High Risk Labor And Delivery Ecab

The high-risk pregnant patient can present to the labor and delivery setup with significant complications that can result in morbidity and mortality. The goal of the obstetricians is always to have a safe outcome for both the mother and the baby, irrespective of the severity of the illness. Therefore, a thorough understanding of the underlying problems and expert management by the obstetrician are extremely important. Further, these parturient can be critically ill, requiring intensive care management. So, good communication among the various teams and the latest information on the management of such patients are critical in order to provide the highest possible level of care. The information in this text will hopefully give the reader the best and most up-to-date knowledge with regard to management of problems and challenges in dealing with a high-risk parturient. This book brings together an outstanding group of authors from the discipline of Obstetrics and Gynaecology in an attempt to present a comprehensive and current summary of high-risk labor and delivery and will be useful to both the practitioner in academic medicine and in private practice.

Even though it seems simple the ability of the mother’s body to retain and nurture the fetus, which is of a non-identical genetic makeup, throughout the gestational period requires a delicate balance of hormonal orchestration to achieve the required immunological permissiveness. The obvious outcome of a failure to achieve this is rejection of the fetal "semi-allograft", which manifests as threatened miscarriage. The occurrence of threatened miscarriage or symptoms suggestive of it is fraught with anxiety both for the patient and the obstetrician, especially if the baby is eagerly awaited. In such a situation, a correct diagnosis and prompt evaluation is imperative to start immediate interventions and prevent the expulsion of the fetus. However it is equally important to rule out the other conditions that may mimic threatened miscarriage and avoid unnecessary interventions. This clinical update handbook attempts to address these and other issues associated with this potentially elusive condition. The first chapter serves to give a concise yet relevant overview about this topic. The various modes of presentation as well as the management protocol are elaborately covered in the second chapter. The chapter on Diagnostic Modalities explains how the risk factors and investigative findings can be used to predict and make an early diagnosis of the condition. It has also touched upon the other conditions that mimic threatened miscarriage and how those can be differentiated from it. The role of stress and how it affects the immunomodulation which is the basis of maternal tolerance of the fetus, is explored in detail in the fourth chapter. The last chapter highlights the complications associated with inappropriate treatment of the condition and explores the adverse effects and relative safety of the recommended treatment protocol. Most of the chapters also include several case reviews that illustrate the aspects covered and are enriched with the vast repertoire of personal experience of the eminent authors.

Endometriosis is a condition that often leads to a variety of symptoms that range from pain complaints to infertility. Endometriosis is also found in women who are asymptomatic. The diagnosis of endometriosis can be made clinically with reliability similar to that of one made surgically. Medical treatment options are effective, as are surgical treatment options. Complications associated with surgery, however, push the balance in favor of medical therapy whenever possible. Based on the body of evidence available at present, women with endometriosis-related complaints should be treated with a first-line medical therapy. If that fails, a second-line medical therapy is warranted under most conditions. Laparoscopic surgery should be reserved for patients in whom second-line medical therapy has failed or is contraindicated by desire to conceive immediately or as soon as possible.

Globally, pregnancy and childbirth are periods of high morbidity and mortality for women. The key to reducing the risks associated with pregnancy and childbirth is early recognition and provision of high quality care. The aims of critical care issues’ management are broad, the need to address the defects in conceiving followed by early recognition, prevention, and management of preterm births and threatened miscarriages along with studying the essential factors responsible for the same. Infertility has been ranked as one of the greatest sources of stress in a person’s life, comparable to a somatic disease such as cancer and ranked second to that involving the death of a family member or divorce. The role of stress and immunomodulation as a causative factor for infertility has been studied in greater details in recent times due to the changing lifestyles and a relevant discussion has been provided by the author with specific considerations in the Indian clinical settings. Endometriosis is the disease of the millennium, a sticky, perplexing and unconquerable pathology, which has remained an enigma. With increased awareness about endometriosis, improved methods of diagnosis like transvaginal sonography, liberal use of laparoscopy and more frequent evaluation of CA 125, the incidence of endometriosis is rising and thus, a clear understanding of the condition with application of the various advances in the recognition and also the new management protocols being followed, are the need of the day for the practitioners across the country. The polycystic ovary syndrome (PCOS), which features amenorrhea, hirsutism, and obesity, which was initially considered a reproductive and cosmetic concern of young women of reproductive age group, has more recently been recognized to have metabolic and cardiovascular associations that make it of major consequence for women of all age groups worldwide. Keeping in mind the requirements of the society, the practitioners need to update themselves on the current approach and the wide variety of choices now available. This book encompasses the rich experience of the specialists in India who are among the stalwarts in this field.

