BOOK
Medical Disorders in Pregnancy, An Issue of Obstetrics and Gynecology Clinics, E-Book
Judith Hibbard | Erika Peterson
(2018)
Additional Information
Book Details
Abstract
The Guest Editors have assembled expert authors to provide current clinical views and recommendations for patients with medical disorders in pregnancy. Clinical reviews are devoted to the following topics: Obstructive sleep apnea in pregnancy; Pregestational Diabetes; Gestational Diabetes; Maternal mortality in the 21 century; Infections in pregnancy and the role of vaccines; Peripartum cardiomyopathy; Update on HIV in pregnancy: Thromboprophylaxis; Opiate abuse in pregnancy.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Medical Disorders in\rPregnancy\r | i | ||
| Copyright | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Foreword: Team-Based Care of Pregnant Women with Challenging Medical Disorders | vii | ||
| Preface: Medical Disorders in Pregnancy | vii | ||
| Maternal Mortality in the Twenty-First Century | vii | ||
| Cancer in Pregnancy | vii | ||
| Opioid Use Disorders and Pregnancy | vii | ||
| Pregnancy in Women with Obesity | vii | ||
| Management of Obstructive Sleep Apnea in Pregnancy | viii | ||
| Maternal Genetic Disorders in Pregnancy | viii | ||
| Maternal Congenital Heart Disease in Pregnancy | viii | ||
| New Insights in Peripartum Cardiomyopathy | viii | ||
| Gestational Diabetes: Underpinning Principles, Surveillance, and Management | ix | ||
| Pregestational Diabetes in Pregnancy | ix | ||
| Hypertensive Disorders in Pregnancy | ix | ||
| Seizures in Pregnancy | ix | ||
| Infections in Pregnancy and the Role of Vaccines | x | ||
| Thromboprophylaxis in Pregnancy | x | ||
| OBSTETRICS AND GYNECOLOGY CLINICS | xi | ||
| FORTHCOMING ISSUES | xi | ||
| September 2018 | xi | ||
| December 2018 | xi | ||
| March 2019 | xi | ||
| RECENT ISSUES | xi | ||
| March 2018 | xi | ||
| December 2017 | xi | ||
| September 2017 | xi | ||
| Foreword:\rTeam-Based Care of Pregnant Women with Challenging Medical Disorders | xiii | ||
| Preface:\rMedical Disorders in Pregnancy | xv | ||
| Maternal Mortality in the Twenty-First Century | 175 | ||
| Key points | 175 | ||
| INTRODUCTION | 175 | ||
| MATERNAL MORTALITY IN THE UNITED STATES | 177 | ||
| RACIAL DISPARITIES AND MATERNAL MORTALITY IN THE UNITED STATES | 179 | ||
| PREVENTABILITY | 180 | ||
| SEVERE MATERNAL MORBIDITY | 180 | ||
| STRATEGIES FOR REDUCTION OF MATERNAL MORTALITY | 181 | ||
| SUMMARY | 183 | ||
| REFERENCES | 183 | ||
| Cancer in Pregnancy | 187 | ||
| Key points | 187 | ||
| INTRODUCTION | 187 | ||
| BREAST CANCER | 187 | ||
| CERVICAL CANCER | 191 | ||
| HEMATOLOGIC CANCERS | 193 | ||
| COLON CANCER | 194 | ||
| SUMMARY | 195 | ||
| REFERENCES | 195 | ||
| Opioid Use Disorders and Pregnancy | 201 | ||
| Key points | 201 | ||
| INTRODUCTION | 201 | ||
| Defining Opioid Use Disorder | 202 | ||
| ISSUES IN PREGNANCY | 202 | ||
| Screening | 202 | ||
| Complications of Opioid Use Disorder | 202 | ||
| Treatment | 203 | ||
| Medication-assisted therapy | 204 | ||
| Methadone | 204 | ||
| Buprenorphine | 204 | ||
| Methadone versus buprenorphine: initiating therapy in pregnancy | 205 | ||
| Alternative treatment options | 206 | ||
| Medically assisted withdrawal | 206 | ||
| Naltrexone | 207 | ||
| COMPREHENSIVE OBSTETRIC CARE AND OPIOID USE DISORDERS | 207 | ||
| Antepartum Care | 207 | ||
| Communication | 207 | ||
