Additional Information
Book Details
Abstract
The new edition of Physiology in Childbearing with Anatomy and Related Biosciences continues to offer readers with a sound introduction to human biology as it relates to pregnancy and childbirth. The new edition retains the online question bank with downloadable image collection and is suitable for midwives – whether qualified or in training – throughout the world.
- Straightforward writing style helps demystify a challenging subject area
- Applies theory to practice to show how a knowledge of the biological sciences can enhance the care given to mothers and babies
- Designed to facilitate early recognition of pathology to help prevent morbidity and mortality
- Ideal introduction to basic biochemistry, cellular biology and genetics for those who have no prior knowledge of the subject areas
- Chapters on embryology help explain the occurrence of neonatal pathology
- A ‘body systems approach’ – including embryological development – enables an understanding of the physiological and pathophysiological changes that occur during pregnancy
- Clear diagrams allow an understanding of the complex three-dimensional concepts seen in biology
- Helpful pedagogy such as ‘Main Points’ boxes at the end of each chapter act as useful aide-memoires
- Enhances the safety of mothers and babies, both in the developed world and those countries where the provision of adequate care remains limited
- Revised contributor team provides an international perspective
- Updated design presents shorter sections of information with concise summaries of ‘key points’ and easy to interpret figures and tables
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Half title page | i | ||
| Dedication | ii | ||
| Physiology in Childbearing | iii | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Contributors | vii | ||
| Preface | ix | ||
| Acknowledgements | xi | ||
| Illustration Acknowledgements | xiii | ||
| List of Abbreviations | xv | ||
| 2A Pregnancy—The Fetus | 77 | ||
| Section Contents | 77 | ||
| 9 General embryology | 79 | ||
| Chapter Contents | 79 | ||
| Introduction | 79 | ||
| Embryology | 79 | ||
| Gametogenesis | 79 | ||
| Oogenesis | 79 | ||
| Spermatogenesis | 79 | ||
| Gamete size | 80 | ||
| Fertilization | 81 | ||
| Results of fertilization | 81 | ||
| The embryo | 81 | ||
| Terminology | 81 | ||
| Programming the embryo | 81 | ||
| Pattern formation | 82 | ||
| Early cell division–cleavage | 82 | ||
| Differentiation | 83 | ||
| Morphogenesis | 83 | ||
| Regulatory genes | 83 | ||
| The homeobox | 84 | ||
| Morphogens | 84 | ||
| Induction | 84 | ||
| Cell communication | 84 | ||
| Programmed cell death | 85 | ||
| Development of the embryo | 85 | ||
| The blastocyst | 85 | ||
| Implantation | 85 | ||
| The effects of enzymatic erosion | 85 | ||
| Development of the germ layers | 85 | ||
| The bilaminar embryonic disc | 85 | ||
| The trilaminar embryo | 85 | ||
| The primitive streak | 86 | ||
| Gastrulation | 86 | ||
| Development of body cavities | 87 | ||
| Formation of the notochord | 87 | ||
| Organogenesis | 88 | ||
| Differentiation of the germ layers | 88 | ||
| Ectoderm | 88 | ||
| Neurulation | 88 | ||
| Mesoderm | 88 | ||
| Endoderm | 88 | ||
| Folding of the embryo | 88 | ||
| Longitudinal folding | 88 | ||
| Transverse folding | 88 | ||
| References | 92 | ||
| Annotated recommended reading | 92 | ||
| 10 Embryological systems 1—trunk, head and limbs | 93 | ||
| Chapter Contents | 93 | ||
| Introduction | 93 | ||
| The trunk | 93 | ||
| Skeletal features | 93 | ||
| The vertebral column | 93 | ||
| Precartilaginous phase | 93 | ||
| Cartilaginous phase | 93 | ||
| Bony phase | 93 | ||
| Ribs and sternum | 93 | ||
| Soft tissues | 94 | ||
| Myotomes | 94 | ||
| Dermatomes | 94 | ||
| The skin and mammary glands | 94 | ||
| The skull | 94 | ||
| The viscerocranium | 94 | ||
| The teeth | 94 | ||
| The brain | 95 | ||
| The changing shape of the brain | 95 | ||
| The forebrain | 95 | ||
| Other brain structures | 95 | ||
| Blood supply to the brain | 95 | ||
| The spinal cord | 95 | ||
| Zones of the spinal cord | 95 | ||
| Cells from the neural crest | 95 | ||
| Structures of the head and neck | 96 | ||
| Pharyngeal apparatus | 96 | ||
| Pharyngeal arches | 96 | ||
| The structure of the pharyngeal arches | 96 | ||
| Pharyngeal pouches and grooves | 96 | ||
| Derivatives of the pharyngeal arches | 96 | ||
| First pharyngeal arch | 96 | ||
| Second pharyngeal arch | 96 | ||
| Third pharyngeal arch | 96 | ||
| Fourth and sixth pharyngeal arches | 96 | ||
| Derivatives of the pharyngeal pouches | 96 | ||
| Derivatives of the pharyngeal grooves | 98 | ||
| The face | 98 | ||
| The ears | 98 | ||
| The outer and middle ear | 98 | ||
| The inner ear | 98 | ||
| The eyes | 98 | ||
| The optic cup | 99 | ||
| The eyelids and lacrimal apparatus | 99 | ||
| The limbs | 99 | ||
| Development of the limbs | 99 | ||
| Formation of the hands and feet | 99 | ||
| Development and rotation of the limbs | 100 | ||
| Muscles and nerves of the limbs | 100 | ||
| Blood supply to the limbs | 100 | ||
| References | 101 | ||
| Annotated recommended reading | 101 | ||
| 11 Embryological systems 2—internal organs | 103 | ||
| Chapter Contents | 103 | ||
| Introduction | 103 | ||
| The cardiovascular system | 103 | ||
| Vasculogenesis and angiogenesis | 103 | ||
| The primordial cardiovascular system | 103 | ||
| Development of the heart | 104 | ||
| Blood flow through the early heart | 104 | ||
| Partitioning of the heart | 105 | ||
| The lower respiratory tract | 105 | ||
| Development of the laryngotracheal tube | 105 | ||
| Development of the lungs | 105 | ||
| The diaphragm | 105 | ||
| The alimentary tract | 105 | ||
| The foregut | 106 | ||
| The oesophagus | 106 | ||
| The stomach | 106 | ||
