Protocols for High-Risk Pregnancies

Alcohol / Robert J. Sokol and Beth Nordstrom Bailey Developmental toxicology and teratology / James W. Hanson and Jan M. Friedman Occupational hazards / George R. Saade Smoking / Jorge E. Tolosa and Surasith Chaithongwongwatthana Ionizing radiation / Robert L. Brent Microwaves and ultrasound / Robert L. Brent Exercise-risks and benefits / James Clapp Routine antenatal laboratory tests and specific screening tests / Calvin J. Hobel Assessment of gestational age / Lawrence D. Platt Second trimester biochemical screening for neural tube defects and aneuploidy / John C. Hobbins Sonographic detection of aneuploidy / Fergal D. Malone Indices of maturity / Alessandro Ghidini and Anna Locatelli Clinical use of doppler / Henry L. Galan Fetal echocardiography / Joshua A. Copel and Charles S. Kleinman Fetal biophysical profile / Michael P. Nageotte Chorionic villus sampling / Ronald J. Wapner Genetic amniocentesis / Katharine D. Wenstrom Third trimester amniocentesis / Nancy Chescheir Fetal blood sampling / Alessandro Ghidini and Anna Locatelli Fetal reduction / Mark I. Evans Intrauterine transfusion / Frederick U. Eruo and Ray O. Bahado-Singh External cephalic version / Monica Longo and Gary D.V. Hankins Induction of labor / Anna M. McKeown and Michael P. Nageotte Amnioinfusion: indications and techniques / Catherine Y. Spong Sickle cell disease / Chad K. Klauser and John C. Morrison Isoimmune thrombocytopenia / Jane Cleary-Goldman and Mary E. D'Alton Autoimmune disease / Charles J. Lockwood and Edmund F. Funai Cardiac disease / Katharine D. Wenstrom Peripartum cardiomyopathy / F. Gary Cunningham Thromboembolism / Alan Peaceman Renal disease / Linda Fonseca, Larry C. Gilstrap III, and Susan Ramin Obesity / Frank J. Zlatnik Gestational diabetes / Donald R. Coustan Diabetes mellitus / Steven G. Gabbe Hypothyroidism / Brian Casey Hyperthyroidism / George D. Wendel Jr Acute and chronic hepatitis / Marshall W. Carpenter Asthma / Michael Schatz Epilepsy / Neil K. Kochenour Chronic hypertension / Baha M. Sibai Immunizations / Stanley A. Gall Cytomegalovirus / Hans M.L. Spiegel and John L. Sever Herpes simplex / Jeanne S. Sheffield Influenza / Jeanne S. Sheffield West Nile virus / Ronald Gibbs and Joel K. Schwartz Human immune deficiency virus infection / Howard Minkoff Parvovirus B19 infection / Maureen P. Malee Syphilis / Vanessa Laibl and George D. Wendel Jr Rubella / Hans M.L. Spiegel and John L. Sever Group B streptococcus / Mara J. Dinsmoor Toxoplasmosis / Shad Deering Varicella / Hans M.L. Spiegel and John L. Sever Tuberculosis / Kim A. Boggess Urinary tract infections / F. Gary Cunningham Acute abdominal pain resulting from non-obstetric causes / Sara Sukalich and Fred M. Howard Acute pancreatitis / Sarah H. Poggi Gallbladder / Monica Longo and Gary D.V. Hankins Mastitis / Wendy F. Hansen, Deborah Hubbard, and Jennifer R. Niebyl First trimester vaginal bleeding / Marsha Wheeler Cervical incompetence / Wendy F. Hansen Nausea and vomiting / Gayle Olson Syncope / Gary D. Helmbrecht Fetal wastage: genetic evaluation / Joe Leigh Simpson Recurrent pregnancy loss: non-genetic causes / Uma M. Reddy Missed abortion and antepartum fetal death / Robert M. Silver Oligohydramnios / Maryam Tarsa and Thomas R. Moore Polyhydramnios / Shad H. Deering and John T. Queenan Pre-eclampsia / Baha M. Sibai Intrauterine growth restriction / Ursula F. Harkness and Ray O. Bahado-Singh Rh and other blood group alloimmunizations / Kenneth J. Moise Jr Early detection of preterm labor / Jay D. Iams Preterm labor-tocolysis / Sarah J. Kilpatrick and Jay D. Iams Premature rupture of the membranes / Brian Mercer Amnionitis / Sindhu K. Srinivas and George A. Macones Third trimester bleeding / Alan Peaceman Amniotic fluid embolus / Robert Resnik Sepsis syndrome / F. Gary Cunningham