Continued part 1, part 2 of ebook Gabbe’s obstetrics essentials: Normal and problem pregnancies provide readers with content about: postpartum care; postpartum care and long-term health consideration; lactation and breastfeeding; complicated pregnancy; surgery during pregnancy; trauma and related surgery in pregnancy; trauma and related surgery in pregnancy; cervical insufficiency; preterm labor and birth; premature rupture of the membranes; intrauterine growth restriction;... Please refer to the ebook for details!
PA R T V I Pregnancy and Coexisting Disease OUTLINE Chapter 36 Prolonged and Postterm Pregnancy Chapter 37 Heart Disease in Pregnancy Chapter 38 Respiratory Disease in Pregnancy Chapter 39 Renal Disease in Pregnancy Chapter 40 Diabetes Mellitus Complicating Pregnancy Chapter 41 Obesity in Pregnancy Chapter 42 Thyroid and Parathyroid Diseases in Pregnancy Chapter 43 Pituitary and Adrenal Disorders in Pregnancy Chapter 44 Hematologic Complications of Pregnancy Chapter 45 Thromboembolic Disorders in Pregnancy Chapter 46 Collagen Vascular Diseases in Pregnancy Chapter 47 Hepatic Disorders During Pregnancy Chapter 48 Gastrointestinal Disorders During Pregnancy Chapter 49 Neurologic Disorders in Pregnancy Chapter 50 Malignant Diseases and Pregnancy Chapter 51 Skin Disease and Pregnancy 611 Chapter 52 Maternal and Perinatal Infection: Chlamydia, Gonorrhea, and Syphilis in Pregnancy Chapter 53 Maternal and Perinatal Infection in Pregnancy: Viral Chapter 54 Maternal and Perinatal Infection in Pregnancy: Bacterial Chapter 55 Mental Health and Behavioral Disorders in Pregnancy 612 CHAPTER 36 Prolonged and Postterm Pregnancy Roxane Rampersad, and George A Macones KEY POINTS • Ultrasonography, preferably done in the first trimester, is the most accurate method with which to establish the EDD • No gestational cutoff has been established by which to define a prolonged pregnancy in multiple gestations The risk for stillbirth increases after 38 weeks in twins and after 35 weeks in triplets • Late-term and postterm pregnancies are associated with an increased risk for perinatal morbidity and mortality, oligohydramnios, macrosomia, postmaturity, and maternal morbidity • It seems prudent to initiate antenatal fetal surveillance at 41 weeks in a normal, uncomplicated pregnancy in the absence of intrauterine growth restriction • Antenatal fetal surveillance at 41 weeks should include a modified biophysical profile at least once a week • If the cervix is favorable at 41 weeks, induction of labor can be considered • Delivery after 420/7 weeks and by 426/7 weeks is recommended based on the small but increased risk of perinatal morbidity and 613 mortality • Either prostaglandin preparation, PGE1 or PGE2, can be used for induction of the postterm pregnancy Definition ▪ Postterm pregnancy is a gestation that has completed or gone beyond 42 weeks or 294 days, from the first day of the last menstrual period (LMP) ▪ Pregnancies are designated as “late term” at 410/7 weeks through 416/7 weeks Incidence ▪ According to the vital statistics reported by the Centers for Disease Control and Prevention, the overall incidence of postterm pregnancies was 5.6% in 2012 and has not significantly changed compared with previous years Etiology ▪ The etiology of the majority of pregnancies that are late term or postterm is unknown Some pregnancies may be defined as late term or postterm as the result of an error in dating ▪ A number of observational studies have identified risk factors for postterm pregnancy, including primigravidity, prior postterm pregnancy, male fetus, obesity, and a genetic predisposition Diagnosis ▪ The diagnosis of truly late term and postterm pregnancy is based on accurate gestational dating 614 ▪ The use of ultrasound to determine the accuracy of