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Management of Labour
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Pain relief: It is essential to provide some form of pain relief – the woman who has gone through birth preparedness classes, yoga, and breathing exercises in the prenatal period have better pain tolerance. Pharmacological and other non-pharmacological methods may be required to relieve pain. Yoga, breathing exercises, and music therapy have been shown to reduce pain. More of this is covered in Chapter 8.
Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
Aminosalicylates are one of the cornerstones of medical therapy of IBD and are considered low risk for use in pregnancy. Most are pregnancy category B (sulfasalazine, mesalamine, and balsalazide) with the exception of olsalazine, which is category C. Sulfasalazine contains a sulfapyridine residue linked to 5-aminosalicylic acid (5-ASA), the active moiety. Its mechanism of action is unknown, but it has been shown to inhibit production of leukotriene B4, an important mediator of inflammation, block prostaglandin production, and inhibit immunoglobulin secretion by mononuclear cells. Sulfasalazine crosses the placenta (85) and is found in breast milk, although in low concentrations. Serum levels of sulfasalazine in newborns are the same as in the mother (86). This drug is thought to be safe during pregnancy (87). There are a few case reports of congenital defects in infants of treated patients; however, a population-based study did not find a significant increase in congenital abnormalities in children of women treated with sulfasalazine (88). Its efficacy in maintaining remission in UC makes its continuation during pregnancy an important consideration. Patients are usually tapered to the lowest dose that is effective in suppressing disease activity. Sulfasalazine has anti-folate effects, and it is recommended that women take folate supplementation of at least 2mg daily during the prenatal period and pregnancy.
Management of pregnancy with one or more early neonatal deaths
Published in Minakshi Rohilla, Recurrent Pregnancy Loss and Adverse Natal Outcomes, 2020
In the preconceptional period, detailed history should be obtained, and records of the prenatal period of previous pregnancy should be reviewed, especially to check whether supervised or not, intake of folic acid, prenatal complications, and gestational age at delivery, that may be the actual cause or a contributory factor. Details of labor and delivery provide insight into intrapartum events that may be responsible for adverse perinatal outcome. The neonatologist's notes wherever available provide information on Apgar score, birth weight, approximate gestational age, need for resuscitation, intensive care unit care, feeding, and many other factors that help in future counseling. An autopsy gives additional information in at least one in three cases. Further information can be obtained from available genetic tests, x-rays, and tests on placenta and umbilical cord. Early neonatal deaths should always be classified using the International Classification of Diseases, Tenth Revision–Perinatal Mortality (ICD-PM) classification. ICD-PM guides health-care providers in correctly documenting pertinent information, as it clarifies which conditions should be considered as underlying causes of death and thus helps in identifying the attributable cause. Correct classification based on underlying neonatal and maternal causes of death helps in finding the risk of recurrence.
The effects of intrauterine growth on physical and intellectual development of one-year-old infants: a study on monochorionic twins with selective intrauterine growth restriction
Published in Journal of Obstetrics and Gynaecology, 2023
Xianping Huang, Huiqiu Xiang, Jiale Bao, Jing Zhu, Jiajia Chen, Panpan Zhou, Tong Zhou, Zhangye Xu
Selective intrauterine growth restriction (sIUGR) could complicate 10–15% of monochorionic (MC) twin pregnancies (Lewi et al. 2008; Bennasar et al. 2017), and it was defined as an intertwin estimated foetal weight (EFW) discordance over 25% with one twin having an EFW below the 10th percentile (Valsky et al. 2010; Khalil et al. 2016). This pathology could increase the risk of intrauterine foetal death, preterm birth, caesarean delivery and adverse neonatal outcomes, especially in smaller foetuses (Khalil and Thilaganathan 2019). To date, studies have concentrated on clinical management of sIUGR, while little attention has been paid to the growth and development of twins after birth. It is well-known that the prenatal period is a time of rapid brain development, which includes remarkable changes in cortical folding (Battin et al. 1998), myelination (Counsell et al. 2002) and grey-matter distribution (Isaacs et al. 2001). These findings raise the hypothesis that infants who suffer from growth restriction during the prenatal period are likely to be deprived of an optimal supply of nutritional substrates, and they are at risk of impaired neural and cognitive development. Given the adverse neurobiological effects of suboptimal nutrition on the brain development, it is essential to determine whether IUGR causes long-term cognitive deficits and physical retardation. The current study has assessed the physical and intellectual development of one-year-old infants of MC twins with sIUGR.
Relationship between prenatal and maternal attachment: a longitudinal study from Turkey
Published in Journal of Obstetrics and Gynaecology, 2022
Nursan Çınar, Sinem Yalnızoğlu Çaka, Sümeyra Topal, Hilal Uslu Yuvacı
Mother infant attachment developing during pregnancy is of critical importance since it influences postnatal bonding and forms the basis of the child's social, emotional and cognitive development in the future (Malm et al. 2016). The healthy development of the attachment which starts in the prenatal period and continues after the birth strengthens, positively supports the newborn care and contributes to raising healthy individuals in the future. It is important that the training and applications that increase mother-infant attachment and are conducted by healthcare professionals are initiated as of the prenatal period. In this study, it was aimed to evaluate the effect of attachment established during pregnancy on mother-infant attachment in the postnatal period, and the factors affecting this process.
Congenital cytomegalovirus infection registry in flanders: opportunities and pitfalls
Published in Acta Clinica Belgica, 2021
Annelies Keymeulen, Els De Leenheer, Julie Goderis, Ingeborg Dhooge, Koenraad Smets
At enrolment, data are collected on the prenatal period (timing of seroconversion, gravidity/mater and prenatal tests such as ultrasound, MRI, amniocentesis), diagnosis (reason for testing, diagnostic tools, epidemiologic features), clinical features at birth, results of additional investigations (blood count, transaminases, CMV IgM/IgG and CMV-DNA polymerase chain reaction (PCR) on serum, central nervous system imaging, audiological testing, ophthalmologic investigation) and therapy. All additional investigations were performed within 1 month after birth to identify those children eligible for treatment. Long-term data are collected on neuromotor skills, hearing and vision. For children with late diagnosis (>21 days of age), these additional investigations have not been performed in most of the children.