Medicine Chapter 7. Medical Disorders during Pregnancy
Medical Disorders during Pregnancy: Introduction
Approximately 4 million births occur in the United States each year. A significant proportion of these are complicated by one or more medical disorders. Three decades ago, many medical disorders were contraindications to pregnancy.
Thyroid Disease (See also Chap. 335) In pregnancy, the estrogen-induced increase in thyroxine-binding globulin causes an increase in circulating levels of total T 3 and total T4. The normal range of circulating levels of free T4, free T3, and thyroidstimulating hormone (TSH) remain unaltered by pregnancy.
The thyroid gland normally enlarges during pregnancy. Maternal hyperthyroidism occurs at a rate of ~2 per 1000 pregnancies and is generally well tolerated by pregnant women. Clinical signs and symptoms should alert the physician to the occurrence of this disease.
Marfan Syndrome (See also Chap. 357) This is an autosomal dominant disease, associated with a high risk of maternal morbidity. Approximately 15% of pregnant women with Marfan syndrome develop a major cardiovascular manifestation during pregnancy, with almost all women surviving.
Diabetes Mellitus in Pregnancy: Treatment Pregnancy complicated by diabetes mellitus is associated with higher maternal and perinatal morbidity and mortality rates. Preconception counseling and treatment are important for the diabetic patient contemplating pregnancy and can reduce the risk of congenital malformations and improve pregnancy outcome. Folate supplementation reduces the incidence of fetal neural tube defects, which occur with greater frequency in fetuses of diabetic mothers.
Gastrointestinal and Liver Disease Up to 90% of pregnant women experience nausea and vomiting during the first trimester of pregnancy. Occasionally, hyperemesis gravidarum requires hospitalization to prevent dehydration, and sometimes parenteral nutrition is required.
Crohn's disease may be associated with exacerbations in the second and third trimesters. Ulcerative colitis is associated with disease exacerbations in the first trimester and during the early postpartum period.
Gestational Hypertension This is the development of elevated blood pressure during pregnancy or in the first 24 h post partum in the absence of preexisting chronic hypertension and other signs of preeclampsia. Uncomplicated gestational hypertension that does not progress to preeclampsia has not been associated with adverse pregnancy outcome or adverse long-term prognosis.
(See also Chaps. 272 and 280)
Normal pregnancy is characterized by an increase in glomerular filtration rate and creatinine clearance.
Các giới từ “during, for và while” thường được dùng với cụm từ chỉ thời gian. Chúng ta hãy xem sự khác nhau khi sử dụng giữa “during, for, và while”. 1/ Cách sử dụng “during” Giới từ “during” + danh từ được dùng để đề cập một sự việc gì xảy ra ở một thời điểm xác định nhưng nó không cho chúng ta biết nó xảy ra bao lâu. Vídụ: - Nobody spoke during the presentation. Không ai nói chuyện trong suốt buổi thuyết trình. - We get plenty of snow here during the winter.
Care for pregnant women differs fundamentally from most other medical
endeavours. ‘Routine’ care during pregnancy and birth interferes in the
lives of healthy people, and in a process which has the potential to be
an important life experience. It is diffi cult to measure the extent to which
our efforts may, for example, disturb the development of a confi dent,
nurturing relationship between mother and baby. The harmful effects we
measure in randomised trials are limited to those we have predicted may
On September 15, 2008, Lehman Brothers, the fourth-largest U.S. investment
bank, filed for bankruptcy, marking the largest bankruptcy in U.S. history and
the burst of the U.S. subprime mortgage crisis. Concerns about the soundness of
U.S. credit and financial markets led to tightened global credit markets around
the world. Spreads skyrocketed. International trade plummeted by double digits,
as figure O.1 illustrates. Banks reportedly could not meet customer demand to
finance international trade operations, leaving a trade finance “gap” estimated at
around $25 billion.
A comprehensive review essential for those preparing
to take the midwifery (AMBC) or women’s health nurse
practitioner certification (NCC) examinations. The
Midwifery & Women’s Health Nurse Practitioner Certification
Review Guide was developed for both of these
nursing specialties because of the many commonalities
they share that enhance the delivery of care to women
during their life span.
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Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Procalcitonin and C-reactive protein during systemic inflammatory response syndrome, sepsis and organ dysfunction...