| The duodenum | 106 | ||
| The liver, gall bladder, pancreas and spleen | 106 | ||
| Development of the veins of the liver | 106 | ||
| The midgut | 106 | ||
| The hindgut: the rectum and anal canal | 107 | ||
| The urinary and genital tracts | 107 | ||
| The kidneys and ureters | 107 | ||
| Development of the collecting system | 107 | ||
| The bladder and urethra | 107 | ||
| The suprarenal glands | 108 | ||
| The reproductive system | 108 | ||
| Testes and the male genital tract | 108 | ||
| Ovaries and the female genital tract | 108 | ||
| The vagina | 109 | ||
| The external genitalia | 109 | ||
| Estimation of embryonic age | 109 | ||
| References | 109 | ||
| Annotated recommended reading | 110 | ||
| 12 The placenta, membranes and amniotic fluid | 111 | ||
| Chapter Contents | 111 | ||
| Introduction | 111 | ||
| Implantation | 111 | ||
| Development of the chorionic villi | 111 | ||
| Formation of the cytotrophoblastic shell | 112 | ||
| Later placental development | 112 | ||
| The mature placenta | 112 | ||
| Appearance | 112 | ||
| The membranes | 115 | ||
| The umbilical cord | 115 | ||
| The umbilical vesicle (yolk sac) and allantois | 115 | ||
| The placental circulation | 116 | ||
| Anatomical variations of the placenta | 116 | ||
| Functions of the placenta | 116 | ||
| Endocrine function | 118 | ||
| The protein hormones | 119 | ||
| The steroid hormones: oestrogens | 119 | ||
| Oestrogen levels in normal pregnancy | 119 | ||
| The steroid hormones: progesterone | 119 | ||
| The function of progesterone in pregnancy | 119 | ||
| Progesterone levels in normal and abnormal pregnancy | 120 | ||
| Transfer of substances | 120 | ||
| Mechanisms of transfer | 120 | ||
| Respiration | 120 | ||
| Fetal oxygen supply | 120 | ||
| Carbon dioxide | 120 | ||
| Nutrition | 120 | ||
| Carbohydrate transfer | 120 | ||
| Amino acid transfer | 120 | ||
| Lipid transfer | 121 | ||
| Vitamin transfer | 121 | ||
| Trace element transfer | 121 | ||
| Water and electrolyte transfer | 121 | ||
| Excretion | 121 | ||
| Protection | 121 | ||
| Immunological role | 121 | ||
| Amniotic fluid | 121 | ||
| Production of amniotic fluid | 121 | ||
| Sources of amniotic fluid | 121 | ||
| Circulation of amniotic fluid | 121 | ||
| Content of amniotic fluid | 121 | ||
| Regulation of amniotic fluid quantity | 121 | ||
| Functions of amniotic fluid | 122 | ||
| Clinical implications: abnormalities of quantity | 122 | ||
| Polyhydramnios | 122 | ||
| Oligohydramnios | 122 | ||
| Diagnostic uses of amniotic fluid | 123 | ||
| Biophysical profile | 123 | ||
| Amniocentesis | 123 | ||
| References | 124 | ||
| Annotated recommended reading | 124 | ||
| 13 Fetal growth and development | 125 | ||
| Chapter Contents | 125 | ||
| Introduction | 125 | ||
| The fetal period | 125 | ||
| Fetal growth | 125 | ||
| Control of cell growth and proliferation | 125 | ||
| Key events in the fetal stage of development | 125 | ||
| Fetal size | 125 | ||
| Estimation of fetal age and assessment of fetal growth | 127 | ||
| Growth curves | 127 | ||
| Maternal weight and fetal growth | 127 | ||
| Ultrasound | 130 | ||
| Linear measurements | 130 | ||
| Non-linear measurements | 130 | ||
| Ratios | 130 | ||
| Doppler wave form analysis | 130 | ||
| Multiple pregnancies | 130 | ||
| Types of twin pregnancy | 130 | ||
| Dizygotic | 130 | ||
| Monozygotic | 130 | ||
| The incidence of multiple pregnancies | 131 | ||
| Triplets and higher-order pregnancies | 131 | ||
| Diagnosis of twin pregnancy | 132 | ||
| Abdominal examination | 132 | ||
| Inspection | 132 | ||
| Palpation | 132 | ||
| Auscultation | 132 | ||
| Ultrasound | 132 | ||
| Complications of pregnancy | 132 | ||
| Fetal problems | 132 | ||
| Abortion (Miscarriage) | 132 | ||
| Single fetus demise | 132 | ||
| Congenital malformations | 132 | ||
| Monoamniotic twins | 132 | ||
| Conjoined twins | 132 | ||
| Acardiac twinning | 133 | ||
| Twin–twin transfusion syndrome | 133 | ||
| Polyhydramnios | 134 | ||
| Intrauterine growth retardation | 134 | ||
| Maternal problems | 134 | ||
| Exacerbation of minor disorders | 134 | ||
| Anaemia | 134 | ||
| Pregnancy-induced hypertension | 134 | ||
| Antepartum haemorrhage | 134 | ||
| Complications of labour | 134 | ||
| Fetal malpresentations | 134 | ||
| Locked twins | 134 | ||
| Umbilical cord problems | 134 | ||
| Preterm onset of labour | 135 | ||
| Mode of delivery | 135 | ||
| Postpartum haemorrhage | 135 | ||
| Undiagnosed twins | 135 | ||
| Postnatal care of mother and babies | 135 | ||
| Care of the babies | 135 | ||
| Care of the mother | 135 | ||
| References | 135 | ||
| Annotated recommended reading | 136 | ||
| 14 Common fetal problems | 137 | ||
| Chapter Contents | 137 | ||
| Introduction | 137 | ||
| Intrauterine growth retardation | 137 | ||
| Complications of IUGR | 137 | ||
| Factors adversely affecting fetal growth | 137 | ||
| Maternal malnutrition | 137 | ||
| Smoking | 138 | ||
| Alcohol consumption | 138 | ||
| Placental insufficiency | 138 | ||
| Multiple pregnancy | 138 | ||
| Genetic factors and chromosomal aberrations | 138 | ||
| Diagnosis and management of IUGR | 138 | ||
| Delivery of the baby | 138 | ||
| Rhesus isoimmunization and ABO incompatibility | 138 | ||
| Rhesus isoimmunization (RhD incompatibility) | 138 | ||
| Prevention of maternal isoimmunization | 139 | ||
| Antenatal management: anti-D prophylaxis | 139 | ||
| Care at delivery | 139 | ||
| Management if rhesus antibodies are present during pregnancy | 139 | ||
| Rhesus haemolytic disease | 139 | ||
| ABO incompatibility | 139 | ||
| Maternal infection in pregnancy | 140 | ||
| Suppression of cell-mediated immunity | 140 | ||
| Sexually transmitted diseases | 140 | ||
| Bacterial infections | 140 | ||
| Gonorrhoea | 140 | ||
| Syphilis | 140 | ||
