1600 John F Kennedy Blvd Ste 1800 Philadelphia, PA 19103-2899 CREASY AND RESNIK’S MATERNAL-FETAL MEDICINE: PRINCIPLES AND ISBN: 978-1-4160-4224-2 PRACTICE, SIXTH EDITION Copyright © 2009, 2004, 1999, 1994, 1989, 1984 by Saunders, an imprint of Elsevier Inc All rights reserved No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher Permissions may be sought directly from Elsevier’s Rights Department: phone: (+1) 215 239 3804 (US) or (+44) 1865 843830 (UK); fax: (+44) 1865 853333; e-mail: healthpermissions@elsevier.com You may also complete your request online via the Elsevier website at http://www.elsevier.com/permissions Notice Knowledge and best practice in this field are constantly changing As new research and experience broaden our knowledge, changes in practice, treatment, and drug therapy may become necessary or appropriate Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions To the fullest extent of the law, neither the Publisher nor the Editors assumes any liability for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this book The Publisher Library of Congress Cataloging-in-Publication Data Creasy & Resnik’s maternal-fetal medicine : principles and practice / editors, Robert K Creasy, Robert Resnik, Jay D Iams ; associate editors, Thomas R Moore, Charles J Lockwood.—6th ed p ; cm Rev ed of: Maternal-fetal medicine 5th ed c2004 Includes bibliographical references and index ISBN 978-1-4160-4224-2 Obstetrics Perinatology I Creasy, Robert K II Maternal-fetal medicine III Title: Creasy and Resnik’s maternal-fetal medicine IV Title: Maternal-fetal medicine [DNLM: Fetal Diseases Pregnancy—physiology Pregnancy Complications Prenatal Diagnosis WQ 211 C912 2009] RG526.M34 2009 618.2—dc22 2007051347 Acquisitions Editor: Rebecca Schmidt Gaertner Developmental Editor: Kristina Oberle Publishing Services Manager: Frank Polizzano Project Manager: Rachel Miller Design Direction: Lou Forgione Working together to grow libraries in developing countries Printed in China Last digit is the print number: www.elsevier.com | www.bookaid.org | www.sabre.org For Judy, Lauren, Pat, Nancy, and Peggy With love and gratitude—for everything CO N T RIB UTO R S Vikki M Abrahams, PhD Ronald Clyman, MD Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut Professor of Pediatrics, Investigator, Cardiovascular Research Institute, University of California, San Francisco Fetal Cardiovascular Physiology The Immunology of Pregnancy David Cohn, MD Michael J Aminoff, MD, DSc, FRCP Professor of Neurology, University of California, San Francisco, School of Medicine, Attending Physician, University of California Medical Center, San Francisco, California Neurologic Disorders Donald and Patsy Jones Professor of Obstetrics and Gynecology, Division of Gynecologic Oncology, Arthur G James Cancer Hospital and Richard J Solove Research Institute, The Ohio State University College of Medicine, Columbus, Ohio Malignancy and Pregnancy Marie H Beall, MD Robert K Creasy, MD Professor of Obstetrics and Gynecology, Geffen School of Medicine at the University of California, Los Angeles; Vice Chair, Department of Obstetrics and Gynecology, Harbor–University of California, Los Angeles, Medical Center, Torrance, California Professor Emeritus, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas School of Medicine at Houston, Houston, Texas; Corte Madera, California Amniotic Fluid Dynamics Preterm Labor and Birth Intrauterine Growth Restriction Kurt Benirschke, MD Mary E D’Alton, MD, FACOG Professor Emeritus, Reproductive Medicine and Pathology, University of California, San Diego, California Professor and Chair, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York; Chair, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York Normal Early Development Multiple Gestation: The Biology of Twinning Daniel G Blanchard, MD, FACC Professor of Medicine, Director, Cardiology Fellowship Program, University of California, San Diego, School of Medicine, La Jolla, California; Chief of Clinical Cardiology, Thornton Hospital, University of California, San Diego, Medical Center, San Diego, California Cardiac Diseases Multiple Gestation: Clinical Characteristics and Management John M Davison, MD, FRCOG Emeritus Professor of Obstetric Medicine, Institute of Cellular Medicine Medical School, Newcastle University; Consultant Obstetrician, Directorate of Women’s Services, Royal Victoria Infirmary Newcastle upon Tyne, United Kingdom Renal Disorders Kristie Blum, MD Assistant Professor of Medicine, Division of Hematology/Oncology, The Arthur G James Cancer Hospital, The Ohio State University, Columbus, Ohio Malignancy and Pregnancy Jan A Deprest, MD, PhD Professor of Obstetrics and Gynecology, Division of Woman and Child, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium Invasive Fetal Therapy Patrick Catalano, MD Professor, Reproductive Biology, Case Western Reserve University; Chairman, Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio Diabetes in Pregnancy Mitchell P Dombrowski, MD Professor, Wayne State University, School of Medicine; Chief, Department of Obstetrics and Gynecology, St John Hospital and Medical Center, Detroit, Michigan Respiratory Diseases in Pregnancy Christina Chambers, PhD, MPH Associate Professor, Departments of Pediatrics and Family and Preventive Medicine, University of California, San Diego, School of Medicine, La Jolla, California Teratogenesis and Environmental Exposure Edward F Donovan, MD Emeritus, Professor of Pediatrics, University of Cincinnati College of Medicine; Medical Director, Child Policy Research Center, Cincinnati Children’s Hospital Research Foundation, Cincinnati, Ohio Neonatal Morbidities of Prenatal and Perinatal Origin vii viii CONTRIBUTORS Patrick Duff, MD Eduardo Gratacos, MD, PhD Professor and Residency Program Director, Associate Dean for Student Affairs, University of Florida College of Medicine, Gainesville, Florida Professor of Obstetrics; Chair, Department of Obstetrics, Hospital Clinic Barcelona, Barcelona, Spain Invasive Fetal Therapy Maternal and Fetal Infections James M Greenberg, MD Rodney K Edwards, MD, MS Clinician, Phoenix Perinatal Associates, Scottsdale, Arizona Maternal and Fetal Infections Associate Professor of Pediatrics, University of Cincinnati College of Medicine; Director, Division of Neonatology, Cincinnati Children’s Hospital Research Foundation, Cincinnati, Ohio Neonatal Morbidities of Prenatal and Perinatal Origin Doruk Erkan, MD Assistant Professor of Medicine, Wall Medical College of Cornell University; Assistant Attending Physician, Hospital for Special Surgery, New York Presbyterian Hospital, New York, New York Pregnancy and Rheumatic Diseases Jeffrey R Fineman, MD Professor of Pediatrics, Investigator, Cardiovascular Research Institute, University of California, San Francisco Fetal Cardiovascular Physiology Michael Raymond Foley, MD Clinical Professor, University of Arizona Medical School, Department of Obstetrics and Gynecology, Tucson, Arizona; Chief Academic Officer, Designated Institutional Officer, Scottsdale Healthcare System, Scottsdale, Arizona Intensive Care Monitoring of the Critically Ill Pregnant Patient Beth Haberman, MD Assistant Professor of Pediatrics, University of Cincinnati College of Medicine; Medical Director, Regional Center for Newborn Intensive Care, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio Neonatal Morbidities of Prenatal and Perinatal Origin Bruce A Hamilton, PhD Associate Professor, Division of Genetics, Department of Medicine, University of California, San Diego, La Jolla, California Basic Genetics and Patterns of Inheritance Mark Hanson, DPhil Director, Developmental Origins of Health and Disease Division; British Heart Foundation Professor of Cardiovascular Science, University of Southampton, Southampton, United Kingdom Developmental Origins of Health and Disease Edmund F Funai, MD Christopher R Harman, MD Associate Professor of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine; Chief of Obstetrics, Yale–New Haven Hospital; Associate Chair for Clinical Affairs, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut Professor and Vice Chair, Department of Obstetrics, Gynecology, and Reproductive Sciences; Director, Center for Advanced Fetal Care, University of Maryland School of Medicine, Baltimore, Maryland Pregnancy-Related Hypertension Robert Gagnon, MD, FRCSC Professor, Departments of Obstetrics and Gynecology, and Physiology/Pharmacology and Pediatrics, University of Western Ontario, Schulich School of Medicine and Dentistry, London, Ontario, Canada Behavioral State Activity and Fetal Health and Development Alessandro Ghidini, MD Professor, Department of Obstetrics and Gynecology, Georgetown University Medical Center, Washington, D.C.; Executive Medical Director, Perinatal Diagnostic Center, Inova Alexandria Hospital, Alexandria, Virginia Benign Gynecologic Conditions in Pregnancy Larry C Gilstrap III, MD Chair Emeritus, Department of Obstetrics and Gynecology and Reproductive Sciences, University of Texas at Houston Health Science Center, Houston, Texas; Clinical Professor, Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas; Director of Evaluation, American Board of Obstetrics and Gynecology, Dallas, Texas Intrapartum Fetal Surveillance Assessment of Fetal Health Nazli Hossain, MBBS, FCPS Associate Professor, Dow University of Health Sciences, Karachi, Pakistan Embryonic and Fetal Demise Andrew D Hull, MD, FRCOG, FACOG Associate Professor of Clinical Reproductive Medicine; Director, Maternal-Fetal Medicine Fellowship, University of California, San Diego, La Jolla, California; Director, Fetal Care and Genetics Center, University of California, San Diego, Medical Center, San Diego, California Placenta Previa, Placenta Accreta, Abruptio Placentae, and Vasa Previa Jay D Iams, MD Frederick P Zuspan Endowed Chair, Division of Maternal-Fetal Medicine; Vice Chair, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio Preterm Labor and Birth Cervical Insufficiency Thomas M Jenkins, MD Director of Prenatal Diagnosis, Legacy Center for Maternal-Fetal Medicine, Legacy Health System, Portland, Oregon Prenatal Diagnosis of Congenital Disorders CONTRIBUTORS ix Alan H Jobe, MD, PhD Michael D Lockshin, MD Professor of Pediatrics, University of Cincinnati School of Medicine; Director, Perinatal Biology, Cincinnati Children’s Hospital, Cincinnati, Ohio Professor of Medicine and Obstetrics and Gynecology, Weill Medical College of Cornell University; Attending Physician, Hospital for Special Surgery, New York Presbyterian Hospital, New York, New York Fetal Lung Development and Surfactant Pregnancy and Rheumatic Diseases Thomas F Kelly, MD Clinical Professor of Reproductive Medicine, Chief, Division of Perinatal Medicine, University of California, San Diego, School of Medicine, La Jolla, California; Director of Maternity Services, University of California, San Diego, Medical Center, San Diego, California Gastrointestinal Disease in Pregnancy Nahla Khalek, MD Assistant Clinical Professor, Department of Obstetrics and Gynecology, Divisions of Maternal-Fetal Medicine and Reproductive Genetics, Columbia University Medical Center; Assistant Clinical Professor, New York Presbyterian Hospital, Sloane Hospital for Women, New York, New York Prenatal Diagnosis of Congenital Disorders Sarah J Kilpatrick, MD, PhD Professor, Head of the Department of Obstetrics