Other Considerations | 34 | ||
| Linkage Analysis | 34 | ||
| Identifying New Disease Genes | 35 | ||
| Association and Linkage Disequilibrium | 35 | ||
| Conclusion | 35 | ||
| Acknowledgments | 36 | ||
| References | 36.e1 | ||
| 2 Normal Early Development | 37 | ||
| Macroscopic Development | 37 | ||
| Microscopic Development | 42 | ||
| Genetic Aspects | 46 | ||
| Individual Genes of Embryonic Development | 46 | ||
| References | 46.e1 | ||
| 3 Amniotic Fluid Dynamics | 47 | ||
| Volume of Amniotic Fluid | 47 | ||
| Production and Composition of Amniotic Fluid | 47 | ||
| Urine Production | 48 | ||
| Lung Fluid Production | 49 | ||
| Minor Sources of Amniotic Fluid | 49 | ||
| Resorption of Amniotic Fluid | 49 | ||
| Fetal Swallowing | 49 | ||
| Intramembranous Flow | 49 | ||
| Possible Mechanisms to Regulate Amniotic Fluid Volume via Intramembranous Flow | 50 | ||
| Membrane Water Flow | 50 | ||
| Membrane Anatomy | 50 | ||
| Possible Regulation of Intramembranous Flow | 51 | ||
| Conclusion | 52 | ||
| References | 52.e1 | ||
| 4 Multiple Gestation: The Biology of Twinning | 53 | ||
| Incidence of Twinning | 53 | ||
| Types of Twins | 53 | ||
| Causes of Twinning | 54 | ||
| Placentation in Twinning | 55 | ||
| Velamentous Insertion of Umbilical Cord and Vasa PrEvia | 57 | ||
| Monoamniotic Twins | 58 | ||
| Diamniotic Monochorionic Twins | 58 | ||
| Twin-to-Twin Transfusion Syndrome | 60 | ||
| Abnormalities of Twin Gestation | 61 | ||
| Fetus Papyraceus | 61 | ||
| Acardiac Twin | 63 | ||
| Other Anomalies | 64 | ||
| “Disappearance” of a Twin | 64 | ||
| Chimeras | 64 | ||
| Identification of Twin Zygosity | 65 | ||
| References | 65.e1 | ||
| 5 Biology of Parturition | 66 | ||
| Morphologic Changes in the Reproductive Tract during Pregnancy | 66 | ||
| The Uterus | 66 | ||
| The Cervix | 66 | ||
| Diagnosis of Labor | 67 | ||
| Timing of Labor | 67 | ||
| Genetic Influences on the Timing of Labor | 67 | ||
| Hormonal Control of Labor | 68 | ||
| Fetal Hypothalamic-Pituitary-Adrenal Axis | 68 | ||
| Progesterone | 70 | ||
| Functional Progesterone Withdrawal before Labor May Be Mediated by Changes in PR-A and PR-B Expression with an Increase in the PR-A/PR-B Ratio | 71 | ||
| Progesterone as an Anti-inflammatory Agent | 71 | ||
| Progesterone Receptor Cofactors Mediate a Functional Withdrawal of Progesterone in the Myometrium at Term | 71 | ||
| Progesterone May Interfere with Cortisol-Mediated Regulation of Placental Gene Expression | 71 | ||
| Progesterone May Act Also through Nongenomic Pathways | 72 | ||
| Possible Role for a Cell Membrane–Bound Progesterone Receptor in Myometrium | 72 | ||
| Effect of Progesterone on Fetal Membranes | 72 | ||
| Estrogens | 72 | ||
| Prostaglandins | 72 | ||
| Oxytocin | 74 | ||
| Myometrial Contractility | 74 | ||
| Regulation of Electrical Activity Within the Uterus | 74 | ||
| Mechanics of Myometrial Contractions | 74 | ||
| Hormonal Regulation of Myometrial Contractility | 76 | ||
| Uterine Stimulants | 77 | ||
| Endothelin. | 77 | ||
| Epidermal Growth Factor. | 77 | ||
| Uterine Relaxants | 77 | ||
| Relaxin. | 77 | ||
| Parathyroid Hormone–Related Protein. | 77 | ||
| Calcitonin Gene–Related Peptide and Adrenomedullin. | 77 | ||
| Nitric Oxide. | 78 | ||
| Magnesium. | 78 | ||
| Non–naturally Occurring Uterine Relaxants. | 78 | ||
| Role of the Cervix in Labor | 78 | ||
| Cervical Softening | 78 | ||
| Cervical Ripening | 79 | ||
| Cervical Dilation | 79 | ||
| Postpartum Repair | 79 | ||
| Achieving a Successful Delivery | 79 | ||
| Conclusions | 79 | ||
| References | 79.e1 | ||
| 6 Immunology of Pregnancy | 80 | ||
| Pregnancy as an Allograft | 80 | ||
| Defining the Immunology of Pregnancy | 80 | ||
| General Concepts of Immunology | 80 | ||
| Types of Immune Response | 80 | ||
| Cytokines and the Immune Response | 80 | ||
| Maternal Immune Response to the Trophoblast: The Pregnant Uterus as an Immune Privileged Site | 81 | ||
| The Placenta as a Mechanical Barrier | 81 | ||
| Systemic Immune Suppression | 82 | ||
| Cytokine Shift | 82 | ||
| Lack of Expression of Human Leukocyte Antigens | 83 | ||
| Local Immune Suppression | 83 | ||
| The Role of Immune Cells during Pregnancy | 84 | ||
| Uterine Natural Killer Cells | 84 | ||
| Macrophages | 84 | ||
| T Regulatory Cells | 84 | ||
| Dendritic Cells | 85 | ||
| Decidual Cells | 85 | ||
| The Maternal Immune System and Its Role in Pregnancy: a Different Perspective | 85 | ||
| Redefining Medawar’s Hypothesis | 85 | ||
| Infection and Pregnancy | 86 | ||
| Pattern Recognition Receptors | 87 | ||
| Toll-Like Receptors | 87 | ||
| NOD-Like Receptors | 87 | ||
| The Role of TLRs and NLRs in Adverse Pregnancy Outcome | 88 | ||
| TLR Expression in the Placenta | 88 | ||
| TLR Function in the Trophoblast | 89 | ||
| NLR Expression and Function in the Placenta | 90 | ||
| Trophoblast–Immune System Interactions Governed by PRRs | 90 | ||
| TLR and NLR Expression and Function by Other Gestational Tissues | 90 | ||
| How a Viral Infection Affects the Fetus and the Pregnancy Outcome | 91 | ||
| Mother-Placenta-Fetus: A Complex Response to Infection | 91 | ||
| Are Prophylaxis and Treatment Appropriate and Beneficial for Pregnant Women? | 92 | ||
| Summary | 92 | ||
| References | 92.e1 | ||
| 7 Maternal Cardiovascular, Respiratory, and Renal Adaptation to Pregnancy | 93 | ||
| Cardiovascular System | 93 | ||
| Blood Volume | 93 | ||
| Anatomic Changes | 93 | ||
| Cardiac Output | 93 | ||
| Blood Pressure | 94 | ||
| Systemic Vascular Resistance | 95 | ||
| Venous Vascular Bed | 95 | ||
| Antepartum Hemodynamics | 95 | ||
| Symptoms and Signs of Normal Pregnancy | 96 | ||
| Intrapartum Hemodynamic Changes | 96 | ||
| Postpartum Hemodynamic Changes | 96 | ||
| Respiratory System | 96 | ||
| Kidneys and Lower Urinary Tract | 97 | ||
| Structure and Dynamics | 97 | ||
| Renal Function | 98 | ||
| Renal Tubular Function | 98 | ||
| Sodium | 98 | ||
| Potassium | 98 | ||
| Calcium | 99 | ||
| Glucose | 99 | ||
| Uric Acid | 99 | ||
| Amino Acids | 99 | ||
| Volume Homeostasis | 99 | ||
| References | 99.e1 | ||