gestational dating based on the LMP is superior to the use of the LMP alone The estimated date of delivery (EDD) is most accurately determined if the crown-rump length is measured in the first trimester with an error of ± to days Perinatal Morbidity and Mortality ▪ More recent observational studies that have evaluated the risk of perinatal mortality at each gestational week show an increased risk as gestational age advances beyond the EDD (Fig 36.1) ▪ Clausson and colleagues evaluated a large Swedish database of term and postterm (defined as ≥294 days) singleton, normal neonates and showed that postterm pregnancies were associated with an increased frequency of neonatal convulsions, meconium aspiration syndrome, and Apgar scores of less than at minutes (Table 36.1) Oligohydramnios ▪ In a setting of oligohydramnios, the risk of perinatal morbidity and mortality is increased, regardless of the pathophysiology ▪ Given the well-described association between oligohydramnios and adverse pregnancy outcome at or beyond term, delivery is a reasonable choice for patients with oligohydramnios 615 FIG 36.1 The summed mortality at each gestation for the rate of stillbirth (red), neonatal death (blue), and postneonatal death (green) expressed per 1000 ongoing pregnancies Modified from Hilder L, Costeloe K, Thilaganathan B Prolonged pregnancy: evaluating gestation specific risks of fetal and infant mortality BJOG 1998;105:169 TABLE 36.1 616 AGA, average for gestational age; SGA, small for gestational age ∗ Values are presented as odds ratios (confidence interval) Modified from Clausson B, Cnattinguis S, Axelsson O Outcomes of post-term births: the role of fetal growth restriction and malformations Obstet Gynecol 1999;94:758 Fetal Growth ▪ The risk of macrosomia has been shown to increase with advancing gestational age ▪ ACOG has warned that the diagnosis of fetal macrosomia by ultrasound is not precise and that early induction of labor or cesarean delivery has not been shown to reduce the morbidity associated with fetal macrosomia Postmaturity ▪ Postmaturity, another complication of prolonged pregnancies, occurs in approximately 10% to 20% of such pregnancies Meconium ▪ Meconium-stained fluid can be seen at any gestational age, although several studies have documented a significantly increased risk of meconium-stained fluid in postterm pregnancies Maternal Complications 617 ▪ Prolonged pregnancies are also associated with significant risk to the mother (perineal lacerations, chorioamnionitis, postpartum hemorrhage, emdomyometritis, cesarean delivery) Management ▪ Accurate assessment of gestational age is paramount in the management of late-term and postterm pregnancies Antenatal Surveillance ▪ Given the increased risk of stillbirth, antenatal surveillance is recommended in the management of prolonged and postterm pregnancies ▪ Based on the studies of perinatal morbidity and mortality, it would seem prudent to initiate fetal testing no later than 41 weeks of gestation ▪ ACOG proposed that amniotic fluid volume should be assessed when surveillance is initiated for late-term pregnancies because oligohydramnios has been associated with abnormal fetal heart tracings, umbilical cord compression, and meconium-stained fluid ▪ ACOG currently recommends the initiation of fetal surveillance at 41 weeks or beyond with assessment of amniotic fluid volume Expectant Management Versus Induction of Labor ▪ New evidence supports the induction of labor after 420/7 weeks and by 426/7 weeks to decrease the risk of perinatal morbidity and mortality, ▪ A Cochrane meta-analysis suggests that induction may yield slightly improved perinatal outcomes ▪ Studies show a small but significantly increased risk in 618 perinatal morbidity and mortality in postterm pregnancies, and