Interassay Variation
Interassay variation between different quantitative serum tests and between different qualitative urine tests can cause confusion and misdiagnosis of pregnancy. Most clinical laboratories participate in external proficiency testing through the College of American Pathologists CAP . CAP surveys have been the biggest indicator of interassay variation. The five most recent CAP surveys each with a single hCG preparation of 2307 to 2324 testing laboratories showed 1.50- to 1.59-fold variations from...
37 the elite athlete
The elite athlete experiences limitations and physiological changes in pregnancy similar to the recreational athlete, including ligament relaxation, change in posture, and weight gain. These changes may in turn impact a woman's competitive ability and increase her desire for strenuous training, making her more prone to injury 12 . The elite athlete should be aware that pregnancy is not a time for improving competitive fitness, but instead she should focus on remaining physically active,...
The kidneys
Kidney Essence is derived from both the mother and the father, so there is a hereditary influence determining a person's constitution. The Essence is stored in the Kidneys but has a fluid nature and circulates all around the body. Kidney Essence determines growth, sexual development, reproduction, conception and pregnancy. See Ch. 14 for a discussion of Kidney Essence in relation to the baby. During pregnancy, a strain can be put on the Qi and Essence of the Kidneys, so the pre-existing state...
Box 22 Priscilla Whites last classification
Gestational diabetes Abnormal glucose tolerance test, euglycemia maintained by diet alone. Diet alone insufficient, insulin required Class A Diet alone sufficient, any duration or onset age Class B Onset at the age of 20 or older, duration lt 10 years Class C Onset between the ages of 10 and 19, or duration 10-19 years Class D Onset before the age of 10, duration gt 20 years, background retinopathy or hypertension not Class R Proliferative retinopathy or vitreous hemorrhage Class F Nephropathy...
Childbirth Labour Delivery And Immediate Postpartum Care
m EXAMINE THE WOMAN IN LABOUR OR WITH RUPTURED MEMBRES FIRST STAGE OF LABOUR 1 WHEN THE WOMAN IS NOT IN ACTIVE LABOUR FIRST STAGE OF LABOUR 2 N ACTIVE LABOUR RESPOND TO PROBLEMS DURING LABOUR AND DELIVERY 1 If fetal heart rate lt 120 or gt 160 bpm RESPOND TO PROBLEMS DURING LABOUR AND DELIVERY 2 RESPOND TO OBSTETRICAL PROBLEMS ON ADMISSION 2 D4 RESPOND TO OBSTETRICAL PROBLEMS ON ADMISSION 1 RESPOND TO OBSTETRICAL PROBLEMS ON ADMISSION 2 SECOND STAGE OF LABOUR DELIVER THE BABYAND GIVE IMMEDIATE...
283 adrenergic receptor blockers
i-blockers acebutolol, alprenolol, atenolol, betaxolol, bisoprolol, Celiprolol, Carvedilol, esniolol, labetalol, rnetoprolol, nadolol, nebivolol, oxprenolol, pindolol, propranolol, sotalol, and timolol have a wide spectrum of activity, and are often used to treat hypertension. There are two types of 3-receptors i -receptors predominate in the heart, and -receptors mediate relaxation dilatation of vascular and other smooth muscle e.g. in the airways and blood vessels . Metoprolol is...
Antenatal care explained
The first 'booking-in' visit 54 Detecting abnormalities of the fetus 58 AFP alpha-fetoprotein test 60 Chorionic villus sampling CVS 62 Getting off the conveyor belt 64 Antenatal maternal infections 64 The aims of antenatal care are, first and foremost, to look after the health and safety of the mother and to ensure delivery of a healthy baby. Monitoring the health of mother and baby throughout the pregnancy allows for the early detection and treatment of any problems. A vital element in good...
