22 gestational weight gain recommendations
Although the need for appropriate weight gain during pregnancy has long been recognized, recommendations for weight gain have changed over the years as new data have become available. The changes in recommended ranges for gestational weight gain are summarized in Table 2.1. Prior to 1970, it was standard obstetric practice to restrict gestational weight gain to between 18 and 20 lb 8-9 kg 2 . Overeating was believed to cause large babies and, as a consequence, more difficult deliveries. In...
224 Immunotherapy
Allergen immunotherapy allergy shots is an antiallergy therapy in which continuously increasing doses of an allergen arc injected sub-cutaneously. This therapy stimulates the production of immunoglobulins that bind the allergen before it can react with the mast cells. After immunotherapy, the allergic reaction on exposure to the allergen will be diminished because less histamine will be released by the mast cells. Immunotherapy is often effective for those allergic patients in whom the symptoms...
252 Antacids and sucralfate
Antacids are basic compounds which neutralize hydrochloric acid in the gastric secretions. For this purpose, the following arc used sodium hydrogen carbonate, aluminum hydroxide, aluminum phosphate, algeldrate, calcium carbonate, magnesium hydr oxide, magnesium carbonate, and magnesium trisilicate u combination preparations of aluminum, magnesium, and carbonate m the structurally newer aluminum-magnesium complexes almasi-late, hydrotalcite, and magaldrate and the aluminum saccharide...
The Sexual Organs
The sexual organs, or genitalia, of both boys and girls may appear relatively large and swollen at birth. This is caused by hormones produced by the mother and fetus, bruising and swelling related to birth trauma, and the natural course of development. In girls, the outer lips of the vagina labia majora often appear puffy. The skin of the labia may be either smooth or somewhat wrinkled. Sometimes, a small piece of glistening pink tissue may protrude between the labia this is a hymenal tag and...
262 Cephalosporins
Cephalosporins also belong to the -lactam antibiotics, but their pharmacokinetic and antibacterial properties are different from those of penicillins. They may cause hypersensitivity reactions. Some patients with penicillin allergy also react with cephalosporins. Cephalosporins are classified according to their antimicrobial activity. First-generation cephalosporins are cefaclor, cefradin, Cefadroxil, cefalexin, cefalotine, and cefazolirt. Second-generation cephalosporins are cefamandole,...
2525 Cholestyramine and other lipid reducers
Cholestyramine is an anion-cxchangc resin which is not absorbed systemically. It binds bile acids, producing an insoluble complex which is excreted in the stool. This leads to a reduction of cholesterol and the low-density LD lipoproteins in the serum. Cholestyramine is used in pregnancy for the treatment of obstetric cholestasis to relieve the itching. Ursodeoxycholic acid is, however, more effective than cholestyramine in intrahepatic cholestasis of pregnancy see ursodeoxycholic acid...
Photographing Nude Subjects
Working with a nude subject presents several challenges for all photographers, male or female. Before beginning the session, make sure you've cultivated a comfortable relationship with the subject. Also, be sure that you fully understand what she wants to achieve during the session and what she is comfortable with. Usually it is the client who wants the nude images, and so she will be fairly comfortable with posing. Next, you will need to determine the best location for the session. Keep in...
Michelle Goldie RM
Specialist Midwife, UHL NHS Trust, Leicester Michelle Goldie trained as a midwife in Leicester and currently works as a specialist midwife in substance and alcohol misuse at the University Hospitals NHS Trust, Leicester. In addition, she works in the maternal medicine clinic, has a research interest in respiratory disease and pregnancy and has published research presented at the American Thoracic Society. Andrea Goodlife RGN RM DipRenalNursing Specialist Midwife in Renal Disease at the...
Diabetes and pregnancy 19401980
In 1946 it was decided, with Professor Brandstrup at the Rigshospital, University of Copenhagen, to centralize the management and study of diabetes and pregnancy to the Obstetrical Department of Professor Brandstrup, who previously had interest in the problems involved.1,2 The first study from the Copenhagen Centre was designed to find possible characteristics of the course of diabetes during pregnancy, to contribute to a quantitative elucidation of the incidence of alterations occurring and to...
3 Effect Of Pregnancy On Drug Metabolism
Physiological changes in pregnancy can affect serum concentrations of psychiatric medications Table 4 . Some of these changes may increase or decrease the dose necessary for some medications. The blood level of nortriptyline, a tricyclic antidepressant, has been found to drop below the therapeutic range as women reach the fifth month of pregnancy 12 . Certain hepatic enzymes in the cytochrome P450 system are induced by high levels of estradiol and progesterone during pregnancy 13-16 . These...