hence, postterm pregnancy is one of the most common reasons for induction of labor in the United States Long-Term Neonatal Outcomes ▪ Several small and older studies show no apparent difference in long-term neonatal outcome for neonates born at 42 weeks and later Multiple Gestation ▪ No defined gestational age cutoff has been established to define a prolonged pregnancy in twin, triplet, or higherorder multiples ▪ It would seem reasonable to utilize antenatal testing as these gestational ages approach and to accomplish delivery at the nadir of stillbirth risk (see Chapter 32) 619 CHAPTER 37 Heart Disease in Pregnancy Jason Deen, Suchitra Chandrasekaran, Karen Stout, and Thomas Easterling KEY POINTS • Hemodynamic changes in pregnancy may adversely affect maternal cardiac performance • Intercurrent events (e.g., infection) in pregnancy are usually the cause of decompensation • Women with heart disease in pregnancy frequently have unique psychosocial needs • Labor, delivery, and postpartum are periods of hemodynamic instability • The postpartum period can be characterized as a “perfect storm” of volume loading, tachycardia, and increased afterload; each of these may contribute to the destabilization of a pregnant woman with heart disease • Invasive hemodynamic monitoring should be used to address specific clinical questions • Many maternal heart conditions can be medically managed during pregnancy • Management of anticoagulation in women with mechanical valves requires an experienced team and careful consideration 620 目录 Title page Table of Contents Copyright Contributors PART I Physiology 27 30 44 Chapter Placental Anatomy and Physiology Placental Anatomy Placental Histology Placental Physiology Chapter Fetal Development and Physiology Umbilical Blood Flow Amniotic Fluid Volume Fetal Growth and Metabolism Fetal Cardiovascular System Fetal Kidney Fetal Gastrointestinal System Fetal Adrenal and Thyroid Glands Fetal Central Nervous System Chapter Maternal Physiology Overview Cardiovascular System Hematologic Changes Respiratory System Urinary System Body Water Metabolism Alimentary Tract Endocrine Changes Pancreas and Fuel Metabolism Skeleton Skin Central Nervous System 1169 45 47 54 55 64 65 65 66 68 74 75 75 76 78 80 80 82 84 87 88 89 91 94 94 95 95 Lower Reproductive Tract Microbiome Chapter Maternal-Fetal Immunology Introduction Immune System Overview: Innate and Adaptive Immunity Innate Immunity: First Line of Host Defense Adaptive Immunity Regulatory T Cells Fetal Immune System Maternal Tolerance of the Fetus Solid Organ Transplantation in Pregnancy Amelioration of Rheumatoid Arthritis in Pregnancy Chapter Developmental Origins of Adult Health and Disease Introduction Epigenetics and Programming Fetal Nutrition and Growth Energy-Balance Programming Maternal Stress and Anxiety Glucocorticoids and Prematurity Immune Function Other Programming PART II Prenatal Care 96 96 98 101 101 101 104 107 108 108 112 112 114 115 115 117 117 122 123 124 124 129 Chapter Preconception and Prenatal Care Definition and Goals of Prenatal Care Components of Preconception Care and Well-Woman Visits Preconception Health Counseling Screening for Chronic Disease, Optimizing Care, and Managing Medication Exposure Prenatal Care Components of the Postpartum Visit Chapter Nutrition During Pregnancy Overview Integrating Nutrition Into the Obstetric History Maternal Weight Gain Recommendations 1170 130 132 133 133 138 138 140 142 143 143 144 Maternal Weight Gain Recommendations for Special Populations Maternal Nutrient Needs: Current Recommendations Vitamin and Mineral Supplementation Guidelines Nutrition-Related Problems During Pregnancy Special Nutritional Considerations During Pregnancy Chapter Drugs and Environmental Agents in Pregnancy and Lactation: Teratology and