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Medical and Surgical Disorders in Pregnancy
Vinita Salvi
1:
Biochemical Parameters in Pregnancy
INTRODUCTION
1. Liver Function Test
Lipids Cholesterol and Triglyceride
2. Renal Function Test
3. Pulmonary Function
4. Carbohydrate Metabolism
Glucose Tolerance Test (GTT) (ACOG criteria)
5. Hematology
6. Coagulation Factors
7. Complement System, Immune Complexes
8. Acid-Base Balance
9. Endocrinology
a. Thyroid Function
b. Serum Prolactin
c. Serum Calcium
d. Adrenal Function
e. Serum Progesterone
PLACENTAL BIOCHEMISTRY
1. Serum Alpha Fetoprotein
2. Human Chorionic Gonadotrophin (HCG)
3. Human Placental Lactogen (HPL)
4. Estriol
FETAL BIOCHEMISTRY
1. Liver Function Test
2. Renal Function
3. Carbohydrate Metabolism
4. Blood gases
N. value for fetal blood gases
5. Hematology
6. Iron Metabolism
7. Amniotic Fluid Bilirubin
8. Thyroid Function
9. Fetal Urinary Biochemistry
2:
Anemia in Pregnancy
MANAGEMENT
Prophylaxis
Treatment
Side Effects
Failure of Oral Iron Therapy1,3
Parenteral Iron Therapy
Indications
Preparation and Administration
Response to Therapy
Guidelines to Assess the Adequacy of Response to Therapy3
Megaloblastic Anemia
Folic Acid
Impaired folate status is associated with:
STRATEGIES FOR INCREASING FOLIC ACID INTAKE
Abnormalities of Hemoglobin Production
Sickle Cell Disorders
Effect on the Mother and Fetus
Diagnosis
Management
To decrease the morbidity and mortality in them patients require:
Treatment of Vaso-occlusive Crisis
Other Hemoglobinopathies
The Thalassemias
Beta Thalassemia
Diagnosis
Beta Thalassemia Major
Prenatal Diagnosis
Hereditary Spherocytosis
Diagnosis
AUTOIMMUNE HEMOLYTIC ANEMIA (AIHA)
Diagnosis
Treatment
GLUCOSE 6 PHOSPHATE DEHYDROGENASE (G6PD) DEFICIENCY
Approach to a Patient with Anemia
Base Line Investigations
Initial Step in the Morphologic Classification of Anemia
Approach to a Macrocytic Anemia
Approach to a Microcytic Anemia
Approach to a Normocytic Anemia
3:
Blood and Blood Products in Obstetrics
INTRODUCTION
Trends in Blood Transfusion
Assessment of Blood Loss
Indications for Transfusion
Incidence of Transfusion in Obstetrics
Blood Components and Products
1. Cellular Components
2. Plasma Components
Whole Blood
Packed Red Blood Cells
Platelet Concentrate
Fresh Frozen Plasma
Cryoprecipitate
Risks of Transfusion Therapy
Patient Directed Donor (PDD)
Pharmacological Alternatives to Transfusion
Recombinant Growth Factors
a Erythropoietin (EPO)
b Granulocyte and Granulocyte—Macrophage Colony-Stimulating Factors (GCSF and GMCSF)
c Red Cell Substitutes
DDAVP
VITAMIN K
Fibrinolytic Inhibitors
Recombinant Products for Hemostasis
Autologous Blood Donation and Transfusion
Preoperative Collection
Intraoperative Hemodilution
Intraoperative Blood Salvage
Postoperative Blood Collection
Role of Autologous Transfusion in Obstetrics
Transfusion Decision-Making: Role of Transfusion Audits and Practice Guidelines in Obstetrics
Blood Transfusion Services in India
Special Situations
Bloodless Obstetric Management (Jehovah's Witnesses)
Promoting the Rational Use of Blood: Recommendations/Conclusions
ACKNOWLEDGEMENT
4:
Disseminated Intra-vascular Coagulation in Obstetrics
INTRODUCTION
Definition
History
Incidence
Etiology and Mechanisms
Pathophysiology
Clinical Features
Laboratory Investigations
Diagnosis
Management Philosophy
Removing the Initial Stimulus
Maintaining Organ Perfusion
