The spectrum of cardiovascular disease affecting women in pregnancy and postpartum is changing and differs between countries. In the western world, the risk of cardiovascular disease in pregnancy has increased due to the increasing age at the first pregnancy and the worldwide obesity epidemic leading also to early diabetes and hypertension. In addition the treatment of congenital heart disease has improved leading to an increased number of women with residual heart disease reaching childbearing age. In the western world maternal heart disease is now the major cause of maternal death during pregnancy. In the developing world rheumatic heart disease and the cardiomyopathies dominate. Those women often need anticoagulation as they might have had a valve replacement or formed a thrombus in the left heart. Drugs during pregnancy and the breastfeeding period is a complex subject and there is a profound shortage of evidence based recommendations. As drug treatment in pregnancy concern the mother and the fetus optimum treatment of both must be targeted. This book aims at discussing the most important indications of drug usage in pregnancy and postpartum with the aim of weighing the potential risk of a drug and the possible benefit against each other.

An infection that occurs during pregnancy presents a constellation of problems above and beyond those normally associated with the disease. Even a relatively minor infection can threaten the lives of both mother and fetus and cause serious birth defects; and many conventional treatments can produce disastrous side effects during pregnancy. Over the past half-decade, enormous strides have been made in our ability to understand, diagnose, and treat infections in pregnant women.
Infections in Pregnancy, Second Edition, is expanded to cover the latest and most useful guidelines for understanding, diagnosing, and treating infections during pregnancy. This comprehensive volume contains in-depth explanations of dozens of diseases and their pathologies, from common infections, such as human papilloma virus, to new and rare diseases. It provides important information on the administration, monitoring, and side effects of new antibiotics; reviews the Centers for Disease Control and Prevention's current guidelines for treating sexually transmitted diseases; and describes the latest methods for treating HIV-positive obstetrical patients.
Additional topics include:
* Microflora of the genital tract
* Urinary tract infection in pregnancy
* Group B streptococcus infection in pregnancy
* Pregnancy and septic shock
* Sexually transmitted diseases: syphilis, gonorrhea, chlamydia, chancroid, lymphogranuloma venereum, granuloma inguinale, molluscum contagiosum, pediculosis pubis, scabies, and herpes simplex
* Cytomegalovirus infection in pregnancy
* Hepatitis in pregnancy
* Varicella-Zoster infection in pregnancy
* Mumps, measles, influenza, and pneumonia inpregnancy
* Human parvovirus B19 infection in pregnancy
* Protozoan infection in pregnancy
Written by two leading experts in the field and supplemented with more than 100 illustrations, Infections in Pregnancy, Second Edition, guides obstetricians, gynecologists, infectious disease specialists, and physicians in family practice and internal medicine in their efforts to minimize the short- and long-term impact of these infections.

Fundamentals of Clinical Practice is an introductory textbook focusing on the patient physician relationship. Formerly closeted behind closed doors, this most intimate of healing relationships is coming under increasing scientific scrutiny. Physicians and other healthcare providers are beginning to understand the critical importance of this relation ship to the health of patients, as well as to larger societal relationships, systems, and values. To facilitate the reader's exploration of the patient-physician relationship, all chap ters include numerous illustrative cases and conclude with cases for discussion that allow small groups of learners to tackle these difficult issues. Our hypothesis is that through discussion a deeper understanding of the dynamics of the patient-physician relationship will allow medical students and other future healthcare providers to form more effective therapeutic relationships with their patients. Part I of this textbook, "The Patient," explores the relationship through the patient's perspective, with chapters on human health and disease and individual and family devel opment. Understanding the patient's perspective is critical to establishing a sound thera peutic relationship. The day when a physician could maintain solely a disease or techno logical perspective is fading fast under the weight of patient criticism, particularly in primary care fields. Patients judge such a disease or technological perspective as less humane and frequently vote with their feet, finding other physicians who are much better able to balance the caring aspects of medicine with the curing.

