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Sickle Cell Disease
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Initial visit: Medical (assess for chronic organ damage, especially pulmonary hypertension, renal disease, retinopathy, and congestive heart failure), obstetrical, transfusion, and social history; nutritional assessment; discuss precipitating factors for painful crises and prior successful pain management. Counseling regarding risks (Tables 15.1 and 15.2), nutrition, hydration, and preventative care. Low-dose aspirin may be considered as the U.S. Preventative Services Task Force recommends the use of aspirin 81 mg/day starting early in pregnancy, i.e., first trimester, in women who are at high risk for pre-eclampsia. There are no trials specifically on this preventive intervention in this population, and we do not routinely offer it. Maternal-fetal medicine, and hematology consults can be considered.
Preconception Care
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Preconception care may often need to be multidisciplinary care. Prior to pregnancy, a patient can have numerous different medical problems affecting different specialties, and her care should occur in close collaboration between the different fields involved. Maternal physiology is different from nonpregnant adult physiology. An entire field, maternal-fetal medicine, is dedicated to the care of pregnancies with maternal or fetal problems, and these specialists are particularly adept at directing best practices for preconception counseling. Preconception care occurs best if all practitioners, including primary and specialty care, either directly implement or appropriately refer for implementation of effective preconception screening and intervention. The worse scenario is the belief that a positive pregnancy test is a good reason to “stop all medicines,” thereby stopping disease treatment. Prevent panic: get patients ready for a healthy pregnancy before contraception is stopped.
Preconceptual Health
Published in Michelle Tollefson, Nancy Eriksen, Neha Pathak, Improving Women's Health Across the Lifespan, 2021
Nancy L. Eriksen, Kristi R. VanWinden, John McHugh
Preconception care is an opportunity to optimize or reverse chronic disease(s). Many women with chronic diseases are not aware of pregnancy-related risks and may not intend to improve their preconception health.116 Another approach for women who are contemplating pregnancy is referring to a Maternal-Fetal Medicine specialist for a preconceptual consult to discuss their pregnancy-related risks.
Effect of initial anesthetic technique on fetal cord blood gas pH for cesarean deliveries performed for the indication of fetal heart rate abnormalities
Published in Baylor University Medical Center Proceedings, 2023
Grace E. Steel, Calvin Phan, Jessica C. Ehrig, Niraj Vora, Kendall P. Hammonds, Michael P. Hofkamp
The Baylor Scott & White Research Institute institutional review board waived informed consent for this study. We searched our electronic medical record (Epic, Verona, WI) for patients who had cesarean deliveries for the indication of fetal heart rate abnormalities from July 1, 2019, to June 30, 2021. Detailed demographic and clinical data were entered by a study investigator into Research Electronic Data Capture hosted at the Baylor Scott & White Research Institute. Patients were included for final analysis if there was a documented fetal cord blood gas. A postgraduate year 4 obstetrics resident reviewed the fetal heart tracing for each patient and determined if they had a category 2 or 3 tracing. A maternal fetal medicine physician reviewed the findings of the obstetrics resident.
The association of maternal serum biomarkers and birth weight in twin pregnancy: a retrospective cohort study
Published in Journal of Obstetrics and Gynaecology, 2022
Young Ran Kim, Nari Kim, Eun Hee Ahn, Sang Hee Jung, Goeun Park, Inkyung Jung, Hee Young Cho
A birth weight (BW) below the 10th percentile according to the gestational age can be used to define small-for-gestational age (SGA) foetuses (Hendrix et al. 2019). SGA neonates are at increased risk for stillbirth, seizures, sepsis, intraventricular haemorrhage, necrotising enterocolitis, hypoxic ischaemic encephalopathy and neonatal mortality compared to those who are appropriate for gestational age (AGA) I (BW 10–50th percentile) and AGA II (BW >50th percentile) (Kloosterman 1969; Alexander et al. 1996; Wilcox 2001; Chen et al. 2011; American College of Obstetricians, Gynecologists' Committee on Practice Bulletins–Obstetrics and The Society For Maternal-Fetal Medicine 2019). In general, additional screenings of foetal well-being are not required when the foetal weight measured by ultrasound is within the normal range for the gestational age. The degree of growth restriction increases with foetal number, and there are several SGA diagnostic criteria for twin pregnancy (Schlembach 2007; Stratieva et al. 2016; Morag et al. 2018).
Mother-to-Infant Bonding is Associated with Maternal Insomnia, Snoring, Cognitive Arousal, and Infant Sleep Problems and Colic
Published in Behavioral Sleep Medicine, 2022
David A. Kalmbach, Louise M. O’Brien, D’Angela S. Pitts, Chaewon Sagong, Lily K. Arnett, Nicholas C. Harb, Philip Cheng, Christopher L. Drake
Inclusion criterion was gestational age between 25 and 30 weeks at time of eligibility screening. Exclusion criteria included certain conditions constituting a high risk pregnancy per self-report at baseline screening (e.g., pre-eclampsia diagnosis, age > 40 years; however, hypertension and diabetes were not exclusionary), being monitored by the maternal-fetal medicine team for high risk pregnancy per electronic medical records, multiple pregnancy, use of prescription or over-the-counter sleep aids or any other sedating medications at the time of screening, alcohol or recreational drug use at time of screening, rotating and/or night shift work, epilepsy or seizures, bipolar disorder, diagnosis of a sleep disorder that is untreated (other than insomnia), and severe depression (see Measures section below).