‘Abnormal parturition, besides ending in death or recovery, not infrequently had a third termination in other diseases… a delay of only a few moments in the substitution of pulmonary for the ceased placental respiration would lead to the apprehension that even the want of a few breathings, if not fatal to the economy, may imprint a lasting injury upon it.’ William John Little On the influence…
Acknowledgements The authors acknowledge Mr Donald Gibb and Elsevier for permission to reproduce in Chapters 9 and 10 some of the figures from Fetal Monitoring in Practice , 2nd ed. Oxford: Butterworth; 1997. ‘By applying the ear to the mother’s belly; if the child is alive you hear quite clearly the beats of its heart and easily distinguish them from the mother’s pulse’. François Mayor Biblioth…
On the qualifications of an accoucheur: ‘Those who intend to practice midwifery, ought first of all to make themselves masters of anatomy, and acquire competent knowledge in surgery and physic … and of practising under a master, before he attempts to deliver by himself. He should also embrace every occasion of being present at real labours.… Over and above the advantages of education, he ought to…
Introduction Induction of labour, which is defined as the process by which labour is started (or attempted) prior to its spontaneous onset leading to active labour and birth, is one of the two options available to women and their caregivers when the continuation of a pregnancy poses a greater risk to either the mother or the fetus than the consequences of interrupting the pregnancy; the remaining…
Placental abruption is the premature separation of the placenta from the uterine wall after 20 weeks’ gestation and before birth; the separation can be complete or partial. It complicates approximately 1% of pregnancies and is a major cause of maternal morbidity and of perinatal morbidity and mortality. The incidence of abruption is lower in Nordic countries and higher in south Asian countries. Traditionally, placental abruptions have…
Introduction Vasa praevia is a rare disorder of pregnancy with a devastating outcome when undiagnosed. The condition classically presents with ruptured membranes, painless vaginal bleeding and fetal distress (Benckiser’s haemorrhage). , Antenatal ultrasound diagnosis of the condition has been possible since the late 1980s and planned hospitalization, targeted steroid administration and scheduled delivery, usually between 34 and 36 weeks of gestation, results in improved fetal survival.…
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Introduction Cervical incompetence occurs in approximately 0.1–1% of all pregnancies. The condition is described where the cervix is unable to retain the contents of the uterus and arises when the volume or pressure within the uterine cavity increases beyond that which the competence mechanism of the cervix is capable of functioning, usually occurring from the middle of the second trimester onwards. The insertion of a cervical…
‘The usual period of a woman’s going with child is nine calendar months; but there is very commonly a difference of one, two or three weeks. A child may be born alive at any time from three months: but we see none born with powers of coming to manhood, or of being reared, before seven calendar months, or near that time. At six months it cannot…
‘When the child is grown big and the mother cannot continue to provide him with enough nourishment, he becomes agitated, breaks through the membranes, and incontinently passes out into the external world free from any bonds’ Hippocrates, On Generation, 4th century BC ‘The stimulus for labour may originate in certain states of vital development or physical expansion of the fundus, corpus or cervix uteri and in…
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The placenta is the central player of the maternal–fetal interface, able to communicate with both the fetus and the mother and to regulate signals from one to the other. Consequently, disturbing its development, growth, or function can have major impacts on both the maternal response to pregnancy and the development of the fetus. Currently, very little is known about the effects of maternal cardiac conditions on…
Recreational drug abuse has increased dramatically in recent years. Approximately 250,000 women in the United States abuse intravenous (IV) drugs, and nearly 90% of them are of childbearing age. Maternal drug addiction may result in life-threatening complications for both the mother and baby. Because social trends affect women with heart disease in the same way as the general population, physicians caring for pregnant women with heart…
Women with congenital heart disease have an increased risk of complications for themselves and their babies, as well as an increased risk of having children with heart disease. Ideally, genetic counseling should take place before pregnancy (see Chapter 4 ), but if not, it still has a role to play. Often, genetic counseling is sought by women who have had a baby with a congenital malformation…
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In situations when gestation carries a significant fetal or maternal risk, it may be appropriate to terminate the pregnancy. The safest time for termination is during the first trimester. Abortions may be induced by medication or performed surgically. This chapter discusses both medical and surgical abortions, with an emphasis on their timing and prevalence in the United States and elsewhere. It also discusses anesthesia and other…
High-Risk Patient Populations The highest-risk patients are those with pulmonary hypertension and those with prior peripartum cardiomyopathy. The American College of Cardiology recommendations for women with adult congenital heart disease are as follows: 1. Women of childbearing potential with congenital heart disease should be counseled about the risks associated with pregnancy and appropriate contraceptive options. 2. Estrogen-containing contraceptives are potentially harmful for women with congenital heart…
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Over the past few years, the coronavirus disease 2019 (COVID-19) pandemic has affected nearly every aspect of human life, including, of course, health care. For expecting women, the normal anxiety of pregnancy has been heightened by concern over the possible effects of the coronavirus on them and their babies. That concern is magnified in women with cardiac conditions or issues. This chapter provides an overview of…