Counseling for fetal anomalies / Lorraine Dugoff Maternal transport / Jerome Yankowitz Medications in labor / Gary S. Eglinton and Isaac P. Lowenwirt Intrapartum fetal heart rate monitoring / Roger K. Freeman Abnormal labor / Alan Peaceman Breech delivery / Martin L. Gimovsky Vaginal birth after cesarean section / James R. Scott Shoulder dystocia / Thomas J. Benedetti Twins, triplets, and beyond / Jacquelyn K. Chyu Post-term pregnancy / Manuel Porto Primary postpartum hemorrhage / Monica Longo and Gary D.V. Hankins Postpartum endometritis / Jonathan Hodor Vaginal and vulvar hematoma / Robert Resnik. Protocols for High-Risk Pregnancies......Page 5 Contents......Page 7 Contributors......Page 13 Preface......Page 19 Part 1 Hazards to Pregnancy......Page 21 1 Developmental Toxicology and Teratology......Page 23 2 Tobacco, Alcohol and the Environment......Page 30 3 Ionizing Radiation......Page 41 4 Exercise during Pregnancy: Risks and Benefits......Page 53 Part 2 Antenatal Testing......Page 61 5 Routine and Prenatal Screening......Page 63 6 Sonographic Screening for Fetal Anomalies......Page 73 7 Sonographic Detection of Aneuploidy......Page 80 8 Fetal Echocardiography......Page 94 9 Clinical Use of Doppler......Page 100 10 Antepartum Testing......Page 112 11 Indices of Maturity......Page 119 Part 3 Special Procedures......Page 127 12 Invasive Fetal Testing: Chorionic Villus Sampling and Amniocentesis......Page 129 13 Third Trimester Amniocentesis......Page 137 14 Fetal Blood Sampling and Transfusion......Page 142 15 Fetal Reduction......Page 149 16 External Cephalic Version: Singleton Fetus......Page 154 17 Induction of Labor......Page 160 Part 4 Maternal Disease......Page 169 18 Maternal Anemia......Page 171 19 Sickle Cell Disease and other Hemoglobinopathies......Page 178 20 Isoimmune Thrombocytopenia......Page 185 21 Autoimmune Disease......Page 191 22 Acquired and Inherited Thrombophilias......Page 205 23 Cardiac Disease......Page 215 24 Peripartum Cardiomyopathy......Page 226 25 Thromboembolism......Page 230 26 Renal Disease......Page 236 27 Obesity......Page 243 28 Diabetes Mellitus......Page 248 29 Hyperthyroidism and Hypothyroidism in Pregnancy......Page 257 30 Acute and Chronic Hepatitis......Page 263 31 Asthma......Page 270 32 Epilepsy......Page 278 33 Chronic Hypertension......Page 284 34 Immunizations......Page 293 35 Cytomegalovirus, Genital Herpes, Rubella, Syphilis and Toxoplasmosis......Page 306 36 Influenza, West Nile Virus, Varicella-Zoster and Tuberculosis......Page 316 37 Malaria in Pregnancy......Page 327 38 Human Immunodeficiency Virus Infection in Pregnancy......Page 333 39 Parvovirus B19 Infection......Page 348 40 Group B Streptococcus......Page 354 41 Urinary Tract Infections......Page 360 42 Acute Abdominal Pain Due to Non-obstetric Causes......Page 364 43 Gallbladder, Fatty Liver and Pancreatic Disease......Page 373 44 Mastitis......Page 381 Part 5 Obstetric Problems......Page 387 45 First Trimester Vaginal Bleeding......Page 389 46 Cervical Insufficiency......Page 393 47 Nausea and Vomiting......Page 403 48 Missed Abortion and Antepartum Fetal Death......Page 411 49 Abnormal Amniotic Fluid Volume......Page 419 50 Preeclampsia......Page 434 51 Fetal Growth Restriction......Page 444 52 Rh and Other Blood Group Alloimmunizations......Page 452 53 Preterm Labor......Page 462 54 Premature Rupture of the Membranes......Page 468 55 Prevention of Cerebral Palsy......Page 481 56 Cooling for Hypoxic Ischemic Encephalopathy......Page 486 57 Amnionitis......Page 492 58 Third Trimester Bleeding......Page 498 59 Amniotic Fluid Embolus......Page 505 Part 6 Labor and Delivery......Page 509 60 Maternal Transport......Page 511 61 Intrapartum Fetal Heart Rate Monitoring......Page 520 62 Abnormal Labor......Page 525 63 Breech Delivery......Page 529 64 Vaginal Birth After