BOOK
Practical Guide to High Risk Pregnancy and Delivery - E-Book
Fernando Arias | Amarnath G Bhide | Arulkumaran S | Kaizad Damania | Shirish N Daftary
(2012)
Additional Information
Book Details
Abstract
The third edition of the book, Practical Guide to High-Risk Pregnancy and Delivery, has been completely revised to present more up-to-date approach to the field. Several changes have been made in the book to keep up with multiple new developments and to facilitate the finding of information. However, the purpose of the book remains unchanged: to provide residents in Obstetrics and Gynecology, fellows in Maternal–Fetal Medicine, obstetricians, general physicians, and interested nurses and medical students with a source of practical information about complications of pregnancy.
- The book is organized into three sections: Fetal Medicine, Obstetrical Complications and Tropical Diseases in Pregnancy
- All chapters have been rearranged, expanded, and updated
- Several new flowcharts, tables, and boxes have been included to make the coverage more comprehensive and contemporary
- Important points at the end of every chapter help in quick recapitulation.
- Separate chapters on Hypertensive Disorders in Pregnancy, Diabetes and Pregnancy, and Cardiac Diseases in Pregnancy.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover\r | Front Cover | ||
| Front Matter\r | i | ||
| Copyright \r | iv | ||
| Dedication\r | v | ||
| Preface to the Third Edition | vi | ||
| Contents | vii | ||
| Section I : Fetal Medicine \r | 1 | ||
| Chapter 1 - Antepartum Care of the High-Risk Pregnancy\r | 3 | ||
| Identification of the High-Risk Patient | 3 | ||
| Preconceptional Counseling | 5 | ||
| Prenatal Care | 6 | ||
| Determination of Gestational Age | 6 | ||
| Clinical Dating | 7 | ||
| Dating by Ultrasound | 7 | ||
| Crown-rump Length | 8 | ||
| Biparietal Diameter | 9 | ||
| Head Circumference | 10 | ||
| Femur Length | 10 | ||
| Humerus Length | 10 | ||
| Abdominal Circumference | 10 | ||
| Other Parameters Used to Determine Gestational Age | 11 | ||
| Determination of Gestational Age | 11 | ||
| Prevention of Abnormal Maternal and Fetal Outcomes | 11 | ||
| Maternal Death | 12 | ||
| Stillbirth | 13 | ||
| Neonatal Death | 15 | ||
| Preterm Delivery and Preeclampsia | 16 | ||
| Low-risk Pregnancies | 16 | ||
| Antepartum Fetal Surveillance | 16 | ||
| Fetal Movement Count | 17 | ||
| The Nonstress Test | 17 | ||
| The Contraction Stress Test | 19 | ||
| The Biophysical Profile | 20 | ||
| The Modified Biophysical Profile | 21 | ||
| Doppler Velocimetry | 22 | ||
| Fetal-Placental Circulation | 22 | ||
| Pathophysiology of Fetal Hypoxia | 23 | ||
| UA Doppler | 23 | ||
| Increased UA Resistance | 24 | ||
| Centralization of Flow | 24 | ||
| Absent Umbilical Artery Diastolic Flow | 24 | ||
| Reversed Umbilical Artery Diastolic Flow | 24 | ||
| Ductus Venosus Doppler | 25 | ||
| Uterine Arteries Doppler | 26 | ||
| Fetal Blood Sampling | 27 | ||
| Indian Experience of Antepartum Surveillance | 28 | ||
| Important Points | 29 | ||
| Chapter 2 - Prenatal Diagnosis of Chromosomal Abnormalities\r | 32 | ||
| Chromosomal Abnormalities | 33 | ||
| Trisomy 21 | 33 | ||
| Trisomy 18 | 34 | ||
| Trisomy 13 | 35 | ||
| Turner's Syndrome | 35 | ||
| Klinefelter's Syndrome | 36 | ||
| Fragile X Syndrome | 36 | ||
| Triploidy | 36 | ||
| Screening for Chromosomal Abnormalities | 36 | ||
| General Considerations | 37 | ||
| First Trimester Screening | 38 | ||
| Nuchal translucency | 38 | ||
| Nasal bone | 39 | ||
| Free beta-hCG | 39 | ||
| Pregnancy-associated plasma protein A | 39 | ||
| Combined ultrasound and biochemical screening | 40 | ||
| Second Trimester Screening | 40 | ||
| Alpha fetoprotein | 40 | ||
| Free beta-hCG | 41 | ||
| Unconjugated estriol | 41 | ||
| Inhibin A | 41 | ||
| Triple test | 41 | ||
| Quad test | 41 | ||
| Genetic sonogram | 41 | ||
| Nuchal fold thickness | 42 | ||
| Nasal bone | 43 | ||
| Cardiac abnormalities | 43 | ||
| Echogenic bowel | 43 | ||
| Short digits | 43 | ||
| Second trimester combined serologic screening and genetic ultrasound | 43 | ||
| First Plus Second Trimester Aneuploidy Screening | 44 | ||
| First trimester combined screening plus second trimester ultrasound examination | 44 | ||
| Integrated test | 44 | ||
| Sequential test | 44 | ||
| Screening Test Selection | 44 | ||
| Genetic Amniocentesis | 46 | ||
| Chorionic Villus Sampling | 47 | ||
| Transcervical CVS | 47 | ||
| Transabdominal CVS | 48 | ||
| Transvaginal CVS | 49 | ||
| Laboratory Aspects of CVS | 49 | ||
| Percutaneous Umbilical Blood Sampling | 50 | ||
| Molecular Genetic Testing | 50 | ||
| Screening for Hematologic Disorders | 51 | ||
| Sickle Cell Disease | 51 | ||
| Alpha- and Beta-Thalassemia | 52 | ||
| Screening for Metabolic Disorders | 52 | ||
| Tay-Sachs Disease | 52 | ||
| Canavan Disease | 52 | ||
| Screening for NTDs | 53 | ||
| Elevated MSAFP | 53 | ||
| Decreased MSAFP | 55 | ||
| Prevention of NTDs | 55 | ||
| Screening for Cystic Fibrosis | 55 | ||
| Indian Experience of Chromosomal Abnormalities | 57 | ||
| Important Points | 57 | ||
| Chapter 3 - Fetal Dysmorphology\r | 62 | ||
| Midtrimester Comprehensive Ultrasound Examination | 63 | ||
| Abnormalities of the Central Nervous System | 63 | ||
| Anencephaly | 64 | ||
| Spina Bifida | 65 | ||
| Ventriculomegaly and Hydrocephaly | 67 | ||
| Aqueductal Stenosis | 68 | ||
| Dandy-Walker Malformation | 68 | ||
| Holoprosencephaly | 69 | ||
| Abnormalities of the Neck | 69 | ||
| Cystic Hygroma | 69 | ||