251 Gastritis and peptic ulcer during pregnancy
During prcgnancy, motility changes occur throughout the gastrointestinal tract. These changes are largely attributed to increased levels of progesterone and estrogen. The mechanisms promoting gastroesophageal reflux during gestation primarily involve decreased lower esophageal sphincter LF.S pressure and a decrease in the sphincter's adaptive responses, but mechanical factors may also be important. Gastroesophageal reflux and heartburn are common during pregnancy. In mild cases, lifestyle and...
Name ALBENDAZOLE
Class Anthelmintic Risk Factor CM Albendazole is an orally administered, benzimidazole class, broad-spectrum anthelmintic used in the treatment of parenchymal neurocysticerosis caused by larval forms of the pork tapeworm, Taenia solium. It is also active against the larval forms of Echinococcus granulosus. Plasma concentrations of albendazole are negligible or undetectable because of poor systemic absorption attributable to low water solubility and its rapid hepatic metabolism to the active...
22 Principles Of Fertilization Conception
a. Fertilization refers to the joining together of the ovum egg and sperm cells. The ovum originates in the graafian follicle within the ovary. The sperm cell originates in the testes. The microscopic union of sperm and ovum increase in size more than 20 billion times from conception to birth. See figure 2-2 for union of sperm and ovum. b. During sexual intercourse, 2 to 5 ml of semen, usually containing more than 300 million sperm, is ejaculated into the female's vagina. By flagellar wiggly...
Sarah C Couch and Richard J Deckelbaum
Summary Obesity in pregnancy is associated with numerous maternal and neonatal complications including difficulty conceiving, increased risk of miscarriage, fetal anomalies and mortality, higher rates of gestational hypertension, gestational diabetes and preeclampsia, and an increased risk of cesarean section and delivery related complications. Nevertheless, more women are entering pregnancy with excessive weight and are gaining weight above the Institute of Medicine IOM recommendations during...
Gestational diabetes
The concept of gestational diabetes, actually meaning hyper-glycemia due to the pregnancy itself but in practice defined as 'carbohydrate intolerance of varying severity with onset or first recognition during pregnancy,' is also recent.15 In the very first recorded case Bennewitz, in 1823, considered that the diabetes was actually a symptom of the pregnancy, and as the symptoms and the glycosuria disappeared after at least two successive pregnancies he had some evidence to support his views.16...
221 Antihistamines blocker
Antihistamines are substances that competitively block the action of histamine on the histamine rcceptors. Histamine release results in the stimulation of H -receptors located on the smooth muscles of many organs, or H2-receptors located in the mucosa of the stomach, producing an increase in acid secretion. Only the blocking of the Hrreceptors is essential in antiallergy therapy. Hj-antihistamines are mostly used in antiallergy therapy some are used as antiemetics and some as sedatives. The...
26 Functions Of The Placenta
Being knowledgeable of the placenta functions gives insight into prenatal life and is helpful in providing nursing care to the unborn and the newborn. The placenta functions as a transport mechanism between the embryo and the mother see figure 2-6 . The placenta has many tasks it transports oxygen, nutrients, and antibodies to the fetus by means of the umbilical vein removes carbon dioxide and metabolic wastes from the fetus by the two umbilical arteries serves as a protective barrier against...
2413 Other agents with antiemetic properties
With respect to the antiemetics such as alizapride and aprepitant, used primarily in oncology, there is insufficient experience to estimate prenatal risk. Betahistine, a histamine analog, and the antihistamines cinnarizine and flimarizin have long been in use, and no increase in birth defects after clinical use has been shown. However, the absence of controlled studies on the use of these agents during pregnancy argues against their routine use. Betahistine and cinnarizine are both effective...
24 Sex Determination
Chromosomes are small, threadlike structures within each cell that contain genes, which carry genetic instructions. These genes control the physical and chemical traits inherited by children from their parents. The inherited traits are color of the eyes, sex, height, and skin color. a. The female has 23 pairs of chromosomes. The pair of chromosomes that determined her sex are named XX. The ovum carries one chromosome from each of the female's pairs 23 chromosomes . The ovum can only carry an X...
Face Presentation
Figure 1.50. Edema and ecchymoses of the face in a premature infant who was delivered as a face presentation. These infants need to be checked for anemia and hyperbilirubinemia. Figure 1.49. Skin incisions over the buttocks in an infant following cesarean birth. Figure 1.50. Edema and ecchymoses of the face in a premature infant who was delivered as a face presentation. These infants need to be checked for anemia and hyperbilirubinemia.