Epidemiology Overview Basic Principles of Teratology Medical Drug Use Drugs of Abuse Drugs in Breast Milk Occupational and Environmental Hazards Chapter Obstetric Ultrasound: Imaging, Dating, Growth, and Anomaly Biophysics of Ultrasound Optimizing the Ultrasound Image Special Ultrasound Modalities Scanning Technique First-Trimester Ultrasound Second- and Third-Trimester Ultrasound Components of the Examination Ultrasound for Determining Gestational Age Safety of Ultrasound Ultrasound Diagnosis of Malformations “Entertainment” Ultrasound Examinations Chapter 10 Genetic Screening and Prenatal Genetic Diagnosis Genetic History Genetic Counseling Chromosome Abnormalities Single-Gene or Mendelian Disorders Multifactorial and Polygenic Disorders Procedures for Prenatal Genetic Diagnosis Preimplantation Genetic Diagnosis 1171 146 147 148 153 156 160 162 163 164 173 175 176 180 181 181 183 183 184 185 187 190 197 198 199 202 204 204 205 212 215 216 217 Chapter 11 Antepartum Fetal Evaluation Defining the Problem of Perinatal Mortality Potential Utility of Antepartum Fetal Testing What Do These Tests Tell Us About the Fetus? Biophysical Techniques of Fetal Evaluation Clinical Application of Tests of Fetal Well-Being PART III Intrapartum Care 219 221 227 228 228 233 237 Chapter 12 Normal Labor and Delivery Labor: Definition and Physiology Mechanics of Labor Cardinal Movements in Labor Normal Progress of Labor Spontaneous Vaginal Delivery Delivery of the Placenta and Fetal Membranes Episiotomy and Perineal Injury and Repair Ultrasound in Labor and Delivery Chapter 13 Abnormal Labor and Induction of Labor Diagnosis Induction of Labor Techniques for Cervical Ripening and Labor Induction Chapter 14 Operative Vaginal Delivery Operative Vaginal Delivery Operative Vaginal Delivery Instruments Risks of Operative Vaginal Delivery Chapter 15 Intrapartum Fetal Evaluation Direct Fetal Heart Rate and Uterine Activity Monitoring Indirect Fetal Heart Rate and Uterine Activity Monitoring Physiologic Basis for Electronic Fetal Heart Rate Monitoring Summary of Placental Causes of Interrupted Oxygenation Fetal Response to Interrupted Oxygen Transfer Pattern Recognition and Interpretation 2008 National Institute of Child Health and Human Development Consensus Report Benefits of Electronic Fetal Monitoring 1172 238 239 240 244 247 252 253 254 254 259 260 262 262 264 265 265 267 272 275 275 275 279 280 281 281 287 Limitations of Electronic Fetal Monitoring Chapter 16 Obstetric Anesthesia Personnel Pain Pathways Effects of Pain and Stress Analgesia for Labor Anesthesia for Instrumented Vaginal Delivery or Perineal Repair Anesthesia for Cesarean Delivery Chapter 17 Malpresentations Overview Clinical Circumstances Associated With Malpresentation Abnormal Axial Lie Management of a Singleton Gestation Face Presentation Brow Presentation Compound Presentation Breech Presentation Term Breech Trial Shoulder Dystocia Chapter 18 Antepartum and Postpartum Hemorrhage Pregnancy-Related Hemodynamic Changes Physiologic Adaptation to Hemorrhage Classification of Hemorrhage Antepartum Hemorrhage Chapter 19 Cesarean Delivery Incidence Indications for Cesarean Delivery Technique of Cesarean Delivery Complications of Cesarean Delivery Tubal Sterilization Chapter 20 Vaginal Birth After Cesarean Delivery Trends Risks Associated With a Trial of Labor After Cesarean 1173 288 290 291 292 292 292 296 297 302 303 303 303 304 304 308 308 312 314 316 325 326 327 328 329 350 351 352 357 361 363 366 367 371 Chapter 21 Placenta Accreta Overview Pathogenesis Epidemiology Management 380 381 381 383 385 PART IV Postpartum Care 390 Chapter 22 The Neonate Cardiopulmonary Transition Abnormalities of Cardiopulmonary Transition Birth Injuries Neonatal Thermal Regulation Clinical Applications Infant Feeding