| Cardiac Abnormalities | 70 | ||
| Ventricular Septal Defects | 72 | ||
| Atrial Septal Defects | 73 | ||
| Atrioventricular Septal Defects | 73 | ||
| Hypoplastic Left Heart | 74 | ||
| Hypoplasia of the Right Ventricle | 74 | ||
| Aortic Coarctation | 75 | ||
| Transposition of the Great Arteries | 75 | ||
| Tetralogy of Fallot | 76 | ||
| Ebstein's Anomaly | 76 | ||
| Fetal Cardiomyopathies | 77 | ||
| Fetal Arrhythmias | 77 | ||
| Thoracic Abnormalities | 79 | ||
| Pleural Effusions | 79 | ||
| Diaphragmatic Hernia | 80 | ||
| Congenital Cystic Adenomatoid Malformation of the Lung | 82 | ||
| Pulmonary Sequestration | 83 | ||
| Abdominal Abnormalities | 83 | ||
| Gastroschisis | 83 | ||
| Omphalocele | 84 | ||
| Abnormalities of the Urinary Tract | 85 | ||
| Fetal Hydronephrosis | 85 | ||
| Obstructive Uropathy | 87 | ||
| Multicystic Dysplastic Kidneys | 88 | ||
| Infantile Polycystic Kidney Disease | 89 | ||
| Adult Polycystic Kidneys | 89 | ||
| Skeletal Abnormalities | 90 | ||
| Achondroplasia | 90 | ||
| Osteogenesis Imperfecta | 91 | ||
| Sacrococcygeal Teratoma | 92 | ||
| Miscellaneous Sonographic Abnormalities | 92 | ||
| Polyhydramnios | 92 | ||
| Oligohydramnios | 94 | ||
| Nonimmune Fetalis Hydrops | 95 | ||
| Environmental Fetal Risks | 96 | ||
| Diagnostic Radiation During Pregnancy | 97 | ||
| Recreational Drugs During Pregnancy | 97 | ||
| Alcohol | 97 | ||
| Cocaine | 98 | ||
| Medications and Pregnancy | 98 | ||
| Anticonvulsant Agents | 99 | ||
| Antidepressants | 99 | ||
| Progesterone | 99 | ||
| Corticosteroids | 99 | ||
| Diazepam | 100 | ||
| Aspirin | 100 | ||
| Metronidazole | 100 | ||
| Vaginal Spermicides | 100 | ||
| Coffee | 100 | ||
| Aspartame | 100 | ||
| Indian Experience of Fetal Dysmorphology | 100 | ||
| Liquor Amnii and its Significance in Monitoring Fetal Health | 100 | ||
| Fetal Congenital Malformations | 101 | ||
| Important Points | 102 | ||
| Chapter 4 - Fetal Growth Restriction\r | 105 | ||
| Definitions | 106 | ||
| Small for Gestational Age | 106 | ||
| Fetal Growth Restriction | 107 | ||
| Incidence | 107 | ||
| Classification | 108 | ||
| Etiology of PFGR | 108 | ||
| Placental Abnormalities | 108 | ||
| Fetal Abnormalities | 110 | ||
| Maternal Conditions | 110 | ||
| Fetal and Neonatal Problems Associated with FGR | 111 | ||
| Antepartum Complications | 111 | ||
| Fetal Hypoxia and Acidosis | 111 | ||
| Stillbirth | 112 | ||
| Oligohydramnios | 112 | ||
| Intrapartum Complications | 112 | ||
| Neonatal Complications | 112 | ||
| Respiratory Distress Syndrome | 112 | ||
| Meconium Aspiration Syndrome | 113 | ||
| Persistent Fetal Circulation | 113 | ||
| Intraventricular Bleeding | 113 | ||
| Neonatal Encephalopathy | 113 | ||
| Hypoglycemia | 113 | ||
| Hypocalcemia | 113 | ||
| Hyperviscosity Syndrome | 113 | ||
| Inadequate Temperature Control | 113 | ||
| Long-Term Prognosis | 113 | ||
| Postnatal Growth | 113 | ||
| Cerebral Palsy | 114 | ||
| Adult Disease | 114 | ||
| Identification and Follow-Up of Patients at Risk | 114 | ||
| Historical Factors | 115 | ||
| Risk Factors During Prenatal Care | 115 | ||
| Poor Maternal Weight Gain | 115 | ||
| Discordance Between Gestational Age and Uterine Size | 115 | ||
| Inability to Assess Uterine Growth During Pregnancy | 115 | ||
| Early Preeclampsia | 115 | ||
| Follow-Up of High-Risk Patients | 115 | ||
| Uterine Artery Doppler Screening | 115 | ||
| Diagnosis | 116 | ||
| Determination of Gestational Age | 116 | ||
| Diagnosis when the Gestational Age is Certain | 116 | ||
| Estimated Fetal Weight | 116 | ||
| Abdominal Circumference | 117 | ||
| Head to Abdomen Ratio | 117 | ||
| Diagnosis when the Gestational Age is Uncertain | 117 | ||
| TCD/AC Ratio | 117 | ||
| Femur to Abdomen Ratio | 118 | ||
| Fetal Ponderal Index | 118 | ||
| Differential Diagnosis Between Normal and Pathological FGR | 118 | ||
| Uterine Artery Doppler | 119 | ||
| Umbilical Artery Doppler | 120 | ||
| Middle Cerebral Artery Doppler | 120 | ||
| Management | 121 | ||
| Methods for Surveillance of the Pathological Growth-Retarded Fetus | 121 | ||
| FHR Monitoring | 121 | ||
| Biophysical Profile | 121 | ||
| Umbilical and Middle Cerebral Artery Doppler | 122 | ||
| Venous Doppler | 122 | ||
| Amniotic Fluid Volume | 123 | ||
| Amniocentesis | 123 | ||
| Umbilical Cord Blood Sampling | 123 | ||
| Management of the Pathological Growth Restricted Fetus | 123 | ||
| Before 24 Weeks of Gestation | 124 | ||
| Between 24 and 32 Weeks of Gestation | 124 | ||
| Between 32 and 36 Weeks of Gestation | 125 | ||
| FGR with Abnormal Uterine and Normal Umbilical Doppler | 125 | ||
| FGR with Normal Uterine and Abnormal Umbilical Doppler | 125 | ||
| FGR with Abnormal Uterine and Umbilical Doppler | 126 | ||
| After 36 Weeks of Gestation | 126 | ||
| Delivery of the Pathological Growth-Retarded Fetus | 126 | ||
| Treatment of FGR | 127 | ||
| Bed Rest | 127 | ||
| Nutritional Supplementation | 127 | ||
| Hyperoxygenation | 128 | ||
| Aspirin | 128 | ||
| Indian Experience of Fetal Growth Restriction | 128 | ||
| Important Points | 130 | ||
| Chapter 5 - Fetal Infections\r | 135 | ||
| Group B Streptococcal Infection | 136 | ||
| Description of the Organism | 136 | ||
| Maternal and Neonatal Colonization and Infection | 136 | ||
| Diagnosis | 137 | ||
| Prevention of Neonatal Infection | 137 | ||
| Treatment of Maternal Infection | 138 | ||
| Immunization | 139 | ||
| Group B Streptococci Infection: Indian Experience | 139 | ||
| Syphilis | 139 | ||
| Maternal Infection | 139 | ||
