Index

Management of High-Risk Pregnancy—A Practical Approach Manju Puri, SS Trivedi

1:Prenatal Diagnosis
- INTRODUCTION
- KEY POINTS
2:Screening and Management of Congenital Anomalies
- INTRODUCTION
- PRENATAL SCREENING
- INDIVIDUAL CONGENITAL MALFORMATIONS
- GENITOURINARY SYSTEM
- NEED FOR EXAMINING FETUS, STILLBIRTH OR NEONATE
- SUMMARY
3:Antepartum Fetal Surveillance
- INTRODUCTION
- OBJECTIVES OF FETAL SURVEILLANCE
- INDICATIONS OF FETAL SURVEILLANCE
- WHEN TO START?
- ANTEPARTUM FETAL SURVEILLANCE TECHNIQUES
- CONDITION SPECIFIC ANTEPARTUM FETAL TESTING
- KEY POINTS
4:Preterm Labor
- INTRODUCTION
- ETIOPATHOGENESIS
- PREDICTION
- PREVENTION OF PRETERM LABOR
- DIAGNOSIS OF PRETERM LABOR
- TREATMENT
- NEONATAL OUTCOME
- KEY POINTS
5:Premature Rupture of Membranes
- DEFINITION AND INCIDENCE
- ETIOPATHOGENESIS
- FACTORS PREDISPOSING TO PROM
- CLINICAL PRESENTATION AND DIAGNOSIS
- CLINICAL COURSE IN PROM
- MATERNAL AND PERINATAL COMPLICATIONS
- MANAGEMENT OF PROM
  - Management of Term PROM
  - Management of Preterm PROM
- COMPONENTS OF EXPECTANT MANAGEMENT
- KEY POINTS
6:Prolonged Pregnancy
- INTRODUCTION
- DEFINITION
- INCIDENCE
- DIAGNOSIS
- PREDISPOSING FACTORS
- PATHOPHYSIOLOGY
- FETOMATERNAL OUTCOME
- MANAGEMENT OF PREGNANCY BEYOND 40 WEEKS GESTATION
  - Recommendations for Induction of Labor
  - Fetal Monitoring
- PREVENTION OF POST-TERM PREGNANCY
- KEY POINTS
7:Polyhydramnios Oligohydramnios
- INTRODUCTION
- DISORDERS OF AMNIOTIC FLUID
  - Incidence
- POLYHYDRAMNIOS
- OLIGOHYDRAMNIOS
- KEY POINTS
8:Antepartum Hemorrhage
- INTRODUCTION
- CAUSES OF ANTEPARTUM HEMORRHAGE
- PLACENTA PREVIA
- ABRUPTIO PLACENTAE
- PROGNOSIS
  - Maternal
  - Fetal
- OTHER CAUSES OF ANTEPARTUM HEMORRHAGE
- KEY POINTS
9:Multifetal Pregnancy
- INTRODUCTION
- PREVALENCE
- ETIOPATHOGENESIS
- PHYSIOLOGICAL CHANGES
- MATERNAL AND FETAL RISKS
- CLINICAL PRESENTATION AND DIAGNOSIS
- MANAGEMENT
- KEY POINTS
10:Intrauterine Growth Restriction (IUGR)
- INTRODUCTION
- DEFINITION
- CLASSIFICATION OF IUGR
  - Early Onset or Symmetrical IUGR
  - Late Onset or Asymmetrical Growth Restriction
- ETIOLOGY
- PATHOPHYSIOLOGY OF PLACENTAL INSUFFICIENCY
- FETAL AND NEONATAL COMPLICATIONS
  - Problems in Babies with IUGR at Birth
  - Complications in Adult Life
- DIAGNOSIS OF IUGR
- MANAGEMENT OF IUGR
- PREVENTION OF INTRAUTERINE GROWTH RESTRICTION
- KEY POINTS
11:Malpresentations
- INTRODUCTION
- PREVALENCE
- ETIOLOGY
- CLINICAL PRESENTATION AND DIAGNOSIS
- BREECH PRESENTATION
- TRANSVERSE LIE
  - Diagnosis