Hypophosphatasia And Skin Dimples
Figure 1.63. Dimples in between the joints over the long bones are considered pathologic until proven otherwise. In this infant with congenital hypophosphatasia, the skin dimple over the middle of the tibia is a very typical finding. Abnormal aberrant skin dimples may occur at a location where there has been a closer than usual proximity between die skin and the underlying bone structure during fetal life, resulting in deficient development of subcutaneous tissue at that locus. Such dimples may...
2511 Other prokinetic agents
Metoclopramide, bromopride, cisapride, and domperidon are licensed for treating motility disturbances in the upper intestinal tract. Dexpanthenol is used for intestinal atonia. Metoclopramide is discussed in Chapter 2.4. In a prospective, controlled multicenter study, the authors concluded that exposure to cisapride during pregnancy was not associated with an increased risk of malformations or other adverse effects, although the sample size 88 first-trimester exposures is too small to draw...
Chapter 2 Dwarfism
Dwarfs frequently present in the newborn period, but sometimes the diagnosis is not obvious until there is additional disproportionate growth. There are many different kinds of dwarfs and the nomenclature is descriptive of the portions of the long bones affected. Rhizomelic shortening refers to the proximal portions of the long bones e.g., upper arms and thighs . Mesomelic shortening refers to the central segments of the long bones e.g., forearms and legs . Acromelic shortening refers to the...
Fetal glucogenesis
Tracer studies in humans68 and sheep10 have shown that when glucose tracer is infused into the mother the specific activity or enrichment ratio of tracer labeled glucose to non-labeled glucose in the fetal plasma is the same as in the maternal plasma. This demonstrates that the only source of glucose in the fetus is from the maternal plasma, otherwise, new glucose production into the fetal plasma from either the fetus itself or from the placenta would dilute the tracer glucose coming from the...
Amniotic Fluid
Amniotic fluid is a body fluid that is unique to pregnancy. The volume of amniotic fluid increases progressively through gestation until approx 34 wk, when the volume begins to decrease. It is approx 200 to 300 mL at 16 wk, 400 to 1400 mL at 26 wk, 300 to 2000 mL at 34 wk, and 300 to 1400 mL at 40 wk 35 . The volume of amniotic fluid at term is approx 800 mL and constitutes only 6 of the total maternal weight gain by fluids 27 Table 7 . During gestation, a woman with a single fetus will gain,...
The Balance of Good Health
Try to eat at least five servings a day. This can include a glass of pure fruit juice. This food group includes fresh, frozen and canned fruit and vegetables, salads, dried fruit, fruit juices. Eat one or two servings a day. Choose lean meat, remove the skin from poultry and cook using the minimum of fat. Try to eat oily fish at least once a week. This food group includes meat except liver , fish, poultry, eggs, beans, pulses, nuts except peanuts . Foods containing fat, foods containing sugar...
23 Process Of Implantation
a. The morula floats in the uterus for 3 to 4 days, gaining in size and weight. At this time, the hollow fluid-filled morula, now called blastocyst burrows into the uterine lining. b. The outer surface of the blastocyst becomes covered with finger-like projections called chorionic villi. Chorionic villi aid in the process of implantation into the endometrium decidua . Villi also manufacture human chorionic gonadotropin HCG which signal the corpus luteum within the ovaries to continue production...
259 Atropine and other anticholinergic spasmolytics
Atropine, a belladonna-alkaloid, is a classic parasympatholytic, which inhibits the action of acetylcholine by competitively blocking muscarine rcccptors. With local application in the eye , systemic availability is negligible when applied properly. I-Atropinc is the biologically active enantiomer, and is sometimes encountered under the name hyoscyarnine. Atropine reaches concentrations in the fetus equivalent to those in the mother within a few minutes. Although atropine may alter fetal heart...
2526 Appetite suppressants obesity and weight loss
Amjepramone synonym diethylpropion , clobenzorex, dexfen-fluramine, fenfluramine, fenproporex, mazindol, mefenorex, norpseu-doephedrine, phentermine. and sibutramine are used as appetite suppressants. Amfepramone, clobenzorex, fenproporex, mefenorex, and phentermine share the pharmacological properties of amphetamines dexfenfluraminc, fenfluramine, and sibutramine stimulate the release of serotonin and block its reuptake norpseudoephedrine is a sympathomimetic amine mazindol is a tricyclic drug...
