Perinatology: Evidence-Based Best Practices in Perinatal Medicine

Foreword
Preface
Acknowledgement
Contents
Contributors
Part I: Periconceptional Care
Chapter 1: Historical Preface: Early Stages of Perinatal Medicine
The Fetus as a New Patient in Obstetrics
Development of New Methods
Assessment of Fetal Heart Activity
Fetal Blood Analysis
Examination of Amniotic Fluid
Application of Ultrasonography
Neonatological Assessment
Development of Clinical Structures
Development of Scientific Publications
Development of Societies and Congresses
Outlook
References
Chapter 2: Professional Ethics in the Clinical Practice of Perinatal Medicine
Introduction
Two Components of Professional Ethics in Perinatal Medicine
Key Ethical Terms and Concepts
Ethical Principles
Two Components of Professional Ethics in Perinatal Medicine
Professional Ethics in Obstetrics
Professional Ethics in Pediatrics
Professional Ethics in Obstetrics and Professional Ethics in Pediatrics Contrasted
Ethical Challenges in Clinical Practice
Counseling the Pregnant Patient About Intrapartum Management
Counseling Prospective Parents About Neonatal Management
Counseling Parents About Setting Ethically Justified Limits on Neonatal Critical Care
Conclusion
References
Chapter 3: Guidance and Assessment of Preconception Risk
What Is Preconception Care?
Preconception Risk Assessment
Medical History
Nutrition, Diet, and Weight
Infertility Evaluation
Prior Pregnancy Outcomes
Maternal and Parental Age
Environmental Exposures
Infections and Immunizations
Recommendations for Preconception Infection Testing
Immunity
Intimate Partner Violence
Genetics
Dental Issues
Conclusions
References
Chapter 4: Genetics for the Obstetrician: Bases of Genetic Counseling
Essential Features of Genetic Counseling
Genetic Counseling Steps
Problem Identification
The Pedigree Construction
Diagnostic Hypothesis
Genetic Counseling in Common Clinical Situations
Maternal Age Advanced
Repeated Pregnancy Losses
Previous Child with Congenital Anomalies
Mendelian Diseases in Relatives
Exposure to Teratogens
Prescreening and Postscreening Counseling
Abnormal Ultrasound Findings
Follow-Up of the Pregnancy
References
Chapter 5: Screening for Chromosomal Anomalies
Isolated Markers
Maternal Age
Biochemical Markers
Ultrasonographic Markers
Cell-Free DNA
Combined Tests
First Trimester Combined Test
Second Trimester Quadruple Test
Integrated Tests
Contingent Tests
References
Chapter 6: Protocol of Immunization of the Adult Woman
Vaccination of Women at Reproductive Age
Preconceptional Counseling
Vaccination During Pregnancy and the Puerperium
Other Immunizations in Pregnant Women
Use of Immunoglobulins
Puerperium
References
Chapter 7: Drugs in Pregnancy and Childbirth
Introduction
Drug Teratogenesis During Pregnancy
The Use of Drugs During Pregnancy
Gastrointestinal Symptoms
Antiemetics
Antacids
Laxative Agents
Antidiarrheic Agents and Antibiotics
Hypoglycemic Agents
Antihypertensive Agents
Hypolipidemic Agents
Anticoagulants
Anorexigenic Drugs and Anti-obesity Drugs
Antifungal Agents
Anticonvulsants
Conclusion
References
Part II: Prenatal Care
Chapter 8: Nutritional Aspects of Gestation and Puerperium
Introduction
Nutritional Aspects of Gestation
Prenatal Care and Maternal Health
Nutritional Intervention During Pregnancy
Anthropometric Assessment
Dietary Assessment
Biochemical and Clinical Evaluation
Functional Assessment
Sociodemographic and Obstetric Assessment
Nutritional Recommendations During Pregnancy
Energy and Macronutrients
Macronutrients
Micronutrients
Vitamin A
Vitamin D
Complex B Vitamins
Folate
Iron
Iodine
Vitamins C and E, Selenium, and Zinc
Calcium
Use of Supplements During Pregnancy
Vitamin A
Calcium
Iron
Folic Acid
Vitamin D
Not Recommended
Recommendations for Specific Contexts
Use of Probiotics in Pregnancy
Nutritional Guidance in Common Situations During Pregnancy
Nausea and Vomiting
Management [185, 235, 297]
Heartburn
Management [185, 235, 287]
Ptyalism or Sialorrhea (Excessive Salivation)
Management [185, 235, 265]
Intestinal Constipation and Flatulence
Management [185, 235, 297]
Pica
Management [33, 71, 235]
Vitamin A Deficiency
Anemia
Management [149, 215, 289, 296, 297]
Hypertensive Disorders of Pregnancy (HDP)
Management [236, 295–297]
Diabetes Mellitus in Pregnancy
Management
Nutritional Aspects of Puerperium
Nutritional Assessment of Lactating Women
Anthropometric Assessment
Dietary Assessment
Clinical and Biochemical Evaluation
Nutritional Requirements of Lactating Women
Nutrient supplementation in lactation
Chrononutrition: Effect on the Health of Pregnant and Postpartum Women
Veganism and Vegetarianism During Pregnancy and Lactation
DASH Diet: Health Benefits for Pregnant and Lactating Women
Early Life Programming
e-Health in Nutritional Counseling for Pregnant and Lactating Women
Nutritional Counseling for Pregnant and Lactating Women
References
Chapter 9: Physical Exercise During Pregnancy
Introduction
Principles of Exercise Prescription
Fetal and Maternal Anatomic and Physiologic Aspects of Exercise
Exercise During Pregnancy
Competitive Athletes
Exercise in the Postpartum Period
Conclusion
References
