APPRAISAL AND REVALIDATION SERIES The new Appraisal and Revalidation Series helps doctors demonstrate their competence to the standard expected by the General Medical Council and to the standard expected if they are recognised as having 'special clinical interests'. It helps doctors gather evidence of their performance for appraisal and revalidation portfolios. This fifth book in the series examines the practical ways to identify learning and service needs within the areas of substance abuse palliative care musculoskeletal conditions and prescribing practice. It also provides guidance on how to collect data to demonstrate learning competence performance and service delivery standards. All general practitioners and those with special clinical interests and primary care organisation leads will find this book essential reading. For more information on other titles in this series please click here

The major objective of our studies in the last decade was a systematic analysis of maternal diseases during pregnancy to reveal their possible adverse effects on birth outcomes. The two most important factors of infant mortality were parti- larly analyzed: structural birth defects, known as congenital abnormalities (CAs) and preterm birth (PB). In general the objectives of scienti c studies might be either to test a new hypothesis or to con rm or confront previously published results. However, less frequently the authors/scientists have personal motivations determined by their professional activities. The authors of this book are practicing physicians and genetic epidemiologist who are mainly interested in the following three practical questions: 1. The possible adverse effects of pharmaceutical products. The possible t- atogenic potential of about 170 drugs has been evaluated very thoroughly using the data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA) in the last 50 years. These drugs were used to treat maternal diseases and the ndings of our population-based case-control studies will be cited in this book and are shown in the Appendix at the end of the book. However, our long experiences showed two problems in the drug teratology. In general the evaluation of clinical doses of these drugs is a particularly dif- cult challenge due to the modi cation effects of confounders. This problem motivated one of the authors to establish a new model of disaster epidemiology.

Based on the protocols in use at the highly acclaimed King's College Hospital in London, Clinical Protocols in Labour presents a consensus of the best and most appropriate techniques for standard delivery and uncommon clinical scenarios. Each chapter is written as a stand-alone unit making the information easy to find. Coverage ranges from a general approach to care, normal labour, and care of the baby to specific issues such as eclampsia and pre-eclampsia, uterine rupture, and postpartum bleeding. In addition, the book includes protocols for emergency closure of the labour ward, communication among members of the labour team, and more. A compact, authoritative volume, Clinical Protocols in Labour provides practical templates for the perinatal management of women and their babies during labour and delivery.

This book presents both theoretical contributions and empirical applications of advanced statistical techniques including geo-additive models that link individual measures with area variables to account for spatial correlation; multilevel models that address the issue of clustering within family and household; multi-process models that account for interdependencies over life-course events and non-random utilization of health services; and flexible parametric alternatives to existing intensity models. These analytical techniques are illustrated mainly through modeling maternal and child health in the African context, using data from demographic and health surveys. In the past, the estimation of levels, trends and differentials in demographic and health outcomes in developing countries was heavily reliant on indirect methods that were devised to suit limited or deficient data. In recent decades, world-wide surveys like the World Fertility Survey and its successor, the Demographic and Health Survey have played an important role in filling the gap in survey data from developing countries. Such modern demographic and health surveys enable investigators to make in-depth analyses that guide policy intervention strategies, and such analyses require the modern and advanced statistical techniques covered in this book. The text is ideally suited for academics, professionals, and decision makers in the social and health sciences, as well as others with an interest in statistical modelling, demographic and health surveys. Scientists and students in applied statistics, epidemiology, medicine, social and behavioural sciences will find it of value.

This updated and expanded edition of The Pregnant Drug Addict (1995) explores the difficulties of managing the maternity care of those who are drug dependent. Catherine Siney has brought together a number of specialists whose combined expertise provides an essential guide to this problematic subject. Key issues include the medical and obstetric problems of mothers, the consequences for the child, pregnant women who are HIV positive or have hepatitis B, outreach work and counselling.

Covering both the pharmacological and the more controversial non-pharmacological management of pain relief, this comprehensive text, edited by an internationally renowned specialist, provides practical guidance to all involved in this aspect of labour care.