| Psychiatric disorders | 207 | ||
| Tobacco use disorders | 208 | ||
| Infectious complications | 208 | ||
| Constipation | 208 | ||
| Fetal surveillance | 208 | ||
| Patient expectations | 209 | ||
| Peripartum Care | 209 | ||
| Intrapartum | 209 | ||
| Postpartum | 209 | ||
| RESPONSIBLE OPIOID PRESCRIBING | 210 | ||
| SUMMARY | 210 | ||
| REFERENCES | 210 | ||
| Pregnancy in Women with Obesity | 217 | ||
| Key points | 217 | ||
| INTRODUCTION | 217 | ||
| ANTEPARTUM MANAGEMENT OF PREGNANCY IN WOMEN WITH OBESITY | 218 | ||
| Counseling Women with Obesity | 218 | ||
| Gestational Weight Gain | 218 | ||
| Ultrasound Limitations | 219 | ||
| Genetic Screening and Testing | 219 | ||
| Fetal Anomalies | 220 | ||
| Spontaneous Abortion | 221 | ||
| Medical Complications | 221 | ||
| Stillbirth | 222 | ||
| Fetal Growth | 222 | ||
| Prior Bariatric Surgery | 223 | ||
| INTRAPARTUM MANAGEMENT OF PREGNANCY IN WOMEN WITH OBESITY | 223 | ||
| Resource and Equipment Considerations | 223 | ||
| Labor Abnormalities | 224 | ||
| Cesarean Delivery | 225 | ||
| Labor and Delivery Anesthesia | 225 | ||
| Prevention of Venous Thromboembolism | 225 | ||
| Prevention of Wound Complications | 226 | ||
| POSTPARTUM MANAGEMENT OF WOMEN WITH OBESITY | 226 | ||
| Breastfeeding | 226 | ||
| Contraception | 227 | ||
| SUMMARY | 227 | ||
| REFERENCES | 227 | ||
| Management of Obstructive Sleep Apnea in Pregnancy | 233 | ||
| Key points | 233 | ||
| WHAT IS SLEEP-DISORDERED BREATHING? | 234 | ||
| GESTATIONAL OBSTRUCTIVE SLEEP APNEA | 234 | ||
| EPIDEMIOLOGY AND RISK FACTORS | 234 | ||
| SCREENING AND DIAGNOSIS | 235 | ||
| TREATMENT | 236 | ||
| MATERNAL MORBIDITY | 236 | ||
| SEVERE MATERNAL MORBIDITY | 237 | ||
| NEONATAL MORBIDITY | 237 | ||
| MECHANISMS OF DISEASE | 237 | ||
| LONG-TERM IMPLICATIONS OF SLEEP APNEA | 239 | ||
| CLINICAL CARE | 239 | ||
| Antepartum Care | 239 | ||
| Intrapartum and Immediate Postpartum Management | 240 | ||
| SUMMARY | 241 | ||
| REFERENCES | 242 | ||
| Maternal Genetic Disorders in Pregnancy | 249 | ||
| Key points | 249 | ||
| INTRODUCTION | 249 | ||
| HEREDITARY HEMORRHAGIC TELANGIECTASIA | 249 | ||
| Pregnancy in Women with Hereditary Hemorrhagic Telangiectasia | 250 | ||
| Pregnancy Management | 251 | ||
| Risk Assessment and Genetic Counseling | 252 | ||
| TUBEROUS SCLEROSIS COMPLEX | 252 | ||
| Pregnancy in Women with Tuberous Sclerosis Complex | 252 | ||
| Pregnancy Management | 254 | ||
| Risk Assessment and Genetic Counseling | 254 | ||
| MYOTONIC DYSTROPHY | 255 | ||
| Pregnancy in Women with Myotonic Dystrophy Type 1 | 256 | ||
| Pregnancy Management | 256 | ||
| Risk Assessment and Genetic Counseling | 258 | ||
| ORNITHINE TRANSCARBAMOYLASE DEFICIENCY | 259 | ||
| Pregnancy in Female Carriers of Ornithine Transcarbamoylase Deficiency | 260 | ||
| Pregnancy Management | 261 | ||
| Risk Assessment for Offspring and Potential Prenatal Testing Options | 262 | ||
| SUMMARY | 262 | ||
| REFERENCES | 262 | ||
| Maternal Congenital Heart Disease in Pregnancy | 267 | ||
| Key points | 267 | ||
| INTRODUCTION | 267 | ||
| MATERNAL PHYSIOLOGIC CHANGES IN PREGNANCY | 267 | ||
| GENERAL CONSIDERATIONS | 268 | ||
| Maternal Risk and Risk Stratification | 268 | ||
| Fetal and Neonatal Risk | 270 | ||
| Preconception Counseling and Management | 270 | ||
| Antepartum Care | 270 | ||
| Intrapartum Care | 271 | ||
| SPECIFIC CARDIAC CONDITIONS | 271 | ||