Chapter 10: Standards In Prenatal Care
Principles of Prenatal Care
First Prenatal Visit
History
Calculation of Gestational Age and Estimated Date of Delivery
Physical Examination
Ultrasound Examination
Screening and Testing for Genetic Abnormalities
Laboratory Tests
Timing and Frequency of Subsequent Visits
Components of Subsequent Prenatal Visits
Second Trimester
Third Trimester
References
Chapter 11: Multiple Pregnancy
Introduction
Classification
Dating of Twin Pregnancy
Identification of Twins
Chromosomal Abnormalities
Ultrasound Screening to Detect Structural Anomalies in Multiple Pregnancy
Ultrasound in the Evaluation of Twin Pregnancy
Screening for Premature Delivery
Maternal Complications
Hypertensive Disorders and Preeclampsia
Gestational Diabetes
Other Third Trimester Complications
Fetal Complications
Premature Membranes Rupture (PMR) in One of the Twins
Intrauterine Growth Restriction (IUGR) Screening, Diagnosis, and Management
Particularity of Monochorionic Pregnancies
Death of One Twin
Exclusive Complications of Monochorionic Pregnancies
Twin-to-Twin Transfusion Syndrome (TTTS)
Polycythemia Anemia Sequence (TAPS)
Reverse Arterial Perfusion Sequence (TRAP)
Monoamniotic Monochorionic Twinning (MCMA)
Conjugated Twins
Childbirth During Twin Pregnancy
Multiple Pregnancy with Gestational Trophoblastic Disease
References
Part III: Fetal Proceedings
Chapter 12: Ultrasound
Introduction
Assessment of Pregnancy Viability, Determination of Gestational Age, and Chorionicity in Twin Pregnancies During the First Trimester of Pregnancy
Assessment of Pregnancy Viability
Early Pregnancy of Unknown Location
Determination of Gestational Age
Twin Pregnancies
Ultrasonographic Determination of Fetal Anomalies
Detection of Fetal Anomalies During the First Trimester
Detection of Fetal Anomalies During the Second Trimester
Assessment of Fetal Growth
Biparietal Diameter
Head Circumference
Abdominal Circumference
Femur Length
Estimated Fetal Weight
Fetal Growth Assessment
Conclusion
References
Chapter 13: Clinical Use of 3D Sonography
Background
Terminology
Safety
3D Transducers
Acquiring the Volume
Clinical Use of 3D Ultrasound and Rendering Options for Detection of Fetal Anomalies
Clinical Evaluation of Embryonic and Early Fetal Period
Ectopic Pregnancy
Fetal Face Assessment
Cleft Lip and Palate (CLP)
Mandibular Anomalies
Macroglossia
Epignathus
Facial Dysmorphism and Syndromes
Micrognathia and Low-Set Ears
Cranial Sutures/Head Shape
Brain and CNS
Fetal Heart
Clinical Use of 3D/4D US in Functional Studies of the Fetus
Assessment of Fetal Behavior
Functional Studies
Maternal Bonding
In Summary
References
Chapter 14: First-Trimester Ultrasonography
Introduction
First-Trimester Ultrasound Between 5 and 10 Weeks
First-Trimester Ultrasound Between 11+0 and 13+6 Weeks
Screening for Fetal Aneuploidy
Screening Ultrasonographic Markers for Aneuploids in the First Trimester
Nucal Translucency
Other First-Trimester Ultrasound Markers
Venous Duct
Nasal Bone
Morphology Evaluation
First-Trimester Cervical Measurement
First-Trimester Uterine Artery Evaluation
References
Chapter 15: Ultrasound in Second and Third Trimester: What Should Be Evaluated?
Introduction
Biometry and Fetal Anatomic Evaluation
Cephalic Pole
Fetal Thorax
Fetal Abdomen
Fetal Pelvis
Fetal Limbs
Other Structures
Fetal Weight
Others
Amniotic Fluid
Placenta
Cervix, Uterus, and Adnexa
References
Chapter 16: Doppler Velocimetry
Doppler Flowmetry
Color Doppler
Fetal Arterial Doppler
Umbilical Artery Doppler
Middle Cerebral Artery (MCA) Doppler
Maternal Arterial Doppler
Uterine Artery Doppler
Fetal Venous Doppler
References
Chapter 17: Antepartum Cardiotography
Introduction
Indications
CTG Tracing Acquisition
CTG Interpretation
Basic FHR Features
Tracing Classification
Clinical Management of Antepartum CTG
Conclusions
References
Chapter 18: Evaluation of Fetal Pulmonary Maturity
Introduction
Fetal Lung Development
Neonatal Respiratory Morbidity
Respiratory Distress Syndrome
Transient Tachypnea of the Newborn
Antenatal Corticosteroids
Fetal Lung Maturity Evaluation
Direct Tests
Lecithin/Sphingomyelin Ratio
Detection of Phosphatidylglycerol
Lamellar Body Count
Surfactant/Albumin Ratio
Clements Test/Shake Test
Indirect Tests
Pulmonary Artery Acceleration to Ejection Time
Ultrasound Lung Texture Analysis
Conclusion
References
Chapter 19: Fetal Surgery
Introduction
Ethical Principles in Medicine
Therapeutic Innovation and Clinical Research
Most Relevant Fetal Surgeries
Renal Agenesis
Principles of in Utero Interventions
The Fetus as a Patient
Fetal Anesthesia
Development of Fetal Pain Sensitivity
Anesthetic Agents and Monitoring of Fetus as a Patient
Maternal Anesthesia for Fetal Surgery
Selection of Route of Anesthesia
Maternal General Anesthesia for Fetal Procedures
Maternal Local Anesthesia for Fetal Procedures
Fetal Intramuscular Anesthesia
Open Fetal Surgery
Myelomeningocele
Sacrococcygeal Teratomas
Congenital Pulmonary Airway Malformation
Fetoscopy-Guided Procedures
Twin-to-Twin Transfusion Syndrome (TTTS)
Cord Occlusion in TRAP and in Complicated Monochorionic Twins
Congenital Diaphragmatic Hernia (CDH).