Cesarean......Page 533 65 Placenta Accreta......Page 540 66 Shoulder Dystocia......Page 549 67 Twins, Triplets and Beyond......Page 555 68 Postpartum Hemorrhage......Page 565 69 Vaginal and Vulvar Hematoma......Page 578 Part 7 Clinical Reference Tables......Page 581 Appendix A. Commonly Used Ultrasound Measurements......Page 583 Appendix B. Laboratory Values in Normal Pregnancy......Page 607 Appendix C. Evaluation of Fetal Defects and Maternal Disease......Page 616 Appendix D. The Newborn: Reference charts and tables......Page 627 Appendix E. Medications......Page 639 A......Page 661 C......Page 663 D......Page 665 E......Page 666 F......Page 667 G......Page 668 H......Page 669 I......Page 670 L......Page 671 M......Page 672 N......Page 673 P......Page 674 R......Page 676 S......Page 677 T......Page 678 V......Page 680 Z......Page 681 Pregnancies compromised by disease, trauma, substance abuse, and other factors are not uncommon. They clearly demand special attention from the obstetrician, obstetric nurse, primary care physician and others. Through three successful editions, Queenan has provided these audiences with a concise yet complete guide to managing pregnant patients and fetuses at risk. For the fourth edition, Dr Queenan has replaced up to a third of the 96 contributors to get some "new blood" into the book. He has invited more contributions from European authors in order to better cater to an international readership. The book does, however, retain the popular "protocols" theme, in which very brief chapters on the spectrum of HRP topics provide quick summaries of a problem and diagnostic and therapeutic steps to manage it. Every chapter has been revised carefully to reflect the latest thinking on the best approach to pregnant patients with risks like tuberculosis, STDs, bleeding, pre-eclampsia, etc. The many quick reference tables and charts are updated as, are the brief bibliographies accompanying each chapter. This new edition provides increased coverage of IUGR, Pre-eclampsia, teratology and genetics. New chapters have been introduced on doppler ultrasound, nuchal translucency and also on AIDS in pregnancy. Furthermore this fourth edition is evidence-based. The new editor, Catherine Spong, is a guru of evidence-based medicine and as well as one of the editors of the journal of the American College of Obstetricians and Obstetrics and Gynaecology , directs the foetal medicine programme at the National Institute of Health in Washington. Pregnancies compromized by medical conditions and other problems are widespread and demand special attention from the obstetrician, obstetric nurse, certified nurse midwife, primary care physician, and others, to ensure optimal outcome to pregnancy. Through three successful editions, John Queenan and John Hobbins have provided readers with a complete, easily referenced, at-point-of-care guide to managing the pregnant patient and fetus at risk. In this, the fourth edition, Catherine Spong has joined them to make this valuable book evidence based.The text retains its popular features: quick reference tables, charts, brief bibliographies accompanying each chapter, and the "protocols" theme, which provides quick summaries of problems and diagnostic and therapeutic steps to manage them.Topics include pregnancy hazards, special procedures, maternal diseases, obstetric problems, and labor and delivery. All problems are addressed by concise protocols that are straightforward, practical, and cost-effective.This new edition also provides increased coverage of IUGR, pre-eclampsia, teratology, and genetics and has new chapters on Doppler ultrasound, nuchal translucency, and AIDS in pregnancy. For over three decades, many in the medical community have recognized the negative consequences of maternal alcohol consumption for the developing fetus.