and Gynecology, University of Illinois at Chicago; Vice Dean, University of Illinois College of Medicine, Chicago, Illinois Anemia and Pregnancy Krzysztof M Kuczkowski, MD Associate Professor of Anesthesiology and Reproductive Medicine; Director of Obstetric Anesthesia, Departments of Anesthesiology and Reproductive Medicine, University of California, San Diego, California Anesthetic Considerations for Complicated Pregnancies Robert M Lawrence, MD Clinical Associate Professor, Department of Pediatrics, University of Florida School of Medicine, Gainesville, Florida The Breast and the Physiology of Lactation Ruth A Lawrence, MD Professor of Pediatrics, Obstetrics, and Gynecology, University of Rochester School of Medicine; Chief of Normal Newborn Services, Medical Director, Breastfeeding and Human Lactation Study Center, Golisano Children’s Hospital at Strong Memorial Hospital, Rochester, New York Charles J Lockwood, MD Anita O’Keefe Young Professor and Chair, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut Pathogenesis of Spontaneous Preterm Labor Coagulation Disorders in Pregnancy Thromboembolic Disease in Pregnancy Stephen J Lye, PhD Vice President of Research, Mount Sinai Hospital; Associate Director, Samuel Lunenfeld Research Institute, Toronto, Canada Biology of Parturition Lucy Mackillop, BM BCh, MA, MRCP Senior Registrar in Obstetric Medicine, Queen Charlotte’s and Chelsea Hospital, London, United Kingdom Diseases of the Liver, Biliary System, and Pancreas George A Macones, MD, MSCE Professor and Head, Department of Obstetrics and Gynecology, Washington University School of Medicine in St Louis; Chief of Obstetrics and Gynecology, Barnes-Jewish Hospital, St Louis, Missouri Evidence-Based Practice in Perinatal Medicine Fergal D Malone, MD, FACOG, FRCPI, MRCOG Professor and Chairman, Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland; Chairman, Department of Obstetrics and Gynaecology, the Rotunda Hospital, Dublin, Ireland Multiple Gestation: Clinical Characteristics and Management Frank A Manning, MD, MSc FRCS Professor, Department of Obstetrics and Gynecology, New York Medical College; Professor, Associate Director, Division of MaternalFetal Medicine, Department of Obstetrics and Gynecology, Westchester County Medical Center, Valhalla, New York Imaging in the Diagnosis of Fetal Anomalies The Breast and the Physiology of Lactation Stephanie Rae Martin, DO Liesbeth Lewi, MD, PhD Assistant Professor, Obstetrics and Gynecology, Division of Woman and Child, University Hospitals Katholieke Universiteit Leuven, Leuven, Belgium Invasive Fetal Therapy James H Liu, MD Arthur H Bill Professor and Chair, Department of Reproductive Biology, Case Western Reserve School of Medicine; Chair, University Hospitals, MacDonald Women’s Hospital, Case Medical Center, Cleveland, Ohio Endocrinology of Pregnancy Assistant Medical Director and Section Chief, Pikes Peak MaternalFetal Medicine, Memorial Health System, Colorado Springs, Colorado Intensive Care Monitoring of the Critically Ill Pregnant Patient Brian M Mercer, MD, FRCSC, FACOG Professor of Reproductive Biology, Case Western Reserve University; Director of Obstetrics and Maternal-Fetal Medicine, Vice Chair of Hospitals, Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio Assessment and Induction of Fetal Pulmonary Maturity Premature Rupture of the Membranes 1268 INDEX Potassium excretion, during pregnancy, 106 Power, statistical, 214 Power stroke, in myometrial contraction, 78f PPD (purified protein derivative), 935, 936, 936f pPROM See Preterm premature rupture of the membranes (pPROM) PPT (postpartum thyroiditis), 1009–1011, 1010f PPV (positive predictive value), 214, 215, 215t, 221 PR See Progesterone receptor (PR) entries Prader-Willi syndrome, 30 Prazosin, for chronic hypertension, 678t Preconception counseling with chronic kidney disease, 910, 910t with maternal heart disease, 797–799, 798t Pre-conceptional care, for preterm birth prevention, 572–573 Predictive adaptive response hypothesis, 155 Predictive values, 214–215, 215t, 221 Prednisolone, for induction of fetal pulmonary maturity, 423t Prednisone for asthma, 940t for hyperemesis gravidarum, 1043 for hypopituitarism, 1023 for idiopathic thrombocytopenic purpura, 838 for impetigo herpetiformis, 1130 for induction of fetal pulmonary maturity, 423t for inflammatory bowel disease, 1049 for neonatal alloimmune thrombocytopenia, 841–842 for pemphigoid gestationis, 1129 for renal transplantation, 918 for rheumatic disease, 1081, 1082t Preeclampsia, 653–676 acute renal failure due to, 907–908 anesthesia with, 1147–1149 and cardiovascular disease in later life, 655– 656, 656f clinical presentation of, 656–661, 656t coagulation system changes with, 1148 diabetes and, 961, 961f diagnostic criteria for, 651 edema in, 651, 652f, 1148 epidemiology of, 653–656 excessive weight gain and, 145 factor V Leiden mutation and, 832 fetal heart rate with late decelerations in, 409f no variability of, 408f, 410f fetal loss due to, 624 genetics of, 666 hemodynamics of, 1172 intravascular volume depletion due to, 1147 laboratory findings in, 657–658, 657t liver disease in, 1062, 1063 management of, 666–675 antepartum, 668–671 antihypertensive therapy in, 673, 673t delivery in, 668, 669–670 for disseminated intravascular coagulation, 674 expectant, 669–671 fetal observation in, 669, 671 follow-up assessment in, 675 initial, 669 intrapartum, 671–674, 671t–673t maternal monitoring in, 668–669 for oliguria, 673–674 philosophy of, 666–667 postpartum, 674–675 for pulmonary edema, 674 Preeclampsia (Continued) seizure prophylaxis and treatment in, 671– 673, 671t, 672t therapies no longer recommended for, 675 and maternal mortality, 655 maternal obesity and, 144 with multiple gestation, 460–461, 654 neonatal outcomes with, 1198 oliguria in, 673–674, 1172 pathologic changes in, 658–661 in brain, 658 in kidney, 653, 653t, 658–660, 659f in liver, 658, 658f placental, 661 vascular, 660–661, 660f pathophysiologic change(s) in, 661–667 cardiovascular, 661–662, 662f in coagulation, 662–663 endothelial cell dysfunction as, 663 immunologic and inflammatory, 666, 667 oxidative stress as, 666–667, 675–676 in renal function, 663–666, 664f, 665t and perinatal mortality, 654–655 prevention of, 675–676 prothrombin gene mutation and, 833 pulmonary edema in, 674, 1175 anesthetic considerations with, 1148 recurrence of, 655, 655t with renal transplantation, 919 risk factors for, 653–654 short-term prognosis for, 654–655 signs and symptoms of, 656–657, 656t spectrum of, 653 superimposed on chronic hypertension, 651–652 vs thrombotic thrombocytopenic purpura and hemolytic uremic syndrome, 843, 843t, 908 vascular reactivity due to, 1147–1148 vasospasm in, 1172 Pregnancy as allograft, 87 duration of, 70 ectopic after cesarean delivery, 710 with renal transplantation, 918 with uterine anomalies, 1144t maintenance of early, 114 as prothrombotic state, 855 symptoms and signs of, 103–104 Pregnancy loss, 619–629 with diabetes, 963, 963t embryonic due to endocrine disorders, 620–621 due to genetic abnormalities, 619–620 management of, 627–629, 627t, 628t peri-implantation, 619 recurrent immunologic causes of, 621–622 management of, 627, 627t, 628–629, 628t due to uterine abnormalities, 622, 622t fetal due to antiphospholipid syndrome, 625 after chorionic villus sampling, 255 after cordocentesis, 385, 385t diagnostic considerations for, 626–627, 627t due to endocrine disorders, 620–621 epidemiology of, 622–623 due to fetomaternal hemorrhage, 624 due to genetic abnormalities, 619–620, 623 due to infection, 623–624 due to inherited thrombophilia, 625–626, 625t, 626t, 628, 831–835, 836–837 management of, 627–629, 627t, 628t Pregnancy loss (Continued) medical conditions causing, 624–625 after mid-trimester amniocentesis, 250–251, 250t in multiple gestation, 625 due to placental abruption, 624 recurrent, 626 cervical cerclage for, 592, 592f immunologic causes of, 621–622 management of, 627, 627t, 628–629, 628t due to uterine abnormalities, 622, 622t uterine myomas and, 62, 1136, 1138 due to hypothyroidism, 1001 due to vasa previa, 729 Pregnancy reduction, multifetal, 470–471, 471t Pregnancy registries, on safety of exposures, 349 Pregnancy termination with conjoined twins, 468 and preterm birth, 557 selective of acardiac twin, 434t, 468 of anomalous fetus, 469–470 for TRAP sequence, 439–440 for twin-to-twin transfusion syndrome, 437, 439 Pregnancy-associated plasma protein A (PAPPA), 229 in twins, 257, 459 Pregnancy-induced hypertension See Hypertension; Preeclampsia Pregnancy-Related Mortality Surveillance System, 1167 Preimplantation genetic screening (PGS), 259–261 Preload, fetal, 162 Premature atrial contractions (PACs), 336–337, 337f Premature infants arterial blood gas values for, 403t breastfeeding of, 134 Premature ovarian failure (POF), fragile X syndrome and, 245, 246 Premature rupture of the membranes (PROM), 599–608 clinical course of, 600 complications after, 600–601 defined, 599 diagnosis of, 601–602, 602f epidemiology of, 600 initial evaluation of, 602 management of, 602–607, 603f oxytocin induction after, 604 pathophysiology of, 599–600 prediction and prevention of, 600 preterm See Preterm premature rupture of the membranes (pPROM) risk factors for, 599–600 due to trichomoniasis, 741 Prematurity, 1199–1202 See also Preterm labor and birth defined, 1199 at limit of viability, 1200–1202 Premutation alleles, 29 Prenatal diagnosis, 246–259 amniocentesis for, 247–251 chorionic villus sampling vs., 258–259 complications of, 250 early, 251 historical perspective on, 247 laboratory considerations for, 249–250 with multiple gestation, 257–258, 258t, 459 pregnancy lost after, 250–251, 250t technique of, 247–249, 248f biopsies for, 259 chorionic villus sampling for, 251–256 INDEX Prenatal diagnosis (Continued) accuracy of, 253–255 amniocentesis vs., 258–259 complications of, 255–256 history of, 251–252 laboratory aspects of, 253 with multiple gestation, 258, 258t pregnancy loss after, 255 risk of fetal abnormality after, 256 transabdominal, 252–253, 253f transcervical, 252, 252f, 253 of fragile X syndrome, 246 indication(s) for, 246–247, 247t, 248t maternal age as, 232–233, 233t with multiple gestation, 256–258, 256t–258t of neural tube defects, 235, 236f noninvasive, 261–263 percutaneous umbilical blood sampling for, 259 for Tay-Sachs disease, 241 for β-thalassemia, 244–245 Prenatal screening, 221–246 for acetylcholinesterase, 234–235, 234t cutoff values in, 221, 222t for Down syndrome, 222–233 ADAM 12 in, 230 combined first- and second-trimester, 232 cutoff values in, 222t ductus venosus wave form in, 231 first-trimester impact of spontaneous miscarriages on, 231–232 serum markers in, 229–230, 230t ultrasound markers in, 227–229, 230–231, 230t, 231f human chorionic gonadotropin in, 229–230 likelihood ratios in, 221–222, 222t, 225, 226, 226t maternal age in, 222, 222t, 232–233, 233t nasal bone in, 225, 230–231, 231f, 232 nuchal translucency in, 228, 230 PAPP-A in, 229 in twins, 257, 459 receiver operating curve in, 222f second-trimester serum markers in, 222–225, 224t, 226 ultrasound markers in, 225–226, 225t, 226t serum markers in first-trimester, 229–230, 230t second-trimester, 222–225, 224t, 226 tricuspid regurgitation in, 231 ultrasound markers in first-trimester, 227–229, 230–231, 230t, 231f second-trimester, 225–226, 225t, 226t first-trimester impact