| Chlamydia | 140 | ||
| Group B streptococcus | 140 | ||
| Viral infections | 140 | ||
| Human immunodeficiency virus | 140 | ||
| TORCH organisms and pregnancy risk | 141 | ||
| Rubella | 141 | ||
| Varicella | 141 | ||
| Cytomegalovirus | 141 | ||
| Toxoplasmosis | 141 | ||
| Herpes simplex | 141 | ||
| Listeriosis | 142 | ||
| Hepatitis B (serum hepatitis) | 142 | ||
| Hepatitis C | 142 | ||
| References | 143 | ||
| Annotated recommended reading | 143 | ||
| 15 Congenital anomalies | 145 | ||
| Chapter Contents | 145 | ||
| Introduction | 145 | ||
| General causes of congenital anomalies | 145 | ||
| Genetic causes | 145 | ||
| Chromosomal abnormalities | 145 | ||
| Down syndrome | 146 | ||
| Single gene disorders | 147 | ||
| Cystic fibrosis | 147 | ||
| Multifactorial inheritance | 148 | ||
| Cleft lip and cleft palate | 148 | ||
| Neural Tube Defects | 148 | ||
| Environmental factors | 149 | ||
| Teratogens | 149 | ||
| Drugs | 150 | ||
| Prenatal screening for congenital anomalies | 150 | ||
| Ultrasonography | 150 | ||
| Obtaining fetal tissue for genetic testing | 150 | ||
| Amniocentesis | 151 | ||
| Chorionic villus sampling | 151 | ||
| Fetal blood sampling | 151 | ||
| Non-invasive prenatal testing | 151 | ||
| Conclusion | 151 | ||
| References | 151 | ||
| Annotated recommended reading | 152 | ||
| 2B Pregnancy—The Mother | 153 | ||
| Section Contents | 153 | ||
| 16 The haematological system—physiology of the blood | 155 | ||
| Chapter Contents | 155 | ||
| Blood as a tissue | 155 | ||
| Functions of blood | 155 | ||
| Constituents of blood | 155 | ||
| Plasma | 156 | ||
| The cellular components of blood | 156 | ||
| Red blood cells | 157 | ||
| Haemoglobin | 157 | ||
| Formation of erythrocytes | 158 | ||
| The life span of red cells | 158 | ||
| Iron metabolism | 158 | ||
| Absorption | 158 | ||
| Serum iron, transferrin and total iron-binding capacity | 159 | ||
| Serum ferritin | 159 | ||
| Marrow iron | 159 | ||
| Folate metabolism | 159 | ||
| Blood groups | 159 | ||
| The ABO system | 159 | ||
| The rhesus (Rh) system | 159 | ||
| White cells | 160 | ||
| Types of white cells | 160 | ||
| The production of granulocytes | 160 | ||
| Agranulocytes | 160 | ||
| Lymphocytes | 160 | ||
| Monocytes | 160 | ||
| Platelets | 160 | ||
| Haemostasis | 161 | ||
| Vascular spasm | 161 | ||
| Formation of a platelet plug | 161 | ||
| Coagulation | 161 | ||
| Clot retraction and fibrinolysis | 162 | ||
| Factors limiting clot growth or formation | 162 | ||
| Maternal haematological adaptations to pregnancy | 162 | ||
| Blood volume and composition | 162 | ||
| Plasma volume | 163 | ||
| Blood cellular components | 163 | ||
| Iron requirements during pregnancy | 163 | ||
| Folate metabolism in pregnancy | 163 | ||
| Haemostasis in pregnancy | 163 | ||
| Intrapartum and immediate postpartum periods | 164 | ||
| References | 166 | ||
| Annotated recommended reading | 166 | ||
| Website | 166 | ||
| 17 The cardiovascular system | 167 | ||
| Chapter Contents | 167 | ||
| Introduction | 167 | ||
| Circulatory pathways | 167 | ||
| Anatomy of the heart | 167 | ||
| Description | 167 | ||
| Layers | 168 | ||
| Chambers and valves | 169 | ||
| The atrioventricular valves | 169 | ||
| The semilunar valves | 169 | ||
| The coronary circulation | 169 | ||
| Pulmonary and systemic circulations | 169 | ||
| Physiology of the heart | 169 | ||
| The electrical conducting system (nodal system) | 170 | ||
| The cardiac cycle | 170 | ||
| Control of the heart rate | 170 | ||
| Intrinsic control | 170 | ||
| Extrinsic control | 170 | ||
| Nervous control | 170 | ||
| Hormonal control | 171 | ||
| Stretch | 171 | ||
| Stroke volume | 171 | ||
| Cardiac output | 172 | ||
| Other influences | 172 | ||
| The vascular system | 172 | ||
| Structure of blood vessels | 172 | ||
| The arterial system | 172 | ||
| Elastic arteries (conducting arteries) | 172 | ||
| Muscular arteries (distributing arteries) | 172 | ||
| Arterioles | 172 | ||
| Capillaries | 172 | ||
| The microcirculation | 173 | ||
| The venous system | 174 | ||
| The physiology of circulation | 175 | ||
| Blood vessel diameter | 175 | ||
| Nervous control | 175 | ||
| Chemical control | 175 | ||
| Endothelial-mediated regulation | 175 | ||
| Blood pressure | 175 | ||
| Fluid pressure | 175 | ||
| Fluid flow | 176 | ||
| Venous return | 176 | ||
| Arterial blood pressure | 176 | ||
| Pulse pressure and mean arterial pressure | 176 | ||
| The regulation of blood pressure | 176 | ||
| Neural system | 176 | ||
| Chemical control | 177 | ||
| The renal system | 177 | ||
| Blood pressure values | 177 | ||
| The formation of tissue fluid | 178 | ||
| Hydrostatic pressure | 178 | ||
| Osmotic pressure | 178 | ||
| Diffusion | 178 | ||
| Maternal adaptations to pregnancy | 179 | ||
| Haemodynamic changes | 179 | ||
| Size and position of the heart | 179 | ||
| Control of cardiovascular changes | 180 | ||
| References | 181 | ||
| Annotated recommended reading | 181 | ||
| 18 Respiration | 183 | ||
| Chapter Contents | 183 | ||
| Introduction | 183 | ||
| Anatomy of the respiratory system | 183 | ||
| The upper airways | 183 | ||
| The lower respiratory tract | 184 | ||
| The thoracic cage | 185 | ||
| Physiology of the respiratory tract | 185 | ||
| The epithelial lining | 185 | ||
| Reflex mechanisms | 185 | ||
| Structure and function of the alveoli | 185 | ||
| Surfactant | 186 | ||
| Blood supply to the lungs | 186 | ||
| Nerve supply to the respiratory muscles | 186 | ||
| The physiology of pulmonary ventilation (breathing) | 186 | ||
| Mechanical factors | 186 | ||
| Inspiration | 187 | ||
| Expiration | 187 | ||
| Pulmonary ventilation | 187 | ||
| Respiratory parameters | 187 | ||
| Respiratory volumes | 187 | ||
| Respiratory capacities | 187 | ||