Neonatal Hematology Perinatal Infection Respiratory Distress Nursery Care Outcome of Neonatal Intensive Care and Threshold of Viability Late Preterm Infant Chapter 23 Postpartum Care and Long-Term Health Considerations Physiologic Changes Management of the Puerperium Health Maintenance Pregnancy Prevention Postpartum Psychological Reactions Chapter 24 Lactation and Breastfeeding Breast Anatomy and Development Physiology of Lactation Breast Milk: The Gold Standard Role of the Obstetrician and Gynecologist Focused Issues in the Successful Management of Breastfeeding 1174 391 392 394 396 397 398 398 399 400 400 401 402 402 404 405 407 408 411 413 415 416 417 418 420 421 Anatomic Abnormalities of the Breast Labor and Delivery Management Maternal Nutrition During Lactation Breast and Nipple Pain Mastitis and Breast Abscess Milk Transfer and Infant Growth Jaundice in the Newborn Galactogogues: Drugs to Improve Milk Production Maternal Disease Breast Masses During Lactation Back-to-Work Issues Contraception PART V Complicated Pregnancy Chapter 25 Surgery During Pregnancy Maternal Physiology Diagnostic Imaging Nonobstetric Surgery and Pregnancy Outcome Fetal Monitoring Laparoscopy in Pregnancy Adnexal Masses in Pregnancy Obesity, Bariatric Surgery, and Pregnancy Chapter 26 Trauma and Related Surgery in Pregnancy Incidence of Trauma in Pregnancy Anatomic and Physiologic Changes of Pregnancy Blunt Trauma Specific Injuries Management Considerations Diagnostic Imaging Exploratory Surgery for Traumatic Injuries During Pregnancy Chapter 27 Early Pregnancy Loss and Stillbirth Introduction Frequency and Timing of Pregnancy Loss Placental Anatomic Characteristics of Successful and 1175 422 422 423 423 423 424 424 424 424 425 425 425 427 428 430 431 432 433 433 434 434 437 438 439 439 441 443 445 445 450 452 452 Unsuccessful Pregnancies Numerical Chromosomal Abnormalities: Most Frequent Cause of Early Pregnancy Loss Chromosomal Rearrangements Mosaics Nonchromosomal Causes of Early Pregnancy Loss Thrombophilias Exogenous Agents Management of Recurrent Early Pregnancy Loss Late Pregnancy Loss (Stillbirth) Obstetric Outcome After Early Pregnancy Complications Chapter 28 Cervical Insufficiency Overview Short Cervix Risk Factors for Cervical Insufficiency Tests for Cervical Insufficiency Clinical Diagnosis of Cervical Insufficiency Sonographic Diagnosis of Cervical Insufficiency Diagnosis of Cervical Insufficiency on Physical Examination Treatment Chapter 29 Preterm Labor and Birth Overview Definitions Frequency of Preterm and Low-Birthweight Delivery Clinical Care for Women in Preterm Labor Diagnosis of Preterm Labor Treatment for Women in Preterm Labor Conduct of Labor and Delivery for the Preterm Infant Prevention of Preterm Birth Chapter 30 Premature Rupture of the Membranes Overview Fetal Membrane Anatomy and Physiology Etiology of Premature Rupture of the Membranes Clinical Course After Premature Rupture of the Membranes 1176 453 455 457 457 459 460 462 463 465 468 469 470 470 470 471 471 472 472 478 479 479 480 482 482 483 489 491 497 498 499 499 500 Risks of Premature Rupture of the Membranes Management of Premature Rupture of the Membranes Chapter 31 Preeclampsia and Hypertensive Disorders Definitions Preeclampsia Eclampsia Chrionic Hypertension Chapter 32 Multiple Gestations Zygosity and Chorionicity Diagnosis of Multiple Gestations Maternal and Fetal Risks of Multiple Gestation Perinatal Morbidity and Mortality Issues and Complications Unique to Multiple Gestations Selective Intrauterine Growth Restriction in Monochorionic Twin Pregnancies Twin Anemia-Polycythemia Sequence Antepartum Management of Multifetal Pregnancy Timing of Delivery in Multiple Gestations Mode of Delivery in Multiple Gestations Intrapartum Management of Twin Vaginal Delivery