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Obstetrics

• Editor's Note
• List of Articles

List of Articles

• Iron Deficiency Anemia in Pregnancy
  Today, iron is the world’s most common micronutrient deficiency, estimated to affect 3 billion people and more than half of pregnancies worldwide, with higher prevalence in under-resourced countries. To make a significant impact, it is likely that a combination of key programs that address the determinants of low blood hemoglobin concentrations will be required. These strategies should be tailored to local conditions, taking into account the specific etiology and prevalence of anemia in a given setting and population group, and should be built into the primary healthcare systems and existing programs. The first-line treatment or iron deficiency anemia is oral iron. New evidence suggests that intermittent dosing is as effective as daily or twice-daily dosing with fewer side effects. For patients who cannot tolerate, absorb, or do not respond to oral iron, intravenous iron is preferred in the third trimester and sometimes as early as the second trimester. Iron supplementation decreases the prevalence of maternal anemia at delivery. Iron deficiency anemia during pregnancy has been associated with an increased risk of low birth weight, preterm delivery, and perinatal mortality. Severe anemia with maternal hemoglobin levels less than 6 g/dL has been associated with abnormal fetal oxygenation resulting in non-reassuring fetal heart rate patterns, reduced amniotic fluid volume, fetal cerebral vasodilatation, and fetal death. Thus, maternal transfusion should be considered for fetal indications.
  
  
• Prevention of Group B Streptococcal Disease in Newborns: Perinatal Management
  Group B streptococcus (GBS) is the leading cause of newborn infection. it is a common commensal in the gut of humans and in the lower genital tract in women, remains an important cause of neonatal mortality and morbidity. This review identifies limitations of current strategies for antepartum and intrapartum prophylaxis of neonatal early-onset GBS infection. The present guidelines are designed to lower the risk of GBS early-onset-disease, which is the most common cause of early-onset neonatal sepsis. Most individuals who report a penicillin allergy are neither truly allergic nor at risk of a developing a hypersensitivity reaction after exposure to penicillin. Approximately 80 – 90% of persons with a history penicillin allergy are actually penicillin tolerant. We advocate for wider consideration and adoption of penicillin allergy testing in pregnant women specifically and the female population in general cared for by providers of obstetrics and gynecology. Vaccines that would prevent GBS colonization are the subject of ongoing research but are not yet applicable in clinical practice.
  
  
• Critical Care in Obstetrics: Disseminated Intravascular Coagulation Syndromes
  Disseminated intravascular coagulation (DIC) is a life-threatening situation that can arise from a variety of obstetrical and non-obstetrical causes. DIC is a syndrome that can be initiated by a myriad of medical, surgical, and obstetric disorders. Also known as consumptive coagulopathy, defibrination syndrome and generalized intravascular coagulation, it is not a disease per se, but rather a clinicopathologic syndrome that can be initiated by a myriad of underlying diseases, conditions, or disorders. The purpose of this review is to discuss the pathophysiology of DIC syndromes, focusing on the triad represented by exaggerated activation of coagulation, consumption of coagulopathy, and impaired synthesis coagulation as well as anticoagulation proteins. The diagnosis of DIC with special attention to the available scores adding prognostic value to the laboratory parameters in patients with this dangerous condition or are at risk for its development are also reviewed. The principles of the treatment of DIC is discussed extensively from the literature. In recent years, novel diagnostic scores and treatment modalities along with bedside point-of-care tests were developed and may assist the clinician in the diagnosis and management of DIC. Team work and prompt treatment are essential for the successful management of patients with DIC. The management of DIC in obstetrics remains a major clinical challenge. The inciting disease-specific syndrome may be complex and require directed management strategies for correction of the underlying disorders. Equally important is treatment of frequently concomitant massive blood loss that worsens the coagulopathy. With limited clinically proven management strategies available, the need for future studies is obvious. We look forward to these studies designated to address our numerous evidence-based deficits, especially regarding management of obstetric DIC syndromes.
  
  
• Marijuana and Pregnancy Implications
  This review is intended to provide practicing clinicians with an understanding of existing literature and recommendations for managing women who use marijuana during pregnancy because this will be an increasingly encountered clinical scenario. Marijuana is the most common illicit drug used in pregnancy, with a prevalence of use ranging from 3% to 30% in various populations. Marijuana freely crosses the placenta and is found in breast milk. It may have adverse effects on both perinatal outcomes and fetal neurodevelopment. Specifically, marijuana may be associated with fetal growth restriction, stillbirth, and preterm birth. There is an emerging body of evidence indicating that marijuana may cause problems with neurological development, resulting in hyperactivity, poor cognitive function, and changes in dopaminergic receptors. In addition, contemporary marijuana products have higher quantities of Delta-9-tetrahydrocannabinol (THC) than in the 1980s when much of the marijuana research was completed. The effects on the pregnancy and fetus may therefore be different than those previously seen. Further research is needed to provide evidence-based counseling of women regarding the anticipated outcomes of marijuana use in pregnancy. In the meantime, women should be advised not to use marijuana in pregnancy or while lactating. We recommend screen all women verbally for marijuana use at intake to obstetrical care and consider rescreening later in pregnancy. The review suggests a need for healthcare provider training on potential consequences of perinatal marijuana use and communication skills for counseling patients about perinatal marijuana. An increasing number of states are passing or considering medical marijuana laws. The goal of this document is to address the public health system's responsibility to educate physicians and public about the impact of marijuana on pregnancy and to establish guidelines that discourage the use of medical marijuana by pregnant women or women considering pregnancy.
  
  

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