BOOK
Obstetrics: Normal and Problem Pregnancies E-Book
Steven G. Gabbe | Jennifer R. Niebyl | Joe Leigh Simpson | Mark B Landon | Henry L Galan | Eric R. M. Jauniaux | Deborah A Driscoll | Vincenzo Berghella | William A Grobman
(2016)
Additional Information
Book Details
Abstract
After 30 years, Obstetrics: Normal and Problem Pregnancies remains your go-to choice for authoritative guidance on managing today’s obstetric patient. International experts put the latest knowledge in this specialty at your fingertips, with current and relevant information on everything from fetal origins of adult disease, to improving global maternal health, to important topics in day-to-day obstetrical practice. Highly readable, well-illustrated, and easy to understand, this bestselling obstetrics reference is an ideal tool for residents and clinicians.
- Take advantage of the collective wisdom of global experts in the field, including two new editors— Drs. Vincenzo Berghella and William Grobman -- and nearly 30 new contributors.
- Gain a new perspective on a wide range of today's key issues - all evidence-based and easy to read.
- Sweeping updates throughout including four new chapters: ‘Vaginal Birth after Cesarean Delivery’; ‘Placenta Accreta’; ‘Obesity’; and ‘Improving Global Maternal Health: Challenges and Opportunities’
- New Glossary of the most frequently used key abbreviations for easy reference
- Expanded use of bolded statements and key points as well as additional tables, flow diagrams, and bulleted lists facilitates and enhances the mastery of each chapter
- More than 100 images in the Obstetrical Ultrasound chapter provide an important resource for normal and abnormal fetal anatomy
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Obstetrics: Normal and Problem Pregnancies | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| Preface | xv | ||
| Table Of Contents | xvii | ||
| Video Contents | xx | ||
| I Physiology | 1 | ||
| 1 Placental Anatomy and Physiology | 2 | ||
| Key Abbreviations | 2 | ||
| Placental Anatomy | 3 | ||
| Overview of the Delivered Placenta | 3 | ||
| Placental Development | 3 | ||
| Amnion and Yolk Sac | 5 | ||
| Maternal-Fetal Relationship During the First Trimester | 5 | ||
| Extravillous Trophoblast Invasion and Physiologic Conversion of the Spiral Arteries | 6 | ||
| Role of the Endometrium During the First Trimester | 8 | ||
| Topology of the Villous Trees | 9 | ||
| Placental Histology | 9 | ||
| Integrity of the Villous Membrane | 11 | ||
| Placental Vasculature | 11 | ||
| Placental Physiology | 12 | ||
| Physiology of the Secondary Yolk Sac and Exocoelomic Cavity | 12 | ||
| Placental Metabolism and Growth | 13 | ||
| Placental Transport | 14 | ||
| Bulk Flow/Solvent Drag | 15 | ||
| Diffusion | 15 | ||
| Transporter Protein–Mediated Processes | 15 | ||
| Endocytosis/Exocytosis | 16 | ||
| A Selective Barrier | 16 | ||
| Substance-Specific Placental Transport | 16 | ||
| Respiratory Gases | 16 | ||
| Glucose | 17 | ||
| Amino Acids | 17 | ||
| Lipids | 18 | ||
| Water and Ions | 19 | ||
| Calcium | 19 | ||
| Placental Nutrient Supply and Intrauterine Growth Restriction | 19 | ||
| Vasomotor Control of the Umbilicoplacental Circulation | 19 | ||
| Placental Endocrinology | 20 | ||
| Progesterone | 20 | ||
| Estrogens | 20 | ||
| Human Chorionic Gonadotropin | 20 | ||
| Placental Lactogen | 21 | ||
| Placental Growth Hormone | 22 | ||
| Leptin | 22 | ||
| Pregnancy-Associated Plasma Protein A | 22 | ||
| Sex Differences in Placental Function | 22 | ||
| Summary | 22 | ||
| Key Points | 22 | ||
| Acknowledgment | 23 | ||
| References | 23 | ||
| 2 Fetal Development and Physiology | 26 | ||
| Key Abbreviations | 26 | ||
| Umbilical Blood Flow | 26 | ||
| Amniotic Fluid Volume | 27 | ||
| Fetal Growth and Metabolism | 28 | ||
| Substrates | 28 | ||
| Hormones | 28 | ||
| Fetal Cardiovascular System | 29 | ||
| Development | 29 | ||
| Fetal Heart | 30 | ||
| Regulation of Cardiovascular Function | 32 | ||
| Autonomic Regulation | 32 | ||
| Hormonal Regulation | 32 | ||
| Arginine Vasopressin | 32 | ||
| Renin–Angiotensin II | 32 | ||
| Fetal Hemoglobin | 33 | ||
| Fetal Kidney | 33 | ||
| Fetal Gastrointestinal System | 34 | ||
| Gastrointestinal Tract | 34 | ||
| Liver | 34 | ||
| Fetal Adrenal and Thyroid Glands | 35 | ||
| Adrenal Glands | 35 | ||
| Thyroid Gland | 35 | ||
| Fetal Central Nervous System | 35 | ||
| Summary | 36 | ||
| Key Points | 36 | ||
| References | 36 | ||
| 3 Maternal Physiology | 38 | ||
| Key Abbreviations | 38 | ||
| Overview | 39 | ||
| Gestational Weight Gain | 39 | ||
| Cardiovascular System | 39 | ||
| Heart | 39 | ||
| Cardiac Output | 39 | ||
| Arterial Blood Pressure and Systemic Vascular Resistance | 41 | ||
| Venous Pressure | 41 | ||
| Central Hemodynamic Assessment | 41 | ||
| Normal Changes That Mimic Heart Disease | 42 | ||
| Effect of Labor and the Immediate Puerperium | 42 | ||
| Cardiac Rhythm | 43 | ||
| Hematologic Changes | 43 | ||
| Plasma Volume and Red Cell Mass | 43 | ||
| Iron Metabolism | 44 | ||
| Platelets | 45 | ||
| Leukocytes | 45 | ||
| Coagulation System | 45 | ||
| Respiratory System | 46 | ||
| Upper Respiratory Tract | 46 | ||
| Mechanical Changes | 46 | ||
| Lung Volume and Pulmonary Function | 47 | ||
| Gas Exchange | 47 | ||
| Sleep | 48 | ||
| Urinary System | 49 | ||
| Anatomic Changes | 49 | ||
| Renal Hemodynamics | 49 | ||
| Renal Tubular Function and Excretion of Nutrients | 50 | ||
| Body Water Metabolism | 51 | ||
| Osmoregulation | 51 | ||
| Salt Metabolism | 51 | ||
| Renin-Angiotensin-Aldosterone System | 51 | ||
| Atrial and Brain Natriuretic Peptide | 52 | ||
| Clinical Implications of Pregnancy-Related Renal and Urologic Changes | 52 | ||
| Alimentary Tract | 52 | ||
| Appetite | 52 | ||
| Mouth | 52 | ||
| Stomach | 53 | ||
| Intestines | 53 | ||
| Gallbladder | 53 | ||
| Liver | 53 | ||
| Nausea and Vomiting of Pregnancy | 54 | ||
| Endocrine Changes | 54 | ||
| Thyroid | 54 | ||
| Adrenals | 55 | ||
| Pituitary | 56 | ||
| Pancreas and Fuel Metabolism | 56 | ||
| Glucose | 56 | ||
| Proteins and Lipids | 56 | ||
| Skeleton | 57 | ||
| Calcium Metabolism | 57 | ||
| Skeletal and Postural Changes | 58 | ||
| Skin | 58 | ||
| Central Nervous System | 59 | ||
| Eyes | 59 | ||
| Breasts | 59 | ||
| Lower Reproductive Tract | 59 | ||
| Vagina | 59 | ||
| Cervix | 59 | ||
| Microbiome | 59 | ||
| Vaginal Microbiome | 60 | ||
| Gut Microbiome | 60 | ||
| Placental Microbiome | 60 | ||
| Summary | 60 | ||
| Key Points | 60 | ||
| Acknowledgment | 61 | ||
| References | 61 | ||
| Bibliography | 63.e1 | ||
| Gestational Weight Gain | 63.e1 | ||
| Cardiovascular Changes | 63.e1 | ||
| Arterial Blood Pressure and Systemic Vascular Resistance | 63.e1 | ||
| Labor Effects on the Cardiovascular System | 63.e1 | ||
| Cardiac Rhythm | 63.e1 | ||
| Hematologic Changes | 63.e1 | ||
| Iron Metabolism | 63.e1 | ||
| Coagulation System | 63.e1 | ||
| Respiratory System | 63.e2 | ||
| Sleep | 63.e2 | ||
| Urinary System | 63.e2 | ||
| Osmoregulation | 63.e2 | ||
| Renin-Angiotensin-Aldosterone System | 63.e2 | ||
| Clinical Implications of Pregnancy-Related Renal and Urologic Changes | 63.e2 | ||
| Appetite and Mouth | 63.e2 | ||
| Stomach | 63.e2 | ||
| Intestines | 63.e3 | ||
| Gallbladder | 63.e3 | ||
| Liver | 63.e3 | ||
| Thyroid | 63.e3 | ||
| Adrenals | 63.e3 | ||
| Pituitary | 63.e3 | ||
| Pancreas and Fuel Metabolism | 63.e3 | ||
| Skeleton: Calcium Metabolism | 63.e3 | ||
| Skeleton: Postural Changes | 63.e3 | ||
| Skin | 63.e3 | ||
| Central Nervous System | 63.e3 | ||
| Eyes | 63.e3 | ||
| Breasts | 63.e3 | ||
| Lower Reproductive Tract | 63.e3 | ||
| Cervix | 63.e3 | ||
| Microbiome | 63.e4 | ||
| 4 Maternal-Fetal Immunology | 64 | ||
| Key Abbreviations | 64 | ||
| Immune System Overview: Innate and Adaptive Immunity | 65 | ||
| Innate Immunity: First Line of Host Defense | 65 | ||
| Antimicrobial Peptides | 68 | ||
| Macrophages | 68 | ||
| Natural Killer Cells | 68 | ||
| Toll-Like Receptors | 68 | ||
| Complement System | 69 | ||
| Cytokines | 69 | ||
| Chemokines | 70 | ||
| Adaptive Immunity | 71 | ||
| Major Histocompatibility Complex | 71 | ||
| Humoral Immune Responses: B Cells and Antibodies | 71 | ||
| Antibody Isotypes | 71 | ||
| T Cells | 72 | ||
| Helper T-Cell Subsets | 73 | ||
| Regulatory T Cells | 73 | ||
| Fetal Immune System | 73 | ||
| Cord Blood Transplantation | 74 | ||
| Maternal Tolerance of the Fetus | 74 | ||
| Tolerance Through Regulation of Maternal T Cells | 75 | ||
| Tolerance Through Regulation of Maternal B Cells | 75 | ||
| Tolerance Through Dendritic Cells and Antigen Presentation | 77 | ||
| Tolerance Through Human Leukocyte Antigens | 77 | ||
| Tolerance Through Regulation of Complement, Chemokines, and Cytokines | 77 | ||
| Fetal Rejection | 77 | ||
| Solid Organ Transplantation in Pregnancy | 78 | ||
| Amelioration of Rheumatoid Arthritis in Pregnancy | 78 | ||
| Summary | 79 | ||
| Key Points | 79 | ||
| Acknowledgments | 80 | ||
| References | 80 | ||
| Bibliography | 82.e1 | ||
| Innate Immunity: First Line of Host Defense | 82.e1 | ||
| Adaptive Immunity | 82.e1 | ||
| Fetal Immune System | 82.e1 | ||
| Maternal Tolerance of the Fetus | 82.e1 | ||
| Amelioration of Rheumatoid Arthritis in Pregnancy | 82.e2 | ||
| 5 Developmental Origins of Adult Health and Disease | 83 | ||
| Key Abbreviations | 83 | ||
| Epigenetics and Programming | 84 | ||
| Fetal Nutrition and Growth | 86 | ||
| Energy-Balance Programming | 86 | ||
| Programming by Environmental Agents | 87 | ||
| Mechanisms of Programmed Obesity: Appetite and Adiposity | 88 | ||
| Hepatic Programming | 89 | ||
| Pancreatic Programming | 90 | ||
| Cardiac Programming | 91 | ||
| Osteoporosis Programming | 92 | ||
| Brain Programming | 92 | ||
| Maternal Stress and Anxiety | 92 | ||
| Glucocorticoids and Prematurity | 93 | ||
| Immune Function | 94 | ||
| Other Programming | 95 | ||
| Endocrine Programming | 95 | ||
| Sexuality Programming | 95 | ||
| Renal Programming | 96 | ||
| Summary | 97 | ||
| Key Points | 97 | ||
| References | 97 | ||
| II Prenatal Care | 101 | ||
| 6 Preconception and Prenatal Care | 102 | ||
| Key Abbreviations | 102 | ||
| Prenatal Care: Changing the Paradigm to Include the Life-Course Perspective | 102 | ||
| Definition and Goals of Care | 103 | ||
| Evidence and Rationale for Paradigm Shift | 103 | ||
| Components of Preconception Care and Well-Woman Visits | 103 | ||
| Reproductive Life Plan: Definition | 105 | ||
| Preconception Health Counseling | 105 | ||
| Maternal Age | 105 | ||
| Advanced Maternal Age | 105 | ||
| Teen Pregnancies | 105 | ||
| Body Mass Index | 106 | ||
| Weight Gain | 106 | ||
| Overweight and Obesity | 106 | ||
| Underweight | 107 | ||
| Pregnancy After Bariatric Surgery | 107 | ||
| Infections and Immunizations | 107 | ||
| Genetic and Family History | 108 | ||
| Substance Abuse and Other Hazards | 108 | ||
| Active and Passive Smoking | 108 | ||
| Alcohol | 108 | ||
| Other Substance Abuse | 109 | ||
| Intimate Partner Violence | 109 | ||
| Mercury Exposure | 109 | ||
| Occupational Hazards and Environmental Exposures | 109 | ||
| Environmental Exposures | 110 | ||