Kratochwil E Eisenhut L. Der Fruheste Nachweis Der Fatalen Herzaction Durch
1. Kratochwill E, Eisenhut L. Der fr heste nachweis der fatalen herzaction durch ultrascall. Geburtsh Frauenheik 1967 27 176-80. 2. Waldenstrom U, Axelsson O, Nilsson S. Sonographic dating of pregnancies conceived after contraceptive pill therapy. Ultrasound Obstet Gynecol 1993 3 23-25. 3. Barlow DH. Short- and long-term risks for women having IVF - what is the evidence Hum Fertil 1999 2 102-6. 4. Rizk B, Tan SL, Morcos S, et al. Heterotopic pregnancies after in vitro fertilization and embryo...
551Weight Loss Strategies for Prepregnancy and Postpartum
Weight loss is not recommended during pregnancy however, overweight and obese women should be advised to aim for a moderate weight loss prior to conception and postpartum. To help motivate women in their efforts, health care providers and obstetricians should clearly define the risks associated with overweight and obesity in pregnancy and beyond. Consultation with a registered dietitian RD should be considered, as these individuals can provide assistance in the assessment of current eating...
2646 Ribavirin
Ribavirin is an antiviral with broad-spectrum activity. Severe viral infections, like hepatitis C in combination with interferon then and respiratory syncytial virus RSV infection in young infants. may be an indication. It was found to be teratogenic and or embry-olethal in several animal studies. The infants of nine women who were treated with ribavirin for severe measles during the second half of pregnancy did not have an increased incidence of anomalies Atmar 1992 . A woman treated at 7...
Glucose alterations in gestational diabetes mellitus
Independent of the mechanisms involved, in GDM, there is a relative lack of insulin during a period of time with high insulin needs to compensate the insulin resistance that develops in the third trimester of pregnancy. When gestational diabetes develops, in the maternal tissues, where glucose uptake is insulin-dependent, this is further decreased and hyperglycemia develops. Because the materno-placenta-fetal transfer of glucose is concentration-dependent9 under conditions of maternal...
Incidence and prevalence of diabetes in the region
Diabetes continues to be a major concern for public health in the Americas and, unfortunately, its prevalence is likely to increase in Latin America and the Caribbean countries due to the demographic changes these countries are experiencing. According to King et al.,7 the number of diabetic people in the Americas is expected to rise from 35 million in 2000 to 64 million in 2025, and the incidence of diabetes in Latin America will increase from 52 to about 62 around 40 million people ,7 as a...
114 Risk communication prior to pharmacotherapeutic choice
Drug administration during pregnancy means that both the mother and unborn child are exposed. The drug or metabolite concentration may be even higher in the embryonic or fetal compartment than it is in the mother. The fetus as an additional patient therefore demands a strict pharmacotherapeutic approach, as it is imperative to try to restore maternal health without endangering the development of the child. In severe conditions, such as bronchial asthma, diabetes melli-tus, epilepsy or...
289 Diazoxide
Diazoxide is fully absorbed when given orally, and has a half-life of between 20 and 40 hours. It readily crosses ihe placenta, and fetal plasma concentrations are similar to those in ihe mother. After bolus injection, observable hypotensive states can be prevented with continual infusion, or repeated small doses Duley 1995 . its use should be reserved for the treatment of hypertensive crises. Diazoxide has a diabetogenic effect on the metabolism Sweetman 2002 . Case reports showed...
Tides in Breastfeeding Practice
Mary Margaret Coates and Jan Riordan Throughout the world today, an infant is apt to receive less breastmilk than at any time in the past. Until the 1940s, the prevalence of breastfeeding was high in nearly all societies. Although the feeding of manufactured milks and baby milks had begun before the turn of the century in parts of Europe and North America, the practice spread slowly during the next decades. It was still generally limited to segments of population elites, and it involved only a...
2810 Magnesium sulfate
Magnesium sulfate, although not actually an antihypertensive, has proven valuable in the treatment of pre-eclampsia. Magnesium sulfate is the drug of choice for treatment of seizures in eclampsia Oettinger 1993 . In a group of 31 fetuses where the mothers were administered the drug i.v. as an initial loading dose of 4-6g, followed by an infusion of 2-3.5 g h. magnesium sulfate was found not to be harmful Gray 1994 . A significantly lower risk of repeated convulsions in eclampsia was seen in a...