| Serology | 139 | ||
| Congenital Syphilis | 140 | ||
| Diagnosis | 140 | ||
| Treatment | 141 | ||
| Management of the Penicillin-Sensitive Patient | 141 | ||
| Serologic Follow-up | 142 | ||
| Cytomegalovirus Infection | 142 | ||
| The Virus | 142 | ||
| Transmission | 142 | ||
| Severe Congenital Infection | 142 | ||
| Late Sequelae | 143 | ||
| Diagnosis | 143 | ||
| Prevention | 144 | ||
| Treatment | 144 | ||
| CMV Infection: Indian Experience | 144 | ||
| Rubella | 144 | ||
| Signs and Symptoms | 144 | ||
| Immunity | 144 | ||
| Congenital Rubella | 144 | ||
| Diagnosis | 145 | ||
| Management | 145 | ||
| Vaccination | 146 | ||
| Rubella Epidemiology: Indian Experience | 146 | ||
| Human Immunodeficiency Virus Infection | 147 | ||
| Virology | 147 | ||
| Maternal Infection | 147 | ||
| Diagnosis | 148 | ||
| Fetal Transmission | 148 | ||
| Detection of HIV Infection During Pregnancy | 149 | ||
| Antepartum Care | 149 | ||
| Intrapartum Management | 150 | ||
| Postpartum Care | 150 | ||
| HIV in Pregnancy: Indian Experience | 150 | ||
| Genital Herpes | 151 | ||
| The Virus | 151 | ||
| Maternal Infection | 151 | ||
| Neonatal Infection | 151 | ||
| Hematogenous Transmission | 152 | ||
| Transmission at Delivery | 152 | ||
| Diagnosis | 152 | ||
| Identification of Women at Risk of Vertical Transmission | 153 | ||
| Antiviral Suppressive Therapy | 153 | ||
| Cesarean Delivery for Women with Genital HSV Lesions | 154 | ||
| Treatment | 154 | ||
| HSV Infection: Indian Experience | 154 | ||
| Varicella | 155 | ||
| The Virus | 155 | ||
| Transmission | 155 | ||
| Maternal Infection | 155 | ||
| Fetal Infection | 155 | ||
| Diagnosis | 156 | ||
| Management | 156 | ||
| Viral Hepatitis | 157 | ||
| Hepatitis A | 157 | ||
| Hepatitis B | 157 | ||
| Transmission | 157 | ||
| Maternal Infection | 157 | ||
| Diagnosis | 158 | ||
| Screening | 158 | ||
| Neonatal Transmission | 158 | ||
| Prevention of Neonatal Infection | 158 | ||
| Hepatitis C | 158 | ||
| Viral Hepatitis: Indian Experience | 159 | ||
| Parvovirus B19 Infection | 159 | ||
| Maternal Infection | 159 | ||
| Fetal Transmission | 160 | ||
| Diagnosis | 160 | ||
| Management | 160 | ||
| Toxoplasmosis | 160 | ||
| The Parasite | 161 | ||
| Maternal Infection | 161 | ||
| Congenital Transmission | 161 | ||
| Congenital Infection | 161 | ||
| Diagnosis | 162 | ||
| Treatment | 163 | ||
| Prevention | 163 | ||
| Toxoplasmosis: Indian Experience | 163 | ||
| Management | 164 | ||
| Malaria | 164 | ||
| Etiology | 164 | ||
| Pathology | 164 | ||
| Clinical Manifestations | 164 | ||
| Diagnosis | 164 | ||
| Effects of Malaria in Pregnancy | 164 | ||
| Effects of Pregnancy on Malaria | 164 | ||
| Complications | 165 | ||
| Management | 165 | ||
| Prevention | 165 | ||
| Treatment | 165 | ||
| Indian Experience of Fetal Infections | 165 | ||
| Bacterial Infections | 165 | ||
| Viral Infections | 165 | ||
| Cytomegalovirus disease | 166 | ||
| Herpes simplex virus | 166 | ||
| Other viruses | 166 | ||
| Human immunodeficiency virus | 166 | ||
| Important Points | 167 | ||
| Chapter 6 - Birth Asphyxia\r | 172 | ||
| Definitions | 172 | ||
| Incidence | 173 | ||
| Pathophysiology | 173 | ||
| CO2 Exchange and Respiratory Acidosis | 173 | ||
| O2 Exchange and Metabolic Acidosis | 174 | ||
| Diagnosis | 174 | ||
| Umbilical Artery Blood Gases | 175 | ||
| Apgar Score | 175 | ||
| Causes of Fetal Asphyxia | 176 | ||
| Differential Diagnosis Between Antepartum and Intrapartum Asphyxia | 176 | ||
| Antepartum criteria | 176 | ||
| Intrapartum criteria | 177 | ||
| Neonatal criteria | 177 | ||
| ACOG's criteria | 178 | ||
| Fhr Monitoring | 178 | ||
| Reassuring FHR Pattern | 179 | ||
| Ominous FHR Patterns | 179 | ||
| Late and variable decelerations | 179 | ||
| Fetal bradycardia | 180 | ||
| Decreased variability | 180 | ||
| Nonreassuring FHR Patterns | 180 | ||
| Absent or decreased variability without periodic changes | 181 | ||
| Late decelerations with normal variability and accelerations | 181 | ||
| Variable decelerations with slow return to baseline | 181 | ||
| Variable decelerations during the second stage of labor | 182 | ||
| Intermittent Auscultation | 182 | ||
| Assessment of Fetal Well-Being when a Nonreassuring FHR Pattern is Present | 182 | ||
| FHR response to scalp stimulation | 182 | ||
| FHR response to VAS | 183 | ||
| Fetal scalp blood gases | 183 | ||
| Fetal pulse oximetry | 183 | ||
| Fetal Asphyxia and CP | 183 | ||
| Neonatal MRI and CP | 185 | ||
| Management of Fetal Asphyxia | 186 | ||
| Indian Experience with Birth Asphyxia | 188 | ||
| Important Points | 188 | ||
| Section II: Obstetrical Complications \r | 192 | ||
| Chapter 7 - Preterm Parturition Syndrome\r | 193 | ||
| Common Pathway of Parturition | 194 | ||
| Cervical Ripening | 194 | ||
| Activation of the Fetal Membranes | 195 | ||
| Activation of the Myometrium | 196 | ||
| Conditions Causing Premature Activation of the Common Pathway of Parturition | 196 | ||
| Maternal and Fetal Stress | 196 | ||
| Infection | 197 | ||
| Acute Chorioamnionitis | 197 | ||
| Subclinical Chorioamnionitis | 199 | ||
| Extrauterine Infections | 200 | ||
| Fetal Inflammatory Response Syndrome | 200 | ||
| Abnormal Placentation | 201 | ||
| Bleeding in the Choriodecidual Interface | 202 | ||
| Uterine Abnormalities | 202 | ||
| Uterine Overdistention | 202 | ||
| Abnormalities of the Cervix | 202 | ||
| Preterm Birth of Unknown Origin | 203 | ||
| Indicated Preterm Birth | 203 | ||