Prenatal Study of the Severity of CDH
Fetal Endoluminal Tracheal Occlusion (FETO)
Myelomeningocele (MMC)
The Management of Meningomyelocele (MOM) Study
Endoscopic Surgery
Maternal Risks of Open MMC Repair
Conclusions
References
Part IV: Clinical Complications in Pregnancy: Diagnosis and Management
Chapter 20: Anemia in Pregnancy
Definition
Physiological Changes in Pregnancy
Causes and Classification
Prevalence and Etiology
Clinical Features
Iron Deficiency Anemia
Megaloblastic Anemia
Aplastic Anemia
Acquired Hemolytic Anemias
Paroxysmal Nocturnal Hemoglobinuria
Hereditary Hemolytic Anemias
Hemoglobinopathies
Sickle Cell Diseases
Thalassemias
Alpha-Thalassemia
Beta-Thalassemia
Spherocytosis
Enzymatic Defects
Fetal Anemia
References
Chapter 21: Chronic Hypertension in Pregnancy
Introduction
Prenatal Care
Diagnosis of Superimposed PE
Prediction of PE
Prevention of PE
Nonpharmacological Treatment of CH
Pharmacological Treatment of CH
Treatment of Hypertensive Crisis
Obstetric Care
CH in the Puerperium
References
Chapter 22: Pregestational Diabetes Mellitus
Introduction
Classification of Diabetes Mellitus
Maternal Metabolism Adaptation Throughout Pregnancy
Pregnancy Affecting Diabetes and Its Complications
Diabetic Ketoacidosis
Hypoglycemia
Diabetic Kidney Disease
Retinopathy
Neuropathy
Atherosclerotic Cardiovascular Disease
Dyslipidemia
Diabetes Affecting Pregnancy
Maternal Risks
Fetal Risks
Future Risks to the Conceptus
Before Conception Care
Treatment of Pregnant Women with Pregestational Diabetes
Nutritional Therapy
Physical Activity
Insulin
Glucose Monitoring and Goals
Management of Arterial Hypertension
Monitoring Fetal Well-Being
Delivery
Postpartum Care
Breastfeeding
Contraception
References
Chapter 23: Acquired Thrombophilia in Pregnancy
Introduction
Antiphospholipid Syndrome (APS)
Clinical Criteria
Laboratory Criteria
Prenatal Care and Treatment
Management in Labor and Delivery
Postpartum Care
Hyperhomocysteinemia
References
Chapter 24: Hereditary Thrombophilia
Factor V Mutation (G1691A)
Mutation of the Prothrombin Gene (G20210A)
Protein S Deficiency
Protein C Deficiency
Antithrombin Deficiency
Polymorphisms of Methylenetetrahydrofolate Reductase (pMTHFR)
Other Thrombophilia
Venous Thromboembolic Disease
Obstetric Complications
Screening for Hereditary Thrombophilia
Recommendations for Screening
Prophylaxis and Treatment of Thromboembolic Events
Recommendations for Prophylaxis and Treatment
Bibliography
Chapter 25: Gastrointestinal Disorders
Gastroesophageal Reflux in Pregnancy
Possible Mechanisms of Disease
Clinical Presentations
Diagnosis
Treatment
Nausea and Vomiting (NV)
Possible Mechanisms of Disease
Prognosis
Differential Diagnosis
Treatment
Inflammatory Bowel Disease (IBD)
Ulcerative Colitis
Crohn’s Disease
Prognosis
Flares
Treatment
Mode of Delivery
References
Chapter 26: Heart Disease during Pregnancy
Introduction
Epidemiology
Hemodynamic Changes in Normal Pregnancy
Pharmacological Changes during Pregnancy
Increased Prevalence of Heart Disease in Pregnant Women
Predictors of Cardiac Events during Pregnancy
High-Risk Cardiovascular Pregnancy
Pregnancy Risk Rating
Childbirth
Anticoagulation
Recommendations Based on “Guidelines for Management of Cardiovascular Diseases During Pregnancy” ESC 2018
Cardiovascular Risk Assessment
Attention in Monitoring Pregnancy, Childbirth, and the Puerperium
Special Situations
Arterial Hypertension
References
Chapter 27: Thyroid Disorders
Introduction
Physiological Changes of the Thyroid Gland during Pregnancy
Reference Range for Serum TSH in Pregnancy
Iodine Requirements
Thyroid Auto-Antibodies
Impact of Thyroid Disease upon Infertility and Assisted Reproduction
Thyroid Illness
Hypothyroidism
Hyperthyroidism
Thyroid Nodules
Postpartum Thyroiditis
Fetal and Neonatal Considerations
Thyroid Disease and Lactation
Closing Remarks
References
Chapter 28: Rheumatological Diseases
Systemic Lupus Erythematosus
Fertility
Preconceptional Care
Preconception Counseling and Contraception
Effects of Pregnancy on the Activity of Systemic Lupus Erythematosus
Effects of Systemic Lupus Erythematosus on Obstetric Outcomes
Neonatal Lupus Syndrome and Anti-Ro/SS-A and Anti-La/SS-B Antibodies
Prenatal Care
Treatment
Lactation
Rheumatoid Arthritis
Other Systemic Autoimmune Diseases
Undifferentiated Connective Tissue Disease (UCTD)
Sjögren’s Syndrome
Systemic Sclerosis
