Best practice & research. Clinical obstetrics & gynaecology
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Best Pract Res Clin Obstet Gynaecol · May 2014
ReviewObstetric anaesthesia and peripartum management.
Anaesthetists play a key role in the management of parturients with cardiac disease. Pregnant women with cardiac disease should be seen antenatally in a high-risk obstetric anaesthesia clinic, and a comprehensive management plan formulated. ⋯ No evidence exists to definitively support either regional or general anaesthesia for caesarean section, and much depends on the urgency of the procedure and the severity of disease. Women with the most severe forms of cardiac disease should be managed by a consultant anaesthetic team, with experience of both cardiac and obstetric anaesthesia.
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The definition of placenta previa based on ultrasound findings is more practical, and the traditional definition (implantation of the placenta in the lower uterine segment) needs to be revised. The term 'placenta previa' should only be used when the placental edge overlaps or is within 2 cm of the internal cervical orifice in late pregnancy. If the placental edge is located further than 2 cm but within 3.5 cm from the internal cervical orifice, the placenta should be termed 'low-lying'. ⋯ Chorioangiomas usually appear as well-circumscribed, rounded, hypo-echoic lesions next to the chorionic surface. Iatrogenic delivery or prenatal intervention are two options, if fetal compromise is present. Prenatal detection leads to a dramatic increase in survival compared with those cases unsuspected antenatally.
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Best Pract Res Clin Obstet Gynaecol · Jan 2014
ReviewThe effect of perinatal exposures on the infant: antidepressants and depression.
Depression, anxiety, or both, during pregnancy are common complications during the perinatal period, with 15-20% of women experiencing depression at some point during their pregnancy. Considerable evidence suggests that untreated or undertreated maternal Axis I mood disorders can increase the risk for preterm birth, low birth weight, and alter neurobehavioral development in utero. ⋯ In this chapter, evidence linking serotonin reuptake inhibitor use with an increased risk for postnatal adaptation syndrome, congenital heart defects, and neonatal persistent pulmonary hypertension is reviewed. Management decisions should include attention to the continuum of depression symptoms, from subclinical to severe major depressive disorder and the long-term developmental risks that might also be associated with pre- and postnatal exposure.
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Insufficient sleep is common in the general population, and can result from environmental and psychosocial factors, medical and psychiatric disorders, and sleep disorders, such as insomnia, circadian rhythm disorders, sleep apnoea and restless legs. Women are particularly at risk for sleep disorders, and complaints of sleep disturbance are more prevalent among women than men across the life span. ⋯ In addition, the role of circadian rhythms in fertility and perinatal health is just beginning to be appreciated. In this chapter, we provide an overview of the current knowledge of the unique aspects of diagnosis and treatment of sleep disorders during the perinatal period.
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Best Pract Res Clin Obstet Gynaecol · Dec 2013
ReviewAlterations in physiology and anatomy during pregnancy.
Pregnant women undergo profound anatomical and physiological changes so that they can cope with the increased physical and metabolic demands of their pregnancies. The cardiovascular, respiratory, haematological, renal, gastrointestinal and endocrine systems all undergo important physiological alterations and adaptations needed to allow development of the fetus and to allow the mother and fetus to survive the demands of childbirth. ⋯ Understanding these changes is important for every practicing obstetrician, as the pathological deviations from the normal physiological alterations may not be clear-cut until an adverse outcome has resulted. Only with a sound knowledge of the physiology and anatomy changes can the care of an obstetric parturient be safely optimized for a better maternal and fetal outcome.