55 Cystic Fibrosis 57
The issues in pregnancy are the same as in the non-pregnant woman, but are more exaggerated. Adequate dietary supplementation Prenatal diagnosis, with careful consideration of termination of pregnancy, becomes an issue. The most serious complications are related to the further compromise of a woman with respiratory failure and pulmonary hypertension. It is important to remember that this can lead to maternal mortality Antibiotic therapy may be complicated in CF, and in some circumstances...
Preconception Issues And Care Ltx
Ideally, all women should be able to make an informed choice about pregnancy based on both maternal and fetal risks, long term prognosis and alternative options such as contraception, termination of pregnancy, adoption, surrogacy and IVF. Encourage realistic expectations, and advocate active preparation for pregnancy. This includes Ensuring easy access to multi-disciplinary care Pre-pregnancy surgery or intervention e.g. change of valve type consider risk of surgery versus reduction in...
284 Hydralazine and dihydralazine
Hydralazine and dihydralazine are structurally similar vasodilator drugs that have been used for the treatment of hypertension in pregnancy for over 40 years. Following oral administration, up to 80 percent absorption occurs, and approximately 66 percent of the drug is deactivated in the liver. The half-life is 2-8 hours. Hydralazine and dihydralazine cross the placenta well, and cord-blood drug concentrations may exceed those in the mother Franke 1986 . Although results from animal studies...
Fetal Risk Summary Fsg
Alprazolam, a member of the benzodiazepine class of agents, is used for the treatment of anxiety. Although no congenital anomalies have been attributed to the use of alprazolam during human pregnancies, other benzodiazepines e.g., see Diazepam have been suspected of producing fetal malformations after 1st trimester exposure. In pregnant rats, the drug produced thoracic vertebral anomalies and increased fetal death only at the highest dose 50 mg kg tested 1 . Researchers described the effects of...
Geographical variations in the prevalence of GDM
Prevalence of GDM varies from one region to another in the same country. Though the overall prevalence of GDM in India was 16.55 , the frequency varied from 12 to 21 in different parts of the country.9 A low prevalence of GDM was observed in the hilly areas of Jammu and Kashmir14 north India 4.4 , Imphal15 north-east India 2.2 , and in Yercaud16 south India 3.5 . This low prevalence could be attributed to the lifestyle adapted by the people living in the hostile terrain. The prevalence of GDM...
C57BL6J mice
The non-obese, non-diabetic BL 6J mice, the genomic host of the ob ob mutation, when placed on an affluent fat and sucrose-rich diet become hypertensive and insulin resistant with first-phase insulin release disappearing at 6 months of age.95-97 Abnormalities, characterized by increased outflow from the sympathetic nervous system, deranged beta-cell function and adipocyte metabolism were found to be responsible for the resultant IGT and insulin-resistance syndrome. No hyper-phagia or elevation...
268 Quinolones
Quinolones impair bacterial DNA metabolism by inhibiting DNA gyrase. They have bactericidal activity at normal doses at higher doses they have also bacteriostatic properties by inhibiting bacterial RNA and protein synthesis. Quinolones have a high affinity for cartilage and bone tissue this affinity is highest in immature cartilage. Pipemidic acid, cinoxacin, and nalidixic acid belong to the group of older quinolones. They concentrate in the urinary tract. Few data on their safety during...
2112 Nonsteroidal antiinflammatory drugs NSAIDs
NSAIDs are the mainstay of antirheumatic therapy. Pregnancy-related conditions such as premature labor, polyhydramnios, and pregnancy induced hypertension have also been indications for treatment with NSAIDs. This group of medications includes many drugs, and the number is still growing, so it is impossible to review them all. The most commonly used are acemetacin, azapropazon, diclofenac, etofenamat, fenbufen, flufenamic acid, flurbiprofen, ibuprofen, indomethacin, indoprofen, hetoprofen,...
