The second edition, like the first one, is intended to provide practical guidance
to clinicians looking after patients with heart disease, or who may be at risk of
cardiac problems, in pregnancy and the puerperium. These will be hospital
physicians and cardiologists, obstetricians, general practitioners and specialist
nurses who provide direct care as well as the anaesthetists responsible for making
delivery safe and the geneticists who answer the many questions posed by
couples with a personal or family history of heart disease....
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.
Advances in obstetrics, neonatology, obstetric anesthesiology, and medicine have increased the expectation that pregnancy will result in an excellent outcome for both mother and fetus despite most of these conditions. Successful pregnancy requires important physiologic adaptations, such as a marked increase in cardiac output. Medical problems that interfere with the physiologic adaptations of pregnancy increase the risk for poor pregnancy outcome; conversely, in some instances pregnancy may adversely impact an underlying medical disorder. ...
Ectopic pregnancy is defined as a pregnancy in which the implantation of the embryo occurs out- side the uterine cavity, most frequently in one of the two fallopian tubes or, more rarely, in the abdo-minal cavity or the cervix .
More than seven hundred thousand teenagers a year get pregnant in the United States. The teen
pregnancy rate has fallen thirty-eight percent since the early nineteen nineties.
And the National Campaign to Prevent Teen and Unplanned Pregnancy says the teen birth rate has
fallen by almost as much. Six out of ten pregnant teenagers in two thousand six gave birth.
The successful epidemiologic evaluation of any particular disease
or condition has several prerequisites. Two of the most important
prerequisites are that the condition should be accurately defi ned
and that there should be measurable outcomes of interest.
Another requirement is that there must be some systematic way
of data collection or surveillance that will allow the measurement
of the outcomes of interest and associated risk factors. The epidemiologic
evaluation of critical illness associated with pregnancy
has met with mixed success on all of these counts....
A national infrastructure council should also be tasked with collecting and dis-
seminating best practices pertaining to project selection, preventative mainte-
nance, and construction cost reduction. It would also promote the use of common
objective measures to evaluate the progress of ongoing and completed infrastruc-
ture projects. The council would work to identify opportunities for innovation
and help develop new mechanisms for leveraging private investment.
A study in Herat province concludes that the extraordinarily high number of deaths of
women during pregnancy and childbirth are largely preventable. They are a direct
consequence of the very young marriage age for women and girls (according to UNIFEM,
54% of girls under the age of 18 are married),12 poor health and nutrition, too-frequent
childbearing, and virtually no access to gynecological and obstetrical services.
The publication of this textbook marks a great milestone in our joint efforts at achieving
the Millennium Development Goal 5, which aims to reduce maternal mortality by
three-quarters, a daunting task indeed for most developing countries. The African
region, especially Eastern and Western Africa, has the highest ratio of women dying as a
result of pregnancy or childbirth in the world, estimated at an average of 1000 per
100 000 live births.
Current practice guidelines for ventilatory management advocate protective lung strategies
to prevent volutrauma, barotrauma, atelectrauma and biotrauma (3-5). The principles are to
use low tidal volumes (Vt) (5-6 ml/kg ideal body weight), maintenance of low mean airway
pressures ≤ 30 cmH2O, judicious use of positive end-expiratory pressure (PEEP) with Δ
pressure ≤ 18 cmH2O, higher respiratory rates and permissive hypercapnia.
A body of research has determined that, by expanding the availability of low cost family
planning services to a broader set of low-income women, the savings associated with averted
unplanned pregnancies and other health improvements substantially exceed the cost of additional
family planning services.
Research has demonstrated that publicly funded family planning
services are effective in promoting contraceptive use among low-income women and in averting
Overweight and obesity in the United States among adults
and children has increased significantly over the last two
decades. Those following typical American eating and
activity patterns are likely to be consuming diets in excess
of their energy requirements. However, caloric intake is
only one side of the energy balance equation. Caloric
expenditure needs to be in balance with caloric intake to
maintain body weight and must exceed caloric intake to
achieve weight loss (see tables 3 and 4).
Although pregnancy can be classified as a normal physiologic condition, it is fraught with considerable risk to both mother and offspring. Fortunately, most of the risk occurs to a minority of patients. Thus, it is prudent to identify those at risk and attempt to prevent the morbidity and mortality. Some factors contributing to risk are quite obvious, but others are very subtle. Thus, care must be taken in definitions, screening programs, and application of the tools available for diagnosis and treatment.
The medical model emphasises health care and remedial treatment. Greater importance
needs now to be attached to primary prevention and health promotion and with which there
is a heightened need for people to accept their personal responsibility and individual
accountability. Traditional approaches to health have not encompassed sufficiently primary
prevention. New models are needed for positive health. These models require a
reassessment of value systems in society that enables improved understanding of the WHO
slogan: ‘health is our real wealth’. ...
Results from the univariate analysis of prostate cancer mortality and incidence do not take
into account the effect of different covariables, which might influence the SMR and SIR.
Various covariables where considered to model longitudinal effects: age, calendar year, year
of immigration, length of stay in Germany; cohort was considered for the analysis of
Multivariate Poisson regression did not show any significant effect of the considered
covariables on mortality (data not shown).
As seen in Table 7, both Planned Parenthood and other WHP clinics typically offer a
comprehensive range of contraceptive methods. The methods include oral contraceptives (the
Pill) as well as long-acting reversible contraceptives (LARCs) such as intrauterine devices
(IUDs), implants (e.g., Implanon), or injectables (e.g., Depo-Provera). LARCs are particularly
important because they are the most effective in preventing unintended pregnancies and have
lower failure rates.
Ensuring universal access to SRH services and information is essential for achieving many, if not
all, of the Millennium Development Goals (MDGs), especially those on maternal health, child
survival, HIV and AIDS and gender equality . Most maternal deaths can be prevented if there is
skilled attendance at birth to cope with potentially fatal complications. Access to safe and
effective family planning services and contraception empowers women to have more control over
when to have children and lessens the incidence of unsafe abortions.
The need for A Bird in the Bush: Failed Domestic Policies of the George W. Bush
Administration was sparked by what many informed and responsible Americans
have seen as serious blunders committed by President George W. Bush during
his first term of office. Especially troublesome is the 2005 Inaugural Address.
This second inaugural address illustrates how “Bush II” is derailing the purpose
of America as a nation. (It is analyzed in the introduction.)
Bush II could not perform this derailing all on his own. He had help.
Previous chapters emphasized physiologic
concepts concerning cardiac and vascular
function at the cellular and organ level. In addition,
they examined mechanisms, such as
baroreceptors and circulating hormones, that
regulate overall cardiovascular function. This
chapter integrates all the components of the
cardiovascular system and shows how they
work together to maintain normal perfusion of
organs under conditions of increased organ
demand for blood flow (e.g., during exercise
and pregnancy) or during abnormal stressful
conditions such as hemorrhage....