| 8 Endocrinology of Pregnancy | 100 | ||
| Implantation | 100 | ||
| Human Chorionic Gonadotropin Production | 102 | ||
| Maintenance of Early Pregnancy: Human Chorionic Gonadotropin and Corpus Luteum of Pregnancy | 103 | ||
| Timing of the Luteal-Placental Shift | 103 | ||
| Fetoplacental Unit as an Endocrine Organ | 104 | ||
| Progesterone | 104 | ||
| Estrogens | 104 | ||
| Role of Progestins during Pregnancy and Parturition | 106 | ||
| Role of Estrogens in Pregnancy | 106 | ||
| Placenta and Growth Factors | 106 | ||
| Insulin-Like Growth Factor, Epidermal Growth Factor, and Transforming Growth Factor-α | 107 | ||
| Human Chorionic Somatomammotropin | 107 | ||
| Human Placental Growth Hormone | 108 | ||
| Endocrine-Metabolic Changes in Pregnancy | 108 | ||
| Inhibin-Related Proteins | 109 | ||
| Corticotropin-Releasing Hormone and Corticotropin-Releasing Hormone–Binding Protein System | 110 | ||
| Oxytocin | 110 | ||
| Relaxin | 110 | ||
| Prolactin in Pregnancy | 111 | ||
| Prostaglandins | 111 | ||
| References | 111.e1 | ||
| 9 The Breast and the Physiology of Lactation | 112 | ||
| Benefits of Breastfeeding | 112 | ||
| Role of the Obstetrician in Promoting Breastfeeding | 113 | ||
| Examination of the Breast | 114 | ||
| Perinatal Period | 114 | ||
| The Breast | 114 | ||
| Embryonic Development | 114 | ||
| Pubertal Development | 115 | ||
| The Mature Breast | 116 | ||
| Abnormalities | 116 | ||
| Nipple and Areola | 117 | ||
| Mammary Gland in Pregnancy | 117 | ||
| Physiology of Lactation | 118 | ||
| Lactogenesis | 118 | ||
| Let-Down (Ejection) Reflex | 119 | ||
| Initiation of Lactation | 120 | ||
| Initiating Breastfeeding | 121 | ||
| Issues in the Postpartum Period | 122 | ||
| Breast Engorgement and Nipple Tenderness | 122 | ||
| Faltering Milk Supply | 122 | ||
| Breastfeeding after Premature or Multiple Births | 122 | ||
| Contraception | 122 | ||
| Maternal Infections during Breastfeeding | 123 | ||
| Complications of the Breast | 126 | ||
| Plugged Ducts | 126 | ||
| Galactocele | 126 | ||
| Mastitis | 126 | ||
| Candidiasis of Nipple and Breast | 127 | ||
| Ongoing Breastfeeding Support | 127 | ||
| Medications While Breastfeeding | 127 | ||
| Milk-to-Plasma Ratio | 129 | ||
| Analgesia and Anesthesia for the Breastfeeding Mother | 129 | ||
| Stem Cells and Human Breast Milk | 129 | ||
| Suggested Readings | 130 | ||
| References | 130.e1 | ||
| 10 Maternal Nutrition | 131 | ||
| Pre-conception Issues | 131 | ||
| Folate | 131 | ||
| Body Mass Index and Obesity | 131 | ||
| Obesity and Pregnancy | 132 | ||
| POSTCONCEPTION Risks | 132 | ||
| Maternal Obesity and Long-Term Offspring Outcomes | 132 | ||
| Bariatric Surgery and Pregnancy | 133 | ||
| Weight Gain during Pregnancy | 133 | ||
| Interventions to Optimize Gestational Weight Gain | 134 | ||
| Dietary Guidelines | 134 | ||
| Exercise/Physical Activity | 135 | ||
| Macronutrient Intake | 135 | ||
| Fruits and Vegetables | 135 | ||
| Carbohydrates | 135 | ||
| Dairy Products | 135 | ||
| Protein | 135 | ||
| Fats | 135 | ||
| Food-Borne Infections | 135 | ||
| Fish Consumption: Mercury and Omega-3 Fatty Acids | 135 | ||
| Supplementation | 136 | ||
| Multivitamins and Prenatal Vitamins | 136 | ||
| Folate | 136 | ||
| Vitamin D | 136 | ||
| Vitamin C and Vitamin E | 136 | ||
| Minerals and Other Supplements | 136 | ||
| Iron | 136 | ||
| Choline | 137 | ||
| Iodine | 137 | ||
| Calcium | 137 | ||
| Fish Oil | 137 | ||
| Vegetarian Diets in Pregnancy | 137 | ||
| Other Clinical Issues | 137 | ||
| Multiple Gestation | 137 | ||
| Nausea and Vomiting | 138 | ||
| References | 138.e1 | ||
| 11 Developmental Origins of Health and Disease | 139 | ||
| Associations between Low Birth Weight and Adult Disease | 139 | ||
| How the Concept Arose: Early Studies | 139 | ||
| Contemporary Viewpoints | 139 | ||
| Testing the Concept in Different Populations | 139 | ||
| Other Disorders Associated with Lower Birth Weight | 140 | ||
| Associations between Maternal Obesity, Diabetes, Raised Birth Weight, and Adulthood Disease | 140 | ||
| Gestational Weight Gain | 141 | ||
| Cardiovascular Risk | 141 | ||
| Mode of Delivery and Early Antibiotic Exposure | 141 | ||
| Breastfeeding | 141 | ||
| Childhood Growth | 142 | ||
| Developmental Effects of Antenatal Glucocorticoids | 142 | ||
| Animal Models | 143 | ||
| Mechanistic Insights | 143 | ||
| Time for Intervention? | 144 | ||
| Nutrient Supplementation | 144 | ||
| Maternal Body Composition | 144 | ||
| Maternal Obesity: an Important Public Health Message | 144 | ||
| Neonatal Feeding Regimens | 144 | ||
| Developmental Effects on the Human Phenotype: Pathology or Survival? | 144 | ||
| Thrifty Phenotype and Predictive Adaptive Models | 145 | ||
| Conclusions | 145 | ||
| Acknowledgments | 145 | ||
| References | 145.e1 | ||
| 12 Fetal Cardiovascular Physiology | 146 | ||
| Blood Flow Patterns and Oxygen Delivery | 146 | ||
| Venous Return to the Heart | 146 | ||
| Cardiac Output and Its Distribution | 148 | ||
| Intracardiac and Vascular Pressures | 149 | ||
| Myocardial Function | 149 | ||
| Sympathetic and Parasympathetic Innervation | 150 | ||
| Energy Metabolism | 150 | ||
| Control of the Cardiovascular System | 151 | ||
| Local Regulation | 151 | ||
| Baroreflex Regulation | 151 | ||
| Chemoreflex Regulation | 151 | ||
| Autonomic Nervous System and Adrenal Medulla | 151 | ||
| Hormonal Regulation of the Circulation Renin-Angiotensin System | 152 | ||
| Vasopressin | 152 | ||
| Natriuretic Peptides | 152 | ||
| Arachidonic Acid Metabolites | 153 | ||
| Endothelial-Derived Factors and Endothelin | 153 | ||
| Ductus Arteriosus | 154 | ||
| References | 154.e1 | ||
| 13 Behavioral States in the Fetus: Relationship to Fetal Health and Development | 155 | ||
| Fetal Behavioral State Activity | 155 | ||
| Animal Studies | 155 | ||
| Human Studies | 155 | ||
| Developmental Changes | 157 | ||
| Hypoxia and Intrauterine Growth Restriction | 157 | ||
| Assessment of Fetal Health: Breathing and Body Movements | 159 | ||
| Fetal Growth and Development | 160 | ||
| Brain | 160 | ||