| Minute volume | 187 | ||
| Alveolar ventilation | 188 | ||
| Transport of gases around the body | 188 | ||
| Gas exchange in tissues | 188 | ||
| Transport of oxygen | 188 | ||
| Partial pressure gradients and gas diffusion | 188 | ||
| The oxygen dissociation curve | 188 | ||
| Factors influencing the oxygen–haemoglobin dissociation curve | 188 | ||
| Increase in carbon dioxide | 188 | ||
| Increase in hydrogen ions | 189 | ||
| Increase in 2,3-diphosphoglycerate | 189 | ||
| Increase in temperature | 189 | ||
| Carbon monoxide | 189 | ||
| Transport of carbon dioxide | 189 | ||
| Bicarbonate ions | 189 | ||
| The chloride shift | 189 | ||
| Hydrogen ions, carbon dioxide and the acid–base balance | 189 | ||
| Control of ventilation | 190 | ||
| Medullary respiratory centres | 190 | ||
| The dorsal respiratory group | 190 | ||
| The respiratory cycle | 190 | ||
| Factors influencing the rate and depth of breathing | 190 | ||
| Voluntary control of breathing | 190 | ||
| Chemoreceptor effects | 190 | ||
| The Hering–Breuer reflex | 190 | ||
| Maternal adaptations to pregnancy | 190 | ||
| Upper respiratory tract changes | 190 | ||
| Anatomical changes | 190 | ||
| Biochemical changes | 191 | ||
| Carbon dioxide | 191 | ||
| Oxygen | 192 | ||
| Postpartum changes | 192 | ||
| References | 194 | ||
| Annotated recommended reading | 194 | ||
| Website | 194 | ||
| 19 The renal tract | 195 | ||
| Chapter Contents | 195 | ||
| Introduction | 195 | ||
| Kidney functions | 195 | ||
| Anatomy of the kidney | 195 | ||
| Structure | 195 | ||
| Microscopic structure of the kidney | 196 | ||
| The role of blood pressure | 197 | ||
| Renal function | 197 | ||
| The production of urine | 197 | ||
| Glomerular filtration | 197 | ||
| Tubular reabsorption and secretion | 198 | ||
| Hormones influencing selective reabsorption | 198 | ||
| Regulation of urine concentration and volume | 199 | ||
| Formation of concentrated urine | 202 | ||
| The lower urinary tract | 202 | ||
| The ureters | 202 | ||
| 2C Pregnancy–The Problems | 315 | ||
| Section Contents | 315 | ||
| 30 Minor disorders of pregnancy | 317 | ||
| Chapter Contents | 317 | ||
| Introduction | 317 | ||
| Maintenance of pregnancy | 317 | ||
| Minor disorders of pregnancy | 317 | ||
| The digestive system | 317 | ||
| Nausea and vomiting | 317 | ||
| Heartburn | 318 | ||
| Ptyalism | 318 | ||
| Pica | 318 | ||
| Constipation | 318 | ||
| Skin | 319 | ||
| The cardiovascular system | 319 | ||
| Fainting | 319 | ||
| Varicosities | 319 | ||
| The musculoskeletal system | 319 | ||
| Backache | 319 | ||
| The nervous system | 319 | ||
| Carpal tunnel syndrome | 319 | ||
| Fatigue and emotional changes | 320 | ||
| The genitourinary system | 320 | ||
| Frequency of micturition | 320 | ||
| Leucorrhoea | 320 | ||
| Conclusion | 320 | ||
| References | 320 | ||
| Annotated recommended reading | 321 | ||
| 31 Bleeding in pregnancy | 323 | ||
| Chapter Contents | 323 | ||
| Bleeding in early pregnancy | 323 | ||
| Implantation bleeding | 323 | ||
| Miscarriage (abortion) | 323 | ||
| Classification of miscarriage (abortion) | 323 | ||
| Threatened miscarriage | 323 | ||
| Inevitable miscarriage | 324 | ||
| Missed miscarriage | 324 | ||
| Recurrent miscarriage | 324 | ||
| Induced abortion (therapeutic) | 324 | ||
| Gestational trophoblastic tumours | 325 | ||
| Hydatidiform mole | 325 | ||
| Aetiology | 325 | ||
| Signs and symptoms | 325 | ||
| Management | 325 | ||
| Choriocarcinoma and placental site tumours | 325 | ||
| Treatment | 326 | ||
| Ectopic pregnancy | 326 | ||
| Tubal pregnancy | 326 | ||
| Risk factors | 326 | ||
| Pathophysiology | 326 | ||
| Diagnosis | 326 | ||
| Management | 327 | ||
| Prognosis | 327 | ||
| Bleeding from associated conditions | 327 | ||
| Cervical polyps | 327 | ||
| Cervical erosion | 327 | ||
| Carcinoma of the cervix | 327 | ||
| Cervical intraepithelial neoplasia | 327 | ||
| Invasive carcinoma of the cervix | 328 | ||
| Vaginitis | 328 | ||
| Antepartum haemorrhage | 328 | ||
| Placenta praevia | 328 | ||
| Classification of placenta praevia | 328 | ||
| Aetiology of placenta praevia | 329 | ||
| Blood loss | 329 | ||
| Management | 329 | ||
| General examination | 329 | ||
| Abdominal examination | 329 | ||
| Conservative management | 329 | ||
| Delivery | 329 | ||
| Active management | 329 | ||
| Third stage | 329 | ||
| Placental abruption (abruptio placentae) | 329 | ||
| Risk factors | 330 | ||
| Blood loss | 330 | ||
| Management of placental abruption | 331 | ||
| Blood coagulation disorders | 331 | ||
| Other complications | 331 | ||
| Vasa praevia | 332 | ||
| References | 332 | ||
| Annotated recommended reading | 333 | ||
| 32 Cardiac and hypertensive disorders | 335 | ||
| Chapter Contents | 335 | ||
| Introduction | 335 | ||
| Cardiac disorders in pregnancy | 335 | ||
| Risk factors | 335 | ||
| Main types of cardiac disorder | 336 | ||
| Congenital heart disease | 336 | ||
| Categorization of congenital heart disease | 336 | ||
| Eisenmenger’s syndrome | 336 | ||
| Marfan’s syndrome | 336 | ||
| Assessment of mothers with heart disease | 336 | ||
| New York Heart Association classification | 336 | ||
| Management of women with heart disease | 336 | ||
| Specific aspects of care | 336 | ||
| Intrapartum care | 336 | ||
| Second stage | 337 | ||
| Third stage | 337 | ||
| Postnatal care | 337 | ||
| Hypertension in pregnancy | 337 | ||
| Terminology | 337 | ||
| Classification | 337 | ||
| Incidence | 337 | ||
| Pathogenesis | 337 | ||
| Outcomes | 338 | ||
| Eclampsia | 338 | ||
| Prediction | 338 | ||
| HELLP syndrome | 338 | ||
| Management of hypertensive conditions | 338 | ||
| Rest and observation | 338 | ||
| Fetal observations | 339 | ||
| Delivery | 339 | ||
| Control of blood pressure | 339 | ||
