Obstetric Clinical Algorithms

Errol R Norwitz, MD, PhD, MBA, Professor of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, USA George A Saade, MD, Professor of Maternal-Fetal Medicine, University of Texas Medical Branch, Galveston, TX, USA Hugh S Miller, MD, Department of Obstetrics and Gynecology, University of Arizona Medical Centre, Tucson, AZ, USA Christina M Davidson, MD, Assistant Professor of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX, USA

Preface vii

List of abbreviations ix

Section 1 Preventative Health 1

1 Abnormal Pap Smear in Pregnancy 2

2 Immunization 5

3 Preconception Care 8

4 Prenatal Care 11

Section 2 Maternal Disorders 13

5 Antiphospholipid Antibody Syndrome 14

6 Asthma 17

7 Cholestasis of Pregnancy 20

8 Chronic Hypertension 22

9 Deep Vein Thrombosis 25

10 Gestational Diabetes Mellitus 28

11 Gestational Hypertension 31

12 Preeclampsia 33

13 Pregestational Diabetes Mellitus 36

14 Pulmonary Edema 38

15 Pulmonary Embolism 41

16 Renal Disease 44

17 Seizure Disorder 46

18 Systemic Lupus Erythematosus 49

19 Thrombocytopenia 52

20 Thyroid Dysfunction 55

Section 3 Infectious Complications 59

21 Asymptomatic Bacteriuria 60

22 Urinary Tract Infection/Pyelonephritis 62

23 Lower Genital Tract Infection 64

24 Group B β]Hemolytic Streptococcus 66

25 Hepatitis B 69

26 Herpes Simplex Virus 71

27 Human Immunodeficiency Virus 73

28 Parvovirus B19 76

29 Syphilis 78

30 Tuberculosis 81

31 Chorioamnionitis (Intraamniotic Infection) 84

Section 4 Antenatal Complications 87

32 Advanced Maternal Age 88

33 Antepartum Fetal Testing 90

34 Breast Lesions 93

35 Cervical Insufficiency 96

36 First]trimester Vaginal Bleeding 99

37 Higher]Order Multifetal Pregnancy 102

38 Hyperemesis Gravidarum 104

39 Intrauterine Fetal Demise 107

40 Fetal Growth Restriction 109

41 Isoimmunization 113

42 Macrosomia 116

43 Medically]Indicated Late Preterm and Early Term Delivery 119

44 Obesity 121

45 Oligohydramnios 124

46 Recurrent Pregnancy Loss 127

47 Placenta Accreta 130

48 Placenta Previa 133

49 Placental Abruption 135

50 Polyhydramnios 138

51 Post]term Pregnancy 141

52 Pregnancy Termination 144

53 Prenatal Diagnosis 147

54 Preterm Labor 150

55 Screening for Preterm Birth 153

56 Preterm Premature Rupture of the Membranes 156

57 Vaginal Birth after Cesarean (VBAC) 159

58 Teratology 161

59 Term Premature Rupture of the Membranes 164

60 Twin Pregnancy 166

Section 5 Intrapartum/Postpartum Complications 169

61 Breech Presentation 170

62 Intrapartum Fetal Testing 173

63 Cesarean Delivery 176

64 Operative Vaginal Delivery 179

65 Severe Perineal Lacerations 182

66 Intrapartum Management of Twin Pregnancy 185

67 Postpartum Hemorrhage 187

68 Retained Placenta 191

69 Postpartum Endomyometritis 194

70 Mastitis 196

71 Vasa Previa 198

72 Postpartum Psychiatric Disorders 200

73 Sterilization 202

Section 6 Obstetric Emergencies 205

74 Acute Abdomen in Pregnancy 206

75 Acute Asthma Exacerbation 209

76 Acute Shortness of Breath 211

77 Cord Prolapse 213

78 Cardiopulmonary Resuscitation 215

79 Diabetic Ketoacidosis 218

80 Eclampsia 220

81 Shoulder Dystocia 223

82 Thyroid Storm 226

Recommended Reading 229

Index 243