| Lungs | 161 | ||
| Musculoskeletal System | 161 | ||
| References | 162.e1 | ||
| 14 Placental Respiratory Gas Exchange and Fetal Oxygenation | 163 | ||
| Transport of Atmospheric Oxygen to the Gravid Uterus | 163 | ||
| Measurement of Uterine and Umbilical Oxygen Uptakes | 163 | ||
| Umbilical Oxygen Uptake | 164 | ||
| Normal Fetal Oxygenation | 165 | ||
| Umbilical Venous Po2 is a Function of Uterine Venous Po2 | 167 | ||
| Venous Equilibration Model of Transplacental Exchange | 167 | ||
| Placental Oxygen Consumption Prevents Transplacental Po2 Equilibration | 167 | ||
| Development of Placental Oxygen Transport in Sheep | 168 | ||
| Development of Oxygen Transport Across the Human Placenta | 169 | ||
| Chronic Regulation of Placental Oxygen Transport | 169 | ||
| Hypoxia of Fetal Growth Restriction | 170 | ||
| Is Placental Oxygen Transport Blood Flow Limited? | 171 | ||
| Factors That Determine Uterine Venous Po2 | 171 | ||
| Fetal Response to Hypoxia | 172 | ||
| Oxygen Therapy | 172 | ||
| Placental Carbon Dioxide Transfer | 174 | ||
| References | 174.e1 | ||
| 15 Fetal Lung Development and Surfactant | 175 | ||
| Overview of Lung Development | 175 | ||
| Normal Lung Development | 175 | ||
| Embryonic Stage (3 to 7 Weeks after Conception) | 175 | ||
| Pseudoglandular Stage (5 to 17 Weeks) | 175 | ||
| Canalicular Stage (16 to 26 Weeks after Conception) | 175 | ||
| Saccular Stage (24 to 36 Weeks after Conception) | 176 | ||
| Alveolar Stage | 177 | ||
| Pulmonary Hypoplasia | 177 | ||
| Fetal Lung Fluid | 178 | ||
| Surfactant | 179 | ||
| Surfactant Composition | 179 | ||
| Surfactant Metabolism | 180 | ||
| Physiologic Effects of Surfactant | 181 | ||
| Surfactant for Respiratory Distress Syndrome | 182 | ||
| Induced Lung Maturation and Pulmonary Outcomes | 183 | ||
| Frequency of Induced Lung Maturation | 183 | ||
| Abnormal Vascular Development and Growth Restriction | 184 | ||
| Corticosteroids | 184 | ||
| Chorioamnionitis and Fetal Inflammation | 184 | ||
| Late Gestational Lung Maturation | 185 | ||
| Overview of Respiratory Distress Syndrome, Bronchopulmonary Dysplasia, and Mediators | 185 | ||
| References | 186.e1 | ||
| 16 Evidence-Based Practice in Perinatal Medicine | 187 | ||
| Evidence-Based Medicine in Perspective | 187 | ||
| Types of Clinical Research Studies | 187 | ||
| Descriptive Studies | 187 | ||
| Analytic Studies | 188 | ||
| Observational Studies | 188 | ||
| Case-Control Studies. | 188 | ||
| Cohort Studies. | 188 | ||
| Interventional Studies | 189 | ||
| Other Study Designs | 190 | ||
| Systematic Review and Meta-analysis | 190 | ||
| Decision Analysis | 191 | ||
| Types of Data for Clinical Research | 191 | ||
| Error in Clinical Research | 192 | ||
| Sources of Error in Clinical Research | 192 | ||
| Confounding | 192 | ||
| Bias | 192 | ||
| Assessing the Role of Systematic Error in Clinical Research | 193 | ||
| Assessing Random Error: Hypothesis Testing and Measures of Effect in Clinical Research | 193 | ||
| Probability Value | 193 | ||
| Relative Risk with 95% Confidence Intervals | 193 | ||
| Other Measures of Effect | 194 | ||
| Approach to Assessing Random Error | 194 | ||
| Step 1. Graph and Summarize | 194 | ||
| Step 2. Perform Univariable Data Analyses | 194 | ||
| Step 3. Perform Stratified Analysis | 194 | ||
| Step 4. Perform Multivariable Analysis | 195 | ||
| Sample Size and Power | 195 | ||
| Assessing Research on Screening and Diagnosis | 195 | ||
| Screening Versus Diagnosis | 196 | ||
| Sensitivity, Specificity, and Predictive Values | 196 | ||
| Likelihood Ratios | 197 | ||
| Receiver Operating Characteristic Curves | 197 | ||
| Summary | 198 | ||
| References | 198.e1 | ||
| 2 Obstetric Imaging | 199 | ||
| I Principles of Fetal Imaging | 201 | ||
| 17 Performing and Documenting the Fetal Anatomy Ultrasound Examination | 202 | ||
| Categorizing Types of Obstetric Ultrasound Examinations | 202 | ||
| Basic Mid-Trimester Fetal Anatomy Scan | 202 | ||
| Documentation of Ultrasound Examinations | 203 | ||
| The Detailed Maternal and Fetal Evaluation Study | 204 | ||
| Typical Images Obtained in a Level II Scan | 205 | ||
| References | 210.e1 | ||
| 18 Doppler Ultrasound: Select Fetal and Maternal Applications | 211 | ||
| Umbilical Artery | 211 | ||
| Anatomy | 211 | ||
| Technique | 211 | ||
| Number of Vessels | 211 | ||
| Doppler Flow Pattern | 211 | ||
| Clinical Use | 211 | ||
| Single Umbilical Artery | 211 | ||
| Fetal Growth Restriction | 211 | ||
| Middle Cerebral Artery | 212 | ||
| Anatomy | 212 | ||
| Technique | 212 | ||
| Clinical Use | 213 | ||
| Fetal Anemia | 213 | ||
| Intrauterine Growth Restriction | 213 | ||
| Ductus Venosus | 213 | ||
| Anatomy | 213 | ||
| Technique | 213 | ||
| Clinical Use | 215 | ||
| First Trimester | 215 | ||
| Second and Third Trimester | 216 | ||
| Uterine Artery | 216 | ||
| Anatomy | 216 | ||
| Technique | 217 | ||
| Clinical Use | 217 | ||
| References | 217.e1 | ||
| 19 Clinical Applications of Three-Dimensional Sonography in Obstetrics | 218 | ||
| Volume Sonography: Basics | 218 | ||
| Imaging Tools in Volume Sonography | 218 | ||
| Use of Three-Dimensional Ultrasound in the First Trimester | 219 | ||
| Uterine Malformations | 220 | ||
| Ectopic Pregnancy | 221 | ||
| Early Detection of Central Nervous System Abnormalities | 222 | ||
| Acrania/Anencephaly | 222 | ||
| Hydrocephalus | 222 | ||
| Encephalocele | 222 | ||
| 3 Fetal Disorders: Diagnosis and Therapy | 415 | ||
| 30 Prenatal Diagnosis of Congenital Disorders | 417 | ||
| Screening for Fetal Genetic Disorders | 417 | ||
| Likelihood Ratios | 417 | ||
| Antenatal Screening for Down Syndrome | 418 | ||
| Maternal Age as a Screening Test | 418 | ||
| First-Trimester Ultrasound Screening for Aneuploidy | 418 | ||
| First-Trimester Biochemical Screening | 421 | ||
| Combined First-Trimester Nuchal Translucency and Biochemistry Screening | 421 | ||
| Additional First-Trimester Markers of Down Syndrome | 421 | ||
| Biochemical Markers | 421 | ||
| Ultrasound Markers | 421 | ||
| Nasal Bone. | 421 | ||
| Tricuspid Regurgitation. | 422 | ||