of spontaneous miscarriages on, 231–232 serum markers in, 229–230, 230t with twins, 257, 459 ultrasound markers in, 227–229, 228f, 228t, 229f, 230–231, 231f for gene mutations, 238–246 in cystic fibrosis, 238–240, 238t–240t, 242t in fragile X syndrome, 245–246, 246t in hemoglobinopathies, 238t, 243–245, 244t informed consent for, 238 in Jewish population, 238t, 240–243, 241t, 242t recommendations on, 238, 238t goal of, 238 for human chorionic gonadotropin, 223, 224, 229–230 in twins, 257, 257t, 458, 459 Prenatal screening (Continued) ideal test for, 221 likelihood ratios in, 221–222, 222t, 225, 226, 226t maternal age as indication for, 222, 222t, 232– 233, 233t for maternal serum α-fetoprotein, 223, 224, 224t, 233–235, 234t in twins, 257, 257t, 458, 459 with multiple gestation, 256–257, 256t, 257t, 458, 459 for neural tube defects, 233–235, 234t, 236f in twins, 257, 459 for pregnancy-associated plasma protein A, 229 receiver operating curve in, 221, 222f second-trimester serum markers in, 223–224, 224t, 226 with twins, 256–257, 257t, 458–459 ultrasound markers in, 225–227, 225t–228t value of, 236–237, 237t sensitivity and specificity of, 221 serum markers in first-trimester, 229–230, 230t with twins, 257, 459 second-trimester, 223–224, 224t, 226 with twins, 256–257, 257t, 458 for twins, 256–257, 256t, 257t, 458–459 ultrasound markers in first-trimester, 227–229, 228f, 228t, 229f, 230–231, 231f second-trimester, 225–227, 225t–228t value of, 236–237, 237t Prepidil (dinoprostone) for cervical ripening, 702t, 703t for post-term pregnancy, 615, 616 for uterine atony, 1183t Preprandial glucose levels, 975t, 978–979 Presentation(s), abnormal, 703–707 breech as, 703–706, 705t compound, 707 deflection abnormalities as, 706–707 transverse lie as, 706 uterine anomalies and, 1144 uterine myomas and, 1137 Preterm and growth-restricted neonates, defined, 635 Preterm labor and birth, 545–573 See also Prematurity antidepressants and, 1118 body mass index and, 144 and cerebral palsy, 552, 1214–1215, 1216–1217 cigarette smoking and, 356, 356f clinical presentations of, 547–548 in common pathway of parturition, 521–524, 522f, 524f complications of, 1199–1200, 1199t, 1201f, 1201t consequence(s) of, 548–552, 549f–554f, 553t long-term, 551–552, 553f, 554f perinatal and infant mortality as, 548–551, 549f–552f, 1199, 1200f perinatal morbidity as, 551, 552f, 553t defined, 521, 545 diagnosis of, 560–561 incidence of, 521, 545–546, 546f, 547f indicated, 521, 545, 548, 548f, 569 infant morbidity and mortality with, 1199, 1200f interventional strategy(ies) for, 560–567 after acute treatment, 567 antenatal corticosteroids as, 561 antibiotics as, 561 neuroprotectants as, 561 1269 Preterm labor and birth (Continued) primary, 560 to reduce morbidity and mortality, 561 regionalization of care as, 561 secondary, 560 tertiary, 560 tocolytic therapy as, 561–567 calcium channel blockers for, 562–563 choice of agent for, 562 clinical uses of, 566–567 contraindications to, 561 cyclooxygenase inhibitors for, 563–564 goals of, 561–562 magnesium sulfate for, 565–566 nitric oxide donors for, 564–565 oxytocin antagonists for, 564 β-sympathomimetic drugs as, 566 and low birth weight, 545–546 with multiple gestation interventions for, 460 pathogenesis of, 529–531, 531f, 558 rates of, 460, 546, 547f, 558, 559f, 559t pathogenesis of, 521–532 allergic phenomena in, 531 cervical disorders in, 531 genetic factors in, 70 hormonal disorders in, 531–532 infection and inflammation in, 524–527, 525f, 526f, 528f maternal and fetal stress in, 529, 530f mechanisms of, 521–524, 522f, 524f uterine overdistention in, 529–531, 531f uteroplacental vascular disease and decidual hemorrhage in, 527–529, 529f prevention of, 567–573 antibiotics for, 570 cervical cerclage for, 568–569, 571–572 cervical examination for, 568–569 with clinical risk factors, 569–573, 570t, 571f modification of maternal activity for, 569 nutritional supplements for, 567–568, 569, 570t, 572 periodontal care for, 568 before pregnancy, 572–573 progestational agents for, 570–571, 570t, 571f in routine prenatal care, 567–569 screening for, 568–569 smoking cessation for, 568, 572 recurrence of, 556–557, 557t, 572 risk factor(s) for, 552–560 assisted reproductive technologies as, 558 asymptomatic bacteriuria as, 568, 751 bleeding as, 558 cervical length as, 558–560, 559f, 560f cervical surgery as, 557–558 current pregnancy characteristics as, 558– 560, 559f, 559t, 560f educational and economic status as, 554, 554t familial, 553 infections as, 556 maternal behaviors and environment as, 554–555 maternal characteristics as, 553–556, 554t, 555f multiple gestation as, 558, 559f, 559t nutritional status as, 555–556, 555f physical activity as, 555, 569 pregnancy termination as, 557 prior preterm birth as, 556–557, 557t psychological, 555 race and ethnic background as, 551, 552f, 554, 554t, 555f, 557 1270 INDEX Preterm labor and birth (Continued) reproductive history as, 556–558, 557t scoring of, 568 uterine anomalies as, 557 uterine contractions as, 558 uterine volume as, 558 spontaneous, 521, 545, 548, 548f prevention of, 569–572, 570t, 571f as syndrome, 524, 525f with uterine anomalies, 1144t uterine myomas and, 1136, 1136t and viability, 521 Preterm lung, physiologic effects of surfactant on, 200–202, 201f Preterm neonates, defined, 635 Preterm premature rupture of the membranes (pPROM) with cervical cerclage, 594, 606–607 early, 601, 603f, 604–607 epidemiology of, 600 due to fetal inflammatory response syndrome, 527, 528f and fetal pulmonary maturity, 423, 601 after fetoscopic procedures, 435, 435t late, 603f, 604 management of, 602–607, 603f antibiotics for, 209, 209f, 210f, 604, 605–606 corticosteroids for, 604, 605 initial evaluation in, 602 tocolysis for, 606 due to maternal herpes infection, 607 due to microbial invasion of the amniotic cavity, 525 prediction and prevention of, 600 previable, 601, 603f, 607 risk factors for, 599–600 due to uteroplacental vascular disease or decidual hemorrhage, 527–529, 529f Pretest odds, 215 Previable premature rupture of the membranes, 601, 603f, 607 Prezista (darunavir), for HIV infection, 772t Primary biliary cirrhosis, 1069 Primary Care Evaluation of Mental Disorders (PRIME-MD), 1114 Primary immune thrombocytopenic purpura, 837–840 Primary pulmonary hypertension, maternal, 805 anesthesia with, 1158 Primary sclerosing cholangitis (PSC), 1070 Probability value, 212 Probenecid, for gonorrhea, 745 Procainamide, during pregnancy, 801t Procaine penicillin, for syphilis, 781t Professional policies, for preterm birth prevention, 572 Progestational agents, for preterm birth prevention, 570–571, 570t, 571f Progesterone as anti-inflammatory agent, 73 in cervical remodeling, 523 constipation due to, 1052 in control of labor, 73–74 and cortisol, 73–74 and fetal loss, 620–621, 628, 628t and fetoplacental unit, 115 and hyperventilation of pregnancy, 927 in implantation, 111 in pregnancy, 114–115, 114f, 115f, 117 for prevention of preterm labor and birth, 570–571, 570t, 571f with multiple gestation, 460 suspension of action of, preterm labor due to, 531–532 Progesterone blockage, 73 Progesterone dermatitis, autoimmune, 1125 Progesterone receptor A (PR-A), 73 Progesterone receptor (PR) antagonist, 73 Progesterone receptor B (PR-B), 73 Progesterone receptor (PR) cofactors, 73 Progestins during pregnancy, 117 for preterm labor, 532 Proinflammatory cytokines, in preterm labor and birth, 526–527, 526f, 556 Prolactin in breastfeeding, 131, 132f and fetal loss, 621 neurohormonal control of, 1015 during pregnancy, 121–122, 121f, 1015, 1017f Prolactinoma, 1018–1020, 1019f, 1020f, 1020t Prolapsed intervertebral disk, 1104 Proliferative phase, of myometrial remodeling, 522 Prolonged deceleration, in fetal heart rate, 406 Prolonged latent phase, 694–695 Prolonged pregnancy See Post-term pregnancy PROM See Premature rupture of the membranes (PROM) Promethazine for hemolytic disease of the fetus and newborn, 494 for hyperemesis gravidarum, 1043 Promoter sequences, Promotility drugs, for GERD, 1044, 1045f Prone ventilation, for acute respiratory distress syndrome, 1174 Pronucleus, 11f Pro-opiomelanocortin (POMC), 1025 Propafenone, during pregnancy, 801t Prophase, 7–8, 7f Propranolol for chronic hypertension, 678t for thyroid storm, 1003, 1003t Propylthiouracil (PTU), for thyroid storm, 1003, 1003t Prospective cohort study, 208 Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED), 860 Prostacyclin, in preeclampsia, 663 Prostaglandin(s) for cervical ripening, 702t in control of labor, 74–75, 75f in fetal cardiovascular regulation, 166 in fetal heart rate, 398 for induction, with multiple gestation, 461 in labor and delivery, 523–524, 524f and patent ductus arteriosus, 167 during pregnancy, 122 in preterm labor and birth, 526f, 556 as uterine stimulants, 80 Prostaglandin 15-methyl F2α (Hemabate), for uterine atony, 1183t Prostaglandin D2 (PGD2), in control of labor, 74 Prostaglandin dehydrogenase (PGDH), in control of labor, 72 Prostaglandin E1 (PGE1) for cervical ripening, 702–703, 702t, 703t for fetal demise, 627–628 for postpartum hemorrhage, 699 for post-term pregnancy, 616 for uterine atony, 1183t Prostaglandin E2 (PGE2) for cervical ripening, 702t, 703t in control of labor, 74 in fetal cardiovascular regulation, 166 and nausea and vomiting, 1042 Prostaglandin E2 (PGE2) (Continued) and patent ductus arteriosus, 167 for post-term pregnancy, 615, 616 for uterine atony, 1183t Prostaglandin F2α (PGF2α) in control of labor, 74 for postpartum hemorrhage, 698–699 Prostaglandin H synthase (PGHS), in control of labor, 72 Prostaglandin H2 (PGH2), in control of labor, 74 Prostaglandin H2 synthase (PGHS), in control of labor, 74–75 Prostaglandin I2 (PGI2) in control of labor, 74 in fetal cardiovascular regulation, 166 Prostaglandin induction, after premature rupture of the membranes, 604 Prostaglandin inhibitors, for cervical insufficiency, 589 Prostaglandin synthesis inhibitors for preterm labor, 563–564 as uterine relaxants, 81 Prosthetic heart valve, pregnancy with, 819–820, 820t, 864 Protease inhibitors, for HIV infection, 772t Protease-activated receptor type (PAR-1), in preterm labor, 528 Protein(s) in diet, 147 serum, 1059 in surfactant, 198 Protein C (PC) activated in anticoagulant system, 828, 828f for septic shock, 763, 1179 in anticoagulant system, 828, 828f Protein C (PC) deficiency, 831t, 834 and fetal loss, 625, 625t, 626t, 834 and venous thromboembolism, 856t Protein hormones, in placental tissues, 117t Protein S (PS) deficiency, 831t, 834–835 and fetal loss, 625, 625t, 626t, 834–835 and venous thromboembolism, 856t Protein synthesis, 5, 5f Protein Z (PZ), in anticoagulant system, 828, 828f Protein Z (PZ) antigen, and fetal loss, 625t Protein Z (PZ) deficiency, 835 Protein Z–dependent protease inhibitor (ZPI), in anticoagulant system, 828, 828f Protein Z-dependent protease inhibitor (ZPI) deficiency, 835 Proteinuria defined, 651 in preeclampsia, 657, 664, 670 Prothrombin G20201A, 833 and fetal loss, 625, 625t, 626t, 833 Prothrombin gene mutation (PGM), 831t, 833 and venous thromboembolism, 856t Prothrombin time, in abruptio placentae, 733t Prothrombotic state, pregnancy as, 855 Proton pump inhibitors for GERD, 1044–1045, 1044t, 1045f for peptic ulcer disease, 1046 Protraction disorders, 695 Protriptyline (Vivactil), dosage of, 1117t PROWESS (Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis) trial, 