There are many changes in the skin, hair, and nails during and after pregnancy. Patients are certainly aware that those changes are occurring, but few physicians and even fewer patients know how to predict the course of those changes. Pigmentary changes occur, but are they permanent? Can they be prevented or reversed? Hair may become thicker during pregnancy, only to fall out in the postpartum period. When will hair stop falling out? Will it grow back? What hormonal changes are occurring to produce these effects on the skin, hair, and nails? Will those hormonal changes affect other organs? Some cutaneous manifestations of pregnancy are common and recognized by most physicians. Abdominal striae, for example, are easily identified, but physicians have many questions about them. Why do they develop? Can they be prevented or treated? Other cutaneous manifestations of pregnancy are less common and recognized by few. For example, pruritic urticarial papules and plaques of pregnancy is a debilitating condition that is treatable once diagnosed. Even more important than the treatment, the knowledge imparted to a worried mother that her child will be fine and that the condition is se- limited is priceless; but the condition must first be recognized by the patient's physician. All of these questions and conditions are addressed in this extraordinary book. Pigm- tary disorders are addressed in detail in Chap. 2.

Prenatal Cocaine Exposures addresses the timely problem of maternal cocaine abuse and its effects on exposed infants, including growth retardation, learning, cardiovascular effects, and seizures. The impact of substance abuse on this and future generations presents an ongoing challenge to medical science. This comprehensive and authoritative volume reviews both animal and clinical studies to explain implications for treatment and long-term outcomes of early exposure.
Prenatal Cocaine Exposures investigates the specific role of cocaine in altering fetal development. Discussions of current studies and state-of-the-art techniques provide a basis for informed clinical decisions. Pediatricians, medical specialists, basic scientists, educators, and policy makers will all benefit from the comprehensive research gathered in this volume.

Based on the presentations given by well-known specialists at a recent multidisciplinary conference of developmental psychobiologists, obstetricians, and physiologists, this book is the first exhaustive attempt to synthesize the present scientific knowledge on fetal behavior. Utilizing a psychobiological analytic approach, it provides the reader with an overview of the perspectives, hypotheses, and experimental results from a group of basic scientists and clinicians who conduct research to elucidate the role of fetal behavior in development. Experimental and clinical as well as human and animal data are explored via comparative developmental analysis. The ontogeny of fetal spontaneous activity -- via the maturation of "behavioral states" -- and of fetal responsiveness to sensory stimulation is studied in detail. Results are provided from studies of embryonic/fetal and newborn behavior in chicks, rats, sheep, primates, and humans. Knowledge of fetal behavior is crucial to the obstetrician, neonatologist, developmental psychologist, and even the future parents, in order to follow and assess the gradual development of spontaneous responsive movements of the fetus. While assessing this important information, this text also examines the neuro-behavioral events taking place during the fetal period as an aid to understanding normal and pathological life span development.

This book provides a comprehensive review of our knowledge of vitamin B-6 requirements and metabolism throughout pregnancy and lactation. It concentrates on two primary points: adequacy of available methodologies and a presentation of the extant knowledge on vitamin B-6 metabolism and requirements in pregnancy, infancy, lactation, and in women of childbearing age. Many of the chapters offer new perspectives on how decisions have been and are being made with regard to the establishment of dietary recommendations about vitamin B-6 and the adequacy of research to support these decisions.

The emerging field of prenatal gene therapy is founded on scientific and technical advances in fetal medicine, molecular biology and gene therapy.This preclinical research subject aims at applying gene therapy during pregnancy for the prevention of human diseases caused by early onset congenital or gestation related conditions.In"Prenatal Gene Therapy: Concepts, Methods and Protocols, "expert researchers in the field detail many of the protocols which are now commonly used to study gene therapy, fetal medicine and medical ethics. These includedetailed protocols for vector production, for breeding and husbandry of the animal models, for the surgical procedures of gene delivery in large and small animals and forthe methods of gene transfer analysis. Written in the highly successful"Methods in Molecular Biology "series format, chapters include introductions to their respective topics, lists of the necessary materials and reagents, step-by-step, readily reproducible laboratory protocols, and key tips on troubleshooting and avoiding known pitfalls.