| Screening for Chronic Disease, Optimizing Care, and Managing Medication Exposure | 110 | ||
| Prenatal Care | 110 | ||
| Components of Prenatal Care | 110 | ||
| High-Tech Versus Low-Tech Care | 110 | ||
| Risk Assessment | 111 | ||
| Initial Prenatal Visit | 111 | ||
| Social and Demographic Risks | 111 | ||
| Medical Risk | 111 | ||
| Obstetric Risk | 112 | ||
| Physical and Laboratory Evaluation | 112 | ||
| Repeat Prenatal Visits | 112 | ||
| Intercurrent Problems | 113 | ||
| Common Patient-Centered Issues | 114 | ||
| Nutrition During Pregnancy | 114 | ||
| Activity and Employment | 114 | ||
| Travel | 114 | ||
| Nausea and Vomiting in Pregnancy | 114 | ||
| Heartburn | 115 | ||
| Backache | 115 | ||
| Sexual Activity | 115 | ||
| Prepared Parenthood and Support Groups | 115 | ||
| Prenatal Record | 115 | ||
| Prenatal Education | 116 | ||
| Postpartum Care | 116 | ||
| Components of the Postpartum Visit | 116 | ||
| Birth Spacing | 116 | ||
| Counseling Regarding Medical Conditions and Obstetric Complications | 116 | ||
| Coming Full Circle: Components of Interconception Care and Well-Woman Visits | 117 | ||
| Key Points | 118 | ||
| References | 119 | ||
| Bibliography | 121.e1 | ||
| Substance Abuse | 121.e1 | ||
| Intimate Partner Violence | 121.e1 | ||
| Mercury | 121.e1 | ||
| Occupational Hazards and Environmental Exposures | 121.e1 | ||
| Prenatal Care | 121.e1 | ||
| High Tech Versus Low Tech | 121.e1 | ||
| Risk Assessment | 121.e1 | ||
| The Initial Prenatal Visit | 121.e1 | ||
| Repeat Prenatal Visits | 121.e2 | ||
| Common Patient-Centered Issues | 121.e2 | ||
| The Prenatal Record | 121.e2 | ||
| Prenatal Education | 121.e2 | ||
| Postpartum Care | 121.e2 | ||
| Birth Spacing | 121.e2 | ||
| Counseling Regarding Medical Conditions and Obstetric Complications | 121.e2 | ||
| Coming Full Circle: Components of Interconception Care and Well-Woman Visits | 121.e3 | ||
| 7 Nutrition During Pregnancy | 122 | ||
| Key Abbreviations | 122 | ||
| Overview | 122 | ||
| Integrating Nutrition Into the Obstetric History | 122 | ||
| Maternal Weight Gain Recommendations | 123 | ||
| Low or Underweight Preconception Body Mass Index | 124 | ||
| Overweight and Obese Prepregnancy Body Mass Index | 124 | ||
| Maternal Weight Gain Recommendations for Special Populations | 124 | ||
| Multiple Gestations | 124 | ||
| Adolescents | 124 | ||
| Other Groups | 125 | ||
| Maternal Nutrient Needs: Current Recommendations | 125 | ||
| Energy | 125 | ||
| Proteins | 126 | ||
| Omega-3 Fatty Acids | 126 | ||
| Vitamin and Mineral Supplementation Guidelines | 127 | ||
| Dietary Reference Intakes | 127 | ||
| Tolerable Upper Intake Level | 127 | ||
| Vitamins | 127 | ||
| Vitamin A | 127 | ||
| Vitamin D | 127 | ||
| Vitamin C | 129 | ||
| Vitamin B6 | 129 | ||
| Vitamin K | 129 | ||
| Folate | 129 | ||
| Folate and Neural Tube Defects | 130 | ||
| Folate Supplementation | 130 | ||
| Minerals | 130 | ||
| Iron | 130 | ||
| Calcium | 131 | ||
| Zinc | 131 | ||
| Choline | 131 | ||
| Nutrition-Related Problems during Pregnancy | 132 | ||
| Nausea and Vomiting | 132 | ||
| Heartburn and Indigestion | 132 | ||
| Constipation | 132 | ||
| Food Contamination | 132 | ||
| Special Nutritional Considerations during Pregnancy | 133 | ||
| Caffeine | 133 | ||
| Vegetarian and Vegan Diets | 133 | ||
| Herbal Supplements | 133 | ||
| Key Points | 133 | ||
| References | 133 | ||
| 8 Drugs and Environmental Agents in Pregnancy and Lactation | 136 | ||
| Key Abbreviations | 136 | ||
| Overview | 136 | ||
| Basic Principles of Teratology | 137 | ||
| Genotype and Interaction With Environmental Factors | 137 | ||
| Timing of Exposure | 138 | ||
| Mechanisms of Teratogenesis | 138 | ||
| Manifestations | 138 | ||
| Agent | 138 | ||
| Dose Effect | 138 | ||
| Epidemiologic Approaches to Birth Defects | 138 | ||
| Case Reports | 138 | ||
| Descriptive Studies | 138 | ||
| Case-Control Studies | 139 | ||
| Cohort Studies | 139 | ||
| Clinical Trials | 139 | ||
| Medical Drug Use | 139 | ||
| Effects of Specific Drugs | 139 | ||
| Estrogens and Progestins | 139 | ||
| Androgenic Steroids | 139 | ||
| Spermicides | 139 | ||
| Antiepileptic Drugs | 140 | ||
| Isotretinoin | 141 | ||
| Vitamin A | 142 | ||
| Psychoactive Drugs | 142 | ||
| Tranquilizers | 142 | ||
| Lithium | 142 | ||
| Antidepressants | 142 | ||
| Anticoagulants | 143 | ||
| Thyroid and Antithyroid Drugs | 144 | ||
| Digoxin | 144 | ||
| Antihypertensive Drugs | 144 | ||
| Sympathetic Blocking Agents | 144 | ||
| Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers | 144 | ||
| Antineoplastic Drugs and Immunosuppressants | 144 | ||
| Antiasthmatics | 145 | ||
| Terbutaline | 145 | ||
| Cromolyn Sodium | 145 | ||
| Isoproterenol and Metaproterenol | 145 | ||
| Corticosteroids | 145 | ||
| Iodide | 145 | ||
| Antiemetics | 145 | ||
| Vitamin B6 | 145 | ||
| Doxylamine | 145 | ||
| Meclizine | 145 | ||
| Dimenhydrinate | 145 | ||
| Diphenhydramine | 146 | ||
| Phenothiazines | 146 | ||
| Metoclopramide | 146 | ||
| Ondansetron | 146 | ||
| Methylprednisolone | 146 | ||
| Ginger | 146 | ||
| Acid-Suppressing Drugs | 146 | ||
| Antihistamines and Decongestants | 146 | ||
| Antibiotics and Antiinfective Agents | 147 | ||
| Penicillins | 147 | ||
| Cephalosporins | 147 | ||
| Sulfonamides | 147 | ||
| Sulfamethoxazole with Trimethoprim | 147 | ||
| Nitrofurantoin | 147 | ||
| Tetracyclines | 147 | ||
| Aminoglycosides | 147 | ||
| Antituberculosis Drugs | 148 | ||
| Erythromycin | 148 | ||
| Clarithromycin | 148 | ||
| Fluoroquinolones | 148 | ||
| Metronidazole | 148 | ||
| Antiviral Agents | 148 | ||
| Lindane | 148 | ||
| Antiretroviral Agents | 148 | ||
| Antifungal Agents | 148 | ||
| Drugs for Induction of Ovulation | 148 | ||
| Mild Analgesics | 148 | ||
| Aspirin | 148 | ||
| Acetaminophen | 149 | ||
| Nonsteroidal Antiinflammatory Agents | 149 | ||
| Codeine | 149 | ||
| Sumatriptan | 149 | ||
| Bisphosphonates | 149 | ||
| Drugs of Abuse | 149 | ||
| Tobacco and Nicotine Products | 149 | ||
| Smoking Cessation During Pregnancy | 149 | ||
| Alcohol | 150 | ||
| Cannabis | 151 | ||
| Cocaine | 151 | ||
| Narcotics and Methadone | 151 | ||
| Caffeine | 151 | ||
| Aspartame | 152 | ||
| Drugs in Breast Milk | 152 | ||
| Drugs Commonly Listed as Contraindicated During Breastfeeding | 152 | ||
| Cytotoxic Drugs That May Interfere With Cellular Metabolism of the Nursing Infant | 152 | ||
| Drugs of Abuse for Which Adverse Effects on the Infant During Breastfeeding Have Been Reported | 152 | ||
| Radioactive Compounds That Require Temporary Cessation of Breastfeeding | 152 | ||
| Drugs for Which the Effect on Nursing Infants Is Unknown but May Be of Concern | 152 | ||
| Drugs Associated With Significant Effects in Some Nursing Infants That Should Be Given to Nursing Mothers With Caution | 153 | ||
| Bromocriptine | 153 | ||
| Ergotamine | 153 | ||
| Lithium | 153 | ||
| Maternal Medication Usually Compatible With Breastfeeding | 153 | ||
| Narcotics, Sedatives, and Anticonvulsants | 153 | ||
| Cold Preparations | 153 | ||
| Antihypertensives | 153 | ||
| Thiazides | 153 | ||
| β-Blockers | 153 | ||
| Angiotensin-Converting Enzyme Inhibitors | 154 | ||
| Calcium Channel Blockers | 154 | ||
| Anticoagulants | 154 | ||
| Corticosteroids | 154 | ||
| Digoxin | 154 | ||
| Antibiotics | 154 | ||
| Acyclovir | 154 | ||
| Antifungal Agents | 154 | ||
| Oral Contraceptives | 154 | ||
| Alcohol | 155 | ||
| Propylthiouracil | 155 | ||
| H2–Receptor Blockers | 155 | ||
| Caffeine | 155 | ||
| Tobacco | 155 | ||
| Occupational and Environmental Hazards | 155 | ||
| Ionizing Radiation | 155 | ||
| Acute Exposure | 155 | ||
| Mutagenesis | 156 | ||
| Video Display Terminals | 156 | ||
| Lead | 156 | ||
| Mercury in Fish | 156 | ||
| Obstetrician’s Role in Evaluating Drug and Reproductive Risks in and Beyond the Workplace | 157 | ||
| Summary | 157 | ||
| Key Points | 157 | ||
| References | 158 | ||
| Bibliography | 159.e1 | ||
| Teratogenesis | 159.e1 | ||
| Epidemiology | 159.e1 | ||
| Hormones | 159.e1 | ||
| Anticonvulsants | 159.e1 | ||
| Vitamin A Derivatives | 159.e1 | ||
| Psychoactive Drugs | 159.e1 | ||
| Anticoagulants | 159.e1 | ||
| Thyroid and Antithyroid Drugs | 159.e2 | ||
| Cardiac and Antihypertensive Medications | 159.e2 | ||
| Antiasthmatics | 159.e2 | ||
| Antiemetics | 159.e2 | ||
| Antihistamines and Decongestants | 159.e2 | ||
| Antibiotics and Antiinfective Agents | 159.e2 | ||
| Ovulation Induction Medications | 159.e3 | ||
| Mild Analgesics | 159.e3 | ||
| Drugs of Abuse | 159.e3 | ||
| Caffeine | 159.e4 | ||
| Drugs in Breast Milk | 159.e4 | ||
| Radiation | 159.e4 | ||
| Lead | 159.e5 | ||
| 9 Obstetric Ultrasound | 160 | ||
| Key Abbreviations | 160 | ||
| Overview | 160 | ||
| Biophysics of Ultrasound | 161 | ||
| Optimizing the Ultrasound Image | 161 | ||
| Frequency | 161 | ||
| Power | 161 | ||
| Gain | 161 | ||
| Attenuation | 161 | ||
| Focus | 162 | ||
| Depth and Zoom | 163 | ||
| Special Ultrasound Modalities | 163 | ||
| M-Mode | 163 | ||
| Color and Pulse-Wave Doppler | 164 | ||
| Three-Dimensional Ultrasound | 165 | ||
| Scanning Technique | 166 | ||
| Orientation | 166 | ||
| Angle of Insonation | 166 | ||
| Using Natural Windows | 167 | ||
| First-Trimester Ultrasound | 168 | ||
| First-Trimester Normal Findings | 168 | ||
| First-Trimester Abnormal Findings | 169 | ||
| Second- and Third-Trimester Ultrasound | 170 | ||
| Types of Examinations | 170 | ||
| Qualifications for Performing and Interpreting Diagnostic Ultrasound Examinations | 171 | ||
| Components of the Examination | 171 | ||
| Cardiac Activity | 171 | ||
| Number of Fetuses | 171 | ||
| Presentation | 171 | ||
| Amniotic Fluid Volume | 171 | ||
| Oligohydramnios | 172 | ||
| Polyhydramnios | 173 | ||
| Placenta and Umbilical Cord | 173 | ||
| Uterus and Adnexa | 174 | ||
| Cervix | 175 | ||
| Adnexa | 175 | ||
| Anatomic Survey | 176 | ||
| Documentation | 176 | ||
| Cleaning and Disinfection of Probes | 176 | ||
| Ultrasound for Determining Gestational Age | 176 | ||
| Standard Measurements | 177 | ||
| Gestational Age Determination | 177 | ||
| When to Use Ultrasound Dating | 180 | ||
| Assessing Fetal Growth | 180 | ||
| Estimating Fetal Weight | 181 | ||
| Diagnosing Abnormal Growth | 181 | ||
| Growth Restriction | 181 | ||
| Macrosomia | 182 | ||
| Safety of Ultrasound | 182 | ||
| Quantifying Machine Power Output | 182 | ||
| Ultrasound Diagnosis of Malformations | 183 | ||
| Ultrasound as a Screening Tool for Birth Defects | 183 | ||
| Screening for Aneuploidy | 184 | ||
| First Trimester | 184 | ||
| Second Trimester | 184 | ||
| Screening for Anomalies With the Standard Ultrasound Examination | 185 | ||
| Head and Neck | 185 | ||
| General Appearance | 185 | ||
| Neural Tube Defects | 185 | ||
| Cystic Hygroma | 186 | ||
| Cleft Lip and Palate | 186 | ||
| Micrognathia | 186 | ||
| Cerebellum and Cisterna Magna | 186 | ||
| Choroid Plexus | 186 | ||
| Lateral Ventricles | 186 | ||
| Midline Falx | 186 | ||
| Chest | 186 | ||
| Chest Masses | 186 | ||
| Four-Chamber View of the Heart | 187 | ||
| Outflow Tracts | 187 | ||
| Abdomen | 187 | ||