Chapter 33 Intrauterine Growth Restriction Perinatal Mortality Regulation of Fetal Growth Definition and Patterns of Fetal Growth Restriction Etiologies of Intrauterine Growth Restriction Maternal and Fetal Manifestations of Intrauterine Growth Restriction Diagnostic Tools in Fetal Growth Restriction Screening and Prevention of Fetal Growth Restriction Management in Clinical Practice Assessment of Fetal Well-Being Timing of Delivery Delivery Chapter 34 Red Cell Alloimmunization 1177 500 501 509 510 512 530 534 540 541 544 546 548 548 552 553 554 561 561 562 563 564 564 565 565 566 568 571 575 578 581 581 585 Nomenclature Historic Perspectives Incidence Pathophysiology Rhesus Alloimmunization and Fetal/Neonatal Hemolytic Disease of the Newborn Prevention of RhD Hemolytic Disease in the Fetus and Newborn Clinical Management Intrauterine Transfusion Hemolytic Disease of the Fetus and Newborn Due to NonRhD Antibodies Chapter 35 Amniotic Fluid Disorders Overview Amniotic Fluid Volume Amniotic Fluid Formation Amniotic Fluid Removal Oligohydramnios Polyhydramnios PART VI Pregnancy and Coexisting Disease Chapter 36 Prolonged and Postterm Pregnancy Definition Incidence Etiology Diagnosis Perinatal Morbidity and Mortality Maternal Complications Management Long-Term Neonatal Outcomes Multiple Gestation Chapter 37 Heart Disease in Pregnancy Maternal Hemodynamics Diagnosis and Evaluation of Heart Disease General Care 1178 586 586 586 587 587 588 591 592 595 599 600 600 604 605 605 609 611 613 614 614 614 614 615 617 618 619 619 620 621 624 624 Congenital Heart Disease 627 Summary Cardiomyopathy Myocardial Infarction Marfan Syndrome Pulmonary Hypertension Other Conditions Critical Care: Hemodynamic Monitoring and Management Chapter 38 Respiratory Disease in Pregnancy Pneumonia in Pregnancy Bacteriology Bacterial Pneumonia Viral Pneumonia Tuberculosis in Pregnancy Asthma in Pregnancy Restrictive Lung Disease Chapter 39 Renal Disease in Pregnancy Altered Renal Physiology in Pregnancy Asymptomatic Bacteriuria Pyelonephritis Acute Renal Disease in Pregnancy Chronic Renal Disease in Pregnancy Chapter 40 Diabetes Mellitus Complicating Pregnancy Perinatal Morbidity and Mortality Maternal Classification and Risk Assessment Early Screening for Overt Diabetes and Detection of Gestational Diabetes Mellitus Treatment of the Patient With Type or Type Diabetes Mellitus Antepartum Fetal Evaluation Timing and Mode of Delivery Glucoregulation During Labor and Delivery Management of Gestational Diabetes Postpartum Follow-up in Gestational Diabetes Mellitus 1179 630 630 631 632 632 632 632 635 636 637 637 640 642 646 651 662 664 664 665 665 668 674 676 677 679 680 683 683 686 687 689 Prepregnancy Counseling in Preexisting Diabetes Mellitus Contraception Chapter 41 Obesity in Pregnancy Prevalence of Obesity in Women of Reproductive Age Pregnancy Complications in Obese Women Postpartum Considerations Neonate/Child Other Considerations Chapter 42 Thyroid and Parathyroid Diseases in Pregnancy Parathyroid Disorders Thyroid Diseases Chapter 43 Pituitary and Adrenal Disorders in Pregnancy Anterior Pituitary Posterior Pituitary Adrenals Chapter 44 Hematologic Complications of Pregnancy Pregnancy-Associated Thrombocytopenia Evaluation of Thrombocytopenia During Pregnancy and the Puerperium Therapy of Thrombocytopenia During Pregnancy Management of Thrombotic Thrombocytopenic Purpura and Hemolytic-Uremic Syndrome Fetal/Neonatal Alloimmune Thrombocytopenia Iron Deficiency Anemia Megaloblastic Anemia Hemoglobinopathies von Willebrand Disease Chapter 45 Thromboembolic Disorders in Pregnancy Epidemiology and Incidence Genetics Pathophysiology of Thrombosis in Pregnancy Chapter 46 Collagen Vascular Diseases in Pregnancy Systemic Lupus Erythematosus Antiphospholipid Syndrome 1180 689 690 