  - Management
    - Antenatal Period
    - Intrapartum Period
- FACE PRESENTATION
- BROW PRESENTATION
  - Diagnosis
    - Abdominal Palpation
    - Vaginal Examination
  - Management
- COMPOUND PRESENTATION
  - Diagnosis
  - Management
- KEY POINTS
12:Pregnancy with Previous Cesarean Section
- INTRODUCTION
- EFFECT OF FUTURE FERTILITY
- ANTENATAL COMPLICATIONS
- MODE OF DELIVERY AFTER PREVIOUS CESAREAN SECTION—VBAC OR ERCS
- MANAGEMENT
- POSTNATAL VISIT
- COST OF VBAC COMPARED WITH REPEAT CS
- AUDIT AND RESEARCH
  - Pending Relevant Trials78
- KEY POINTS
  - End notes
13:Rh Negative Pregnancy
- INTRODUCTION
- PREVALENCE
- PATHOPHYSIOLOGY
- DIAGNOSIS
  - Agglutination Test
    - Saline
    - Colloid
  - Antiglobulin or Coombs’ Test
    - Indirect
    - Direct
- PRINCIPLES OF TREATMENT
- KEY POINTS
14:Anemia in Pregnancy
- INTRODUCTION
- PREVALENCE OF ANEMIA
- DEFINITION
- ETIOPATHOGENESIS OF ANEMIA IN PREGNANCY
- CLINICAL FEATURES OF ANEMIA IN PREGNANCY
- WORKUP OF PREGNANT WOMEN WITH ANEMIA
  - History and Examination
  - Investigations
- MATERNAL AND FETAL COMPLICATIONS
- IRON DEFICIENCY ANEMIA
- MEGALOBLASTIC ANEMIA
- THALASSEMIA
- SICKLE CELL ANEMIA
- MANAGEMENT OF LABOR IN ANEMIA
  - Postnatal Care and Contraception in Anemic Women
- KEY POINTS
15:Hypertensive Disorders of Pregnancy
- INTRODUCTION
- DEFINITION
- CLASSIFICATION
- ETIOPATHOGENESIS
- PREDICTION
- PREVENTION
- MANAGEMENT
- TREATMENT OF ACUTE SEVERE HYPERTENSION
- CARE FOLLOWING DELIVERY
- LONG-TERM COMPLICATIONS
- SUMMARY OF MANAGEMENT PROTOCOLS
- ECLAMPSIA
- HELLP SYNDROME
- CHRONIC HYPERTENSION
16:Diabetes Mellitus with Pregnancy
- INTRODUCTION
- PREVALENCE OF DIABETES MELLITUS
- CLASSIFICATION OF DIABETES MELLITUS IN PREGNANCY
- PATHOPHYSIOLOGY
  - Carbohydrate Metabolism in Pregnancy15,16,25
  - Carbohydrate Metabolism in Diabetic Pregnancy15,17,25
- EFFECT OF PREGNANCY ON DIABETES MELLITUS18,19,25
- EFFECT OF DIABETES MELLITUS ON PREGNANCY
- SCREENING AND DIAGNOSIS
- MANAGEMENT DURING PREGNANCY
- POSTPARTUM CARE AND ADVICE72
- KEY POINTS
17:Jaundice in Pregnancy
- INTRODUCTION—MAGNITUDE OF PROBLEM
- PHYSIOLOGICAL CHANGES AND LIVER FUNCTIONS IN PREGNANCY
- CAUSES OF JAUNDICE IN PREGNANCY
- WORK UP OF A PREGNANT WOMEN WITH JAUNDICE
- AN APPROACH TO CLINICAL DIAGNOSIS
- SPECIFIC CONDITIONS
- MANAGEMENT OF LIFE-THREATENING HEPATIC FAILURE
  - Differential Diagnosis
- KEY POINTS
18:Heart Disease in Pregnancy
- INTRODUCTION
- HEMODYNAMIC CHANGES DURING PREGNANCY
- PRECONCEPTION COUNSELLING
