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Maternal, Fetal, & Neonatal Physiology - E-Book
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Front matter | iii | ||
| Maternal, fetal, & neonatal physiology | iii | ||
| Copyright | iv | ||
| Contributors and reviewers | v | ||
| Contributors | v | ||
| Reviewers | v | ||
| Preface | vii | ||
| Acknowledgments | vii | ||
| 1 Biologic basis for reproduction | 1 | ||
| Chromosomes and genes | 1 | ||
| Chromosomes | 1 | ||
| X chromosomes | 2 | ||
| Genes | 2 | ||
| DNA and RNA | 4 | ||
| Genomics and epigenetics | 5 | ||
| Cell division | 6 | ||
| Mitosis | 6 | ||
| Meiosis | 7 | ||
| Gametogenesis | 8 | ||
| Oogenesis | 8 | ||
| Spermatogenesis | 10 | ||
| Abnormal gamete development | 10 | ||
| Genetic and chromosomal disorders | 11 | ||
| Alterations in chromosome number | 11 | ||
| Alterations in chromosome structure | 13 | ||
| Gene disorders | 14 | ||
| Modes of inheritance | 15 | ||
| Autosomal inheritance | 16 | ||
| Autosomal recessive inheritance | 16 | ||
| Autosomal dominant inheritance | 16 | ||
| Sex-linked inheritance | 17 | ||
| X-linked recessive inheritance | 17 | ||
| X-linked dominant inheritance | 17 | ||
| Y-linked inheritance | 17 | ||
| Multifactorial inheritance | 17 | ||
| Nontraditional modes of inheritance | 18 | ||
| Embryonic and fetal development of the reproductive system | 19 | ||
| Development of the primordial germ cells | 20 | ||
| Development of the gonads | 20 | ||
| Indifferent stage | 20 | ||
| Development of the testes | 21 | ||
| Development of the ovaries | 21 | ||
| Development of the genital ducts | 21 | ||
| Indifferent stage | 21 | ||
| Development of the male genital ducts | 21 | ||
| Development of the female genital ducts | 22 | ||
| Development of the external genitalia | 22 | ||
| Indifferent stage | 22 | ||
| Development of the male external genitalia | 22 | ||
| Development of the female external genitalia | 24 | ||
| Anomalies of the genital tract | 24 | ||
| Disorders of sex development | 24 | ||
| Hypospadias and epispadias | 25 | ||
| Uterovaginal malformation | 25 | ||
| Clinical implications | 25 | ||
| Genetic screening | 25 | ||
| Genetic disorders and pregnancy | 26 | ||
| Summary | 26 | ||
| References | 27 | ||
| 2 Physiologic basis for reproduction | 29 | ||
| Hypothalamic-pituitary-ovarian/testicular axis | 29 | ||
| Hormones | 29 | ||
| Hormone activators, receptors, and messenger systems | 29 | ||
| Hormone storage | 30 | ||
| Hypothalamic and pituitary glands | 31 | ||
| Reproductive hormones in females and males | 33 | ||
| Luteinizing hormone | 35 | ||
| Follicle-stimulating hormone | 35 | ||
| Activin | 35 | ||
| Inhibin | 37 | ||
| Follistatin | 37 | ||
| Steroid hormones | 37 | ||
| Dehydroepiandrosterone sulfate, dehydroepiandrosterone, 5xdihydrotestosterone, and androstenedione | 38 | ||
| Estrogens | 38 | ||
| Progestogens | 42 | ||
| Testosterone | 42 | ||
| Oocyte maturation inhibitor | 43 | ||
| Luteinization inhibitor | 43 | ||
| Gonadotropin surge–inhibiting factor | 43 | ||
| Relaxin | 43 | ||
| Feedback systems | 43 | ||
| Gonadotropin-releasing hormone | 44 | ||
| Reproductive processes in the female and male | 44 | ||
| Oogenesis | 44 | ||
| Spermatogenesis | 45 | ||
| Puberty | 45 | ||
| Male puberty | 46 | ||
| Female puberty | 48 | ||
| Ovarian cycle | 48 | ||
| Ovulation | 52 | ||
| Luteal phase | 52 | ||
| Corpus luteum demise | 53 | ||
| Menstruation | 53 | ||
| Endometrial cycle | 53 | ||
| Menstrual phase | 54 | ||
| Proliferative phase | 55 | ||
| Secretory phase | 55 | ||
| Midsecretory and late secretory phases | 56 | ||
| Premenstrual and ischemic phase | 56 | ||
| Gestational follicular development | 56 | ||
| Male reproductive endocrinology | 56 | ||
| Climacteric | 57 | ||
| Aging male | 58 | ||
| Summary | 59 | ||
| References | 59 | ||
| 3 Prenatal period and placental physiology | 61 | ||
| Overview of pregnancy | 61 | ||
| First trimester | 61 | ||
| Second trimester | 62 | ||
| Third trimester | 63 | ||
| Conception | 63 | ||
| Ovulation | 63 | ||
| Corpus luteum | 65 | ||
| Sperm transport | 65 | ||
| Fertilization | 66 | ||
| Cleavage and zygote transport | 68 | ||
| Embryonic and fetal development | 69 | ||
| Regulation of development | 69 | ||
| Mechanisms of morphogenesis | 71 | ||
| Cell differentiation | 71 | ||
| Induction | 72 | ||
| Differential cell proliferation | 72 | ||
| Programmed cell death | 72 | ||
| Cell size and shape changes | 72 | ||
| Cell migration | 72 | ||
| Cell recognition and adhesion | 73 | ||
| Folding of the embryo | 73 | ||
| Overview of embryonic development | 73 | ||
| Overview of fetal development | 78 | ||
| Intrauterine environment | 79 | ||
| The placenta and placental physiology | 79 | ||
| Placental development | 79 | ||
| Implantation | 79 | ||
| Ectopic pregnancy. | 81 | ||
| Endometrium and decidua | 81 | ||
| Development of the amniotic cavity | 82 | ||
| Placentation | 82 | ||
| Development of the villi | 83 | ||
| Placental growth | 84 | ||
| Placental structure | 85 | ||
| Placental circulation | 85 | ||
| Fetal-placental circulation | 86 | ||
| Maternal uteroplacental circulation | 86 | ||
| Placental function | 89 | ||
| Placental metabolism | 89 | ||
| Placental endocrinology | 89 | ||
| Human chorionic gonadotropin. | 90 | ||
| Human chorionic somatomammotropin. | 91 | ||
| Steroidogenesis. | 91 | ||
| Progesterone. | 91 | ||
| Estrogens. | 92 | ||
| Placental immunologic function | 92 | ||
| Placental transport | 92 | ||
| Simple (passive) diffusion. | 92 | ||
| Facilitated diffusion. | 93 | ||
| Active transport. | 93 | ||
| Endocytosis and exocytosis. | 94 | ||
| Bulk flow, solvent drag, and water channels. | 94 | ||
| Accidental capillary breaks. | 94 | ||
| Independent movement. | 94 | ||
| Transfer of substances across the placenta | 94 | ||
| Separation of the placenta | 95 | ||