| Anticonvulsive therapy | 339 | ||
| Prevention | 339 | ||
| References | 340 | ||
| Annotated recommended reading | 341 | ||
| 33 Anaemia and clotting disorders | 343 | ||
| Chapter Contents | 343 | ||
| Anaemia | 343 | ||
| Recognition and incidence of anaemia | 343 | ||
| Iron-deficiency anaemia | 343 | ||
| Pathology | 343 | ||
| Folic acid–deficiency anaemia and the role of vitamins | 343 | ||
| Management | 345 | ||
| Haemoglobinopathies | 345 | ||
| The globin chains | 345 | ||
| Sickle cell disease | 347 | ||
| Pathophysiology | 347 | ||
| Thalassaemia | 347 | ||
| Glucose-6-phosphate dehydrogenase deficiency | 348 | ||
| Thromboembolism and pregnancy | 348 | ||
| Superficial thrombophlebitis | 348 | ||
| Deep vein thrombosis | 348 | ||
| Factors associated with pregnancy predisposing to thromboembolism | 348 | ||
| Pathogenesis | 348 | ||
| 3A Labour–Normal | 371 | ||
| Section Contents | 371 | ||
| 36 The onset of labour | 373 | ||
| Chapter Contents | 373 | ||
| Introduction | 373 | ||
| The onset of labour | 373 | ||
| Fetal factors associated with the onset of labour | 373 | ||
| The role of the fetal hypothalamus– pituitary–adrenal axis | 373 | ||
| The fetal posterior pituitary gland | 375 | ||
| The role of the placenta (Fig. 36.3) | 375 | ||
| Progesterone | 375 | ||
| Oestrogens | 375 | ||
| Fetal membranes | 375 | ||
| Prostaglandins | 375 | ||
| Maternal influences | 376 | ||
| The endocrine system | 376 | ||
| Neurohormonal control | 376 | ||
| Control of cervical changes in labour | 376 | ||
| Definitions of labour | 377 | ||
| Maternal physiological adaptation in labour | 378 | ||
| Cardiovascular system | 378 | ||
| Haematological system | 378 | ||
| Respiratory system | 378 | ||
| Maternal acidosis | 378 | ||
| Maternal alkalosis | 378 | ||
| Renal system | 379 | ||
| Gastrointestinal system | 379 | ||
| Gastric emptying | 379 | ||
| Metabolism | 379 | ||
| Clinical implications | 379 | ||
| Recognition of the onset of labour | 379 | ||
| Initial examination of the woman | 379 | ||
| The history | 379 | ||
| General examination | 379 | ||
| Assessing progress in labour | 380 | ||
| References | 380 | ||
| Annotated recommended reading | 380 | ||
| 37 The first stage of labour | 381 | ||
| Chapter Contents | 381 | ||
| Physiology of the first stage of labour | 381 | ||
| Uterine activity in labour | 381 | ||
| Mechanical factors | 381 | ||
| Phases of the first stage of labour | 383 | ||
| Individualized care | 383 | ||
| Assessing progress in the first stage of labour | 384 | ||
| Abdominal examination in labour | 384 | ||
| Vaginal examination in labour | 384 | ||
| Maternal position in the first stage of labour | 388 | ||
| Immersion in water | 390 | ||
| Nutrition and hydration in labour | 390 | ||
| Nutrition | 390 | ||
| Hydration | 390 | ||
| Monitoring the fetal condition | 391 | ||
| The fetus in the first stage of labour | 391 | ||
| Heart rate | 392 | ||
| Intermittent monitoring | 392 | ||
| Continuous fetal heart recording | 392 | ||
| Telemetry | 393 | ||
| Findings | 393 | ||
| Baseline fetal heart rate | 393 | ||
| Baseline variability | 393 | ||
| Response of the fetal heart to uterine contractions | 394 | ||
| Fetal blood sampling | 395 | ||
| Amniotic fluid | 396 | ||
| References | 397 | ||
| Annotated recommended reading | 397 | ||
| 38 Pain relief in labour | 399 | ||
| Chapter Contents | 399 | ||
| Introduction | 399 | ||
| Pain perception | 399 | ||
| Pain reception | 399 | ||
| Classification of pain | 399 | ||
| Pain pathways | 400 | ||
| The anatomy of the dorsal horn | 400 | ||
| Ascending pathways | 400 | ||
| Pain modulation | 400 | ||
| Control systems descending from the brain | 400 | ||
| The gate control theory of pain | 400 | ||
| Visceral sensory neurons | 401 | ||
| Pain pathways in labour | 401 | ||
| The effect of pain | 402 | ||
| Management of pain | 403 | ||
| Working with pain model | 403 | ||
| Non-pharmacological support | 403 | ||
| Transcutaneous electrical nerve stimulation | 404 | ||
| Systemic analgesia | 405 | ||
| Inhalational analgesia | 405 | ||
| Stages of anaesthesia | 406 | ||
| Obstetric use of inhalational anaesthetics | 406 | ||
| Epidural analgesia | 406 | ||
| Anatomy of the epidural space | 406 | ||
| Indications for epidural analgesia | 407 | ||
| Contraindications | 407 | ||
| Other drugs | 409 | ||
| Spinal anaesthesia | 409 | ||
| Pudendal block | 409 | ||
| Perineal infiltration | 409 | ||
| References | 410 | ||
| Annotated recommended reading | 410 | ||
| Website | 410 | ||
| 39 The second stage of labour | 411 | ||
| Chapter Contents | 411 | ||
| Introduction | 411 | ||
| Physiology of the second stage of labour | 411 | ||
| Contractions | 411 | ||
| The secondary powers | 411 | ||
| Descent of the fetus | 411 | ||
| Onset of the second stage | 411 | ||
| Duration of the second stage | 411 | ||
| Mechanisms of labour | 412 | ||
| The mechanism of a normal labour | 413 | ||
| The movements | 413 | ||
| Physiological changes | 413 | ||
| The length of the second stage of labour | 415 | ||
| Management | 415 | ||
| Position of the woman | 415 | ||
| Squatting | 415 | ||
| Hands and knees/all-fours positions | 415 | ||
| Birthing chairs | 416 | ||
| Review of upright positions | 416 | ||
| Maternal effort in the second stage of labour | 416 | ||
| Effect on pelvic soft tissues | 416 | ||
| Perineal lacerations | 416 | ||
| The episiotomy | 416 | ||
| Recommendations for performing an episiotomy | 417 | ||
| The incision | 417 | ||
| Suturing the perineum | 418 | ||
| Infiltration of the perineum | 418 | ||
| Obstetric anal sphincter injuries | 418 | ||
| The fetus in the second stage of labour | 418 | ||
| References | 420 | ||
| Annotated recommended reading | 420 | ||
| 40 The third stage of labour | 421 | ||
| Chapter Contents | 421 | ||
