Obstetrics and gynecology clinics of North America
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Although most neurologic problems require conservative management, such as headaches and nerve compression syndromes, other demand aggressive treatment, such as plasmapheresis in Guillain-Barré syndrome and prompt surgery in those patients with hemorrhagic strokes secondary to a ruptured aneurysm or arteriovenous malformation. Myasthenia gravis, discussed in the autoimmune disease section, and epilepsy are associated with congenital anomalies, whereas the progeny of patients with multiple sclerosis are at a much greater risk than the general population of contracting this disease. ⋯ Pregnancy provides many physiologic changes that alter the course of preexisting neurologic conditions as well as increasing the risks and morbidity of other diseases. It is for this reason that a cooperative team effort, including the obstetrician, neurologist, and, if needed, the neurosurgeon, is essential for an optimal outcome.
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Disorders of the pituitary gland such as diabetes insipidus, pituitary adenomas, and hyperprolactinemia, disorders of the thyroid gland such as Graves' disease and hypothyroidism, and diseases of the adrenal gland such as adrenocortical insufficiency and Cushing's syndrome can complicate pregnancy. The goals of this article were to provide a basic scientific understanding of the normal function of these endocrine glands, their pregnancy-related changes, and suggestions for diagnosis and treatment of maternal and fetal endocrine disorders during pregnancy. Antenatal recognition and appropriate management of the disorders that especially affect the fetus (i.e., maternal Graves' disease, fetal hypothyroidism, and congenital adrenal hyperplasia) is essential in order to prevent fetal and neonatal morbidity and mortality.