| Thoracic Aortic Disease | 271 | ||
| Marfan Syndrome | 271 | ||
| Aortic Coarctation | 272 | ||
| Tetralogy of Fallot | 272 | ||
| Transposition of the Great Arteries | 273 | ||
| Fontan Circulation | 273 | ||
| Atrial Septal Defects | 274 | ||
| Atrioventricular Septal Defect (Endocardial Cushion Defect) | 275 | ||
| Ventricular Septal Defect | 275 | ||
| Patent Ductus Arteriosus | 275 | ||
| Pulmonary Stenosis and Regurgitation | 276 | ||
| Pulmonary Hypertension | 276 | ||
| SUMMARY | 277 | ||
| REFERENCES | 277 | ||
| New Insights in Peripartum Cardiomyopathy | 281 | ||
| Key points | 281 | ||
| INTRODUCTION | 281 | ||
| PROPOSED PATHOGENIC MECHANISMS | 282 | ||
| Hormonal/Vascular Derangements | 282 | ||
| Genetics | 283 | ||
| Risk Factors | 284 | ||
| Diagnosis | 284 | ||
| Management of Heart Failure in Pregnancy | 284 | ||
| Other Novel Therapies | 289 | ||
| Management of Delivery | 290 | ||
| Maternal Prognosis | 291 | ||
| Prognosis with Subsequent Pregnancies | 292 | ||
| SUMMARY | 293 | ||
| REFERENCES | 293 | ||
| Gestational Diabetes | 299 | ||
| Key points | 299 | ||
| INTRODUCTION | 299 | ||
| Physiology | 300 | ||
| Fetal Programming | 301 | ||
| Diagnosis | 301 | ||
| Glucose Challenge Tests | 303 | ||
| Management (Glucose Monitoring) | 304 | ||
| Management (Diet Control) | 305 | ||
| Gestational Weight Gain and Gestational Diabetes Mellitus | 306 | ||
| Management (Pharmacologic Control: Oral Hypoglycemic Agents and Insulin) | 306 | ||
| Oral Hypoglycemic Agents | 307 | ||
| Fetal Surveillance | 308 | ||
| Intrapartum Management and Delivery Timing | 308 | ||
| Delivery Mode | 308 | ||
| Insulin Glucose Tolerance Test Protocol and Glycemic Monitoring Protocol Intrapartum | 309 | ||
| Postpartum Screening | 309 | ||
| SUMMARY | 310 | ||
| REFERENCES | 311 | ||
| Pregestational Diabetes in Pregnancy | 315 | ||
| Key points | 315 | ||
| INTRODUCTION | 315 | ||
| Glucose Metabolism in Pregnancy | 315 | ||
| Classification | 316 | ||
| RISKS OF PREGESTATIONAL DIABETES DURING PREGNANCY | 317 | ||
| Maternal Complications | 317 | ||
| Chronic hypertension | 317 | ||
| Nephropathy | 317 | ||
| Preeclampsia | 318 | ||
| Retinopathy | 318 | ||
| Neuropathy | 318 | ||
| Coronary artery disease | 318 | ||
| Diabetic ketoacidosis | 318 | ||
| Fetal Complications | 318 | ||
| Normal fetal glucose physiology | 318 | ||
| Risks to fetus in early pregnancy | 319 | ||
| Abnormal fetal growth | 319 | ||
| Amniotic fluid abnormalities | 319 | ||
| Stillbirth | 319 | ||
| Prematurity | 319 | ||
| MANAGEMENT OF PREGESTATIONAL DIABETES IN PREGNANCY | 319 | ||
| Preconception Counseling | 319 | ||
| Nutrition | 319 | ||
| Intensive Glucose Monitoring | 319 | ||
| Hemoglobin A1c in Pregnancy | 320 | ||
| Insulin Requirements Through Pregnancy | 320 | ||
| Insulin | 321 | ||
| Dosing Regimens | 322 | ||
| Oral Hypoglycemics | 322 | ||
| Glyburide | 322 | ||
| Metformin | 322 | ||
| Hypoglycemia | 322 | ||
| Management of Diabetic Ketoacidosis | 322 | ||
| Intrapartum Glucose Control | 323 | ||
| Fetal Monitoring | 323 | ||
| Timing of Delivery | 324 | ||
| Mode of Delivery | 324 | ||
| Postpartum Care | 324 | ||
| Maternal insulin requirements | 324 | ||
| Breastfeeding | 324 | ||
| Contraception | 324 | ||
| Postpartum transition of care | 324 | ||
| SUMMARY | 325 | ||
| REFERENCES | 325 | ||
| Hypertensive Disorders in Pregnancy | 333 | ||
| Key points | 333 | ||
| INTRODUCTION | 333 | ||