Replacement of Blood Components
Other Treatment Options for DIC
CONCLUSIONS
5:
Dyspnea
INDIRECT METHOD
Clinical Interview and Questionnaires
Measurement of Exercise Performance
Direct Method
Etiology of Dyspnea
6:
Pregnancy and Asthma
INTRODUCTION
WHAT IS ASTHMA
Definition2
EFFECTS OF ASTHMA ON PREGNANCY
EFFECT OF PREGNANCY ON ASTHMA
ESTABLISHING DIAGNOSIS OF ASTHMA
Peak Expiratory Flow Rate (PEFR) Monitoring
Lung Function Testing
MANAGEMENT OF ASTHMA DURING PREGNANCY
TREATMENT
Patient Education
Avoidance Therapy
Pharmacological Therapy
Management of acute asthma during pregnancy
Special Considerations During Obstetric Management18-21
CONCLUSION
ACKNOWLEDGEMENT
7:
Pregnancy and Tuberculosis
INTRODUCTION
INCIDENCE
EPIDEMIOLOGY
CLINICAL FEATURES
Symptoms
Signs
1. Tuberculous Meningitis:
2. Intestinal Obstruction:
3. Ectopic Pregnancy:
4. Tuberculous Mastitis:
5. Childhood Tuberculosis of the Spine or Tuberculous Osteomyelitis:
INVESTIGATIONS
Microscopy
Smear and Culture
Radiometric method for detection of M. tuberculosis (Bactec system)
Antimicrobial Sensitivity
Biochemical Tests
Biochemical Markers for Diagnosis
Serological Tests
Molecular Diagnosis
PCR and other gene probe methods are useful in cases of
EFFECT OF PREGNANCY ON TUBERCULOSIS
EFFECT OF TUBERCULOSIS ON PREGNANCY
MANAGEMENT OF A CASE OF PREGNANCY WITH TUBERCULOSIS
Prenatal Management
Intranatal Management
Postnatal Management
Contraception
CHEMOTHERAPY DURING PREGNANCY
DRUG RESISTANCE AND HIV CONSIDERATION
CONGENITAL TUBERCULOSIS
MANAGEMENT OF THE NEONATE
MOTHER ON CHEMOTHERAPY
CONCLUSION
8:
Cardiac Emergencies in Pregnancy
THERAPEUTIC ABORTION IN CARDIAC DISEASE
CONGESTIVE HEART FAILURE IN PREGNANCY
CORONARY HEART DISEASE IN PREGNANCY
Arrhythmias in Pregnancy
CARDIAC EMERGENCIES IN PREGNANCY WITH ACQUIRED VALVULAR HEART DISEASE
CARDIAC EMERGENCIES IN PREGNANCY WITH CARDIOMYOPATHY
CARDIAC EMERGENCIES IN PREGNANCY WITH CONGENITAL HEART DISEASE
CARDIAC EMERGENCIES IN PREGNANCY WITH MISCELLANEOUS CONDITIONS
MATERNAL AND FETAL RISK DUE TO HEART DISEASE
9:
Pregnancy and Congenital Heart Disease
INTRODUCTION
SPECIFIC MALFORMATIONS
Atrial Septal Defect (ASD)
Ventricular Septal Defect (VSD)
Patent Ductus Arteriosus (PDA)
Congenital Aortic Valve Disease
Coarctation of Aorta
Pulmonic Stenosis
Tetralogy of Fallot
Eisenmenger's Syndrome
Ebstein's Anomaly
Transposition of Great Vessels
Complex Cyanotic CHDs
Management of Pregnant Women with Congenital Heart Diseases
Preconceptional Aspects
Antibiotic Prophylaxis for Infective Endocarditis (AHA)
Antepartum Care
Intrapartum Management
The Puerperium
Genetic Implications of Congenital Heart Diseases
Prenatal Diagnosis of Congenital Heart Disease
10:
Pulmonary Edema in Pregnancy
INTRODUCTION
Clinical Diagnosis
Investigations
Treatment of Pulmonary Edema
Common Conditions Specific to Pregnancy Causing Pulmonary Edema
Tocolytic Therapy
Preeclampsia/Eclampsiam
Peripartum Cardiomyopathy
Management of Pulmonary Edema during Labor
Future advice to prevent pulmonary edema
11:
Hepatic Disorders in Pregnancy
INTRODUCTION
Hepatic Changes in Normal Pregnancy
Liver Tests in Normal Pregnancy
Jaundice in Pregnancy
Jaundice in the First Trimester
Jaundice in the Second Trimester
Jaundice in the Third Trimester and Postpartum
CAUSES OF JAUNDICE SPECIFIC TO PREGNANCY INTRAHEPATIC CHOLESTASIS OF PREGNANCY (IHCP)
Definition
Incidence
Clinical Features
Laboratory Diagnosis
Pathology