| Urinary Tract | 187 | ||
| Kidneys | 187 | ||
| Bladder | 188 | ||
| Placenta and Umbilical Cord | 188 | ||
| Umbilical Cord Insertion Into the Abdomen | 188 | ||
| Number of Umbilical Cord Vessels | 188 | ||
| Spine | 188 | ||
| Extremities | 188 | ||
| Hydrops | 189 | ||
| Clinical Value of Birth Defect Screening | 189 | ||
| “Entertainment” Ultrasound Examinations | 189 | ||
| Key Points | 190 | ||
| References | 190 | ||
| 10 Genetic Screening and Prenatal Genetic Diagnosis | 193 | ||
| Key Abbreviations | 193 | ||
| Genetic History | 194 | ||
| Genetic Counseling | 194 | ||
| Communication | 194 | ||
| Nondirective Counseling | 195 | ||
| Psychological Defenses | 195 | ||
| Chromosome Abnormalities | 195 | ||
| Autosomal Trisomy | 196 | ||
| Trisomy 21 | 196 | ||
| Trisomy 13 | 197 | ||
| Trisomy 18 | 197 | ||
| Other Autosomal Trisomies | 197 | ||
| Autosomal Deletions and Duplications | 197 | ||
| Sex Chromosome Abnormalities | 197 | ||
| Monosomy X (45,X) | 197 | ||
| Klinefelter Syndrome | 198 | ||
| Polysomy X in Girls (47,XXX; 48,XXXX; 49,XXXX) | 198 | ||
| Polysomy Y in Boys (47,XYY and 48,XXYY) | 198 | ||
| Screening for Aneuploidy | 198 | ||
| First-Trimester Screening | 198 | ||
| Second-Trimester Serum Screening | 200 | ||
| First- and Second-Trimester Screening | 200 | ||
| Cell-Free DNA Analysis | 200 | ||
| Aneuploidy Screening in Multiple Gestation | 201 | ||
| Ultrasound Screening for Aneuploidy | 202 | ||
| Prenatal Diagnostic Testing for Chromosome Abnormalities | 202 | ||
| Indications for Prenatal Cytogenetic Testing | 202 | ||
| Previous Child with a Chromosome Abnormality | 202 | ||
| Parental Chromosome Rearrangements | 202 | ||
| Assisted Reproduction Through Intracytoplasmic Sperm Injection | 203 | ||
| Cytogenetic Testing | 203 | ||
| Chromosome Microarrays | 203 | ||
| Fluorescence in Situ Hybridization | 204 | ||
| Quantitative Fluorescent Polymerase Chain Reaction | 205 | ||
| Accuracy of Prenatal Cytogenetic Diagnosis | 205 | ||
| Mosaicism | 205 | ||
| Implications of De Novo Structural Abnormalities | 205 | ||
| Single-Gene or Mendelian Disorders | 206 | ||
| Carrier Screening for Heritable Disorders | 206 | ||
| Ashkenazi Jewish Genetic Diseases | 207 | ||
| Hemoglobinopathies | 207 | ||
| Cystic Fibrosis | 207 | ||
| Newborn Screening | 208 | ||
| Molecular Approach to Prenatal Diagnosis of Single-Gene Disorders | 208 | ||
| Mendelian Disorders Without Known Molecular Basis | 209 | ||
| Multifactorial and Polygenic Disorders | 209 | ||
| Screening for Neural Tube Defects | 209 | ||
| Obstetric Significance of Unexplained Elevated Maternal Serum Alpha-Fetoprotein | 209 | ||
| Indications for Prenatal Genetic Testing | 210 | ||
| Procedures for Prenatal Genetic Diagnosis | 210 | ||
| Amniocentesis | 210 | ||
| Amniocentesis in Twin Pregnancies | 210 | ||
| Safety of Amniocentesis | 210 | ||
| Chorionic Villus Sampling | 211 | ||
| Safety of Chorionic Villus Sampling | 211 | ||
| Chorionic Villus Sampling in Twin Pregnancies | 212 | ||
| Invasive Diagnostic Testing in Women With Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus | 212 | ||
| Fetal Blood Sampling | 212 | ||
| Technique | 212 | ||
| Safety of Fetal Blood Sampling | 213 | ||
| Preimplantation Genetic Diagnosis | 213 | ||
| Obtaining Embryonic and Gamete DNA | 213 | ||
| Novel Indications Addressed Only by Preimplantation Genetic Diagnosis | 213 | ||
| To Avoid Pregnancy Termination | 213 | ||
| Nondisclosure of Parental Genotype | 213 | ||
| Human Leukocyte Antigen–Compatible Embryos for Umbilical Cord Blood Stem Cell Transplantation | 214 | ||
| Preimplantation Genetic Diagnosis for Chromosomal Indications | 214 | ||
| Methodology | 214 | ||
| Numeric Chromosome Abnormalities | 214 | ||
| Structural Chromosome Abnormalities | 214 | ||
| Preimplantation Genetic Diagnosis for Single-Gene Disorders | 214 | ||
| Safety of Preimplantation Genetic Diagnosis | 215 | ||
| Intact Fetal Cells | 215 | ||
| Key Points | 215 | ||
| References | 216 | ||
| 11 Antepartum Fetal Evaluation | 219 | ||
| Key Abbreviations | 219 | ||
| Defining the Problem of Perinatal Mortality | 219 | ||
| Characteristics of Fetal Death | 220 | ||
| Causes of Fetal Death | 221 | ||
| Timing of Fetal Death | 221 | ||
| Identifying Those at Risk | 222 | ||
| Details on Select Antenatal Conditions | 222 | ||
| Maternal Characteristics | 222 | ||
| Maternal Age | 222 | ||
| Maternal Race | 222 | ||
| Socioeconomic Factors, Prenatal Care, and Substance Abuse | 222 | ||
| Maternal Comorbidities | 223 | ||
| Obesity | 223 | ||
| Diabetes Mellitus | 223 | ||
| Hypertensive Disorders | 223 | ||
| Thrombophilia | 224 | ||
| Intrahepatic Cholestasis | 224 | ||
| Renal Disease and Systemic Lupus Erythematosus | 224 | ||
| Obstetric Factors | 224 | ||
| Fertility History and Assisted Reproductive Technology | 224 | ||
| Parity | 225 | ||
| Multiple Gestations | 225 | ||
| Early Pregnancy Markers | 225 | ||
| Amniotic Fluid Abnormalities | 225 | ||
| Fetal Growth Restriction | 225 | ||
| Postterm Pregnancy | 225 | ||
| Fetal Malformations | 225 | ||
| Conclusions | 225 | ||
| Potential Utility of Antepartum Fetal Testing | 225 | ||
| What Do These Tests Tell Us About the Fetus? | 226 | ||
| Fetal State | 226 | ||
| Biophysical Techniques of Fetal Evaluation | 227 | ||
| Maternal Assessment of Fetal Activity | 227 | ||
| Contraction Stress Test | 228 | ||
| Predictive Value of the Contraction Stress Test | 229 | ||
| Nonstress Test | 230 | ||
| Fetal Heart Rate Patterns Observable on the Nonstress Test | 230 | ||
| Reactive | 230 | ||
| Nonreactive | 231 | ||
| Other Nonstress Test Patterns or Findings | 232 | ||
| Sinusoidal Pattern | 232 | ||
| Bradycardia | 232 | ||
| Tachycardia | 233 | ||
| Arrhythmia | 233 | ||
| Deceleration | 234 | ||
| Predictive Value of the Nonstress Test | 234 | ||
| Fetal Biophysical Profile | 234 | ||
| Predictive Value of the Biophysical Profile | 236 | ||
| Modified Biophysical Profile | 237 | ||
| Doppler Ultrasound | 237 | ||
| Clinical Application of Tests of Fetal Well-Being | 237 | ||
| Evidence for Condition-Specific Testing | 239 | ||
| Assessment of Fetal Pulmonary Maturation | 240 | ||
| Tests of Fetal Pulmonary Maturity | 240 | ||
| Quantitation of Pulmonary Surfactant | 240 | ||
| Measurements of Surfactant Function | 241 | ||
| Determination of Fetal Pulmonary Maturation in Clinical Practice | 241 | ||
| Summary | 241 | ||
| Key Points | 241 | ||
| References | 242 | ||
| Bibliography | 243.e1 | ||
| III Intrapartum Care | 245 | ||
| 12 Normal Labor and Delivery | 246 | ||
| Key Abbreviations | 246 | ||
| Overview | 246 | ||
| Labor: Definition and Physiology | 246 | ||
| Mechanics of Labor | 249 | ||
| Uterine Activity (Powers) | 249 | ||
| Fetus (Passenger) | 249 | ||
| Maternal Pelvis (Passage) | 251 | ||
| Cardinal Movements in Labor | 253 | ||
| Engagement | 253 | ||
| Descent | 253 | ||
| Flexion | 253 | ||
| Internal Rotation | 253 | ||
| Extension | 255 | ||
| External Rotation | 255 | ||
| Expulsion | 255 | ||
| Normal Progress of Labor | 255 | ||
| Interventions That Affect Normal Labor Outcomes | 259 | ||
| Active Management of Labor | 260 | ||
| Second Stage of Labor | 260 | ||
| Spontaneous Vaginal Delivery | 261 | ||
| Delivery of the Placenta and Fetal Membranes | 262 | ||
| Episiotomy and Perineal Injury and Repair | 263 | ||
| Ultrasound in Labor and Delivery | 265 | ||
| Key Points | 266 | ||
| References | 267 | ||
| 13 Abnormal Labor and Induction of Labor | 271 | ||
| Key Abbreviations | 271 | ||
| Overview | 271 | ||
| Diagnosis | 271 | ||
| Abnormal Labor at Term | 271 | ||
| Disorders of the Latent Phase | 272 | ||
| Disorders of the Active Phase | 273 | ||
| Electromechanical Classification | 274 | ||
| Disorders of the Second Stage | 274 | ||
| Disorders of the Third Stage | 275 | ||
| Anesthesia Effects on Labor Progress | 275 | ||
| Management of Abnormal Labor and Delivery | 276 | ||
| Pharmacologic Augmentation | 276 | ||
| Side Effects | 276 | ||
| Induction of Labor | 276 | ||
| Indications and Contraindications | 276 | ||
| Prolonged Pregnancy | 277 | ||
| Elective Induction of Labor | 278 | ||
| Prediction of Labor Induction Success | 279 | ||
| Cervical Ripening | 280 | ||
| Failed Induction | 280 | ||
| Techniques for Cervical Ripening and Labor Induction | 281 | ||
| Oxytocin | 281 | ||
| Oxytocin Dosing Intervals and Protocols | 282 | ||
| Prostaglandins | 283 | ||
| Prostaglandin E2 | 283 | ||
| Prostaglandin E1 | 283 | ||
| Alternative Methods | 284 | ||
| Midtrimester Induction | 285 | ||
| Summary | 286 | ||
| Key Points | 286 | ||
| References | 287 | ||
| Bibliography | 288.e1 | ||
| Overview | 288.e1 | ||
| Abnormal Labor at Term | 288.e1 | ||
| Disorders of the Active Phase | 288.e1 | ||
| Disorders of the Second Stage | 288.e1 | ||
| Precipitous Labor | 288.e1 | ||
| Anesthesia Effects on Labor Progress | 288.e1 | ||
| Management of Abnormal Labor and Delivery | 288.e1 | ||
| Induction of Labor | 288.e1 | ||
| Prolonged Pregnancy | 288.e1 | ||
| Cervical Ripening | 288.e1 | ||
| Elective Induction of Labor | 288.e1 | ||
| Prediction of Labor Induction Success | 288.e1 | ||
| Techniques for Cervical Ripening and Labor Induction | 288.e2 | ||
| Prostaglandins | 288.e2 | ||
| Alternative Methods | 288.e2 | ||
| Midtrimester Induction | 288.e3 | ||
| 14 Operative Vaginal Delivery | 289 | ||
| Key Abbreviations | 289 | ||
| Operative Vaginal Delivery | 290 | ||
| Classification, Prerequisites, and Indications | 290 | ||
| Operative Vaginal Delivery Instruments | 291 | ||
| Forceps Instruments | 291 | ||
| Classic Forceps | 291 | ||
| Rotational Forceps | 293 | ||
| Other Specialized Instruments | 294 | ||
| Vacuum Extraction Devices | 294 | ||
| Stainless Steel Devices | 294 | ||
| Soft-Cup Devices | 294 | ||
| Operative Vaginal Delivery Techniques | 294 | ||
| Classic Forceps: Application for Occiput Anterior and Occiput Posterior Positions | 294 | ||
| Rotational Forceps: Application for Occiput Transverse Positions | 297 | ||
| Classic Forceps | 297 | ||
| Kielland Forceps | 297 | ||
| Forceps Rotation: Application for the Occiput Posterior Position | 297 | ||
| Vacuum Extraction | 298 | ||
| Risks and Benefits of Operative Vaginal Delivery | 298 | ||
| Benefits of Operative Vaginal Delivery | 298 | ||
| Maternal Risks | 298 | ||
| Perineal Trauma | 299 | ||
| Urinary Incontinence | 299 | ||
| Fecal Incontinence | 299 | ||
| Fetal Risks | 300 | ||
| Craniofacial and Intracranial Injury | 300 | ||
| Cephalohematoma and Subgaleal Hemorrhage | 300 | ||
| Intracranial Hemorrhage | 301 | ||
| Neurologic and Cognitive Effects | 301 | ||
| Complex Operative Vaginal Delivery Procedures | 302 | ||
| Rotations Greater Than 45 Degrees | 302 | ||
| Midpelvic Cavity Delivery | 302 | ||
| Sequential Use of Vacuum and Forceps | 303 | ||
| Trial of Operative Vaginal Delivery | 303 | ||
| Vacuum Delivery and the Preterm Fetus | 303 | ||
| Counseling: Forceps, Vacuum, OR Cesarean Delivery | 303 | ||
| Simulation and Residency Training in Operative Vaginal Delivery | 304 | ||
| Key Points | 305 | ||
| References | 305 | ||
| 15 Intrapartum Fetal Evaluation | 308 | ||