The phenomenon of bleeding has been shown to appear in up to 22% of all pregnancies and is associated with significant maternal and fetal morbidities, and even mortality. Although vaginal bleeding occurs mainly during the first trimester, it can appear at any stage of pregnancy and in the postpartum period. This sometimes life-threatening event requires an extensive work-up in order to recognize its cause and establish a rapid and effective therapeutic approach. This book is a comprehensive appraisal of this critical condition. It draws on evidence-based data and brings together, in a single volume, updated information on all aspects of pregnancy-related bleeding. A global group of interdisciplinary experts contributed chapters on: bleeding during early pregnancy (early pregnancy loss, ectopic pregnancy, gestational trophoblastic disease, and cancer of the reproductive tract during pregnancy); bleeding in late pregnancy (preterm delivery, placental abruption, placenta previa, vasa previa and uterine rupture); and postpartum hemorrhage.

Originally published in 2006, this book provides an in-depth account of trophoblast: the tissue derived from the fertilised egg that nourishes and protects the developing fetus. The cells of the trophoblast have many unique qualities, and exhibit great variability across different species. It has a fascinating role in the development of the placenta and as a regulator during early growth of the embryo. These aspects are all fully covered as well as studies on why it is not rejected by the mother as 'foreign' tissue. Disorders of trophoblast during development also manifest themselves in several clinical conditions during pregnancy, including gestational trophoblastic disease and pre-eclampsia. From stem cells through to epigenetics, implantation and X-chromosome inactivation, there is a lot to be learned about trophoblast, this volume provides a detailed summary of knowledge regarding the subject.

During the past several years, there has been an extensive reappraisal of the physiologic changes of pregnancy and their associated disorders, along with a refinement of diagnostic procedures and evaluation of the therapeutic approaches that are of primary concern to the physician. In Shoulder Dystocia and Birth Injury: Prevention and Treatment, Third Edition, noted authority James A. O'Leary, M.D., with 40 years experience as an M.D. academician, lecturer, practitioner and clinical researcher with almost 200 contributions to the OB-GYN literature and textbooks, shares his insight on treatment techniques, identification and treatment of predisposing risk factors, current statistical data, ultrasound diagnosis and the necessary steps toward prevention, along with a thorough review of the important medical-legal issues.

Shoulder Dystocia and Birth Injury: Prevention and Treatment, Third Edition supplements the limits of personal experience with the accumulated experience of many talented clinicians to aid physicians, midwives, and professionals in training with the most current information in this vital field.

A growing body of research identifies strong links between children's health, social and educational outcomes; it also notes the reciprocal benefits of access to quality education on individual and family health status. In response to these findings, the World Health Organization developed the concept of the Health-Promoting School (HPS), a living catalyst for healthy lives, and for positive changes that students can take home and into the community. Case Studies in Global School Health Promotion provides readers with a theoretical and research base needed to understand the methods used in communities all over the world to put this captivating concept in place.

Case examples from over two dozen countries (representing urban and rural areas in developing and developed nations) outline the strategies taken to implement HPS programs in individual schools, municipalities, and nations. For each program, case study authors explain the problems they tackled, their motivation and supports to respond creatively; and the barriers they faced. In the cases, authors describe the capacities and infrastructure they created and mechanisms for cooperation; as well as the personnel, financial, and time requirements involved. Case studies were drawn from the following regions:

Case Studies in Global School Health Promotion offers a world of insights, ideas, and guidance to those addressing social determinants of health at this formative stage, including: education and health policy makers; professionals and administrators; and researchers in national governments, universities, local schools, community, non-governmental organizations and civil society. The material provides interesting and useful information to those dedicated to these issues within WHO, FRESH Partners and other United Nations agencies. It is also an instructive text for graduate students in public health, education, allied health professions and social sciences.

This volume examines the role of steroids and peptides in the regulation of pregnancy and pregnancy outcome, and their long-term effects including possible influences on adult-onset diseases. During pregnancy the placenta acts as a central regulator and coordinator of maternal and fetal physiology, and the onset of labor, through its production and regulation of steroids and peptides. Perturbations to this regulatory system can result in poor pregnancy outcome, such as preterm birth and low birth weight. These in turn are linked to diseases in later life. Intriguingly, many of these regulatory actions of steroids and peptides also occur in the brain. The induction and suppression of peptides by steroids appears to be key to regulatory function in both brain and placenta. These interweaving strands, linking basic science with obstetrics, are all reviewed in depth here producing a fascinating account of an important area of materno-fetal medicine.