1179 Prozac (fluoxetine), dosage of, 1117t PRRs (pattern recognition receptors), 87, 91, 92 in preterm labor, 526 Prurigo gestationis, 1125t, 1126–1127, 1127f Prurigo of pregnancy, 1125t, 1126–1127, 1127f INDEX Pruritic urticarial papules and plaques of pregnancy (PUPPP), 1125t, 1126, 1126f Pruritus gravidarum, 1125–1126, 1125t due to intrahepatic cholestasis of pregnancy, 1061, 1125 PS (protein S) deficiency, 831t, 834–835 and fetal loss, 625, 625t, 626t, 834–835 and venous thromboembolism, 856t PSC (primary sclerosing cholangitis), 1070 Pseudoglandular stage, of fetal lung development, 193, 194f, 194t Pseudohypoparathyroidism, 1035 Pseudomosaicism, 249 Pseudotumor cerebri, 1094–1095 Pseudo–von Willebrand disease (pseudo-vWD), 843–845, 844t, 845t PSF (polypyrimidine tract binding protein– associated splicing factor), 73 Psoriasis, 1132 pustular, 1125t, 1129–1130, 1130f Psoriatic arthritis, 1085 PSV (peak systolic velocity), in fetal middle cerebral artery, 374–375, 374f Psychiatric disorder(s), 1109–1110, 1113–1120 diagnostic criteria for, 1113, 1114t, 1115t epidemiology of, 1113 identification of, 1113–1114 impact on pregnancy outcome of, 1114–1116 treatment of, 1114–1120 clinical approach to, 1118–1119 dosage for, 1116t, 1117t during lactation, 1119–1120 perinatal complications of, 1119 risks of, 1116–1118 Psychological factors, and preterm birth, 555 Psychopharmacologic treatment clinical approach to, 1118–1119 dosages for, 1116t, 1117t during lactation, 1119–1120 perinatal complications of, 1119 risks of, 1116–1118 teratogenicity of, 351t, 353 Psychosis diagnostic criteria for, 1113, 1114t, 1115t epidemiology of, 1113 identification of, 1113–1114 impact on pregnancy outcomes of, 1114–1115 Korsakoff, 1107 treatment of clinical approach to, 1118, 1119 dosages for, 1116t during lactation, 1119–1120 perinatal complications of, 1119 risks of, 1116 Psychotherapeutic medications clinical approach to, 1118–1119 dosages for, 1116t, 1117t during lactation, 1119–1120 perinatal complications of, 1119 risks of, 1116–1118 as teratogens, 351t, 353 Psychotic symptoms, 1113, 1114t, 1115t Psychotropic medications clinical approach to, 1118–1119 dosages for, 1116t, 1117t during lactation, 1119–1120 perinatal complications of, 1119 risks of, 1116–1118 as teratogens, 351t, 353 Psyllium, for constipation, 1052, 1052t PTH (parathyroid hormone), in calcium metabolism, 1032 PTHrP (parathyroid hormone–related protein), 1032, 1032f, 1033f hypercalcemia due to increased production of, 1034 as uterine relaxant, 80 PTHrPR (parathyroid hormone–related protein receptor), in skeletal growth, 297 PTU (propylthiouracil), for thyroid storm, 1003, 1003t Pubertal development, of breast, 127f, 128 Public educational interventions, for preterm birth prevention, 572 Public policies, for preterm birth prevention, 572 PUBS (percutaneous umbilical blood sampling) See Cordocentesis PUD (peptic ulcer disease), 1045–1046, 1045f Pudendal block, for labor and delivery, 716 Puerperal endometritis, 760–761 breastfeeding with, 136t Chlamydia trachomatis and, 747 Puerperal fever, 760–761 PUFA (polyunsaturated fatty acids), for preterm birth prevention, 569, 570t Pulmonary arterial hypertension congenital diaphragmatic hernia and, 441–442 hemodynamics of, 1171 Pulmonary arteriography, for pulmonary embolus, 860–861, 862 Pulmonary artery, fetal echocardiography of, 309, 309f, 314–315, 314f Pulmonary artery catheter (PAC), 1168 complications of, 1169–1170, 1169t hemodynamic variables measured by, 1170, 1170t, 1171t indications for, 1169 insertion of, 1168–1169 Pulmonary atresia with intact ventricular septum, 328, 328f tetralogy of Fallot with, 332, 332f Pulmonary capillary wedge pressure (PCWP) central venous pressure and, 1170, 1170f with hypertension, 1172 with mitral stenosis, 1171 nonpregnant, 1171t during pregnancy, 103t, 1168, 1171t Pulmonary complications, of prematurity, 1199t Pulmonary edema, 1174–1175 colloid osmotic pressure abnormalities and, 1174 hydrostatic or cardiogenic, 1174–1175 in preeclampsia, 674, 1175 anesthetic considerations with, 1148 tocolytic-induced, 1175 Pulmonary embolus (PE) clinical findings with, 858–859 diagnosis and evaluation of, 858–862, 859t, 861f epidemiology of, 855 prevention of, 835–837, 864–865 risk factors for, 855–856, 856t risk score for, 859, 859t treatment of, 862–864, 862t Pulmonary hypertension fetal, congenital diaphragmatic hernia and, 441–442 maternal, 805 anesthesia with, 1158 hemodynamics of, 1171 in neonatal period, 1207 Pulmonary hypoplasia, 196–197, 196t, 1203–1204 with preterm premature rupture of the membranes, 601 1271 Pulmonary stenosis fetal invasive fetal therapy for, 277t, 445, 446t tetralogy of Fallot with, 324f, 331–332, 332f maternal, 806–807, 806f, 807f Pulmonary valve absent, tetralogy of Fallot with, 332–333, 333f fetal echocardiography of, 309, 314 Pulmonary valvuloplasty, fetal, 277t, 445, 446t Pulmonary vascular resistance (PVR) nonpregnant, 1171t during pregnancy, 103t, 1171t Pulmonary veins, fetal echocardiography of, 308f, 311, 312f Pulmonary venous anomalies, 321–322, 321f Pulmonary venous return partial anomalous, 321–322 total anomalous, 321f, 322 Pulse oximetry, fetal, 414–415 Pump twin, 467 PUPPP (pruritic urticarial papules and plaques of pregnancy), 1125t, 1126, 1126f Purified protein derivative (PPD), 935, 936, 936f Purpura, thrombocytopenic idiopathic (primary immune, autoimmune), 837–840 thrombotic, 842–843, 843t acute renal failure due to, 908 Pustular psoriasis, 1125t, 1129–1130, 1130f PVL (periventricular leukomalacia), 1212 chorioamnionitis and, 758–759, 758t PVR (pulmonary vascular resistance) nonpregnant, 1171t during pregnancy, 103t, 1171t Pyelectasis, in Down syndrome, 225 Pyelonephritis acute, 754–756, 906–907 asymptomatic bacteriuria and, 751 diagnosis of, 754–755, 906 epidemiology of, 754 fetal risks from, 906 pathogenesis of, 754 prevention of, 756, 907 signs and symptoms of, 906 treatment of, 755–756, 755t, 756t, 906–907 chronic, 913 Pygopagus, 468 Pyloric stenosis, 27, 27t, 28 Pyogenic granuloma, 1124 Pyomyoma, 1138 Pyrazinamide, for tuberculosis, 937t Pyridoxine for HIV infection, 771 for tuberculosis, 936 Pyrimethamine, for toxoplasmosis, 783 Pyuria, 905 PZ See Protein Z (PZ) Q Q bands, 12 q region, 12, 12f QRNG (quinolone-resistant Neisseria gonorrhoeae), 745 Quad screen, for Down syndrome, 223 Quadrivalent, 17, 18f Qualitative traits, 26 Quantitative traits, 26 Queenan curve, to monitor Rh-immunized pregnancies, 483–484, 484f Quetiapine (Seroquel), dosage of, 1116t Quinidine, during pregnancy, 801t Quinolone-resistant Neisseria gonorrhoeae (QRNG), 745 1272 INDEX Quintero staging system, for twin-to-twin transfusion syndrome, 436, 436t Quinupristin/dalfopristin, for mastitis, 764 QUOROM statement, 210 R R bands, 12 RAAS (renin-angiotensin-aldosterone system), in preeclampsia, 664–665, 664f Racial differences in fetal loss, 622 in fetal pulmonary maturity, 421 in preeclampsia and eclampsia, 654 in preterm birth, 551, 552f, 554, 554t, 555f, 557 Radial aplasia, 299 Radiation exposure teratogenicity of, 354 for trauma patients, 1186, 1186t Radiation therapy for breast cancer, 893–894 for cervical cancer, 888, 889, 890 for Hodgkin lymphoma, 898–899 for non-Hodgkin lymphoma, 898–899 during pregnancy, 890 Radical trachelectomy, for cervical cancer, 889 Radioactive compounds, while breastfeeding, 139t, 140 Radiographic imaging, during pregnancy, 889– 890, 890t Radioiodine goiter due to, 1007 and gonadal function, 1001 RADIUS (Routine Antenatal Diagnostic Imaging with Ultrasound) study, 236, 615 Random error, 210, 211–213, 212t, 213t Randomized clinical trial, 208–209 Ranitidine, for peptic ulcer disease, 1046 Rapid eye movement (REM) sleep, fetal, 171, 173–174, 176, 176t Rapid plasma reagin (RPR) test, 779 Rapid postnatal growth hypothesis, and developmental origins of health and disease, 153 RAS See Renin-angiotensin system (RAS) Rash(es), 1124–1130, 1125t atopic eruption of pregnancy (prurigo gestationis) as, 1125t, 1126–1127, 1127f autoimmune progesterone dermatitis as, 1125t, 1130 general treatment of, 1125 impetigo herpetiformis as, 1125t, 1129–1130, 1130f pemphigoid gestationis (herpes gestationis) as, 1125t, 1127–1129, 1128f, 1129f pruritic urticarial papules and plaques of pregnancy as, 1125t, 1126, 1126f pruritus gravidarum as, 1125–1126, 1125t RASTER (First- and Second-Trimester Evaluation of Risk) study, 567 RB(s) (reticulate bodies), of Chlamydia, 93f, 95f, 747 RBCs See Red blood cell(s) (RBCs) RdD pseudogene, 479 RDS See Respiratory distress syndrome (RDS) Recall bias, 211 Receiver operating characteristic (ROC) curves, 216–217, 216f, 221, 222f Recessive trait, 22 Reciprocal translocation, 16–17, 18f Recombinant factor VIIa (rFVIIa, NovoSeven), for obstetric hemorrhage, 1182, 1183t Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) trial, 1179 Recombinant human erythropoietin (rHuEPO), 917 Recurrence risk, 25–26, 27, 27t Red blood cell(s) (RBCs) in anemia, 869 for intrauterine transfusion, 491–492 packed for abruptio placentae, 733t for hemorrhagic shock, 1181, 1181t Red blood cell (RBC) count, in anemia, 870t Red blood cell genotype determination, fetal, 262 Red blood cell mass, during pregnancy, 101 Red blood cell morphology, in abruptio placentae, 733t Red blood cell (RBC)-saving devices, 1182 Red blood cell (RBC) volume, in anemia, 870– 871, 871f Red cell alloimmunization, 477–479 See also Hemolytic disease of the fetus and newborn (HDFN) Red cell isoimmunization, 477 Reduction mammoplasty, breastfeeding after, 126, 132 REDV (reverse end-diastolic velocities) in middle cerebral artery, 375 in umbilical artery, 372, 373–374, 374f Reflex late decelerations, in fetal heart rate, 408– 409, 409f Reflux nephropathy, 913, 916t Regional anesthesia for cesarean delivery, 712–713 for placenta previa, 727–728 Regression to the mean, 26 Reinversion, of uterus, 699 Relative risk, 212 Relaxin for cervical ripening, 702t in pregnancy, 118f, 121 as uterine relaxant, 80 REM (rapid eye movement) sleep, fetal, 171, 173–174, 176, 176t Remicade (infliximab) for inflammatory bowel disease, 1049 for rheumatic disease, 1081, 1082t Renal agenesis, 295, 295f Renal anomalies, and aneuploidy, 227t Renal biopsy, 912 Renal blood flow, during pregnancy, 102, 105 Renal calculi, 913, 916t Renal cortical necrosis, acute, 908–909 Renal dialysis for diabetic nephropathy, 960 hemo-, 915–917, 916t peritoneal, 917–918 Renal disorder(s), 905–921 acute fatty liver of pregnancy as, 909 acute renal cortical necrosis as, 908–909 acute renal failure as, 907–909, 907t acute renal obstruction as, 909 autosomal dominant polycystic kidney disease as, 913, 916t chronic kidney disease as, 910–912, 910t, 911t diabetic nephropathy as, 913–914, 916t effect of pregnancy on, 915, 916t factors affecting prognosis for, 915, 916t focal glomerular sclerosis as, 916t glomerulonephritis as, 912, 916t hemodialysis for, 915–917, 916t in hemolytic uremic syndrome and thrombotic thrombocytopenic purpura, 908 HIV-associated nephropathy as, 915 Renal disorder(s) (Continued) IgA nephropathy as, 916t nephrotic syndrome as, 915 due to nephrotoxic drugs, 909 in periarteritis nodosa, 914, 916t peritoneal dialysis for, 917–918 in preeclampsia, 907–908 due to previous urinary tract surgery, 914–915, 916t pyelonephritis as acute, 906–907 chronic, 913, 916t reflux nephropathy as, 913, 916t renal transplantation