| Key Terms | 308 | ||
| Key Abbreviations | 308 | ||
| Overview | 309 | ||
| Brief History of Fetal Monitoring | 309 | ||
| Instrumentation | 309 | ||
| Direct Fetal Heart Rate and Uterine Activity Monitoring | 309 | ||
| Indirect Fetal Heart Rate and Uterine Activity Monitoring | 310 | ||
| Physiologic Basis for Electronic Fetal Heart Rate Monitoring | 310 | ||
| Transfer of Oxygen From the Environment to the Fetus | 311 | ||
| External Environment | 311 | ||
| Maternal Lungs | 311 | ||
| Maternal Blood | 312 | ||
| Maternal Heart | 312 | ||
| Maternal Vasculature | 312 | ||
| Uterus | 313 | ||
| Placenta | 313 | ||
| Intervillous Space PaO2 | 314 | ||
| Intervillous Space Blood Flow | 314 | ||
| Chorionic Villous Surface Area | 314 | ||
| Diffusion Across the Blood-Blood Barrier | 314 | ||
| Interruption of Placental Blood Vessels | 314 | ||
| Summary of Placental Causes of Interrupted Oxygenation | 314 | ||
| Fetal Blood | 315 | ||
| Umbilical Cord | 315 | ||
| Fetal Response to Interrupted Oxygen Transfer | 315 | ||
| Mechanisms of Injury | 316 | ||
| Injury Threshold | 316 | ||
| Pattern Recognition and Interpretation | 317 | ||
| Evolution of Standardized Fetal Heart Rate Definitions | 317 | ||
| 2008 National Institute of Child Health and Human Development Consensus Report | 317 | ||
| Definitions and General Considerations | 318 | ||
| Specific Fetal Heart Rate Patterns | 318 | ||
| Baseline Rate | 318 | ||
| Definition | 318 | ||
| Physiology | 319 | ||
| Variability | 319 | ||
| Definition | 319 | ||
| Physiology | 320 | ||
| Acceleration | 322 | ||
| Definition | 322 | ||
| Physiology | 322 | ||
| Decelerations | 323 | ||
| Early Deceleration | 323 | ||
| IV Postpartum Care | 467 | ||
| 22 The Neonate | 468 | ||
| Key Abbreviations | 468 | ||
| Cardiopulmonary Transition | 469 | ||
| Pulmonary Development | 469 | ||
| First Breaths | 472 | ||
| Fetal Breathing | 472 | ||
| Mechanics of the First Breath | 472 | ||
| Circulatory Transition | 473 | ||
| Abnormalities of Cardiopulmonary Transition | 474 | ||
| Birth Asphyxia | 474 | ||
| Delivery Room Management of the Newborn | 475 | ||
| Cord Clamping | 478 | ||
| Sequelae of Birth Asphyxia | 478 | ||
| Birth Injuries | 478 | ||
| Neonatal Thermal Regulation | 480 | ||
| Physiology | 480 | ||
| Clinical Applications | 480 | ||
| Delivery Room | 480 | ||
| Nursery | 480 | ||
| Neonatal Nutrition and Gastroenterology | 481 | ||
| Infant Feeding | 481 | ||
| Neonatal Hypoglycemia | 482 | ||
| Congenital Gastrointestinal Surgical Conditions | 483 | ||
| Necrotizing Enterocolitis | 483 | ||
| Neonatal Jaundice | 483 | ||
| Neonatal Hematology | 486 | ||
| Anemia | 486 | ||
| Polycythemia | 486 | ||
| Thrombocytopenia | 486 | ||
| Vitamin K–Deficiency Bleeding of the Newborn | 486 | ||
| Perinatal Infection | 487 | ||
| Early-Onset Bacterial Infection | 487 | ||
| Respiratory Distress | 487 | ||
| Cardiovascular Causes | 487 | ||
| Pulmonary Causes | 488 | ||
| Neonatal Neurology | 490 | ||
| Intraventricular Hemorrhage and Periventricular Leukomalacia | 490 | ||
| Classification of Newborns by Growth and Gestational Age | 490 | ||
| Nursery Care | 491 | ||
| Care of the Parents | 493 | ||
| Kangaroo Care | 494 | ||
| Outcome of Neonatal Intensive Care and Threshold of Viability | 495 | ||
| Late Preterm Infant | 496 | ||
| Key Points | 496 | ||
| References | 496 | ||
| Bibliography | 498.e1 | ||
| Cardiopulmonary Transition | 498.e1 | ||
| Abnormalities of Cardiopulmonary Transition | 498.e1 | ||
| Birth Injuries | 498.e2 | ||
| Neonatal Thermal Regulation | 498.e2 | ||
| Neonatal Nutrition and Gastroenterology | 498.e2 | ||
| Neonatal Hematology | 498.e2 | ||
| Perinatal Infection | 498.e2 | ||
| Respiratory Distress | 498.e2 | ||
| Neonatal Neurology | 498.e3 | ||
| Classification of Newborns by Growth and Gestational Age | 498.e3 | ||
| Nursery Care | 498.e3 | ||
| Outcome of Neonatal Intensive Care | 498.e3 | ||
| The Late Preterm Infant | 498.e4 | ||
| 23 Postpartum Care and Long-Term Health Considerations | 499 | ||
| Key Abbreviations | 499 | ||
| Postpartum Involution | 499 | ||
| Uterus | 499 | ||
| Cervix | 501 | ||
| Fallopian Tube | 501 | ||
| Ovarian Function | 501 | ||
| Weight Loss | 501 | ||
| Thyroid Function | 502 | ||
| Cardiovascular System, Immunity, and Coagulation | 502 | ||
| Urinary Tract and Renal Function | 503 | ||
| Hair Growth and Bone Loss | 503 | ||
| Management of the Puerperium | 504 | ||
| Health Maintenance | 505 | ||
| Perineal and Pelvic Care | 505 | ||
| Delayed Postpartum Hemorrhage and Postpartum Anemia | 507 | ||
| Postpartum Infection | 507 | ||
| Maternal-Infant Attachment | 507 | ||
| Pregnancy Prevention | 508 | ||
| Long-Acting Reversible Contraception | 509 | ||
| Injectable Contraception | 510 | ||
| Combined Hormonal Contraception | 510 | ||
| Progestin-Only Oral Contraception | 511 | ||
| Emergency Contraception | 511 | ||
| Sterilization | 511 | ||
| Barrier Methods | 512 | ||
| Natural Family Planning Methods | 512 | ||
| Postpartum Psychological Reactions | 512 | ||
| Managing Perinatal Grieving | 512 | ||
| Postpartum Posttraumatic Stress Disorder | 514 | ||
| Key Points | 514 | ||
| References | 514 | ||
| Bibliography | 516.e1 | ||
| Postpartum Involution | 516.e1 | ||
| Postpartum Ovulation | 516.e1 | ||
| Thyroid Function | 516.e1 | ||
| Cardiovascular System, Immunity, Coagulation | 516.e1 | ||
| Urinary Tract and Renal Function | 516.e1 | ||
| Management of Puerperium | 516.e1 | ||
| Perineal Care | 516.e1 | ||
| Birth Control | 516.e1 | ||
| Sterilization | 516.e1 | ||
| Postpartum Psychological Reactions | 516.e1 | ||
| 24 Lactation and Breastfeeding | 517 | ||
| Key Abbreviations | 517 | ||
| Breast Anatomy and Development | 518 | ||
| Physiology of Lactation | 519 | ||
| Stages of Lactogenesis | 521 | ||
| Endocrinology of Lactogenesis | 521 | ||
| Milk Transfer | 523 | ||
| Breast Milk: The Gold Standard | 526 | ||
| Overview | 526 | ||
| Role of the Obstetrician and Gynecologist | 531 | ||
| Focused Issues in the Successful Management of Breastfeeding | 533 | ||
| Anatomic Abnormalities of the Breast | 533 | ||
| Previous Breast Surgeries | 534 | ||
| Labor and Delivery Management | 535 | ||
| Breast Milk Expression | 536 | ||
| Maternal Nutrition and Exercise during Lactation | 537 | ||
| Breast and Nipple Pain | 538 | ||
| Mastitis and Breast Abscess | 539 | ||
| Milk Transfer and Infant Growth | 540 | ||
| Jaundice in the Newborn | 541 | ||
| Galactogogues: Drugs to Improve Milk Production | 541 | ||
| Maternal Disease | 542 | ||
| Drugs in Breast Milk | 543 | ||
| Breast Masses during Lactation | 543 | ||
| Back-to-Work Issues | 544 | ||
| Contraception | 545 | ||
| Weaning | 545 | ||
| Key Points | 546 | ||
| References | 546 | ||
| V Complicated Pregnancy | 549 | ||
| 25 Surgery During Pregnancy | 550 | ||
| Key Abbreviations | 550 | ||
| Maternal Physiology | 550 | ||
| Diagnostic Imaging | 551 | ||
| Ionizing Radiation | 551 | ||
| Ultrasound | 552 | ||
| Magnetic Resonance Imaging | 552 | ||
| Contrast in Pregnancy | 552 | ||
| Anesthesia during Nonobstetric Surgery | 552 | ||
| Anesthesia and Teratogenicity | 553 | ||
| Anesthesia and Pregnancy Physiology | 553 | ||
| Nonobstetric Surgery and Pregnancy Outcome | 553 | ||
| Fetal Monitoring | 554 | ||
| Laparoscopy in Pregnancy | 554 | ||
| Laparoscopic Entry Techniques in Pregnancy | 554 | ||
| Laparoscopy and Pregnancy Outcome | 555 | ||
| Adnexal Masses in Pregnancy | 556 | ||
| Obesity, Bariatric Surgery, and Pregnancy | 560 | ||
| Cardiac Surgery in Pregnancy | 561 | ||
| Neurosurgery in Pregnancy | 561 | ||
| Key Points | 561 | ||
| References | 562 | ||
| 26 Trauma and Related Surgery in Pregnancy | 565 | ||
| Key Abbreviations | 565 | ||
| Incidence of Trauma in Pregnancy | 565 | ||
| Anatomic and Physiologic Changes of Pregnancy | 566 | ||
| Fetal Physiology | 566 | ||
| Maternal Anatomic and Physiologic Changes | 566 | ||
| Blunt Trauma | 566 | ||
| Motor Vehicle Crashes | 567 | ||
| Falls | 567 | ||
| Domestic Violence and Intimate Partner Violence | 567 | ||
| Specific Injuries | 567 | ||
| Fractures | 567 | ||
| Penetrating Trauma | 568 | ||
| Thermal Injuries (Burns) | 568 | ||
| Direct Fetal Injuries | 569 | ||
| Pathophysiology of Fetal Loss Resulting From Maternal Trauma | 569 | ||
| Predictors of Fetal Mortality | 569 | ||
| Management Considerations | 569 | ||
| Initial Approach | 569 | ||
| Evaluation on Labor and Delivery | 569 | ||
| Fetal Monitoring | 570 | ||
| Laboratory Testing | 571 | ||
| Diagnostic Imaging | 571 | ||
| Ultrasound | 571 | ||
| Ionizing Radiation | 572 | ||
| Magnetic Resonance Imaging | 572 | ||
| Contrast Agents | 572 | ||
| Suggested Guidelines for Radiologic Evaluation of Trauma | 573 | ||
| Exploratory Surgery for Traumatic Injuries during Pregnancy | 573 | ||
| Uterine Rupture | 574 | ||
| Implications of Cardiac Arrest and Perimortem Cesarean Section | 574 | ||
| Other Considerations | 574 | ||
| Medical and Legal Implications After Maternal Trauma | 574 | ||
| Long-Term Effects of Trauma | 574 | ||
| Prevention of Trauma | 574 | ||
| Screening and Identification of Women at Risk for Domestic Violence | 576 | ||
| Key Points | 576 | ||
| References | 576 | ||
| 27 Early Pregnancy Loss and Stillbirth | 578 | ||
| Key Abbreviations | 578 | ||
| Frequency and Timing of Pregnancy Loss | 579 | ||
| Placental Anatomic Characteristics of Successful and Unsuccessful Pregnancies | 579 | ||
| Numerical Chromosomal Abnormalities: the Most Frequent Cause of Early Pregnancy Loss | 580 | ||
| Types of Numerical Chromosomal Abnormalities | 581 | ||
| Autosomal Trisomy | 581 | ||
| Polyploidy | 582 | ||
| Sex Chromosome Polysomy (X or Y) | 582 | ||
| Monosomy X | 582 | ||
| Relationship Between Recurrent Losses and Numerical Chromosomal Abnormalities | 583 | ||
| Genetic Counseling and Management for Recurrent Aneuploidy | 583 | ||
| Chromosomal Rearrangements | 583 | ||
| Translocations | 583 | ||
| Inversions | 584 | ||
| Mendelian and Polygenic/Multifactorial Etiology | 584 | ||
| Luteal Phase Defects | 585 | ||
| Thyroid Abnormalities | 585 | ||
| Diabetes Mellitus | 585 | ||
| Intrauterine Adhesions (Synechiae) | 585 | ||
| Müllerian Fusion Defects | 585 | ||
| Leiomyomas | 586 | ||
| Cervical Insufficiency | 586 | ||
| Infections | 586 | ||
| Acquired Thrombophilias | 586 | ||
| Inherited Thrombophilias | 587 | ||
| Exogenous Agents | 587 | ||
| Radiation and Chemotherapeutic Agents | 587 | ||
| Alcohol | 587 | ||
| Caffeine | 587 | ||
| Contraceptive Agents | 588 | ||
| Chemicals | 588 | ||
| Cigarette Smoking | 588 | ||
| Trauma | 588 | ||
| Psychological Factors | 588 | ||
| Common Medications | 588 | ||
| Management of Recurrent Early Pregnancy Loss | 589 | ||
| When Is Formal Evaluation Necessary? | 589 | ||
| Recommended Evaluation | 589 | ||
| Late Pregnancy Loss (Stillbirth) | 590 | ||
| Recurrence | 590 | ||
| Genetic Factors | 591 | ||
| Polygenic/Multifactorial Disorders | 591 | ||
| Maternal Evaluation | 591 | ||
| Management in Subsequent Pregnancies | 591 | ||
| Obstetric Outcome after Early Pregnancy Complications | 592 | ||
| Key Points | 592 | ||
| References | 593 | ||