| Ductus Venosus Waveform. | 422 | ||
| Impact of Spontaneous Miscarriages on First-Trimester Screening | 423 | ||
| Second-Trimester Maternal Serum Screening | 423 | ||
| Abnormal Second-Trimester Maternal Serum Markers in Pregnancies with a Normal Karyotype | 423 | ||
| Unexplained Elevated Maternal Serum α-Fetoprotein | 423 | ||
| Unexplained Elevated Human Chorionic Gonadotropin Levels | 424 | ||
| Elevated Human Chorionic Gonadotropin and Maternal Serum α-Fetoprotein | 424 | ||
| Low Second-Trimester Maternal Serum Estriol | 424 | ||
| Second-Trimester Ultrasound Markers of Down Syndrome | 425 | ||
| Use of Second-Trimester Ultrasound to Estimate the Risk for Down Syndrome | 426 | ||
| Combined Ultrasound and Second-Trimester Maternal Serum Marker Risk Assessment | 426 | ||
| Second-Trimester Ultrasound Screening for Other Chromosomal Abnormalities | 427 | ||
| Other Approaches to Down Syndrome Screening: Combining First- and Second-Trimester Screening Tests | 427 | ||
| Integrated Aneuploidy Screening (Noninformative Sequential). | 428 | ||
| Sequential Testing. | 428 | ||
| Nasal Bone Contingency Screening. | 428 | ||
| ANEUPLOIDY Screening Using Cell-Free Fetal DNA in the Maternal Circulation | 428 | ||
| Characteristics of Cell-Free DNA in the Maternal Circulation | 428 | ||
| Aneuploidy Detection Using Cell-Free Fetal DNA in the Maternal Plasma | 428 | ||
| Is Maternal Age Alone an Indication for Invasive Testing? | 430 | ||
| Maternal Serum α-Fetoprotein Screening for Neural Tube and Other Structural Defects | 431 | ||
| Physiology | 431 | ||
| Screening | 432 | ||
| Evaluation of an Elevated Maternal Serum AFP | 432 | ||
| Other Fetal Causes of Elevated Maternal Serum AFP and Amniotic Fluid AFP | 433 | ||
| Ultrasound Screening for Fetal Congenital Anomalies | 434 | ||
| Increased Nuchal Translucency and Normal Karyotype | 435 | ||
| Screening for Gene Mutations That Lead to Fetal Disease | 435 | ||
| Cystic Fibrosis Screening | 436 | ||
| Jewish Genetic Disease Testing | 438 | ||
| Tay-Sachs Disease | 438 | ||
| Canavan Disease | 440 | ||
| Familial Dysautonomia | 440 | ||
| Other Diseases Increased in the Jewish Population | 440 | ||
| Hemoglobinopathies | 440 | ||
| Sickle Cell Syndromes | 440 | ||
| Hemoglobin Variants. | 441 | ||
| Sickle Thalassemias. | 442 | ||
| β-Thalassemia | 442 | ||
| α-Thalassemia | 443 | ||
| Fragile X Syndrome | 444 | ||
| Spinal Muscular Atrophy | 445 | ||
| Universal Carrier Screening | 446 | ||
| Diagnostic Tests | 447 | ||
| Indications for Invasive Testing | 447 | ||
| Amniocentesis | 447 | ||
| Historical Perspective | 447 | ||
| Technique of Amniocentesis | 448 | ||
| Complications of Amniocentesis | 449 | ||
| Pregnancy Loss after Mid-Trimester Amniocentesis | 449 | ||
| Early Amniocentesis (Performed before 15 Weeks’ Gestation) | 450 | ||
| Chorionic Villus Sampling | 451 | ||
| History of Chorionic Villus Sampling | 451 | ||
| Technique of Transcervical Chorionic Villus Sampling | 451 | ||
| Technique of Transabdominal Chorionic Villus Sampling | 452 | ||
| Comparison of Transcervical and Transabdominal Chorionic Villus Sampling | 452 | ||
| Pregnancy Loss after Chorionic Villus Sampling | 452 | ||
| Other Complications of Chorionic Villus Sampling | 453 | ||
| Risk for Fetal Abnormality after Chorionic Villus Sampling | 453 | ||
| Laboratory Analysis of Prenatal Diagnostic Samples | 454 | ||
| Laboratory Considerations for Amniocentesis | 454 | ||
| Mosaic Results. | 454 | ||
| Use of Fluorescence in Situ Hybridization. | 454 | ||
| Laboratory Aspects of Chorionic Villus Sampling | 455 | ||
| Accuracy of Chorionic Villus Sampling | 455 | ||
| Cytogenetic Results. | 455 | ||
| Maternal Cell Contamination. | 455 | ||
| Confined Placental Mosaicism. | 455 | ||
| Chromosomal Microarray for Prenatal Testing | 456 | ||
| Current Indications for Microarray Analysis in Prenatal Diagnosis | 457 | ||
| Evaluation of Ultrasound Structural Anomalies. | 457 | ||
| Interpretation of Uncertain Karyotype Findings. | 457 | ||
| Marker Chromosomes. | 457 | ||
| Apparently Balanced de Novo Reciprocal Translocation. | 457 | ||
| Evaluation of a Stillborn Fetus. | 457 | ||
| As First-Tier Test for Advanced Maternal Age and Positive Down Syndrome Screening. | 458 | ||
| Interpretation of Copy Number Variation. | 458 | ||
| Limitations of CMA. | 458 | ||
| Prenatal Diagnosis and Multifetal Gestations | 458 | ||
| Risk for Fetal Aneuploidy in Multifetal Gestations | 458 | ||
| Screening Tests in Twins | 459 | ||
| Second Trimester. | 459 | ||
| First Trimester. | 460 | ||
| Amniocentesis in Multifetal Gestations | 460 | ||
| Complications of Amniocentesis in Multifetal Gestations. | 460 | ||
| Chorionic Villus Sampling in Multifetal Gestations | 460 | ||
| Complications of Chorionic Villus Sampling in Multifetal Gestations. | 461 | ||
| Which Procedure to Perform? | 461 | ||
| Percutaneous Umbilical Blood Sampling | 461 | ||
| Technique of Percutaneous Umbilical Blood Sampling | 462 | ||
| Other Invasive Diagnostic Procedures | 462 | ||
| Preimplantation Genetic Screening | 462 | ||
| Preimplantation Genetic Screening for Karyotype Analysis | 462 | ||
| Indications for Preimplantation Genetic Screening | 462 | ||
| Carriers of Balanced Rearrangements | 462 | ||
| Aneuploid Screening | 463 | ||
| Preimplantation Genetic Screening for Monogenetic Disorders | 463 | ||
| Perinatal Risks of in Vitro Fertilization and Preimplantation Genetic Screening | 463 | ||
| References | 464.e1 | ||
| 31 Teratogenesis and Environmental Exposure | 465 | ||
| Historical Perspective | 465 | ||
| Principles of Teratology | 465 | ||
| Sources of Safety Data on Exposures in Pregnancy | 467 | ||
| Case Reports of Adverse Events | 467 | ||
| Pregnancy Registries | 467 | ||
| Observational Cohort Studies | 467 | ||
| Database Cohorts | 467 | ||
| Case-Control Studies | 467 | ||
| Summary of Data Sources | 468 | ||
| Risk Assessments and Resources | 468 | ||
| Selected Human Teratogenic Exposures | 468 | ||
| Vitamin K Antagonists | 468 | ||
| Antiepileptic Drugs | 468 | ||
| Phenytoin | 468 | ||
