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29 results

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  • Chapter 5 - Interventions in Pregnancy to Reduce Risk of Stillbirth

  • from Section 1: - General Principles
  • Edited by Mark D. Kilby, University of Birmingham, Anthony Johnson, Dick Oepkes
  • Book: Fetal Therapy
  • Published online: 21 October 2019
  • Print publication: 02 January 2020, pp 48-60

  • Summary

    Stillbirth remains a global health challenge, with more than 2.6 million stillbirths per year [1]. Although only 2% of the global burden of stillbirths is in high-income countries (HICs), with virtually no improvement in rates for over two decades, action in HICs is urgently needed [2]. There is a six-fold difference between the highest and lowest rates (Ukraine 8.8 stillbirths per 1,000 births after 28 weeks vs. Iceland 1.3 stillbirths per 1,000 births). As well as variation between countries it is well established that there is variation within countries, with women from indigenous or minority ethnic groups, migrant populations or socioeconomically deprived groups as well as women at extremes of maternal age being at increased risk of stillbirth [2]. The disparity between and within countries suggests that more could be done in HICs to reduce stillbirth rates: this includes reducing the frequency of substandard care recurrently described in Confidential Enquiries into Stillbirth and implementing strategies to mitigate the increased risk of stillbirth in specific groups of women [3, 4].

  • 4 - Severe preeclampsiaand eclampsia

  • from Section 2 - Algorithms for Management of the Top Five ‘Direct Killers’
  • Edited by Edwin Chandraharan, Sabaratnam Arulkumaran
  • Book: Obstetric and Intrapartum Emergencies
  • Published online: 05 November 2012
  • Print publication: 11 October 2012, pp 24-32

  • Summary

    This chapter discusses the pathophysiology, key implications, diagnostic signs and management of severe preeclampsia and eclampsia in an obstetric setting. Preeclampsia may affect multiple organ systems. Blood pressure greater than or equal to160/110 mmHg, severe headache with visual disturbance, epigastric pain, clonus and papilloedema are some of the diagnostic signs of severe preeclampsia. Patients should be managed in a high-dependency obstetric care setting with one-to-one experienced midwifery care. Hourly measurement and documentation of maternal observations like (blood pressure, pulse, respiratory rate, oxygen saturation, temperature, urine output, and neurological status) should be done. Magnesium sulphate should be commenced at diagnosis of severe preeclampsia/eclampsia; continuing until 24 hours following delivery/last seizure/commencement of magnesium sulphate therapy, whichever is the later. Antihypersensitives should be administered, and fluid management should be considered. Postpartum haemorrhage should be anticipated and managed efficiently. Regular 'skills drills' should be conducted on management of severe preeclampsia/eclampsia.

Hypertension in Pregnancy
  • Alexander Heazell, Errol R. Norwitz, Louise C. Kenny, Philip N. Baker
  • Published online: 05 August 2011
  • Print publication: 26 August 2010
  • Hypertensive disorders are among the most common medical complications of pregnancy, with an incidence of approximately 6-10%. This spectrum of conditions includes essential hypertension, pre-eclampsia and HELLP syndrome. For patients with pre-existing hypertension, management ideally commences prior to conception, and continues through pregnancy to the postnatal period. This book provides information on the evidence-based management of women with hypertension throughout pregnancy, supported by important background information on the etiology, risk-factors and pathophysiology of these disorders. Illustrated with accompanying algorithms, tables and lists for quick reference on diagnostic criteria, drugs and side-effects, this book will help clinicians rapidly gain access to the information they need to care for these patients. This will to be of interest to all grades of obstetric trainees as well as specialists, obstetric anesthetists and anesthetic trainees, midwives and maternal-fetal physicians.

  • 9 - Obstetric haemorrhage

    • By Alexander Heazell, Clinical Research Fellow, Maternal and Fetal Health Research Centre, St Mary's Hospital, University of Manchester, Manchester, UK
  • Alexander Heazell, University of Manchester, John Clift
  • Book: Obstetrics for Anaesthetists
  • Published online: 21 August 2009
  • Print publication: 06 March 2008, pp 107-119

  • Summary

    Obstetric haemorrhage results in massive blood loss endangering the life of the mother, and the infant in the case of antepartum haemorrhage (APH). This chapter discusses placenta praevia, vasa praevia, postpartum haemorrhage (PPH), uterine atony, genital tract trauma, clotting disorders, and uterine inversion. The Confidential Enquiry into Maternal and Child Health (CEMACH) recommends that all obstetric units have a protocol for the management of obstetric haemorrhage; all individuals working in delivery units should be familiar with local guidelines. APH is a major cause of perinatal morbidity and mortality, including an increased risk of premature delivery. Placental abruption may be partial or complete separation and can occur at any stage of pregnancy. The intervention following placental abruption is dependent upon the severity of the abruption and the presence of fetal compromise. General anaesthesia with relaxation by volatile agents is the most proven anaesthetic technique to correct the inversion.

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