Caudal Regression Syndrome
Figure 1.13. Radiograph of the lower extremities of the same infant. Note the abnormal development of the pelvis due to the lumbosacral agenesis, the thin, poorly developed bones and lack of muscle mass. This is due to lack of fetal movement and resulting arthrogryposis. Figure 1.14. An asymmetric form of the caudal regression syndrome and hypoplastic left lower extremity associated with hypopla-sia of muscles and sciatic nerve on the left Figure 1.14. An asymmetric form of the caudal...
Sebaceous Gland Hyperplasia
Figure 1.31. Sebaceous gland hyperplasia represents a physiologic phenomenon of the newborn manifested by multiple, yellow to flesh-colored tiny greasy-looking papules that occur on the nose, cheeks, and upper lips of full term infants. These papules, a manifestation of maternal androgen stimulation, represent a temporary disorder that resolves spontaneously within the first few weeks of life. Figure 1.32. A close-up view of sebaceous gland hyperplasia. Figure 1.32. A close-up view of sebaceous...
The Sanctification Of Im Offended
In a few months, the celebrity names and teen-panics-du-jour will change in America's bizarro politician, institution, church, and media-figure sexca-pades. As celebrity basher Chelsea Handler declared after a particularly scandal-laden week in which more big icons bungeed off the infidelity cliff, The hits just keep on coming. Still, even toughened up by America's certifiable craziness about sex or maybe jealous that I am apparently having less fun than evangelicals exhibiting hot new versions...
Forceps Delivery
Figure 1.44. Abrasion of the nose sheet burns in an infant with hyperactivity due to drug withdrawal. At the present time hyperactivity is most commonly seen with drug withdrawal, but may occur in infants experiencing pain, congenital hyperthyroidism, etc. The abrasions and erythema generally develop over prominent body parts such as the nose, ears, cheeks, elbows, and knees. Figure 1.45. Sheet burn of the cheeks in a hyperactive infant who was lying in a pool of regurgitated gastric contents....
c Fallopian Tubes Two
1 Location. Each tube is about 4 inches long and extends medially from each ovary to empty into the superior region of the uterus. 2 Function. The fallopian tubes transport ovum from the ovaries to the uterus. There is no contact of fallopian tubes with the ovaries. 3 Description. The distal end of each fallopian tube is expanded and has finger-like projections called fimbriae, which partially surround each ovary. When an oocyte is expelled from the ovary, fimbriae create fluid currents that...
Three Reasons Why Teen Pregnancy Does Not Exist
Here is teen pregnancy, the short take. Teen birth, unwed birth, abortion, total pregnancy, and sexually transmitted disease STD rates closely parallel those of adults of their community, class, and era.1 In fact, 6 in 10 men who impregnate teenagers are adults.2 The younger the pregnant teen, the bigger the partner age gap and the more likely she was to have suffered family chaos, including sexual abuse and other violence.3 In 2005, among females under age 20, 60 percent of all live births, 64...
16 Facts About The Menstrual Cycle
Menstruation is the periodic discharge of blood, mucus, and epithelial cells from the uterus. It usually occurs at monthly intervals throughout the reproductive period, except during pregnancy and lactation, when it is usually suppressed. a. The menstrual cycle is controlled by the cyclic activity of follicle stimulating hormone FSH and LH from the anterior pituitary and progesterone and estrogen from the ovaries. In other words, FSH acts upon the ovary to stimulate the maturation of a...
Scaphoid Abdomen
Figure 1.67. Radiograph of another infant with congenital cystic adenomatoid malformation of the lung on the left side. This infant developed increasingly severe respiratory distress within 18 hours of birth as a result of progressive air trapping and hyperinflation. In these infants, surgical removal of the malformation is essential. Congenital cystic adenomatoid malformation may present initially as an intrapulmonary mass which appears solid or has a few scattered translucent areas, but this...
Edmund S Howarth MB ChB MRCOG
Consultant in Maternal and Fetal Medicine, and Head of Service, at the University Hospitals of Leicester NHS Trust General training in Obstetrics and Gynaecology followed by sub-specialty training in maternal and fetal medicine. Provides tertiary level service for both maternal medical problems and fetal problems. Well-established service for management of neurological problems in pregnancy in conjunction with the local neurology service. Javed Iqbal BSc MSc Hons FRCPath FRCP Consultant in...