| Valproic Acid | 469 | ||
| Carbamazepine | 469 | ||
| Other Antiepileptic Drugs | 469 | ||
| Chemotherapeutic and Immunosuppressive Agents | 469 | ||
| Cyclophosphamide | 469 | ||
| Methotrexate | 469 | ||
| Adrenal Corticosteroids | 469 | ||
| Mycophenolate | 469 | ||
| Ace Inhibitors and Angiotensin II Receptor Antagonists | 470 | ||
| Lithium | 470 | ||
| Retinoids | 470 | ||
| Vitamin A | 470 | ||
| Isotretinoin and Other Oral Synthetic Retinoids | 470 | ||
| Ionizing Radiation | 470 | ||
| Environmental Agents | 471 | ||
| Methylmercury | 471 | ||
| Lead | 471 | ||
| Social and Illicit Drugs | 471 | ||
| Ethanol | 471 | ||
| Tobacco | 472 | ||
| Cocaine | 472 | ||
| References | 472.e1 | ||
| 32 Assessment of Fetal Health | 473 | ||
| Principles of Ideal Fetal Monitoring | 473 | ||
| Assessment of Normal Fetal Physiology | 473 | ||
| Fetal Heart Rate Changes during Development | 473 | ||
| Fetal Behavior | 474 | ||
| Methods of Monitoring Fetal Health | 474 | ||
| Fetal Heart Rate Monitoring | 474 | ||
| Biophysical Profile | 475 | ||
| Biophysical Profile Score Variables | 475 | ||
| Amniotic Fluid Measurement. | 475 | ||
| Amniotic Fluid Volume. | 476 | ||
| Diagnosis of Oligohydramnios. | 476 | ||
| Fetal Breathing Movements. | 476 | ||
| Fetal Movement and Tone. | 476 | ||
| Biophysical Profile Technique | 477 | ||
| Score of 10/10, 8/8, or 8/10 with Normal Fluid Volume. | 477 | ||
| Oligohydramnios with a Score of 8/10. | 477 | ||
| Equivocal or Abnormal Scores. | 477 | ||
| Vibroacoustic Stimulation | 477 | ||
| Contraction Stress Test and Oxytocin Challenge Test | 478 | ||
| Doppler Ultrasound | 479 | ||
| Fetal Doppler Velocimetry | 480 | ||
| Umbilical Artery | 480 | ||
| Hemodynamics. | 480 | ||
| Measurement. | 480 | ||
| Clinical Significance. | 481 | ||
| Middle Cerebral Artery | 482 | ||
| Hemodynamics. | 482 | ||
| Measurement. | 483 | ||
| Clinical Significance. | 483 | ||
| Fetal Venous Doppler Studies | 483 | ||
| Ductus Venosus. | 483 | ||
| Umbilical Vein. | 484 | ||
| Other Veins. | 484 | ||
| Clinical Significance. | 484 | ||
| Patterns of Deterioration | 485 | ||
| Practical Aspects of Fetal Testing | 485 | ||
| Who, When, and How to Test | 485 | ||
| Impacts of Monitoring on Perinatal Mortality and Long-Term Outcomes | 486 | ||
| Summary | 487 | ||
| Acknowledgments | 487 | ||
| References | 487.e1 | ||
| 33 Intrapartum Fetal Surveillance | 488 | ||
| Factors Controlling Fetal Heart Rate | 488 | ||
| Parasympathetic Nervous System | 488 | ||
| Sympathetic Nervous System | 488 | ||
| Chemoreceptors | 488 | ||
| Baroreceptors | 488 | ||
| Central Nervous System | 489 | ||
| Hormonal Regulation | 489 | ||
| Adrenal Medulla | 489 | ||
| Renin-Angiotensin System | 489 | ||
| Prostaglandins | 489 | ||
| Other Hormones | 489 | ||
| Blood Volume Control | 489 | ||
| Capillary Fluid Shift | 489 | ||
| Intraplacental Pressures | 489 | ||
| Frank-Starling Mechanism | 489 | ||
| Umbilical Blood Flow | 489 | ||
| Monitoring the Fetal Heart Rate | 490 | ||
| Fetal Heart Rate Detection | 490 | ||
| Fetal Electrode | 490 | ||
| Doppler Ultrasound Transducer | 490 | ||
| Uterine Activity Detection | 490 | ||
| Intra-amniotic Catheter | 490 | ||
| Tocodynamometer | 490 | ||
| Fetal Responses to Hypoxia or Acidemia | 490 | ||
| Fetal Acid-Base Balance | 491 | ||
| Physiology | 491 | ||
| Carbonic Acid | 491 | ||
| Nonvolatile Acids | 491 | ||
| Buffers | 491 | ||
| Ph Determination | 491 | ||
| Terminology | 492 | ||
| Factors Affecting Acid-Base Balance | 492 | ||
| Respiratory Factors | 492 | ||
| Metabolic Factors | 492 | ||
| Effects of Labor | 493 | ||
| Umbilical Cord Blood Acid-Base Analysis | 493 | ||
| Technique | 493 | ||
| Normal Values | 493 | ||
| Pathologic Fetal Acidemia | 494 | ||
| Acute Neurologic Injury | 494 | ||
| Other Clinical Events and Umbilical Blood Acid-Base Status | 495 | ||
| Acute Chorioamnionitis. | 495 | ||
| Nuchal Cords. | 495 | ||
| Meconium-Stained Amniotic Fluid. | 495 | ||
| Prolonged Pregnancy. | 495 | ||
| Fetal Heart Rate Abnormalities. | 495 | ||
| Method of Delivery. | 496 | ||
| Shoulder Dystocia. | 496 | ||
| Effect of Oxytocin. | 496 | ||
| Measuring Acid-Base Status | 496 | ||
| Characteristics of Fetal Heart Rate Patterns | 496 | ||
| Basic Patterns | 496 | ||
| Baseline Features | 496 | ||
| Baseline Rate. | 496 | ||
| Fetal Heart Rate Variability. | 496 | ||
| Periodic Heart Rate Patterns | 497 | ||
| Late Decelerations. | 497 | ||
| Early Decelerations. | 497 | ||
| Variable Decelerations. | 497 | ||
| Accelerations. | 497 | ||
| Quantification. | 497 | ||
| Normal and Abnormal Heart Rate Patterns | 497 | ||
| Baseline Rate | 497 | ||
| Bradycardia. | 497 | ||
| Tachycardia. | 498 | ||
| Classification and Significance of Baseline Variability | 498 | ||
| Periodic Changes in Fetal Heart Rate | 499 | ||
| Late Decelerations. | 499 | ||
| Variable Decelerations. | 501 | ||
| Classification of Fetal Heart Rate Tracings. | 501 | ||
| Effect of in Utero Treatment. | 501 | ||
| Other Heart Rate Patterns | 501 | ||
| Sinusoidal Pattern. | 501 | ||
| Saltatory Pattern. | 504 | ||
| Congenital Anomalies | 504 | ||
| Efficacy, Risks, and Recommendations for Monitoring | 504 | ||
| Electronic Monitoring Versus Auscultation | 504 | ||
| Adjuncts to Electronic Fetal Heart Rate Monitoring | 505 | ||
| Acknowledgments | 506 | ||
| References | 506.e1 | ||
| 34 Assessment and Induction of Fetal Pulmonary Maturity | 507 | ||
| Assessment of Fetal Pulmonary Maturity | 507 | ||
| Direct Evaluation of Amniotic Fluid | 507 | ||
| Noninvasive Assessment of Fetal Pulmonary Maturity | 508 | ||
| Impact of Gestational Age on Fetal Pulmonary Maturity Testing | 508 | ||
| Assessment of Fetal Pulmonary Maturity in Special Groups | 509 | ||
| Impact of Contaminants on Fetal Pulmonary Testing Results | 509 | ||
| Assessment of Fetal Pulmonary Maturity from Vaginal Fluid Specimens | 509 | ||
| Induction of Fetal Pulmonary Maturity | 510 | ||
| Antenatal Corticosteroids | 511 | ||
| Neonatal Outcomes | 511 | ||
| Other Fetal and Neonatal Effects | 513 | ||