Polymyositis and Dermatomyositis
Mixed Connective Tissue Disease (DMTC)
Systemic Vasculitis
Behçet’s Disease
Takayasu’s Arteritis
Granulomatosis with Polyangiitis (GPA), Formerly Wegener Granulomatosis
Microscopic Polyangiitis (MPA)
Eosinophilic with Polyangiitis (EGPA), Formerly Churg-Strauss Syndrome
Antirheumatics and their Use in Pregnancy and Lactation
Acetylsalicylic Acid and Paracetamol
Nonsteroidal Anti-Inflammatory Drugs and Cyclooxygenase 2 Inhibitors
Antimalarials
Corticosteroids
Azathioprine
Sulfasalazine
Cyclophosphamide
Methotrexate
Leflunomide
Mycophenolate Mofetil
Biological Agents
Anti-TNF
Rituximab
Belimumab
References
Chapter 29: Prophylaxis for Deep Venous Thrombosis During Pregnancy, Delivery, and Postpartum
Acquired Thrombophilia—Antiphospholipid Syndrome
Inherited Thrombophilia
DVT and PE in Pregnancy
Prophylaxis
Nonpharmacological Thromboprophylaxis
Pharmacological Thromboprophylaxis
Complications of Anticoagulation
Heparin-Induced Thrombocytopenia
Heparin-Induced Osteoporosis
Delivery Route and Anticoagulation
References
Chapter 30: Metabolomics Application in Fetal Medicine
Introduction
Metabolomic Methods
Metabolomics in Fetal Medicine
Metabolomics and Normal Pregnancy
Metabolomics and Chromosomal Anomalies
Metabolomics and Preterm Delivery
Metabolomics and Preeclampsia
Metabolomics and Congenital Heart Disease
Metabolomics and Mendelian Diseases
Conclusion
References
Part V: Pregnancy Complications: Prevention, Diagnosis and Management
Chapter 31: Prematurity: Relevant Aspects in Asymptomatic Patients
Introduction
Prematurity Prediction in Asymptomatic Women
Single Pregnancy Prediction
Biochemical Methods
Biophysical Methods
Association of Methods: Prediction Models
Multiple Pregnancy Prediction
Biochemical Methods
Biophysical Methods
Prevention Measures
Prevention of Prematurity in Asymptomatic Single-Pregnancy Women
Cerclage
Cerclage Indicated Due to History
Cerclage Indicated Due to Ultrasound Findings
Cerclage Indicated Due to Physical Examination
Progesterone
Pessary
Comparison and Association of Prevention Strategies
Strategies to Prevent Prematurity in Asymptomatic Women with Twin Pregnancy.
Cerclage
Cerclage Indicated Due to Ultrasound Findings
Cerclage Indicated Due to Physical Examination
Cerclage Indicated Due to History
Progesterone
Pessary
References
Chapter 32: Prematurity: Relevant Aspects in the Symptomatic Patient
Overview
Pathogenesis of Spontaneous Preterm Birth
Premature Activation of the Maternal or Fetal HPA Axis
Exaggerated Inflammatory Response and/or Infection
Decidual Hemorrhage
Pathologic Uterine Distention
Maternal Genome
Preventing Preterm Birth
Tertiary Interventions
Early Diagnosis of Preterm Labor
Treatment of Women with Acute Risk of Preterm Birth
Fetal Monitoring
Mode of Birth
Timing of Cord Clamping for Preterm Babies
Preterm Labor Algorithms
References
Chapter 33: Prematurity: Evaluation of Fetal Well-Being and Delivery
Prediction and Prevention of Preterm Birth
Risk Marker
Cervical Assessment by Ultrasonography
Biochemical Markers
Inflammation/Infection
Prevention and Management
Multiple Pregnancy
Cervical Cerclage
Cerclage Contraindications
Pessary
Preterm Birth Treatment: Tocolytic
Types of Tocolytics
Calcium Channel Blockers
Mechanism of Action
Pharmacokinetics
Dose and Administration
Efficacy
Adverse Effects
Contraindications
Agonists of Beta-adrenergic Receptors
Action Mechanism
Pharmacokinetics
Dose and Administration
Efficacy
Adverse Effects
Contraindications
Inhibitors of Prostaglandin Synthesis
Mechanism of Action
Pharmacokinetics
Dose and Administration
Efficacy
Adverse Effects
Contraindications
Antagonists of Oxytocin Receptors
Action Mechanism
Pharmacokinetics
Dose and Administration
Efficacy
Adverse Effects
Contraindications
Nitric Oxide Donors
Action Mechanism
Pharmacokinetics
Dose and Administration
Efficacy
Adverse Effects
Contraindications
Magnesium Sulfate
Action Mechanism
Pharmacokinetics
Dose and Administration
Efficacy
Adverse Effects
Contraindications
Combination of Several Uterine Inhibitors
Tocolysis Maintenance
Twin Gestational Pregnancy
Prevention of Premature Preterm Labor
Progesterone
Use of Progesterone in Pregnant Women Without Previous History of Spontaneous Preterm Births
tsc
References
Chapter 34: Antenatal Corticosteroid
Introduction
Recommended Dosage
Corticotherapy Recommendations
Previable Gestation