for, 918–921, 918t solitary kidney as, 909, 915, 916t in systemic lupus erythematosus, 914, 916t in systemic sclerosis (scleroderma), 914, 916t tubulointerstitial disease as, 913, 916t urinary tract infection as, 905–907 urolithiasis as, 913, 916t in Wegener granulomatosis, 914 Renal failure acute, 907–909, 907t anemia in, 881–882 Renal function in preeclampsia, 657, 657t, 663–666, 664f, 665t during pregnancy, 105–106, 910 Renal insufficiency, anemia due to, 917 Renal obstruction, acute, 909 Renal pathology, in preeclampsia, 653, 653t, 658– 660, 659f Renal plasma flow, during pregnancy, 102, 105 Renal transplantation, 918–921, 918t for diabetic nephropathy, 960–961 Renal tubular function in preeclampsia, 664–666, 664f, 665t during pregnancy, 106–107, 106f Renin physiology of, 1025 during pregnancy, 1026 Renin-angiotensin system (RAS), 1025 in fetal cardiovascular regulation, 165–167 in fetal heart rate, 398 in preeclampsia, 664–665, 664f Renin-angiotensin-aldosterone system (RAAS), in preeclampsia, 664–665, 664f Replication, 5, 5f errors in, 5–6, 6f Replicative segregation, 29 Reproductive history, and preterm birth, 556– 558, 557t Reproductive tract, during pregnancy, 69 REPROTOX, 350 Rescriptor (delavirdine), for HIV infection, 772t Research, clinical, 207–217 importance of, 207 on screening and diagnosis in, 214–217, 215t, 216f sources of error in, 210–214, 212t, 213t types of studies in, 207–210, 208t, 209f, 210f Reserpine, for chronic hypertension, 678t Residual volume, during pregnancy, 105t, 927 Respiratory acidemia, 401, 401t Respiratory acidosis, 401 Respiratory alkalosis, 401 during pregnancy, 104, 927 “Respiratory arrhythmia,” 368f Respiratory disease(s), 927–948 anesthesia with, 1150–1152 asthma as, 937–945 breastfeeding with, 945 classification of, 938, 938t diagnosis of, 938 effects of pregnancy on, 938 INDEX Respiratory disease(s) (Continued) effects on pregnancy of, 938–939, 939t management of, 939–945 antenatal, 942–945, 943t, 944t assessment and monitoring in, 939–940 avoiding or controlling asthma triggers in, 940 exacerbated by allergic rhinitis, 942 during labor and delivery, 943–945 patient education in, 940 pharmacologic therapy in, 940–942, 940t, 941t overview during pregnancy of, 945 cystic fibrosis as, 946–948 pneumonia as, 929–934 aspiration, 930 bacterial, 930–932, 931f bacteriology of, 930 epidemiology of, 929–930 with HIV infection, 933–934, 934f viral, 932–933, 933f restrictive, 945–946 sarcoidosis as, 945–946 tuberculosis as, 934–937 diagnosis of, 935–936, 935f, 935t epidemiology of, 934 multidrug-resistant, 934–935 prevention of, 936, 936f treatment of, 936–937, 937t Respiratory distress syndrome (RDS), 419 adult (acute), 1174 with acute pyelonephritis, 755 chorioamnionitis and, 758, 759 clinical presentation of, 1204 complications of, 1204–1205 continuous positive airway pressure for, 1204 in infants of diabetic mothers, 967–968, 968f management of, 1204, 1205 mechanical ventilation for, 1204 in neonatal period, 1203f, 1204–1205 perinatal risk factors for, 1204 prematurity and, 1201t after preterm premature rupture of the membranes, 605 surfactant for, 202, 202f, 1204 surfactant in, 200, 201f Respiratory factors, affecting fetal acid-base balance, 401 Respiratory failure, 1173–1175, 1173t Respiratory gas exchange, placental, 181–187 Respiratory papillomatosis, 748–749 Respiratory problem(s), in neonatal period, 1202–1207 bronchopulmonary dysplasia as, 1205–1206, 1206f, 1206t after cesarean delivery, 710 meconium aspiration syndrome as, 1206–1207 pulmonary hypertension as, 1207 pulmonary hypoplasia as, 1203–1204 respiratory distress syndrome as, 1204–1205 transient tachypnea of the newborn as, 1202– 1203, 1203f Respiratory rate, during pregnancy, 104 Respiratory system, during pregnancy, 104–105, 105t, 927–928 Restless legs syndrome, 1102 Restriction enzymes, 31–32, 31f Restriction fragment length polymorphisms (RFLPs), 30, 30f, 33 Restrictive lung disease, 945–946 Retained placenta, 698 Reticulate bodies (RBs), of Chlamydia, 93f, 95f, 747 Reticulocyte count, in anemia, 869, 870t Retinal changes, in preeclampsia, 657 Retinoids, as teratogens, 348, 351t, 353–354 Retinol, as teratogen, 353 Retinopathy diabetic, 958 of prematurity, 1201t Retrobulbar neuropathy, 1107 Retrospective cohort study, 208 Retrospective secondary analysis of prospectively collected data, 208 Retrovir (zidovudine), for HIV infection, 771, 772t, 773 Reverse dot-blot analysis, 31, 31f Reverse end-diastolic velocities (REDV) in middle cerebral artery, 375 in umbilical artery, 372, 373–374, 374f Reverse transcriptase inhibitors, for HIV infection, 772t Reverse transcription, Reverse triiodothyronine (reverse T3), 995, 996f Reyataz (atazanavir), for HIV infection, 772t RFLPs (restriction fragment length polymorphisms), 30, 30f, 33 rFVIIa (recombinant factor VIIa), for obstetric hemorrhage, 1182, 1183t Rh alloimmunization See Rhesus (Rh) alloimmunization Rh (rhesus) blood group, prenatal determination of, 262 Rh gene locus, 479, 479f Rhabdomyoma, cardiac, 335, 335f RhC antigen, 496 Rhc antigen, 496 RHCE gene, 479, 479f RhD (rhesus D) antibody, 477, 478 maternal titer of, 481 RhD gene, 479, 479f RhE antigen, 496 Rhe antigen, 496 Rhesus (Rh) alloimmunization, 477–495 due to amniocentesis, 250 clinical management of, 486–495 chemotherapeutic agents for, 494–495 in first affected pregnancy, 486–488, 487f intrauterine transfusion for, 488–493 access site for, 488 adjunctive measures with, 491 amount of, 490, 490t method of, 488–490, 490f outcome of, 492–493 with severely anemic early-secondtrimester fetus, 491 source of red blood cells in, 491–492 timing of, 492 intravenous immune globulin for, 493–494 nasal tolerance for, 495 oral tolerance for, 494 plasmapheresis for, 493, 494 with previously affected fetus or infant, 488, 489f sensitization to paternal leukocyte antigens for, 495 due to cordocentesis, 386 diagnosis of, 481–483 fetal blood typing through genetics for, 481– 483, 482f–484f, 482t in vitro tests for, 481 maternal antibody determination for, 481 genetics of, 479, 479f historical perspectives on, 477 incidence of, 478, 478f neonatal outcomes with, 1199 due to non-RhD antibodies, 496, 497t pathophysiology of, 478–479 1273 Rhesus (Rh) alloimmunization (Continued) prevention of, 479–481 sinusoidal fetal heart rate due to, 410–413, 412f terminology for, 477 Rhesus (Rh) blood group, prenatal determination of, 262 Rhesus D (RhD) antibody, 477, 478 maternal titer of, 481 Rhesus immune globulin (RhIG), 478, 479–481 for idiopathic thrombocytopenic purpura, 839 Rheumatic disease(s), 1079–1086 antiphospholipid syndrome as, 1080t, 1083– 1084, 1083f, 1084t diagnosis of, 1080–1081, 1080t epidemiology of, 1079 juvenile arthritis as, 1080t management and prevention of, 1081, 1082t pathogenesis of, 1079–1080 pregnancy management with, 1085–1086, 1086t rheumatoid arthritis as, 1080t, 1084–1085 scleroderma as, 1080t, 1085 Sjögren syndrome as, 1085 spondyloarthropathy as, 1080t, 1085 systemic lupus erythematosus as, 1080t, 1081–1083 Takayasu arteritis as, 1080t, 1085 Rheumatic fever, maternal, 810 Rheumatic heart disease, maternal, 810–812, 811f Rheumatoid arthritis, 1084–1085 diagnosis of, 1080, 1080t epidemiology of, 1079 fertility with, 1081 labor and delivery with, 1084–1085 pathogenesis of, 1079 pregnancy loss with, 1084 RhG antigen, 496 RhIG (rhesus immune globulin), 478, 479–481 for idiopathic thrombocytopenic purpura, 839 Rhinitis, asthma exacerbated by, 942 RhoGAM, 479–480 Rhophylac, 480 rHuEPO (recombinant human erythropoietin), 917 Ribavirin, for hepatitis C virus, 1068 Ribonucleic acid (RNA), messenger, 5, 5f translation of, 5, 5f Rifampin, for tuberculosis, 937, 937t Right ventricle double-outlet, 333 fetal echocardiography of, 313, 313f Right ventricular outflow tract (RVOT), fetal echocardiography of, 309 Right-to-left shunt anesthesia with, 1157–1158 without pulmonary hypertension, 807–808, 807f, 808f Ring chromosome, 15, 16f Ringer’s lactate, for burns, 1187 Risk assessments, teratogenic, 350–351, 350t Risk difference, 212 Risperidone (Risperdal), dosage of, 1116t Ritodrine, for preterm labor, 566 Ritonavir (Norvir), for HIV infection, 772, 772t RNA (ribonucleic acid), messenger, 5, 5f translation of, 5, 5f Robertson, W R B., 17 Robertsonian translocation, 17–18, 18f, 19f Down syndrome due to, 247, 247t ROC (receiver operating characteristic) curves, 216–217, 216f, 221, 222f 1274 INDEX Root lesions, 1104 Rotation, during labor and delivery, 693 abnormalities of, 696–697 Route of administration, of teratogens, 348 Routine Antenatal Diagnostic Imaging with Ultrasound (RADIUS) study, 236, 615 Roux-en-Y procedure, 1051, 1051t RPR (rapid plasma reagin) test, 779 RU-486 (mifepristone), 73 for cervical ripening, 702t Rubella, 775–776, 1100 intrauterine growth restriction due to, 638 in newborn period, 1219 as teratogen, 347, 799 Rubella vaccine, 776 Rubeola, 776–777 Rupture of the membranes See also Abruptio placentae physiology of, 599–600 premature See Premature rupture of the membranes (PROM) spontaneous, 599 RVOT (right ventricular outflow tract), fetal echocardiography of, 309 S S antigen, 498 s antigen, 498 S phase, 7, 7f S/A ratio See Surfactant/albumin (S/A) ratio Saccular aneurysms, intracranial, 1097–1098, 1098f Saccular stage, of fetal lung development, 194– 195, 194f, 194t, 195f Sacrococcygeal teratoma hydrops fetalis due to, 509 invasive fetal therapy for, 434t Saddle block, for labor and delivery, 716 Salmeterol, for asthma, 940t, 941 Saltatory fetal heart rate, 413, 413f Sample size, 213–214 Saphenous nerve palsy, 1106 SAPS (Simplified Acute Physiologic Score), 1167 Saquinavir (Invirase, Fortovase), for HIV infection, 772t Sarcoidosis, 945–946 Sarcopenia, 177 SCA (sickle cell anemia), 878t, 879–880, 880t Schilling test, 872 Schizoaffective disorder diagnostic criteria for, 1113, 1115t epidemiology of, 1113 impact on pregnancy outcomes of, 1115 treatment of clinical approach to, 1118, 1119 dosage for, 1116t during lactation, 1119–1120 perinatal complications of, 1119 risks of, 1116 Schizophrenia diagnostic criteria for, 1113, 1114t, 1115t epidemiology of, 1113 identification of, 1113 impact on pregnancy outcomes of, 1114–1115 treatment of clinical approach to, 1118, 1119 dosage for, 1116t during lactation, 1119–1120 perinatal complications of, 1119 risks of, 1116 Schlusskoagulum, 37 Scianna antigen, 495t Sciatic nerve palsy, 1105, 1106 Scleroderma, 1085 diagnosis of, 1080, 1080t epidemiology of, 1079 fertility with, 1081 renal, 914, 916t, 1085 Sclerosing cholangitis, primary, 1070 Sclerotherapy, for hemorrhoids, 1053 Scottish Pregnancy Intervention (SPIN) study, 628 SCPE (Surveillance of Cerebral Palsy in Europe) Collaborative Group, 1215 Screening carrier, 238–246 for cystic fibrosis, 238–240, 238t–240t, 242t for fragile X syndrome, 245–246, 246t for hemoglobinopathies, 238t, 243–245, 244t informed consent for, 238 in Jewish population, 238t, 240–243, 241t, 242t recommendations on, 238, 238t for congenital heart disease, 306–310 background of, 306–307 technique of, 307–309, 307f–309f with three-dimensional imaging, 307, 309–310 defined, 214 preimplantation genetic, 259–261 prenatal See Prenatal screening successful program for, 214 Screening tests assessing research on, 214–217, 215t, 216f defined, 214 Secundum atrial septal defect, 322 Sedatives, for labor and delivery, 715 Segregation, 22, 23f