Maternal Risks
Fetal Risks
Management
Maternal Symptom Relief
Monitoring of Fetal Well Being
Timing of Delivery
Vitamin K Supplementation
Postpartum Course and Care
Contraceptive Advice
ACUTE FATTY LIVER OF PREGNANCY (AFLP)
Definition
Incidence
Etiology
Clinical Features
Clinical Diagnosis
Laboratory Diagnosis
Maternal Risks
Fetal Risk
Management
Postpartum course and care
HYPEREMESIS GRAVIDARUM
Definition
Incidence
Maternal Risks
Fetal Risks
Management
SEVERE PRE-ECLAMPSIA
Definition and Incidence
Maternal Risks
Fetal Risks
Management
Post-partum Course
CAUSES OF JAUNDICE NOT SPECIFIC TO PREGNANCY
Gilbert's disease
Viral Infections
Autoimmune Hepatitis
CONCLUSION
12:
Viral Hepatitis in Pregnancy
13:
Gastro-esophageal Reflux Disease
INTRODUCTION
SYMPTOMATOLOGY
PATHO-PHYSIOLOGY
DIAGNOSIS
Management
Life-style Modifications
Antacids
Sucralfate
H2RA antagonists
Prokinetics
Proton pump inhibitors
SUMMARY
14:
Inflammatory Bowel Disease
15:
Portal Hypertension and Pregnancy
INTRODUCTION
Normal Changes in Liver Anatomy, Physiology and Function in Pregnancy.
Anatomy and Physiology
Liver Blood Flow
Changes in Serum Proteins
Serum Bilirubin Level
Liver Tests
Pathophysiology of Portal Hypertension
Classification of Portal Hypertension
Cirrhosis and Pregnancy
Extra Hepatic Portal Vein Obstruction (EHPVO) and Pregnancy
Non-Cirrhotic Portal Fibrosis (NCPF) and Pregnancy
Budd Chiari Syndrome
Our Experience
CONCLUSION
16:
Neurological Diseases in Pregnancy
INTRODUCTION
Disorders of Central Nervous System
Disorders of Nerves and Nerve Roots
Disorders of Muscle and Neuromuscular Transmission
INTRODUCTION
Investigations for Neurologic Diseases during Pregnancy
Disorders of Central Nervous System
Syncope
Headache
Tension Headache
Migraine
Trigeminal Neuralgia
Tumours
Cerebrovascular Disease
Cerebral Infarction
Intracerebral Haemorrhage
Subarachnoid Haemorrhage
Cerebral Venous Thrombosis
Epilepsy
Multiple Sclerosis
Chorea Gravidarum
Listeriosis
DISORDERS OF THE NERVES AND THE NERVE ROOTS
DISORDERS OF MUSCLE AND NEURO-MUSCULAR TRANSMISSION
17:
Epilepsy in Pregnancy
INTRODUCTION
Effect of Pregnancy on Epilepsy
Effect of Epilepsy on Pregnancy
Effect of Epilepsy on Fetus
Management
Prenatal
Labour Delivery
Postnatal
Status Epilepticus
Steps of Management24
18:
Psychiatric Disturbances in Pregnancy
19:
Infections and Vaccines in the First Trimester
INTRODUCTION
HISTORY
TYPES OF INFECTIONS
Effects of Pregnancy on the Immune System
Fetal Immunology
Effects of Infections on Pregnancy
Effects of Infections on Fetus
Clinical Presentations
I. Fever with Rash
II. Malformations
III. Recurrent Abortions
Screening
Diagnostic Techniques
Maternal diagnosis
Fetal Diagnosis
Management Options
Observation
Medical Termination of Pregnancy
Antibiotics
Immunoglobulins
Vaccines
Counseling
Conclusions
Case Situations
I. Fever and rash in the first trimester:
II. History of exposure to infection in the first trimester:
III. History of recurrent abortions with a TORCH screen:
20:
Viral Infections in Pregnancy
INTRODUCTION
Pathogenesis
Placenta and Fetus
Viral Teratogenesis
Respiratory Viruses
Influenza
Management
Mumps
Measles (Rubeola)
Varicella-zoster
Parvovirus B19
Ebstein-Barr Virus
Rabies
Enteroviruses (Echo, Coxsackie, Polio)
Arboviruses (or arthropod-borne viruses)
Arenavirus (or haemorrhagic fever viruses)
Human Papilloma Virus
Treatment in Pregnancy
Molluscum Contagiosum
Diagnosis of Viral Infections