Late Preterm
Term Gestation
Multi-fetal Gestation
Preexisting or Gestational Diabetes
Fetal Growth Restriction
Rescue Dosage
References
Chapter 35: Magnesium Sulfate in Prevention of Cerebral Palsy
References
Chapter 36: Premature Rupture of Membranes
Introduction
Etiology
Diagnosis
Term Prelabor Rupture of Membranes
Preterm Premature of Membranes
Antibiotics
Antenatal Infection
Management
Midtrimester Premature Rupture of Membranes
Maternal and Neonatal Outcomes
References
Chapter 37: Fetal Growth Restriction
Identification of Small-for-Gestational Age (SGA)
Definition Issues
Distinction Between “Fetal Growth Restriction (FGR)” and SGA
Placental Insufficiency that Appears Early in the Pregnancy
Placental Insufficiency that Appears Late in the Pregnancy
Distinction Between Early and Late-Onset FGR
Clinical Management
Amniotic Fluid
Doppler Parameters
Umbilical Artery (UA) Doppler
Middle Cerebral Artery (MCA) Doppler/Cerebral-Placental Ratio (CPR)
Ductus Venosus (DV) Doppler
Aortic Isthmus (AoI) Doppler
Fetal Heart Rate (FHR) Analysis by Conventional and Computerized Cardiotocography (CTG and cCTG)
Biophysical Profile
Prevention and Treatment: Evidence on Timing of Delivery
Prevention
Treatment
Timing of Delivery
A Stage-Based Protocol for Managing FGR/SGA
References
Chapter 38: Perinatal Hemolytic Disease
Introduction
Epidemiology and Relevance
Pathophysiology
Etiology
Diagnosis
Care of Unimmunized Pregnant Women
Prenatal Care
Labor and Delivery Care
Postpartum Care
Care of Immunized Pregnant Women
Prenatal Care
Labor and Delivery Care
Intrauterine Treatment
Phenobarbital to Accelerate Liver Maturity
Other Situations
Abortion and Threatened Abortion
Other Types of Antepartum Hemorrhages
Ectopic Pregnancy
Gestational Trophoblastic Disease
Tubal Ligation
References
Chapter 39: Disorders of Amniotic Fluid Volume: Oligoamnios and Polyhydramnios
Function and Production of Amniotic Fluid
Echographic Evaluation of the Amniotic Fluid Volume
Alterations of the Amniotic Fluid (AF)
Oligoamnios
Incidence
First Trimester
Second Trimester
Third Trimester
The Duration of Oligoamnios Is Also a Prognostic Factor
Prenatal Care
Considerations in the Oligoamnios for the Calculation of Fetal Weight
Strategies to Increase the Volume of Amniotic Fluid
Amnioinfusion
Recommendations
Polyhydramnios
Maternal Causes
Clinical Importance
Management of Pregnancy with Polyhydramnios
Amnioreduction
Indometacina
Delivery Management
Summary and Recommendations
Conclusions
Bibliography
Chapter 40: Preeclampsia
Physiopathology
Defective Placentation and Reduced Placental Perfusion
Endothelial Dysfunction
Immunological Maladaptation of the Fetal Graft
Genetic Predisposition
Vasopressor Substances
Hypoxia
Oxidative Stress
Imbalance of Angiogenic Factors
Pathological Anatomy of the Placenta in Preeclampsia
Clinical Aspects
Maternal Syndrome and Fetal Syndrome
Clinical Evaluation
Early and Late Preeclampsia
Epidemiology and Risk Factors
Pathogenesis
Clinical Aspects
Early Prediction
Prevention of Preeclampsia
Early Recognition of Risk Factors
Biomarkers
Specific Preventive Approaches
Lifestyle Intervention
Diet Interventions and Supplements
Pharmacological Interventions
Discrepancies Among Clinical Studies of Aspirin
Conclusions
Antihypertensive Treatments
Treatment of Chronic Hypertension
Treatment of Gestational Hypertensive Emergency
Protocol for the Treatment of Hypertensive Emergencies
Induction of Labor
Route of Delivery
Antihypertensive Treatment of the Emergency
References
Chapter 41: Gestational Diabetes
Introduction
Gestational Diabetes
Management of Gestational Diabetes Mellitus
Preexisting Diabetes (Type 1 and Type 2) in Pregnancy
Fetal Environment
Pathophysiological Aspects
Evaluation of the Fetal Response
Fetal Management
Intrapartum Management
Postpartum
Newborn Care
Final Considerations
References
Chapter 42: Complications of Monochorionic Twin Pregnancy: Double Trouble?
Monochorionicity: What We Know
Monozygosity: A Reproductive Anomaly
Time Matters in Zygotic Splitting: Sharing Levels and a Model of Placentation
How Identical Are MZ Twins? The Combination of Genetic, Epigenetic, and Environmental Factors
Discordance for Major Malformations
The Limits of Zygosity Testing: Postnatal Importance
Chorionicity: A (Re)definition of Perinatal Prognosis
Prenatal Screening and Diagnosis of Aneuploidies: Does Chorionicity Matter?