Thorough and intuitive, "Prenatal Gene Therapy: Concepts, Methods and Protocols"seeks to aid scientists in the further study ofprenatal disease and gene therapy projects beyond the scope of fetal medicine.

Intrauterine development and birth constitute an uninterrupted sequence of events that have a molecular physiologic background. Perinatal Biochemistry presents a comprehensive review of this subject. Specific topics addressed include maternal metabolism during pregnancy, maternal insulin resistance, embryonic and fetal metabolism and fuel consumption, the fetal pancreas, growth factors, brain metabolism, and biochemical adaptations to early extrauterine life. The book will be useful to biochemists and physiologists interested in perinatology; clinicians working in areas related to maternal health, gestational development, and delivery; gynecologists, neonatologists; pediatricians; endocrinologists; and internists.

The fetus occupies a critical phase during human development. It is at this stage when the body systems that will support us throughout our lives begin to face up to the challenge of life outside the womb. While the fetus can demonstrate a remarkably robust response to challenges in the uterus, it is also an exquisitely sensitive phase of development. It is now well recognized that disturbances to the materno-fetal environment can influence and even undermine our state of health well into adulthood. This exciting new publication provides a valuable insight into fetal growth and development across all the main body systems, and examines the influence of the materno-fetal environment on adult-onset diseases. This text contains additional chapters on the embryo, placenta, and parturition, to insure that this is a fully self-contained introduction. This book is written by world-renowned experts from leading centers of excellence and will be an invaluable introduction for students of medicine, reproductive biology, and human biology.

In this unique book emphasis is placed on tests necessary to evaluate fetal well-being and to detect those fetuses at risk of hypoxia and acidosis in utero. Written by pioneers in the neonatal field, this publication contains chapters on the pathophysiology, obstetric management, and collagen diseases of intrauterine growth retardation. Ultrasound in detection of growth retarded fetuses is explored, as well as magnetic resonance imaging and magnesium substitution for the prevention of intrauterine growth retardation. Containing never-before-published information, this volume is an excellent reference source for both investigators in the field and those entering it.
Topics Include:
Perinatal growth chart for international reference
Ultrasound guided procedures in small for gestation fetuses
Utero-placental and fetal circulation

Technology has come to dominate the modern experience of pregnancy and childbirth, but instead of empowering pregnant women, technology has been used to identify the foetus as a second patient characterised as a distinct entity with its own needs and interests. Often, foetal and the woman's interests will be aligned, though in legal and medical discourses the two 'patients' are frequently framed as antagonists with conflicting interests. This book focuses upon the permissibility of encroachment on the pregnant woman's autonomy in the interests of the foetus. Drawing on the law in England & Wales, the United States of America and Germany, Samantha Halliday focuses on the tension between a pregnant woman's autonomy and medical actions taken to protect the foetus, addressing circumstances in which courts have declared medical treatment lawful in the face of the pregnant woman's refusal of consent. As a work which calls into question the understanding of autonomy in prenatal medical care, this book will be of great use and interest to students, researchers and practitioners in medical law, comparative law, bioethics, and human rights.

Embryology at a Glance is a highly illustrated and innovative introduction to key embryological concepts, with concise, memorable descriptions of major embryological developments. This new edition covers the basic principles of human development, from mitosis and meiosis, before exploring the primary formation of each body system, including the development of the musculoskeletal, circulatory, digestive, reproductive, and nervous systems during the foetal and neonatal periods. Key features include: New chapters on cell signalling genes, stem cells, and antenatal screening for common congenital and genetic defects Full colour photographs and illustrations Links to clinical practice highlighted throughout Timelines of each developmental stage MCQs and EMQs for revision and review A companion website at www.ataglanceseries.com/embryology featuring 15 brand new animations, and podcasts to help clearly explain the processes that occur during development. An additional instructor resource contains an image bank of all the figures from the book to aid teaching this fascinating area Embryology at a Glance provides the perfect alternative to the overwhelming detail seen in conventional embryology texts. It provides just the right level of detail on embryology and congenital abnormalities for all medical students and health professionals to develop a thorough understanding of human development and its implications for clinical practice.

