Protocols for High-Risk Pregnancies An Evidence-Based Approach

• better understand your patients' conditions
• devise optimum management strategies
• maximize the outcome and minimize the complications for both the mother and her fetus

To enhance clinical relevance, each protocol is written as if the patient were present. Evidence to support an intervention is given where it exists. The authors' experience provides additional wise counsel. Key references provide the springboard for a deeper understanding of a topic. In this more compact and fully updated sixth edition, new protocols include

• Amniotic fluid disorders
• Depression
• Fetal growth restriction
• HIV
• Indicated late preterm and early term birth
• Malaria
• Noninvasive prenatal diagnosis

Designed for clinical practice by the leaders of two generations of maternal-fetal medicine, no obstetrician or obstetric health care provider can afford to miss Protocols for High-Risk Pregnancy.

John T. Queenan, MD, Professor and Chairman Emeritus, Department of Obstetrics & Gynecology, Georgetown University, School of Medicine, Washington, DC, USA.

Catherine Y. Spong, MD, Bethesda, Maryland,?USA.

Charles J. Lockwood, MD, MHCM, Dean, Morsani College of Medicine; Senior Vice President, USF Health Professor of Obstetrics and Gynecology and Public Health, University of South Florida, Tampa, FL, USA.

List of Contributors ix

Preface xiii

Part I Concerns in Pregnancy

1 Tobacco, Alcohol, and the Environment 3
Jorge E. Tolosa and George Saade

2 Ionizing Radiation 14
Robert L. Brent

3 Depression 27
Kimberly Yonkers

Part II Antenatal Testing

4 Prenatal Detection of Fetal Chromosome Abnormality 35
Fergal D. Malone

5 Fetal Echocardiography 48
Joshua A. Copel

6 Clinical Use of Doppler 54
Henry L. Galan

7 Antepartum Testing 65
Michael P. Nageotte

8 Fetal Blood Sampling and Transfusion 71
Alessandro Ghidini

Part III Maternal Disease

9 Maternal Anemia 81
Alessandro Ghidini

10 Sickle Cell Disease 88
Marc R. Parrish, John Morrison

11 Isoimmune Thrombocytopenia 97
Richard L. Berkowitz, Sreedhar Ghaddipati

12 Autoimmune Disease 104
Charles J. Lockwood

13 Antiphospholipid Antibody Syndrome 115
Charles J. Lockwood

14 Inherited Thrombophilias 119
Andra H. James

15 Cardiac Disease 128
Katharine D. Wenstrom

16 Peripartum Cardiomyopathy 139
F. Garry Cunningham

17 Thromboembolism 143
Alan Peaceman

18 Renal Disease 150
Susan Ramin

19 Obesity 157
Raul Artal

20 Diabetes Mellitus 163
Mark B. Landon, Steven G. Gabbe

21 Thyroid Disorders 172
Stephen F. Thung

22 Acute and Chronic Hepatitis 180
Patrick Duff

23 Asthma 188
Michael Schatz

24 Epilepsy 196
Men-Jean Lee

25 Chronic Hypertension 203
Baha M. Sibai

26 Cytomegalovirus, Genital Herpes, Rubella, Syphilis, and Toxoplasmosis 213
Brenna L. Hughes

27 Influenza, West Nile Virus, Varicella-Zoster, and Tuberculosis, 222
Jeanne S. Sheffield

28 Malaria 232
Richard M.K. Adanu

29 Human Immunodeficiency Virus Infection 238
Jane Hitti

30 Parvovirus B19 Infection 245
Maureen P. Malee

31 Group B Streptococcus 251
Mara J. Dinsmoor

32 Acute Abdominal Pain Due to Nonobstetric Causes 260
Fred M. Howard

33 Gallbladder, Fatty Liver, and Pancreatic Disease 270
Jeffrey R. Johnson

Part IV Obstetric Problems

34 First Trimester Vaginal Bleeding 281
John T. Queenan Jr.

35 Cervical Insufficiency 288
John Owen

36 Nausea and Vomiting 298
Gayle Olson

37 Fetal Death and Stillbirth 306
Robert M. Silver

38 Abnormal Amniotic Fluid Volume 315
Thomas R. Moore

39 Preeclampsia 329
Baha M. Sibai

40 Fetal Growth Restriction 340
Henry L. Galan

41 Rh and Other Blood Group Alloimmunizations 353
Kenneth J. Moise Jr

42 Preterm Labor 363
Vincenzo Berghella

43 Premature Rupture of the Membranes 369
Brian Mercer

44 Indicated Late-Preterm and Early-Term Deliveries 383
Catherine Y. Spong

45 Prevention of Cerebral Palsy 388
Dwight J. Rouse

46 Amnionitis 392
George A. Macones

47 Third Trimester Bleeding 398
Yinka Oyelese

48 Amniotic Fluid Embolus 406
Robert Resnik

Part V Labor and Delivery

49 Induction of Labor 411
Deborah A. Wing

50 Intrapartum Fetal Heart Rate Monitoring 418
Roger K. Freeman

51 Breech Delivery 423
G. Justus Hofmeyr

52 Vaginal Birth After Cesarean 428
James R. Scott

53 Placenta Accreta 435
Robert M. Silver

54 Shoulder Dystocia 445
Robert Gherman

55 Twins, Triplets and Beyond 451
Mary E. D’Alton

56 Postpartum Hemorrhage 462
David S. McKenna

Appendix A: Evaluation of Fetal Health and Defects 470

Lynn L. Simpson

Index 483

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