Twin-to-Twin Transfusion Syndrome (TTTS): A Disease for Two
Diagnosis of TTTS
Discordance in Amniotic Fluid Volume (Oligohydramnios Sequence)
Discordance in Fetal Size
Abnormal Doppler Findings
Fetal Echocardiography
Signs of Hydrops in the Recipient Twin
Other Ultrasonographic Findings
Treatment of TTTS
Prediction of TTTS
Twin Anemia-Polycythemia Sequence (TAPS)
Twin Reversed Arterial Perfusion (TRAP)
Conjoined Twins
Discordance of Fetal Growth: Adaptation, Promotion, and Growth Restriction in Multiples
Death of a Co-twin
Conclusion
References
Part VI: Infectious Diseases
Chapter 43: Urinary Tract Infections
Introduction
Influence of Pregnancy on Urinary Tract Infections
Influence of UTI on Pregnancy
Etiology
Virulence Factors of Uropathogenic Strains
Diagnosis
Asymptomatic Bacteriuria
Asymptomatic Group B Streptococcus Bacteriuria
Acute Cystitis
Treatment
Acute Pyelonephritis
Diagnosis
Treatment
References
Chapter 44: Congenital Infection 1 (Syphilis, AIDS, and Viral Hepatitis)
Congenital Syphilis
Congenital Syphilis Case Definition [45]
Clinical Manifestations
Recommendations
Treatment
Aids in Pregnancy
Management Recommendations [12, 41]
Antiretroviral Therapy
Delivery and Breastfeeding
Adherence to ARV Treatment
Viral Hepatitis
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Clinical Manifestations
Laboratory Diagnosis
References
Chapter 45: Congenital Infection 2 (Toxoplasmosis, CMV, Rubella)
Toxoplasmosis
Ultrasound Findings in Congenital Toxoplasmosis
Diagnosis of Fetal Infection
Prevention of Fetal Infection
Screening Test
Treatment for Reduction of Congenital Toxoplasmosis
Rubella
Prevention: Vaccine
Cytomegalovirus Infection
Ultrasound Findings in Congenital CMV
Diagnosis of Maternal and Fetal Infection
Maternal Infection
Fetal Infection
Prevention of Fetal Infection
Screening Test
Diagnose Fetal Infection
Treatment for Reduction of Congenital CMV Infection
Antiviral Drug Therapy
Hyperimmunoglobulin
Post-natal Diagnostic Approach
Parvovirus B19 Infection
Diagnosis
Serological Diagnosis
Diagnosis of Fetal Infection
Treatment of Fetal Infection
References
Chapter 46: Group B Streptococcus and Pregnancy
Introduction
Epidemiology
Maternal Infections
Maternal Colonization
Neonatal GBS Infection
Prevention Strategies
Collection of Specimens
Culture-Based Procedure
Intrapartum Prophylaxis
Secondary Prevention Among Infants
Indications for Newborn Sepsis Investigation [18]
References
Chapter 47: Arboviruses and Pregnancy (Zika, Dengue, Chikungunya, and Yellow Fever)
Introduction
Transmission
Clinical Conditions
Zika
Chikungunya
Dengue
Yellow Fever
Diagnoses
Clinical Presentation
Laboratory Tests
Prevention
Vaccines
Vector Control
Other Measures During Pregnancy
Management
Fetal and Neonatal Outcomes
Zika
Chikungunya
Dengue
Yellow Fever
References
Part VII: Childbirth and Postpartum
Chapter 48: Cervical Ripening and Labor Induction
Introduction
Indications
Contraindications for Labor Induction
Assessment Prior to Labor Induction
Options for Unfavorable Cervix
Mechanical Techniques
Contraindications [19]
Pharmacological Method
Contraindications [19, 23]
Options for Favorable Cervix
Amniotomy
Oxytocin
Administration
Other Drugs and Techniques
Complications Associated with Induction of Labor
Uterine Overactivity
Failed Induction
Uterine Rupture
References
Chapter 49: Analgesia and Anesthesia at Birth
Introduction
Anesthetic Information in Risk Pregnancy
Anesthetic Information in Low-Risk Pregnancy
The Role of LRA in the Current Multi-Professional Childbirth Attention
Pain in Labor
LRA and Labor Management
LRA Techniques
Inhaled Analgesia
Parenteral Analgesia
Regional Analgesia Versus Other Techniques
RLA and Quality
Anesthesia
Guideline Before Anesthetic Procedure
Bronco Aspiration Prophylaxis
Anxiety and Sedation
Regional Anesthesia Techniques
Management of Hypotension
Other Regional Techniques
General Anesthesia
Postoperative Analgesia
References
Chapter 50: Cesarean Delivery
Introduction
ACOG/SMFM Guidelines for the Prevention of Primary Cesarean Delivery
Indications
Maternal and Fetal Indications
Contraindications
Cesarean Delivery on Maternal Request
Preoperative Management
Laboratory Testing
Imaging Studies
Skin Preparation
Anesthesia
Cesarean Delivery
Technique
Laparotomy
Transverse Incisions
Midline Vertical Incision
Hysterotomy
Low-Transverse Cesarean Incision
Uterine Incision
Delivery of the Fetus
Uterine Repair
Abdominal Closure
Postoperative Management
Complications
Reasons for Cesarean Rates
Complication Prevention
Long-Term Monitoring
Future and Controversies
References
Chapter 51: Perinatal Asphyxia (Acute Fetal Distress)
Introduction