This proposed book draws on the expertise of 35 experts in the field of Addiction Medicine to provide the reader with a current and comprehensive view of addiction as related to women, pregnancy, newborns, infants and children. The volume begins by placing current attitudes towards addicted women in a historical context, and continues with contributions on the relationship of gender to substance abuse research, addiction as a general health issue in women, and ethical dilemmas faced when approaching drug use during pregnancy. The volume discusses high-risk pregnancies and HIV infection related to maternal drug abuse. It details specific pharmacotherapy such as methadone and buprenorphine, and assesses society's punitive view toward illicit drug using women. Finally, the book describes outcomes of newborns, infants and children born following intrauterine drug exposure. Health providers in many related disciplines, specialists in Addiction Medicine, social workers and ethicists are among those who will gain insight into the complex interdisciplinary matrix of abuse in women, its unique relationship to pregnancy, and its impact on drug-exposed children. This book was published as a special issue in the Journal of Addictive Diseases.

A strikingly effective, one-of-a-kind learning resource This one-of-a-kind learning resource for Neonatal Nurse Practitioner/CNS students in both academic and clinical settings is distinguished by its use of complex case studies to reinforce best practices in treating vulnerable neonatal patients. Based on applications and outcomes, the case study approach is a particularly effective method of enhancing critical thinking and clinical decision-making and fostering effective role transition in practice-based disciplines. Authored by leading NNP educators nationwide, these multi-faceted, unfolding case studies address and synthesize the most important content covered throughout the NNP curriculum. Topics addressed include maternal/neonatal complexities, risk factors, neonatal disorders and emergencies by body system, health promotion/maintenance, communicating effectively with parents, and guidance on handling unexpected outcomes. Case studies progress from basic to complex, and each includes objectives, clinical pearls, and critical thinking questions. A robust instructor toolkit contains pedagogical strategies for facilitating online discussion, chapter conclusion quizzes, a variety of simulation experiences, and more. Key Features: Uses a complex case-based learning approach for neonatal advanced practice nursing - the first book to do so Authored by leading NNP educators nationwide Provides 40-50 case studies synthesizing key content areas Helps prepare students for effective role transition Includes a robust instructor toolkit and can be used in online courses

My initial purpose in writing this book was to offer readers an update of my book Fetal Alcohol Syndrome and Fetal Alcohol Effects (Plenum, 1984), which con tained a broad overview of the history (actually the absence of any history) ofthe awareness of alcohol's teratogenic potential; a review of alcohol's pharmacology, especially with respect to pregnancy; a survey of the physical and behavioral effects of prenatal alcohol exposure; and an overview of the mechanisms sus pected of being responsible for those effects. I have omitted most of the previously examined historical and pharmacologi cal information because not much of what was previously discussed needed revision. On the other hand, because much more has been learned about the consequences of prenatal alcohol exposure and its potential mechanisms of action, I have considerably expanded my discussion of these topics. In doing so, I have attempted to include as much new material as possible without (I hope) being overly pedantic and thereby losing the proverbial forest for the trees. No book is ever entirely neutral in the topics it discusses, the issues it raises, or in its conclusions. In sifting through hundreds and oftentimes thousands of articles, writers have to choose which facts to emphasize and which to ignore. Every idea cannot be chronicled and every article cannot (and should not) be cited. In going about the business of picking and choosing, however, a writer has an obligation to present the arguments for and against a particular conclusion."