- DIAGNOSIS AND WORKUP
- MANAGEMENT
  - General Principles
- SPECIFIC LESIONS
- CYANOTIC HEART LESIONS
  - Tetralogy of Fallot
  - Transposition of Great Arteries
- COARCTATION OF AORTA
- MITRAL VALVE PROLAPSE
- RHEUMATIC HEART DISEASE
- PROSTHETIC HEART VALVES
- PERIPARTUM CARDIOMYOPATHY
- HYPERTROPHIC CARDIOMYOPATHY
- MYOCARDIAL INFARCTION
- CARDIAC ARRHYTHMIAS
- KEY POINTS
19:Thromboembolism in Pregnancy
- INTRODUCTION
- PATHOPHYSIOLOGY
  - Hypercoagulability
    - Inherited Factors
  - Acquired Factors
- CLINICAL PRESENTATION AND DIAGNOSIS
  - Deep Vein Thrombosis
  - Pulmonary Embolism (Flow chart 19.2)
- PROPHYLACTIC MEASURES
- MANAGEMENT
- KEY POINTS
20:Thyroid Disorders with Pregnancy
- INTRODUCTION
- MATERNAL PHYSIOLOGY
- CHANGES IN THYROID PHYSIOLOGY DURING PREGNANCY (TABLE 20.1)
- ASSESSMENT OF THYROID FUNCTION IN PREGNANCY
- FETAL THYROID PHYSIOLOGY
- IODINE NUTRITION IN PREGNANCY
- GESTATIONAL HYPERTHYROIDISM
  - Subclinical Hyperthyroidism
- HYPERTHYROIDISM
- MANAGEMENT
- HYPOTHYROIDISM
- SUBCLINICAL HYPOTHYROIDISM (SCH)
- AUTOIMMUNE THYROID DISORDERS AND MISCARRIAGES
- THYROID NODULES AND THYROID CARCINOMA
- POSTPARTUM THYROIDITIS
  - Management
- SCREENING FOR THYROID DYSFUNCTION DURING PREGNANCY
- KEY POINTS
21:Renal Disease in Pregnancy
- INTRODUCTION
  - Effect of Pregnancy on Renal Structure and Function
  - Effect of Renal Disease on Pregnancy
- GENERAL PRINCIPLES OF ANTEPARTUM MANAGEMENT
  - Maternal Surveillance
  - Fetal Surveillance
- SPECIFIC RENAL PATHOLOGY IN PREGNANCY
- KEY POINTS
22:Tuberculosis in Pregnancy
- INTRODUCTION
- MAGNITUDE OF DISEASE
- CLINICAL PRESENTATION
- EFFECT OF PREGNANCY ON TUBERCULOSIS (TABLE 22.2)
- EFFECT OF TUBERCULOSIS ON PREGNANCY
- FACTORS DETERMINING EFFECT OF DISEASE ON FETOMATERNAL OUTCOME
- CONGENITAL TUBERCULOSIS
- CONTRACEPTION
- KEY POINTS
23:Epilepsy with Pregnancy
- INTRODUCTION
- EFFECT OF PREGNANCY ON EPILEPSY
- EFFECT OF EPILEPSY ON PREGNANCY
- MANAGEMENT
- STATUS EPILEPTICUS
  - Management
    - Control of Seizures
- KEY POINTS
24:TORCH Infections in Pregnancy
- INTRODUCTION
- FETAL/NEONATAL COMPLICATIONS (TABLE 24.1)
- DIAGNOSIS OF MATERNAL INFECTION
- PREGNANT WOMEN AT HIGH RISK FOR TORCH INFECTIONS
- PRENATAL DIAGNOSIS OF FETAL INFECTION
  - Sonographic Findings Reported in Congenital Infections
- MANAGEMENT
  - Screening Recommendations and Prevention
  - Some Preventive Measures
- KEY POINTS
25:HIV in Pregnancy
- INTRODUCTION
- MAGNITUDE OF PROBLEM
- WHY ARE FEMALES MORE VULNERABLE TO HIV INFECTION?