| Umbilical cord | 95 | ||
| Amnion and chorion | 96 | ||
| Amniotic fluid | 96 | ||
| Amniotic fluid volume and turnover | 96 | ||
| Amniotic fluid production and disposition | 97 | ||
| Composition of amniotic fluid | 97 | ||
| Clinical implications | 97 | ||
| Assisted reproductive technology | 97 | ||
| Assessment of the embryo and fetus | 99 | ||
| Prenatal screening | 99 | ||
| First trimester screening. | 99 | ||
| Second trimester screening. | 100 | ||
| Fetal cell-free DNA analysis. | 100 | ||
| Other techniques. | 100 | ||
| Prenatal diagnosis | 100 | ||
| Preimplantation genetic diagnosis. | 101 | ||
| Chorionic villus sampling. | 102 | ||
| Amniocentesis. | 102 | ||
| Umbilical blood sampling. | 102 | ||
| Alterations in placenta, umbilical cord, and amniotic fluid | 102 | ||
| Alterations in the appearance of the placenta and membranes | 103 | ||
| Alterations in amniotic fluid volume | 103 | ||
| Polyhydramnios. | 103 | ||
| Oligohydramnios. | 104 | ||
| Abnormalities of the cord and placenta | 105 | ||
| Abnormalities of implantation and separation. | 105 | ||
| Abnormalities of placentation. | 105 | ||
| Abnormalities of the umbilical cord. | 106 | ||
| Gestational trophoblast disease | 106 | ||
| Multiple gestation | 106 | ||
| Monozygotic twins | 108 | ||
| Dizygotic twins | 109 | ||
| Placental abnormalities in multiple gestations | 109 | ||
| Summary | 110 | ||
| References | 111 | ||
| 4 Parturition and uterine physiology | 115 | ||
| Uterus | 115 | ||
| Uterine structure | 115 | ||
| Uterine growth | 116 | ||
| Myometrium | 116 | ||
| Myometrial cell structure | 116 | ||
| Changes during pregnancy | 118 | ||
| Cervix | 118 | ||
| Structure of the cervix | 119 | ||
| Changes during pregnancy | 119 | ||
| Cervical ripening and dilation | 119 | ||
| Rupture of fetal membranes | 121 | ||
| Parturition | 121 | ||
| Initiation of labor | 122 | ||
| Endocrine and other factors | 124 | ||
| Corticotropin-releasing hormone and the fetal hypothalamic-pituitary-adrenal axis | 124 | ||
| Progesterone | 124 | ||
| Estrogen | 126 | ||
| Prostaglandins | 126 | ||
| Oxytocin | 127 | ||
| Relaxin | 127 | ||
| Nitric oxide | 127 | ||
| Cytokines and other factors | 128 | ||
| Myometrial contraction | 128 | ||
| Coordination of uterine contractions | 129 | ||
| Gap junction formation | 130 | ||
| Physiologic events during a uterine contraction | 131 | ||
| Clinical implications for the pregnant woman and her fetus | 131 | ||
| Maternal position during labor | 131 | ||
| Maternal pushing efforts during the second stage | 132 | ||
| Preterm labor and birth | 133 | ||
| Altering uterine motility and cervical ripening | 135 | ||
| Control of cervical ripening | 135 | ||
| Induction and augmentation of uterine activity | 135 | ||
| Inhibition of labor | 136 | ||
| Dystocia | 137 | ||
| Postterm labor | 137 | ||
| Summary | 137 | ||
| References | 138 | ||
| 5 Postpartum period and lactation physiology | 142 | ||
| Involution of the reproductive organs | 142 | ||
| Uterus | 142 | ||
| Lochia | 143 | ||
| Cervix, vagina, and perineum | 143 | ||
| Urinary function | 144 | ||
| Physical activity and sexual function | 144 | ||
| Endocrine changes | 144 | ||
| Estrogen and progesterone | 144 | ||
| Pituitary gonadotropin | 145 | ||
| Prolactin | 145 | ||
| Oxytocin | 145 | ||
| Resumption of menstruation and ovulation | 145 | ||
| Anatomy of the mammary glands | 146 | ||
| Physiology of lactation | 147 | ||
| Embryogenesis | 147 | ||
| Mammogenesis | 148 | ||
| Lactogenesis | 148 | ||
| Prolactin patterns during lactation | 149 | ||
| Oxytocin release during lactation | 150 | ||
| Mammary involution | 151 | ||
| Human milk | 151 | ||
| Importance of human milk | 151 | ||
| Milk production and composition | 151 | ||
| Composition of human milk | 153 | ||
| Carbohydrate synthesis and release | 153 | ||
| Fat synthesis and release | 154 | ||
| Protein synthesis and release | 155 | ||
| Human milk for the preterm infant | 155 | ||
| Nutrition during the postpartum period and lactation | 157 | ||
| Common breastfeeding problems | 157 | ||
| Social and cultural barriers to breastfeeding | 158 | ||
| Summary | 159 | ||
| References | 160 | ||
| 6 Fetal assessment | 162 | ||
| Physiology of fetal heart function | 162 | ||
| Autonomic control of fetal heart rate | 162 | ||
| Central nervous system influences | 162 | ||
| Baroreceptors and chemoreceptors | 162 | ||
| Fetal acid-base physiology | 163 | ||
| Uteroplacental circulation and gas exchange | 163 | ||
| Uterine blood flow in the intervillous space | 164 | ||
| Umbilical blood flow | 165 | ||
| Placental area | 165 | ||
| Transfer of oxygen and carbon dioxide | 165 | ||
| Oxygen transfer | 165 | ||
| Carbon dioxide transfer | 165 | ||
| Summary of fetal respiration | 165 | ||
| Fetal response to hypoxia | 166 | ||
| Acute fetal hypoxia | 166 | ||
| Chronic fetal hypoxemia | 166 | ||
| Severe asphyxia: Hypoxic-ischemic encephalopathy and neonatal encephalopathy | 167 | ||
| Cerebral palsy after hypoxic-ischemic injury | 168 | ||
| Newborn umbilical cord gas analysis | 168 | ||
| Respiratory acidemia | 168 | ||
| Metabolic acidemia | 169 | ||
| Mixed acidemia | 169 | ||
| Characteristics of the fetal heart rate | 169 | ||
| Beat-to-beat variability | 169 | ||
| Accelerations | 170 | ||
| Alterations in fetal heart rate | 170 | ||
| Tachycardia | 171 | ||
| Bradycardia | 171 | ||
| Periodic and episodic fetal heart rate decelerations | 171 | ||
| Early decelerations | 171 | ||
| Late decelerations | 171 | ||
| Variable decelerations | 172 | ||
| Sinusoidal pattern | 172 | ||
| Fetal heart rate pattern evolution | 172 | ||
| Third trimester fetal assessment techniques | 173 | ||
| Fetal movement | 174 | ||
| Nonstress test | 174 | ||
| Vibroacoustic stimulation | 175 | ||
| Contraction stress test | 175 | ||
| Amniotic fluid index | 175 | ||