Characterization of Perinatal Asphyxia
Physiopathology
Etiology
Diagnosis
Umbilical Cord Blood Sample
Electronic Delivery Monitoring: Intrapartum Cardiotocography
Intermittent Fetal Auscultation
Meconium
Microanalysis of Fetal Blood
Pulse Oximetry
Fetal Electrocardiogram
Prophylaxis
Treatment
References
Chapter 52: Maternal Complications in the Immediate Postpartum Period
Introduction
Hypertensive Disorders
Infectious Complications
Puerperal Infection
Clinical Picture and Initial Treatment
Sepsis
Immediate Management of Sepsis
Specific Infections
Endometritis
Surgical Site Infections
Septic Pelvic Thrombophlebitis
Salpingitis and Oophoritis
Parametritis
Peritonitis
Other Infections
Fever in the First 24 Hours After Delivery
Breast Changes
Respiratory Complications
Pyelonephritis
Hemorrhage
Clinical Picture of Hemorrhage
Hemorrhage Etiology
Prophylaxis and Treatment of PPH
Embolism
Pain
Headaches
Urinary Changes
References
Chapter 53: Care of the Newborn Infant during the Third Stage of Labor
Definition
Umbilical-Placental Circulation and the Cardiopulmonary Switch during the Third Stage of Labor
Elective Interruption of Umbilical Blood Flow (Cord Clamping)
Assessing Fetal Vitality at Birth
Fetal Asphyxia
Respiration during the Third Stage of Labor
During the Third Stage of Labor, the Baby Turns from Blue to Pink and the Umbilical Cord from Blue to White (Bloodless)
The Third Stage at Shorter Gestational Ages: No Gestational Week Is Identical to Other Weeks
Changes in Blood Volume from Fetal to Neonatal Life
“The Iron Minutes”
Fetal Hemoglobin and Stem Cells Load
Heat Loss and Thermal Environment
Birth of the Microbiome
The Changing Setting for Neonatal Care at Delivery
Neonatal Resuscitation Management in Fetal Asphyxia
A Practical Scheme for Special Neonatal Support at Birth
The Family at Birth and the Maternal-Infant Space
Warnings
Skin-to-Skin Contact (SSC) during the Third Stage of Labor
The Perinatal Information System (SIP): Monitoring Quality of Care
References
Part VIII: Neonatal Period
Chapter 54: Breastfeeding
Introduction
Breastfeeding Benefits
Lactation Physiology
Cellular Composition of Breast Tissue and Breast Anatomy
Lactation Hormone Control
Development of the Mammary Gland (Mammogenesis)
Development of the Mammary Gland Ability to Secrete Milk (Lactogenesis)
Process of Milk Production (Lactation)
Breast Milk Composition
Colostrum and Mature Milk
Practices to Support Breastfeeding
Breastfeeding and Recommended Practices
Reflexes in the Baby
How a Baby Attaches and Suckles at the Breast
Different Nipple Shapes
Effective Suckling
Positioning the Mother and Baby for Good Attachment
Breastfeeding Pattern
Breastfeeding during Pregnancy
Proper Storage and Preparation of Breast Milk
Twins
HIV and Infant Feeding
Drug Safety during Breastfeeding
Antibiotics
Antidepressants, Anxiolytics, and Antipsychotics
Drugs of Abuse
Pain Medications
Galactagogues
Diagnostic Imaging during Breastfeeding
Breastfeeding and Vaccines
Management of Breastfeeding Difficulties
Blocked Duct
Breast Engorgement
Fissured Nipple
Mastitis
Breast Abscess
Candida Infection (Thrush) in Mother and Baby
References
Chapter 55: Caring for the Normal Newborn
Introduction
Intrauterine Environment and the Neonate
Labor and Birthing Process and the Neonate
The Transition from Intrauterine to Extrauterine Life
Promotion of Breastfeeding and Skin-to-Skin Contact
Microbiome and the Neonate
Assessment of Healthy Term Newborn After Birth and Preventive Methods in the Early Neonatal Period
Assessment of Healthy Term Newborn
Physical Examination of the Newborn
Routine Prophylactic Procedures in the Immediate Postnatal Care
Umbilical Cord Clamping and Core Care to Prevent Infection
Umbilical Cord Clamping
Umbilical Cord Care
Prophylactic Care to Prevent Neonatal Gonococcal Ophthalmia
Prevention of Vitamin K Deficiency Bleeding
Vaccination in the Early Neonatal Period
Newborn Screening
Screening for Metabolic and Genetic Disorders
Hearing Screening
Postnatal Screening for Congenital Heart Defects (CHD)
Other Screening Programs
Neonatal Screening in Developing Countries
Breastfeeding Assessment and Follow-Up
Assessment of Hyperbilirubinemia in Low-Risk Term Newborns
Safety Issues in Term Neonate
Discharge Home of Well Term Newborn
References
Chapter 56: Palliative Care in Perinatology
Definition of Pediatric Palliative Care
When to Take Care
During Pregnancy
Delivery Room
Postnatal Period: During Hospitalization [15]
Childcare
Non-opioid Analgesics
Opioid Analgesics
Care for Family Members After the Loss
Bioethics and Decision-Making
Therapeutic Adequacy
Decision-Making
Health Team Discussion
Deliberation
Applying Decisions