Improving clinicians' understanding of effects nutrition can have on maternal health and fetal and neonatal development can have considerable impact on achieving a healthy pregnancy and reducing childhood morbidity. This book defines the nutritional requirements with regard to each stage of fetal development and growth, placing scientific developments into a clinical context. Clinicians and scientists discuss: how the fetus grows and what macro- and micronutrients it requires; what happens when there is nutrient deficiency and when placental development is abnormal; aspects of infant feeding, both with breast milk and formula milk. Specific problems encountered in pregnancy that pose a nutritional challenge are also considered, including pregnancy in teenagers, multiple pregnancies and pregnancy in those who are vegetarians or vegans. All doctors, health-care workers or scientists who either care for women, their newborn and growing infants, or who are involved in research in these areas, will find this to be essential reading.

Updated by a team of internationally renowned experts, this book gives a thorough overview of fetal pathophysiology and an evidence base for in utero: both medical (non-invasive) and surgical treatments. Many topics are expanded to cover recent advances, including: stem cell transplantation; tissue scaffolding; minimally invasive approaches to 'open fetal surgery'; the etiology, prevention and treatment of preterm birth and PROM; the genetic etiologies of fetal disease; and gene therapy. In addition, there are in-depth discussions as to the role of open fetal myelomeningocele repair and several fetoscopic approaches to therapy. The international editors have added important new chapters on reducing stillbirth and prenatal counselling. This book is an invaluable reference guide to the latest fetal therapy options, and an essential, in-depth study book for maternal-fetal and neonatology specialists.

Collectively known as the alloimmune cytopenias, hemolytic disease of the fetus and newborn, alloimmune thrombocytopenia and alloimmune neutropenia are all consequences of maternal immunisation to fetal blood cells. The effective prevention, diagnosis and management of these disorders has become a team effort involving haematologists, obstetricians, paediatricians, immunologists, laboratory technicians, midwives and research scientists. This book has been written by experts in their respective fields to bring together the issues of pathogenesis, epidemiology, prevention, diagnosis and clinical management. This comprehensive but accessible account is extensively cross-referenced to emphasise the links between pathogenesis and clinical sequelae, between epidemiology and the rationale for screening programmes, and between diagnosis and therapeutic intervention. This is an authoritative overview suitable for trainees in obstetrics, materno-fetal medicine, transfusion medicine and clinical immunology.

This study brings together two important literatures together in the one volume. One concerns the role of quality assessments in social policy, especially health policy. The second concerns ethical and social issues raised by prenatal testing for disability. Hitherto, these two literatures have had little contact with each other: few scholars have written about both, or have compared the two domains in a systematic way, while people with disabilities and disability scholars are underrepresented in recent discussion on health policy and quality of assessment. This book turns the perspectives of disability scholars on issues that have largely been the province of health methodology, policy and philosophy, while angling philosophical policy analysis on problems that have largely been the province of disability scholarship. This volume will be sought after by bioethicists, philosophers, and specialists in disability studies and healthcare economics.

This study brings together two important literatures together in the one volume. One concerns the role of quality assessments in social policy, especially health policy. The second concerns ethical and social issues raised by prenatal testing for disability. Hitherto, these two literatures have had little contact with each other: few scholars have written about both, or have compared the two domains in a systematic way, while people with disabilities and disability scholars are underrepresented in recent discussion on health policy and quality of assessment. This book turns the perspectives of disability scholars on issues that have largely been the province of health methodology, policy and philosophy, while angling philosophical policy analysis on problems that have largely been the province of disability scholarship. This volume will be sought after by bioethicists, philosophers, and specialists in disability studies and healthcare economics.

