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With higher risks to mother and baby in pregnant women with renal disease, critical decision-making is key. Giving practical guidance for antenatal, post-partum and maternity unit challenges, this book supports good practice and evidence-based management. The book includes evidence on antenatal and post-partum care; management of acute kidney injury in the delivery suite; and care guidelines for acute, chronic, and previously undiagnosed kidney diseases. The book also covers acute kidney injury, transplant, dialysis, pre-conception counselling, and medications. Previously published by RCOG, this revised edition includes:• Updated expert consensus statements• Complete revision, with a new chapter on contraception• Updates in management of acute kidney injury, hypertension, dialysis and pregnancy, renal transplantation and pre-eclampsia.Structured to help clinicians make decisions, this book is for use by obstetricians, renal physicians, maternal medicine clinicians, midwives, urologists and specialist nurses.
Thyroid hormones play a crucial role during fetal development, and are especially important for growth and neurodevelopment in utero. The maternal physiological alterations that occur during pregnancy help regulate an adequate supply to the growing fetus, and pregnancy provides a “stress test” to the maternal thyroid gland. Thyroid disease is the second most common cause of endocrine dysfunction in women of childbearing age, after diabetes. Hypothyroidism is the more prevalent thyroid disorder, present in up to 2–5% of pregnancies, while hyperthyroidism (usually Graves’ disease) complicates another ~0.2%. It can often be challenging to diagnose and manage, because many of the symptoms of the disease are common symptoms in pregnancy. Physiological changes in pituitary and thyroid hormone levels may add complexity to the diagnosis, and a clear understanding of these changes is needed when managing women with suspected or known thyroid disease. The management of hypo- and hyperthyroid states is discussed in detail in this chapter, with an overview of thyroid cancer management.
Obstetricians most commonly encounter shock in the form of hemorrhage, but it is important to realize that shock can be classified in several types, and correction of the physiological derangement can correct the dysoxia at the tissue level before shock becomes irreversible. Etiologically shock is classified into the following types: hypovolemic shock (i.e. hemorrhage in coagulopathy), cardiogenic shock (myocardial dysfunction in the systemic inflammatory response syndrome and with toxins associated with septicemia), distributive shock (through activation of the systemic inflammatory response system), and obstructive shock (septic embolism). Therapy for cardiogenic shock requires restoration of adequate coronary perfusion in order to minimize further myocardial depression and necrosis. Anaphylactic and anaphylactoid reactions are clinically indistinguishable. The goals of management of anaphylaxis are interrupting contact with the responsible drug, modulating the effects of the released mediators, and preventing further mediator production and release.