Practical Guide to High Risk Pregnancy and Delivery - E-Book , livre ebook

Practical Guide to High-Risk Pregnancy and Delivery
A South Asian Perspective
Third Edition

Fernando Arias MD, PhD, FACOG
Professor of Obstetrics and Gynecology University of Toledo, College of Medicine, The Toledo Hospital, Department of Maternal-Fetal Medicine, Toledo, Ohio, USA

Shirish N Daftary MD, DGO, FICS, FIC, FICOG
Professor Emeritus and Former Medical Advisor, Nowrosjee Wadia Maternity Hospital, Mumbai, India Formerly Dean, Nowrosjee Wadia Maternity Hospital Past President, Federation of Obstetrics and Gynaecological Societies of India Former Jt. Associate Editor, Journal of Obstetrics and Gynaecology of India Past President, Indian College of Obstetrics and Gynaecology Past Chairman, MTP Committee of FOGSI Vice President, Indian Academy of Juvenile and Adolescent Gynaecology Obstetrics Chairman, Indian College of Maternal and Child Health

Amarnath G Bhide MD, DGO, DNB, DFP, MICOG, MRCOG London
Consultant in Maternal-Fetal Medicine and Obstetrics, St. George's Hospital, London, UK Honorary Senior Lecturer, St. George's University of London Scientific Editor, BJOG: An International Journal of Obstetrics and Gynaecology Formerly, Professor and Unit Head Nowrosjee Wadia Maternity Hospital, Mumbai, India
Elsevier
Table Of Contents
Instructions for online access
Cover image
Title page
Copyright
Dedication
Preface to the Third Edition
Section I: Fetal Medicine
1: Antepartum Care of the High-Risk Pregnancy
2: Prenatal Diagnosis of Chromosomal Abnormalities
3: Fetal Dysmorphology
4: Fetal Growth Restriction
5: Fetal Infections
6: Birth Asphyxia
Section II: Obstetrical Complications
7: Preterm Parturition Syndrome
8: Preterm Labor
9: Premature Rupture of Membranes
10: Cervical Insufficiency
11: Prolonged Pregnancy
12: Multifetal Gestation
13: Bleeding During Pregnancy
14: Rh Alloimmunization
15: Abnormal Labor and Delivery
16: Hypertensive Disorders in Pregnancy
17: Diabetes and Pregnancy
18: Hematologic Disorders in Pregnancy
19: Abnormalities of the Urinary System During Pregnancy
20: Cardiac Disease and Pregnancy
Section III: Tropical Diseases in Pregnancy
21: Tropical Diseases in Pregnancy
Index
Copyright
Practical Guide to High-Risk Pregnancy and Delivery: A South Asian Perspective, 3/e Arias, Daftary, and Bhide
ELSEVIER
A division of
Reed Elsevier India Private Limited
Mosby, Saunders, Churchill Livingstone, Butterworth Heinemann and Hanley Belfus are the Health Science imprints of Elsevier.
2008 Elsevier
First edition 1984
Second edition 1993
Third edition 2008
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher.
ISBN: 978-81-312-1155-7
Medical knowledge is constantly changing. As new information becomes available, changes in treatment, procedures, equipment and the use of drugs become necessary. The authors, editors, contributors and the publisher have, as far as it is possible, taken care to ensure that the information given in this text is accurate and uptodate. However, readers are strongly advised to confirm that the information, especially with regard to drug dose/usage, complies with current legislation and standards of practice.
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Printed and bound at
Dedication
In loving memory of
Dr Fernando Arias
June 11, 1943 - August 7, 2007
To our families
Dr (Mrs) Sindhu Daftary, Dr Gaurang Daftary,
Dr Ameet, and (Mrs) Aanal Mehta Daftary
Shirish N Daftary
To our families
Mr Govind Bhide, Mrs Manik Bhide, Dr (Mrs) Priya Bhide,
(Miss) Anuradha Bhide, and (Miss) Malvika Bhide
Amarnath G Bhide
Preface to the Third Edition
The second edition of this book was widely applauded by students in training and practitioners alike. It presented concisely the present-day trends in the management of pregnant women and provided guidance for the optimum care of high-risk pregnancies. An update of this treatise has been long awaited. In appreciation of the popularity of the book, Professor Fernando Arias was persuaded to revive it and bring it back to the offices of practicing obstetricians along with added observations and experiences of Indian workers. The experiences of the senior Indian author-an obstetrician practicing the art for over 40 years, author of several works in the specialty, and a teacher at the Seth GS Medical College and Nowrosjee Wadia Maternity Hospital, Mumbai for over 30 years-combined with the expertise of the joint author who has been professor of Obstetrics and Gynecology at the Seth GS Medical College and Nowrosjee Wadia Maternity Hospital, Mumbai for many years and is presently a consultant in maternal-fetal medicine at the well-known St. George's Hospital, London, UK, have provided fresh inputs to update this book to suit the Indian subcontinent.
A separate chapter on Tropical Diseases in Pregnancy has been added keeping in mind Indian conditions. Data of relevance to India has been added at relevant places in all the chapters. The addition of Indian experiences at the end of every chapter lends additional information about the experiences of practitioners in India, which may be of relevance to readers of the subcontinent.