Assisted reproduction refers to a number of advanced techniques that aid fertilization in a couple diagnosed to have reduced fertility such as in women who have irreversible damage to their fallopian tubes or cervical mucous problems. These techniques can also benefit couples with unexplained infertility. Before 1978, infertility diagnosis and treatment revolved around surgical interventions such as fallopian tube(s) repair or inserting sperms into the uterus. Thus, the management was applicable and aimed at removing the mechanical blockage that prevented the fertilization of egg. Then ca.me Louise Brown and Dr. Patrick Steptoe, a couple who were destined to be associated forever in the infertility history books forever. This is because in 1978, Dr. Steptoe made it possible for Louise to conceive in a laboratory in England with IVF. From this turning point in the science of infertility, came techniques that addressed the biochemical and hormonal aspects of infertility thus marking the beginning of a whole new subspecialty called Reproductive Endocrinology. With Dr. Steptoe’s technique, called IVF (In Vitro Fertilization), couples who otherwise had no problems that could be surgically treated now had another option. With the inclusion of Information technology in all aspects of our life, the explosion of Assisted Reproduction Technologies (ART) has resulted in further sophistication of additional techniques, now responsible for the existence of over 20,000 human beings a year that would never have existed. ART deals with all aspects of the science of conception, be it investigating the couple, or determining their ovarian reserve to application of the most appropriate technique to aid conception in that couple.

Critical Issues in Obstetrics and Gynecology - ECAB - E-Book

It is an established fact that thyroid hormones play an important role in the metabolism of the body. Pregnancy is a state of significant hormonal as well as metabolic changes, and thyroid hormones have a significant impact on maternal metabolism and fetal development during pregnancy. The fetus relies on maternal thyroid hormone for the development of the CNS, especially in the early stages of gestation, and uncorrected maternal hypothyroidism in this period can leave the child with permanent life-long neurological deficits. From the maternal point of view, a thyroid dysfunction encountered during pregnancy may continue even after delivery as postpartum thyroiditis. Hence, any thyroid dysfunction, be it hypo- or hyperthyroidism, can have serious deleterious consequences if not detected promptly and managed properly. The established guidelines and newer trends for the treatment of thyroid dysfunction are discussed in this update. Thyroid hypofunction has also been known to affect the fertility of women in reproductive age group. With the increasing incidence of infertility and advent of methods to treat them, the early detection and adequate treatment of thyroid hypofunction becomes an unavoidable part of assisted reproductive techniques, in the present day scenario. Even subclinical thyroid disorders can affect the reproductive capacity of non-pregnant women and impact the fetomaternal wellbeing in those who conceive. However, not all cases of subclinical hypothyroidism warrant pharmacological treatment. The guidelines for treatment of subclinical hypothyroidism in the pregnant and non-pregnant states are discussed in detail in this clinical update. An important aspect of reproductive health is family planning, and one of the commonly used means to achieve it is hormonal contraceptives. The interaction of thyroid hormones with hormonal contraceptives and the means of testing thyroid dysfunction in an individual taking hormonal contraceptives have been elucidated in this update.

Bleeding in Pregnancy - ECAB - E-Book