| 28 Cervical Insufficiency | 595 | ||
| Key Abbreviations | 595 | ||
| Overview | 595 | ||
| Cervical Insufficiency: a Distinct Entity or Evidence of Preterm Parturition? | 596 | ||
| Short Cervix | 596 | ||
| Risk Factors for Cervical Insufficiency | 597 | ||
| Tests for Cervical Insufficiency | 599 | ||
| Clinical Diagnosis of Cervical Insufficiency | 599 | ||
| Patient History | 599 | ||
| Sonographic Diagnosis of Cervical Insufficiency | 599 | ||
| Diagnosis of Cervical Insufficiency on Physical Examination | 600 | ||
| Treatment: Cerclage | 601 | ||
| Cerclage Technique | 601 | ||
| History-Indicated Cerclage | 601 | ||
| Physical Examination–Indicated Cerclage | 604 | ||
| Risks of Cerclage | 605 | ||
| Cerclage in the Presence of Premature Rupture of Membranes or Preterm Labor | 605 | ||
| Cerclage Effectiveness Based on Evidence | 605 | ||
| History-Indicated Cerclage | 605 | ||
| Ultrasound-Indicated Cerclage | 607 | ||
| Physical Examination–Indicated Cerclage | 608 | ||
| Cerclage in Multiple Gestations | 609 | ||
| Alternative Treatments to Cervical Cerclage | 609 | ||
| Activity Restriction | 609 | ||
| Pessary | 609 | ||
| Progesterone | 610 | ||
| Comparative Trials of Treatment of Cervical Insufficiency | 611 | ||
| Summary | 611 | ||
| Key Points | 612 | ||
| References | 612 | ||
| Bibliography | 614.e1 | ||
| 29 Preterm Labor and Birth | 615 | ||
| Key Abbreviations | 615 | ||
| Definitions | 616 | ||
| Frequency of Preterm and Low-Birthweight Delivery | 616 | ||
| Outcomes for Infants Born Preterm | 616 | ||
| Perinatal Mortality | 616 | ||
| Infant Mortality | 616 | ||
| Perinatal Morbidity | 618 | ||
| Long-Term Outcomes | 618 | ||
| Epidemiology of Preterm Birth | 619 | ||
| Clinical Risk Factors for Spontaneous Preterm Birth | 619 | ||
| Maternal Factors | 619 | ||
| Medical | 620 | ||
| Infections | 620 | ||
| Periodontal Disease | 620 | ||
| Genitourinary Tract Factors | 620 | ||
| Cervical Length | 620 | ||
| Cervical Procedures | 620 | ||
| Congenital Abnormalities of the Uterus | 620 | ||
| Behavioral | 620 | ||
| Smoking and Substance Abuse | 620 | ||
| Physical Activity | 620 | ||
| Nutritional Factors | 620 | ||
| Demography, Stress, and Social Determinants of Health | 620 | ||
| Black Race | 621 | ||
| Genetic Contributors to Preterm Birth | 622 | ||
| Pregnancy History | 622 | ||
| Current Pregnancy Risks | 623 | ||
| Bleeding and Vanishing Twins | 623 | ||
| Multifetal Gestation and Uterine Distension | 623 | ||
| Risk-Scoring Systems | 623 | ||
| Pathophysiology of Spontaneous Preterm Birth | 623 | ||
| Cervical Changes: Softening and Ripening | 624 | ||
| Increased Uterine Contractility | 624 | ||
| Decidual Membrane Activation | 625 | ||
| Fetal Participation in the Onset of Labor | 625 | ||
| Preterm Parturition Syndrome | 625 | ||
| Intrauterine Infection | 625 | ||
| Frequency of Intrauterine Infection in Spontaneous Preterm Birth | 626 | ||
| Intrauterine Infection as a Chronic Process | 626 | ||
| Infection, Preterm Labor, and Neonatal Outcomes | 626 | ||
| Gene-Environment Interactions | 626 | ||
| Uteroplacental Ischemia and Decidual Hemorrhage | 626 | ||
| Uterine Overdistension | 627 | ||
| Breakdown of Fetal-Maternal Tolerance | 627 | ||
| Allergy-Induced Preterm Labor | 627 | ||
| Cervical Insufficiency | 627 | ||
| Endocrine Disorders | 628 | ||
| Summary of the Preterm Parturition Syndrome | 628 | ||
| Clinical Care for Women in Preterm Labor | 628 | ||
| Diagnosis of Preterm Labor | 628 | ||
| Diagnostic Tests for Preterm Labor | 629 | ||
| Amniocentesis for Women With Preterm Labor | 629 | ||
| Treatment for Women in Preterm Labor | 630 | ||
| Maternal Transfer | 630 | ||
| Antibiotics | 630 | ||
| Antenatal Corticosteroids | 630 | ||
| Fetal Effects | 631 | ||
| Other Fetal Effects of Glucocorticoids | 631 | ||
| Maternal Effects | 631 | ||
| Duration of Benefit | 631 | ||
| Risks of Antenatal Corticosteroid Treatment | 631 | ||
| Sequelae of Antenatal Treatments to Reduce Fetal/Neonatal Morbidity | 631 | ||
| Respiratory Distress | 631 | ||
| Neurologic Morbidity | 631 | ||
| Treatment Protocol | 632 | ||
| Tocolysis in Preterm Labor | 632 | ||
| Efficacy | 632 | ||
| Choosing a Tocolytic Agent | 633 | ||
| Pharmacology | 633 | ||
| Contraindications to Tocolysis | 633 | ||
| Calcium Channel Blockers | 633 | ||
| Maternal Effects | 634 | ||
| Fetal Effects | 634 | ||
| Treatment Protocol | 634 | ||
| Summary of Treatment with Calcium Channel Blockers | 635 | ||
| Magnesium Sulfate | 635 | ||
| VI Pregnancy and Coexisting Disease | 795 | ||
| 36 Prolonged and Postterm Pregnancy | 796 | ||
| Key Abbreviations | 796 | ||
| Definition | 796 | ||
| Incidence | 796 | ||
| Etiology | 797 | ||
| Diagnosis | 797 | ||
| Perinatal Morbidity and Mortality | 797 | ||
| Oligohydramnios | 798 | ||
| Fetal Growth | 799 | ||
| Postmaturity | 799 | ||
| Meconium | 799 | ||
| Maternal Complications | 799 | ||
| Management | 799 | ||
| Antenatal Surveillance | 799 | ||
| Expectant Management Versus Induction of Labor | 800 | ||
| Labor Induction | 800 | ||
| Long-Term Neonatal Outcomes | 800 | ||
| Multiple Gestation | 801 | ||
| Key Points | 801 | ||
| References | 801 | ||
| 37 Heart Disease in Pregnancy | 803 | ||
| Key Abbreviations | 803 | ||
| Maternal Hemodynamics | 804 | ||
| Blood Volume | 805 | ||
| Diagnosis and Evaluation of Heart Disease | 806 | ||
| General Care | 807 | ||
| Risk-Scoring Strategies | 808 | ||
| Valvular Disease | 809 | ||
| Mitral Stenosis | 809 | ||
| Mitral Regurgitation | 811 | ||
| Aortic Stenosis | 811 | ||
| Aortic Regurgitation | 812 | ||
| Prosthetic Valves | 812 | ||
| First Trimester | 813 | ||
| Second and Third Trimester | 813 | ||
| Labor and Delivery | 813 | ||
| Postpartum | 813 | ||
| Congenital Heart Disease | 814 | ||
| Isolated Septal Defects | 815 | ||
| Patent Ductus Arteriosus | 816 | ||
| Tetralogy of Fallot | 816 | ||
| Transposition of the Great Arteries | 816 | ||
| Fontan Procedure | 817 | ||
| Eisenmenger Syndrome | 818 | ||
| Coarctation of the Aorta | 819 | ||
| Summary | 819 | ||
| Cardiomyopathy | 819 | ||
| Myocardial Infarction | 820 | ||
| Marfan Syndrome | 821 | ||
| Pulmonary Hypertension | 822 | ||
| Other Conditions | 822 | ||
| Critical Care: Hemodynamic Monitoring and Management | 823 | ||
| Hemodynamic Monitoring | 823 | ||
| Hemodynamic Management | 824 | ||
| Key Points | 825 | ||
| References | 826 | ||
| Bibliography | 827.e1 | ||
| General Care | 827.e1 | ||
| Diagnosis and Evaluation of Heart Disease | 827.e1 | ||
| Valvular Disease | 827.e1 | ||
| Congenital Heart Disease | 827.e1 | ||
| Cardiomyopathy | 827.e1 | ||
| Myocardial Infarction | 827.e1 | ||
| Marfan Syndrome | 827.e1 | ||
| Pulmonary Hypertension | 827.e1 | ||
| Critical Care: Hemodynamic Monitoring and Management | 827.e1 | ||
| 38 Respiratory Disease in Pregnancy | 828 | ||
| Key Abbreviations | 828 | ||
| Pneumonia in Pregnancy | 828 | ||
| Bacteriology | 829 | ||
| Bacterial Pneumonia | 829 | ||
| Viral Pneumonia | 831 | ||
| Influenza Virus | 831 | ||
| Varicella Virus | 832 | ||
| Pneumocystis jiroveci Pneumonia | 833 | ||
| Tuberculosis in Pregnancy | 834 | ||
| Diagnosis | 834 | ||
| Prevention | 835 | ||
| Treatment | 836 | ||
| Summary | 836 | ||
| Asthma in Pregnancy | 837 | ||
| Diagnosis | 837 | ||
| Effects of Pregnancy on Asthma | 837 | ||
| Effects of Asthma on Pregnancy | 838 | ||
| Asthma Management | 838 | ||
| Objective Measures for Assessment and Monitoring | 838 | ||
| Patient Education | 839 | ||
| Avoidance or Control of Asthma Triggers | 839 | ||
| Pharmacologic Therapy | 839 | ||
| Step Therapy | 840 | ||
| Inhaled Corticosteroids | 840 | ||
| Inhaled β2-Agonists | 840 | ||
| Omalizumab | 841 | ||
| Theophylline | 841 | ||
| Leukotriene Moderators | 841 | ||
| Oral Corticosteroids | 841 | ||
| Management of Allergic Rhinitis and Gastroesophageal Reflux | 841 | ||
| Antenatal Asthma Management | 841 | ||
| Home Management of Asthma Exacerbations | 842 | ||
| Hospital and Emergency Department Management of Asthma Exacerbations | 842 | ||
| Labor and Delivery Management of Asthma | 842 | ||
| Breastfeeding | 843 | ||
| Summary | 843 | ||
| Restrictive Lung Disease | 843 | ||
| Sarcoidosis | 844 | ||
| Cystic Fibrosis | 844 | ||
| Effect of Pregnancy on Cystic Fibrosis | 845 | ||
| Counseling Patients with Cystic Fibrosis in Pregnancy | 846 | ||
| Management of the Pregnancy Complicated by Cystic Fibrosis | 846 | ||
| Key Points | 847 | ||
| References | 847 | ||
| 39 Renal Disease in Pregnancy | 850 | ||
| Key Abreviations | 850 | ||
| Overview | 850 | ||
| Altered Renal Physiology in Pregnancy | 850 | ||
| Asymptomatic Bacteriuria | 851 | ||
| Pyelonephritis | 852 | ||
| Acute Renal Disease in Pregnancy | 853 | ||
| Urolithiasis | 853 | ||
| Glomerular Disease | 853 | ||
| Acute Renal Failure in Pregnancy | 854 | ||
| Hemolytic Uremic Syndrome | 855 | ||
| Polycystic Kidney Disease | 855 | ||
| Vesicoureteral Reflux | 855 | ||
| Renal Artery Stenosis | 855 | ||
| Nephrotic Syndrome | 855 | ||
| Chronic Renal Disease in Pregnancy | 855 | ||
| Effect of Pregnancy on Renal Function | 856 | ||
| Effect of Chronic Renal Disease on Pregnancy | 856 | ||
| Management of Chronic Renal Disease in Pregnancy | 857 | ||
| Hemodialysis in Pregnancy | 857 | ||
| Renal Transplant | 858 | ||
| Key Points | 859 | ||
| References | 859 | ||
| 40 Diabetes Mellitus Complicating Pregnancy | 862 | ||
| Key Abbreviations | 862 | ||
| Pathophysiology | 863 | ||
| Normal Glucose Tolerance | 863 | ||
| Glucose Metabolism | 863 | ||
| Diabetes Mellitus | 866 | ||
| Type 1 Diabetes Mellitus | 866 | ||
| Type 2 Diabetes and Gestational Diabetes | 867 | ||
| Amino Acid Metabolism | 869 | ||
| Lipid Metabolism | 870 | ||
| Maternal Weight Gain and Energy Expenditure | 871 | ||
| Perinatal Morbidity and Mortality | 871 | ||
| Fetal Death | 871 | ||
| Congenital Malformations | 872 | ||
| Fetal Macrosomia | 873 | ||
| Hypoglycemia | 874 | ||
| Respiratory Distress Syndrome | 874 | ||
| Calcium and Magnesium Metabolism | 874 | ||
| Hyperbilirubinemia and Polycythemia | 875 | ||
| Cardiomyopathy | 875 | ||
| Maternal Classification and Risk Assessment | 875 | ||
| Nephropathy | 875 | ||
| Retinopathy | 877 | ||
| Coronary Artery Disease | 878 | ||
| Early Screening for Overt Diabetes and Detection of Gestational Diabetes Mellitus | 878 | ||
| Treatment of the Patient with Type 1 or Type 2 Diabetes Mellitus | 881 | ||
| Ketoacidosis | 884 | ||
| Antepartum Fetal Evaluation | 884 | ||
| Timing and Mode of Delivery | 887 | ||
| Glucoregulation During Labor and Delivery | 888 | ||
| Management of the Woman with Gestational Diabetes | 889 | ||
| Is There a Benefit to the Treatment of Gestational Diabetes Mellitus? | 889 | ||
| Randomized Treatment Trials for Gestational Diabetes Mellitus | 889 | ||
| Treatment of the Woman with Gestational Diabetes Mellitus | 889 | ||
| Postpartum Follow-Up of Women with Gestational Diabetes Mellitus | 892 | ||
| Long-Term Effects of Glucose Intolerance on Mother and Fetus | 893 | ||
| Prepregnancy Counseling of Women with Preexisting Diabetes Mellitus | 894 | ||
| Contraception | 894 | ||