| Biophysical profile | 175 | ||
| Umbilical artery doppler velocimetry | 176 | ||
| Clinical implications: Intrapartum fetal assessment and therapeutic interventions | 176 | ||
| Electronic fetal monitoring | 176 | ||
| Therapeutic interventions | 177 | ||
| Summary | 177 | ||
| References | 178 | ||
| 7 Pharmacology and pharmacokinetics during the perinatal period | 180 | ||
| Pharmacokinetics | 180 | ||
| Pharmacogenetics and pharmacogenomics | 181 | ||
| Pharmacokinetics during pregnancy | 182 | ||
| Drug use during pregnancy | 182 | ||
| Alterations in drug absorption, distribution, metabolism, and excretion during pregnancy | 183 | ||
| Drug absorption | 184 | ||
| Drug distribution | 185 | ||
| Hepatic drug metabolism | 186 | ||
| Renal drug excretion | 187 | ||
| Alterations in drug absorption, distribution, metabolism, and excretion during the intrapartum and postpartum periods | 187 | ||
| Transfer of drugs across the placenta | 187 | ||
| Patterns of transfer kinetics | 188 | ||
| Factors influencing placental transfer | 188 | ||
| Diffusing distance and surface area. | 189 | ||
| Physiochemical characteristics and concentration gradients. | 189 | ||
| Protein binding. | 190 | ||
| Placental blood flow. | 191 | ||
| Route of administration. | 191 | ||
| Placental metabolism of drugs | 191 | ||
| Placental influx and efflux transporters | 191 | ||
| Summary | 193 | ||
| Pharmacokinetics in the fetus | 194 | ||
| Drug distribution, metabolism, and excretion in the fetus | 194 | ||
| Fetal drug distribution | 194 | ||
| Fetal drug metabolism and elimination | 194 | ||
| Fetal hepatic metabolism. | 194 | ||
| Fetal renal elimination. | 195 | ||
| Fetal drug therapy | 195 | ||
| Neonatal pharmacokinetics | 196 | ||
| Drug absorption | 197 | ||
| Oral agents | 197 | ||
| Intramuscular and rectal absorption | 198 | ||
| Skin absorption | 198 | ||
| Drug distribution | 198 | ||
| Hepatic drug metabolism | 199 | ||
| Renal drug excretion | 201 | ||
| Summary | 201 | ||
| Clinical implications for the pregnant woman, fetus, and neonate | 202 | ||
| Teratogenesis | 202 | ||
| Principles of teratogenesis | 203 | ||
| Mechanisms of teratogenesis | 205 | ||
| Effects of drug exposure in utero | 205 | ||
| Cigarette smoking | 205 | ||
| Alcohol | 206 | ||
| Marijuana | 206 | ||
| Opioids | 206 | ||
| Cocaine and amphetamines | 207 | ||
| Drugs and lactation | 208 | ||
| Minimizing infant drug exposure | 210 | ||
| Summary | 211 | ||
| References | 212 | ||
| 8 Hematologic and hemostatic systems | 215 | ||
| Maternal physiologic adaptations | 215 | ||
| Antepartum period | 215 | ||
| Changes in blood and plasma volume | 215 | ||
| Changes in blood cellular components | 216 | ||
| Changes in red blood cells. | 216 | ||
| Changes in white blood cells and platelets. | 217 | ||
| Changes in plasma components | 219 | ||
| Changes in coagulation factors and hemostasis | 220 | ||
| Intrapartum period | 222 | ||
| Changes in hematologic parameters | 222 | ||
| Changes in hemostasis | 222 | ||
| Postpartum period | 223 | ||
| Changes in blood volume | 223 | ||
| Changes in hematologic parameters | 223 | ||
| Changes in hemostasis | 223 | ||
| Clinical implications for the pregnant woman and her fetus | 224 | ||
| Iron requirements during pregnancy | 224 | ||
| Anemia and pregnancy | 225 | ||
| Iron-deficiency anemia | 225 | ||
| Megaloblastic anemia | 226 | ||
| Sickle cell disease | 226 | ||
| Thalassemias | 226 | ||
| Thromboembolism and pregnancy | 227 | ||
| Platelet and coagulation disorders during pregnancy | 227 | ||
| Summary | 228 | ||
| Development of the hematologic system in the fetus | 229 | ||
| Formation of blood cells | 229 | ||
| Development of red blood cells | 230 | ||
| Development of white blood cells and platelets | 231 | ||
| Formation of hemoglobin | 231 | ||
| Fetal iron requirements | 232 | ||
| Development of the hemostatic system | 233 | ||
| Neonatal physiology | 233 | ||
| Transitional events | 233 | ||
| Changes in hematologic parameters | 234 | ||
| Blood volume | 234 | ||
| Red blood cells | 234 | ||
| Hemoglobin and hematocrit | 234 | ||
| 2,3-diphosphoglycerate | 235 | ||
| Erythropoietin | 235 | ||
| Reticulocytes | 235 | ||
| Iron and serum ferritin | 235 | ||
| White blood cells | 236 | ||
| Platelets | 236 | ||
| Alterations in hemostasis | 236 | ||
| Coagulation | 236 | ||
| Fibrinolysis | 238 | ||
| Clinical implications for neonatal care | 238 | ||
| Factors influencing hematologic parameters | 238 | ||
| Site of sampling | 238 | ||
| Iatrogenic losses | 239 | ||
| Growth influences | 239 | ||
| Alterations in hemoglobin–oxygen affinity | 239 | ||
| Vitamin k deficiency bleeding | 239 | ||
| Physiologic anemia of infancy | 240 | ||
| Anemia of prematurity | 242 | ||
| Iron supplementation | 243 | ||
| Blood transfusions | 243 | ||
| Neonatal polycythemia and hyperviscosity | 243 | ||
| Infants with a hemoglobinopathy | 243 | ||
| Infants at risk for altered platelets and hemostasis | 244 | ||
| Maturational changes during infancy and childhood | 245 | ||
| Changes in hematologic parameters | 245 | ||
| Changes in oxygen–hemoglobin affinity | 246 | ||
| Summary | 246 | ||
| References | 247 | ||
| 9 Cardiovascular system | 251 | ||
| Maternal physiologic adaptations | 251 | ||
| Antepartum period | 251 | ||
| Hemodynamic changes | 251 | ||
| Total blood volume. | 251 | ||
| Plasma volume. | 252 | ||
| Red blood cell volume. | 252 | ||
| Cardiac output and stroke volume. | 252 | ||
| Heart rate. | 253 | ||
| Blood pressure. | 254 | ||
| Systemic vascular resistance. | 254 | ||
| Regional blood flow. | 255 | ||
| Uterine blood flow. | 255 | ||
| Renal blood flow. | 255 | ||
| Skin perfusion. | 255 | ||
| Pulmonary blood flow. | 255 | ||
| Oxygen consumption | 256 | ||
| Physical changes | 256 | ||
| Heart sounds. | 257 | ||
| Electrocardiograph and echocardiograph changes. | 258 | ||