| Introduction | 421 | ||
| Physiology of the third stage of labour | 421 | ||
| Separation of the placenta | 421 | ||
| Control of bleeding | 421 | ||
| Management of the third stage of labour | 422 | ||
| The development and use of oxytocic drugs to manage the third stage of labour | 423 | ||
| Active versus physiological management | 423 | ||
| Syntometrine versus oxytocin | 424 | ||
| Examination of the placenta | 424 | ||
| References | 425 | ||
| Annotated recommended reading | 426 | ||
| 3B Labour—Problems | 427 | ||
| Section Contents | 427 | ||
| 41 Abnormalities of uterine action and onset of labour | 429 | ||
| Chapter Contents | 429 | ||
| Introduction | 429 | ||
| Abnormalities of uterine action | 429 | ||
| Prolonged labour | 429 | ||
| Timing of the onset of labour | 429 | ||
| Latent or active phase? | 430 | ||
| Inefficient uterine action | 430 | ||
| Hypotonic uterine action | 430 | ||
| Incoordinate uterine action | 430 | ||
| Active management of labour | 430 | ||
| Augmentation of labour | 431 | ||
| Amniotomy | 431 | ||
| Oxytocic infusion | 431 | ||
| Prolonged second stage of labour | 431 | ||
| Management | 431 | ||
| Over-efficient uterine action | 431 | ||
| Precipitate labour | 431 | ||
| Dangers of precipitate labour | 431 | ||
| Tonic contraction of the uterus | 433 | ||
| Cervical dystocia | 433 | ||
| Problems: timing of the onset of labour | 433 | ||
| Preterm onset of labour | 433 | ||
| Aetiology | 433 | ||
| Fetal fibronectin | 433 | ||
| Preterm rupture of the membranes | 433 | ||
| The use of drugs in preterm onset of labour and preterm rupture of the membranes | 434 | ||
| Corticosteroids | 434 | ||
| Antibiotics | 434 | ||
| Tocolytic drugs | 434 | ||
| Labour and delivery | 435 | ||
| Prolonged pregnancy | 435 | ||
| Risk factors | 435 | ||
| Management of post-term pregnancy | 435 | ||
| Induction of labour | 436 | ||
| Methods | 436 | ||
| Cervical ripening | 436 | ||
| Prostaglandins | 436 | ||
| Mechanical methods for induction of labour | 437 | ||
| Sweeping the membranes | 437 | ||
| Amniotomy with or without oxytocin | 437 | ||
| References | 438 | ||
| Annotated recommended reading | 439 | ||
| 42 Breech presentation | 441 | ||
| Chapter Contents | 441 | ||
| Introduction | 441 | ||
| Breech presentation | 441 | ||
| Types of breech presentation | 441 | ||
| Aetiology | 441 | ||
| Diagnosis of breech presentation | 441 | ||
| On discussion | 441 | ||
| On abdominal examination | 441 | ||
| On vaginal examination | 443 | ||
| Ultrasound scan | 443 | ||
| Associated risk factors | 443 | ||
| Congenital abnormality | 443 | ||
| Risks at delivery | 443 | ||
| Management of pregnancy | 443 | ||
| Cephalic version | 444 | ||
| Promotion of spontaneous cephalic version | 444 | ||
| Moxibustion | 444 | ||
| External cephalic version | 444 | ||
| The procedure for ECV | 444 | ||
| The role of planned caesarean section at term | 445 | ||
| Vaginal delivery | 446 | ||
| Management | 446 | ||
| The mechanism of a breech delivery | 446 | ||
| The movements | 446 | ||
| Compaction and flexion | 446 | ||
| Internal rotation of the buttocks | 446 | ||
| Lateral flexion of the trunk | 446 | ||
| Restitution | 446 | ||
| Internal rotation of the shoulders | 446 | ||
| Birth of the shoulders | 447 | ||
| Internal rotation and delivery of the head | 447 | ||
| The first stage of labour | 447 | ||
| The second stage of labour | 447 | ||
| Vaginal breech birth | 447 | ||
| Assisted breech delivery | 447 | ||
| The buttocks | 447 | ||
| Extended legs | 448 | ||
| The body | 448 | ||
| The arms | 448 | ||
| Extended arms | 448 | ||
| The head | 448 | ||
| Mauriceau–Smellie–Veit (modified) manoeuvre | 449 | ||
| Burns–Marshall manoeuvre | 449 | ||
| Entrapment of the fetal head | 450 | ||
| Undiagnosed cephalopelvic disproportion | 450 | ||
| Posterior rotation of the occiput | 450 | ||
| References | 450 | ||
| Annotated recommended reading | 451 | ||
| 43 Malposition and cephalic malpresentations | 453 | ||
| Chapter Contents | 453 | ||
| Introduction | 453 | ||
| Occipitoposterior position of the vertex | 453 | ||
| Causes | 453 | ||
| Attitude | 453 | ||
| Diagnosis in pregnancy | 453 | ||
| Diagnosis in labour | 453 | ||
| The first stage of labour | 453 | ||
| The role of maternal position | 454 | ||
| The second stage of labour | 456 | ||
| Deep transverse arrest of the head | 456 | ||
| Diagnosis and management | 456 | ||
| Short internal rotation of sinciput and ‘face to pubes’ delivery | 458 | ||
| Diagnosis | 458 | ||
| Management of the spontaneous delivery | 458 | ||
| Face presentation | 458 | ||
| Causes | 458 | ||
| Risks | 458 | ||
| Diagnosis | 459 | ||
| Per abdomen | 459 | ||
| Per vaginam | 459 | ||
| Progress and outcomes of labour | 459 | ||
| Mentoanterior position | 459 | ||
| Mentoposterior position | 459 | ||
| Management of labour | 459 | ||
| Brow presentation | 459 | ||
| 4A Puerperium—The Baby as a Neonate | 499 | ||
| Section Contents | 499 | ||
| 48 Adaptation to extrauterine life 1 | 501 | ||
| Chapter Contents | 501 | ||
| Introduction | 501 | ||
| The appearance of the normal neonate | 501 | ||
| General appearance and the skin and hair at birth | 501 | ||
| Posture and crying | 502 | ||
| Eyes | 502 | ||
| Ears | 502 | ||
| Nose | 502 | ||
| Mouth and throat | 502 | ||
| Neck and chest | 503 | ||
| Major systemic characteristics of the neonate | 503 | ||
| The haematological system | 503 | ||
| Circulatory volume | 503 | ||
| Early versus delayed clamping of the umbilical cord | 503 | ||
| Adaptations in the neonate’s haematological parameters | 503 | ||
| The cardiovascular system | 504 | ||
| The fundamentals of fetal circulation | 504 | ||
| Résumé of cardiovascular and haemodynamic changes at birth | 507 | ||
| The respiratory system | 507 | ||
