Pub Date : 2012-02-01DOI: 10.1017/S096553951100012X
C. Aiken, M. Mehasseb, A. Prentice
Secondary postpartum haemorrhage is defined as any abnormal or excessive bleeding from the birth canal occurring between 24 hours and up to 12 weeks postpartum. The quantity of blood loss that constitutes secondary postpartum bleeding, unlike primary postpartum hemorrhage, is not clearly defined. Subjective estimation of the amount of blood loss constituting ‘haemorrhage’ accounts for at least some of the variation in reported incidence of secondary postpartum haemorrhage from 0.47% to 2%
{"title":"Secondary postpartum haemorrhage","authors":"C. Aiken, M. Mehasseb, A. Prentice","doi":"10.1017/S096553951100012X","DOIUrl":"https://doi.org/10.1017/S096553951100012X","url":null,"abstract":"Secondary postpartum haemorrhage is defined as any abnormal or excessive bleeding from the birth canal occurring between 24 hours and up to 12 weeks postpartum. The quantity of blood loss that constitutes secondary postpartum bleeding, unlike primary postpartum hemorrhage, is not clearly defined. Subjective estimation of the amount of blood loss constituting ‘haemorrhage’ accounts for at least some of the variation in reported incidence of secondary postpartum haemorrhage from 0.47% to 2%","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"23 1","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S096553951100012X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-02-01DOI: 10.1017/S0965539512000010
D. Hill, Paul McMACKIN
The epidural route is currently the gold standard for labour analgesia, although it is not without serious consequences, especially when incorrect placement goes unrecognised. Intravascular, intrathecal and subdural placements have been reported to occur with incidences of 1 in 5000, 1 in 2900 and 1 in 4200 respectively. Until recent years there has not been a viable alternative to epidural analgesia.
{"title":"REVIEW OF OPIOID PCA FOR LABOUR ANALGESIA","authors":"D. Hill, Paul McMACKIN","doi":"10.1017/S0965539512000010","DOIUrl":"https://doi.org/10.1017/S0965539512000010","url":null,"abstract":"The epidural route is currently the gold standard for labour analgesia, although it is not without serious consequences, especially when incorrect placement goes unrecognised. Intravascular, intrathecal and subdural placements have been reported to occur with incidences of 1 in 5000, 1 in 2900 and 1 in 4200 respectively. Until recent years there has not been a viable alternative to epidural analgesia.","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"23 1","pages":"15-31"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0965539512000010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-11-01DOI: 10.1017/S0965539511000155
Eileen Sung, J. George, M. Porter
Sepsis is associated with high morbidity and mortality worldwide. Although, it is not the major reason for intensive care unit admissions during pregnancy, several physiological changes that occur during pregnancy limit the ability of the pregnant woman to compensate for the derangements produced by severe sepsis, often resulting in severe organ dysfunction. Moreover, there are several disorders peculiar to the pregnant state, including preeclampsia, placental abruption, amniotic fluid embolism and postpartum haemorrhage, all of which can produce potentially life-threatening organ failure and may be present concurrently with sepsis contributing to maternal mortality. Evidence-based guidelines advocate assessment and monitoring aimed at early recognition and treatment of sepsis. Early goal-directed therapy, adequate blood glucose control, and corticosteroid replacement when indicated are improving outcomes in patients with severe sepsis, although most of these have not been validated in pregnancy.
{"title":"SEPSIS IN PREGNANCY","authors":"Eileen Sung, J. George, M. Porter","doi":"10.1017/S0965539511000155","DOIUrl":"https://doi.org/10.1017/S0965539511000155","url":null,"abstract":"Sepsis is associated with high morbidity and mortality worldwide. Although, it is not the major reason for intensive care unit admissions during pregnancy, several physiological changes that occur during pregnancy limit the ability of the pregnant woman to compensate for the derangements produced by severe sepsis, often resulting in severe organ dysfunction. Moreover, there are several disorders peculiar to the pregnant state, including preeclampsia, placental abruption, amniotic fluid embolism and postpartum haemorrhage, all of which can produce potentially life-threatening organ failure and may be present concurrently with sepsis contributing to maternal mortality. Evidence-based guidelines advocate assessment and monitoring aimed at early recognition and treatment of sepsis. Early goal-directed therapy, adequate blood glucose control, and corticosteroid replacement when indicated are improving outcomes in patients with severe sepsis, although most of these have not been validated in pregnancy.","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"22 1","pages":"287-305"},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0965539511000155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-11-01DOI: 10.1017/S0965539511000131
K. Schreiber, O. Ateka-Barrutia, M. Khamashta, G. Hughes
The Antiphospholipid syndrome (APS) is one of the current hot topics embracing rheumatology and obstetrics.The first clinical description of APS was in 1983. Venous or arterial thrombosis, abortion and cerebral manifestations along with circulating antibodies were the first described hallmarks of the syndrome. In the following years other clinical features, which include pregnancy complications, such as recurrent miscarriages (RM), pre-eclampsia or severe placental insufficiency were described.