This forward-looking resource shines needed light on-and offers realistic solutions for eliminating-health disparities affecting one of the most vulnerable populations: children. Its multilevel framework identifies sources of pediatric health inequities in developmental, societal, familial, financial, and service delivery contexts and sets out innovations for breaking down and addressing longstanding concerns. Plentiful opportunities are described for reducing gaps and promoting equity at various service platforms, from locally-based improvements to systemwide tech upgrades, that can be used as models for revamping larger health policy. And the authors' long-term perspective emphasizes screening, wellness care, early intervention, and prevention strategies to support young patients in the transitions between childhood, adolescence, and young adulthood. Included in this compact idea book: Disparities in child health: a review Quality of care in pediatrics and health disparities: the increasing role of quality improvement science Community health worker interventions Technology-based interventions to address pediatric health disparities Place-based strategies in promoting health equity Future directions for a solutions-based approach With its clear delineation of issues and priorities, and its workable recommendations for addressing them, Disparities in Child Health is a ready source of ideas and advocacy for practitioners and researchers in pediatrics, maternal and child health, and general practice/family medicine.

This volume brings together an unusually broad range of experts from reproductive medicine, medical ethics, and law to address the important ethical problems in maternal-fetal medicine which impact directly on clinical practice. The book is divided into parts by the stages of pregnancy, within which the authors cover four main areas: the balance of power in the doctor-patient relationship and the justifiable limits of paternalism and autonomy; the impact of new technologies and new diseases; disability and enhancement; and difference--to what extent should the clinician respect the tenets of other faiths in a multicultural society.

The effective prevention, diagnosis, and management of alloimmune cytopenias has become a team effort involving hematologists, obstetricians, pediatricians, immunologists, laboratory technicians, midwives, and research scientists. This book has been written by experts in their respective fields to bring together the issues of pathogenesis, epidemiology, prevention, diagnosis, and clinical management. This comprehensive but accessible account is extensively cross-referenced to emphasize the links between pathogenesis and clinical sequels, between epidemiology and the rationale for screening programs, and between diagnosis and therapeutic intervention.

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.

This immensely practical handbook provides the busy clinician with a self-contained account of the diagnosis and management of ectopic pregnancy. Such pregnancies, which develop outside the uterine cavity, are an increasingly common occurrence. The focus throughout is on diagnosis and management issues, and the author provides rapid solutions to the most difficult problems posed by ectopic pregnancy. The text is fully supported by numerous and helpful ultrasound images, line diagrams illustrating surgical techniques, and by highlighted summaries of key facts and decision trees.

This book explores the emerging speciality of fetal medicine. The new technology for examining DNA is described as a background to later chapters concerned with gene therapy and the examination of the conceptus. An account of laboratory techniques for studying the mouse embryo is illustrated by outstanding photographs of scanning electron microscopy. This book will be of interest to all those who are involved with the care of the pregnant woman and her fetus whether in medicine or in the law.

The fourth edition of this popular resource features step-by-step skill instruction and practice-focused exercises covering maternal and fetal care. Developed by a distinguished editorial board, the Perinatal Continuing Education Program (PCEP) is a comprehensive, self-paced education program in 4 volumes. This book features 12 units containing information and skills essential for the recognition and initial management of high-risk and sick pregnant women and their fetuses. In this updated fourth edition, new units have been added on medical risk factors in pregnancy and obstetric risk factors in prior or current pregnancy. TOPICS INCLUDE Hypertension in pregnancy Obstetric hemorrhage Infectious diseases in pregnancy Gestational diabetes Prelabor rupture of membranes and intra-amniotic infection Preterm labor Inducing and augmenting labor Abnormal labor progress and difficult deliveries Imminent delivery and preparation for maternal/fetal transport And more...