- HIV IN CHILDREN
- MANAGEMENT
- KEY POINTS
26:Obesity and Pregnancy
- INTRODUCTION
- PREVALENCE
  - Indian Scenario
- BASIC BIOLOGY OF ENERGY BALANCE
- OBESITY AND FERTILITY
- OBESITY-RELATED ADVERSE OUTCOMES IN PREGNANCY
- INTRAPARTUM ISSUES
  - Vaginal Birth After Cesarean Section
- POSTPARTUM ISSUES
- OBESITY AND ANESTHESIA
- LACTATION
- COST IMPLICATIONS
- IMPLICATIONS FOR THE FETUS OF OBESE MOTHER
  - Short-term
  - Long-Term Fetal Implications
- LONG-TERM IMPLICATIONS FOR THE MOTHER
- MANAGEMENT OF OBESITY IN PREGNANCY
- KEY POINTS
27:Gynecological Diseases in Pregnancy
- LEIOMYOMAS AND PREGNANCY
- MYOMECTOMY AND PREGNANCY
  - Antenatal Myomectomy
  - Myomectomy during Cesarean Section
- CERVICAL CANCER IN PREGNANCY
- PREINVASIVE CANCER
- INVASIVE CERVICAL CANCER
- RETROVERSION OF THE GRAVID UTERUS
- OVARIAN TUMOR/ADNEXAL MASS IN PREGNANCY
28:Critical Care Issues in High-Risk Obstetric Patient
- INTRODUCTION
- OBSTETRIC CASES REQUIRING CRITICAL CARE
- OVERVIEW OF THE PROBLEM
- PHYSIOLOGICAL CHANGES IN PREGNANCY5,6 (TABLE 28.2)
- TRANSPORT OF A CRITICALLY ILL OBSTETRIC PATIENT
- FINDINGS IN AN OBSTETRIC PATIENT THAT MIGHT PROMPT ICU ADMISSION
- GENERAL CONSIDERATIONS
- DIAGNOSIS AND MANAGEMENT OF SOME COMMON CRITICAL CONDITIONS IN OBSTETRIC PATIENTS
- WHAT IS THE OBSTETRICIAN–GYNECOLOGIST’S ROLE IN THE CARE OF A PATIENT IN A CRITICAL CARE UNIT?
- CARDIOPULMONARY RESUSCITATION IN PARTURIENTS25,26
  - Modifications in Emergency Cardiac Care for the Parturients
- KEY POINTS
29:Drugs in Pregnancy
- INTRODUCTION
- TERATOGENICITY
- DRUGS WITH PROVEN TERATOGENIC POTENTIAL
- TOCOLYTICS
  - Adverse Effects12,13
- CORTICOSTEROIDS
- ANTIEMETICS
  - Antiemetic Drugs used in Pregnancy1,3
- DRUGS FOR BRONCHIAL ASTHMA
  - Safety in Pregnancy3,5,18
- GASTROINTESTINAL DRUGS
  - Antacids
  - Proton Pump Inhibitors
  - H2 Receptor Antagonist
- ANTIDOPAMINERGIC DRUGS IN PREGNANCY
  - Dose
- ANTIEPILEPTICS IN PREGNANCY1–6
- ANTIHYPERTENSIVES IN PREGNANCY
  - Alphamethyldopa (Aldomet)
  - Labetalol
  - Atenolol
  - Vasodilators
    - Nitroprusside
    - Hydralazine
  - Calcium Channel Blockers
    - Nifedipine
    - Diuretics
- ANTICONVULSANTS
- ANTITHROMBOTIC THERAPY
- ANTITUBERCULAR DRUGS IN PREGNANCY
- VACCINES
  - Vaccines that should be Avoided during Pregnancy
- ANTIDEPRESSANT DRUGS
- ANALGESICS DURING PREGNANCY
- IMMUNOSUPPRESSIVE DRUGS
- ANTINEOPLASTICS
  - Antimetabolites
  - Alkylating Agents
  - Plant Alkaloids
  - Antibiotics
  - Alcohol
- ANTI-INFECTIVE AGENTS (TABLE 29.6)
- ANESTHETIC DRUGS
  - General Anesthesia
  - Local Anesthesia
- ORAL CONTRACEPTIVES
- ESTABLISHING PREGNANCY EXPOSURE REGISTRIES38

INDEX

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Chapter Notes