| Maternal and Fetal Consequences of Preterm Birth | 203 | ||
| Neonatal RDS | 204 | ||
| Tests for Assessment of Fetal Pulmonary maturity | 204 | ||
| Acceleration of Fetal Pulmonary Maturity with Steroids | 205 | ||
| Surfactant Replacement Therapy | 205 | ||
| Intraventricular Hemorrhage | 206 | ||
| Intrapartum Hypoxia and Acidosis | 207 | ||
| Cerebral Palsy | 208 | ||
| Chronic Lung Disease | 211 | ||
| Indian Experience of Preterm Parturition Syndrome | 211 | ||
| Contributory Factors | 211 | ||
| Medical Disorders | 212 | ||
| Important Points | 212 | ||
| Chapter 8 - Preterm Labor\r | 217 | ||
| Diagnosis | 217 | ||
| Uterine Contractions | 217 | ||
| Digital Pelvic Examination | 218 | ||
| Advanced Preterm Labor | 219 | ||
| Identification of Women Who Need to be Delivered | 219 | ||
| Acute Chorioamnionitis | 219 | ||
| Subclinical Chorioamnionitis | 220 | ||
| Severe Placental Insufficiency | 221 | ||
| Fetal Congenital Abnormalities | 222 | ||
| Fetuses with Adequate Pulmonary Maturity | 222 | ||
| Advanced Cervical Dilatation | 222 | ||
| Women in Advanced Preterm Labor and No Indication for Immediate Delivery | 222 | ||
| Delivery of the Preterm Infant | 222 | ||
| Early Preterm Labor | 223 | ||
| Management | 224 | ||
| Tocolysis | 224 | ||
| Nifedipine | 224 | ||
| Magnesium Sulfate | 224 | ||
| Beta-Adrenergic Agents | 224 | ||
| Indomethacin | 226 | ||
| Nitroglycerin | 226 | ||
| Diazoxide | 227 | ||
| Prophylactic Tocolysis | 227 | ||
| Steroids | 227 | ||
| Antibiotics | 227 | ||
| Inpatient Versus Outpatient Management | 228 | ||
| Threatened Preterm Labor | 228 | ||
| Cervical Assessment by Endovaginal Ultrasound | 229 | ||
| Women with Cervical Length Greater than 2.5cm | 230 | ||
| Women with Cervical Length Between 1.5 and 2.5cm | 230 | ||
| Women with Cervical Length Less than 1.5cm | 231 | ||
| Prevention of Preterm Labor | 231 | ||
| Identification of Asymptomatic Women at Risk | 231 | ||
| Sociodemographic Risk Factors | 232 | ||
| Obstetrical Risk Factors | 232 | ||
| Tests for the Identification of Women at Risk | 233 | ||
| Home Uterine Monitoring | 233 | ||
| Cervical Length | 233 | ||
| Fetal Fibronectin | 233 | ||
| Vaginal Infections | 234 | ||
| Management of Women at Risk | 234 | ||
| Progesterone | 235 | ||
| Indian Experience of Preterm Labor | 235 | ||
| Important Points | 236 | ||
| Chapter 9 - Premature Rupture of Membranes\r | 240 | ||
| Mechanisms and Etiology | 240 | ||
| Infection | 241 | ||
| Abnormal Placentation | 242 | ||
| Repetitive Stress | 242 | ||
| Maternal and Fetal Problems Associated with PROM | 242 | ||
| Maternal Problems | 242 | ||
| Acute Chorioamnionitis | 242 | ||
| Subclinical Chorioamnionitis | 243 | ||
| Placental Separation | 243 | ||
| Postpartum Endometritis | 243 | ||
| Fetal/Neonatal Problems | 243 | ||
| Hyaline Membrane Disease | 243 | ||
| Nonreassuring Fetal Status | 244 | ||
| Pulmonary Hypoplasia | 244 | ||
| Cerebral Palsy | 244 | ||
| Congenital Abnormalities | 245 | ||
| Fetal Deformities | 245 | ||
| Diagnosis | 245 | ||
| Nitrazine Test | 245 | ||
| Fern Test | 245 | ||
| Intra-Amniotic Injection of Indigo Carmine | 245 | ||
| Fetal Fibronectin | 245 | ||
| Alpha-Fetoprotein | 245 | ||
| High Leaks | 246 | ||
| Management | 246 | ||
| Initial Assessment | 246 | ||
| Speculum Examination | 246 | ||
| Laboratory Assessment | 246 | ||
| Ultrasound Examination | 246 | ||
| Determination of Gestational Age | 247 | ||
| Identification of Women Who Need to be Delivered | 247 | ||
| Women in Advanced Labor | 247 | ||
| Women with Acute Chorioamnionitis | 247 | ||
| Subclinical Infection/Inflammation | 248 | ||
| Women at High Risk for Severe Infection | 249 | ||
| Fetuses with Mature Lungs | 249 | ||
| Fetuses with Nonreassuring Well-Being Testing | 249 | ||
| Fetuses with Lethal Abnormalities | 250 | ||
| Management According to Gestational Age at the Time of Rupture | 250 | ||
| PROM at 36 or More Weeks | 250 | ||
| PPROM between 32 and 36 Weeks | 250 | ||
| PPROM between 24 and 32 weeks | 250 | ||
| Antibiotics | 252 | ||
| Steroids | 253 | ||
| Tocolysis | 253 | ||
| Fetal Surveillance | 253 | ||
| Monitoring for Infection | 253 | ||
| Delivery | 254 | ||
| PPROM before 24 weeks | 255 | ||
| Surgical Approaches to the Treatment of Early PPROM | 255 | ||
| Special Situations in Women with PPROM | 256 | ||
| PPROM with Cerclage \"In Situ | 256 | ||
| PPROM in Multifetal Pregnancies | 256 | ||
| PPROM in Women with Herpetic Lesions | 256 | ||
| Prevention of PPROM | 256 | ||
| Indian Experience of Premature Rupture of Membranes | 257 | ||
| Important Points | 257 | ||
| Chapter 10 - Cervical Insufficiency\r | 262 | ||
| Causes of Incompetent Cervix | 262 | ||
| Pathophysiology | 263 | ||
| Diagnosis | 263 | ||
| Acute Presentation | 264 | ||
| Historical Diagnosis | 264 | ||
| Ultrasound Diagnosis | 265 | ||
| Cervical Length | 265 | ||
| Funneling | 266 | ||
| Dynamic Cervical Changes | 266 | ||
| Management | 266 | ||
| Acute Presentation | 267 | ||
| Selection of Patients for Surgical Treatment | 267 | ||
| Surgical Treatment | 268 | ||
| Espinosa-Flores Operation | 268 | ||
| Wurm Operation | 268 | ||
| Pessaries | 270 | ||
| Women with Cervical Changes by Ultrasound Examination | 270 | ||
| Shirodkar Operation | 271 | ||
| McDonald Operation | 271 | ||
| Women with Risk Factors for Incompetent Cervix | 271 | ||
| Women with Incompetent Cervix and Failed Vaginal Cerclage | 272 | ||
| Abdominal Cerclage | 272 | ||
| Indian Experience of Cervical Insufficiency | 273 | ||
| Important Points | 274 | ||