| Key Points | 895 | ||
| References | 896 | ||
| Bibliography | 898.e1 | ||
| Pathophysiology | 898.e1 | ||
| Diabetes Mellitus | 898.e1 | ||
| Perinatal Morbidity and Mortality | 898.e2 | ||
| Maternal Classification and Risk Assessment | 898.e3 | ||
| Detection and Significance of Gestational Diabetes Mellitus | 898.e3 | ||
| Treatment of the Patient with Type 1 or Type 2 Diabetes Mellitus | 898.e4 | ||
| Antepartum Fetal Evaluation | 898.e4 | ||
| Timing and Mode of Delivery | 898.e4 | ||
| Glucoregulation During Labor and Delivery | 898.e4 | ||
| Management of the Woman with Gestational Diabetes | 898.e4 | ||
| Postpartum Follow-Up of Women with Gestational Diabetes Mellitus | 898.e5 | ||
| Prepregnancy Counseling of Women with Preexisting Diabetes Mellitus | 898.e5 | ||
| Contraception | 898.e5 | ||
| 41 Obesity in Pregnancy | 899 | ||
| Key Abbreviations | 899 | ||
| Overview | 899 | ||
| Prevalence of Obesity in Women of Reproductive Age | 899 | ||
| Metabolism in Obese Pregnant Women | 900 | ||
| Recommendations for Gestational Weight Gain in Obese Women | 901 | ||
| Pregnancy Complications in Obese Women | 903 | ||
| Early Pregnancy | 903 | ||
| Mid to Late Pregnancy | 903 | ||
| Intrapartum Complications | 904 | ||
| Postpartum Considerations | 905 | ||
| Maternal | 905 | ||
| Neonate/Child | 906 | ||
| Other Considerations | 906 | ||
| Facilities | 906 | ||
| Key Points | 906 | ||
| References | 907 | ||
| 42 Thyroid and Parathyroid Diseases in Pregnancy | 910 | ||
| Key Abbreviations | 910 | ||
| Parathyroid Diseases | 911 | ||
| Calcium Homeostasis During Pregnancy | 911 | ||
| Hyperparathyroidism | 911 | ||
| Hypercalcemia | 912 | ||
| Differential Diagnosis | 912 | ||
| Therapy | 913 | ||
| Hypoparathyroidism | 914 | ||
| Pseudohypoparathyroidism | 914 | ||
| Vitamin D Deficiency | 915 | ||
| Osteoporosis | 915 | ||
| Thyroid Diseases | 916 | ||
| Thyroid Function Tests | 916 | ||
| Thyroid-Stimulating Hormone Receptor Antibodies | 917 | ||
| Prepregnancy Counseling | 918 | ||
| Maternal-Placental-Fetal Interactions | 918 | ||
| Hyperthyroidism | 918 | ||
| Gestational Hyperthyroidism | 918 | ||
| Transient Hyperthyroidism of Hyperemesis Gravidarum | 918 | ||
| Graves Disease | 920 | ||
| Treatment of Thyroid Storm | 924 | ||
| Fetal Hyperthyroidism | 925 | ||
| Neonatal Hyperthyroidism | 926 | ||
| Neonatal Central Hypothyroidism | 926 | ||
| Resistance to Thyroid Hormone Syndrome | 926 | ||
| Hypothyroidism | 926 | ||
| Etiology and Classification of Hypothyroidism | 927 | ||
| Subclinical Hypothyroidism | 927 | ||
| Neurologic Development and Subclinical Hypothyroidism | 928 | ||
| Clinical Hypothyroidism | 928 | ||
| Isolated Hypothyroxinemia | 928 | ||
| Universal Versus Selective Screening for Thyroid Disease | 929 | ||
| Euthyroid Chronic or Hashimoto Thyroiditis | 930 | ||
| Treatment of Hypothyroidism | 931 | ||
| Single Nodule of the Thyroid Gland | 931 | ||
| Patients With Known Thyroid Cancer Before Pregnancy | 933 | ||
| Postpartum Thyroid Dysfunction | 933 | ||
| Key Points | 935 | ||
| References | 935 | ||
| Bibliography | 937.e1 | ||
| Calcium Metabolism, Parathyroid, Calcitonin, Bone | 937.e1 | ||
| Parathyroid Diseases | 937.e1 | ||
| Vitamin D | 937.e2 | ||
| Osteoporosis | 937.e2 | ||
| Thyroid Diseases | 937.e2 | ||
| Iodine | 937.e2 | ||
| Maternal-Fetal Physiopathology | 937.e3 | ||
| Human Chorionic Gonadotropin and Thyrotoxicosis | 937.e3 | ||
| Hyperthyroidism | 937.e3 | ||
| Antithyroid Drug Therapy | 937.e4 | ||
| Fetal and Neonatal Pathology | 937.e4 | ||
| Thyroxine Resistance Syndrome | 937.e4 | ||
| Hypothyroidism | 937.e4 | ||
| Screening | 937.e5 | ||
| Chronic or Hashimoto Thyroiditis | 937.e5 | ||
| Goiter, Thyroid Nodules, and Cancer | 937.e5 | ||
| Postpartum Thyroiditis | 937.e6 | ||
| 43 Pituitary and Adrenal Disorders in Pregnancy | 938 | ||
| Key Abbreviations | 938 | ||
| Anterior Pituitary | 938 | ||
| Anterior Pituitary Hormone Changes in Pregnancy | 938 | ||
| Pituitary Tumors | 938 | ||
| Prolactinoma | 938 | ||
| Acromegaly | 939 | ||
| Thyrotropin-Secreting Tumors | 940 | ||
| Clinically Nonfunctioning Adenomas | 940 | ||
| Hypopituitarism | 940 | ||
| Sheehan Syndrome | 940 | ||
| Lymphocytic Hypophysitis | 941 | ||
| Posterior Pituitary | 941 | ||
| Diabetes Insipidus | 941 | ||
| Adrenals | 941 | ||
| Cushing Syndrome | 941 | ||
| Adrenal Insufficiency | 942 | ||
| Primary Hyperaldosteronism | 943 | ||
| Pheochromocytoma | 943 | ||
| Key Points | 944 | ||
| References | 944 | ||
| 44 Hematologic Complications of Pregnancy | 947 | ||
| Key Abbreviations | 947 | ||
| Pregnancy-Associated Thrombocytopenia | 947 | ||
| Gestational Thrombocytopenia | 947 | ||
| Immune Thrombocytopenic Purpura | 948 | ||
| Thrombotic Thrombocytopenic Purpura and Hemolytic Uremic Syndrome | 948 | ||
| Evaluation of Thrombocytopenia during Pregancy and the Puerperium | 949 | ||
| Therapy of Thrombocytopenia during Pregnancy | 950 | ||
| Gestational Thrombocytopenia | 950 | ||
| Immune Thrombocytopenic Purpura | 950 | ||
| Management of Thrombotic Thrombocytopenic Purpura and Hemolytic Uremic Syndrome | 951 | ||
| Fetal/Neonatal Alloimmune Thrombocytopenia | 952 | ||
| Iron Deficiency Anemia | 952 | ||
| Megaloblastic Anemia | 955 | ||
| Hemoglobinopathies | 956 | ||
| Hemoglobin S | 956 | ||
| Hemoglobin SC Disease | 958 | ||
| Thalassemia | 958 | ||
| Von Willebrand Disease | 960 | ||
| Key Points | 962 | ||
| References | 962 | ||
| Bibliography | 964.e1 | ||
| Thrombocytopenia | 964.e1 | ||
| Anemias (Iron, Folate, Vitamin B12) | 964.e1 | ||
| Hemoglobinopathies | 964.e1 | ||
| Von Willebrand Disease | 964.e2 | ||
| 45 Thromboembolic Disorders in Pregnancy | 965 | ||
| Key Abbreviations | 965 | ||
| Background and Historic Notes | 965 | ||
| Diagnoses and Definitions | 965 | ||
| Symptoms | 966 | ||
| Deep Venous Thrombosis | 966 | ||
| Pulmonary Embolism | 966 | ||
| Epidemiology and Incidence | 966 | ||
| Genetics | 966 | ||
| Physiology of Hemostasis | 966 | ||
| Vasoconstriction and Platelet Action | 966 | ||
| Coagulation Cascade | 966 | ||
| Anticoagulant System | 967 | ||
| Clot Lysis and Fibrinolysis | 967 | ||
| Pathophysiology of Thrombosis in Pregnancy | 967 | ||
| Antiphospholipid Syndrome | 968 | ||
| Inherited Thrombophilias | 968 | ||
| Risk Factors and Associations | 968 | ||
| Complications | 969 | ||
| Considerations in Management of Pregnant Women | 969 | ||
| Diagnosis of Venous Thromboembolism | 969 | ||
| Deep Venous Thrombosis | 969 | ||
| Clinical Signs and Symptoms | 969 | ||
| Risk-Scoring System | 969 | ||
| Imaging | 969 | ||
| D-Dimer Assays | 970 | ||
| Workup of Patients with Suspected Deep Venous Thrombosis | 970 | ||
| Pulmonary Embolus | 970 | ||
| Clinical Signs and Symptoms | 970 | ||
| Nonspecific Studies | 970 | ||
| Ventilation-Perfusion Scanning. | 971 | ||
| Spiral Computed Tomographic Pulmonary Angiography. | 971 | ||
| Ventilation-Perfusion Scanning Versus Computed Tomographic Pulmonary Angiography. | 971 | ||
| Magnetic Resonance Angiography. | 971 | ||
| D-Dimer Assays. | 972 | ||
| Lower Extremity Evaluation. | 972 | ||
| Workup of Patients with Suspected Pulmonary Embolus | 972 | ||
| Radiation Exposure from Diagnostic Procedures | 973 | ||
| Fetal Exposure | 973 | ||
| Maternal Exposure | 973 | ||
| Management of Venous Thromboembolism | 974 | ||
| Prevention | 974 | ||
| Perioperative Prevention | 974 | ||
| Preconception Counseling | 974 | ||
| Therapy | 974 | ||
| Unfractionated Heparin | 974 | ||
| Low-Molecular-Weight Heparin | 974 | ||
| Fondaparinux | 974 | ||
| Coumarin | 975 | ||
| Treatment of Acute Deep Venous Thrombosis or Pulmonary Embolus | 975 | ||
| Prophylactic Anticoagulation Recommendations for Low-, Moderate-, and High-Risk Groups. | 975 | ||
| Inferior Vena Cava Filters | 976 | ||
| Delivery and Anesthesia Concerns | 976 | ||
| Postpartum Breastfeeding | 977 | ||
| Key Points | 977 | ||
| References | 977 | ||
| 46 Collagen Vascular Diseases in Pregnancy | 981 | ||
| Key Abbreviations | 981 | ||
| Systemic Lupus Erythematosus | 981 | ||
| Epidemiology and Etiology | 981 | ||
| Clinical Manifestations | 982 | ||
| Diagnosis | 982 | ||
| Lupus Flare in Pregnancy | 982 | ||
| Lupus Nephritis in Pregnancy | 983 | ||
| Pregnancy Complications | 983 | ||
| Pregnancy Loss | 983 | ||
| Intrauterine Growth Restriction | 984 | ||
| Preterm Birth | 984 | ||
| Hypertensive Disorders of Pregnancy | 984 | ||
| Neonatal Lupus Erythematosus | 984 | ||
| Management of Pregnancies Complicated by Systemic Lupus Erythematosus | 984 | ||
| Management of Congenital Heart Block | 985 | ||
| Drug Used to Treat Systemic Lupus Erythematosus and Pregnancy Considerations | 986 | ||
| Drugs with Acceptable Risk Profiles in Pregnancy (See Chapter 8) | 986 | ||
| Hydroxychloroquine | 986 | ||
| Glucocorticoids | 986 | ||
| Nonsteroidal Antiinflammatory Drugs | 986 | ||
| Azathioprine | 987 | ||
| Cyclosporine A | 987 | ||
| Drugs with Uncertain or Higher Risk Profiles in Pregnancy | 987 | ||
| Cyclophosphamide | 987 | ||
| Drugs Contraindicated in Pregnancy | 987 | ||
| Mycophenolate Mofetil | 987 | ||
| Antiphospholipid Syndrome | 987 | ||
| Clinical Presentation | 988 | ||
| Recurrent Early Miscarriage | 988 | ||
| Stillbirth | 988 | ||
| Placental Insufficiency | 988 | ||
| Diagnosis | 988 | ||
| Definite Antiphospholipid Syndrome | 988 | ||
| Catastrophic Antiphospholipid Syndrome | 988 | ||
| Possible or Probable Antiphospholipid Syndrome and Equivocal Cases | 989 | ||
| Management of Antiphospholipid Syndrome in Pregnancy | 989 | ||
| Treatment during Pregnancy | 989 | ||
| Refractory Obstetric Antiphospholipid Syndrome | 990 | ||
| Catastrophic Antiphospholipid Syndrome | 990 | ||
| Pregnancy Complications and Surveillance | 990 | ||
| Rheumatoid Arthritis | 991 | ||
| Clinical Manifestations | 991 | ||
| Diagnosis | 991 | ||
| Pregnancy Considerations | 991 | ||
| Antirheumatic Drugs | 992 | ||
| Drugs With Acceptable Risk Profiles in Pregnancy | 992 | ||
| Sulfasalazine | 992 | ||
| Drugs with Uncertain or Higher Risk Profiles in Pregnancy | 992 | ||
| Tumor Necrosis Factor-α Inhibitors | 992 | ||
| Biologic Agents | 992 | ||
| Drugs Contraindicated in Pregnancy | 992 | ||
| Methotrexate | 992 | ||
| Leflunomide | 992 | ||
| Management of Pregnancies Complicated by Rheumatoid Arthritis | 993 | ||
| Systemic Sclerosis | 993 | ||
| Clinical Manifestations | 993 | ||
| Diagnosis | 993 | ||
| Pregnancy Considerations | 993 | ||
| Management of Pregnancies Complicated by Systemic Sclerosis | 993 | ||
| Sjögren Syndrome | 994 | ||
| Key Points | 994 | ||
| References | 994 | ||
| 47 Hepatic Disorders During Pregnancy | 998 | ||
| Key Abbreviations | 998 | ||
| Physiologic Effects of Pregnancy and Assessment of Liver Disease | 999 | ||
| Differential Diagnosis of Hepatobiliary Symptoms and Conditions during Pregnancy | 999 | ||
| Maternal Jaundice | 999 | ||
| Right Upper Quadrant Abdominal Pain | 999 | ||
| Nausea and Vomiting | 1000 | ||
| Pruritus | 1000 | ||
| Hepatic Lesions | 1000 | ||
| Ascites | 1000 | ||
| Neonatal Cholestasis | 1000 | ||
| Abdominal Imaging during Pregnancy | 1000 | ||
| Therapeutic Endoscopy during Pregnancy | 1001 | ||