Seizure(s) due to perinatal stroke, 1213, 1213f in preeclampsia, 671–673, 671t, 672t, 674 Seizure disorders, maternal, 1089–1092 effect of pregnancy on, 1089–1090 effect on fetus and neonate of, 1090–1091 effect on pregnancy and lactation of, 1090 epidemiology of, 1089 general therapeutic approaches to, 1091–1092 L-selectin, in implantation, 113t Selection bias, 211 Selective serotonin reuptake inhibitors (SSRIs) dosage of, 1117t perinatal complications of, 1119 as teratogens, 351t, 353, 1118 Selective termination of acardiac twin, 434t, 468 of anomalous fetus, 469–470 for TRAP sequence, 439–440 for twin-to-twin transfusion syndrome, 437, 439 Selegiline (Emsam), dosage of, 1117t Sella turcica, 1015 Semilunar valves, fetal echocardiography of, 309, 314 Senna, for constipation, 1052t Sense strand, Sensitivity, 214, 221 Sentinel lesions, in cerebral palsy, 1216 Sentinel lymph node biopsy, for breast cancer, 892 Sepsis, 1175–1179 due to burns, 1187–1188 clinical manifestations of, 1176, 1177t definitions for, 1175–1176, 1176t epidemiology of, 1175 management of, 1176–1179, 1178t pathophysiology of, 1176, 1177f severe, 1176t Septal defects, 313–314, 322–324, 323f, 324f Septal hypertrophy, in infants of diabetic mothers, 967 Septate uterus, 1143, 1144, 1144t and pregnancy loss, 622t Septic pelvic vein thrombophlebitis, 763–764 Septic shock, 762–763, 1175–1179 clinical manifestations of, 1176, 1177t cold (late), 1176, 1177t definitions for, 1175–1176, 1176t epidemiology of, 1175 hemodynamics of, 1172–1173 hemostatic mechanisms in, 1176, 1177f management of, 1176–1179, 1178t pathophysiology of, 1176, 1177f secondary (irreversible), 1176, 1177t warm (early), 1176, 1177t Septostomy, for twin-to-twin transfusion syndrome, 437, 465 Sequential testing, for Down syndrome, 232 Serial reduction amniocentesis, for twin-to-twin transfusion syndrome, 465–466 Seroquel (quetiapine), dosage of, 1116t Serotonin-norepinephrine reuptake inhibitors (SNRIs), dosage of, 1117t Sertoli-Leydig cell tumors, 886, 1032 Sertraline (Zoloft), dosage of, 1117t Serum screening for adnexal masses, 1140–1141 first-trimester, 229–230, 230t with twins, 257, 459 second-trimester, 223–224, 224t, 226 with twins, 256–257, 257t, 458–459 “7-3” rule, for fluid resuscitation, 763 Sex chromosomes, 7, 19 abnormalities of, 19–20, 20t Sex cord–stromal tumors, 886 Sex determination, prenatal, 262 Sex differences in fetal pulmonary maturity, 421 in meiosis, 9–10, 10f, 11f Sex-linked inheritance, 24–25, 25f Sexual intercourse, for cervical ripening, 702t Sexually transmitted infections in neonatal period, 1219–1220 and preterm birth, 556 SGA infant See Small-for-gestational-age (SGA) infant Shake test, 420 Sheehan syndrome, 1022–1023, 1096 Shingles, 783–784 Shirodkar cerclage, 590, 590f, 593 Shock, 1175–1184 hemorrhagic, 1179–1184 clinical staging of, 1180, 1180t incidence and etiology of, 1179–1180 management of, 1180–1184 additional supportive measures in, 1182 hemostasis in, 1182–1184, 1183t, 1184f volume replacement in, 1180–1182, 1180t–1182t septic, 762–763, 1175–1179 clinical manifestations of, 1176, 1177t cold (late), 1176, 1177t definitions for, 1175–1176, 1176t epidemiology of, 1175 hemodynamics of, 1172–1173 hemostatic mechanisms in, 1176, 1177f management of, 1176–1179, 1178t pathophysiology of, 1176, 1177f secondary (irreversible), 1176, 1177t warm (early), 1176, 1177t Short arm, 12, 12f Short tandem repeats, 33 INDEX Shoulder dystocia, 697–698 diabetes and, 966–967, 966f, 984 umbilical cord acid-base balance with, 405 Shoulder presentation, 706 Sickle cell anemia (SCA), 878t, 879–880, 880t Sickle cell disease, carrier screening for, 238t, 243 Sickle cell trait, 878–879, 878t Sickle cell–hemoglobin C disease, 878t, 880–881 Sickle thalassemias, carrier screening for, 243 “Significance,” 212 Silent mutations, 5f Silent substitutions, Simethicone, for GERD, 1044t Simple diffusion, 50 Simple sequence repeat length polymorphisms (SSLPs), 31, 32, 33 Simple sequence repeats, 33 Simplified Acute Physiologic Score (SAPS), 1167 Simpson, James, 715 Sinequan (doxepin), dosage of, 1117t Single gene disorders, noninvasive diagnosis of, 262 Single nucleotide polymorphisms (SNPs), 3, 31, 32, 33 Single-gene traits, 22 Singulair (montelukast), for asthma, 940t, 942 Sinus bradycardia, in fetus, 338 Sinus rhythm, fetal, 336, 337f Sinus venosus atrial septal defects, 321, 322 Sinusitis, asthma exacerbated by, 942 Sinusoidal fetal heart rate, 410–413, 412f Sirenomelia, 60 SIRS (systemic inflammatory response syndrome), 1175 Sister chromatids, 7, 7f Sjögren syndrome, 1085 Skeletal anomalies, 297–299, 298t Skeletal dysplasia, 297–299, 298t Skeletal growth, 297 Skin biopsy, fetal, 259 Skin changes, induced by pregnancy, 1123–1124 Skin disorder(s), 1124–1132 affected by pregnancy, 1130–1132, 1131t acne as, 1131 atopic dermatitis as, 1131 erythema nodosum as, 1131 Fox-Fordyce disease as, 1132 genodermatoses as, 1132 psoriasis as, 1132 with prematurity, 1199t specific to pregnancy, 1124–1130, 1125t atopic eruption of pregnancy (prurigo gestationis) as, 1125t, 1126–1127, 1127f autoimmune progesterone dermatitis as, 1125t, 1130 general treatment of, 1125 impetigo herpetiformis as, 1125t, 1129–1130, 1130f pemphigoid gestationis (herpes gestationis) as, 1125t, 1127–1129, 1128f, 1129f pruritic urticarial papules and plaques of pregnancy as, 1125t, 1126, 1126f pruritus gravidarum as, 1125–1126, 1125t Skin edema, due to nonimmune hydrops, 507, 507f Skin tags, 1124 SLE See Systemic lupus erythematosus (SLE) Sleep state activity, fetal, 171–174 animal studies of, 171–172, 172f and brain development, 176, 176t developmental changes in, 173–174, 173t effect of hypoxia and intrauterine growth restriction on, 174, 174f human studies of, 172–173, 173f Sleep-wake cycle, in fetus, 364–364, 364f Small bowel obstruction, 292, 292f Small bowel wireless capsule endoscopy, 1053 Small intestine, in pregnancy, 1041 Small-for-gestational-age (SGA) infant antidepressants and, 1118 and cerebral palsy, 1215 defined, 635 inadequate weight gain and, 145 maternal obesity and, 144 with post-term pregnancy, 614 Smellie, William, 713 Smith-Lemli-Opitz syndrome, 224 Smoke inhalation injury, 1187 Smoking See Cigarette smoking Smoking cessation, for preterm labor prevention, 568, 572 SNPs (single nucleotide polymorphisms), 3, 31, 32, 33 SNRIs (serotonin-norepinephrine reuptake inhibitors), dosage of, 1117t Social and illicit drugs, as teratogens, 351t, 354– 356, 354f–356f Socioeconomic status and preeclampsia and eclampsia, 654 and preterm birth, 554 Sodium dicloxacillin, for mastitis, 764 Sodium excretion, during pregnancy, 106 Sodium ferric gluconate, for iron deficiency anemia, 873, 874 Sodium nitroprusside for preeclampsia, 673t, 675 during pregnancy, 801t Sodium restriction, for preeclampsia, 675 Sodium retention, in preeclampsia, 665–666, 665t Soft fibromas, 1124 Solenoids, Somatic support, 1189–1190, 1189t Somatomedin-C in acromegaly, 1020 during pregnancy, 1016 Somatostatin, in neurohormonal control, 1015 Somatostatin analogues, for acromegaly, 1021 Sorbitol, for constipation, 1052, 1052t Sore nipples, 134 Sotalol, during pregnancy, 801t Source control, for septic shock, 1178 Southampton Women’s Survey, 153 Southern blotting, 30, 31–32, 31f SP-A (surfactant protein A), 198, 199f Spastic diplegia, 1212 SP-B (surfactant protein B), 198, 199f SP-C (surfactant protein C), 198, 199f SP-D (surfactant protein D), 198, 199f Species specificity, of teratogens, 348 Specificity, 214, 221 Spectinomycin, for gonorrhea, 745, 745t Spectral Doppler evaluation, of fetal arrhythmias, 336, 337f Spectral karyotyping, 13–14, 14f Spectrum of outcomes, of teratogenic exposure, 348–349 Spermatid, 10f Spermatocytes, 9, 10f Spermatogenesis, 9, 10f Spermatogonia, 9, 10f Spermatozoa, 10f Spherocytosis, hereditary, 874 Spider angioma, 1123 SPIN (Scottish Pregnancy Intervention) study, 628 Spina bifida, 281–282, 283f Spinal abnormalities, anesthesia with, 1160–1161 1275 Spinal anesthesia for cesarean delivery, 712 for labor and delivery, 716 Spinal arteriovenous fistulas, 1099 Spinal cord injury, 1103–1104 anesthesia with, 1149–1150 Spinal muscular atrophy, prenatal diagnosis of, 248t Spinal root lesions, 1104 Spinal surgery, anesthesia with previous, 1160–1161 Spinal vascular anomalies, 1099 Spiral arteries, in preeclampsia, 660, 660f, 661 Spiral artery vasculopathy, preterm labor due to, 527, 529f Splenectomy, for idiopathic thrombocytopenic purpura, 838–839 Splenic artery aneurysm, 1071 Splenic perimeter, in Rh-immunized pregnancy, 485 Splicing, 5, 5f Spondylitis, ankylosing, 1085 Spondyloarthropathy, 1085 diagnosis of, 1080, 1080t epidemiology of, 1079 fertility with, 1081 pathogenesis of, 1079 Spontaneous abortion chromosomal abnormalities in, 21, 21t, 22, 22t and first-semester screening, 231–232 with uterine anomalies, 1144t uterine myomas and, 1136, 1138 Spontaneous rupture of the membranes (SROM), 599 SSLPs (simple sequence repeat length polymorphisms), 31, 32, 33 SSRIs (selective serotonin reuptake inhibitors) dosage of, 1117t perinatal complications of, 1119 as teratogens, 351t, 353, 1118 ST analysis (STAN), of fetal electrocardiography, 415 Stab wounds, 1186 Staphylococcus aureus breastfeeding with, 137t pneumonia due to, 930 Staphylococcus infection, breastfeeding with, 135 Stations, of labor and delivery, 696t Status epilepticus, 1090 Stavudine (d4T, Zerit), for HIV infection, 772t Steroids See Corticosteroid(s) Stillbirth See also Pregnancy loss chromosome abnormalities in, 21 epidemiology of, 622–623 genetic evaluation of, 263 maternal obesity and, 144–145 with multiple gestation, 453, 454f, 461 preeclampsia and, 654 recurrent, 626 Stimulant laxatives, for constipation, 1052, 1052t Stomach, in pregnancy, 1041 STOX1, in preeclampsia, 667 Stratified analysis, 213, 213t Streptococcal pneumonia, 930, 931–932, 931f Streptococcus infection, breastfeeding with, 135, 136t, 137t Streptococcus pneumoniae, pneumonia due to, 930, 931–932, 931f Streptococcus pyogenes See Group B Streptococcus (GBS) infection Streptomycin as teratogen, 351t for tuberculosis, 937t 1276 INDEX Stress, maternal and fetal, preterm labor and birth due to, 529, 530f, 555 Stretch, myometrial, preterm labor due to, 529– 531, 531f Stretch marks, 1124 Striae, 1124 Stripping of membranes, for cervical ripening, 702t Stroke maternal, 1095–1096, 1095f–1097f perinatal, 1213–1214, 1213f Stroke volume with multiple gestation, 455 during pregnancy, 102, 102f Stromelysin-3, 43 Student t test, 213 Study design, 207–210, 208t, 209f, 210f Subarachnoid hemorrhage fetal due to idiopathic thrombocytopenic purpura, 839 due to neonatal alloimmune thrombocytopenia, 840, 841–842 maternal, 1096–1098, 1097f, 1098f anesthesia with, 1150 Subarterial ventricular septal defects, 324 Subcostal angle, during pregnancy, 927 Subpubic arch, in labor, 693 Substance abuse anesthesia with, 1161–1162 neonatal outcomes with, 1199 and pregnancy loss, 626–627 and preterm birth, 554–555 while breastfeeding, 139t, 140 Sucralfate for GERD, 1044t, 1045f for peptic ulcer disease, 1046 Sulfadiazine, for toxoplasmosis, 783 Sulfatase deficiency, 117 Sulfisoxazole, for asymptomatic bacteriuria and acute cystitis, 752t Sulfsasalazine, for inflammatory bowel disease, 1049 Summary estimate, 209, 209f, 210f Sun exposure, avoidance of, 1124 Superfecundation, 56 Superior sagittal sinus thrombosis, 1096f Superior vena cava (SVC), persistent left-sided, 318–320, 319f, 320f Supine hypotensive syndrome, 102 Supraventricular tachycardia (SVT), in fetus, 339, 339f, 407 Surfactant, 197–202 composition of, 197–198, 197f metabolism of, 198–200, 199f, 201f physiologic effects of, 200–202, 201f for respiratory distress syndrome, 202, 202f, 1204 Surfactant deficiency, primary, 202 Surfactant protein A (SP-A), 198, 199f Surfactant protein B (SP-B), 198, 199f Surfactant protein C (SP-C), 198, 199f Surfactant protein D (SP-D), 198, 199f Surfactant/albumin (S/A) ratio, 420, 421f in diabetic pregnancy, 421 impact of contaminants on, 422t from vaginal fluid specimens, 423 Surmontil (trimipramine), dosage of, 1117t Surveillance of Cerebral Palsy in Europe (SCPE) Collaborative Group, 1215 Sustiva (efavirenz), for HIV infection, 772t SVC (superior vena cava), persistent left-sided, 318–320, 319f, 320f SVO2 (mixed venous oxygen saturation), 929 SVR See Systemic vascular resistance (SVR) SVT (supraventricular tachycardia), in fetus, 339, 339f, 407 Swallowing, fetal, 49 Sweeping of membranes, for cervical ripening, 702t Sydenham chorea, 1102 Sympathetic innervation, of fetal heart, 163–164 Sympathetic nervous system, in fetal heart rate, 397 β-Sympathomimetic drugs, for preterm labor, 566 Synaptonemal complex, Syncytiotrophoblast, 41, 42f, 44 in preeclampsia, 661 Syncytium, 42 Syndrome of painful myomas, 1138 Synthetic phase, of myometrial remodeling, 522 Syphilis, 777–782 congenital case definition for, 780, 780t clinical manifestations of, 778–779, 1101 diagnosis of, 780 epidemiology of, 777–778, 778f, 779 pregnancy outcome with, 779, 1101 transmission of, 779, 1101, 1220 treatment of, 782 diagnosis of, 779–780, 780t epidemiology of, 777–778, 778f fetal loss due to, 623 hydrops fetalis due to, 510 Jarisch-Herxheimer reaction in, 781–782 latent, 778, 782 neuro-, 779–780, 781 in newborn period, 1220 pathogenesis of, 778 prevention of, 782 primary, 778, 782 secondary, 778, 782 tertiary, 778 treatment of, 780–782, 781t, 1101 Systematic error, 210–211 Systematic reviews, 209–210, 209f, 210f Systemic diseases, anemia associated with, 881–882 Systemic immune suppression, 88 Systemic inflammatory response syndrome (SIRS), 1175 Systemic lupus erythematosus (SLE), 1081–1083 antiphospholipid antibodies and, 829, 830t diagnosis of, 1080, 1080t epidemiology of, 1079 fertility with, 1081 fetal complications of, 1081–1082 flare in, 914, 1081 maternal complications of, 1081 neonatal outcomes with, 1198 pathogenesis of, 1079 renal dysfunction in, 914, 916t Systemic sclerosis, renal dysfunction in, 914, 916t Systemic vascular resistance (SVR) with hypertension, 1172 nonpregnant, 1171t in preeclampsia, 1147 during pregnancy, 103, 103t, 1153, 1171t Systemic venous anomalies, 318–320, 319f–321f Systolic blood pressure, during pregnancy, 102, 102f Systolic murmurs, during pregnancy, 104 T T bands, 12 T helper lymphocytes (TH cells), 88, 89f T regulatory cells (Tregs), 90 t test, 213 T3 See Triiodothyronine (T3) T4 See Thyroxine (T4) Tachycardia, fetal, 338–340, 339f, 340f baseline, 405, 406–407 in utero treatment of, 411f Tachypnea of the newborn, transient, 1202–1203, 1203f Tacrolimus, for renal transplantation, 918 TAFI (thrombin-activated fibrinolytic inhibitor), in fibrinolysis, 828–829, 828f Takayasu arteritis, 1085 diagnosis of, 1080–1081, 1080t epidemiology of, 1079 Talipes, and aneuploidy, 227t Talipes equinovarus, early amniocentesis and, 251 Tap test, 420 TAPVR (total anomalous pulmonary venous return), 321f, 322 TAR (thrombocytopenia with absent radii), 846, 847 TAT (thrombin/antithrombin) complexes, in preterm labor, 528 Tay-Sachs disease carrier screening for, 238t, 240–241, 241t, 242t prenatal diagnosis of, 248t TBG (thyroxine-binding globulin) in normal thyroid physiology, 995 during pregnancy, 996, 997f, 999, 999t TBIIs (thyroid-binding inhibitory immunoglobulins), during pregnancy, 999 3TC (lamivudine) for hepatitis B virus, 1066–1067 for HIV infection, 772t TCAs (tricyclic antidepressants) dosage of, 1117t risks of, 1118, 1119 TDx FLM assay, 420, 421f impact of contaminants on, 422, 422t from vaginal fluid specimens, 423 TE (tracheoesophageal) fistula, 290–291, 290f feeding problems due to, 1209 TEE (transesophageal echocardiography), 1173 Tegretol (carbamazepine) dosage of, 1116t as teratogen, 348, 351t, 352, 1117 Telangiectasias, 1123 Telogen, 1124 Telogen effluvium, 1124 Telomere, 7, 7f Telophase meiotic, 8f mitotic, 7f, Tenofovir (Viread), for HIV infection, 772t Tension headaches, 1092 Teratogen(s), 347–356, 351t androgens and norprogesterones as, 351t antiepileptic drugs as, 351t, 352 antihypertensive medications as, 351t, 353 cervical insufficiency due to, 586 chemotherapeutic and immunosuppressive agents as, 351t, 352 congenital cardiac defects due to, 279 corticosteroids as, 351t, 352 defined, 347 diethylstilbestrol as, 351t dose response to, 348 environmental agents as, 354 genetic susceptibility to, 348 historical perspective on, 347–348 ionizing radiation as, 354 penicillamine as, 351t psychotherapeutic medications as, 351t, 353 retinoids as, 351t, 353–354 risk assessments and sources of information on, 350–351, 350t INDEX Teratogen(s) (Continued) route of administration of, 348 social and illicit drugs as, 351t, 354–356, 354f–356f species specificity of, 348 streptomycin as, 351t tetracycline as, 351t trimethadione as, 351t vitamin K antagonists as, 351–352, 351t Teratogenic exposure defined, 347 gestational timing of, 348 sources of safety data on, 349–350 specific mechanisms leading to pathogenesis with, 349 spectrum of outcomes of, 348–349 Teratology, principles of, 348–349 Teratoma intrapericardial, 335–336, 336f sacrococcygeal hydrops fetalis due to, 509 invasive fetal therapy for, 434t Terbutaline for asthma, 941, 943 for external version, 705 for preterm labor, 566 Terconazole, for vulvovaginal candidiasis, 740t TERIS, 350 Term growth-restricted neonates, defined, 635 Terminal deletion, 15, 16f Termination of pregnancy with conjoined twins, 468 and preterm birth, 557 selective of acardiac twin, 434t, 468 of anomalous fetus, 469–470 for TRAP sequence, 439–440 for twin-to-twin transfusion syndrome, 437, 439 thyroiditis after, 1010 Testes, fetal, 115 Testosterone, during pregnancy, 1026 Tetanus, 1100 Tetracycline, as teratogen, 351t Tetracycline-resistant Neisseria gonorrhoeae, 745 Tetralogy of Fallot (TOF) fetal, 324, 331–333 with absent pulmonary valve, 332–333, 333f with pulmonary atresia, 332, 332f with pulmonary stenosis, 324f, 331–332, 332f maternal, 807–808, 807f–809f anesthesia with, 1157–1158 TF (tissue factor) in fibrin plug formation, 826, 827f pregnancy effect on, 829 TFPI (tissue factor pathway inhibitor), in anticoagulant system, 828, 828f TGA (transposition of the great arteries), 333– 334, 333f, 334f tricuspid atresia with, 327 TH cells (T helper lymphocytes), 88, 89f α-Thalassemia, 877 carrier screening for, 238t, 245, 878, 879f genotypes of, 877, 877f hematologic and clinical aspects of, 878t hydrops fetalis due to, 510 prenatal diagnosis of, 248t silent carrier for, 878t β-Thalassemia, 877–878 carrier screening for, 238t, 243–245, 244t, 878, 879f hematologic and clinical aspects of, 878t major, 877 β-Thalassemia (Continued) minor, 877–878 prenatal diagnosis of, 248t Thalassemia syndromes, 877–878, 877f, 878t, 879f α-Thalassemia trait, 878t β-Thalassemia trait, 877–878 Thalidomide, as teratogen, 347 Theophylline, for asthma, 940t, 941t, 942 Therapeutic narcosis, for prolonged latent phase, 694 Thiamine for hyperemesis gravidarum, 1043 for Korsakoff psychosis, 1107 Thiazide, for chronic hypertension, 678t Thiazide diuretics, during pregnancy, 800 Thick filament, in myometrial contraction, 78f Thin filament, in myometrial contraction, 78f Thionamide, for hyperthyroidism, 1002 Thioridazine (Mellaril), dosage of, 1116t Thiothixene (Navane), dosage of, 1116t Third circulation, 62 Third-trimester bleeding, 725–734 due to abruptio placentae, 730f, 731–734, 733t epidemiology of, 725 due to placenta accreta, 728–729, 728f due to placenta previa, 725–729, 726f, 726t, 727t, 728f due to vasa previa, 729–730, 730f Thoms, Herbert, 132 Thomsen disease, 1109 Thoracic abnormalities, hydrops fetalis due to, 508t, 509–510 Thoracic compression syndromes, pulmonary hypoplasia due to, 196, 196t Thoracic space-occupying lesions, invasive fetal therapy for, 434t Thoracopagus, 468, 468f Three-dimensional fetal cardiac imaging, 307, 309–310, 316–317, 317f–319f Threshold traits, 26 Thrifty phenotype hypothesis, 155 Thrombasthenia, Glanzmann, 825, 844t–846t, 847 Thrombin in anticoagulant system, 828, 828f in preterm labor, 528, 529, 529f Thrombin time, in abruptio placentae, 733t Thrombin-activated fibrinolytic inhibitor (TAFI), in fibrinolysis, 828–829, 828f Thrombin/antithrombin (TAT) complexes, in preterm labor, 528 Thrombin-thrombomodulin complex, in fibrinolysis, 828f, 829 Thrombocytopenia drug-induced, 843 heparin-induced, 863–864 incidental (essential, gestational), 838 neonatal alloimmune, 840–842, 840t Thrombocytopenia with absent radii (TAR), 846, 847 Thrombocytopenic purpura idiopathic (primary immune, autoimmune), 837–840 thrombotic, 842–843, 843t acute renal failure due to, 908 Thromboembolism, venous See Venous thromboembolism (VTE) Thrombolytic therapy, 864 Thrombophilia(s), 829–837 acquired, 829–831, 830t inherited, 831–835 due to antithrombin deficiency, 831t, 834 due to factor V Leiden mutation, 831–833, 831t 1277 Thrombophilia(s) (Continued) fetal loss due to, 625–626, 625t, 626t, 628 hyperhomocysteinemia as, 833–834 due to mutations in fibrinolytic pathway genes, 835 due to other factor V mutations, 833 due to protein C deficiency, 831t, 834 due to protein S deficiency, 831t, 834–835 due to protein Z-dependent protease inhibitor and protein Z deficiency, 835 due to prothombin gene mutation, 831t, 833 and venous thromboembolism, 855–856, 856t screening for, 835–837 Thrombophilia in Pregnancy Prophylaxis Study (TIPPS), 628 Thrombophlebitis, septic pelvic vein, 763–764 Thromboprophylaxis, with mechanical heart valves, 819–820, 820t, 864 Thrombosis, prevention of, 826–828, 828f Thrombotic thrombocytopenic purpura (TTP), 842–843, 843t acute renal failure due to, 908 Thyroarytenoid muscle, phasic activity of fetal, 172f Thyroglobulin, in normal thyroid physiology, 995 Thyroid adenomas, 1008 Thyroid biopsy, 1008–1009, 1009f Thyroid cancer, 1008–1009, 1009f radioiodine for, 1001 Thyroid disease, 995–1011 autoimmune miscarriage due to, 620, 1001 postpartum, 1009–1011, 1010f fetal loss due to, 620, 1001 hyperthyroidism as, 1000 diagnosis of, 1001 differential diagnosis of, 1001–1002 fetal and neonatal, 1003–1004, 1004f in pregnancy, 1001–1003, 1001t, 1003t related to human chorionic gonadotropin, 1004–1005 signs and symptoms of, 1001 subclinical, 1003 thyroid storm due to, 1003, 1003t treatment of, 1002–1003 hypothyroidism as, 1000–1001 differential diagnosis of, 1007 fetal and neonatal, 1008 iodine deficiency and, 1005–1006, 1005f in pregnancy, 1005–1008 signs and symptoms of, 1006–1007 subclinical, 1007–1008 treatment of, 1007 intrauterine growth restriction due to, 641 iodine deficiency and goiter as, 996–997, 998f postpartum, 1009–1011 Graves disease as, 1009 thyroiditis as, 1009–1011, 1010f pregnancy immunology and, 998–999 thyroid nodules, malignant tumors, and nontoxic goiter as, 1008–1009, 1009f Thyroid function drug effects on, 1000, 