| Maternal Consequences | 513 | ||
| Repeated Courses | 513 | ||
| Rescue Antenatal Corticosteroids | 514 | ||
| Summary | 515 | ||
| References | 515.e1 | ||
| 35 Invasive Fetal Therapy | 516 | ||
| Open Fetal Surgery | 516 | ||
| EXIT Procedure | 518 | ||
| Fetoscopy | 519 | ||
| Instrumentation | 519 | ||
| Iatrogenic Preterm Rupture of the Membranes | 520 | ||
| Amniopatch. | 520 | ||
| Fetal Analgesia during Procedures | 521 | ||
| Complicated Monochorionic Twin Pregnancies | 521 | ||
| Twin-Twin Transfusion Syndrome | 521 | ||
| Diagnosis of TTTS | 521 | ||
| Prediction of TTTS | 522 | ||
| Staging of TTTS | 523 | ||
| Treatment of TTTS | 524 | ||
| Amnioreduction | 524 | ||
| Septostomy | 524 | ||
| Selective Feticide | 524 | ||
| Fetoscopic Laser Coagulation | 525 | ||
| Complications | 527 | ||
| Amnioreduction versus Laser Coagulation | 528 | ||
| Measures to Improve the Outcome of TTTS | 530 | ||
| Selective Feticide for Other Complications | 531 | ||
| Results of Selective Feticide in Monochorionic Twins | 531 | ||
| Indications for Selective Feticide in Monochorionic Twins | 531 | ||
| Twin Reversed Arterial Perfusion Sequence | 533 | ||
| Chorioangioma | 534 | ||
| Sacrococcygeal Teratoma | 534 | ||
| Prognostic Factors | 535 | ||
| Prenatal Treatment | 536 | ||
| Outcomes | 537 | ||
| Isolated Congenital Diaphragmatic Hernia | 538 | ||
| Etiology and Consequences of CDH | 538 | ||
| Prenatal Assessment of CDH | 539 | ||
| Individualized Prenatal Prediction of CDH Outcome | 539 | ||
| Two-Dimensional Ultrasonography | 539 | ||
| Three-Dimensional Techniques | 540 | ||
| Lung Vascularization | 541 | ||
| Prenatal Intervention for CDH | 541 | ||
| Trials Comparing FETO with Expectant Management | 542 | ||
| Congenital Thoracic Malformations | 542 | ||
| Congenital Cystic Adenomatoid Malformation | 543 | ||
| Pulmonary Sequestration | 543 | ||
| Prenatal Management of CCAM and Pulmonary Sequestration | 545 | ||
| Other Thoracic Lesions | 546 | ||
| Lower Urinary Tract Obstruction | 546 | ||
| Pathophysiology | 546 | ||
| LUTO Shunt Case Selection | 546 | ||
| Outcomes for Antenatal Therapy for LUTO | 547 | ||
| Congenital Heart Defects | 548 | ||
| Rationale and Case Selection | 548 | ||
| Antenatal Intervention for Congenital Heart Defects | 548 | ||
| Technical Outcome of Antenatal Interventions for Congenital Heart Defects | 549 | ||
| Atrial Septostomy for Hypoplastic Left Heart Syndrome | 549 | ||
| Balloon Valvuloplasty for Hypoplastic Left Heart Syndrome | 550 | ||
| Balloon Valvuloplasty for Pulmonary Atresia | 550 | ||
| Myelomeningocele Repair | 551 | ||
| Antenatal Impact of Myelomeningocele | 551 | ||
| Prenatal Diagnosis | 551 | ||
| Fetal Surgery: Experimental Basis and Early Experience | 552 | ||
| Results of Fetal Surgery for Myelomeningocele | 554 | ||
| Fetoscopic Surgery | 556 | ||
| Amniotic Band Syndrome | 556 | ||
| Acknowledgments | 557 | ||
| References | 557.e1 | ||
| 36 Hemolytic Disease of the Fetus and Newborn | 558 | ||
| Red Cell Alloimmunization | 558 | ||
| Terminology | 558 | ||
| Epidemiology | 558 | ||
| Pathogenesis | 558 | ||
| Genetics | 559 | ||
| Diagnosis | 559 | ||
| Maternal Antibody Determination | 559 | ||
| Paternal Zygosity | 560 | ||
| Fetal Genotype Testing | 560 | ||
| Middle Cerebral Artery Doppler | 561 | ||
| Clinical Management | 561 | ||
| First Affected Pregnancy | 561 | ||
| Previously Affected Fetus or Infant | 563 | ||
| Treatment | 563 | ||
| Access Site for Intrauterine Transfusion | 563 | ||
| Method of Intrauterine Transfusion | 563 | ||
| Intrauterine Transfusion Technique | 564 | ||
| Severely Anemic Early-Second-Trimester Fetus in a Previous Pregnancy | 564 | ||
| Timing of Delivery | 565 | ||
| Outcome | 565 | ||
| Prevention | 565 | ||
| Formulations | 565 | ||
| Administration | 566 | ||
| The “Weak D” Dilemma | 566 | ||
| Mass Screening of RhD-Negative Women with cffDNA | 567 | ||
| Hemolytic Disease of the Fetus and Newborn Caused by Non-RhD Antibodies | 567 | ||
| Anti-Rhc | 567 | ||
| Anti-RhC, -RhE, and -Rhe | 567 | ||
| Anti-RhG | 568 | ||
| Anti-K (K1) | 568 | ||
| Anti-k (K2) | 568 | ||
| Anti-M and Anti-N | 568 | ||
| Anti-Duffy | 568 | ||
| Anti-Kidd | 568 | ||
| Future Therapy | 568 | ||
| Summary and Recommendations | 568 | ||
| References | 568.e1 | ||
| 37 Nonimmune Hydrops | 569 | ||
| Initial Signs and Symptoms | 569 | ||
| Ultrasonography | 569 | ||
| Fetal Fluid Accumulation | 570 | ||
| Etiology | 571 | ||
| Cardiovascular Causes | 571 | ||
| Chromosomal Abnormalities | 573 | ||
| Thoracic Abnormalities | 573 | ||
| Twinning | 574 | ||
| Fetal Anemia | 574 | ||
| Infection | 574 | ||
| Syphilis | 574 | ||
| Cytomegalovirus | 575 | ||
| Parvovirus | 575 | ||
| Other Infections | 575 | ||
| Metabolic Disease | 575 | ||
| Other Malformations | 575 | ||
| Other Causes | 575 | ||
| Experimental Management of Idiopathic Cases | 575 | ||
| Diagnostic Approach to the Fetus with Hydrops | 576 | ||
| Management | 576 | ||
| Recurrence Risks | 577 | ||
| Delivery Considerations | 577 | ||
| Summary | 577 | ||
| References | 577.e1 | ||
| 38 Multiple Gestation: Clinical Characteristics and Management | 578 | ||
| Perinatal Mortality and Morbidity | 578 | ||
| Maternal Mortality and Morbidity | 579 | ||
| Maternal Adaptations | 579 | ||
| Ultrasonography in Multiple Gestation | 579 | ||
| Diagnosis of Multiple Gestation | 579 | ||
| Chorionicity | 579 | ||
| Detection of Fetal Anomalies | 580 | ||
| Evaluation of Fetal Growth | 580 | ||
| Measurement of Cervical Length | 581 | ||
| Confirmation of Fetal Well-Being | 581 | ||
| Prenatal Diagnosis | 581 | ||
| Risks of Chromosomal Abnormalities | 581 | ||
| First-Trimester Screening for Aneuploidy | 582 | ||
| Second-Trimester Serum Screening for Aneuploidy | 583 | ||
| Screening for Neural Tube Defects | 583 | ||
| Genetic Amniocentesis | 583 | ||
| Chorionic Villus Sampling | 583 | ||
| Antepartum Management | 583 | ||
| Preterm Labor and Delivery | 584 | ||
| Preeclampsia | 585 | ||
| Other Maternal Complications | 585 | ||
| Fetal Surveillance | 585 | ||
