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The Immunology of Preeclampsia

Editors' comment : In Chesley's single-authored first edition, there was limited information regarding immunology and preeclampsia. He did note that as early as 1902, Viet had proposed that deported trophoblastic fragments were antigenic and could elicit antibodies that he named “syncytiolysin” (edition 1 p. 467). He further commented that Dienst, in 1905, suggested incompatibility of maternal and fetal blood groups as an etiologic factor (edition 1…

Unbiased Approaches for Addressing the Complexities of the Placenta’s Role in the Preeclampsia Syndrome

Editors' comment: This is a modified chapter since the fourth edition. When it was published in 2015, the editors had come to the realization that methods revealing the molecular biology of the trophoblast were likely to contribute in new ways to the understanding of placental dysfunction in preeclampsia. The current rendition of this analysis promises to elucidate, using agnostic and unbiased methods to assess relative levels…

Placentation and Placental Function in Normal and Preeclamptic Pregnancies

Acknowledgments The authors gratefully acknowledge the input of their clinical and research colleagues over the years that have helped shape their views and to funders including The Wellcome Trust, Medical Research Council, Tommy's and Wellbeing of Women, who have supported their research. Editors' comment : This is a reengineered chapter in the fifth edition of Chesley's Hypertensive Disorders in Pregnancy. In the last editions of the…

Preconceptional and Periconceptional Pathways to Preeclampsia

Editors' comment: Chapter 4 titled “Pre- and Peri-Conception Pathways to Preeclampsia” is a new addition to Chesley's Hypertensive Disorders in Pregnancy. The rationale for this chapter stems from the emerging evidence supporting the concept that the antecedents of preeclampsia may reside in the pre- and periconception periods and early pregnancy. Although there are undoubtedly multiple origins of preeclampsia in light of the heterogeneous nature of the…

Genetic Factors in the Etiology of Preeclampsia/Eclampsia

Editors' comment : Case reports describing familial clustering of eclampsia were first reported in the late 1800s, but Chesley was one of the first to perform a true genetic analysis. Chesley's first edition text summarized his early investigations in hundreds of mother–daughter pairs. He reported that among daughters of women with eclampsia, 26% had preeclampsia in their first pregnancies. By contrast, the daughters-in-law control group had…

Epidemiology of Hypertensive Disorders in Pregnancy

Editor's comment: Preeclampsia–eclampsia is a leading cause of maternal mortality and morbidity. Eclampsia has decreased dramatically in the last several decades in high-resource countries, probably reflecting improvements in medical care rather than a change in the disease's natural history. Conversely, preeclampsia's frequency is increasing in the United States (25% between 1987 and 2004 and 21% between 2005 and 2014 ), although it may be decreasing in…

The Spectrum of Hypertensive Disorders in Pregnancy: Dr. Leon Chesley’s Legacy

Editors ' comment: When Leon Chesley's Hypertensive Disorders in Pregnancy was initially published in 1978 , as now, hypertension complicating pregnancy was a major cause of fetal and maternal morbidity and death. Most of this morbidity was and remains associated with preeclampsia, a disorder with devastating effects on many organ systems, high blood pressure being but one aspect of the disease. The first edition was single…

Self-Assessment

Chapter 1: Structure and Function of the Genome Questions 1. How many pairs of autosome chromosomes does each adult possess? A. 11 B. 22 C. 23 D. 44 E. 46 2. What is the most common process used for identifying chromosomes in the lab? A. Geisma stain B. PCR C. FISH D. Leishman stain E. Q banding 3. How many possible combinations of DNA are there?…

Clinical Research Methodology

Introduction Research is an organised, systematic and rigorous process of enquiry to develop concepts and theories and describe phenomena. It aims to add to a scientific body of knowledge. A fundamental understanding of how to approach clinical research is now a basic requirement for any specialist. In recent years, regulation around research governance has resulted in many mandatory requirements to set up, monitor and execute research…