692 693 694 695 696 696 697 698 699 708 709 712 712 719 721 723 723 724 725 725 726 727 730 733 734 734 735 744 745 751 Rheumatoid Arthritis 755 Systemic Sclerosis Sjögren Syndrome Chapter 47 Hepatic Disorders During Pregnancy Overview Differential Diagnosis of Hepatobiliary Symptoms and Conditions During Pregnancy Abdominal Imaging During Pregnancy Pancreatobiliary Disease Common Liver Diseases Incidental to Pregnancy Chapter 48 Gastrointestinal Disorders During Pregnancy Differential Diagnosis and Evaluation of Gastrointestinal Symptoms During Pregnancy Diagnostic Testing During Pregnancy Chapter 49 Neurologic Disorders in Pregnancy Epilepsy and Seizures Multiple Sclerosis Stroke Carpal Tunnel Syndrome Chapter 50 Malignant Diseases and Pregnancy Introduction Cancer Therapy During Pregnancy Radiation Therapy Surgery and Anesthesia Pregnancy Following Cancer Treatment Cancer During Pregnancy Postoperative Adjuvant Therapy Central Nervous System Tumors Neonatal Outcomes Fetal-Placental Metastasis Fertility Preservation Gestational Trophoblastic Disease and Pregnancy-Related Issues Chapter 51 Skin Disease and Pregnancy 1181 757 758 760 761 761 763 764 766 771 772 775 786 787 793 796 797 799 800 801 803 803 803 804 813 816 816 816 817 817 822 Preexisting Skin Diseases and Tumors Affected by Pregnancy Cutaneous Manifestations of Autoimmune Disorders Pruritus in Pregnancy Specific Dermatoses of Pregnancy Chapter 52 Maternal and Perinatal Infection: Chlamydia, Gonorrhea, and Syphilis in Pregnancy Chlamydia Gonorrhea Syphilis Congenital Syphilis Chapter 53 Maternal and Perinatal Infection in Pregnancy: Viral Viral Infections Human Immunodeficiency Virus Influenza Parvovirus Measles Cytomegalovirus Infection Herpesvirus Varicella Hepatitis Human Papillomavirus Ebola Chapter 54 Maternal and Perinatal Infection in Pregnancy: Bacterial Group B Streptococcal Infection Urinary Tract Infections Upper Genital Tract Infections Chapter 55 Mental Health and Behavioral Disorders in Pregnancy Mood Disorders Anxiety Disorders Eating Disorders Schizophrenia Substance-Related Disorders 1182 826 828 830 830 837 838 840 843 846 851 853 853 861 861 861 864 866 867 868 872 872 874 875 877 880 889 891 896 897 897 898 PART VII Legal and Ethical Issues in Perinatology Chapter 56 Patient Safety and Quality Measurement in Obstetric Care Patient Safety Approaches to Improve Obstetric Safety Measurement of Obstetric Quality of Care Chapter 57 Ethical and Legal Issues in Perinatology Reproductive Liberty Abortion Politics and “Obamacare” Human Embryonic Stem Cell Research Funding Genetic Counseling, Screening, and Prenatal Diagnosis Forced Cesarean Delivery Chapter 58 Improving Global Maternal Health: Challenges and Opportunities Maternal and Reproductive Health Sexual and Reproductive Health Major Obstetric Complications: Prevention and Management in Resource-Poor Countries Practical Advice on Volunteering to Work Overseas Appendix 904 905 906 906 907 909 910 911 912 912 913 916 917 921 922 925 932 Appendix A Normal Values in Pregnancy and Ultrasound Measurements Appendix B Anatomy of the Pelvis Appendix C Glossary of Key Abbreviations Index 1183 933 946 975 1004 ... symptoms, severity, and drug therapy: A prospective study of effects on 22 05 pregnancies Obstet Gynecol 20 03;1 024 :739–7 52 52 Mihrshani S, Belousov E, Marks G, Peat J Pregnancy and birth outcomes... pressure falls in parallel by 20 % to about 19 mm Hg 622 623 FIG 37.1 Changes in hemodynamic parameters throughout pregnancy (mean ± standard deviation) PP, postpartum Diagnosis and Evaluation of Heart... Control and Prevention, the overall incidence of postterm pregnancies was 5.6% in 20 12 and has not significantly changed compared with previous years Etiology ▪ The etiology of the majority of pregnancies