| Chapter 11 - Prolonged Pregnancy\r | 277 | ||
| Definition | 277 | ||
| Incidence | 277 | ||
| Etiology | 278 | ||
| Changes Associated with Prolonged Gestation | 278 | ||
| Amniotic Fluid Changes | 278 | ||
| Placental Changes | 278 | ||
| Fetal and Neonatal Problems Associated with Prolongation of Pregnancy | 279 | ||
| Perinatal Mortality | 279 | ||
| Intrapartum Fetal Distress | 279 | ||
| Meconium Aspiration | 279 | ||
| Fetal Trauma | 279 | ||
| Postmaturity Syndrome | 280 | ||
| Antepartum Management | 280 | ||
| Reliability of the Gestational Age Estimation | 280 | ||
| Identification of Patients Who Need to be Delivered | 281 | ||
| High-Risk pregnancies | 281 | ||
| Women with Favorable Cervices | 281 | ||
| Decreased Amniotic Fluid Volume | 282 | ||
| Macrosomic Fetuses | 282 | ||
| Fetal Growth Restriction | 282 | ||
| Suspected Fetal Compromise | 283 | ||
| Fetuses with Congenital Abnormalities | 283 | ||
| Advanced Placental Grade | 283 | ||
| Expectant Management | 284 | ||
| Induction of Labor | 284 | ||
| Mechanical Cervical Ripening Agents | 284 | ||
| Chemical Cervical Ripening Agents | 285 | ||
| Misoprostol | 285 | ||
| Prostaglandin E2 Derivatives | 286 | ||
| Glyceryl Trinitrate | 286 | ||
| Intrapartum Management | 287 | ||
| Nonreassuring FHR Monitoring Patterns | 287 | ||
| Fetal Trauma | 287 | ||
| Shoulder Dystocia | 287 | ||
| Meconium Aspiration | 289 | ||
| Indian Experience of Prolonged (Postmature) Pregnancy | 290 | ||
| Important Points | 290 | ||
| Chapter 12 - Multifetal Gestation\r | 293 | ||
| Incidence and Epidemiology | 293 | ||
| Assisted Reproductive Technology | 294 | ||
| Oral Contraceptives | 294 | ||
| Race and Geographical Area | 294 | ||
| Advanced Maternal Age | 294 | ||
| Maternal Weight | 294 | ||
| Classification | 294 | ||
| By Zygocity | 294 | ||
| By Chorionicity and Amnionicity | 295 | ||
| Etiology | 297 | ||
| Complications | 297 | ||
| Maternal Morbidity | 297 | ||
| Perinatal Mortality and Morbidity | 297 | ||
| Hypertension | 298 | ||
| Gestational Diabetes | 298 | ||
| Fatty Liver of Pregnancy | 298 | ||
| Anemia | 298 | ||
| Postpartum Bleeding | 299 | ||
| Preterm Birth | 299 | ||
| Discordant Growth | 299 | ||
| Twin-Twin Transfusion Syndrome | 300 | ||
| Mechanism | 301 | ||
| Diagnosis | 301 | ||
| Classification | 302 | ||
| Differential Diagnosis | 302 | ||
| Treatment | 302 | ||
| Serial Amnioreduction | 302 | ||
| Laser Photocoagulation of Placental Vascular Anastomoses | 303 | ||
| Septostomy | 303 | ||
| Selective Feticide | 304 | ||
| Monoamniotic Twins | 304 | ||
| Fetal Demise of One Twin | 305 | ||
| Congenital Abnormalities | 306 | ||
| Conjoined Twins | 306 | ||
| Acardiac Twin | 307 | ||
| Umbilical Cord Problems | 307 | ||
| Cerebral Palsy | 307 | ||
| Diagnosis | 308 | ||
| Antepartum Management | 308 | ||
| Prevention of Preterm Birth | 308 | ||
| Bed Rest | 309 | ||
| Prophylactic Tocolysis | 309 | ||
| Home Uterine Activity Monitoring | 309 | ||
| Infection Surveillance | 309 | ||
| Progesterone | 310 | ||
| Fetal Fibronectin | 310 | ||
| Cervical Length | 310 | ||
| Cervical Cerclage | 310 | ||
| Fetal Growth | 310 | ||
| Discordant Growth | 310 | ||
| Screening for Chromosomal Abnormalities | 311 | ||
| Fetal Surveillance | 312 | ||
| Fetal Lung Maturation | 312 | ||
| Summary of Antepartum Management | 312 | ||
| Management of Labor and Delivery | 313 | ||
| Timing of Delivery | 313 | ||
| Fetal Presentations | 313 | ||
| Vaginal Delivery | 315 | ||
| Delayed Delivery of the Second Twin | 316 | ||
| Cesarean Delivery | 316 | ||
| Management of Gestations with High Fetal Number | 317 | ||
| Reduction of Multifetal Pregnancies | 317 | ||
| Indian Experience of Multifetal Gestation | 317 | ||
| Important Points | 319 | ||
| Chapter 13 - Bleeding During Pregnancy\r | 323 | ||
| First Trimester Bleeding | 323 | ||
| First Trimester Spontaneous Abortion | 324 | ||
| Etiology | 324 | ||
| Clinical and laboratory findings | 325 | ||
| Ultrasound assessment | 325 | ||
| Management | 325 | ||
| Second Trimester Bleeding | 326 | ||
| Etiology | 326 | ||
| Genetic abnormalities | 326 | ||
| Antiphospholipid antibody syndrome | 327 | ||
| Maternal thrombophilia | 328 | ||
| Subchorionic bleeding | 329 | ||
| Incompetent cervix | 329 | ||
| Infection | 329 | ||
| Uterine synechia | 330 | ||
| Mullerian abnormalities | 330 | ||
| Abnormal placentation | 330 | ||
| Autoimmune antibodies | 330 | ||
| Progesterone deficiency | 331 | ||
| Thyroid deficiency | 331 | ||
| Diabetes | 331 | ||
| Polycystic ovary syndrome | 331 | ||
| Alloimmune antibodies | 331 | ||
| Clinical and Laboratory Assessment | 332 | ||
| Ultrasound Assessment | 332 | ||
| Treatment | 333 | ||
| Third Trimester Bleeding | 333 | ||
| Placenta Previa | 333 | ||
| Definition and classification | 333 | ||
| Incidence | 333 | ||
| Etiology | 333 | ||
| Clinical presentation | 334 | ||
| Diagnosis | 334 | ||
| Outcome | 335 | ||
| Management | 335 | ||
| Evaluation of severity of bleeding | 336 | ||
| Management of patients with severe bleeding | 337 | ||
| Management of patients with moderate bleeding | 339 | ||
| Management of patients with mild bleeding | 340 | ||
| Placental Abruption | 342 | ||
| Definition and incidence | 342 | ||
| Etiology | 343 | ||
| Clinical presentation | 343 | ||
| Classification | 343 | ||
| Management of severe abruption causing fetal demise | 344 | ||
| Evaluation and replacement of blood loss | 344 | ||
| Internal jugular vein catheterization | 344 | ||