| Intrapartum Management | 585 | ||
| Timing of Delivery | 585 | ||
| Preparations | 586 | ||
| Vertex-Vertex Twins | 586 | ||
| Vertex-Nonvertex Twins | 586 | ||
| Nonvertex First Twin | 587 | ||
| Higher-Order Multiple Gestations | 587 | ||
| Asynchronous Delivery | 587 | ||
| Special Considerations in Management | 587 | ||
| Twin-Twin Transfusion Syndrome | 587 | ||
| Background and Pathogenesis | 587 | ||
| Clinical and Sonographic Features | 588 | ||
| Management | 589 | ||
| Laser Therapy for Severe TTTS | 589 | ||
| Monoamniotic Twins | 590 | ||
| Twin Reversed Arterial Perfusion Sequence | 591 | ||
| Conjoined Twins | 592 | ||
| Intrauterine Demise of One Fetus | 593 | ||
| Selective Termination of an Anomalous Fetus | 594 | ||
| Multifetal Pregnancy Reduction | 595 | ||
| Prevention of Higher-Order Multifetal Gestation | 596 | ||
| References | 596.e1 | ||
| 4 Disorders at the Maternal-Fetal Interface | 597 | ||
| 39 Pathogenesis of Spontaneous Preterm Birth | 599 | ||
| Preterm Birth Syndrome: New Phenotypic Classification | 599 | ||
| Mechanisms of Spontaneous Preterm Birth | 599 | ||
| The Common Pathway | 599 | ||
| Prostaglandins as Key Activators of the Common Pathway of Parturition | 601 | ||
| Inflammation, Stress, and Term and Preterm Parturition | 601 | ||
| Preterm Birth Resulting from Intra-amniotic Infection | 602 | ||
| Role of Proinflammatory Agents in Preterm Birth | 604 | ||
| Bacterial Species and the Intensity of Intra-amniotic Inflammatory Responses | 606 | ||
| Stretch and Parturition | 606 | ||
| Myometrial Stretch and Term and Preterm Birth | 606 | ||
| Fetal Membrane Stretch and Term and Preterm Birth | 607 | ||
| Activation of the Maternal-Fetal HPA Axis in Term and Preterm Birth | 607 | ||
| Fetal Control of the Onset of Parturition | 608 | ||
| Progesterone Withdrawal and Parturition | 609 | ||
| Gene-Environment Interaction | 609 | ||
| Spontaneous Preterm Parturition as a Syndrome | 610 | ||
| Myometrial Contractility | 610 | ||
| Cervical Adaptation and Remodeling during Human Pregnancy | 610 | ||
| Cervical Adaptation and Remodeling during Preterm Birth | 613 | ||
| Decidual Activation and Bleeding | 613 | ||
| Preterm Premature Rupture of Membranes | 615 | ||
| Phenotypic Components of the Preterm Birth Syndrome | 616 | ||
| Maternal Conditions | 616 | ||
| Extrauterine Infection | 616 | ||
| Clinical Chorioamnionitis | 617 | ||
| Maternal Trauma and Uterine Rupture | 617 | ||
| Worsening Maternal Disease, Including Preeclampsia | 617 | ||
| Maternal Stress and Anxiety | 617 | ||
| Cervical Disorders | 618 | ||
| Fetal Conditions | 619 | ||
| Intrauterine Fetal Demise | 619 | ||
| Intrauterine Growth Restriction | 619 | ||
| Abnormal Fetal Heart Rate or Biophysical Profile | 620 | ||
| Infection and the Fetal Inflammatory Response Syndrome | 620 | ||
| Fetal Anomaly | 621 | ||
| Polyhydramnios | 621 | ||
| Multiple Pregnancies | 621 | ||
| Placental Pathologic Conditions | 622 | ||
| Histologic Chorioamnionitis | 622 | ||
| Placental Abruption | 622 | ||
| Placenta Previa | 622 | ||
| Other Placental Abnormalities | 623 | ||
| Summary | 623 | ||
| References | 623.e1 | ||
| 40 Preterm Labor and Birth | 624 | ||
| The Problem of Preterm Birth | 624 | ||
| Definitions | 624 | ||
| Incidence of Preterm Birth | 625 | ||
| Ascertainment of Preterm Birth and Low Birth Weight | 625 | ||
| Changes in the Incidence of Preterm Birth | 625 | ||
| Clinical Presentations of Preterm Birth | 626 | ||
| Consequences of Preterm Birth | 626 | ||
| Perinatal and Infant Mortality | 626 | ||
| Factors Affecting Perinatal, Infant, and Childhood Mortality and Morbidity | 627 | ||
| Data Collection. | 627 | ||
| Gestational Age. | 628 | ||
| Birth Weight. | 628 | ||
| Very-Low-Birth-Weight Infants. | 628 | ||
| Extremely-Low-Birth-Weight Infants. | 628 | ||
| Maternal Race. | 628 | ||
| Other Factors. | 628 | ||
| Perinatal Morbidity | 628 | ||
| Long-Term Outcomes | 629 | ||
| Epidemiology and Risk Factors for Preterm Birth | 629 | ||
| Maternal Characteristics | 629 | ||
| Familial Risk | 629 | ||
| Education and Economic Status, Age, and Marital Status | 629 | ||
| Race and Ethnic Background | 629 | ||
| Maternal Behaviors and Environment | 630 | ||
| Stress and Depression | 630 | ||
| Maternal Physical Activity | 630 | ||
| Nutritional Status | 631 | ||
| Infections | 631 | ||
| Genital Tract Infection and Colonization. | 631 | ||
| Specific Infections. | 631 | ||
| Periodontal Disease. | 632 | ||
| Uterine Abnormalities | 632 | ||
| Uterine Anomalies. | 632 | ||
| Cervical Surgery. | 632 | ||
| Reproductive History | 632 | ||
| Prior Preterm Birth | 632 | ||
| Prior Spontaneous Preterm Birth. | 632 | ||
| Prior Twin Preterm Birth. | 633 | ||
| Prior Indicated Preterm Birth. | 633 | ||
| Prior Stillbirth. | 633 | ||
| Pregnancy Termination. | 633 | ||
| Current Pregnancy Characteristics | 634 | ||
| Bleeding | 634 | ||
| Assisted Reproductive Technologies | 634 | ||
| Multiple Gestation | 634 | ||
| Uterine Factors | 634 | ||
| Uterine Volume. | 634 | ||
| Uterine Contractions. | 635 | ||
| Cervical Length. | 635 | ||
| Interventional Strategies | 635 | ||
| Preterm Labor | 636 | ||
| Diagnosis of Preterm Labor | 636 | ||
| Symptoms and Signs | 636 | ||
| Tests for Preterm Labor | 637 | ||
| Management of Preterm Labor | 637 | ||
| Strategies to Reduce Morbidity and Mortality | 637 | ||
| Regionalized Care. | 637 | ||
| Strategies to Reduce Morbidity | 637 | ||
| Antenatal Corticosteroids. | 637 | ||
| Antibiotics. | 638 | ||
| Neuroprotectants. | 638 | ||
| Tocolytic Therapy | 638 | ||
| Goals of Tocolysis | 638 | ||
| Contraindications to Arrest of Labor | 639 | ||
| Choosing a Tocolytic Agent | 639 | ||
| Calcium Channel Blockers | 639 | ||
| Pharmacology. | 639 | ||
| Effectiveness. | 639 | ||
| Maternal Effects. | 639 | ||
| Fetal Effects. | 639 | ||
| Treatment Protocol. | 639 | ||
| Calcium Channel Blockers: Summary. | 640 | ||
| Cyclooxygenase Inhibitors | 640 | ||
| Pharmacology. | 640 | ||
| Effectiveness. | 640 | ||
| Maternal Effects. | 640 | ||
| Fetal and Neonatal Effects. | 640 | ||