Karen Watkins MB ChBHons MRCOG
Lead Obstetrician for Intrapartum Care and Maternal Medicine at The Royal Cornwall Hospital, Truro Karen graduated in 1993 with honours. She completed her basic training in Obstetrics and Gynaecology then in 1998 she became Clinical Research Fellow for the Magpie Trial, a large international randomised trial investigating magnesium sulphate and its role in preventing eclampsia. Following this, Karen worked for a number of years in Australia and during this time was awarded 'Best of Free...
Female Factor Subfertility
In the female, any factor that prevents the sperm from reaching the egg ovum in the fallopian tube will result in subfertility refer to Figure 5.3 . Anovulation failure of the ovaries to produce an egg This commonly results from stress, excessive weight loss or exercise, poor nutrition, chronic medical conditions, inherent ovarian problems such as polycystic ovarian syndrome or previous ovarian surgeries. They usually manifest as an absence, delay or irregularity in the menses. Figure 5.3...
2629 Quinine
Quinine is the oldest antimalarial agent. It has a good and rapid sch-izonticide activity against the erythrocytic forms of all Plasmodium species. In spite of relatively high toxicity and a narrow therapeutic range, it is used more often for the treatment of chloroquine-resistant malaria today. Concentrations in the fetus are just as high as in the mother, and arc potentially toxic. There are some reports describing eye defects and hearing loss in children after use of quinine in pregnancy....
Teenage Sex Is Just Like Adult Sex
Even more than the economic and adult-teen aspects of teen sex and pregnancy, the uncanny parallels between teen and adult sexual outcomes are the most ignored factor of all. In fact, teenage sex is a closely controlled behavior, reflecting the sexual behaviors of adults around them. Where and when adults have high rates of pregnancy, abortion, birth, unwed birth, STD, and HIV AIDS, so do teenagers. The chief complication is that high rates of poverty shift a population's sexual outcomes to...
2711 Poliomyelitis vaccine
Oral polio vaccine Sabin contains attenuated live poliomyelitis viruses of all three poliovirus types. It is no longer recommended for routine vaccinations because in very rare cases it may cause poliomyelitis. The inactivated form of the vaccine Salk , mostly in combinations with other vaccines injection , is now preferred. When there were outbreaks of poliovirus in Israel and Finland, mass oral polio vaccinations of the population, including pregnant women, were performed. Based on the...
Eisbn 1592597874
Library of Congress Cataloging-in-Publication Data Handbook of clinical laboratory testing during pregnancy edited by Ann M. Gronowski. p. cm. -- Current clinical pathology Includes bibliographical references and index. ISBN 1-58829-270-3 alk. paper 1. Obstetrics--Diagnosis--Handbooks, manuals, etc. 2. Prenatal diagnosis Handbooks, manuals, etc. manuals, etc. 4. manuals, etc. 5. Diagnosis, Laboratory--Handbooks, manuals, etc. DNLM 1. Prenatal Diagnosis--methods--Handbooks. 2. Fetal...
Nucleosides
Nucleosides such as adenosine or thymidine are rapidly taken up by cells. The characteristics of transport are consistent with facilitated diffusion, i.e. transport along a downhill concentration gradient by carrier-mediated transport mechanisms. Transport has a broad specificity including both purine and pyrimidine nucleosides. In the human placenta these transporters have been identified at the microvillous and basal membrane of the syncytiotrophoblast. Distinct from other tissues such as...
Cord and fetal membranes
The length of the cord at term is between 40 and 70 cm and the diameter is usually between 1 and 3 cm. A short or excessively long cord is related to an increased risk for fetal damage. Marginal cord insertion or velamentous cord insertion, which probably are due to disturbed implantation, may be also associated with fetal or neonatal damage. Histopathologic features such as thrombosis of vessels or the observation of a single artery should be already suspected by a macroscopic analysis of cord...
Jane Scullion BAHons RGN MSc
Respiratory Nurse Consultant at University Hospitals of Leicester NHS Trust Honorary Senior Lecturer at De Montfort University Clinical Research Fellow at Aberdeen University Jane Scullion is a Respiratory Nurse Consultant working across the interface of primary and secondary care with patients with chronic respiratory diseases and developing respiratory services. She has published widely and presented both nationally and internationally. Specialist Midwife - Diabetes at the University...