| Management of coagulopathy | 345 | ||
| Evaluation of fetal presentation and size | 345 | ||
| Delivery | 345 | ||
| Management of abruptio placentae with alive fetus | 346 | ||
| Prognosis for future pregnancies | 347 | ||
| Other Causes of Third Trimester Bleeding | 347 | ||
| Vasa previa | 348 | ||
| Peripheral placental separation | 348 | ||
| Postpartum Bleeding | 348 | ||
| Etiology | 349 | ||
| Diagnosis | 349 | ||
| Treatment | 349 | ||
| Uterine atony | 350 | ||
| Cervical and vaginal lacerations | 351 | ||
| Retained placental fragments | 351 | ||
| Indian Experience of Early Pregnancy Loss | 351 | ||
| Indian Experience of Third Trimester Bleeding | 353 | ||
| Indian Experience of Postpartum Hemorrhage | 353 | ||
| Important Points | 355 | ||
| Chapter 14 - Rh Alloimmunization\r | 358 | ||
| Pathophysiology | 358 | ||
| Genetics | 360 | ||
| Diagnosis | 360 | ||
| Management | 361 | ||
| Management of Rh-Negative Nonimmunized Women | 361 | ||
| Detection of Rh Alloimmunization | 361 | ||
| Prevention of Rh Alloimmunization | 361 | ||
| Management of Rh-Negative Immunized Women | 363 | ||
| Paternal Rh Phenotype and Genotype | 363 | ||
| Fetal Rh Determination | 363 | ||
| First Affected Pregnancy | 363 | ||
| Serum Antibody Titers | 364 | ||
| Women with a Previous Affected Pregnancy | 364 | ||
| Middle Cerebral Artery Peak Velocity | 364 | ||
| Amniotic Fluid Bilirubin | 365 | ||
| Ultrasound Assessment | 368 | ||
| Fetal Blood Sampling | 368 | ||
| Intrauterine Transfusion | 368 | ||
| Early Delivery and Glucocorticoids | 369 | ||
| Other Treatment Modalities | 369 | ||
| Alloimmunization to Rh Antigens Different from D | 369 | ||
| Indian Experience of Erythroblastosis Fetalis | 370 | ||
| Important Points | 371 | ||
| Chapter 15 - Abnormal Labor and Delivery\r | 373 | ||
| Normal Labor | 374 | ||
| Lack of Progress in Labor | 375 | ||
| Power | 375 | ||
| The Passenger | 375 | ||
| The Pelvis | 375 | ||
| Lack of Progress During The Latent Phase of Labor | 376 | ||
| Diagnosis | 376 | ||
| Etiology | 376 | ||
| Management | 376 | ||
| Prognosis | 377 | ||
| Lack of Progress During The Active Phase of Labor | 377 | ||
| Diagnosis | 377 | ||
| Etiology | 377 | ||
| Management | 377 | ||
| Prognosis | 378 | ||
| Lack of Progress in The Second Stage of Labor | 379 | ||
| Diagnosis | 379 | ||
| Etiology | 379 | ||
| Management | 380 | ||
| Prognosis | 381 | ||
| Abnormal Fetal Presentations | 381 | ||
| Breech Presentation | 382 | ||
| External Cephalic Version | 382 | ||
| Breech Delivery | 383 | ||
| Persistent OP Position | 383 | ||
| Etiology | 384 | ||
| Associated Labor Abnormalities | 384 | ||
| Management | 384 | ||
| Other Abnormal Presentations | 386 | ||
| Shoulder Presentation | 386 | ||
| Face Presentation | 386 | ||
| Compound Presentations | 386 | ||
| Operative Vaginal Delivery | 386 | ||
| Vacuum Delivery | 387 | ||
| Cesarean Delivery | 388 | ||
| Indian Experience About Intrapartum Management | 389 | ||
| Partography | 389 | ||
| Induction of Labor | 390 | ||
| Abnormal Fetal Presentations- Breech Presentation | 390 | ||
| Transverse (Oblique) Lie-Shoulder Presentation | 391 | ||
| Occipitoposterior Malposition | 391 | ||
| Transverse Lie and Shoulder Presentations | 391 | ||
| Brow Presentation and Mentoposterior Presentations | 392 | ||
| Shoulder Presentation | 392 | ||
| Cord Complications | 392 | ||
| Antepartum Hemorrhage | 392 | ||
| Operative Delivery | 392 | ||
| Cervical OS Tightening (Incompetent Cervical OS) | 392 | ||
| Obstetric Forceps and Vacuum Extraction | 392 | ||
| Cesarean Section | 393 | ||
| Important Points | 394 | ||
| Chapter 16 - Hypertensive Disorders in Pregnancy\r | 397 | ||
| Definitions | 397 | ||
| Gestational Hypertension | 398 | ||
| Classification | 398 | ||
| Pathophysiology | 398 | ||
| Maternal and Perinatal Outcome | 399 | ||
| Prediction | 399 | ||
| Management | 399 | ||
| Initial Evaluation | 399 | ||
| Gestational Hypertension without Risk Factors | 400 | ||
| Gestational Hypertension with Risk Factors | 400 | ||
| Delivery | 402 | ||
| Chronic Hypertension and Pregnancy | 402 | ||
| Etiology | 402 | ||
| Pathophysiology | 403 | ||
| Diagnosis | 403 | ||
| Maternal and Fetal Risks | 403 | ||
| Severe Hypertension | 404 | ||
| Superimposed Preeclampsia | 404 | ||
| Fetal Growth Restriction | 404 | ||
| Abruptio Placentae | 404 | ||
| Management | 405 | ||
| Severity Assessment | 405 | ||
| Self-Monitoring of Blood Pressure | 405 | ||
| Nonpharmacologic Therapy | 406 | ||
| Bed Rest | 406 | ||
| Salt Restriction | 406 | ||
| Weight Gain and Exercise | 406 | ||
| Antihypertensive Therapy | 406 | ||
| Beta-Blockers | 407 | ||
| Labetalol | 407 | ||
| Nifedipine | 408 | ||
| Methyldopa | 408 | ||
| Diuretics | 408 | ||
| Prazosin | 409 | ||
| Hydralazine | 409 | ||
| Selection of Antihypertensive Medications | 409 | ||
| General Care During Pregnancy | 410 | ||
| Delivery | 411 | ||
| Preeclampsia | 411 | ||
| Pathophysiology | 411 | ||
| Hemodynamic Changes | 412 | ||
| Changes in Intravascular Volume | 412 | ||
| Changes in PVR | 412 | ||
| Hemostatic Abnormalities | 412 | ||
| Renal Changes | 413 | ||
| Prediction | 413 | ||
| Angiotensin Sensitivity Test | 413 | ||
| Roll-Over Test | 413 | ||
| Mean Blood Pressure in the Second Trimester | 413 | ||
| Urinary Calcium | 414 | ||
| Fibronectin | 414 | ||
| Uterine Artery Doppler | 414 | ||
| Diagnosis | 414 | ||
| Blood Pressure Elevation | 414 | ||
| Proteinuria | 414 | ||
| Vasoconstriction | 415 | ||
| Excessive Weight Gain and Edema | 415 | ||