The aim of the two-volume set of Placenta and Trophoblast: Methods and Protocols is to offer contemporary approaches for studying the biology of the placenta. The chapters contained herein also address critical features of the female organ within which the embryo is housed, the uterus, and some aspects of the embryo-fetus itself, particularly those of common experimental animal models. In keeping with the organization used effectively in other volumes in this series, each chapter has a brief introduction followed by a list of required items, protocols, and notes designed to help the reader perform the expe- ments without difficulty. In both volumes, sources of supplies are given and illustrations highlight particular techniques as well as expected outcomes. A key aspect of these volumes is that the contributors are at the forefronts of their disciplines, thus ensuring the accuracy and usefulness of the chapters. Placenta research has progressed rapidly over the past several decades by taking advantage of the technical advances made in other fields. For example, the reader will note that many techniques, such as reverse transcriptase po- merase chain reaction, northern and western blotting, microarray analyses and in situ hybridization experiments, are routinely used for dissecting a wide range of experimental questions. Protein analysis and functional experiments on tissues and cells that comprise the maternal-fetal interface benefit from studies in en- crinology, immunology, and developmental biology. These volumes also present new ideas on investigating gene imprinting and gene transfer via viral vectors.

Since the middle of the twentieth century, the development of plastics has been one of the main factors influencing the history of medicine. For example, an anaesthesiologist was formerly an expert in delivering drugs by inhalation. Today, this expert delivers drugs through plastic catheters, in particular via intravenous and epidural routes. Traditionally, the scalpel was the symbol of surgery. Today, surgeons operate on internal organs with flexible plastic endoscopes - without cutting the skin. A typical modern woman in labour has one of her arms connected to a plastic bag through a plastic tube, while a plastic catheter is inserted in the epidural space in her spine. Focusing on obstetrics, this first book about the history of medicine in relation to the plastic revolution asks vital questions about childbirth today - and tomorrow - and demonstrates that the current turning point in the history of childbirth is also a turning point in the history of humanity. Introduced as a medical student to the surgical unit of a Paris hospital in 1949, and still involved in several fields of medicine, Michel Odent has the authority to study contemporary history from this new perspective.

This book presents and brings together research on child sexual abuse from various countries and cultures in the Arab Region. It addresses the multiple types of Child Sexual Abuse Exploitation and Trafficking (CSAET) and responds to the expanding burden of its diverse presentations. The book identifies appropriate structures for efficient programs that are to be accepted and developed by diverse cultures in the region, in order to develop an action plan to combat sexual violence against children. It studies the gathered to date child sexual abuse protection systems in the Arab region, covering issues such as children's rights, challenges of protection and advocates for peaceful, safe, healthy and happy environments for children and their families.

For the ultrasound practitioner it is now more important than ever to have a rigorous understanding of fetal anatomy and development. This resource publishes a selection of very high-quality ultrasound images of the fetus alongside embryological preparations and fetoscopy images. This unique comparative technique will be an essential educational tool and work of reference for all involved in fetal ultrasound, including specialists in maternal-fetal medicine, ultrasound physicians, ultrasonography technicians, and midwives.

At the cutting-edge of maternal and neonatal management and research, this reference presents the most recent advances in fetal DNA/RNA, embryoscopy/fetoscopy, open fetal surgery, and ethnic population screening to manage pre-existing and newly detected maternal medical complications, detect genetic and congenital abnormalities, prevent preterm births, and optimize pregnancy outcomes. With illustrative color photographs, this source offers contributions by esteemed professionals at respected institutions around the globe and covers legal issues concerning prenatal assessment and diagnosis.

With collaboration of Dr. Lucky Jain, Consulting Editor, Dr. Caplan has assembled articles devoted to the most current clinical advances in necrotizing enterocolitis. He has invited expert authors from top institutions to contribute timely reviews on the following topics: Biomarker Discovery: New markers that improve early diagnostic capability; Probiotics: State of the art; NEC Pathophysiology: How microbiome data alters our understanding; Effect of Human Milk on NEC; Influence of Growth Factors on the Development of NEC; Can Fish Oil Reduce the Incidence of NEC by Altering the Inflammatory Response; Oral Mother's Milk: State of the art and influence on NEC; Does Surgical Management Alter the Outcome of NEC; Epidemiology of NEC: New considerations and influence of PRBC transfusions and anemia; Role of Abdominal Ultrasound in Diagnosis of NEC; and Modifiable Risk Factors in NEC: 2018. Readers will come away with the scientific and medical information they need to make clinical decisions to improve patient outcomes.