HIGH RISK CASES IN OBSTETRIC

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Chapter 1: High Risk Pregnancy 1
Shruti Bangale Daflapurkar
• Definition 1
• Incidence 2
• Conditions Associated with High Risk Pregnancy 2
• Screening of High Risk Pregnant Women 6
• Prevention 10
Chapter 2: Anemia in Pregnancy 13
Niranjan Rathod
• Physiological Changes in Pregnancy 14
• Increased Iron Requirements during Pregnancy 15
• Life Cycle of RBCs 15
• Definition of Anemia 16
• Causes of Anemia during Pregnancy 16
• Diagnosis 17
• Iron Deficiency in Pregnancy 18
• Megaloblastic Anemia in Pregnancy 22
• Infections Causing Anemia in Pregnancy 24
• Hemoglobinopathies in Pregnancy 26
Chapter 3: Pregnancy Induced Hypertension 33
Shruti Bangale Daflapurkar
• History 34
• Definition, Classification and Pathophysiology 35
• Pathological Changes in Pre-eclampsia 39
• Signs and Symptoms 41
• Laboratory Investigations 42
• Management 43
• Complications 51
• Prevention of Pregnancy Induced Hypertension 56
Chapter 4: Diabetes in Pregnancy 59
Shruti Bangale Daflapurkar
• Glucose Metabolism in Pregnancy 60
• Effect of Diabetes on Pregnancy 61
• Effect of Pregnancy on Diabetes 62
CONTENTS

xvi High Risk Cases in Obstetrics • Gestational Diabetes 62
• Diagnosis 63
• Classification of Diabetes in Pregnancy 64
• Management 65
• Examinations 65
• Insulin Therapy 68
• Complications 74
• Preconception Counseling 76
Chapter 5: Thyroid Diseases in Pregnancy 78
Shruti Bangale Daflapurkar
• Physiology of Thyroid Function during Pregnancy 79
• Fetal Thyroid Physiology 81
• Hypothyroidism 82
• Hyperthyroidism 84
Chapter 6: Rh Isoimmunization 93
Nitin H Shah, Purva P Bhatlavande
• Incidence 94
• Genetics 94
• Isoimmunization 96
• Pathogenesis 98
• Clinical Manifestations 99
• Management 104
Chapter 7: Nonimmune Hydrops Fetalis 119
Shruti Bangale Daflapurkar
• Definition 119
• Incidence 120
• Causative Factors 120
• Pathophysiology 121
• Investigations 122
• Management during Pregnancy 127
• Mirror Syndrome 131
• Maternal Complications 131
Chapter 8: Epilepsy in Pregnancy 133
Yogeshwar Kalkonde
• Causes, Incidence and Risk Factors 134
• Signs, Symptoms and Investigations 134
• Effects of Epilepsy on Conception 135
• Effects of Epilepsy and Anti-epileptic Drugs on Pregnancy 136
• Management of Epilepsy in Pregnancy 138

Contents xvii
Chapter 9: Chorea Gravidarum
(Rheumatic Chorea in Pregnancy) 143
Shruti Bangale Daflapurkar
• Incidence 144
• Causes 144
• Sydenham’s Chorea 145
• Diagnosis 147
• Huntington’s Disease 147
• Antiphospholipid Antibody Syndrome 147
• Laboratory Investigations 148
• Treatment 149
• Prognosis 149
Chapter 10: Liver Diseases in Pregnancy 151
Vaibhav Banait
• Hyperemesis Gravidarum 152
• Intrahepatic Cholestasis of Pregnancy 153
• Hypertension Associated Liver Diseases in Pregnancy 155
• Acute Fatty Liver of Pregnancy 157
• Liver Diseases Incidentally Occurring during Pregnancy 158
• Budd-Chiari Syndrome 159
• Drug-induced Hepatic Injury 159
• Chronic Viral Hepatitis 159
• Autoimmune Liver Disease 160
• Portal Hypertension 161
Chapter 11: Renal Diseases and Pregnancy 162
Reena J Wani, Manzer Sahibole
• Renal Changes in Normal Pregnancy 162
• Urinary Tract Infections 163
• Symptomatic Infections 165
• Acute Renal Failure 167
• Nephrotic Syndrome 169
• Acute Nephrolithiasis 169
• Pregnancy in Patients with Pre-existing Renal Disease 169
• Pregnancy after Renal Transplantation 170
Chapter 12: Tuberculosis in Pregnancy 173
Shruti Bangale Daflapurkar
• Microbiology 174
• Pathophysiology of Tuberculosis 175
• Effect of Pregnancy on Tuberculosis 176
• Effect of Tuberculosis on Pregnancy 176