| Surfactant | 508 | ||
| Onset of respirations | 508 | ||
| The urinary system | 509 | ||
| Postnatal development of the kidneys | 509 | ||
| Neonatal renal physiology | 509 | ||
| The urinary bladder and micturition | 509 | ||
| Body composition | 510 | ||
| Sexual characteristics | 510 | ||
| References | 511 | ||
| Annotated recommended reading | 512 | ||
| 49 Adaptation to extrauterine life 2 | 513 | ||
| Chapter Contents | 513 | ||
| Introduction | 513 | ||
| The gastrointestinal tract | 513 | ||
| Neonatal characteristics | 513 | ||
| The oral cavity | 513 | ||
| The stomach at birth | 513 | ||
| Meconium | 514 | ||
| The liver | 514 | ||
| Metabolism | 514 | ||
| Glucose metabolism | 514 | ||
| Fat metabolism | 515 | ||
| Protein metabolism | 515 | ||
| Calcium, phosphorus and magnesium balance | 515 | ||
| Calcium | 515 | ||
| Neonatal aspects of calcium metabolism | 515 | ||
| Phosphorus | 515 | ||
| Magnesium | 515 | ||
| The neonatal nervous system | 515 | ||
| Autonomic functions | 516 | ||
| Sensory functions | 516 | ||
| Motor functions | 516 | ||
| Ongoing neural development | 516 | ||
| Reflexes | 516 | ||
| Behavioural state regulation | 517 | ||
| Sleep states | 517 | ||
| Deep sleep | 517 | ||
| Light sleep | 517 | ||
| Awake states | 517 | ||
| Drowsy state | 517 | ||
| Quiet but alert state | 517 | ||
| Active alert state | 517 | ||
| Active crying state | 517 | ||
| The essence of immunocompetence | 517 | ||
| Gastrointestinal perspectives | 517 | ||
| Thermoregulation | 517 | ||
| Adult mechanisms | 518 | ||
| Neonatal mechanisms | 518 | ||
| Heat production and BAT | 518 | ||
| Thermal care of the neonate | 518 | ||
| References | 519 | ||
| Annotated recommended reading | 519 | ||
| 50 Health challenges and problems in neonates of low birthweight | 521 | ||
| Content Chapters | 521 | ||
| Introduction | 521 | ||
| Defining low birthweight | 521 | ||
| Causes of low birthweight | 521 | ||
| Assessment of gestational age | 521 | ||
| The preterm neonate | 524 | ||
| Characteristics of the premature neonate | 524 | ||
| Causes of preterm birth | 526 | ||
| Immediate management | 526 | ||
| In labour | 527 | ||
| At birth | 527 | ||
| Ongoing care of premature neonates | 527 | ||
| Potential problems | 527 | ||
| Maintenance of temperature | 527 | ||
| Respiration | 528 | ||
| Oxygen therapy | 528 | ||
| Nutrition | 528 | ||
| Fats | 528 | ||
| Proteins | 528 | ||
| Carbohydrates | 528 | ||
| Method of feeding | 528 | ||
| Supplements | 529 | ||
| Excretion | 529 | ||
| Pain | 529 | ||
| Environmental neonatology | 529 | ||
| Noise | 529 | ||
| Positioning | 530 | ||
| Infection | 530 | ||
| The small-for-gestational-age baby | 530 | ||
| Asymmetrical growth retardation | 530 | ||
| Symmetrical growth retardation | 531 | ||
| Immediate management | 531 | ||
| Labour and delivery | 531 | ||
| Ongoing care of small-for-gestational age babies | 531 | ||
| Transitional and follow-up care | 531 | ||
| References | 531 | ||
| Annotated recommended reading | 532 | ||
| 51 Developmental anatomy | 533 | ||
| Chapter Contents | 533 | ||
| Introduction | 533 | ||
| Aspects of cardiovascular development | 533 | ||
| Cardiovascular problems | 533 | ||
| Cardiovascular abnormalities | 533 | ||
| Risk factors | 534 | ||
| Presenting features in a neonate | 534 | ||
| Investigations | 534 | ||
| Chest radiograph | 534 | ||
| Electrocardiography | 534 | ||
| Echocardiography | 534 | ||
| Magnetic resonance imaging | 535 | ||
| Cardiac catheterization and angiocardiography | 535 | ||
| Arterial blood gases | 535 | ||
| Some common disorders: acyanotic lesions | 535 | ||
| Patent ductus arteriosus | 535 | ||
| Ventricular septal defects | 535 | ||
| Atrial septal defects | 536 | ||
| Some common disorders: cyanotic lesions | 537 | ||
| Transposition of the great arteries | 537 | ||
| Total anomalous pulmonary venous drainage | 537 | ||
| Tetralogy of Fallot | 537 | ||
| Some common disorders: obstructive lesions | 538 | ||
| Coarctation of the aorta | 538 | ||
| Pulmonary valve stenosis and aortic valve stenosis | 538 | ||
| Hypoplastic left heart syndrome | 538 | ||
| Congestive cardiac failure | 539 | ||
| Excessive volume overload | 539 | ||
| Excessive pressure load | 539 | ||
| Arrhythmias in the newborn | 539 | ||
| Lower respiratory tract problems in neonates | 539 | ||
| Respiratory distress syndrome | 539 | ||
| Pathophysiology | 539 | ||
| Clinical symptoms | 540 | ||
| Management of respiratory distress syndrome | 540 | ||
| Prebirth maternal treatment with corticosteroids | 540 | ||
| Surfactant therapy | 540 | ||
| Respiratory support. | 540 | ||
| Bronchopulmonary dysplasia | 541 | ||
| Meconium aspiration syndrome | 541 | ||
| Pneumothorax | 541 | ||
| Transient tachypnoea of the newborn | 541 | ||
| Sudden infant death syndrome | 542 | ||
| References | 542 | ||
| Annotated recommended reading | 543 | ||
| 52 Jaundice and common metabolic problems in neonates | 545 | ||
| Chapter Contents | 545 | ||
| Introduction | 545 | ||
| Neonatal jaundice | 545 | ||
| Morphological factors | 545 | ||
| Synthesis and metabolism of bilirubin | 545 | ||
| Bilirubin in the neonate | 546 | ||
| Kernicterus | 546 | ||
| A résumé of common causes of neonatal jaundice | 547 | ||
| Prehepatic: unconjugated bilirubin | 548 | ||
| Hepatic: unconjugated bilirubin | 549 | ||
| Hepatic: mixed unconjugated and conjugated bilirubin | 549 | ||
| Posthepatic: mixed unconjugated and conjugated bilirubin | 549 | ||
| Management of jaundice | 550 | ||
| Investigations | 550 | ||
| Phototherapy | 550 | ||
| Use of immunoglobulin and exchange blood transfusion | 550 | ||
| Common metabolic disorders | 550 | ||
| Hypoglycaemia | 550 | ||
| The clinical evidence | 551 | ||
| Hypocalcaemia and hypomagnesaemia | 551 | ||
