During pregnancy, most women remain well and require little formal medical input, while a much smaller group develop complications with significant morbidity and mortality for their baby and, occasionally, for themselves. Providers of antenatal care must be able to distinguish between these two groups of women and arrange with them an appropriate and personalised plan of care. This book covers all aspects of identifying and caring for women who develop disorders during their pregnancies. This second edition has been comprehensively updated to reflect changes in clinical practice and new research since publication of the previous edition. The contents take into account that care of such women is provided by multidisciplinary teams of physicians, obstetricians, general practitioners and midwives.
The book covers the curriculum for the antenatal disorders section of the Part 2 MRCOG, so is a key examination preparation test
Approximately 2000 candidates sit the Part 2 MRCOG each year - this is the final stage of becoming a member of the RCOG
In addition to being of interest to Part 2 candidates, the book provides a useful update for all healthcare professionals involved in caring for women who develop disorders during pregnancy: physicians, obstetricians, general practitioners and midwives
Author(s): Dilly Anumba, Shehnaaz Jivraj
Edition: 2
Publisher: Cambridge University Press
Year: 2016
Language: English
Tags: Obstetrics and gynecology; reproductive medicine
Cover
Half-title
Title page
Copyright information
Table of contents
LIst of contributors
Preface
1 Antenatal care and risk assessment
Introduction
What is the purpose of antenatal care?
Antenatal risk assessment
Who should see women at antenatal visits, and where?
Antenatal interventions which are not routinely recommended
Who should provide antenatal care?
Basic principles of antenatal care
Organization and content of the antenatal visit
Frequency of antenatal visits
First contact with a healthcare professional
The booking visit
Follow-up visits
General lifestyle advice during pregnancy
Pre-pregnancy counselling and care
Key summary points
References
2 Antepartum haemorrhage
Introduction
General management principles
Placental abruption
Pathophysiology
Aetiology
Clinical presentation
Management
Fluid management of hypovolaemia
Coagulopathy/disseminated intravascular coagulation (DIC)
Placenta praevia
Aetiology and risk factors
Diagnosis
Clinical presentation
Management
Delivery
Vasa praevia
Clinical presentation
Risk factors
Diagnosis
Management and prognosis
Marginal bleed
Uterine rupture
Risk factors
Clinical presentation
Management
Unexplained bleeding
Management
Key summary points
References
Further reading
3 Multiple pregnancy
Prevalence and epidemiology
Classification of multiple pregnancy
Complications
Twin-to-twin transfusion syndrome
Discordant growth
Monofetal death
Selective fetal reduction
Higher-order multiple pregnancies
Antenatal care
Mode and timing of delivery
Intrapartum care
Key summary points
References
4 Hypertensive disorders in pregnancy
Introduction
Definitions (NICE 2010)
Degrees of hypertension
Significant proteinuria
Measurement of blood pressure
Measurement of proteinuria (NICE 2010)
Why is hypertensive disease in pregnancy important?
Maternal mortality and morbidity
Perinatal mortality and morbidity
Pre-conception care
Antihypertensive medication
Antihypertensive medication and breastfeeding
Outpatient management of hypertensive disorders in pregnancy
Management of chronic hypertension
Management of gestational hypertension
Antepartum care
Timing of delivery
Care in labour
Postnatal care
Long-term significance of hypertension in pregnancy
Pre-eclampsia
Aetiology and pathogenesis
Prediction of pre-eclampsia
Reducing the risk of pre-eclampsia
Management of pre-eclampsia
Maternal monitoring and management of hypertension (NICE 2010)
Fetal monitoring
Timing of delivery
Management of delivery
Seizure prophylaxis
Postpartum care
Eclampsia
Management
HELLP syndrome
Laboratory diagnosis
Differential diagnosis
Complications of HELLP
Management
Postpartum hypertension
Aetiology of hypertension in the postpartum
Why detect and treat postpartum hypertension?
