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Books > Medicine > Clinical & internal medicine > Gynaecology & obstetrics > Materno-fetal medicine
The HIV pandemic continues to levy a heavy burden on the human race world-wide. The estimated number of people who became newly infected with HIV in 2009 was 2.6 million; most of these individuals live in Sub-Saharan Africa, followed by India and Southeast Asia. An estimated 370,000 new cases of pediatric infections occurred globally in 2009 (or more than 1,000 new infections every day), practically all of them through mother-to-child transmission. Up to 40% of all new infant HIV infections occur during breastfeeding. While breastfeeding by HIV-infected mothers is not recommended in the U.S. and other resource-rich settings where safe replacement feeding is easily available, the situation is different in many resource-limited settings, where replacement feeding is not safe or available and carries a high risk of infections (diarrhea, pneumonia) and infant malnutrition. Mothers in such settings are faced with a difficult dilemma: to breastfeed their infants in order to provide their infants with its many benefits (nutritional, immunologic, cognitive), but to also risk transmitting HIV. These challenges have prompted an intensive search for new prophylactic and therapeutic strategies in order to prevent infants from acquiring HIV infection through breastfeeding. In this book, expert HIV researchers critically review every aspect of this highly evolving and topical subject. The opening chapters deal with the epidemiology, global magnitude and biologic mechanisms of HIV-1 transmission from mother to child through breastfeeding and include considerations of the virus (quantity, compartments, characteristics) and the host (genetic, immunity-innate, cellular, humoral). The effects of breastfeeding on the HIV-infected mother's health and nutritional status, and the social and cultural issues associated with the practice of breastfeeding are also discussed. The next few chapters provide cutting-edge reviews of the latest approaches to prevention of HIV transmission to the infant through breastfeeding, including antiretroviral strategies, nutritional and immune-based approaches, and treatment of expressed breast milk. The remaining chapters provide a fascinating review of the many iterations this subject has received, as reflected in the several different sets of guidelines for infant feeding by HIV-infected mothers issued by the World Health Organization, and a debate by leading scientists on whether HIV-infected mothers should breastfeed their infants-in resource-limited and in resource-rich settings. A comprehensive overview of the current state of implementing the new evidence for prevention of breastfeeding transmission of HIV all over the world is also presented. Essential reading for the many disciplines of scientists and clinicians working on HIV/AIDS and other retroviruses, pediatricians, obstetricians/gynecologists, as well as all health-care professionals interested in expanding their understanding on the subject.
Perinatal Depression among Spanish-Speaking and Latin American Women A Global Perspective on Detection and Treatment Sandraluz Lara-Cinisomo and Katherine Leah Wisner, editors As more is known about postpartum depression, the more it is recognized as a global phenomenon. Yet despite the large numbers, information about this condition as experienced by Spanish speaking women and Latinas has not always been easy to come by. Perinatal Depression among Spanish-Speaking and Latin American Women focuses on four diverse Latina populations (Mexico, Chile, Spain, and U.S.) to analyze key similarities and differences within this large and wide-ranging group. This first-of-its-kind reference reviews current research on the topic, including prevalence, screening methods, interventions, and--of particular salience for this population--barriers to care. Findings on psychoeducation, assessment tools, and cognitive-behavioral and other forms of therapy provide important insights into best practices, and continuity of care. And psychosocial, cultural, and linguistic considerations in working with Latinas are described in depth for added clinical usefulness. This landmark volume: Outlines characteristics of Spanish-speaking women and Latinas screened for postpartum depression Introduces the Edinburgh Postnatal Depression Scale, English and Spanish versions, and reviews their use with Latina women Compares postpartum depression and health behaviors in Spanish and Latina immigrant mothers Offers streamlined assessment-to-intervention models Provides two in-depth case studies illustrating cultural factors influencing the treatment of Latinas with perinatal depression. Presents an instructive firsthand account of postpartum depression. Between its thorough coverage of the issues and its innovative clinical ideas, Perinatal Depression among Spanish-Speaking and Latin American Women has a wealth of information of interest to researchers and practitioners in maternal and child health, obstetrics/gynecology, mental health, and women's health.
A description of our current understanding of antiepileptic drug use during pregnancy, this book includes chapters on the impact of seizures on the mother and developing child, changes in maternal physiology during pregnancy and its impact on drug disposition, and the pharmacokinetic differences between the various anti-seizure medications. It also deals with the possible harmful effects of antiepileptic drug exposure during pregnancy on the physical and intellectual development of the fetus. Clinicians have to balance the potential adverse effects of the medicine for the fetus and mother-to-be against the risks that uncontrolled seizures hold for both when treating pregnant women with antiepileptic drugs. Only recently have enough scientific data emerged to provide a rational basis for treatment decisions that take in both aspects. This work provides a single, accessible and up-to-date resource for busy clinicians.