{"title":"OBSTETRIC ANTIPHOSPHOLIPID SYNDROME - A REVIEW","authors":"K. Schreiber, O. Ateka-Barrutia, M. Khamashta, G. Hughes","doi":"10.1017/S0965539511000131","DOIUrl":"https://doi.org/10.1017/S0965539511000131","url":null,"abstract":"The Antiphospholipid syndrome (APS) is one of the current hot topics embracing rheumatology and obstetrics.The first clinical description of APS was in 1983. Venous or arterial thrombosis, abortion and cerebral manifestations along with circulating antibodies were the first described hallmarks of the syndrome. In the following years other clinical features, which include pregnancy complications, such as recurrent miscarriages (RM), pre-eclampsia or severe placental insufficiency were described.","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"22 1","pages":"265-286"},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0965539511000131","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-11-01DOI: 10.1017/S0965539511000143
G. Senoun, M. Singh, H. Mousa, Z. Alfirevic
Some half a million women die annually across the world from causes related to pregnancy and childbirth. Approximately one-quarter of these deaths are caused by complications of the third stage of labour, mainly postpartum haemorrhage (PPH). In the developing world, the risk of maternal death from PPH is approximately one in 1000 deliveries. In the United Kingdom the risk of maternal death from obstetric haemorrhage is about 0.39 in 100000 deliveries.
{"title":"UPDATE ON THE NEW MODALITIES ON THE PREVENTION AND MANAGEMENT OF POSTPARTUM HAEMORRHAGE","authors":"G. Senoun, M. Singh, H. Mousa, Z. Alfirevic","doi":"10.1017/S0965539511000143","DOIUrl":"https://doi.org/10.1017/S0965539511000143","url":null,"abstract":"Some half a million women die annually across the world from causes related to pregnancy and childbirth. Approximately one-quarter of these deaths are caused by complications of the third stage of labour, mainly postpartum haemorrhage (PPH). In the developing world, the risk of maternal death from PPH is approximately one in 1000 deliveries. In the United Kingdom the risk of maternal death from obstetric haemorrhage is about 0.39 in 100000 deliveries.","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"22 1","pages":"247-264"},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0965539511000143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-08-01DOI: 10.1017/S0965539511000106
D. Roberts
Premature rupture of membranes (PROM) is a major cause of perinatal mortality and morbidity associated with preterm delivery in a third of cases. Fetal survival is even more compromised when the membranes rupture early in the second trimester (very early PROM). Survival is associated with problems of delivery of the very preterm fetus as well as associated risks of feto-maternal infection. In the context of studies of amnioinfusion, very early rupture of membranes is defined as rupture between 16 and 26 weeks of pregnancy.