A guide for essential practice
Department of Making Pregnancy Safer Integrated Management of Pregnancy and Childbirth Pregnancy, Childbirth, Postpartum and Newborn Care World Health Organization Geneva 2006 WHO Library Cataloguing-in-Publication Data Pregnancy, childbirth, postpartum and newborn care a guide for essential practice. At head of title Integrated Management of Pregnancy and Childbirth. 1.Labor, Obstetric 2.Delivery, Obstetric 3.Prenatal care 4.Perinatal care -methods 5.Postnatal care - methods 6.Pregnancy...
Palpation and position of the baby
As pregnancy advances, more information than just the fundal height will be needed and the midwife will carry out an abdominal examination at every visit. After emptying her bladder, the woman should lie flat, supported by pillows if necessary, with only her abdomen exposed. She should be as relaxed and at ease as possible. There are three stages to the examination. 1 Inspection - to note the size and shape of the uterus. The size should correspond with the estimated dates and period of...
Endocrinological tests
In most cases of early pregnancy assessment, hCG and progesterone assays are not required unless the location of the pregnancy is in doubt. Knowledge of the 'normal' increases in hCG levels in early pregnancy are useful as a guide after a non-diagnostic ultrasound of pregnancy of unknown location, provided they are combined with other features such as clinical symptoms, other ultrasound findings and progesterone results.5,6 The hCG 'doubling time' is used as a guide to the viability and...
Rationale for universal screening
Selective screening based on risk factors scored poorly in predicting GDM.22 If selective screening is employed, it is likely that 16 of GDM women will go undetected.23 Further selective screening recommended by ADA may be applicable for women belonging to the ethnic group with low prevalence of GDM. Whereas, among ethnic groups in South Asian countries, Indian women have the highest frequency of GDM necessitating universal screening.24 The recognition of glucose intolerance during pregnancy is...
Prolactin
During pregnancy, maternal prolactin levels increase 7- to 10-fold. Gustafson et al.27 reported that the basal insulin concentration and post-challenge glucose and insulin responses were greater in women with hyperprolactinemia than in healthy controls. These findings were supported by studies showing that the culture of pancreatic islet cells with prolactin induces an increase in insulin secretion.28 Skouby et al.29 investigated the relationship between the deterioration in glucose tolerance...
Clinical Symptoms And Risk Factors For Ectopic Pregnancy
When evaluating pregnant women in the first trimester, it is very important to take into account the history and symptomatology. The Figure 3.4 Blood in the pouch of Douglas seen as ground glass fluid on transvaginal scan. Reproduced from Condous et al. Ultrasound Obstet Gynecol 2003 2 420-30. Figure 3.4 Blood in the pouch of Douglas seen as ground glass fluid on transvaginal scan. Reproduced from Condous et al. Ultrasound Obstet Gynecol 2003 2 420-30. end of the fallopian tube. It is very...
Fabrics
There are thousands of fabrics available today, but only those that are thin, lightweight, and have texture will work well as attire for your subject. Some of the most effective fabrics for draping over and around the human form are gauze, tulle, muslin, silk, crepe, stretch velvet, and chiffon. In the past, the color selection available for each of these fabric types was rather limited. Today, muslin is not just available in the traditional beige but in numerous colors too. For unique colors...
2517 Castor oil
Castor oil oleum ricini is a triglyceride that is hydrolyzed in the small intestine to release glycerol and ricinoleic acid. This causes a laxative effect by irritating the intestinal mucosa. Castor oil is a laxative with a harsh action it is not appropriate for long-term therapy. In addition, it has a vei unpleasant taste. No specific embryotoxic effects have been observed in human beings however, studies during early pregnancy have to our knowledge not been reported. Many authors warn against...