| Therapeutic Endoscopic Retrograde Cholangiopancreatography | 1001 | ||
| Endoscopic Variceal Sclerotherapy or Banding | 1001 | ||
| Team Approach and Informed Consent | 1002 | ||
| Pancreatobiliary Disease | 1002 | ||
| Acute Pancreatitis | 1002 | ||
| Cholelithiasis and Cholecystitis | 1003 | ||
| Choledocholithiasis | 1003 | ||
| Choledochal Cysts | 1003 | ||
| Common Liver Diseases Incidental to Pregnancy | 1004 | ||
| Acute Viral Hepatitis A, B, and C | 1004 | ||
| Hepatitis E | 1004 | ||
| Chronic Hepatitis B | 1005 | ||
| Chronic Hepatitis C | 1005 | ||
| Wilson Disease | 1005 | ||
| Autoimmune Hepatitis | 1005 | ||
| Hepatic Hemangiomas, Cysts, and Abscesses | 1005 | ||
| Hepatocellular Carcinoma and Hepatic Metastases | 1005 | ||
| Liver Diseases Significantly Affected by Pregnancy | 1006 | ||
| Hepatic Adenomas | 1006 | ||
| Acute Intermittent Porphyria | 1006 | ||
| Sickle Cell Hemoglobinopathies | 1006 | ||
| Portal Hypertension | 1006 | ||
| Budd-Chiari Syndrome | 1007 | ||
| Pregnancy After Liver Transplantation | 1007 | ||
| Liver Disease Strongly Related to or Unique to Pregnancy | 1007 | ||
| Alcoholism During Pregnancy | 1007 | ||
| Hepatic Involvement in Hyperemesis Gravidarum | 1007 | ||
| Herpes Simplex Hepatitis | 1007 | ||
| Intrahepatic Cholestasis of Pregnancy | 1008 | ||
| Acute Fatty Liver of Pregnancy | 1008 | ||
| Summary | 1009 | ||
| Key Points | 1009 | ||
| References | 1010 | ||
| 48 Gastrointestinal Disorders During Pregnancy | 1012 | ||
| Key Abbreviations | 1012 | ||
| Physiologic Effects of Pregnancy on Abdominal Disorders | 1012 | ||
| Differential Diagnosis and Evaluation of Gastrointestinal Symptoms during Pregnancy | 1013 | ||
| Abdominal Pain | 1013 | ||
| Upper Gastrointestinal Symptoms | 1015 | ||
| Nausea and Vomiting | 1015 | ||
| Dyspepsia or Pyrosis | 1015 | ||
| Hematemesis | 1015 | ||
| Dysphagia | 1016 | ||
| Lower Gastrointestinal Symptoms | 1016 | ||
| Diarrhea | 1016 | ||
| Constipation | 1016 | ||
| Red Blood Per Rectum | 1016 | ||
| Diagnostic Testing during Pregnancy | 1016 | ||
| Radiologic Imaging | 1016 | ||
| Endoscopy During Pregnancy | 1017 | ||
| Team Approach and Informed Consent | 1018 | ||
| Gastrointestinal Disorders | 1019 | ||
| Predominantly Upper Gastrointestinal Disorders | 1019 | ||
| Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum | 1019 | ||
| Gastroesophageal Reflux and Peptic Ulcer Disease | 1019 | ||
| Diaphragmatic Rupture | 1021 | ||
| Predominantly Lower Gastrointestinal Disorders | 1021 | ||
| Acute Appendicitis | 1021 | ||
| Intestinal Obstruction | 1022 | ||
| Intestinal Pseudoobstruction | 1023 | ||
| Colon Cancer | 1023 | ||
| Inflammatory Bowel Disease | 1024 | ||
| Hemorrhoids | 1025 | ||
| Mesenteric Ischemia and Infarction | 1026 | ||
| Irritable Bowel Syndrome | 1026 | ||
| Splenic Artery Aneurysm Rupture | 1026 | ||
| Summary | 1026 | ||
| Key Points | 1026 | ||
| References | 1027 | ||
| 49 Neurologic Disorders in Pregnancy | 1030 | ||
| Key Abbreviations | 1030 | ||
| Epilepsy and Seizures | 1031 | ||
| Epilepsy and Fertility | 1032 | ||
| Epilepsy and Pregnancy | 1032 | ||
| Teratogenic Effects of Antiepileptic Drugs | 1032 | ||
| Valproate | 1032 | ||
| Carbamazepine | 1034 | ||
| Lamotrigine | 1034 | ||
| Levetiracetam | 1035 | ||
| Phenytoin | 1035 | ||
| Phenobarbital | 1035 | ||
| Other Antiepileptic Drugs | 1035 | ||
| Effect of Antiepileptic Drug Dose | 1036 | ||
| Polytherapy | 1036 | ||
| Effects of Pregnancy on Anticonvulsant Medications | 1036 | ||
| Pregnancy and Seizure Frequency | 1037 | ||
| Obstetric and Neonatal Outcomes | 1037 | ||
| Preconception Counseling for Women With Epilepsy | 1038 | ||
| Genetic Counseling | 1038 | ||
| Folic Acid Supplementation | 1039 | ||
| Care of the Patient During Pregnancy | 1040 | ||
| Vitamin K Supplementation | 1040 | ||
| Labor and Delivery | 1040 | ||
| New Onset of Seizures in Pregnancy and in the Puerperium | 1040 | ||
| Breastfeeding and the Postpartum Period | 1041 | ||
| Postpartum Safety | 1041 | ||
| Contraception | 1041 | ||
| Multiple Sclerosis | 1041 | ||
| Multiple Sclerosis and Fertility | 1042 | ||
| Effect of Pregnancy on Multiple Sclerosis | 1042 | ||
| Effect of Multiple Sclerosis on Pregnancy Outcomes | 1042 | ||
| Disease-Modifying Agents and Pregnancy | 1042 | ||
| First-Line Agents | 1043 | ||
| Second-Line Agents | 1044 | ||
| Prepregnancy Counseling for Patients With Multiple Sclerosis | 1045 | ||
| Management of Multiple Sclerosis During Pregnancy | 1045 | ||
| Labor and Delivery | 1045 | ||
| Breastfeeding and the Postpartum Period | 1046 | ||
| Headache | 1046 | ||
| Migraine | 1046 | ||
| Secondary Headache in Pregnancy | 1049 | ||
| Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) | 1049 | ||
| Cerebral Vein Thrombosis | 1049 | ||
| Subarachnoid Hemorrhage | 1050 | ||
| Reversible Cerebral Vasoconstriction | 1050 | ||
| Stroke | 1050 | ||
| Ischemic Stroke | 1050 | ||
| Hemorrhagic Stroke and Vascular Malformations | 1051 | ||
| Carpal Tunnel Syndrome | 1051 | ||
| Key Points | 1052 | ||
| References | 1052 | ||
| 50 Malignant Diseases and Pregnancy | 1057 | ||
| Key Abbreviations | 1057 | ||
| Chemotherapy During Pregnancy | 1058 | ||
| Pharmacology of Chemotherapy During Pregnancy | 1058 | ||
| Drug Effects on the Fetus | 1058 | ||
| Classification of Chemotherapy Agents | 1058 | ||
| Antimetabolites | 1058 | ||
| Alkylating Agents | 1059 | ||
| Antitumor Antibiotics | 1059 | ||
| Vinca Alkaloids | 1059 | ||
| Platinum Agents | 1059 | ||
| Miscellaneous | 1059 | ||
| Targeted Therapies | 1059 | ||
| Radiation Therapy | 1059 | ||
| Surgery and Anesthesia | 1059 | ||
| Pregnancy Following Cancer Treatment | 1059 | ||
| Cancer During Pregnancy | 1060 | ||
| Breast Cancer | 1060 | ||
| Diagnosis and Staging | 1060 | ||
| Treatment | 1061 | ||
| Local Therapy | 1061 | ||
| Pregnancy Termination | 1061 | ||
| Chemotherapy | 1061 | ||
| Prognosis | 1061 | ||
| Subsequent Pregnancy | 1061 | ||
| Lactation and Breast Reconstruction | 1062 | ||
| Lymphoma | 1062 | ||
| Hodgkin Lymphoma | 1062 | ||
| Non-Hodgkin Lymphoma | 1063 | ||
| Acute Leukemia | 1063 | ||
| Chronic Leukemia | 1064 | ||
| Melanoma | 1064 | ||
| Cervical Cancer | 1065 | ||
| Microinvasion | 1066 | ||
| Invasive, Early-Stage Disease | 1066 | ||
| Invasive, Locally Advanced Disease | 1067 | ||
| Invasive, Distant Metastasis | 1067 | ||
| Method of Delivery | 1067 | ||
| Survival | 1067 | ||
| Ovarian Cancer | 1067 | ||
| Postoperative Adjuvant Therapy | 1068 | ||
| Vulvar and Vaginal Cancer | 1068 | ||
| Endometrial Cancer | 1069 | ||
| Gastrointestinal Cancers | 1069 | ||
| Upper Gastrointestinal Cancers | 1069 | ||
| Colon and Rectal Cancer | 1069 | ||
| Urinary Tract Cancers | 1069 | ||
| Central Nervous System Tumors | 1069 | ||
| Neonatal Outcomes | 1070 | ||
| Fetal-Placental Metastasis | 1070 | ||
| Fertility Preservation | 1070 | ||
| Gestational Trophoblastic Disease and Pregnancy-Related Issues | 1070 | ||
| Hydatidiform Mole (Complete Mole) | 1070 | ||
| Invasive Mole (Chorioadenoma Destruens) | 1072 | ||
| Partial Hydatidiform Mole | 1072 | ||
| Placental Site Trophoblastic Tumor | 1072 | ||
| Choriocarcinoma | 1072 | ||
| Key Points | 1073 | ||
| References | 1073 | ||
| 51 Skin Disease and Pregnancy | 1075 | ||
| Key Abbreviations | 1075 | ||
| Physiologic Skin Changes Induced by Pregnancy | 1075 | ||
| Pigmentary Changes | 1075 | ||
| Vascular Changes | 1076 | ||
| Connective Tissue Changes | 1077 | ||
| Glandular Changes | 1078 | ||
| Hair and Nail Changes | 1078 | ||
| Preexisting Skin Diseases and Tumors Affected by Pregnancy | 1078 | ||
| Atopic Eczema and Dermatitis | 1078 | ||
| Acne Vulgaris | 1079 | ||
| Other Inflammatory Skin Diseases | 1079 | ||
| Autoimmune Progesterone Dermatitis | 1079 | ||
| Impetigo Herpetiformis | 1079 | ||
| Cutaneous Manifestations of Autoimmune Disorders | 1080 | ||
| Bullous Disorders | 1081 | ||
| Skin Tumors | 1081 | ||
| Malignant Melanoma | 1081 | ||
| Pruritus in Pregnancy | 1082 | ||
| Specific Dermatoses of Pregnancy | 1082 | ||
| Pemphigoid (Herpes) Gestationis | 1082 | ||
| Polymorphic Eruption of Pregnancy | 1084 | ||
| Atopic Eruption of Pregnancy | 1085 | ||
| Prurigo of Pregnancy | 1086 | ||
| Pruritic Folliculitis of Pregnancy | 1086 | ||
| Key Points | 1087 | ||
| References | 1087 | ||
| 52 Maternal and Perinatal Infection | 1089 | ||
| Key Abbreviations | 1089 | ||
| Chlamydia | 1089 | ||
| Epidemiology | 1089 | ||
| Pathogenesis | 1090 | ||
| Diagnosis | 1091 | ||
| Treatment | 1091 | ||
| Gonorrhea | 1092 | ||
| Epidemiology | 1092 | ||
| Pathogenesis | 1092 | ||
| Diagnosis | 1092 | ||
| Treatment | 1093 | ||
| Syphilis | 1093 | ||
| Epidemiology | 1093 | ||
| Pathogenesis | 1094 | ||
| Diagnosis | 1094 | ||
| Treatment | 1095 | ||
| Congenital Syphilis | 1095 | ||
| Key Points | 1096 | ||
| References | 1097 | ||
| 53 Maternal and Perinatal Infection in Pregnancy | 1099 | ||
| Key Abbreviations | 1099 | ||
| Human Immunodeficiency Virus | 1101 | ||
| Virology | 1101 | ||
| Epidemiology | 1101 | ||
| Diagnosis | 1101 | ||
| Clinical Manifestations and Staging | 1102 | ||
| Evolution of Human Immunodeficiency Virus Infection and Treatment | 1103 | ||
| Ethical Considerations | 1104 | ||
| Management During Pregnancy | 1104 | ||
| Initial Evaluation | 1104 | ||
| Antepartum Care | 1104 | ||
| Nucleoside/Nucleotide Reverse Transcriptase Inhibitors | 1108 | ||
| Nonnucleoside Reverse Transcriptase Inhibitors | 1108 | ||
| Protease Inhibitors | 1108 | ||
| Integrase Strand Transfer Inhibitors | 1108 | ||
| Hepatitis Coinfection | 1108 | ||
| Opportunistic Infection Prophylaxis | 1109 | ||
| Ongoing Management | 1109 | ||
| Factors That Influence Transmission | 1109 | ||
| Invasive Prenatal Testing | 1110 | ||
| Intrapartum Management of Human Immunodeficiency Virus | 1110 | ||
| Elective Cesarean Delivery | 1110 | ||
| Spontaneous Rupture of Membranes | 1111 | ||
| Untreated Women | 1111 | ||
| Intrapartum Testing | 1111 | ||
| Postpartum Care of Women with Human Immunodeficiency Virus | 1111 | ||
| Infant Screening and Diagnosis | 1112 | ||
| Preconception Counseling for Women With Human Immunodeficiency Virus | 1112 | ||
| Human Immunodeficiency Virus Discordant Couples | 1112 | ||
| Counseling and Coordination of Care | 1112 | ||
| Influenza | 1113 | ||
| Virology and Epidemiology | 1113 | ||
| Clinical Manifestations | 1113 | ||
| Diagnosis | 1113 | ||
| Management of Influenza During Pregnancy | 1113 | ||
| Parvovirus | 1114 | ||
| Virology and Epidemiology | 1114 | ||
| Clinical Manifestations | 1114 | ||
| Diagnosis | 1114 | ||
| Management of Parvovirus During Pregnancy | 1114 | ||
| Measles | 1115 | ||
| Virology and Epidemiology | 1115 | ||
| Clinical Manifestations | 1115 | ||
| Diagnosis | 1116 | ||
| Management of Measles During Pregnancy | 1116 | ||
| Rubella | 1117 | ||
| Virology and Epidemiology | 1117 | ||
| Clinical Manifestations | 1117 | ||
| Diagnosis | 1117 | ||
| Management of Rubella Infection During Pregnancy | 1117 | ||
| Congenital Infection | 1117 | ||
| Cytomegalovirus Infection | 1118 | ||
| Virology and Epidemiology | 1118 | ||
