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5 results

  • Chapter 11 - Optimal Management of Pregnancy beyond 12 Weeks, Labour and the Puerperium for Women over 40

  • from Section 6 - Obstetric Management beyond 40
  • Edited by Dimitrios S. Nikolaou, David B. Seifer
  • Book:
    Optimizing the Management of Fertility in Women over 40
    Published online:
    15 September 2022
    Print publication:
    06 October 2022, pp 131-140

  • Summary

    This chapter examines the risks of pregnancy for women over 40 and the strategies to optimize the management of pregnancy, labour and puerperium in this age group. In the UK, antenatal care is not usually any different at less than 40 years unless there are other confounding factors. Women at advanced age booking for pregnancy should have a thorough risk assessment to ascertain risk of hypertensive diseases of pregnancy and those at higher risk should be started on 75 mcg aspirin from 12 weeks till until 36 weeks Increased surveillance for GDM is not recommended in the UK based on age alone. However, it should be noted that AMA is associated with an increased background incidence of diabetes and it is our practice to offer a mini glucose tolerance test. Risk of venous thromboembolism should be assessed at booking and at each encounter. Serial growth scans with doppler studies are to be performed starting from 26-28 weeks of gestation in women more than 40 years. Induction of labour is recommended between 39 to 40 weeks when maternal age is more than 40 years. There is insufficient evidence to comment on the possible effect on perinatal mortality and rates of operative delivery from this intervention and this should be mentioned when counselling for induction of labour.

  • Section 5 - Management and policy

  • Edited by Matthew W. Gillman, Lucilla Poston, King's College London
  • Book:
    Maternal Obesity
    Published online:
    05 August 2012
    Print publication:
    19 July 2012, pp -

  • Summary

    This chapter summarizes the clinical management of obesity in pregnancy, based on evidence where it exists, and highlights the areas where further research is needed. Obese women who are pregnant are recognized as a high-risk group by both the American College of Obstetricians and Gynecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG) and should therefore be referred for appropriate antenatal care. All obese women should receive a dietary assessment and nutritional counseling. Obstetric ultrasound is used widely in the developed world for pregnancy dating, detection of higher order pregnancies and fetal anomaly, and estimation of fetal growth. Obesity is a well-recognised risk factor for gestational diabetes mellitus, and pre-gestational diabetes is more prevalent in obese women. It has long been recognized that hypertensive disorders are more prevalent in the obese population. The anesthetist plays an important role in the care of the obese parturient.

  • Section 3 - Long-term consequences

  • Edited by Matthew W. Gillman, Lucilla Poston, King's College London
  • Book:
    Maternal Obesity
    Published online:
    05 August 2012
    Print publication:
    19 July 2012, pp -

  • Summary

    This chapter focuses on the evidence for the association between gestational weight gain and postpartum weight retention among obese women, as well as the association between obesity and lack of breastfeeding, and how these associations are potentially interrelated to cause further disease in obese women. Overweight and obese women are less likely to initiate breastfeeding and more likely to prematurely stop breastfeeding compared to their normal weight counterparts. There is currently little investigation of the interrelationships between obesity, pregnancy, and chronic disease. Risks of hypertensive disorders are highest among obese women who maintained or increased their BMI between pregnancies. Maternal obesity is also associated with later development of type 2 diabetes mellitus (T2DM/pre-T2DM) and heart disease (CHD)/pre-CHD. The current literature suggests that maternal obesity has many long-term health consequences for the mother; however, the degree to which pregnancy contributes to these outcomes is uncertain.

  • Chapter 13 - Multiple Gestation

  • from Part II - INTRAPARTUM AND POSTPARTUM
    • By V. Ravishankar, Clinical Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences State University of New York at Stony Brook Stony Brook University School of Medicine Stony Brook, New York, J. Gerald Quirk, Professor and Chair, Department of Obstetrics, Gynecology, and Reproductive Medicine State University of New York at Stony Brook
  • John Patrick O'Grady, Tufts University, Massachusetts, Martin L. Gimovsky, Lucy A. Bayer-Zwirello, Kevin Giordano
  • Book:
    Operative Obstetrics
    Published online:
    07 May 2010
    Print publication:
    04 August 2008, pp 322-347

  • Summary

    This chapter explores the maternal and fetal complications, advances in prenatal diagnosis, and management of complications unique to multiple gestations. Tidal volume and oxygen consumption in multiple gestations are increased, as is the normal alkalosis seen in singleton pregnancy. Hypertensive disorders increase by at least twofold in twin gestations. Hemorrhagic complications occur more frequently with twins. Growth of singletons and twins is comparable until 27 weeks gestation. The uterus accommodates the larger volume imposed by twins by overdistension, and beyond a certain limit, premature labor can result. Preterm deliveries (less than 37 weeks' gestation) occurred in 10.6% of singleton pregnancies against a phenomenal rate of 61.2% of live births in multiple gestations. Diagnosis of multiple gestations, establishing chorionicity, identifying anomalies, foreseeing possible maternal and fetal complications, prevention and treatment of preterm labor, and management of growth restriction are some of the areas of medicolegal concerns in multiple gestations.

  • 3 - Maternal and fetal thrombocytopenia

  • Edited by Ann Harper
  • Book:
    Haemorrhage and Thrombosis for the MRCOG and Beyond
    Published online:
    05 October 2014
    Print publication:
    01 June 2005, pp 27-41

  • Summary

    Thrombocytopenia in the mother and fetus is a common problem. This chapter reviews its causes, clinical significance, investigation and management. Thrombocytopenia complicating hypertensive disorders of pregnancy is responsible for about 20% of cases of maternal thrombocytopenia. The pregnancy-related causes of disseminated intravascular coagulation (DIC) include pre-eclampsia, placental abruption, amniotic fluid embolism and, rarely, retention of a dead fetus. Immune thrombocytopenia is responsible for about 4% of maternal thrombocytopenia. Most cases are due to idiopathic autoimmune thrombocytopenia, but some are drug-related and some associated with HIV infection. Neonatal thrombocytopenia has many causes, and is the most common haematological problem in the newborn infant, and probably the fetus as well. A better understanding of the risks of thrombocytopenia in pregnancy to the mother and fetus has resulted in better targeting of treatment: withholding it in low-risk situations and using intensive therapy where there is high risk.