| Other Signs and Symptoms | 415 | ||
| Laboratory Findings | 415 | ||
| Altered Renal Function | 415 | ||
| Changes in Liver Function Tests | 416 | ||
| Hematologic Abnormalities | 416 | ||
| Abnormal Fetal Growth | 416 | ||
| Classification | 417 | ||
| Management | 417 | ||
| Mild Preeclampsia | 417 | ||
| Initial Evaluation | 417 | ||
| Gestational Age 37 Weeks | 417 | ||
| Gestational Age Between 32 and 36 Weeks | 417 | ||
| Gestational Age < 32 Weeks | 417 | ||
| General Measures | 418 | ||
| Diuretics | 418 | ||
| Antihypertensive Treatment | 418 | ||
| Delivery | 419 | ||
| Severe Preeclampsia | 420 | ||
| Gestational Age 34 Weeks | 420 | ||
| Prevention of Seizures | 420 | ||
| Antihypertensive Treatment | 421 | ||
| Gestational Age 28-33 Weeks | 422 | ||
| Gestational Age 24-28 Weeks | 422 | ||
| Expectant Management | 422 | ||
| Gestational Age < 24 Weeks | 423 | ||
| Delivery | 424 | ||
| Eclampsia | 424 | ||
| Pathophysiology | 425 | ||
| Maternal and Perinatal Outcome | 425 | ||
| Diagnosis | 425 | ||
| Management | 426 | ||
| Seizure Treatment | 426 | ||
| Treatment of Hypertension | 426 | ||
| Diuretics | 427 | ||
| Fetal Response to Maternal Seizures | 427 | ||
| Delivery | 427 | ||
| Postpartum Care | 427 | ||
| Prevention | 427 | ||
| Long-Term Prognosis | 427 | ||
| Hellp Syndrome | 427 | ||
| Diagnosis | 428 | ||
| Maternal and Perinatal Outcomes | 428 | ||
| Management | 428 | ||
| Severe Complications of Preeclampsia | 429 | ||
| Pulmonary Edema | 429 | ||
| Acute Renal Failure | 429 | ||
| Abruptio Placentae | 430 | ||
| Intracranial Bleeding | 430 | ||
| Visual Disorders | 430 | ||
| Long-Term Prognosis of Preeclampsia and Eclampsia | 431 | ||
| Prevention of Preeclampsia | 431 | ||
| Low-Dose Aspirin | 432 | ||
| Calcium | 432 | ||
| Antioxidants | 432 | ||
| Indian Experience of Hypertensive Disorders in Pregnancy | 433 | ||
| Predictive Tests | 433 | ||
| Clinical Aspects of Pregnancy-Induced Hypertension | 434 | ||
| Indian Experience with Chronic Hypertension and Pregnancy | 435 | ||
| Important Points | 435 | ||
| Chapter 17 - Diabetes and Pregnancy\r | 440 | ||
| Carbohydrate Metabolism During Pregnancy | 440 | ||
| Effects of Diabetes on Pregnancy | 441 | ||
| Effects of Pregnancy on Diabetes | 441 | ||
| Diagnosis | 441 | ||
| Screening for Gestational Diabetes | 441 | ||
| Diagnosis of Diabetes in Pregnancy | 443 | ||
| Renal Glycosuria | 443 | ||
| Hypoglycemia During the GTT | 443 | ||
| Classification | 444 | ||
| Gestational Diabetes | 444 | ||
| Maternal Risks | 445 | ||
| Fetal and Neonatal Risks | 445 | ||
| Fetal Macrosomia | 445 | ||
| Blood Glucose Monitoring | 446 | ||
| Nutritional Treatment | 446 | ||
| Total Daily Caloric Intake | 446 | ||
| Carbohydrate Counting | 447 | ||
| Glycemic Index | 448 | ||
| Other Components of the Meal Plan | 448 | ||
| Glyburide | 448 | ||
| Insulin | 449 | ||
| Fetal Surveillance | 449 | ||
| Delivery | 449 | ||
| Type II Diabetes | 450 | ||
| Metabolic Syndrome | 450 | ||
| Nutritional Treatment | 450 | ||
| Glyburide | 451 | ||
| Insulin | 451 | ||
| Assessment of Blood Glucose Control | 452 | ||
| Type I Diabetes | 452 | ||
| Preconceptional Counseling | 452 | ||
| The Importance of Blood Glucose Control | 452 | ||
| The Importance of Self-Monitoring of Blood Glucose | 452 | ||
| The Importance of Fetal Surveillance | 452 | ||
| The Cost of the Diabetic Pregnancy | 453 | ||
| Maternal Complications | 453 | ||
| Fetal/Neonatal Complications | 453 | ||
| Congenital Anomalies | 453 | ||
| Neonatal Hypoglycemia | 453 | ||
| Neonatal Hyperbilirubinemia | 453 | ||
| Neonatal RDS | 453 | ||
| Hyperviscosity Syndrome | 453 | ||
| Feeding Problems | 454 | ||
| Incidence | 454 | ||
| Objectives of Prenatal Care | 454 | ||
| Detection of Diabetic Embryopathy | 454 | ||
| Blood Glucose Control | 455 | ||
| Nutritional Therapy | 455 | ||
| Insulin Therapy | 455 | ||
| Total Daily Insulin Requirement | 456 | ||
| Insulin to Carbohydrate Ratio | 456 | ||
| Insulin Sensitivity Factor | 457 | ||
| Abnormalities in Blood Glucose Control | 457 | ||
| Patients on Insulin Pumps | 457 | ||
| Assessment of Fetal Well-Being | 458 | ||
| Labor and Delivery | 458 | ||
| Preterm Labor | 458 | ||
| Preterm Premature Rupture of Membranes | 458 | ||
| Time of Delivery | 458 | ||
| Mode of Delivery | 458 | ||
| Intrapartum Management | 458 | ||
| Postpartum Management | 459 | ||
| Unstable Type I Diabetics | 459 | ||
| Diabetic Ketoacidosis | 459 | ||
| Somogyi's Phenomenon | 461 | ||
| Dawn Phenomenon | 461 | ||
| Hypoglycemic Episodes | 461 | ||
| Changes in Insulin Pharmacokinetics | 461 | ||
| Diabetics with End-Organ Damage | 462 | ||
| Diabetic Nephropathy | 462 | ||
| Diabetic Retinopathy | 462 | ||
| Diabetic Neuropathy | 462 | ||
| Diabetic Cardiomyopathy | 462 | ||
| Indian Experience of Diabetes Complicating Pregnancy | 462 | ||
| Important Points | 463 | ||
| Chapter 18 - Hematologic Disorders in Pregnancy\r | 465 | ||
| Physiological Changes in the Red Cell Count During Pregnancy | 465 | ||
| Anemia in Pregnancy | 466 | ||
| Effects of Anemia on Mother and Fetus | 466 | ||
| Effects of Pregnancy on Anemia | 466 | ||
| Iron-Deficiency Anemia | 466 | ||
| Iron Metabolism | 466 | ||
| Iron Requirements During Pregnancy | 467 | ||
| Clinical and Laboratory Assessment | 467 | ||
| Treatment | 468 | ||
| Megaloblastic Anemia | 469 | ||
| Diagnosis | 469 | ||
| Treatment | 470 | ||
| Hemolytic Anemias | 470 | ||
| Microangiopathic Hemolytic Anemia | 471 | ||