Management of Viral infections
A. Acyclovir
B. Zidovudine (Retrovir)
21:
Malaria in Pregnancy
INTRODUCTION
Life Cycle
Clinical Features
Diagnosis
Malaria and Pregnancy
Management
Prophylaxis
22:
Other Infections in Pregnancy
INTRODUCTION
23:
Acute Renal Failure in Pregnancy
24:
Pregnancy and Chronic Renal Disease
THE FINAL WORD
25:
The Urinary Tract in Pregnancy
26:
Hypertension in Pregnancy
INTRODUCTION
DEFINITIONS
American College of Obstetricians and Gynecologists (ACOG)
PREECLAMPSIA
RISK FACTORS3
DIAGNOSIS
CRITERIA FOR THE DIAGNOSIS OF SEVERE PREECLAMPSIA
PREDICTION OF PREECLAMPSIA
TESTS PROPOSED FOR EARLY DETECTION OF PREGNANCY INDUCED HYPERTENSIVE DISEASE
Prevention of Preeclampsia
Pharmacological Manipulation
Personal Habit Changes
Laboratory Findings
1. Altered Renal Function
2. Altered Liver Function Tests
3. Hematological Abnormalities
MANAGEMENT
Management of Mild Preeclampsia
TRADITIONAL MANAGEMENT
Hospital versus Home Management
MANAGEMENT ALTERNATIVES
HOME MONITORING
OUT PATIENT MANAGEMENT REQUIREMENT
MANAGEMENT PROTOCOL
MANAGEMENT OF SEVERE PREECLAMPSIA
Preeclampsia Affects Two Patients: The Mother and Fetus
Criteria for Delivery of Patients with Severe Preeclampsia21
MANAGEMENT ACCORDING TO GESTATIONAL AGE
Antihypertensive Drugs in Severe Preeclampsia
Drugs for Acute Treatment of Severe Hypertension
1. Hydralazine
2. Labetalol
3. Nifedipine
Other Antihypertensive Agents
Drugs for Acute Treatment of Severe Hypertension
INTRAPARTUM MANAGEMENT
Anesthesia
COMPLICATED FORMS OF PREECLAMPSIA
Eclampsia
Definition
Pathophysiology
Classification
Clinical Course
Management
II. Control of Convulsions
CONTROL OF HYPERTENSION
Objectives
Fluid Therapy
Delivery
Maternal Complications Assessment with Eclampsia28 Sibai et al (n = 254)
Complications in relation to the timing of conclusions
HELLP SYNDROME
HELLP
Etiology
Effect of Disease on Pregnancy
Complications
Treatment
Delivery
CHRONIC HYPERTENSION
INTRODUCTION
ETIOLOGY
Causes
Vascular Disease
PATHOPHYSIOLOGY
Maternal and Fetal Risks
Management
LOW RISK CHRONIC HYPERTENSION
HIGH RISK CHRONIC HYPERTENSION
MANAGEMENT
Pregnancy
Laboratory Investigations
Maternal and Fetal Risks
1. Superimposed Preeclampsia
2. Fetal Growth Retardation
3. Preterm Labor
4. Abruptio Placenta
Initial and subsequent prenatal visits
ANTIHYPERTENSIVE DRUGS
1. Methyldopa
Calcium Channel Blockers
Nifedipine
β Blockers
Propranolol
Diuretics
Management During Pregnancy
Fetal Well Being
Delivery
CONCLUSION
27:
Skin Diseases in Pregnancy
I. PHYSIOLOGICAL CHANGES
Pigmentary Changes
Hair Changes
Nail Changes
Glandular Changes
Vascular Changes
Connective Tissue Changes
Striae Distensae
Others
II. ERUPTIONS SPECIFICALLY ASSOCIATED WITH PREGNANCY
Pruritus Gravidarum
Synonyms
Clinical Features
Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)
PEMPHIGOID GESTATIONIS
PRURIGO OF PREGNANCY
PRURITIC FOLLICULITIS OF PREGNANCY
PAPULAR DERMATITIS OF PREGNANCY
AUTOIMMUNE PROGESTERONE DERMATITIS OF PREGNANCY
LINEAR IGM DERMATOSES OF PREGNANCY
IMPETIGO HERPETIFORMIS
III. SKIN DISEASES MODIFIED DURING PREGNANCY
a. Infections and Immunity in Pregnancy
b. Autoimmune Disorders
c. Metabolic Disease
d. Disorders of Connective Tissue
e. Tumours
f. Miscellaneous Dermatoses
28:
Sexually Transmitted Diseases in Pregnancy
INTRODUCTION
SYPHILIS
Introduction
I. Early Infectious Phase Diagnosed in the first two years of infection