Breast Feeding Summary Fet
Amoxapine and its metabolite are excreted into breast milk. A 29-year-old woman suffering from depression was treated with approximately 250 mg day of amoxapine 2 . She developed galactorrhea and oligomenorrhea. Milk samples were collected after 10 and 11 months of therapy and analyzed for amoxapine and the active metabolite, 8-hydroxyamoxapine. The levels of the parent compound at the sample collection times were both less than 20 ng mL, but the metabolite was present in both samples, 45...
234Total Energy Cost of Pregnancy
The total energy cost of pregnancy in well-nourished women has been estimated from the sum of BMR or TEE and energy deposited in laying down maternal and fetal tissues 14 . Gestational weight gain is a major determinant of the incremental energy needs during pregnancy because it reflects not only energy deposition, but also the increase in BMR and TEE resulting from the energy cost of metabolism and moving a larger body mass. Using the gestational weight gain recommended by IOM for pregnant...
Parvovirus
In childhood, human parvovirus causes erythema infectiosum or fifth disease, which is sometimes mistaken for rubella or German measles. It may also be called 'slapped face syndrome' because of the reddened appearance of a child's face. Infection is commonly asymptomatic. In pregnancy, if the fetus is infected this causes anaemia and fluid retention or hydrops. In approximately half of all cases of fetal infection, miscarriage or still birth occurs but in the remainder the anaemia and hydrops...
Forgetfulness and clumsiness
Until she was pregnant, Joanne never would have believed that misplacing keys, bumping into furniture, and dropping things could be real side effects of pregnancy. We don't know of any medical explanation for these effects, but some women do feel they're more scatterbrained and clumsy. If it happens to you, don't worry. You're not losing your mind. Look at it this way Now you have an excuse for having forgotten your best friend's birthday. And rest assured you'll go back to being your...
Insulin and hypoglycemic compounds
The passage of plasma proteins across the human placental barrier in humans is a highly selective process. It cannot be predicted on a simple way based on physical properties, i.e. protein binding, lipid solubility or molecular weight. In diabetic pregnancy, the safe use of insulin, insulin analogs and oral hypoglycemic agents relies on the absence of transfer from maternal to fetal circulation. It has been known for years that free maternal insulin does not cross the materno-fetal barrier...
2516 Anthraquinone derivatives
Anthraquinone derivatives with a laxative action occur in a number of plants folia sennae, rhizoma rhei, cortex frangulae, and aloe. They have a laxative effect by directly stimulating colonic smooth muscles. Anthraquinone derivatives occur as glycosides. After the sugar portion is cleaved in the intestine, these agents are partially absorbed and excreted in the urine colored . Anthraquinone derivatives do not appear to be teratogenic. Reported experience is the most extensive with senna...
The Eastern philosophy of childbirth
The Yellow Emperor 1963 said 'After the person's connection, the Jing is first composed. Then the Jing composes the brain and the bone marrow. The bones become the Stem, the vessels become the Ying, the muscles become firm. The flesh becomes a wall, the Jing is hard and then the hair and body grow'. The chapter on preconception discusses the importance of getting healthy, regulating periods and correcting imbalances before becoming pregnant. In my experience, a woman's physical and emotional...
Threatened Miscarriage
Women who present in the first trimester with vaginal bleeding with or without lower abdominal pain are given the label of a threatened miscarriage. This is a common first trimester problem occurring in up to one-third of pregnancies.19 This condition requires an ultrasound scan to establish the viability of the pregnancy. If the uterus contains an embryopositive cardiac activity, then the woman can be reassured that she has a viable intrauterine pregnancy. If the crown-rump length CRL is at...
2617 Other local conazole antimycotics
Bifonazole, croconazole, econazole, fenticonazole, isoconazole, ketoconazole, omoconazole, oxiconazole, sertaconazole, sulcona-zole, and tioconazole are imidazole derivatives, and structurally and functionally related to clotrimazole. No teratogenic effects have been observed as a result of local treatment with these antimycotics. For econazole, these findings were confirmed in a population-based case control study Czeizel 2003A . They are, however, less tried than clotrimazole and miconazole...