| Intrapartum period | 258 | ||
| Postpartum period | 258 | ||
| Clinical implications for the pregnant woman and her fetus | 259 | ||
| Arrhythmias | 259 | ||
| Supine hypotension | 259 | ||
| Exercise during pregnancy: Cardiovascular effects | 260 | ||
| Physiologic responses to exercise during pregnancy | 260 | ||
| Benefits and recommendations | 261 | ||
| Multiple pregnancy | 262 | ||
| Cardiac disease and pregnancy | 262 | ||
| Obstructive lesions | 263 | ||
| Mitral stenosis. | 263 | ||
| Mitral regurgitation. | 263 | ||
| Mitral valve prolapse. | 263 | ||
| Left-to-right shunts | 264 | ||
| Atrial septal defect. | 264 | ||
| Ventricular septal defect. | 264 | ||
| Right-to-left shunts | 264 | ||
| Eisenmenger syndrome. | 264 | ||
| Tetralogy of fallot. | 265 | ||
| Pulmonary artery hypertension. | 265 | ||
| Marfan syndrome | 265 | ||
| Peripartum cardiomyopathy | 265 | ||
| Hypertensive disorders | 265 | ||
| Preeclampsia | 265 | ||
| Summary | 268 | ||
| Development of the cardiovascular system in the fetus | 268 | ||
| Anatomic development | 269 | ||
| Development of the primitive heart | 270 | ||
| Septation of the heart | 271 | ||
| Atrioventricular canal. | 271 | ||
| Atria. | 272 | ||
| Ventricles. | 272 | ||
| Bulbus cordis and truncus arteriosus. | 272 | ||
| Cardiac valves. | 273 | ||
| Conducting system | 273 | ||
| Vasculature | 273 | ||
| Veins. | 274 | ||
| Developmental basis for common anomalies | 275 | ||
| Functional development | 276 | ||
| Fetal myocardium | 276 | ||
| Myocardial performance | 276 | ||
| Fetal circulation | 278 | ||
| Oxygen content | 279 | ||
| Control of fetal circulation | 280 | ||
| Neonatal physiology | 280 | ||
| Transitional events | 280 | ||
| Closure of the ductus venosus | 281 | ||
| Closure of the foramen ovale | 282 | ||
| Closure of the ductus arteriosus | 282 | ||
| Neonatal myocardium | 283 | ||
| Pulmonary vasculature | 283 | ||
| Metabolic rate and oxygen transport | 283 | ||
| Myocardial performance in the neonate | 284 | ||
| Preload | 284 | ||
| Contractility | 285 | ||
| Heart rate | 285 | ||
| Afterload | 285 | ||
| Regulation of fetal and neonatal circulation | 286 | ||
| Clinical implications for neonatal care | 287 | ||
| Assessment of heart sounds | 287 | ||
| Cardiac shunts | 287 | ||
| Cyanosis | 287 | ||
| Patent ductus arteriosus in the preterm infant | 288 | ||
| Congenital heart defects | 288 | ||
| Total anomalous pulmonary venous return | 289 | ||
| Transposition of the great arteries | 289 | ||
| Truncus arteriosus | 289 | ||
| Tricuspid atresia | 290 | ||
| Aortic atresia and hypoplastic left heart syndrome | 290 | ||
| Coarctation of the aorta | 290 | ||
| Ventricular septal defect | 291 | ||
| Tetralogy of fallot | 291 | ||
| Maturational changes during infancy and childhood | 291 | ||
| Summary | 292 | ||
| References | 293 | ||
| 10 Respiratory system | 297 | ||
| Maternal physiologic adaptations | 297 | ||
| Antepartum period | 297 | ||
| Factors influencing respiratory function | 297 | ||
| Mechanical factors. | 297 | ||
| Hormonal and biochemical factors. | 297 | ||
| Lung volume | 298 | ||
| Lung function | 299 | ||
| Ventilation. | 299 | ||
| Airflow. | 299 | ||
| Diffusing capacity. | 300 | ||
| Acid-base changes | 300 | ||
| Oxygen-hemoglobin dissociation curve. | 300 | ||
| Intrapartum period | 301 | ||
| Postpartum period | 303 | ||
| Clinical implications for the pregnant woman and her fetus | 303 | ||
| Pregnancy-related dyspnea | 303 | ||
| Upper respiratory tract capillary engorgement | 303 | ||
| Exercise | 304 | ||
| Effects of altitude and air travel | 304 | ||
| Pulmonary disease and pregnancy | 305 | ||
| Respiratory infection | 305 | ||
| Asthma | 305 | ||
| Smoking | 306 | ||
| Inhalation anesthesia | 307 | ||
| Summary | 307 | ||
| Development of the respiratory system in the fetus | 308 | ||
| Anatomic development | 308 | ||
| Pulmonary vasculature | 311 | ||
| Congenital anomalies of the lungs | 312 | ||
| Functional development | 312 | ||
| Surfactant | 312 | ||
| Surfactant biosynthesis. | 315 | ||
| Influences on fetal lung maturation | 315 | ||
| Antenatal corticosteroids. | 316 | ||
| Factors enhancing and delaying lung maturation. | 316 | ||
| Antioxidant defenses | 317 | ||
| Lung liquid | 317 | ||
| Fetal blood gases | 318 | ||
| Fetal breathing movements | 318 | ||
| Neonatal physiology | 318 | ||
| Transitional events | 319 | ||
| Establishment of extrauterine respiration | 319 | ||
| Control of respiration | 322 | ||
| Chemoreceptors | 323 | ||
| Chest wall reflexes | 324 | ||
| Laryngeal and pulmonary reflexes | 324 | ||
| Upper airway | 325 | ||
| Respiratory pump | 325 | ||
| Diaphragm | 325 | ||
| Rib cage and chest wall muscles | 326 | ||
| Chest wall compliance | 326 | ||
| Mechanical properties of the respiratory system | 328 | ||
| Lung compliance | 328 | ||
| Airway resistance | 329 | ||
| Ventilation | 329 | ||
| Dead space ventilation | 329 | ||
| Lung volumes | 329 | ||
| Functional residual capacity | 329 | ||
| Closing capacity | 329 | ||
| Pulmonary blood flow | 330 | ||
| Ventilation-perfusion relationships | 330 | ||
| Effect of v./q. mismatching on oxygen | 332 | ||
| Effect of v./q.mismatch on carbon dioxide | 332 | ||
| Developmental differences in v./q. matching | 332 | ||
| Oxygen-hemoglobin dissociation curve | 333 | ||
| Clinical implications for neonatal care | 334 | ||
| Physiologic basis for clinical findings | 335 | ||
| Periodic breathing and apnea of prematurity | 336 | ||
| Respiratory outcomes in preterm infants | 337 | ||
| Hypoxia and hyperoxia | 337 | ||
| Transient tachypnea of the newborn | 339 | ||
| Respiratory distress syndrome | 339 | ||
| Clinical manifestations | 340 | ||
| Treatment | 341 | ||
| Bronchopulmonary dysplasia | 342 | ||
| Meconium aspiration syndrome | 343 | ||
| Persistent pulmonary hypertension of the newborn | 344 | ||