II. Late Non-Infectious Stage (Diagnosed at the end of 2 years)
Pathological Effects on Mother
Pathological Effect on Fetus
Changes in Syphilitic Placenta
Different Diagnostic Methods of Screening
Choice of Tests and Interpretation of Results
Clinical Features
1. Early Infectious Stage
Recurrent Stage
Early Latent Stage
2. Late Noninfectious Stage
Gummata
Cardiovascular Syphilis
Neurosyphilis
Congenital Syphilis
Radiological Appearance
Prophylaxis
Treatment Guidelines for Acquired Syphilis During Pregnancy
Side Effects of Drugs on Fetus
Treatment of Re-infections
GONORRHOEA
Introduction
Natural History of Infection
Routes of Transmission from Mother to Foetus
Pathological Effects on the Mother
Pathological Effects on the Foetus
Diagnostic Methods of Screening
Clinical Manifestations2
In males
Females
Rectal Infection
Pharyngeal Infection
GONOCOCCAL DISEASE OF THE NEWBORN
Ophthalmia neonatorum
Complications of Gonorrhoea
Systemic Complications: Disseminated Gonococcal infections (DGI)
Prophylaxis
Therapeutic Management of Infections
Ophthalmia Neonatorum
Side effects of drugs on fetus
Management of recurrent infections
LYMPHOGRANULOMA VENEREUM/CHLAMYDIAL INFECTIONS
Introduction
Natural History
Routes of Transmission from Mother to Fetus
Pathological Effect on Mother
Effect of C. trachomatis on Reproduction and Pregnancy
Role of C. trachomatis in Maternal Puerperal Morbidity
Pathological Effect on Foetus
Diagnostic methods of screening
Clinical Manifestations
Sites
Prophylaxis
Therapeutic Management
Side Effects
Management of Recurrent Infection
GENITAL HERPES
Introduction
Natural History of HSV Infection
Routes of Transmission from Mother to Fetus
Pathological Effect on Mother
Pathological Effects on Foetus
I. Intrauterine infection:
II. Babies who are infected intrapartum or postnatally can be divided into 3 categories.
1. Skin, Eye and/or Mouth Infection:
2. Encephalitis
3. Disseminated Infection
Diagnostic Methods of Screening34
1. Cytopathology
2. Histopathology
3. Electron microscopy
4. Immunofluorescence methods
5. Immunoenzyme methods
6. Nucleic acid probes (NAP)
7. Polymerase chain reaction
8. Cultures
9. Serology
Clinical Features
Primary Genital Infection
Non-primary Genital Herpes Infection
Recurrent Genital Herpes
Prophylaxis
Prevention of HSV Acquisition in Pregnancy
Prevention of Neonatal HSV Infection
Therapeutic Management
Management of herpes in Pregnancy 37
First episode genital herpes
Third Trimester Acquisition
Side Effects of Drugs on Fetus 39
ANOGENITAL WARTS, VIRAL WARTS
Introduction
Natural History of Infection
Routes of Transmission from Mother to Foetus
Pathological Effects on Mother
Pathological Effects on Foetus
Diagnostic Methods of Screening
Clinical Manifestations
Cervical HPV Infections
Prophylaxis
Therapeutic Management
Management of Recurrence
29:
HIV Infection in Pregnancy
INTRODUCTION
History
Magnitude of the Problem
Virology
Routes of Spread
Epidemiology of HIV in pregnancy
Identification
Screening
Diagnosis
The Immune System in Pregnant HIV Infected Women
Effects of Pregnancy on HIV Infection
Effect of HIV Infection on Pregnancy Outcome
Rates of Transmission
Timing of Transmission
Factors Affecting Mother to Child Transmission
Management Goals
Antenatal Investigations
Strategies to Prevent Perinatal HIV Transmission
Antiretroviral Therapy
Correction of Risk Factors
Optimizing Obstetric Practice: Intrapartum Care and the Role of Elective LSCS.