Daksha Elliott RGN RSCN
Specialist Nurse for Obstetric Haematology at the University Hospitals of Leicester Daksha has been working in the field of haemostasis and thrombosis since 1999, with her previous clinical background being paediatric nursing. The haematology obstetric service provides shared patient management of high-risk patients who have a haematological problem including those with inherited coagulation disorders and patients with haem-oglobinopathies. Her current role involves working as part of a...
Kinetics of glucose uptake and transport by the placenta
Although the effect of the maternal glucose concentration on net placental-to-fetal glucose transfer demonstrates saturation kinetics,10 this relationship does not necessarily define the quantitative characteristics of placental-to-fetal glucose transport capacity, because as maternal glucose concentration and placental glucose transport are increased, both fetal glucose concentration and fetal glucose utilization rates increase. Other studies in which glucose was infused directly into the...
2514 Hyperosmotic and saline laxatives
Lactulose, a poorly absorbed disaccharide, and its analog, lactitol, increase osmolar tension, creating an increase in water collection, distension, peristalsis, and evacuation. Lactulose is widely used, and in moderate use it is well tolerated. Poorly absorbed alcohols such as mannitol and sorbitol are used with the same effect. Macrogol works similarly macrogols with a molecular weight of more than 3000 are not absorbed. Saline laxatives are poorly absorbed as well they work in a similar way...
JM Duncan On puerperal diabetes Trans Obstet Soc London 1882 24 2568529
Matthews Duncan graduated in Aberdeen and became one of the leading obstetricians of his day Figure 1.3 . This compilation of cases from the literature, from anecdotal reports and Figure 1.2 Die Charite in Berlin 1785-1800 from a lithograph by von C Koppen from Murken AH, Vom Armenhospital zum Grossklinikum die Geschichte des Krankenhauses, Vom 18. Jahrhundert biszur Gegenwart Koln, Durmont, 1988, 39 . Figure 1.2 Die Charite in Berlin 1785-1800 from a lithograph by von C Koppen from Murken AH,...
Erythema Toxicum
Figure 1.25. Close-up of the lesions in erythema toxicum neonatorum. The etiology is unknown but biopsy of the lesions show the presence of numerous eosinophils. It has been suggested that the presence of erythema toxicum is evidence of maturity. Figure 1.27. Lentigines are smooth, freckle-like, pigmented macules. They are usually present at birth, have a scattered distribution, and have been considered by some to be a manifestation of intrauterine erythema toxicum neonatorum. They usually...
Contributors
Adewale Adeyinka, mbbs, PhD Cytogenetics Laboratory, Mayo Clinic and Mayo Foundation, Rochester, MN Edward R. Ashwood, md ARUP Laboratories, University of Utah School of Medicine, Salt Lake City, UT William A. Bennett, PhD Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson , MS Isaac Blickstein, md Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot and the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel Lynn Bry, md,...
Arms Hands Fingers Knees and Toes
The arms and legs of full-term newborns generally are all scrunched up flexed and held close to the body just as they were in the cramped uterus. The hands are usually tightly closed, and it may be difficult for you to open them. Touching or placing an object in their palms triggers a strong grasp reflex. Immediately after birth, many parents perform a quick finger and toe count and usually there are 10 of each. However, extra digits can form on the hands and feet. This occurs in about 10...
Negative influences on prenatal health Stress
The medical world remains divided on the effect of stress on fertility although studies have shown it can affect both the man's and woman's ability to conceive Berga et al 2003, Bethea et al 2005, Brkovich amp Fisher 1998, Campagne 2006, Marcus et al 2001 . For women there is a link with the endocrine system and the hormones produced during stressful times. A recent pilot study from the USA showed that 85 women started to ovulate again following a 20-week course of cognitive behaviour therapy...
What does it mean to be a mother Changes for women
Social roles such as 'mother' or 'shopkeeper' or 'friend' are governed by certain rules or expectations. The role of 'mother' has changed drastically in the past hundred years and has probably always been changing in terms of the needs of the wider society at a particular time. For example, during the wars of the past century women were expected to maintain the supply of food and products, especially munitions, that would keep society functioning in time of war. Often they also had to accept...
Refighting Yesterdays War
By the 2000s, the standard 90-second volleying between dueling teen-sex foes in the news media had become a hollaback drill Sex education SENDS TEENS DOUBLE MESSAGES . Give me abstinence-only DENIES TEENS LIFESAVING FACTS . For all the sound and fury lamenting teens having sex and or babies, these issues get raised the way jousters raise lances. On the progressive shows and blogs such as RachelMaddow, Countdown with Keith Olbermann, Huffington Post, and Salon, teen pregnancy's main utility...