Eligible Patients
Extreme Prematurity
References
Chapter 57: Hypoxic-Ischemic Encephalopathy
Introduction
Clinical Features
Potential Therapies for Neonatal Hypoxic-Ischemic Encephalopathy
Intensive Supportive Care
Seizures Control
Renal Function
Cardiovascular System
Neuroimaging
Neuroprotective Strategies
Therapeutic Hypothermia
Drugs
Conclusion
References
Chapter 58: Neonatal Complications of Prematurity
Introduction
Epidemiology
Short-Term Neonatal Complications
Perinatal Asphyxia
Respiratory Disorders
Respiratory Distress Syndrome (RDS)
Transient Tachypnea of the Newborn (TTN)
Persistent Pulmonary Hypertension of Newborn (PPHN)
Bronchopulmonary Dysplasia (BPD)
Pulmonary Hemorrhage (PH)
Apnea of Prematurity
Cardiovascular Disorders
Arterial Hypotension
Patent Duct Arteriosus (PDA)
Infections
Sepsis
Necrotizing Enterocolitis (NEC)
Germinal Matrix Hemorrhage/Intraventricular Hemorrhage (IVH)
Retinopathy of Prematurity (ROP)
Extrauterine Growth Restriction (EUGR)
Pediatric Complications in Long-Term Prematurity
Impact of Prematurity on Adult Health
Conclusions
References
Chapter 59: Small for Gestational Age
Definitions
Fetal Growth
Fetal Growth Restriction
Classification
Maternal Causes Associated with High Risk of Fetal Growth Restriction
Neonatal Consequences of SGA
References
Chapter 60: Respiratory Distress Syndrome in the Newborn
Introduction
Prenatal and Perinatal Care
Pathophysiology
Clinical Manifestation
Diagnosis
Treatment
Methods of Ventilatory Assistance
Administration of Exogenous Surfactant
Prevention
References
Chapter 61: Transient Tachypnea of the Newborn
Etiology
Epidemiology
Pathophysiology
History and Physical Examination
Diagnostic Approach
Treatment
Differential Diagnosis
Prognosis
Complications
References
Chapter 62: Bronchopulmonary Dysplasia
Introduction
Definition
Incidence
Risk Factors
Mechanical Ventilation Nasal CPAP and Supplemental Oxygen
Clinical Management and Profiles
Pulmonary Hypertension
Long-Term Outcome
Pharmacologic Treatment
Postnatal Steroids
Nitric Oxide
Caffeine
Stem Cell
References
Chapter 63: Retinopathy of Prematurity
Introduction and Epidemiology
Patophysiology and Risk Factors
Classification
Location
Severity
Stage 1: Demarcation Line
Stage 2: Ridge
Stage 3: Extraretinal Fibrovascular Proliferation
Stage 4: Partial Retinal Detachment
Stage 5: Total Retinal Detachment
Extension
Plus and Preplus Disease
Aggressive ROP
ROP Regression, long-term sequelae and reactivation
Screening, Monitoring, and Examination
Screening
Who to Screen?
High-Income Countries
Low- and Middle-Income Countries
When to Screen?
Monitoring
Examination
Preparation of the Eye
Care and Comfort During Examination
Treatment
When to Treat?
How to treat?
Long-Term Outcomes
New ROP Approaches
Conclusions
References
Chapter 64: Necrotizing Enterocolitis
Introduction
Epidemiology
Risk Factors
Antenatal Risk Factors
Postnatal Risk Factors
Pathophysiology
Genetic Predisposition
Intestinal Immaturity
Intestinal Microbiota Versus Bacterial Colonization
Endothelial Dysfunction
Inflammatory Mediators
Probiotics
Clinical Presentation
Laboratory
Radiographic Findings
Treatment
Clinical Management
Surgical Treatment
Complications
References
Chapter 65: Persistent Pulmonary Hypertension of the Newborn
Physiology Concepts
Classification of PPHN
Fetal Circulation
Transitional Circulation
Cellular Biochemical Physiology
Hemodynamic Physiology
Clinical Presentation
Echocardiography
Assessment of Severity of HRF and Monitoring Response to Therapy
PPHN Treatment
Extracorporeal Membrane Oxygenation (ECMO)
Follow-Up
Conclusion
References
Chapter 66: Intracranial Hemorrhage
Background
Definition and Classification
Germinal Matrix–Intraventricular Hemorrhage
Clinical Manifestations of GMH-IVH
Manifestations in Term
Best Evidences for Prevention
Antenatal Steroids
Perinatal Centers and Delivery Room Management
Delayed Cord Clamping
Long-Term Development
Periventricular Leukomalacia
History
Incidence
Physiopathology
Diagnostic Imaging
Clinical Outcomes
References
Chapter 67: Resuscitation of the Newborn Development of Algorithms, Present Status and Future Perspectives
Need for Resuscitation
Development of the Resuscitation Algorithm
Anticipation, Preparation, and Initial Stabilization
Equipment and Preparation
Initial Stabilization
Monitoring: Heart Rate Assessment
Suctioning
Oxygenation in the Delivery Room
Delayed Cord Clamping
Temperature Regulation
Meconium Delivery
10. Noninvasive Ventilation
Advanced Airway
Chest Compressions /Drugs/ Volume
Respiratory Management for the Preterm Infant
Low-Income Countries
Teaching and Debriefing
Future Aspects
References
Index