The idea for this book developed during the course of several discussions among the editors while we were working together as staff scientists in the laboratories of the Clinical Neuro science Branch of the National Institute of Mental Health. It was a happy coincidence that the three of us, child psychiatrists with predominantly clinical interests, selected a collaborative bench research project involving neurotransmitter receptor characterization and regulation. We appreciated the relevance of our work to child psychiatry and wished for a forum to share the excitement we enjoyed in the laboratory with our clinical colleagues. Moreover, it seemed to us that much of the pharmacological research in child psychiatry proceeded on an empirical basis, often without a compelling neurochemical rationale. This could reflect the paucity of neurochemical data that exists in child psychiatry and the very limited understanding of the pathophysiology in most psychiatric disorders that occur in childhood. Also, we bemoaned the fact that there was a virtual absence of meaningful interchange between clinical investigators in child psychiatry and their colleagues in the neurosciences. We believed that an edited book appealing to clinicians and basic scientists could serve as an initial effort to foster interchange between them. The editors wish to emphasize that this book is viewed as only a beginning in the process of interchange that must take place."

Rheumatic and autoimmune diseases are often present in women during the childbearing years and as such, correct management of pregnancy throughout its course is of significance to all those affected. Previously women with systemic rheumatic diseases were counselled against pregnancy as the majority of medications carried potential or perceived teratogenic risk. But in recent years new therapies have emerged that have advanced treatment. Patients have experienced significant improvements in physical function, quality of life, and reduced damage accrual. As a result, an expanded cadre of health care providers now need to be able to manage pregnancy in women with underlying rheumatic disease, both in acute or chronic settings. Practical Management of the Pregnant Patient with Rheumatic Disease is a quick-access guide of the most up-to-date understanding of the interplay between pregnancy and rheumatic diseases and principles of management before, during and after pregnancy assisting in decision making regarding treatment of women with autoimmune diseases. This collection of 70 cases covers pregnancy counseling, the management of disease flares, thromboembolic disease, the management of patients with end organ disease, advice on medications, obstetric complications, infections and the management of rare diseases in women with rheumatic diseases before and during pregnancy and post-partum. The handbook provides concise recommendations for all providers who may encounter women of child-bearing age including rheumatologists, gynaecologists, paediatricians, primary care providers and health professionals dealing with pre-conceptional and pregnant women with rheumatic diseases.

This book evaluates the effectiveness of prenatal care interventions and provides a framework for prenatal care that looks beyond the limited perspective of immediate neonatal outcomes. Ultimately, this book seeks to improve the content and the implementation of prenatal care by shifting the focus away from short-term technocentric medical advances to concentrate on the broader public health issues. A unique aspect of this book is its focus on the effectiveness of prenatal care interventions on longer-term benefits for women and children's health. Traditional medical interventions, as well as social support and behavioral interventions during prenatal care are reviewed. Effectiveness is considered within the context of its implications for public policy and service delivery. This book is an important resource for maternal and child health professionals, policy makers and health care managers because it provides evidence of the prenatal care services that improve the long-term health of women and children.

Based on the curriculum of the Royal College of Obstetricians and Gynaecologists' Advanced Training Skills Module in Fetal Medicine, this book provides a comprehensive knowledge base for all doctors practising in obstetrics and maternal-fetal medicine worldwide. It acts as a reference source for the many changing concepts in fetal medicine and is well-illustrated with images of normal and abnormal findings in pregnancy that will facilitate proper understanding of normal and pathological fetal development. Coverage includes embryology, fetal physiology; fetal anomalies; fetal diseases; prescribing and teratogenesis in pregnancy; termination of pregnancy; fetal growth and wellbeing; multiple pregnancy; the placenta and amniotic fluid; and diagnostic and therapeutic invasive procedures. Readers will benefit from the theoretical knowledge and vast clinical experience of the internationally renowned authorship. Overall this book will prepare you for dealing with congenital abnormalities detected during pregnancy, including the organization and supervision of screening programmes for structural and chromosomal anomalies.

Over the last decade, epidemiological studies have suggested that the risk of coronary heart disease, stroke mortality and hypertension is, in part, related to the environment encountered during fetal life. In particular, maternal undernutrition during pregnancy has been highlighted as a causal factor in the long-term programming of disease risk. This book, which brings together the perspectives of leading researchers from Europe, the USA and Australasia, provides the reader with a detailed account of the evidence for and against the nutritional programming of human disease, and considers the biological basis of programming. The book addresses a topic of great current interest and consists of three sections: programming the fetus, programming human disease, and the biological basis of nutritional programming.