Book contents
- Frontmatter
- Contents
- Editor biographies
- List of contributors
- Preface
- Introduction
- Part I Medical management
- 1 Anesthesia management of the surgical patient
- 2 Nutrition
- 3 Preoperative testing
- 4 Chronic medications around the time of surgery
- 5 Ethical considerations in the surgical patient
- 6 Cardiovascular disease
- 7 Postoperative chest pain and shortness of breath
- 8 Perioperative management of hypertension
- 9 Perioperative pulmonary risk evaluation and management for non-cardiothoracic surgery
- 10 Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS)
- 11 Postoperative pulmonary complications
- 12 Peptic ulcer disease
- 13 Liver disease
- 14 Inflammatory bowel disease
- 15 Postoperative gastrointestinal complications
- 16 Disorders of red cells
- 17 Assessment of bleeding risk in the patient with no history of hemostatic problems
- 18 Surgical issues affecting patients with hemotologic malignancies
- 19 Prophylaxis for deep venous thrombosis and pulmonary embolism in surgery
- 20 Blood transfusion/preoperative considerations and complications
- 21 Prevention of surgical site infections
- 22 Medical care of the HIV-infected surgical patient
- 23 Fever and infection in the postoperative setting
- 24 Surgery in the patient with renal disease
- 25 Postoperative electrolyte disorders
- 26 Diabetes mellitus
- 27 Disorders of the thyroid
- 28 Disorders of the adrenal cortex
- 29 Disorders of calcium metabolism
- 30 Pheochromocytoma
- 31 Rheumatologic diseases
- 32 Cerebrovascular disease
- 33 Management of the surgical patient with dementia
- 34 Neuromuscular disorders
- 35 Perioperative management of patients with Parkinson's disease
- 36 Delirium in the surgical patient
- 37 Surgery in the elderly
- 38 Obesity
- 39 Depression
- 40 Substance abuse
- 41 Care of the peripartum patient
- Part II Surgical procedures and their complications
- Index
- References
41 - Care of the peripartum patient
Published online by Cambridge University Press: 12 January 2010
Book contents
- Frontmatter
- Contents
- Editor biographies
- List of contributors
- Preface
- Introduction
- Part I Medical management
- 1 Anesthesia management of the surgical patient
- 2 Nutrition
- 3 Preoperative testing
- 4 Chronic medications around the time of surgery
- 5 Ethical considerations in the surgical patient
- 6 Cardiovascular disease
- 7 Postoperative chest pain and shortness of breath
- 8 Perioperative management of hypertension
- 9 Perioperative pulmonary risk evaluation and management for non-cardiothoracic surgery
- 10 Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS)
- 11 Postoperative pulmonary complications
- 12 Peptic ulcer disease
- 13 Liver disease
- 14 Inflammatory bowel disease
- 15 Postoperative gastrointestinal complications
- 16 Disorders of red cells
- 17 Assessment of bleeding risk in the patient with no history of hemostatic problems
- 18 Surgical issues affecting patients with hemotologic malignancies
- 19 Prophylaxis for deep venous thrombosis and pulmonary embolism in surgery
- 20 Blood transfusion/preoperative considerations and complications
- 21 Prevention of surgical site infections
- 22 Medical care of the HIV-infected surgical patient
- 23 Fever and infection in the postoperative setting
- 24 Surgery in the patient with renal disease
- 25 Postoperative electrolyte disorders
- 26 Diabetes mellitus
- 27 Disorders of the thyroid
- 28 Disorders of the adrenal cortex
- 29 Disorders of calcium metabolism
- 30 Pheochromocytoma
- 31 Rheumatologic diseases
- 32 Cerebrovascular disease
- 33 Management of the surgical patient with dementia
- 34 Neuromuscular disorders
- 35 Perioperative management of patients with Parkinson's disease
- 36 Delirium in the surgical patient
- 37 Surgery in the elderly
- 38 Obesity
- 39 Depression
- 40 Substance abuse
- 41 Care of the peripartum patient
- Part II Surgical procedures and their complications
- Index
- References
Summary
Introduction
The past two decades have brought a greater understanding of pregnancy along with advances in the recognition and management of disorders that are unique to pregnancy or complicate pregnancy. Increasingly, generalist physicians are being asked to assist in the management of medical conditions that develop prior to or as a result of pregnancy. Coverage of the breadth of medical disorders that can complicate pregnancy is the topic of several excellent textbooks. Instead, this chapter focuses on the medical care of several conditions that are unique to pregnancy or influenced by the physiologic changes that occur around late pregnancy, labor, delivery and the immediate postpartum period.
Normal physiologic changes in pregnancy
Knowledge of the normal physiologic changes that occur with pregnancy is important to understand the effect that existing maternal disease has on maternal and fetal health. A few of the more important physiologic changes associated with pregnancy are listed in Table 41.1.
The hemodynamic adaptations are some of the most significant physiologic changes that occur during pregnancy. Soon after implantation systemic vascular resistance (SVT) falls. This adaptation, mediated by gestational hormones, prostaglandins and the creation of a low resistance circulation in the uterus and placenta, reaches its nadir at 20 weeks gestation. During the latter half of pregnancy, the SVR rises, reaching near normal levels at term. Cardiac output rises 30%–50% during pregnancy. An increased stroke volume, a result of expanded blood volume, accounts for the majority of the increase in CO in the early stages of pregnancy.