| Maturational changes during infancy and childhood | 345 | ||
| Summary | 346 | ||
| References | 347 | ||
| 11 Renal system and fluid and electrolyte homeostasis | 351 | ||
| Maternal physiologic adaptations | 351 | ||
| Antepartum period | 351 | ||
| Structural changes | 351 | ||
| Urodynamic changes | 352 | ||
| Changes in renal hemodynamics | 353 | ||
| Changes in glomerular filtration | 354 | ||
| Alterations in tubular function | 354 | ||
| Fluid and electrolyte homeostasis | 355 | ||
| Sodium homeostasis. | 355 | ||
| Renin-angiotensin-aldosterone system | 356 | ||
| Volume homeostasis and regulation of osmolarity | 357 | ||
| Arginine vasopressin. | 358 | ||
| Intrapartum period | 359 | ||
| Postpartum period | 359 | ||
| Clinical implications for the pregnant woman and her fetus | 360 | ||
| Urinary frequency, incontinence, and nocturia | 360 | ||
| Dependent edema | 361 | ||
| Effects of position on renal function | 361 | ||
| Inability to void postpartum | 361 | ||
| Risk of urinary tract infection | 361 | ||
| Fluid needs in labor | 362 | ||
| Maternal-fetal fluid and electrolyte homeostasis | 362 | ||
| Evaluation of renal function during pregnancy | 363 | ||
| Glycosuria | 363 | ||
| Hypertension and the renal system | 364 | ||
| Renal disease and pregnancy | 364 | ||
| Pregnancy after renal transplantation | 364 | ||
| Summary | 364 | ||
| Development of the renal system in the fetus | 365 | ||
| Anatomic development | 366 | ||
| Development of the kidneys | 366 | ||
| Development of the urinary system | 367 | ||
| Developmental basis for common anomalies | 367 | ||
| Functional development | 368 | ||
| Neonatal physiology | 369 | ||
| Transitional events | 370 | ||
| Body composition | 370 | ||
| Bladder | 371 | ||
| Urine output and micturition | 371 | ||
| Renal blood flow and glomerular filtration | 371 | ||
| Tubular function | 373 | ||
| Sodium | 373 | ||
| Sodium balance in preterm infants. | 374 | ||
| Glucose | 374 | ||
| Renal handling of other solutes | 374 | ||
| Acid-base homeostasis | 375 | ||
| Water balance | 375 | ||
| Hormonal regulation | 376 | ||
| Renin-angiotensin-aldosterone system | 376 | ||
| Arginine vasopressin | 377 | ||
| Other regulating factors | 377 | ||
| Clinical implications for neonatal care | 377 | ||
| Fluid and electrolyte balance | 377 | ||
| Insensible water loss | 378 | ||
| Urine water loss | 378 | ||
| Estimating fluid and electrolyte needs | 379 | ||
| Sodium requirements of preterm infants | 379 | ||
| Risk of overhydration and dehydration | 380 | ||
| Electrolyte imbalances | 380 | ||
| Hyponatremia | 380 | ||
| Hypernatremia | 380 | ||
| Hyperkalemia in preterm infants | 380 | ||
| Measurement of renal function and hydration status | 381 | ||
| Renal function during neonatal illness | 381 | ||
| Maturational changes during infancy and childhood | 382 | ||
| Summary | 383 | ||
| References | 384 | ||
| 12 Gastrointestinal and hepatic systems and perinatal nutrition | 387 | ||
| Maternal physiologic adaptations | 387 | ||
| Antepartum period | 387 | ||
| Mouth and pharynx | 387 | ||
| Esophagus | 389 | ||
| Stomach | 389 | ||
| Small and large intestines | 389 | ||
| Pancreas | 390 | ||
| Gallbladder | 390 | ||
| Liver | 390 | ||
| Weight gain during pregnancy | 392 | ||
| Intrapartum period | 393 | ||
| Postpartum period | 393 | ||
| Clinical implications for the pregnant woman and her fetus | 394 | ||
| Nutritional requirements of pregnancy | 394 | ||
| Fetal nutritional needs | 395 | ||
| Heartburn and gastroesophageal reflux | 395 | ||
| Constipation | 397 | ||
| Hemorrhoids | 397 | ||
| Nausea and vomiting | 397 | ||
| Food and fluid intake in labor | 398 | ||
| Effects of altered maternal nutrition | 398 | ||
| Undernutrition and pregnancy | 399 | ||
| Maternal obesity and pregnancy | 399 | ||
| Pregnancy and gastrointestinal disorders | 399 | ||
| Pregnancy and acute appendicitis | 400 | ||
| Pregnancy in women with inflammatory bowel disease | 400 | ||
| Pregnancy in women with peptic ulcer disease | 400 | ||
| Cholelithiasis and pregnancy | 400 | ||
| Pregnancy and liver disease | 401 | ||
| Summary | 401 | ||
| Development of the gastrointestinal and hepatic systems in the fetus | 402 | ||
| Anatomic development | 402 | ||
| Development of the pharyngeal gut | 403 | ||
| Development of the foregut and common anomalies | 403 | ||
| Esophagus. | 403 | ||
| Stomach, duodenum, and pancreas. | 404 | ||
| Liver and gallbladder. | 405 | ||
| Development of the midgut and common anomalies | 405 | ||
| Common anomalies of the midgut. | 407 | ||
| Development of the hindgut and common anomalies | 407 | ||
| Functional development | 408 | ||
| Fetal growth | 409 | ||
| Fetal growth restriction | 410 | ||
| Neonatal physiology | 410 | ||
| Transitional events | 411 | ||
| Maturation of gastrointestinal function | 411 | ||
| Initiation of enteral feeding | 411 | ||
| Minimal enteral feedings | 412 | ||
| Passage of meconium | 413 | ||
| Functional and anatomic maturation | 413 | ||
| Sucking and swallowing | 413 | ||
| Esophageal motility and lower esophageal sphincter function | 414 | ||
| Gastric emptying | 414 | ||
| Intestinal motility | 415 | ||
| Intestinal surface area | 415 | ||
| Intestinal circulation | 415 | ||
| Physiologic limitations | 415 | ||
| Digestion and absorption of proteins | 416 | ||
| Digestion and absorption of carbohydrates | 417 | ||
| Digestion and absorption of fats | 418 | ||
| Absorption of other substances | 418 | ||
| Liver function in the neonate | 419 | ||
| Clinical implications for neonatal care | 419 | ||
| Infant growth | 419 | ||
| Nutritional requirements of term and preterm infants | 420 | ||
| Composition of feedings | 421 | ||
| Protein | 421 | ||
| Carbohydrate | 421 | ||
| Fat | 421 | ||
| Vitamins, minerals, and micronutrients | 422 | ||
| Vitamin A. | 422 | ||