{"title":"AMNIOINFUSION FOR VERY EARLY RUPTURE OF MEMBRANES","authors":"D. Roberts","doi":"10.1017/S0965539511000106","DOIUrl":"https://doi.org/10.1017/S0965539511000106","url":null,"abstract":"Premature rupture of membranes (PROM) is a major cause of perinatal mortality and morbidity associated with preterm delivery in a third of cases. Fetal survival is even more compromised when the membranes rupture early in the second trimester (very early PROM). Survival is associated with problems of delivery of the very preterm fetus as well as associated risks of feto-maternal infection. In the context of studies of amnioinfusion, very early rupture of membranes is defined as rupture between 16 and 26 weeks of pregnancy.","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"22 1","pages":"207-218"},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0965539511000106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-08-01DOI: 10.1017/S0965539511000118
K. Boyle, J. Friedman
{"title":"MATERNAL OBESITY AND OXIDATIVE STRESS IN THE FETUS: MECHANISMS UNDERLYING EARLY LIFE SHIFTS IN SKELETAL MUSCLE METABOLISM","authors":"K. Boyle, J. Friedman","doi":"10.1017/S0965539511000118","DOIUrl":"https://doi.org/10.1017/S0965539511000118","url":null,"abstract":"","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"22 1","pages":"219-246"},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0965539511000118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-05-01DOI: 10.1017/S0965539511000052
M. Gidiri, I. Greer
Obesity is a growing problem in obstetric practice. A recent study from Glasgow (UK) showed that 50% of women of childbearing age are either overweight (Body Mass Index [BMI] = 24.9–29.9kg/m 2 ) or obese with 18% starting pregnancy as obese. Obesity prevalence has doubled over a decade from the early 1990’s. In the US it is estimated that 30% of reproductive-age women have a BMI greater than 30 kg/m while 7% have a BMI > 40 kg/m 2 . A recent report from the UK found that 5% of women had a BMI >35 kg/m 2 , 2% > 40 kg/m 2 and 0.2% >50 kg/m 2 with an association not only with social deprivation, but also with a higher prevalence of pre-existing medical disorders such as diabetes and hypertension and medical complications of pregnancy such as preeclampsia. Obesity was also associated with increased rates of macrosomia, operative delivery and postpartum haemorrhage. These data highlight the fact that obesity is an increasing health concern particularly in young women of childbearing age. Obesity will expose them to significant pregnancy complications ranging from miscarriage and fetal abnormality through to operative delivery and thromboembolism. There are also challenges for the delivery of maternity care to meet the needs of these women. As obesity is associated with significant pregnancy complications it is important that women enter pregnancy with an optimum body weight. Many complications, such as fetal abnormality occur in the first trimester and so pre-pregnancy weight reduction is preferred. Further, there is insufficient evidence to recommend specific dietary and/or physical activity interventions to reduce weight or moderate weight gain during pregnancy.
{"title":"BARIATRIC SURGERY IN PREGNANCY: BENEFITS, RISKS AND OBSTETRIC MANAGEMENT","authors":"M. Gidiri, I. Greer","doi":"10.1017/S0965539511000052","DOIUrl":"https://doi.org/10.1017/S0965539511000052","url":null,"abstract":"Obesity is a growing problem in obstetric practice. A recent study from Glasgow (UK) showed that 50% of women of childbearing age are either overweight (Body Mass Index [BMI] = 24.9–29.9kg/m 2 ) or obese with 18% starting pregnancy as obese. Obesity prevalence has doubled over a decade from the early 1990’s. In the US it is estimated that 30% of reproductive-age women have a BMI greater than 30 kg/m while 7% have a BMI > 40 kg/m 2 . A recent report from the UK found that 5% of women had a BMI >35 kg/m 2 , 2% > 40 kg/m 2 and 0.2% >50 kg/m 2 with an association not only with social deprivation, but also with a higher prevalence of pre-existing medical disorders such as diabetes and hypertension and medical complications of pregnancy such as preeclampsia. Obesity was also associated with increased rates of macrosomia, operative delivery and postpartum haemorrhage. These data highlight the fact that obesity is an increasing health concern particularly in young women of childbearing age. Obesity will expose them to significant pregnancy complications ranging from miscarriage and fetal abnormality through to operative delivery and thromboembolism. There are also challenges for the delivery of maternity care to meet the needs of these women. As obesity is associated with significant pregnancy complications it is important that women enter pregnancy with an optimum body weight. Many complications, such as fetal abnormality occur in the first trimester and so pre-pregnancy weight reduction is preferred. Further, there is insufficient evidence to recommend specific dietary and/or physical activity interventions to reduce weight or moderate weight gain during pregnancy.","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"22 1","pages":"109-122"},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0965539511000052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56977558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-05-01DOI: 10.1017/S0965539511000040
Marilyn J Cipolla, Richard P Kraig
