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Obstetrics

• Editor's Note
• List of Articles

List of Articles

• Preeclampsia and Eclampsia
  Hypertensive disease occurs in approximately 12-22% of pregnancies, and it is directly responsible for 17.6% of maternal deaths in the United States. However, there is confusion about the terminology and classification of these disorders. We hope to provide guidelines for the diagnosis and management of hypertensive disorders unique to pregnancy (preeclampsia and eclampsia), as well as the various associated complications. The purpose this document is to provide guidelines for the diagnosis and management of hypertensive disorders unique to pregnancy -- preeclampsia and eclampsia. Various associated complications are also discussed. Expectant management should be considered for women remote from term who have mild preeclampsia. For the prevention and treatment of seizures in women with severe preeclampsia or eclampsia magnesium sulfate is the drug of choice. Practitioners should be aware that various laboratory tests may be useful in the management of women with preeclampsia. The differential diagnosis is also discussed. It is important that clinician make the accurate diagnosis when possible because the management and complications from these syndromes may be different.
  
  
• Mapping the Theories of Preeclampsia
  Preeclampsia is a major cause of maternal and perinatal mortality and morbidity worldwide. Its etiology is elusive and theories abound regarding its pathogenesis. Preeclampsia can cause changes in virtually all organ systems. Several organ systems are consistently and characteristically involved. The pathologic findings indicate that the pathogenetic factor of primary importance is not blood pressure elevation, but rather poor tissue perfusion. The histologic data support the clinical impression that the poor perfusion is secondary to profound vasospasm, which also increases total peripheral resistance and blood pressure. Preeclampsia is not merely an alternate form of malignant hypertension. Recently homocysteine, a metabolite of the essential amino acid methionine has been postulated to produce oxidative stress and endothelial cell dysfunction, alterations associated with preeclampsia. The studies examining the relationship between serum homocysteine concentrations and preeclampsia are also discussed.
  
  
• Teen Pregnancy: Understanding the Social Impact
  The impact of teenage pregnancy and subsequent childbirth on parents, child and society reaches far and wide and has negative consequences to all involved. Too many teenagers become parents either they cannot envision another positive future direction to their lives, or because they lack concrete educational or employment goals and opportunities that would convince them to delay parenthood. No single or simple approach has successfully reduced the teen pregnancy rate; much more study and efforts are required. Other industrialized countries have much lower teen pregnancy and abortion rates than USA. There is few, if any other social problem that has a greater impact on us as a nation. It will take the involvement and efforts on the part of families, society and government to negotiate a change in the right direction. As physicians, we are in a unique position to take a leadership role in the decision making process, at all levels.
  
  
• Drugs in Pregnancy and Lactation
  The ideal time to address medication exposure and consider alternative treatment is prior to conception. Many pharmacologic agents have teratogenic potential as well as the potential to induce fetal harm later in gestation with effects that may be lethal or cause long-term handicaps. Many women will present already pregnant, thus providing a narrow window of time in which to evaluate the fetal risks and weigh them against the maternal benefits of continuing the medication. This chapter reviews the risks of commonly used medications during pregnancy, highlights medications with particularly high risk, and reviews the evaluation of fetuses who are exposed.
  
  

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