| Vitamin C. | 422 | ||
| Vitamin D. | 422 | ||
| Vitamin E. | 422 | ||
| Folate. | 422 | ||
| Calcium, phosphorus, and magnesium. | 422 | ||
| Iron. | 422 | ||
| Micronutrients and other substances. | 423 | ||
| Zinc. | 423 | ||
| Copper. | 423 | ||
| Electrolytes. | 423 | ||
| Calories and renal solute load | 423 | ||
| Human milk | 423 | ||
| Parenteral nutrition solutions | 424 | ||
| Issues in infants with various health problems | 424 | ||
| Very-low-birth-weight infants | 425 | ||
| Infants with respiratory problems | 425 | ||
| Infants with cardiac problems | 425 | ||
| Infants with short-bowel syndrome | 425 | ||
| Considerations related to feeding method | 425 | ||
| Regurgitation and reflux | 426 | ||
| Necrotizing enterocolitis | 427 | ||
| Maturational changes during infancy and childhood | 428 | ||
| Introduction of solid foods | 428 | ||
| Summary | 428 | ||
| References | 429 | ||
| 13 Immune system and host defense mechanisms | 435 | ||
| Maternal physiologic adaptations | 435 | ||
| Antepartum period | 435 | ||
| Alterations in innate immunity | 437 | ||
| Alterations in the complement system | 438 | ||
| Alterations in adaptive immunity | 438 | ||
| Alterations in cell-mediated immunity. | 440 | ||
| Alterations in antibody-mediated (humoral) immunity. | 440 | ||
| Immune function at the fetal-maternal interface | 440 | ||
| Natural killer cells. | 442 | ||
| Decidual macrophages. | 442 | ||
| T cells. | 442 | ||
| Maternal and placental microbiome | 443 | ||
| Transplacental passage of maternal antibodies | 443 | ||
| Protection of the fetus from infection | 443 | ||
| Intrapartum period | 444 | ||
| Postpartum period | 444 | ||
| Immunologic properties of human milk | 444 | ||
| Clinical implications for the pregnant woman and her fetus | 445 | ||
| Spontaneous abortion | 445 | ||
| Risk of maternal infection | 446 | ||
| Inflammation, infection, and preterm labor | 446 | ||
| Infections and neurodevelopmental disorders in offspring | 447 | ||
| Immunization and the pregnant woman | 447 | ||
| The pregnant woman with an autoimmune disease | 448 | ||
| Fetal and neonatal complications associated with transplacental passage of maternal antibodies | 448 | ||
| Rho(D) alloimmunization and ABO incompatibility | 449 | ||
| Abo incompatibility | 450 | ||
| Summary | 451 | ||
| Development of host defense mechanisms in the fetus | 452 | ||
| Neonatal physiology | 453 | ||
| Transitional events | 453 | ||
| Neonatal microbiome | 454 | ||
| Skin colonization. | 454 | ||
| Intestinal colonization. | 454 | ||
| Alterations in innate immunity | 455 | ||
| Alterations in the complement system | 458 | ||
| Alterations in adaptive immunity | 458 | ||
| Alterations in cell-mediated immunity | 458 | ||
| Alterations in antibody-mediated (humoral) immunity | 459 | ||
| Gut host defense mechanisms | 460 | ||
| Clinical implications for neonatal care | 461 | ||
| Neonatal vulnerability to infection | 461 | ||
| Limitations in immune responses to bacterial infections | 461 | ||
| Immune responses to viral infections | 462 | ||
| Diagnosis of neonatal infection | 463 | ||
| Maturational changes during infancy and childhood | 464 | ||
| Maturation of host defense factors | 464 | ||
| Physiologic hypogammaglobulinemia | 465 | ||
| Immunizations | 465 | ||
| Development of allergic disease | 466 | ||
| Summary | 466 | ||
| References | 467 | ||
| 14 Integumentary system | 471 | ||
| Maternal physiologic adaptations | 471 | ||
| Antepartum period | 471 | ||
| Alterations in pigmentation | 471 | ||
| Hyperpigmentation. | 471 | ||
| Melasma. | 472 | ||
| Changes in connective tissue | 472 | ||
| Vascular and hematologic changes | 473 | ||
| Vasomotor instability. | 473 | ||
| Spider angioma. | 473 | ||
| Palmar erythema. | 474 | ||
| Nonpitting edema. | 474 | ||
| Capillary hemangiomas. | 474 | ||
| Varicosities. | 474 | ||
| Alterations in cutaneous tissue and mucous membranes | 474 | ||
| Alterations in secretory glands | 474 | ||
| Alterations in hair growth | 475 | ||
| Alterations in the nails | 475 | ||
| Pruritus | 475 | ||
| Postpartum period | 475 | ||
| Hair loss | 475 | ||
| Clinical implications for the pregnant woman and her fetus | 478 | ||
| Dermatoses associated with pregnancy | 478 | ||
| Effects of pregnancy on preexisting skin disorders | 478 | ||
| Summary | 478 | ||
| Development of the integumentary system in the fetus | 479 | ||
| Anatomic development | 479 | ||
| Epidermis | 479 | ||
| Dermis | 481 | ||
| Adipose tissue | 482 | ||
| Cutaneous innervation | 482 | ||
| Epidermal appendages | 482 | ||
| Hair and nails. | 482 | ||
| Sebaceous glands. | 482 | ||
| Arrector pili muscle. | 482 | ||
| Eccrine and apocrine glands. | 483 | ||
| Vernix caseosa | 483 | ||
| Functional development | 484 | ||
| Neonatal physiology | 484 | ||
| Transitional events | 484 | ||
| Barrier properties | 487 | ||
| Permeability | 487 | ||
| Acid mantle and other protective mechanisms | 487 | ||
| Transepidermal water loss | 488 | ||
| Thermal environment | 488 | ||
| Cohesion between epidermis and dermis | 489 | ||
| Collagen and elastin instability | 489 | ||
| Cutaneous blood flow | 489 | ||
| Clinical implications for neonatal care | 489 | ||
| Bathing | 490 | ||
| Umbilical cord care | 491 | ||
| Use of adhesives | 491 | ||
| Protection from infection | 491 | ||
| Transepidermal absorption | 491 | ||
| Extremely immature infants | 492 | ||
| Maturational changes during infancy and childhood | 493 | ||
| Summary | 493 | ||
| References | 494 | ||
| 15 Neurologic, muscular, and sensory systems | 497 | ||
| Maternal physiologic adaptations | 497 | ||
| Antepartum period | 497 | ||
| Neurologic adaptations | 497 | ||
| Ocular changes | 497 | ||
| Otolaryngeal changes | 498 | ||
| Musculoskeletal changes | 498 | ||
| Sleep | 499 | ||
| Intrapartum period | 500 | ||
| Pain and discomfort during labor | 500 | ||