| Associated hypomagnesaemia | 551 | ||
| Hypernatraemia | 551 | ||
| Signs of hypernatraemia | 552 | ||
| References | 552 | ||
| Annotated recommended reading | 553 | ||
| 53 Risks of infection and trauma in neonates | 555 | ||
| Chapter Contents | 555 | ||
| Infections | 555 | ||
| Fetal and neonatal immunocompetence | 555 | ||
| Perinatal and postnatal infections | 555 | ||
| Skin and surface infections | 555 | ||
| Serious infections | 556 | ||
| Necrotizing enterocolitis | 556 | ||
| Therapeutic interventions | 557 | ||
| Gastroenteritis | 557 | ||
| Birth trauma | 557 | ||
| Head injuries | 557 | ||
| Cephalhaematoma | 557 | ||
| Subaponeurotic haemorrhage | 558 | ||
| Intracranial haemorrhage | 558 | ||
| Nerve palsies | 559 | ||
| Facial palsy | 559 | ||
| Erb’s palsy | 559 | ||
| Klumpke’s palsy | 560 | ||
| Soft tissue injuries | 560 | ||
| References | 560 | ||
| Annotated recommended reading | 561 | ||
| 4B Puerperium—The Mother | 563 | ||
| Section Contents | 563 | ||
| 54 The breasts and lactation | 565 | ||
| Chapter Contents | 565 | ||
| Introduction | 565 | ||
| The anatomy of the breast | 565 | ||
| Situation, shape and size | 565 | ||
| Internal structure | 565 | ||
| The parenchyma | 565 | ||
| The secretory cells | 566 | ||
| The stroma | 566 | ||
| The nipple and areola | 566 | ||
| Blood and lymphatic supply | 566 | ||
| Nerve supply | 567 | ||
| Development of the breast | 567 | ||
| Early development and puberty | 567 | ||
| Development in pregnancy | 567 | ||
| Maternal nutrition and lactation | 568 | ||
| The physiology of lactation | 568 | ||
| Neuroendocrine control | 569 | ||
| Prolactin | 569 | ||
| Oxytocin | 569 | ||
| The effect of higher brain centres | 570 | ||
| Autocrine control | 571 | ||
| Suckling and removal of milk | 571 | ||
| Breast milk | 572 | ||
| The contents of breast milk | 572 | ||
| Protein | 572 | ||
| Carbohydrate | 572 | ||
| Fats | 573 | ||
| Variations in fat content of milk | 573 | ||
| Electrolytes | 573 | ||
| Minerals | 573 | ||
| Trace elements | 573 | ||
| Vitamins | 573 | ||
| Enzymes | 573 | ||
| Hormones | 573 | ||
| Anti-infective factors | 573 | ||
| The transmission of viruses in milk | 574 | ||
| Anti-allergic properties | 574 | ||
| References | 574 | ||
| Annotated recommended reading | 575 | ||
| 55 Breastfeeding practice and problems | 577 | ||
| Chapter Contents | 577 | ||
| Introduction | 577 | ||
| Benefits of breastfeeding | 577 | ||
| Physiology applied to practice | 578 | ||
| Antenatal preparation | 578 | ||
| The first feed | 578 | ||
| Positioning | 578 | ||
| Attachment of the baby’s mouth to the breast | 579 | ||
| Effective milk transfer | 579 | ||
| Responsive feeding | 580 | ||
| Breastfeeding problems | 580 | ||
| Breast refusal | 580 | ||
| Painful nipples | 580 | ||
| Insufficient milk | 581 | ||
| Full breasts and engorgement | 581 | ||
| Mastitis | 581 | ||
| Breast abscess | 581 | ||
| Feeding after breast surgery | 582 | ||
| Problems arising with the baby | 582 | ||
| Congenital abnormalities in the baby | 582 | ||
| Tongue-tie | 582 | ||
| Prematurity in the baby | 582 | ||
| Chemicals in breast milk | 583 | ||
| Environmental toxins | 583 | ||
| Medications | 583 | ||
| Smoking | 583 | ||
| Alcohol use | 583 | ||
| Recreational drugs | 583 | ||
| Suppression of lactation | 583 | ||
| Lactation and fertility | 584 | ||
| Modification of cow’s milk | 584 | ||
| Differences between human and cow’s milk | 584 | ||
| The manufacture of infant formulae | 584 | ||
| References | 585 | ||
| Annotated recommended reading | 586 | ||
| 56 The puerperium | 587 | ||
| Chapter Contents | 587 | ||
| Introduction | 587 | ||
| Physiological changes | 587 | ||
| Endocrine changes in the puerperium | 587 | ||
| Resumption of menstruation and ovulation | 588 | ||
| Involution | 588 | ||
| Physiology | 589 | ||
| Positional changes | 589 | ||
| Uterine contractions | 589 | ||
| The decidua | 589 | ||
| Vaginal blood loss | 589 | ||
| Other parts of the genital tract | 590 | ||
| The body systems | 590 | ||
| The cardiovascular and respiratory systems | 590 | ||
| The renal system | 590 | ||
| The gastrointestinal tract | 590 | ||
| Postpartum (puerperal) infection | 590 | ||
| Causative organisms | 590 | ||
| Streptococci: Lancefield groups | 591 | ||
| Sepsis | 591 | ||
| Genital tract infection | 591 | ||
| Postpartum endometritis | 592 | ||
| Urinary tract infection | 592 | ||
| Other postpartum (puerperal) infections | 592 | ||
| Emotional states and mental disorders in the puerperium | 592 | ||
| ‘Baby blues’ | 593 | ||
| Postnatal depression | 593 | ||
| Risk factors | 593 | ||
| Postpartum (puerperal) psychosis | 593 | ||
| References | 594 | ||
| Annotated recommended reading | 595 | ||
| 57 Biobehavioural aspects of parenting | 597 | ||
| Chapter Outline | 597 | ||
| Introduction | 597 | ||
| What is biobehavioural science? | 597 | ||
| What does biobehavioural mean in relation to early parenting? | 597 | ||
| A hormonal orchestration | 597 | ||
| A window of heightened sensitivity | 598 | ||
| The key hormonal players | 598 | ||
| Oxytocin | 598 | ||
| Serotonin | 599 | ||
| Vasopressin | 599 | ||
| β-Endorphin | 599 | ||
| Prolactin | 600 | ||
| Catecholamines | 600 | ||
| Cortisol | 600 | ||
| The effects of stress and separation on attachment and bonding | 601 | ||
| Implications for practice | 601 | ||
| References | 602 | ||
| Index | 605 | ||
| A | 605 | ||
| B | 606 | ||
| C | 607 | ||
| D | 609 | ||
| E | 610 | ||
| F | 611 | ||
| G | 612 | ||
| H | 613 | ||
| I | 614 | ||
| J | 615 | ||
| K | 615 | ||
| L | 615 | ||
| M | 616 | ||
| N | 617 | ||
| O | 618 | ||
| P | 618 | ||
| R | 621 | ||
| S | 622 | ||
| T | 623 | ||
| U | 624 | ||
| V | 625 | ||
| W | 625 | ||
| X | 626 | ||
| Y | 626 | ||
| Z | 626 |