xviii High Risk Cases in Obstetrics • Tuberculosis in Newborn 177
• Diagnosis 177
• Treatment 179
• Multi-drug Resistant Tuberculosis 186
• Extensively Drug Resistant Tuberculosis 186
• Breastfeeding 187
• HIV and Tuberculosis Co-infection 187
• Prevention of Tuberculosis 188
Chapter 13: Skin Diseases in Pregnancy 190
Santosh Daflapurkar
• Physiologic Changes during Pregnancy 190
• Dermatoses Associated with Fetal Risk 195
• Dermatoses not Associated with Fetal Risk 199
Chapter 14: Infectious Diseases during Pregnancy 203
Shruti Bangale Daflapurkar, Santosh Daflapurkar
• TORCH Infection 203
• Other Infections 216
Chapter 15: Sexually Transmitted Diseases during Pregnancy 223
Santosh Daflapurkar
• Common Sexually Transmitted Diseases 224
Chapter 16: HIV in Pregnancy 245
Santosh Daflapurkar, Shruti Bangale Daflapurkar
• History 245
• Human Immunodeficiency Virus 246
• HIV in Pregnancy 250
• Prevention of Parent to Child Transmission of HIV 255
• Infant ART Prophylaxis 259
• Hepatitis Co-infection 259
• Cesarean Delivery 260
Chapter 17: Antepartum Hemorrhage I: Placenta Previa,
Placenta Accreta and Vasa Previa 263
Suresh S Rawte, Sonali S Deshpande
• Definition 264
• Placenta Previa 264
• Incidence 265
• Etiology and Associated Risk Factors 265
• Clinical Presentation 267
• Diagnosis 268
• Management 269

Contents xix
• Placenta Accreta 274
• Vasa Previa 281
Chapter 18: Antepartum Hemorrhage II: Placental Abruption 289
Suresh S Rawte, Shrinivas N Gadappa
• Definition 291
• Incidence 291
• Risk Factors 291
• Pathophysiology 294
• Clinical Signs and Symptoms 295
• Diagnosis 298
• Management 299
Chapter 19: Gynecological Cancers in Pregnancy 314
Suresh S Rawte, Swati Shiradkar
• Diagnosis and Treatment of Cancer during Pregnancy 315
• Cervical Cancer in Pregnancy 319
• Ovarian Cancer in Pregnancy 327
• Vulvar Cancer in Pregnancy 329
• Vaginal Cancer in Pregnancy 330
• Endometrial Cancer in Pregnancy 331
• Breast Cancer in Pregnancy 331
Chapter 20: Teenage Pregnancy 338
Shruti Bangale Daflapurkar
• Definition 339
• Overview and Epidemiology 339
• Incidence 339
• Causes 341
• Complications of Teenage Pregnancy 342
• Prevention of Teenage Pregnancy 345
• Social Issues Associated with Teenage Pregnancy 345
Chapter 21: Puerperal Pyrexia 351
Shruti Bangale Daflapurkar
• Causative Organisms 352
• Definition 352
• Etiology 353
• Examinations 353
• Investigations 353
• Management 354
• Complications 356
• Prognosis 356
• Prevention 356

xx High Risk Cases in Obstetrics
Chapter 22: Ectopic Pregnancy 358
Shruti Bangale Daflapurkar
• Definition 359
• Sites 359
• Risk Factors 360
• Investigations 362
• Tubal Ectopic Pregnancy 364
• Treatment 366
• Cervical Ectopic Pregnancy 371
• Ovarian Ectopic Pregnancy 372
• Abdominal Pregnancy 373
• Heterotopic Pregnancy 374
Chapter 23: Anesthesia for Obstetrics 376
Shrigopal Bhattad
• Maternal Physiology and Anesthesia 378
• Labor Analgesia 379
• Anesthesia for Cesarean Section 385
• Specific Maternal Conditions and Anesthesia 392
Index 399

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El objetivo final de la atención prenatal de las mujeres embarazadas es tener una madre sana y un bebé sano. Con la obstetricia moderna, este objetivo se puede lograr en la mayoría. Sin embargo, cada embarazo es una situación desafiante individual y las cosas que parecen normales pueden empeorar en algunas horas. El libro Casos de alto riesgo en obstetricia tiene como objetivo guiar a los estudiantes de posgrado para hacer frente a varios embarazos de emergencia o propensos al riesgo.<br\>

Con el cambio de estilo de vida, el aumento de la edad materna, el aumento del uso de técnicas de reproducción asistida, ciertas condiciones como la diabetes, la hipertensión esencial y los embarazos ectópicos están en aumento. Por el contrario, incluso con la modernización, la demografía de la población analfabeta y desfavorecida no mejora mucho. Estas personas tienen falta de acceso a una atención médica de calidad a su alcance. Entonces, los problemas como la anemia, la PIH, las infecciones de transmisión sexual también son comunes en la práctica de la obstetricia.

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