| Clinical Manifestations | 1118 | ||
| Diagnosis | 1118 | ||
| Management of Cytomegalovirus During Pregnancy | 1118 | ||
| Congenital Infection | 1118 | ||
| Herpesvirus | 1119 | ||
| Virology and Epidemiology | 1119 | ||
| Clinical Manifestations | 1119 | ||
| Diagnosis | 1119 | ||
| Management of Herpesvirus During Pregnancy | 1119 | ||
| Neonatal Herpes Infection | 1120 | ||
| Varicella | 1120 | ||
| Virology and Epidemiology | 1120 | ||
| Clinical Manifestations | 1120 | ||
| Diagnosis | 1121 | ||
| Management of Varicella During Pregnancy | 1121 | ||
| Congenital Infection | 1121 | ||
| Hepatitis | 1121 | ||
| Hepatitis A | 1122 | ||
| Hepatitis B | 1122 | ||
| Virology and Epidemiology | 1122 | ||
| Diagnosis | 1122 | ||
| Management of Hepatitis B Virus Infection During Pregnancy | 1122 | ||
| Hepatitis C | 1123 | ||
| Virology and Epidemiology | 1123 | ||
| Diagnosis | 1124 | ||
| Hepatitis C Virus in Pregnancy | 1124 | ||
| Hepatitis C Virus Preconceptional Counseling | 1124 | ||
| Hepatitis D | 1124 | ||
| Hepatitis E | 1125 | ||
| Coxsackie Virus | 1125 | ||
| Human Papillomavirus | 1125 | ||
| Epstein-Barr Virus | 1125 | ||
| Smallpox | 1125 | ||
| Ebola | 1126 | ||
| Virology and Epidemiology | 1126 | ||
| Clinical Manifestations | 1126 | ||
| Diagnosis | 1126 | ||
| Management of Ebola in Pregnancy | 1127 | ||
| Key Points | 1127 | ||
| References | 1127 | ||
| Bibliography | 1129.e1 | ||
| Human Immunodeficiency Virus | 1129.e1 | ||
| Influenza | 1129.e1 | ||
| Parvovirus | 1129.e1 | ||
| Measles | 1129.e1 | ||
| Rubella | 1129.e1 | ||
| Cytomegalovirus | 1129.e1 | ||
| Herpes Simplex Virus | 1129.e1 | ||
| Varicella | 1129.e1 | ||
| Hepatitis | 1129.e1 | ||
| Human Papillomavirus | 1129.e1 | ||
| 54 Maternal and Perinatal Infection in Pregnancy | 1130 | ||
| Key Abbreviations | 1130 | ||
| Group B Streptococcal Infection | 1130 | ||
| Epidemiology | 1130 | ||
| Maternal Complications | 1131 | ||
| Diagnosis | 1131 | ||
| Prevention of Group B Streptococcal Infection | 1131 | ||
| Urinary Tract Infections | 1133 | ||
| Acute Urethritis | 1133 | ||
| Asymptomatic Bacteriuria and Acute Cystitis | 1133 | ||
| Acute Pyelonephritis | 1134 | ||
| Upper Genital Tract Infections | 1135 | ||
| Chorioamnionitis | 1135 | ||
| Epidemiology | 1135 | ||
| Diagnosis | 1135 | ||
| Management | 1135 | ||
| Puerperal Endometritis | 1137 | ||
| Epidemiology | 1137 | ||
| Clinical Presentation and Diagnosis | 1137 | ||
| Management | 1138 | ||
| Prevention of Puerperal Endometritis | 1138 | ||
| Serious Sequelae of Puerperal Infection | 1139 | ||
| Wound Infection | 1139 | ||
| Pelvic Abscess | 1140 | ||
| Septic Pelvic Thrombophlebitis | 1140 | ||
| Severe Sepsis | 1141 | ||
| Toxoplasmosis | 1142 | ||
| Epidemiology | 1142 | ||
| Clinical Manifestations | 1143 | ||
| Diagnosis | 1143 | ||
| Congenital Toxoplasmosis | 1143 | ||
| Management | 1143 | ||
| Listeriosis | 1144 | ||
| Key Points | 1145 | ||
| References | 1145 | ||
| 55 Mental Health and Behavioral Disorders in Pregnancy | 1147 | ||
| Key Abbreviations | 1147 | ||
| Overview | 1147 | ||
| Mood Disorders | 1149 | ||
| Major Depressive Episode | 1149 | ||
| Diagnosis and Prevalence During Pregnancy and Postpartum | 1149 | ||
| Natural History Across Childbearing | 1149 | ||
| Treatment of Major Depressive Episode During Pregnancy | 1151 | ||
| Side Effects of Medical Treatment of Major Depressive Episode During Pregnancy | 1151 | ||
| Miscarriage | 1151 | ||
| Structural Malformations | 1152 | ||
| Preterm Birth and Growth Effects | 1152 | ||
| Behavioral Teratogenicity | 1152 | ||
| Neonatal Effects | 1153 | ||
| Recommendations for Treatment During Pregnancy | 1153 | ||
| Dosage Changes Across Pregnancy | 1153 | ||
| Integrative Treatments | 1153 | ||
| Treatment of Major Depressive Episode in the Postpartum Period | 1154 | ||
| Prevention of Postpartum-Onset Major Depressive Episode | 1154 | ||
| Treatment During Breastfeeding | 1154 | ||
| Psychiatric Disorders and Suicidal Ideations | 1154 | ||
| Bipolar Disorder | 1155 | ||
| Diagnosis and Prevalence | 1155 | ||
| Natural History Across Childbearing | 1156 | ||
| Treatment of Bipolar Disorder During Childbearing | 1156 | ||
| Lithium | 1156 | ||
| Valproic Acid | 1158 | ||
| Carbamazepine and Oxcarbazepine | 1158 | ||
| Lamotrigine | 1158 | ||
| Atypical Antipsychotics | 1159 | ||
| Alternate and Supplemental Treatment Options | 1159 | ||
| Prevention of Bipolar Disorder Recurrence Postpartum | 1159 | ||
| Breastfeeding for Women with Bipolar Disorder | 1159 | ||
| Anxiety Disorders | 1160 | ||
| Diagnosis and Prevalence | 1160 | ||
| Fear of Labor and Delivery | 1160 | ||
| Natural History Across Childbearing | 1160 | ||
| Effects of Anxiety During Childbearing | 1161 | ||
| Treatment of Anxiety Disorders | 1161 | ||
| Eating Disorders | 1161 | ||
| Diagnosis and Prevalence | 1161 | ||
| Natural History Across Childbearing | 1162 | ||
| Treatment of Eating Disorders | 1163 | ||
| Anorexia Nervosa | 1163 | ||
| Bulimia Nervosa | 1163 | ||
| Schizophrenia | 1163 | ||
| Diagnosis and Prevalence | 1163 | ||
| Natural History Across Childbearing | 1164 | ||
| Extrapolating From Studies on the General Population | 1164 | ||
| Treatment Interventions for Women With Schizophrenia | 1164 | ||
| Antipsychotic Drugs During Pregnancy | 1164 | ||
| Antipsychotic Drugs During Breastfeeding | 1165 | ||
| Substance-Related Disorders | 1165 | ||
| Diagnosis and Prevalence | 1165 | ||
| Screening, Brief Intervention, and Referral to Treatment | 1166 | ||
| Specific Drugs of Abuse: Impact and Treatment Approaches | 1166 | ||
| Alcohol | 1166 | ||
| Management of Alcohol Withdrawal | 1167 | ||
| Smoking | 1167 | ||
| Cannabis | 1168 | ||
| Cocaine | 1168 | ||
| Methamphetamine | 1168 | ||
| Opioids | 1169 | ||
| Opioid Agonist Therapy | 1169 | ||
| Prenatal Care | 1169 | ||
| Neonatal Abstinence Syndrome | 1170 | ||
| Acute Pain Management for Women on Opioid Agonist Therapy | 1170 | ||
| Additional Resources | 1172.e1 | ||
| Key Points | 1170 | ||
| References | 1171 | ||
| Bibliography | 1172.e1 | ||
| Treatment of Bipolar Disorder During Childbearing | 1172.e1 | ||
| Lithium | 1172.e1 | ||
| Valproic Acid | 1172.e1 | ||
| Carbamazepine and Oxcarbazepine | 1172.e1 | ||
| Lamotrigine | 1172.e1 | ||
| Atypical Antipsychotics | 1172.e1 | ||
| Alternative or Supplemental Treatment Options | 1172.e2 | ||
| Prevention of Bipolar Disorder Recurrence Postpartum | 1172.e2 | ||
| Breastfeeding for Women with Bipolar Disorder | 1172.e2 | ||
| Anxiety Disorders | 1172.e2 | ||
| Natural History Across Childbearing | 1172.e2 | ||
| Effects of Anxiety During Childbearing | 1172.e2 | ||
| Treatment of Anxiety Disorders | 1172.e2 | ||
| Eating Disorders | 1172.e2 | ||
| Natural History Across Childbearing | 1172.e3 | ||
| Treatment of Anorexia Nervosa | 1172.e3 | ||
| Treatment of Bulimia Nervosa | 1172.e3 | ||
| Schizophrenia | 1172.e3 | ||
| Natural History of Schizophrenia Across Childbearing | 1172.e3 | ||
| Treatment Interventions for Women with Schizophrenia | 1172.e3 | ||
| Antipsychotic Drugs During Pregnancy | 1172.e3 | ||
| Antipsychotic Drugs During Breastfeeding | 1172.e3 | ||
| Substance-Related Disorders | 1172.e3 | ||
| Specific Drugs and Abuse: Impact and Treatment Approaches | 1172.e4 | ||
| Smoking | 1172.e4 | ||
| Cannabis | 1172.e4 | ||
| Cocaine | 1172.e5 | ||
| Methamphetamine | 1172.e5 | ||
| Opioids | 1172.e5 | ||
| Acute Pain Management for Women on Maintenance Opioids | 1172.e5 | ||
| VII Legal and Ethical Issues in Perinatology | 1173 | ||
| 56 Patient Safety and Quality Measurement in Obstetric Care | 1174 | ||
| Key Abbreviations | 1174 | ||
| Patient Safety | 1174 | ||
| Overview | 1174 | ||
| Frequency of Preventable Obstetric Adverse Events | 1174 | ||
| Factors That Contribute to Preventable Adverse Events | 1175 | ||
| Approaches to Improve Obstetric Safety | 1175 | ||
| Checklists and Protocols | 1175 | ||
| Simulation | 1176 | ||
| Shoulder Dystocia | 1176 | ||
| Eclampsia | 1177 | ||
| Other Obstetric Events | 1177 | ||
| Enhancement of Communication | 1177 | ||
| Multifaceted Approaches | 1177 | ||
| Summary | 1178 | ||
| Measurement of Obstetric Quality of Care | 1178 | ||
| Overview | 1178 | ||
| Quality Measures | 1178 | ||
| Attempts to Establish Quality Measures | 1179 | ||
| Traditional Measures | 1179 | ||
| Newer Approaches to Measures | 1179 | ||
| Data Sources | 1180 | ||
| Quality Improvement | 1180 | ||
| Key Points | 1181 | ||
| References | 1181 | ||
| 57 Ethical and Legal Issues in Perinatology | 1183 | ||
| Key Abbreviations | 1183 | ||
| Reproductive Liberty | 1183 | ||
| Abortion Politics and “Obamacare” | 1186 | ||
| Human Embryonic Stem Cell Research Funding | 1188 | ||
| Genetic Counseling, Screening, and Prenatal Diagnosis | 1189 | ||
| Forced Cesarean Delivery | 1193 | ||
| Key Points | 1194 | ||
| References | 1195 | ||
| 58 Improving Global Maternal Health | 1196 | ||
| Key Abbreviations | 1196 | ||
| Maternal and Reproductive Health | 1196 | ||
| Maternal Health and the Burden of Death and Disability | 1196 | ||
| A Place Between Life and Death | 1197 | ||
| Where Mothers Die | 1197 | ||
| Adolescent Girls and Lifetime Risk of Maternal Death | 1197 | ||
| United States | 1198 | ||
| Mothers Who Survive: Severe Maternal Morbidity | 1198 | ||
| Babies Who Die | 1198 | ||
| Why Mothers Die | 1199 | ||
| Clinical Causes | 1199 | ||
| Health System Factors | 1199 | ||
| Vulnerability and Underlying Social Determinants | 1200 | ||
| “Causes of the Causes” | 1200 | ||
| Women’s Rights | 1200 | ||
| Sexual and Reproductive Health | 1201 | ||
| Unintended Pregnancy | 1201 | ||
| Contraception | 1202 | ||
| Contraceptive Methods | 1202 | ||
| Induced Abortion | 1203 | ||
| Improving Reproductive Health and Well-Being of All Mothers | 1204 | ||
| Major Obstetric Complications: Prevention and Management in Resource-Poor Countries | 1205 | ||
| Postpartum Hemorrhage | 1205 | ||
| Preeclampsia/Eclampsia | 1205 | ||
| Sepsis | 1206 | ||
| Human Immunodeficiency Virus and Malaria | 1206 | ||
| Obstructed Labor and Obstetric Fistula | 1206 | ||
| Cesarean Delivery | 1207 | ||
| Practical Advice on Volunteering to Work Overseas | 1207 | ||
| Respect | 1208 | ||
| Realism | 1208 | ||
| Health Care Staff | 1208 | ||
| Research | 1209 | ||
| Predeparture Preparation | 1209 | ||
| Key Points | 1209 | ||
| Acknowledgment | 1210 | ||
| References | 1210 | ||
| Appendices | 1213 | ||
| Appendix I Normal Values in Pregnancy and Ultrasound Measurements | 1214 | ||
| Appendix II Anatomy of the Pelvis* | 1224 | ||
| Key Points | 1224 | ||
| Suggested Reading | 1224 | ||
| Appendix III Glossary of Key Abbreviations | 1225 | ||
| Index | 1231 | ||
| A | 1231 | ||
| B | 1236 | ||
| C | 1238 | ||
| D | 1244 | ||
| E | 1247 | ||
| F | 1249 | ||
| G | 1252 | ||
| H | 1254 | ||
| I | 1259 | ||
| J | 1261 | ||
| K | 1261 | ||
| L | 1262 | ||
| M | 1264 | ||
| N | 1268 | ||
| O | 1271 | ||
| P | 1272 | ||
| Q | 1281 | ||
| R | 1281 | ||
| S | 1283 | ||
| T | 1286 | ||
| U | 1290 | ||
| V | 1292 | ||
| W | 1295 | ||
| X | 1295 | ||
| Y | 1295 | ||
| Z | 1295 | ||
| Inside Back Cover | ibc1 |