Eclampsia is currently defined in the obstetrical literature as the occurrence of unexplained seizure during pregnancy in a woman with preeclampsia.1,2 In the Western world, the incidence of eclampsia is ~1 in 2000 to 1 in 3000 pregnancies3–5, but the incidence is 10-fold higher than that in tertiary referral centers and undeveloped countries where there is poor prenatal care, and in multi-fetal gestations.6,7 Eclampsia is associated with high maternal and fetal mortality and morbidity.3,8,9 Nearly 1 in 50 women with eclampsia die as do 1 in 14 of their offspring, and mortality rates are considerably higher in undeveloped countries.3,8,9 Eclampsia is also associated with significant life-threatening complications, including neurological events. In the brain, seizure can cause stroke, hemorrhage, edema and brain herniation acutely,10–13 but also predisposes to epilepsy and cognitive impairment later in life.13,14 Preeclampsia by definition is a prodrome for eclampsia, making hypertension and proteinuria prerequisite for seizure during pregnancy. However, women who develop eclampsia exhibit a wide spectrum of signs and symptoms ranging from severe hypertension and proteinuria to mild or absent hypertension with no proteinuria.6,9,15 In a study of 53 pregnancies complicated by eclampsia, only 7 women (13%) could be considered to have severe preeclampsia prior to seizure.15 A similar result was found in a study in the United Kingdom in which high blood pressure (≥120 mmHg diastolic) was recorded in only 20% of patients with eclampsia.3 The findings that a fair number of women with eclampsia do not have the clinical definition of hypertension or proteinuria suggests that eclampsia is not always a progression from severe preeclamptic disease to seizure (eclampsia). While this alternative view of the eclamptic seizure was presented over 10 years ago, there has been little progress in understanding the underlying cause of eclampsia.3 Eclampsia remains a significant life-threatening complication of pregnancy, yet there are no reliable tests or symptoms for predicting the development of seizure. In addition, while magnesium sulfate (MgSO4) is the primary treatment of preeclamptic women for prevention of eclampsia, its use is controversial because of potential serious side effects including areflexia and respiratory distress.16–19 Thus, eclampsia is difficult to predict and treat likely because of our lack of understanding of its underlying cause. This review will highlight our current understanding of how pregnancy and preeclampsia affect the brain and cerebral circulation that could promote neuronal excitability (seizure) and ways in which to manage seizure in preeclamptic women during pregnancy and preeclampsia.
{"title":"Seizures in Women with Preeclampsia: Mechanisms and Management.","authors":"Marilyn J Cipolla, Richard P Kraig","doi":"10.1017/S0965539511000040","DOIUrl":"https://doi.org/10.1017/S0965539511000040","url":null,"abstract":"Eclampsia is currently defined in the obstetrical literature as the occurrence of unexplained seizure during pregnancy in a woman with preeclampsia.1,2 In the Western world, the incidence of eclampsia is ~1 in 2000 to 1 in 3000 pregnancies3–5, but the incidence is 10-fold higher than that in tertiary referral centers and undeveloped countries where there is poor prenatal care, and in multi-fetal gestations.6,7 Eclampsia is associated with high maternal and fetal mortality and morbidity.3,8,9 Nearly 1 in 50 women with eclampsia die as do 1 in 14 of their offspring, and mortality rates are considerably higher in undeveloped countries.3,8,9 Eclampsia is also associated with significant life-threatening complications, including neurological events. In the brain, seizure can cause stroke, hemorrhage, edema and brain herniation acutely,10–13 but also predisposes to epilepsy and cognitive impairment later in life.13,14 \u0000 \u0000Preeclampsia by definition is a prodrome for eclampsia, making hypertension and proteinuria prerequisite for seizure during pregnancy. However, women who develop eclampsia exhibit a wide spectrum of signs and symptoms ranging from severe hypertension and proteinuria to mild or absent hypertension with no proteinuria.6,9,15 In a study of 53 pregnancies complicated by eclampsia, only 7 women (13%) could be considered to have severe preeclampsia prior to seizure.15 A similar result was found in a study in the United Kingdom in which high blood pressure (≥120 mmHg diastolic) was recorded in only 20% of patients with eclampsia.3 The findings that a fair number of women with eclampsia do not have the clinical definition of hypertension or proteinuria suggests that eclampsia is not always a progression from severe preeclamptic disease to seizure (eclampsia). While this alternative view of the eclamptic seizure was presented over 10 years ago, there has been little progress in understanding the underlying cause of eclampsia.3 \u0000 \u0000Eclampsia remains a significant life-threatening complication of pregnancy, yet there are no reliable tests or symptoms for predicting the development of seizure. In addition, while magnesium sulfate (MgSO4) is the primary treatment of preeclamptic women for prevention of eclampsia, its use is controversial because of potential serious side effects including areflexia and respiratory distress.16–19 Thus, eclampsia is difficult to predict and treat likely because of our lack of understanding of its underlying cause. This review will highlight our current understanding of how pregnancy and preeclampsia affect the brain and cerebral circulation that could promote neuronal excitability (seizure) and ways in which to manage seizure in preeclamptic women during pregnancy and preeclampsia.","PeriodicalId":89369,"journal":{"name":"Fetal and maternal medicine review","volume":"22 2","pages":"91-108"},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0965539511000040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29968099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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