| Treatment Protocol. | 640 | ||
| Indomethacin: Summary. | 641 | ||
| Oxytocin Antagonists | 641 | ||
| 5 Maternal Complications | 783 | ||
| 49 Patient Safety in Obstetrics | 785 | ||
| The Patient Safety Movement | 785 | ||
| Safety Challenges in Obstetrics | 785 | ||
| Potential Strategies to Improve Patient Safety | 787 | ||
| Outside Expert Review | 787 | ||
| Protocols and Guidelines | 788 | ||
| Checklists | 788 | ||
| Checklists in Medicine and Surgery | 788 | ||
| Checklists in Obstetrics | 789 | ||
| Areas in Which Checklists May Have an Impact | 789 | ||
| Oxytocin Use. | 789 | ||
| “Routine” Cesarean Delivery. | 789 | ||
| Emergent Cesarean Delivery. | 790 | ||
| Perinatal Patient Safety Nurse | 790 | ||
| Anonymous Event Reporting | 790 | ||
| The Obstetric Hospitalist | 791 | ||
| Obstetric Patient Safety Committee | 791 | ||
| Safety Attitudes Survey or Questionnaire | 791 | ||
| Team Training | 792 | ||
| Electronic Fetal Monitoring Certification | 792 | ||
| Simulation | 792 | ||
| Evaluation of Progress | 793 | ||
| Economics of Patient Safety | 793 | ||
| Coping with the Aftermath of Adverse Events | 794 | ||
| Conclusions | 794 | ||
| References | 794.e1 | ||
| 50 Maternal Mortality | 795 | ||
| Measurement | 795 | ||
| Trends in Rate and Data Collection Issues | 796 | ||
| Demographics | 797 | ||
| Causes and Preventability of Maternal Mortality | 797 | ||
| IMPROVEMENT Opportunities | 798 | ||
| Obstetric Hemorrhage | 798 | ||
| Amniotic Fluid Embolism | 799 | ||
| Venous Thromboembolic Events | 799 | ||
| Preeclampsia and Eclampsia | 799 | ||
| Cardiovascular Disease | 800 | ||
| Suicides and Homicides | 800 | ||
| African-American Maternal Mortality Rates | 801 | ||
| Role of Obstetric Leaders in Reducing Maternal Mortality | 801 | ||
| References | 801.e1 | ||
| 51 Maternal and Fetal Infections | 802 | ||
| Candidiasis (Monilial Vaginitis) | 802 | ||
| Epidemiology | 802 | ||
| Pathogenesis | 802 | ||
| Diagnosis | 803 | ||
| Treatment | 803 | ||
| Trichomoniasis | 803 | ||
| Clinical Presentation | 803 | ||
| 6 The Neonate | 1213 | ||
| 72 Neonatal Morbidities of Prenatal and Perinatal Origin | 1215 | ||
| Obstetric Decisions and Neonatal Outcomes | 1215 | ||
| The Perinatal Consultation and Role of the Neonatologist | 1215 | ||
| Common Morbidities of Pregnancy and Neonatal Outcome | 1215 | ||
| Complications of Prematurity | 1217 | ||
| Decisions at the Threshold of Viability | 1219 | ||
| Planning for Delivery at the Limits of Viability | 1220 | ||
| Neonatal Resuscitation at the Limits of Viability | 1220 | ||
| Respiratory Problems | 1220 | ||
| Transient Tachypnea of the Newborn | 1220 | ||
| Definition. | 1220 | ||
| Pathophysiology. | 1220 | ||
| Risk Factors. | 1221 | ||
| Clinical Presentation. | 1221 | ||
| Diagnosis. | 1221 | ||
| Management. | 1221 | ||
| Neonatal Implications. | 1221 | ||
| Pulmonary Hypoplasia | 1221 | ||
| Respiratory Distress Syndrome | 1222 | ||
| Perinatal Risk Factors. | 1222 | ||
| Clinical Presentation. | 1222 | ||
| Management Principles | 1222 | ||
| General Measures. | 1222 | ||
| Surfactant Therapy. | 1222 | ||
| Continuous Positive Airway Pressure. | 1222 | ||
| Mechanical Ventilation. | 1223 | ||
| Complications of Respiratory Distress Syndrome. | 1223 | ||
| Bronchopulmonary Dysplasia | 1223 | ||
| Pathophysiology. | 1223 | ||
| Long-Term Complications. | 1224 | ||
| Prevention Strategies. | 1224 | ||
| Meconium-Stained Amniotic Fluid and Meconium Aspiration Syndrome | 1224 | ||
| Pulmonary Hypertension | 1225 | ||
| Gastrointestinal Problems in THE Neonatal Period | 1226 | ||
| Hyperbilirubinemia | 1227 | ||
| Feeding Problems | 1228 | ||
| Investigational Strategies | 1228 | ||
| Neonatal Management of Neurologic Problems | 1228 | ||
| Hypoxic-Ischemic Encephalopathy | 1228 | ||
| Definition of Asphyxia. | 1228 | ||
| Clinical Markers. | 1228 | ||
| Neonatal Encephalopathy. | 1229 | ||
| Multiorgan Injury. | 1229 | ||
| Neuropathology. | 1229 | ||
| Neuroimaging. | 1229 | ||
| Neuroprotection Strategies. | 1229 | ||
| Investigational Strategies. | 1229 | ||
| Intraventricular Hemorrhage | 1229 | ||
| Incidence. | 1230 | ||
| Pathogenesis. | 1230 | ||
| Outcomes. | 1230 | ||
| Antenatal Prevention. | 1230 | ||
| Postnatal Prevention. | 1230 | ||
| Posthemorrhagic Hydrocephalus. | 1230 | ||
| Investigational Strategies. | 1230 | ||
| Periventricular Leukomalacia | 1230 | ||
| Neuropathology. | 1231 | ||
| Pathogenesis. | 1231 | ||
| Clinical Outcomes. | 1231 | ||
| Investigational Strategies. | 1231 | ||
| Perinatal Stroke | 1231 | ||
| Clinical Presentation. | 1231 | ||
| Pathophysiology and Risk Factors. | 1231 | ||
| Neuroimaging and Electroencephalographic Assessment. | 1231 | ||
| Outcome. | 1232 | ||
| Investigational Strategies. | 1232 | ||
| Cerebral Palsy | 1232 | ||
| Classification. | 1232 | ||
| Etiology. | 1233 | ||
| Prematurity. | 1233 | ||
| Multiple Births. | 1233 | ||
| Growth Restriction. | 1234 | ||
| Perinatal Infections. | 1234 | ||
| Placental Abnormalities. | 1234 | ||
| Coexisting Impairments. | 1235 | ||
| Investigational Strategies. | 1235 | ||
| Infectious Disease Problems | 1235 | ||
| Neonatal Infection | 1235 | ||
| Group B β-Hemolytic Streptococci. | 1236 | ||
| Chorioamnionitis. | 1236 | ||
| Viral Infections | 1236 | ||
| Cytomegalovirus. | 1236 | ||
| Hepatitis B. | 1236 | ||
| Herpes Simplex Virus. | 1237 | ||
| Human Immunodeficiency Virus. | 1237 | ||
| Rubella. | 1237 | ||
| Sexually Transmitted Infections | 1238 | ||
| Chlamydia. | 1238 | ||
| Gonococcal Infections. | 1238 | ||
| Syphilis. | 1238 | ||
| References | 1239.e1 | ||
| Index | 1241 | ||
| A | 1241 | ||
| B | 1246 | ||
| C | 1248 | ||
| D | 1253 | ||
| E | 1255 | ||
| F | 1257 | ||
| G | 1260 | ||
| H | 1262 | ||
| I | 1265 | ||
| J | 1267 | ||
| K | 1267 | ||
| L | 1267 | ||
| M | 1269 | ||
| N | 1273 | ||
| O | 1275 | ||
| P | 1276 | ||
| Q | 1282 | ||
| R | 1282 | ||
| S | 1285 | ||
| T | 1288 | ||
| U | 1291 | ||
| V | 1293 | ||
| W | 1294 | ||
| X | 1294 | ||
| Y | 1294 | ||
| Z | 1294 | ||
| Clinical Key ad | IBC1 |