Shirish N Daftary
Amarnath G Bhide
Section I Fetal Medicine
1
Antepartum Care of the High-Risk Pregnancy

Andres Sarmiento R *

Chapter Outline
Identification of the High-Risk Patient
Preconceptional Counseling
Prenatal Care
Determination of Gestational Age
Prevention of Abnormal Maternal and Fetal Outcomes
Antepartum Fetal Surveillance
Fetal Movement Count
The Nonstress Test
The contraction Stress Test
The Biophysical Profile
The Modified Biophysical Profile
Doppler Velocimetry
Fetal Blood Sampling
Indian Experience of Antepartum Surveillance
Important Points
References
A high-risk pregnancy is that with a significant probability for a poor maternal or fetal outcome. In some cases, these patients are recognized in the initial prenatal office visit because they have a poor obstetrical history or a well-recognized medical complication. In other cases women become high-risk pregnancies because they develop unexpected complications in the course of otherwise normal pregnancies. These patients with unexpected complications are in a vulnerable emotional position due to the sudden loss of their expectations for a normal pregnancy and the lack of preparedness for invasive testing and obstetrical interventions. High-risk patients require sophisticated maternal and fetal surveillance and in many occasions difficult management decisions in order to optimize their outcome. This chapter provides (a) a description of the available systems to identify women at high risk for abnormal pregnancy outcomes, (b) a general description of prenatal care focused in the prevention of morbid outcomes not analyzed in other chapters of this book, and (c) an overview of the methods used for fetal surveillance in high-risk pregnancies, the rationale behind their use, the situations where their use is indicated, their limitations, their clinical usefulness, and their impact on the maternal and fetal outcome.
Identification of the High-Risk Patient
A high-risk pregnancy can be identified only if the woman has access to prenatal care. Poverty-limiting access to the health care system-and lack of ability of societies and governments to provide medical coverage to those unable to pay for these services are powerful factors that prevent access to prenatal care. Once the woman has access to prenatal care, the second limiting factor preventing the identification of those at risk is the quality of the prenatal care itself, because in many cases the services provided are of marginal quality, and high-risk patients are not identified.
High-risk pregnancies are a small segment of the obstetrical population that produces the majority of the maternal and infant mortality and morbidity. This denomination includes women with chronic hypertension, pregestational diabetes, anemia, chronic lung disease, Rh alloimmunization, cardiac and renal disease, women at risk for congenital abnormalities in the offspring, and other conditions ( Box 1-1 ) that place the pregnancy at risk ( Martin et al., 2003 ). Women with a poor obstetrical history ( Box 1-2 ) are also at high risk for abnormal outcomes.

Box 1-1 Partial list of medical conditions that place pregnancy at high risk for a poor outcome
Malnutrition Anemia Chronic hypertension Diabetes Asthma Thrombophilia (history of DVT or PE) Cardiac disease Seizure disorder Family history of genetic disease Hemoglobinopathy Renal disease Psychiatric illness Lupus erythematosus and other connective tissue disorders Drug and alcohol abuse Smoking Rh alloimmunization Hepatitis B carrier Human immunodeficiency virus infection Syphilis Gonorrhea and Chlamydia infection Asymptomatic bacteriuria

Box 1-2 Obstetrical high-risk factors
History of previous prolonged labor-instrumental assisted delivery History of previous obstructed labor/rupture-uterus/traumatic delivery History of postpartum hemorrhage (high parity status)/obstetric shock History of puerperal sepsis Prior preterm birth (less than 36, less than 32, less than 28 weeks) History of birth asphyxia/neonatal convulsions/birth injuries Prior stillbirth Prior fetal growth restricted infant Second trimester pregnancy loss Prior neonatal death Prior infant with cerebral palsy Prior cesarean delivery Diagnosis of incompetent cervix in pri