Breastfeeding Substitutes
Diagnosis of Pediatric HIV Infection
Conclusions
30:
Connective Tissue Disorders and Pregnancy
INTRODUCTION
Spectrum of Connective Tissue Disorders
RHEUMATOID ARTHRITIS
Effect of Pregnancy on Rheumatoid Arthritis
Effect of Rheumatoid Arthritis on Pregnancy
ANKYLOSING SPONDYLITIS
SJOGREN'S SYNDROME
SCLERODERMA (PROGRESSIVE SYSTEMIC SCLEROSIS PSS)
DERMATOMYOSITIS
POLYARTERITIS NODOSA
WEGENER GRANULOMATOSIS
EHLER-DANLOS SYNDROME
MARFANS SYNDROME
PSEUDOXANTHOMA ELASTICUM
31:
SLE in Pregnancy
SLE EMERGING CONCEPTS 1
Immune Dysregulation in SLE2,3
Auto-antibodies in Lupus: Relevance during Pregnancy
Anticardiolipin antibody
Pathogenesis of SLE Activity during Pregnancy3–6
Effect of SLE Activity on Fetal Outcome 8
SLE Flare during Pregnancy 7–10
Pre-eclampsia Versus Nephropathy
Thomas’ Lupus Pregnancy Clinic Assessment Protocol 13
Lupus Flare and Previous Lupus Nephritis11
Lupus Nephritis and Pregnancy Outcome12
Prevention of SLE Flare with Corticosteroids during Pregnancy 13–15
Treatment of Lupus Flares
Chloroquine/Hydroxychloroquine(HCQ)16
NSAIDs
32:
Drugs in Pregnancy
INTRODUCTION
Pharmacokinetics3
ABSORPTION
I. FACTORS REGARDING DRUG ABSORPTION
1. GI Absorption
2. Transdermal, Subcutaneous and Intramuscular Absorption1
3. Lung absorption
II. FACTORS REGARDING DRUG DISTRIBUTION
III. PROTEIN BINDING
IV. FACTORS PERTAINING TO DRUG CLEARANCE (BIOTRANSFORMATION AND METABOLISM)
V. FACTORS PERTAINING TO DRUG ELIMINATION.
Teratogenecity
Role of the Placenta1,15 and Feto-Placental Unit
Drug Usage in Pregnancy
33:
Contraception in Medical Disorders
CARDIOVASCULAR DISEASE
CONTRACEPTION AND DYSLIPIDEMIA
ENDOCRINE DISORDERS
THYROID DISEASE
DIABETES
PROLACTINOMA
PCOS
CONTRACEPTION IN WOMEN WITH NEUROLOGICAL DISORDERS
CONTRACEPTION IN WOMEN WITH BEHAVIORAL DISORDERS
CONTRACEPTION CONSIDERATIONS IN STD/RTI
CONCLUSION
BARRIER CONTRACEPTIVES55
CONCLUSION
CONTRACEPTION IN OTHER INFECTIONS
Malaria2
Infectious Diseases
Tuberculosis2
HAEMATOLOGICAL DISORDERS2
Anemia
Sickle-Cell Disease
Thalassaemia
LIVER DISEASE2
VIRAL HEPATITIS
CIRRHOSIS
CONTRACEPTION IN THE PERIMENOPAUSE2
HORMONAL CHANGES IN PERIMENOPAUSE
Oral Contraceptives
Reasons Why OC May be a Good Choice
Beneficial Effects of OCs in Perimenopause
Adverse Effects
Barrier Methods
IUCD
Injectables
Implants
CONCLUSION
THE IMPACT OF CONTRACEPTION ON GYNAECOLOGIC CANCERS
BREAST CANCER, BENIGN BREAST DISEASE AND CONTRACEPTION
ENDOMETRIAL CANCER
OVARIAN CANCER
PREGNANCY AND CANCER
REPRODUCED WITH PERMISSION
Who Categories for Temporary Methods
Simplified 2-Category System
Who Categories for Female Sterilization and Vasectomy
Who Medical ELigibility Criteria for Starting Contraceptive Methods
34:
Acute Abdomen in Pregnancy
INTRODUCTION
Appendicitis in Pregnancy
Diagnosis
Symptoms
Differential Diagnosis
Investigations
Management
Treatment Options
Outcome
Biliary Tract Disease and Pancreatitis in Pregnancy
Symptoms and Signs
Diagnosis
A. Imaging Studies
B. Hematological and Biochemical Tests
Management
Timing of Surgery
Treatment Options
Intestinal Obstruction in Pregnancy
Etiology
Diagnosis
Clinico-Pathological Sequence of Intestinal Obstruction
Investigations
Treatment
Intra-operative Procedure
Outcome
Perforative Peritonitis in Pregnancy
Diagnosis
Investigations
Etiology
Management
Urinary Tract Stones in Pregnancy
Clinical Presentation
Investigations
Medical Management
Surgical Management
Other Unusual Conditions Occurring During Pregnancy
35:
Gestational Diabetes Mellitus
MANAGEMENT OF GDM
Diet
Exercise
Insulin Therapy
Patient Education
36:
Thyroid Disorders in Pregnancy
THYROID HORMONE ECONOMY IN NORMAL PREGNANCY
Thyroid Function in Iodine Deficiency
AUTOIMMUNE THYROID DISEASE AND PREGNANCY
Effect of Pregnancy on Immune Function
Pregnancy and its Effect on Thyroid Function in Women with Thyroid Antibody
PRIMARY HYPOTHYROIDISM
Diagnosis and Screening of Hypothyroidism during Pregnancy
Treatment
Maternal Hypothyroidism and Fetal Outcome
THYROTOXICOSIS
Clinical Features Suggesting the Possibility of Thyrotoxicosis in the Pregnant State
History
Thyroid Enlargement
Physical Examination
Graves' Disease in Pregnancy
Treatment
Guidelines for the Management of Thyrotoxicosis during Pregnancy
Fetal/Neonatal Outcome
Breastfeeding
Thyrotoxicosis in Postpartum Period
Gestational Thyrotoxicosis (GTT)
Screening for Hyperthyroidism
CONCLUSION
37:
Burns in Pregnancy
COMPLICATIONS
Immediate Complications
1. Pre-term Labor
2. Fetal Demise
3. Fluid and Electrolyte Imbalances
4. Respiratory Difficulties
5. Infection
Late Complications
1. Abdominal Wall Scarring
2. The Breasts
Pregnancy Termination
SUMMARY
38:
Cervical Intraepithelial Neoplasia and Cervical Cancer in Pregnancy
INTRODUCTION
Incidence
Diagnosis
Investigations of Abnormal Smears
Cone Biopsy of the Cervix in Pregnancy
Evaluation of Suspected Cervical Cancer
Stage IA1 Cervical Carcinoma
Stage IA2 Cervical Carcinoma
Stage IB and IIA (Table 38.1)
Cervical Cancer Stage IIB or More Advanced (Table 38.2)
Mode of Delivery
Prognosis
SUMMARY
39:
Prolapse in Pregnancy
MANAGEMENT
Procedure of Introital Tightening
40:
Iatrogenic Problems in Pregnancy
ECTOPIC PREGNANCY
TERMINATION OF PREGNANCY
INDUCTION OF LABOUR
CAESAREAN SECTION
RUPTURE OF UTERUS
DRUG USE IN PREGNANCY
TOCOLYTIC DRUGS
ANESTHESIA AND ANALGESIA
CARDIOTOCOGRAPHIC ASSESSMENT OF FETAL WELL-BEING IN PREGNANCY
MATERNAL MORTALITY
INDEX
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