Statistics and Evidence-Based Healthcare

Introduction Many doctors often equate statistics with the numbers and equations seen in research papers, but the term ‘statistics’ does not mean ‘numbers’; indeed, a competent statistical analysis of a paper should include non-numerical issues such as the nature of the sampling methods or the validity of a ‘gold standard’ diagnostic test. Furthermore, papers may be overflowing with numerical data but contain no statistics at all.…

Physics in Obstetrics and Gynaecology

Introduction The application of the theories, principles and methods of physics to medicine and healthcare, in general, belongs to a branch of medicine called ‘medical physics’. This chapter focuses on the use of medical physics in obstetrics and gynaecology, with a focus also on its surgical application. Physics for Surgery A trainee will encounter plenty of situations where the principles of physics are integral to the…

Drugs and Drug Therapy

Introduction A drug is broadly defined as any chemical agent that affects living protoplasm. About one-third of women in the UK take drugs at least once during pregnancy, but only 6% take a drug during the first trimester. In the puerperium, the use of drugs increases substantially with no difference in the pattern of prescribing between mothers who breastfeed and those who bottle-feed. Possible effects of…

Endocrinology

Introduction In this chapter, the endocrine system is introduced by describing mechanisms of hormone action and the types of hormones. Six groups of hormones and/or endocrine systems will then be discussed, which include: (1) hypothalamus, pituitary and pineal glands; (2) reproduction (puberty, menstrual cycle, pregnancy, lactation and menopause); (3) growth; (4) metabolism and the pancreas; (5) thyroid; (6) adrenal. Mechanisms of Hormone Action and Second Messenger…

Physiology

Biophysical Definitions Molecular Weight One mole of an element or compound is the atomic weight or molecular weight, respectively, in grams. For example, 1 mol of sodium is 23 g (atomic weight Na = 23) and 1 mol of sodium chloride is 58.5 g (atomic weight Cl = 35.5; 35.5 + 23 = 58.5). A ‘normal’ (molar) solution contains 1 mol/L of solution. Therefore a ‘normal’…

Biochemistry

Structure and Function of the Normal Cell All cells possess certain basic structural features, regardless of their location, type and function ( Fig. 9.1 ). The major division is into nucleus and cytoplasm. Nucleus The nucleus contains the chromosomes (see Chapter 1 ) and is surrounded by a nuclear envelope consisting of an inner and outer membrane, both of which are formed from a lipid bilayer.…

Immunology

Introduction The immune system exists to protect the organism from the consequences of infectious disease and, to a lesser extent, neoplasia. It does this by having a complex system of organs, cells and molecules that are distributed throughout the body. Most of the cells involved are highly motile, adding to the complexity of the system. The importance of the immune system in health and disease is…

Microbiology and Virology

Bacteriology, Mycology and Parasitology Introduction Bacteria are the smallest organisms capable of a free-living existence. That is, with the exception of a few highly evolved examples, they are able to take up nutrients from the environment, grow and self-replicate independently of other living cells. Their basic biochemical pathways are similar to those of other organisms, and while they are morphologically less complex than the cells of…

Pathology

General Pathological Principles Adequate understanding of the underlying pathophysiological disease processes associated with the range of obstetric and gynaecological presentations is essential for the rational evaluation of appropriate investigations, therapies and outcomes. Huge volumes of literature are available on almost all of the topics covered in this chapter, but the most important essential points are summarised in the sections below. A basic understanding of general pathological…

Applied Anatomy

Introduction This chapter will address general anatomical principles as well as cover detailed anatomy relevant to the obstetrician and gynaecologist and the Membership of Royal College of Obstetricians and Gynaecologists (MRCOG) exams. Particular attention is given to how this knowledge should be applied clinically, and readers are advised to refer to more detailed comprehensive anatomy books to supplement this applied anatomy approach. Body Tissues and Cells…

Fetal and Placental Physiology

Introduction The subject of fetal and placental physiology encompasses a large and complex branch of the reproductive sciences, and any one of the subsections below could form the subject of an entire textbook. The concepts described here should aid the understanding of how fetal and placental physiology influence clinical assessment of fetal wellbeing, as well as diseases of prematurity and the unwell term neonate. Understanding of…