Antihypertensive treatment
Key summary points
References
5 Prematurity
Introduction
Pathogenesis
Antenatal management
Risk assessment
Investigations
Cervical length scanning
Infection screening
Fetal fibronectin (FFN)
Other technologies
Preventive treatment
Cerclage
Progesterone
Cervical pessary
Bed rest
Multiple pregnancy and preterm birth prophylaxis
Symptomatic women
Assessment
Fetal fibronectin
Actim Partus
Cervical length scanning
Treatment
Tocolysis
Steroids
In-utero transfer
Magnesium sulphate for fetal neuroprotection
Management of women with PPROM
Perinatal issues
Parental counselling
Mode of delivery
Key summary points
References
Further reading
RCOG Green-top Guidelines
RCOG Scientific Impact Papers
NICE guidance
6 Previous caesarean section
Introduction
Antenatal care for a woman who has had a previous caesarean delivery
Morbidly adherent placenta
Options for birth after previous caesarean section
Vaginal birth after caesarean section (VBAC)
Contraindications to VBAC
Risks of VBAC versus elective LSCS
Planned repeat caesarean section
Special circumstances
Preterm delivery
Multiple pregnancy
Induction and augmentation of labour
External cephalic version (ECV) after previous LSCS
When there is disagreement between the clinician and woman regarding mode of delivery after previous caesarean section
Delivery after intrauterine fetal death in the second trimester, or termination of pregnancy in the second trimester, in a woman with a previous LSCS
Reviewing local practice
Key summary points
References
Further reading
7 Common medical disorders in pregnancy
7.1 Anaemia
Background and clinical relevance
Treatment
Oral iron supplements
Parenteral iron
Serum ferritin
Blood transfusion
Megaloblastic anaemias
Key summary points
References
7.2 Endocrine disorders
Diabetes
Background
Effect of pregnancy on diabetes
Effect of diabetes on pregnancy
Management of diabetic pregnancy
Pre-pregnancy care
Antenatal management
Intrapartum management
Gestational diabetes
Screening at first antenatal visit
Screening later in pregnancy
Diagnosis of gestational diabetes
Importance of gestational diabetes
Key summary points
Thyroid disease
Physiology
Hyperthyroidism
Effect of pregnancy on hyperthyroidism
Effect of hyperthyroidism on pregnancy
Management of hyperthyroidism
Hypothyroidism
Effect of pregnancy on hypothyroidism
Effect of hypothyroidism on pregnancy
Management of hypothyroidism
Key summary points
Prolactinoma
Effect of pregnancy on prolactinoma
Effect of prolactinoma on pregnancy
Management of prolactinoma
Key summary points
References
Further reading
7.3 Gastrointestinal and hepatic disease
Physiological changes during pregnancy
Reflux oesophagitis
Peptic ulcer disease
Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
Intrahepatic cholestasis of pregnancy
Acute fatty liver of pregnancy
Key summary points
References
7.4 Haematological disorders
Introduction
Haemoglobinopathies
Sickle cell disease
Beta-thalassaemia
Antenatal screening
Management of sickle cell disease in pregnancy
Pre-conception care
Antenatal care
Intrapartum care
Postpartum care
Sickle cell crisis
Thrombocytopenia
Immune thrombocytopenic purpura (ITP)
Thrombotic thrombocytopenic purpura (TTP)
Neonatal alloimmune thrombocytopenia (NAIT)
Thrombophilia
Key summary points
References
7.5 Malignancy
Introduction
Cervical cancer
Previous treatment
Breast cancer
Ovarian cancer
Melanoma
Acute leukaemia
Pregnancy following previous chemotherapy
Gestational trophoblastic disease
Key summary points
References
7.6 Obesity
The scale of the problem
Pre-pregnancy counselling
Antenatal care
Intrapartum care
Postnatal care
The future
Key summary points
References
7.7 Kidney disease
Physiological changes in renal function with pregnancy
Effect of chronic kidney disease on pregnancy
Effect of pregnancy on chronic kidney disease
Women on dialysis and with transplant
Management
Pre-pregnancy
Antepartum
Postpartum
Key summary points
References
7.8 Skin disorders
Introduction
Physiological changes in pregnancy
Atopic eruption of pregnancy (AEP)
Polymorphic eruption of pregnancy (PEP)
Pemphigoid gestationis (PG)
Key summary points
References
8 Cardiac disease in pregnancy
Introduction
Principles of management
Specific heart diseases
Key summary points
References
9 Alloimmunization in pregnancy
Introduction
Prediction
Prevention
Silent sensitization
Consent and refusal
Fetal genotyping
Treatment
Red blood cell alloimmunization
Investigation
Ultrasound monitoring
Cordocentesis and intrauterine transfusion
Planning for delivery
Platelet alloimmunization
Key summary points
References
Further reading
10 Maternal mental health disorders
Introduction
Psychiatric disorders in pregnancy
Depression in pregnancy
Incidence
Onset
Risk factors
Clinical features
Treatment
Psychosis in pregnancy
Clinical features
Treatment
Postnatal psychiatric disorders
Postpartum blues
Incidence
Onset
Clinical features
Prognosis
Treatment
Postnatal depression
Incidence
Onset
Risk factors
Clinical features
Treatment
Postpartum (puerperal) psychosis
Incidence
Onset
Risk factors
Clinical features
Treatment
Conclusion
Key summary points
References
Further reading
11 Drug and alcohol misuse in pregnancy
Introduction
What is substance misuse?
Accepted definitions of substance misuse
How common is substance misuse in pregnancy?
Substances of misuse
Effects of substances of misuse on pregnancy
Alcohol
Associated problems
Cannabis
Associated problems
Heroin
Associated problems
Methadone
Buprenorphine
Codeine
Benzodiazepines
Associated problems
Cocaine/crack cocaine, amphetamines and mephedrone
Associated problems
Ketamine
Ecstasy
Solvents
‘Legal’ highs
General principles of management
Philosophy of care
Attitude
Holistic care
Comorbid medical problems
Social problems
Engagement
Communication
Model of care
Pre-conception care
Antenatal care
Identification of patients
Management of substance misuse
Assessment
Antenatal screening and investigations
Drug screening
Harm reduction advice
Facilitating change
Safeguarding
Obstetric care
Venous damage and thromboembolic disease
Management
Blood-borne viruses and sepsis
Management
Placental problems and preterm delivery
Management
Mental health problems
Management
Complex social factors
Chaos
Management
Family planning
Management
Planning intrapartum and postnatal care
Intrapartum care
Postnatal care
Neonatal and infant problems
Maternal health
Key summary points
References
Further reading
12 Screening for fetal anomalies
Introduction
Screening for structural anomalies
Diagnostic value of the routine scan during pregnancy
Screening for Down’s syndrome
The provision of Down’s syndrome screening during antenatal care
Key summary points
References
Index