| Hemolytic Anemias Associated with Hemoglobinopathies | 471 | ||
| Sickle Cell Disease | 471 | ||
| Treatment | 472 | ||
| Sickle Cell Trait | 473 | ||
| Beta Thalassemia Minor | 473 | ||
| Immune Hemolytic Anemia | 474 | ||
| Aplastic Anemias | 474 | ||
| Abnormalities of the Hemostatic System | 475 | ||
| Platelet Disorders | 475 | ||
| Gestational Thrombocytopenia | 475 | ||
| Immune Thrombocytopenia | 475 | ||
| Disorders of Platelet Function | 476 | ||
| Coagulation Disorders | 477 | ||
| Von Willebrand's Disease | 477 | ||
| Thrombophilia | 478 | ||
| Factor V Leiden | 478 | ||
| Prothrombin 20210 Mutation | 479 | ||
| Protein S Deficiency | 480 | ||
| Protein C Deficiency | 480 | ||
| Hyperhomocysteinemia | 480 | ||
| Thromboembolism During Pregnancy | 481 | ||
| Deep Vein Thrombosis | 481 | ||
| Pulmonary Embolization | 482 | ||
| Treatment of DVT and Pulmonary Embolization | 483 | ||
| Indian Experience of Anemia Complicating Pregnancy | 484 | ||
| Indian Experience of Thrombocytopenia in Pregnancy | 485 | ||
| Important Points | 486 | ||
| Chapter 19 - Abnormalities of the Urinary System During Pregnancy\r | 489 | ||
| Changes in the Urinary System During Pregnancy | 489 | ||
| Renal Disease and Pregnancy | 490 | ||
| Urinary Conditions of New Onset During Pregnancy | 490 | ||
| Urinary Tract Infections | 490 | ||
| Asymptomatic Bacteriuria | 490 | ||
| Acute Pyelonephritis | 491 | ||
| Acute Nephrolithiasis | 492 | ||
| Acute Renal Failure | 494 | ||
| Definition | 494 | ||
| Pathophysiology | 494 | ||
| Diagnosis | 495 | ||
| Treatment | 496 | ||
| Hemolytic-Uremic Syndrome | 497 | ||
| Renal Cortical Necrosis | 498 | ||
| ARF Secondary to Obstructive Uropathy | 498 | ||
| Nephrotic Syndrome | 498 | ||
| Etiology and Diagnosis | 498 | ||
| Management | 499 | ||
| Pregnancy in Patients with Known Renal Disease | 500 | ||
| Maternal and Fetal Prognoses | 500 | ||
| Complications | 501 | ||
| Hypertension | 501 | ||
| Fetal Growth Restriction | 501 | ||
| Preterm Birth | 501 | ||
| Fetal Distress | 501 | ||
| Management | 502 | ||
| General Measures | 502 | ||
| Antihypertensive Treatment | 502 | ||
| Monitoring of Renal Function | 502 | ||
| Fetal Evaluation | 502 | ||
| Delivery | 502 | ||
| Chronic Pyelonephritis | 502 | ||
| Pregnancy in Women with Renal Transplants | 502 | ||
| Pregnancy in Women in Chronic Dialysis | 503 | ||
| Indian Experience of Renal Diseases in Pregnancy | 503 | ||
| Important Points | 503 | ||
| Chapter 20 - Cardiac Disease and Pregnancy\r | 506 | ||
| Preconceptional Counseling | 507 | ||
| Hemodynamic Changes During Pregnancy | 508 | ||
| Effects Of Pregnancy On Maternal Cardiac Disease | 509 | ||
| Effects Of Maternal Cardiac Disease On Pregnancy | 510 | ||
| General Measures For The Care Of Pregnant Patients With Heart Disease | 510 | ||
| Monitoring Cardiac Function During Pregnancy | 510 | ||
| Measures and Medications Frequently Used in Women with Heart Disease and Pregnancy | 511 | ||
| Antepartum | 511 | ||
| During Labor and Delivery | 511 | ||
| Treatment Of Acute CHF During Pregnancy | 512 | ||
| Acute Pulmonary Edema During Pregnancy | 514 | ||
| Specific Cardiac Conditions And Pregnancy | 514 | ||
| Valvular Lesions | 515 | ||
| Mitral Stenosis | 515 | ||
| Aortic Stenosis | 515 | ||
| Pulmonic Stenosis | 515 | ||
| Mitral Regurgitation | 516 | ||
| Aortic Regurgitation | 516 | ||
| Mitral Valve Prolapse | 516 | ||
| Women With Prosthetic Heart Valves | 517 | ||
| Left to Right Shunts | 517 | ||
| Atrial Septal Defects | 517 | ||
| Ventricular Septal Defects | 518 | ||
| Patent Ductus Arteriosus | 518 | ||
| Right to Left Shunts | 518 | ||
| Myocardial Conditions | 518 | ||
| Peripartum Cardiomyopathy | 518 | ||
| Ischemic Heart Disease | 519 | ||
| Other Cardiac Conditions Of Importance During Pregnancy | 520 | ||
| Aortic Coarctation | 520 | ||
| Eisenmenger's Syndrome | 520 | ||
| Primary Pulmonary Hypertension | 520 | ||
| Marfan's Syndrome | 521 | ||
| Cardiac Arrhythmias During Pregnancy | 521 | ||
| Indian Experience Of Heart Disease Complicating Pregnancy | 522 | ||
| Important Points | 523 | ||
| Section III: Tropical Diseases In Pregnancy \r | 526 | ||
| Chapter 21 - Tropical Diseases in Pregnancy\r | 527 | ||
| Malaria in Pregnancy | 528 | ||
| The Malarial Parasite | 528 | ||
| Pathology | 528 | ||
| Clinical Features | 529 | ||
| Diagnosis | 529 | ||
| Effects of Malaria During Pregnancy | 529 | ||
| Maternal Effects | 529 | ||
| Fetal and Perinatal Effects | 529 | ||
| Effects of Pregnancy on Malaria | 530 | ||
| Prognostic Parameters | 530 | ||
| Management | 530 | ||
| Preventative Treatment | 530 | ||
| Congenital and Neonatal Malaria | 531 | ||
| Dengue Fever in Pregnancy | 531 | ||
| Causative Organism | 531 | ||
| Pathology | 531 | ||
| Clinical Features | 531 | ||
| Diagnosis | 531 | ||
| Maternal Risks | 531 | ||
| Fetal Risks | 531 | ||
| Management | 532 | ||
| Intestinal Parasitic Infestations in Pregnancy | 532 | ||
| Amebiasis in Pregnancy | 532 | ||
| Definition | 532 | ||
| Pathology | 532 | ||
| Clinical Features | 532 | ||
| Diagnosis | 532 | ||
| Maternal Effects | 532 | ||
| Index\r | 553 | ||
| A | 553 | ||
| B | 555 | ||
| C | 555 | ||
| D | 557 | ||
| E | 558 | ||
| F | 559 | ||
| G | 560 | ||
| H | 561 | ||
| I | 562 | ||
| J | 563 | ||
| K | 563 | ||
| L | 563 | ||
| M | 563 | ||
| N | 565 | ||
| O | 566 | ||
| P | 566 | ||
| Q | 568 | ||
| R | 568 | ||
| S | 569 | ||
| T | 570 | ||
| U | 571 | ||
| V | 572 | ||
| W | 572 | ||
| Z | 572 | ||
| Color Plates\r | 573 |