Among women's health concerns, reproductive issues, both prenatal and postpartum, hold particular prominence. Yet despite the many programs dedicated to improving women's reproductive health, maternal and infant morbidity and mortality rates in minority communities remain unchanged-or have increased. Confronting this alarming statistic head-on, Reducing Racial/Ethnic Disparities in Reproductive and Perinatal Outcomes is the first book systematically examining public health interventions designed toward meeting this important and elusive goal. Its contributors offer the best thinking and practice on this complicated topic, clarifying the relationship between evidence-based medicine and evidence-based public health and its potential for increasing parity, considering interventions in the multiple contexts of women's lives, reviewing the evidence base for each program or initiative featured, and describing methodologies for evaluating interventions. The resulting volume advocates for an integrative lifespan approach, including topics related to: Family planning STI and HIV/AIDS screening and treatment Smoking cessation and reducing exposure to environmental smoke Preconceptional well-woman care Depression screening and treatment Labor/delivery approaches and intrapartum care Emerging prenatal care interventions, from centering pregnancy to doula support For professionals and graduate students in psychiatry, psychology, sociology, women's health, and public health, Reducing Racial/Ethnic Disparities in Reproductive and Perinatal Outcomes reframes a set of ongoing issues and guides the reader toward state-of-the-art solutions.
This book is a comprehensive guide to the screening, management, and treatment of female patients with addictions. There are a range of clinical issues specific to women with substance use disorders and substance abuse during pregnancy is known to have deleterious effects on neonates. This book focuses on the effective care of the addicted patient and discusses novel outpatient therapy, therapeutic substitution, abstinence therapy, and the importance of counseling in the delivery of care. Topics include the physiology of nicotine, opiates, EtOH, and other substances of abuse; the role of receptors and neurotransmitters in addiction; the effects of tobacco and substance abuse on women' s health; and tobacco cessation methods. Featuring practical approaches to gender-responsive treatment, Tobacco Cessation and Substance Abuse in Women's Healthcare is a valuable resource for obstetricians, gynecologists, family medicine practitioners, and residents hoping to expand their knowledge of tobacco cessation and substance abuse in women's health.
This book offers an in-depth examination of labor pain and analgesia with the aim of promoting natural childbirth without pain. All aspects of the subject are covered, including the latest techniques of delivering labor analgesia. Importantly, emphasis is placed on a holistic approach, detailed attention being paid to the humanization of childbirth and behavioral aspects in addition to evidence-based medicine. Potential future developments are also addressed, with discussion of opportunities that have yet to be realized. In order to ensure that the text is easily readable for trainees as well as established practitioners, chapters have been restricted to a manageable length and information is presented clearly and succinctly. Step-by-step tutorials and boxes highlighting practical points are used to clarify technical aspects. The authors include both well-established experts and young emerging professionals from various European countries, ensuring an intercultural perspective.
This book is an indispensable reference for pediatric and musculoskeletal radiologists, as well as orthopedic surgeons. It offers in depth analysis of pediatric orthopedic imaging, covering normal and aberrant development as well as both common and unusual pediatric disorders. Chapters on the spine, shoulder, elbow, hand and wrist, hip and pelvis, lower extremity, and foot and ankle address site-specific congenital and acquired lesions. Subsequent chapters cover generalized orthopedic diseases such as neurofibromatosis and osteogenesis imperfecta, infectious processes, neuromuscular diseases, musculoskeletal tumors, trauma, and orthopedic procedures. The chapters review associated epidemiology, clinical presentation and evolution, treatment, and differential diagnoses, with in-depht analysis of imaging characteristics. With more than 1800 images, high-quality MRI, CT, and US examples complement the radiographs of a broad variety of musculoskeletal disorders.
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.
Three decades into the HIV pandemic, the goals remain clear: reduce the number of infections,improve the health outcomes of those who are infected, and eliminate disparities in care. And one observation continues to gain credence: families are a powerful resource in preventing, adapting to, and coping with HIV. Recognizing their complex role as educators, mentors, and caregivers, Family and HIV/AIDS assembles a wealth of findings from successful prevention and intervention strategies and provides models for translating evidence into effective real-world practice. Chapters spotlight the differing roles of mothers and fathers in prevention efforts, clarify the need for family/community collaborations, and examine core issues of culture,ethnicity, gender, and diagnosis (e.g., minority families, adolescents with psychological disorders). Throughout, risk reduction and health promotion are shown as a viable public health strategy A reference with considerable utility across the health, mental health, and related disciplines,Family and HIV/AIDS will be a go-to resource for practitioners working with families, researchers studying at-risk populations, administrators seeking to create new (or evaluate existing)prevention and care programs, and policymakers involved in funding such programs.
Globally, postnatal depression (PND) is a growing public health problem. PND affects 10 to 15% of women in Western society. It caused by a combination of biological, psychological and social factors. Two models have attempted to define and explain PND; the biomedical and the sociological models. The traditional biomedical model views PND as a medical condition which implies there is individual pathology and abnormality. Whilst the biomedical model has been the dominant model in treating PND, it has been criticized by feminist sociologists and psychologists for its rigidity in defining and explaining PND. In contrast, the psychosocial model of health acknowledges the biological factors that impact on emotional well-being, but places more emphasis on the personal and social factors that impact on emotional well-being, but places more emphasis on the personal and social factors that contribute to depressive symptoms such as gender, poverty, social disadvantage and social class. The central argument throughout this book is the importance of support before and after the birth for women's emotional well-being. This book will also include women's journeys through pregnancy, childbirth, motherhood, postnatal depression, and resolution. To date, literature has focused on women's lived experiences of PND rather than their personal journeys through pregnancy, childbirth and early motherhood. Additionally, the adjustment to fatherhood has received less attention. For example, little is known about the impact of postnatal depression on the partner, what support partners offer when women with the intention to fill the gap in knowledge of cultural and social issues relating to pregnancy, childbirth, and motherhood for woman who were diagnosed with, and had resolved, PND.