| β-endorphins | 502 | ||
| Postpartum period | 502 | ||
| Sleep during the postpartum period | 502 | ||
| Postpartum discomfort | 503 | ||
| Clinical implications for the pregnant woman and her fetus | 503 | ||
| Ocular adaptations | 503 | ||
| Musculoskeletal discomforts | 504 | ||
| Restless legs syndrome (willis-ekborn disease) | 505 | ||
| Headache | 505 | ||
| Migraine headaches | 505 | ||
| The pregnant woman with a chronic neurologic disorder | 506 | ||
| The pregnant woman with epilepsy | 506 | ||
| Peripheral neuropathies | 507 | ||
| The woman with a spinal cord injury | 507 | ||
| Cerebral vascular disorders | 508 | ||
| Preeclampsia and eclampsia | 508 | ||
| Summary | 509 | ||
| Development of the neurologic, muscular, and sensory systems in the fetus | 510 | ||
| Anatomic development of the central nervous system | 510 | ||
| Embryonic development of the central nervous system | 510 | ||
| Anomalies arising in the embryonic period | 514 | ||
| Fetal neurodevelopment | 515 | ||
| Neuronal and glial proliferation | 515 | ||
| Migration | 515 | ||
| Organization | 516 | ||
| Myelination | 517 | ||
| Cerebellar development | 518 | ||
| Development of specific systems | 518 | ||
| Autonomic nervous system. | 518 | ||
| Peripheral nervous system. | 518 | ||
| Functional development | 518 | ||
| Sensory abilities | 518 | ||
| Motor abilities | 520 | ||
| Fetal state patterns | 521 | ||
| Neonatal physiology | 522 | ||
| Transitional events | 522 | ||
| Autonomic regulation | 522 | ||
| Motor functions | 522 | ||
| Sensory functions | 522 | ||
| Sleep-wake pattern | 523 | ||
| Circulation in the neonatal brain | 523 | ||
| Blood-brain barrier | 523 | ||
| Cerebral autoregulation | 523 | ||
| Neonatal sensory function | 524 | ||
| Sensory modalities | 525 | ||
| Sensory processing | 526 | ||
| Neural (brain) plasticity | 526 | ||
| Neonatal motor function | 526 | ||
| Muscle development | 527 | ||
| Neonatal reflexes | 527 | ||
| Sleep-wake pattern | 528 | ||
| Definition of infant states | 528 | ||
| Sleep-wake states related to brain maturation | 528 | ||
| Development of infant states | 529 | ||
| State modulation | 529 | ||
| Neurobehavioral organization | 529 | ||
| Clinical implications for neonatal care | 530 | ||
| Risks posed by the caregiving environment | 530 | ||
| Vulnerability to brain injury in preterm and term infants | 530 | ||
| Germinal matrix and intraventricular hemorrhage | 531 | ||
| White matter injury (periventricular leukomalacia) | 532 | ||
| Cerebellar injury in preterm infants | 533 | ||
| Hypoxic-ischemic encephalopathy | 533 | ||
| Neuroprotection strategies | 534 | ||
| Neonatal seizures | 534 | ||
| Neonatal pain | 535 | ||
| Consequences of pain in the neonate | 536 | ||
| Maturational changes during infancy and childhood | 537 | ||
| Summary | 537 | ||
| References | 538 | ||
| 16 Carbohydrate, fat, and protein metabolism | 543 | ||
| Maternal physiologic adaptations | 543 | ||
| Antepartum period | 543 | ||
| Basal metabolic rate | 544 | ||
| Carbohydrate metabolism | 544 | ||
| Protein metabolism | 545 | ||
| Lipid metabolism | 545 | ||
| Insulin | 546 | ||
| Absorptive versus postabsorptive states | 548 | ||
| Absorptive state. | 548 | ||
| Postabsorptive and fasting state. | 548 | ||
| Effects of placental hormones and other substances | 550 | ||
| Intrapartum period | 551 | ||
| Postpartum period | 551 | ||
| Clinical implications for the pregnant woman and her fetus | 551 | ||
| Effects of metabolic changes on glucose tolerance tests | 551 | ||
| Maternal-fetal relationships | 552 | ||
| The pregnant diabetic woman | 553 | ||
| Fetus of a diabetic mother | 554 | ||
| Summary | 555 | ||
| Development of carbohydrate, fat, and protein metabolism in the fetus | 555 | ||
| Carbohydrate metabolism | 556 | ||
| Lipid metabolism | 559 | ||
| Protein metabolism | 560 | ||
| Neonatal physiology | 560 | ||
| Transitional events | 560 | ||
| Carbohydrate metabolism | 561 | ||
| Lipid metabolism | 562 | ||
| Protein metabolism | 563 | ||
| Clinical implications for neonatal care | 563 | ||
| Neonatal hypoglycemia | 563 | ||
| The preterm infant | 565 | ||
| The growth-restricted infant | 565 | ||
| The infant of a diabetic mother | 565 | ||
| Large-for-gestational-age infants. | 566 | ||
| The infant with asphyxia | 566 | ||
| Neonatal hyperglycemia | 566 | ||
| Maturational changes during infancy and childhood | 567 | ||
| Summary | 567 | ||
| References | 567 | ||
| 17 Calcium and phosphorus metabolism | 571 | ||
| Maternal physiologic adaptations | 571 | ||
| Antepartum period | 571 | ||
| Calcium | 571 | ||
| Phosphorus and magnesium | 573 | ||
| Parathyroid hormone | 573 | ||
| Vitamin D | 573 | ||
| Calcitonin | 574 | ||
| Changes in bone formation and density | 574 | ||
| Intrapartum period | 575 | ||
| Postpartum period | 575 | ||
| Clinical implications for the pregnant woman and her fetus | 575 | ||
| Maternal nutritional needs | 575 | ||
| Leg cramps | 576 | ||
| Maternal calcium metabolism and pregnancy complications | 576 | ||
| Maternal-fetal interactions | 577 | ||
| Summary | 578 | ||
| Development of calcium and phosphorus metabolism in the fetus | 578 | ||
| Anatomic development | 578 | ||
| Parathyroid glands | 578 | ||
| Skeletal development and growth | 579 | ||
| Functional development | 579 | ||
| Neonatal physiology | 580 | ||
| Transitional events | 580 | ||
| Calcium | 580 | ||
| Phosphorus | 581 | ||
| Parathyroid hormone | 581 | ||
| Vitamin D | 581 | ||
| Calcitonin | 581 | ||
| Magnesium | 581 | ||
| Clinical implications for neonatal care | 582 | ||
| Calcium intake in preterm infants | 582 | ||
| Bone mineralization | 582 | ||
| Alterations in neonatal calcium homeostasis | 582 | ||
| Neonatal hypocalcemia | 582 | ||
| Hypocalcemia in the preterm infant. | 584 | ||
| Hypocalcemia in the infant of a diabetic mother. | 584 | ||