| CHRONIC HYPERTENSION | 334 | ||
| Definition and Epidemiology | 334 | ||
| Diagnosis | 334 | ||
| Complications | 334 | ||
| Management | 334 | ||
| GESTATIONAL HYPERTENSION | 335 | ||
| Definition and Epidemiology | 335 | ||
| Diagnosis | 336 | ||
| Complications | 336 | ||
| Management | 336 | ||
| PREECLAMPSIA-ECLAMPSIA | 337 | ||
| Definition and Epidemiology | 337 | ||
| Diagnosis | 337 | ||
| Complications | 338 | ||
| Management | 339 | ||
| Antepartum | 339 | ||
| Intrapartum | 340 | ||
| Postpartum | 341 | ||
| Prevention | 342 | ||
| PREECLAMPSIA SUPERIMPOSED ON CHRONIC HYPERTENSION | 342 | ||
| Definition and Epidemiology | 342 | ||
| Diagnosis | 343 | ||
| Complications | 343 | ||
| Management | 343 | ||
| SUMMARY | 343 | ||
| REFERENCES | 343 | ||
| Seizures in Pregnancy | 349 | ||
| Key points | 349 | ||
| INTRODUCTION: BACKGROUND AND EPIDEMIOLOGY | 349 | ||
| Epilepsy | 349 | ||
| DEFINITION AND CLASSIFICATION | 350 | ||
| Definition | 350 | ||
| Classification System | 350 | ||
| INITIAL EVALUATION | 351 | ||
| PRECONCEPTION COUNSELING AND MANAGEMENT | 353 | ||
| Contraception | 353 | ||
| Maternal and Fetal Risks | 353 | ||
| Maternal complications | 354 | ||
| Fetal complications | 354 | ||
| Selection and Management of Antiepileptic Drugs | 355 | ||
| Folate Supplementation | 356 | ||
| ANTEPARTUM MANAGEMENT | 356 | ||
| Anticonvulsant Drug Monitoring | 356 | ||
| Vitamin K | 357 | ||
| Antepartum Testing | 357 | ||
| INTRAPARTUM CARE | 358 | ||
| Route of Delivery | 358 | ||
| Management of the Acute Seizure During Labor | 358 | ||
| Epileptic seizure | 358 | ||
| Eclamptic seizure | 358 | ||
| Initial management considerations | 359 | ||
| Fetal heart rate monitoring | 359 | ||
| Delivery | 361 | ||
| POSTPARTUM MANAGEMENT | 361 | ||
| Antiepileptic Drug Management | 361 | ||
| Safety in the Postpartum Period | 361 | ||
| Breastfeeding | 361 | ||
| SUMMARY | 362 | ||
| REFERENCES | 362 | ||
| Infections in Pregnancy and the Role of Vaccines | 369 | ||
| Key points | 369 | ||
| INTRODUCTION | 369 | ||
| MATERNAL IMMUNIZATION BENEFITS | 370 | ||
| Types of Vaccines | 370 | ||
| VACCINES RECOMMENDED IN PREGNANCY OR POSTPARTUM | 372 | ||
| Influenza Vaccine | 372 | ||
| Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine | 373 | ||
| Tetanus Vaccine | 374 | ||
| Measles, Mumps, Rubella Vaccine | 374 | ||
| Varicella Vaccine | 375 | ||
| VACCINES RECOMMENDED IN PREGNANCY AND POSTPARTUM IN SPECIAL CIRCUMSTANCES | 375 | ||
| Hepatitis A | 375 | ||
| Hepatitis B | 378 | ||
| Pneumococcal Vaccine | 378 | ||
| Meningococcal Vaccine | 379 | ||
| VACCINES CURRENTLY UNDER INVESTIGATION | 379 | ||
| Zika Vaccine | 379 | ||
| Group B Streptococcus Vaccine | 380 | ||
| Respiratory Syncytial Virus Vaccine | 381 | ||
| Cytomegalovirus Vaccine | 381 | ||
| ROLE OF OBSTETRICIANS AS VACCINATORS | 382 | ||
| SUMMARY | 382 | ||
| REFERENCES | 383 | ||
| Thromboprophylaxis in Pregnancy | 389 | ||
| Key points | 389 | ||
| BACKGROUND | 389 | ||
| DEFINITION, RISKS, AND GUIDING PRINCIPLES | 390 | ||
| ANTENATAL OUTPATIENT THROMBOPROPHYLAXIS | 392 | ||
| POSTPARTUM THROMBOPROPHYLAXIS | 395 | ||
| THROMBOPROPHYLAXIS FOR OTHER SIGNIFICANT EVENTS | 396 | ||
| Hospital Admission | 396 | ||
| Cesarean Delivery | 396 | ||
| ADDITIONAL CONSIDERATIONS | 399 | ||
| Obesity | 399 | ||
| Immobilization | 399 | ||
| Breastfeeding | 399 | ||
| SUMMARY | 399 | ||
| REFERENCES | 400 |