Ovulation induction and controlled ovarian stimulation lie at the very heart of treatment for infertility, but have been subject to a bewildering variety of variations and improvements over recent years. The Second Edition of this highly successful book updates the reader on the progress and developments in this area. Furthermore, it provides the busy clinician with a reliable overview of the principles involved and the management needed. As with the previous edition, the emphasis throughout this book is on logical evidence and evidence-based solutions supplemented with Professor Homburg's extensive clinical experience gleaned from more than forty years working in the field. A number of highly useful algorithms and explanatory tables reinforce this approach, ensuring that the reader is presented with easy-to-grasp, well-presented information that maximizes clarity and understanding. This book offers a concise, no-nonsense, practical guide to ovulation induction and controlled ovarian stimulation and will be an essential resource for the general gynaecologists, fertility specialists and trainees, health workers and students.
As we near the 50th anniversary of the landmark article by C. Henry Kempe and his colleagues entitled "The Battered Child Syndrome", which ushered in the modern era of professional attention by pediatricians and other child health professionals, we have reason for both celebration and concern. We can take heart that over the recent ve decades, a great deal of professional attention focused on the problem of child abuse and neglect. In every state of the country, there are mandatory repo- ing laws that require nurses, physicians, and social workers to report suspicions of maltreatment to the appropriate authorities for investigation. The act of repo- ing provides legal immunity to the reporter except when performed in bad faith. Progress in understanding the factors that place children at risk for harm from ph- ical abuse and neglect now permits prevention and intervention. The peer-reviewed literature dealing with child abuse and neglect has proliferated with high quality work being done and reported on the many dimensions related to the epidemi- ogy, mechanism, treatment, and prognosis of child maltreatment. Efforts are being directed toward developing an evidence-based approach to the prevention of child abuse and neglect. These are some of the positives. However, negatives exist and remain reasons for concern. Despite a tremendous amount of attention to the pr- lem of maltreatment, there are at least 3 million reports of suspected child abuse and neglect made annually, with nearly 1 million cases being substantiated.
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.
Mental health problems during and immediately after pregnancy are a major concern across the world. As well as affecting the health of the mother, they can have significant, harmful, and long term effects on the infant if not dealt with effectively. Perinatal Psychiatry honours the work of Channi Kumar, one of the seminal figures in the history of perinatal psychiatry, and presents a comprehensive multidisciplinary review of the field. Bringing together the leading researchers in the area, it covers the causes of perinatal mental health problems, the biology of perinatal depression and its more extreme form, puerperal psychosis, as well as psychosocial and psychological interventions, hormonal and neural substrates of perinatal depression, and risk factors and epidemiology.
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.
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.
Michel Odent, the leading pioneer for natural childbirth, indicates that the period between conception and a child's first birthday is critical to life-long health. In this prophetic book - first published in 1986 and reproduced here in its original form - he argues that different parts of the 'primal adaptive system' develop, regulate and adjust themselves during foetal life and the time around birth and infancy. 'Everything which happens during this period of dependence on the mother has an influence on this basic state of health, this primal health.' He suggests that the later well-being of adults, their ability to withstand the 'diseases of civilization' such as hypertension, cancer, alcoholism and failures of the immune system resulting in AIDS, allergies and viral diseases, can all be traced back to society's ignorance of the vital importance of the primal period. Since the first edition of this groundbreaking work, research has continued apace, offering further evidence to substantiate Odent's ideas. In the important new "Introduction and Postscript", the author reviews recent developments and relates them to the central themes of Primal Health. This book is essential reading for all who care about the health of our children and the ongoing health of society as a whole.
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.
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.
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.
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.
With advances in ultrasound, birth defects are increasingly detected during pregnancy and may be amenable to surgical correction before delivery, to improve outcomes. This essential book discusses the different birth defects that can be treated during pregnancy and the important anesthetic considerations for the mother and fetus undergoing these procedures. Experts in the fields of anesthesiology, maternal fetal medicine, surgery, and pediatrics have come together to develop the content of this book. Enhanced throughout with full color images and illustrations, the book covers important topics such as spina bifida, twin-twin transfusion syndrome, sacrococcygeal teratoma, and lung masses, as well as fetal cardiac intervention, intrauterine transfusion, ex utero intrapartum treatment, and multidisciplinary approaches to fetal surgery. An invaluable guide for pediatric and obstetric anesthesiologists, anesthesiology, obstetrics, and surgical trainees, nurse anesthetists, and maternal-fetal medicine specialists.
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.
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. |
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