| Hypocalcemia and perinatal hypoxic-ischemic events. | 584 | ||
| Late neonatal hypocalcemia. | 584 | ||
| Neonatal hypercalcemia | 585 | ||
| Alterations in neonatal magnesium homeostasis | 585 | ||
| Neonatal osteopenia and rickets | 585 | ||
| Maturational changes during infancy and childhood | 586 | ||
| Summary | 586 | ||
| References | 587 | ||
| 18 Bilirubin metabolism | 589 | ||
| Maternal physiologic adaptations | 589 | ||
| Clinical implications for the pregnant woman and her fetus | 589 | ||
| Maternal hyperbilirubinemia | 589 | ||
| Development of bilirubin metabolism in the fetus | 591 | ||
| Neonatal physiology | 592 | ||
| Transitional events | 592 | ||
| Benefits of bilirubin | 592 | ||
| Bilirubin production in the neonate | 593 | ||
| Physiologic jaundice | 593 | ||
| Patterns of physiologic jaundice | 593 | ||
| Causes of physiologic jaundice | 594 | ||
| Clinical implications for neonatal care | 596 | ||
| Neonatal hyperbilirubinemia | 596 | ||
| Direct hyperbilirubinemia | 597 | ||
| Breastfeeding and neonatal jaundice | 597 | ||
| Prevention of hyperbilirubinemia in breastfed infants | 598 | ||
| Management of hyperbilirubinemia in breastfed infants | 598 | ||
| Measurement of serum bilirubin | 599 | ||
| Management of neonatal hyperbilirubinemia | 599 | ||
| Pharmacologic agents | 599 | ||
| Exchange transfusion | 600 | ||
| Phototherapy | 600 | ||
| Physics of phototherapy. | 600 | ||
| Side effects of phototherapy. | 601 | ||
| Methods of providing phototherapy. | 602 | ||
| Competition for albumin binding | 603 | ||
| Acute bilirubin encephalopathy and kernicterus | 604 | ||
| Maturational changes during infancy and childhood | 605 | ||
| Summary | 605 | ||
| References | 606 | ||
| 19 Pituitary, adrenal, and thyroid function | 609 | ||
| Maternal physiologic adaptations | 609 | ||
| Antepartum period | 609 | ||
| Hypothalamic-pituitary-adrenal axis | 609 | ||
| Anterior pituitary function. | 609 | ||
| Posterior pituitary function. | 611 | ||
| Adrenal function. | 611 | ||
| Hypothalamic-pituitary-thyroid axis | 612 | ||
| Intrapartum period | 615 | ||
| Postpartum period | 615 | ||
| Clinical implications for the pregnant woman and her fetus | 616 | ||
| Iodine needs during pregnancy | 616 | ||
| Thyroid function tests during pregnancy | 616 | ||
| Thyroid function and nausea and vomiting in pregnancy | 617 | ||
| The pregnant woman with hyperthyroidism | 617 | ||
| The pregnant woman with hypothyroidism | 618 | ||
| Postpartum thyroid disorders | 619 | ||
| Breastfeeding in women with thyroid disorders | 619 | ||
| Use of radioiodine and iodides | 620 | ||
| Maternal-fetal endocrine relationships | 620 | ||
| Maternal stress responses and fetal endocrine programming | 621 | ||
| Summary | 622 | ||
| Development of hypothalamic, pituitary, adrenal, and thyroid function in the fetus | 623 | ||
| Hypothalamus and pituitary gland | 623 | ||
| Anatomic development | 623 | ||
| Hypothalamic and pituitary function | 623 | ||
| Hypothalamic-pituitary-gonadal axis. | 624 | ||
| Adrenal glands | 624 | ||
| Anatomic development | 624 | ||
| Adrenal function | 624 | ||
| Thyroid gland | 626 | ||
| Anatomic development | 626 | ||
| Thyroid function | 626 | ||
| Role of maternal thyroid hormones | 627 | ||
| Neonatal physiology | 628 | ||
| Transitional events | 628 | ||
| Hypothalamic-pituitary-adrenal axis | 628 | ||
| Hypothalamic-pituitary-thyroid axis | 628 | ||
| Clinical implications for neonatal care | 629 | ||
| Neonatal stress | 630 | ||
| Adrenal cortex insufficiency | 630 | ||
| Thyroid function and thermoregulation | 631 | ||
| Transient alterations in thyroid function in preterm infants | 631 | ||
| Neonatal hyperthyroidism | 632 | ||
| Neonatal hypothyroidism | 633 | ||
| Neonatal screening for hypothyroidism | 633 | ||
| Congenital adrenal hyperplasia | 633 | ||
| Maturational changes during infancy and childhood | 634 | ||
| Summary | 634 | ||
| References | 635 | ||
| 20 Thermoregulation | 639 | ||
| Maternal physiologic adaptations | 639 | ||
| Antepartum period | 639 | ||
| Intrapartum period | 639 | ||
| Postpartum period | 640 | ||
| Clinical implications for the pregnant woman and her fetus | 641 | ||
| Maternal hyperthermia and fever | 641 | ||
| Maternal exercise and temperature elevations | 641 | ||
| Summary | 642 | ||
| Development of thermoregulation in the fetus | 642 | ||
| Neonatal physiology | 643 | ||
| Transitional events | 643 | ||
| Heat exchange | 645 | ||
| Heat transfer | 645 | ||
| Heat production and conservation | 645 | ||
| Brown adipose tissue metabolism | 646 | ||
| Heat dissipation and loss | 648 | ||
| Clinical implications for neonatal care | 648 | ||
| Neutral thermal environment | 648 | ||
| Prevention of excessive heat loss or heat gain | 649 | ||
| Conduction | 649 | ||
| Convection | 650 | ||
| Evaporation | 650 | ||
| Radiation | 651 | ||
| Monitoring temperature | 651 | ||
| Servocontrol | 652 | ||
| Methods of promoting thermal stability | 652 | ||
| Convective incubators | 653 | ||
| Radiant warmers | 653 | ||
| Skin-to-skin care | 653 | ||
| Use of head coverings, clothing, blankets, and polyethylene wraps | 654 | ||
| Neonatal hypothermia and cold stress | 654 | ||
| Use of hypothermia for neuroprotection | 654 | ||
| Hyperthermia and fever in the neonate | 656 | ||
| Maturational changes during infancy and childhood | 657 | ||
| Summary | 657 | ||
| References | 658 | ||
| List of abbreviations | 661 | ||
| Index | 667 | ||
| A | 667 | ||
| B | 669 | ||
| C | 669 | ||
| D | 673 | ||
| E | 675 | ||
| F | 676 | ||
| G | 679 | ||
| H | 680 | ||
| I | 684 | ||
| J | 685 | ||
| K | 685 | ||
| L | 686 | ||
| M | 687 | ||
| N | 689 | ||
| O | 691 | ||
| P | 692 | ||
| Q | 698 | ||
| R | 698 | ||
| S | 699 | ||
| T | 701 | ||
| U | 703 | ||
| V | 704 | ||
| W | 705 | ||
| X | 705 | ||
| Y | 705 | ||
| Z | 705 |