- Type
- Chapter
- Information
- Medical Management of the Surgical PatientA Textbook of Perioperative Medicine, pp. 503 - 512Publisher: Cambridge University PressPrint publication year: 2006
References
Balk, M. A. & Watkins, C. Heart disease in pregnancy. In , , , & , eds. Cardiology in Primary Care. New York: McGraw-Hill, 2000: 791–805.Google Scholar
Poppas, A., Carson, M. P., Rosene-Montella, K., & Powrie, R. O. Cardiovascular disease. In , , et al. eds. Medical Care of the Pregnant Patient. Philadelphia: American College of Physicians, 2000: 345–386.Google Scholar
National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy. Report of the National High Blood Pressure Education Program Working Group on high blood pressure in pregnancy. NIH Publication # 00–3029, 2000: 1–38.
& Preeclampsia: more than pregnancy-induced hypertension. Lancet 1993; 341: 1447–1451.CrossRefGoogle ScholarPubMed
Powrie, R. O. & Rosene-Montella, K. Hypertension and preeclampsia. In , et al., eds. Medical Care of the Pregnant Patient. Philadelphia, PA: American College of Physicians, 2000; 185–205.Google Scholar
Management of acute severe hypertension and encephalopathy. Clin. Obstet. Gynecol. 1999; 42(3): 519–531.CrossRefGoogle ScholarPubMed
Watkins, C., Bernstein, L. B., & Higgins, S. M. Medical disorders of pregnancy. In , ed. Office Practice of Medicine. 609–620 Philadelphia, PA: W. B. Saunders, 2000: 609–620.Google Scholar
& Risk factors for preeclampsia, abruptio placentae and adverse neonatal outcomes among women with chronic hypertension. N. Engl. J. Med. 1998; 339(10): 667–671.CrossRefGoogle ScholarPubMed
& Management of mild chronic hypertension during pregnancy: a review. Obstet. Gynecol. 2000; 96(5): 849–860.Google ScholarPubMed
Hypertension in pregnancy: diagnosis and treatment. Mayo Clin. Proc. 2000; 75: 1071–1076.CrossRefGoogle ScholarPubMed
& Peripartum cardiomyopathy: a comprehensive review. Am. J. Obstet. Gynecol. 1998; 178(2): 409–414.CrossRefGoogle ScholarPubMed
, , et al. Peripartum cardiomyopathy: a condition intensivists should be aware of. Intens. Care Med. 2003; 29: 167–174.CrossRefGoogle Scholar
& Contractile reserve in patients with peripartum cardiomyopathy and recovered left ventricular function. Am. J. Obstet. Gynecol. 1997; 176(1): 187–195.CrossRefGoogle ScholarPubMed
& Venous thromboembolism during pregnancy. N. Engl. J. Med. 1996; 335(2): 108–114.CrossRefGoogle ScholarPubMed
Rosene-Montella, K. & Barbour, L. A. Thromboembolic disease and hypercoagulable states. In et al., eds. Medical Care of the Pregnant Patient. Philadelphia: American College of Physicians, 2000: 423–448.Google Scholar
, , & Magnetic resonance imaging of deep venous thrombosis in pregnant women with lower extremity edema. Obstet. Gynecol. 1995; 85: 603–607.CrossRefGoogle ScholarPubMed
, , , et al. Risks to the fetus of anticoagulant therapy during pregnancy. Thromb. Haemost. 1989; 61: 197–203.Google ScholarPubMed
, , et al. Low molecular weight heparins: a guide to their optimum use in pregnancy. Drugs 2002; 62(3): 463–477.CrossRefGoogle ScholarPubMed
Intrahepatic cholestasis of pregnancy. Semin Perinatol. 1998; 22(2): 104–111.CrossRefGoogle ScholarPubMed
Intrahepatic cholestasis of pregnancy: estrogen related disease. Semin. Liver Dis. 1993; 13: 289–301.CrossRefGoogle ScholarPubMed
The spectrum of liver and gastrointestinal disease seen in cholestasis of pregnancy. Gastroenterol. Clin. North Am. 1992; 21: 905–921.Google ScholarPubMed
Serum bile acids in the early diagnosis of intrahepatic cholestasis of pregnancy. Obstet. Gynecol. 1983; 61: 581–587.Google ScholarPubMed
, , & Idiopathic fatty liver of pregnancy: findings in ten cases. Medicine 1984; 63: 1–11.CrossRefGoogle ScholarPubMed
, , , et al. A fetal fatty acid oxidation disorder as a cause of liver disease in pregnant women. N. Engl. J. Med. 1999; 340(22): 1723–1731.CrossRefGoogle ScholarPubMed
Riely, C. A. Gestational liver disease. In , et al., eds. Medical Care of the Pregnant Patient. Philadelphia: American College of Physicians, 2000: 585–598.Google Scholar
& Hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome: a review of diagnosis and management. Semin. Perinatol. 1998; 22(2): 118–133.CrossRefGoogle ScholarPubMed
, , et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am. J. Obstet. Gynecol. 1993; 169: 1000–1006.CrossRefGoogle Scholar
, , , & Maternal hemolysis, elevated liver enzymes and low platelet count, and neonatal outcome. Am. J. Perinatol. 1995; 12: 1–6.CrossRefGoogle Scholar
& Imitators of preeclampsia and eclampsia. Clin. Obstet. Gynecol. 1999; 42(3): 551–562.CrossRefGoogle ScholarPubMed
& Twelve steps to optimal management of HELLP syndrome. Clin. Obstet. Gynecol. 1999; 42(3): 532–550.CrossRefGoogle ScholarPubMed
, , & HELLP syndrome and postpartum corticosteroids. Int. J. Gynecol. Obstet. 2001; 73: 157–159.CrossRefGoogle ScholarPubMed