List of Articles
- Common Sleep Disorders in Pregnancy
Many patients come into pregnancy, with a pre-existing sleep issue. Sleep disturbances are commonly reported during pregnancy, affecting more than one-half of all pregnancies and increasing as gestation progresses. Obstructive Sleep Apnea (OSA), Insomnia and Restless Legs Syndrome (RLS) are the most common sleep disorders seen in pregnancy, and data suggest that they may be associated with an increased risk of adverse pregnancy outcomes. This review outlines epidemiology, work-up and management of these common sleep disorders in pregnancy. Regardless of their potential influence on pregnancy outcomes such as gestational diabetes and preterm birth, recognizing, evaluating, and treating these conditions in pregnancy is critical for some patients because they are associated with poor sleep quality, impaired daytime functioning, and reduced quality of life. - Iron Deficiency Anemia in Pregnancy
Today, iron is the world’s most common micronutrient deficiency, estimated to affect 3 billion people and more than half of pregnancies worldwide, with higher prevalence in under-resourced countries. To make a significant impact, it is likely that a combination of key programs that address the determinants of low blood hemoglobin concentrations will be required. These strategies should be tailored to local conditions, taking into account the specific etiology and prevalence of anemia in a given setting and population group, and should be built into the primary healthcare systems and existing programs. The first-line treatment or iron deficiency anemia is oral iron. New evidence suggests that intermittent dosing is as effective as daily or twice-daily dosing with fewer side effects. For patients who cannot tolerate, absorb, or do not respond to oral iron, intravenous iron is preferred in the third trimester and sometimes as early as the second trimester. Iron supplementation decreases the prevalence of maternal anemia at delivery. Iron deficiency anemia during pregnancy has been associated with an increased risk of low birth weight, preterm delivery, and perinatal mortality. Severe anemia with maternal hemoglobin levels less than 6 g/dL has been associated with abnormal fetal oxygenation resulting in non-reassuring fetal heart rate patterns, reduced amniotic fluid volume, fetal cerebral vasodilatation, and fetal death. Thus, maternal transfusion should be considered for fetal indications. - Prevention of Group B Streptococcal Disease in Newborns: Perinatal Management
Group B streptococcus (GBS) is the leading cause of newborn infection. it is a common commensal in the gut of humans and in the lower genital tract in women, remains an important cause of neonatal mortality and morbidity. This review identifies limitations of current strategies for antepartum and intrapartum prophylaxis of neonatal early-onset GBS infection. The present guidelines are designed to lower the risk of GBS early-onset-disease, which is the most common cause of early-onset neonatal sepsis. Most individuals who report a penicillin allergy are neither truly allergic nor at risk of a developing a hypersensitivity reaction after exposure to penicillin. Approximately 80 – 90% of persons with a history penicillin allergy are actually penicillin tolerant. We advocate for wider consideration and adoption of penicillin allergy testing in pregnant women specifically and the female population in general cared for by providers of obstetrics and gynecology. Vaccines that would prevent GBS colonization are the subject of ongoing research but are not yet applicable in clinical practice. - Critical Care in Obstetrics: Disseminated Intravascular Coagulation Syndromes
Disseminated intravascular coagulation (DIC) is a life-threatening situation that can arise from a variety of obstetrical and non-obstetrical causes. DIC is a syndrome that can be initiated by a myriad of medical, surgical, and obstetric disorders. Also known as consumptive coagulopathy, defibrination syndrome and generalized intravascular coagulation, it is not a disease per se, but rather a clinicopathologic syndrome that can be initiated by a myriad of underlying diseases, conditions, or disorders. The purpose of this review is to discuss the pathophysiology of DIC syndromes, focusing on the triad represented by exaggerated activation of coagulation, consumption of coagulopathy, and impaired synthesis coagulation as well as anticoagulation proteins. The diagnosis of DIC with special attention to the available scores adding prognostic value to the laboratory parameters in patients with this dangerous condition or are at risk for its development are also reviewed. The principles of the treatment of DIC is discussed extensively from the literature. In recent years, novel diagnostic scores and treatment modalities along with bedside point-of-care tests were developed and may assist the clinician in the diagnosis and management of DIC. Team work and prompt treatment are essential for the successful management of patients with DIC. The management of DIC in obstetrics remains a major clinical challenge. The inciting disease-specific syndrome may be complex and require directed management strategies for correction of the underlying disorders. Equally important is treatment of frequently concomitant massive blood loss that worsens the coagulopathy. With limited clinically proven management strategies available, the need for future studies is obvious. We look forward to these studies designated to address our numerous evidence-based deficits, especially regarding management of obstetric DIC syndromes.
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Dedicated to Women's and Children's Well-being and Health Care Worldwide
www.womenshealthsection.com