1000t laboratory evaluation of, 999–1000, 999t, 1000t neonatal, 998 nonthyroidal illness and, 1000 placental transfer of drugs affecting, 998 Thyroid gland anatomy of, 995 development of, 997–998 1278 INDEX Thyroid hormone(s) fetal, 998 in normal thyroid physiology, 995–996, 996f placental transfer of, 998 during pregnancy, 996, 997f, 999 resistance to, 999 Thyroid hormone receptors, 995 Thyroid hypertrophy, due to iodine deficiency, 996, 998f Thyroid nodules, 1008–1009, 1009f Thyroid peroxidase, in normal thyroid physiology, 995 Thyroid physiology maternal-fetal, 996–997, 997f, 998f normal, 995–996, 996f placental-fetal, 997–998 Thyroid storm, 1003, 1003t Thyroid tumors, 1008–1009, 1009f Thyroid-binding inhibitory immunoglobulins (TBIIs), during pregnancy, 999 Thyroiditis after abortion, 1010 Hashimoto (chronic lymphocytic), 1007 postpartum, 1009–1011, 1010f Thyroid-stimulating hormone (TSH, thyrotropin) fetal, 998 neonatal, 998 in normal thyroid physiology, 995 during pregnancy, 999, 1016 Thyroid-stimulating immunoglobulins (TSIs), during pregnancy, 999 fetal and neonatal hyperthyroidism due to, 1003 Thyrotoxicosis factitia, 1005 fetal, 1003 gestational transient, 1004 neonatal, 1003–1004 Thyrotropin See Thyroid-stimulating hormone (TSH, thyrotropin) Thyrotropin receptor antibodies, during pregnancy, 999 Thyrotropin-releasing hormone (TRH) fetal, 997 for fetal lung maturation, 203–204 neonatal, 998 in neurohormonal control, 1015 in normal thyroid physiology, 995 Thyrotropin-secreting tumors, 1021 Thyroxine (T4) fetal, 997, 998 free fetal, 998 neonatal, 998 in normal thyroid physiology, 995 during pregnancy, 999 for hypothyroidism, 1007, 1008 for induction of fetal pulmonary maturity, 423–424 neonatal, 998 in normal thyroid physiology, 995, 996f placental transfer of, 998 during pregnancy, 996, 997f, 999 Thyroxine-binding globulin (TBG) in normal thyroid physiology, 995 during pregnancy, 996, 997f, 999, 999t Thyroxinemia, in fetus, 1005f TIBC (total iron-binding capacity), 870, 870t, 872 Ticarcillin-clavulanic acid for puerperal endometritis, 760 for septic shock, 763 Tidal volume in acute respiratory distress syndrome, 1174 during pregnancy, 104, 105t, 927, 1173 TIMPs (tissue inhibitors of matrix metalloproteinases), in membrane rupture, 599 Tinel sign, 1105 Tinidazole, for trichomoniasis, 741 Tinzaparin, for venous thromboembolism, 863 Tioconazole, for vulvovaginal candidiasis, 740t TIPPS (Thrombophilia in Pregnancy Prophylaxis Study), 628 Tipranavir (Aptivus), for HIV infection, 772t Tissue factor (TF) in fibrin plug formation, 826, 827f pregnancy effect on, 829 Tissue factor pathway inhibitor (TFPI), in anticoagulant system, 828, 828f Tissue inhibitors of matrix metalloproteinases (TIMPs), in membrane rupture, 599 Tissue-type plasminogen activator (tPA), in fibrinolysis, 828, 828f TLRs (toll-like receptors), 91f, 92–93 in preterm labor, 526 TMP-SMX See Trimethoprim-sulfamethoxazole (TMP-SMX) TNF-α (tumor necrosis factor-α) and insulin sensitivity, 958 in preterm labor, 526, 526f, 527 Tobacco See Cigarette smoking Tocodynamometer, 399 Tocolytic therapy, 561–567 calcium channel blockers for, 562–563 choice of agent for, 562 clinical uses of, 566–567 contraindications to, 561 cyclooxygenase inhibitors in, 563–564 goals of, 561–562 magnesium sulfate in, 565–566 with multiple gestation, 460 nitric oxide donors in, 564–565 oxytocin antagonists in, 564 for preterm premature rupture of the membranes, 606 pulmonary edema due to, 1175 β-sympathomimetic drugs in, 566 TOF See Tetralogy of Fallot (TOF) Tofranil (imipramine), dosage of, 1117t Tolerance maternal-fetal, 87 maternal-placental, 87 Toll-like receptors (TLRs), 91f, 92–93 in preterm labor, 526 Total anomalous pulmonary venous return (TAPVR), 321f, 322 Total iron-binding capacity (TIBC), 870, 870t, 872 Total lung capacity, during pregnancy, 105t Total parenteral nutrition, for hyperemesis gravidarum, 1043 Total-body irradiation, for aplastic and hypoplastic anemia, 876 Toxemia, 661 See also Preeclampsia Toxins, intrauterine growth restriction due to, 640 Toxoplasmosis, 782–783, 1100–1101 tPA (tissue-type plasminogen activator), in fibrinolysis, 828, 828f TP-PA (Treponema pallidum particle agglutination) test, 779 Tracheal occlusion, in utero, for congenital diaphragmatic hernia, 288–289, 442–444 Trachelectomy, radical, for cervical cancer, 889 Tracheoesophageal (TE) fistula, 290–291, 290f feeding problems due to, 1209 Transabdominal cervicoisthmic cerclage, 590– 591, 591f Transabdominal chorionic villus sampling, 252– 253, 253f Transabdominal ultrasound, of placenta previa, 726, 726f Transcervical chorionic villus sampling, 252, 252f, 253 Transcription, 5, 5f Transesophageal echocardiography (TEE), 1173 Transferrin saturation, 870t Transforming growth factor α, in pregnancy, 118 Transforming growth factor β, in implantation, 113, 113t Transfusion(s) for hemorrhagic shock, 1181–1182, 1181t, 1182t intrauterine, for Rh alloimmunization, 488–493 access site for, 488 adjunctive measures with, 491 amount of, 490, 490t method of, 488–490, 490f outcome of, 492–493 with severely anemic early-second-trimester fetus, 491 source of red blood cells in, 491–492 timing of, 492 Transfusion reactions, 1181–1182 Transient cerebral ischemic attacks, 1095 Transient tachypnea of the newborn (TTN), 1202–1203, 1203f Transitional atrioventricular canal defect, 326 Translation, 5, 5f Translocation(s), 16–18 interstitial, 17f reciprocal, 16–17, 18f robertsonian, 17–18, 18f, 19f Down syndrome due to, 247, 247t Transplacental exchange, venous equilibration model of, 183–184, 183f Transplantation heart, pregnancy after, 817 liver, 1072–1073 pancreatic, 1074 renal, 918–921, 918t for diabetic nephropathy, 960–961 Transposition of the great arteries (TGA), 333– 334, 333f, 334f tricuspid atresia with, 327 Transvaginal cerclage, 590, 590f Transvaginal ultrasound (TVUS) of placenta previa, 726, 726f of preterm labor, 560 Transverse lie, 706 Transverse sinus thrombosis, 1097f Tranylcypromine (Parnate), dosage of, 1117t TRAP (twin reversed arterial perfusion) sequence, 64–65, 65f, 66f, 467–468 invasive fetal therapy for, 439–440 Trastuzumab, for breast cancer, 894 Trauma cervical insufficiency due to, 586–587 in pregnancy, 1184–1186, 1185f, 1186t Traumatic mononeuropathies, 1106 Traumatic paraplegia, 1103–1104 Tregs (T regulatory cells), 90 Treponema pallidum See Syphilis Treponema pallidum particle agglutination (TPPA) test, 779 TRH See Thyrotropin-releasing hormone (TRH) Trial of labor, after cesarean section, 710, 711–712 INDEX Triamcinolone for asthma, 941t for induction of fetal pulmonary maturity, 423t Trichomonas vaginalis, 741 breastfeeding with, 137t and preterm birth, 556 Tricuspid atresia, 327–328, 327f Tricuspid regurgitation fetal echocardiography of, 313 prenatal screening for, 231 Tricuspid valve Ebstein anomaly of, 326–327, 327f maternal, 810, 810f fetal echocardiography of, 308f, 313 Tricuspid valve dysplasia, 326–327, 326f, 327f Tricyclic antidepressants (TCAs) dosage of, 1117t risks of, 1118, 1119 Triggers, for asthma, 940 Triglyceride(s), during pregnancy, 119 Triglyceride concentrations, and fetal obesity, 966 Triiodothyronine (T3) fetal, 998 free fetal, 998 in normal thyroid physiology, 995 during pregnancy, 999 neonatal, 998 in normal thyroid physiology, 995, 996f placental transfer of, 998 during pregnancy, 996, 997f, 999 reverse, 995, 996f Triiodothyronine (T3) resin uptake, during pregnancy, 999 Trimethadione, as teratogen, 351t Trimethoprim, for urinary tract infections, 906 Trimethoprim-sulfamethoxazole (TMP-SMX) for acute pyelonephritis, 756, 756t for asymptomatic bacteriuria and acute cystitis, 752t, 753 for HIV infection, 771 for Pneumocystis jiroveci pneumonia, 933–934 Trimipramine (Surmontil), dosage of, 1117t Trinucleotide repeats, 29–30 Triple screen, for Down syndrome, 223 Triplets, breastfeeding of, 134 Triploidy, 15 Trisomy, 15, 17, 18f Trisomy 18, prenatal screening for, 227, 227t, 228t Trisomy 21 See Down syndrome Trizivir (zidovudine + lamivudine + abacavir), for HIV infection, 772t Trophoblast, 37, 41 maternal immune response to, 88–90, 89f–91f, 91–92 response to infection by, 92–93 chlamydial, 94–96, 95f Trophoblast invasion, 619 Trophoblastic shell, 41, 42f Trophotropism, 725–726 Tropomyosin, in myometrial contraction, 78, 78f Troponin complex, in myometrial contraction, 78f Truncus arteriosus, 334–335, 335f TSH See Thyroid-stimulating hormone (TSH, thyrotropin) TSIs (thyroid-stimulating immunoglobulins), during pregnancy, 999 fetal and neonatal hyperthyroidism due to, 1003 TTN (transient tachypnea of the newborn), 1202–1203, 1203f TTP (thrombotic thrombocytopenic purpura), 842–843, 843t acute renal failure due to, 908 TTTS See Twin-to-twin transfusion syndrome (TTTS) Tuberculosis, 934–937 breastfeeding with, 125, 135, 137t, 937 diagnosis of, 935–936, 935f epidemiology of, 934 extrapulmonary, 935–936 multidrug-resistant, 934–935, 937 prevention of, 936, 936f risk factors for, 935, 935t treatment of, 936–937, 937t Tubulin, 7–8 Tubulointerstitial disease, 913, 916t Tumor necrosis factor-α (TNF-α) and insulin sensitivity, 958 in preterm labor, 526, 526f, 527 Turner syndrome, 19–20, 20t TVUS (transvaginal ultrasound) of placenta previa, 726, 726f of preterm labor, 560 TWAR agent, pneumonia due to, 931 Twin(s), 55–67, 453–471 abnormalities of, 64–66, 64f–66f acardiac, 64–65, 65f, 66f, 467–468 invasive fetal therapy for, 434t, 468 amniocentesis with, 257–258, 258t, 459 aneuploidy in, 256, 256t, 458–459, 458t antepartum management of, 459–461 birth weight of, 454 breastfeeding of, 134 causes of, 56, 57f cerebral palsy in, 1215 cervical length with, 457, 460 chimeras with, 66 chorionic villus sampling with, 258, 258t, 459 conjoined, 57, 60, 468–469, 468f diagnosis of, 455 diamniotic, 57, 57f, 58 acardiac, 65f dichorionic, 57–58, 58f, 59f monochorionic, 58, 58f, 60–61, 61f, 62f twin-to-twin transfusion syndrome with, 63f dichorionic, 57, 57f–59f, 58 diagnosis of, 455–456, 456f selective termination with, 470 disappearance of, 66 dizygotic, 55 causes of, 56 frequency of, 56 identification of, 66–67 placentation of, 57–58, 58f, 59f Down syndrome in, 256, 256t, 257, 257t, 458– 459, 458t fetal loss with, 625 fetal pulmonary maturity in, 421, 461 fetal surveillance in, 457, 461 fetal well-being of, 457 fraternal, 55 hydrops fetalis in, 508t, 510 identical, 55 identification of zygosity in, 66–67, 67f incidence of, 55, 453, 454t intrapartum management of, 461–463 intrauterine demise of one, 469 intrauterine growth restriction in, 639 maternal adaptations to, 454–455 maternal complications of, 461 maternal mortality and morbidity with, 454 membranous, 64, 64f, 65f 1279 Twin(s) (Continued) monoamniotic, 57, 58, 59f, 60, 61, 466–467, 466f monochorionic, 57, 57f, 58, 60f acardiac, 65f antenatal diagnosis of, 455–456, 456t diamniotic, 58, 58f, 60–61, 61f, 62f intrauterine demise of one fetus with, 469 invasive fetal therapy with, 436–440, 436t, 438f, 439t monoamniotic, 60 selective termination with, 470 twin-to-twin transfusion syndrome with, 62f, 63f monozygotic, 55 causes of, 56, 57f frequency of, 55–56 heterokaryotic, 66 identification of, 66–67 placentation of, 57, 58, 58f neural tube defects with, 459 nonvertex first, 462–463 perinatal mortality and morbidity with, 453– 454, 454f, 461 placentation in, 57–61, 57f–60f preeclampsia with, 460–461, 654 prenatal diagnosis with, 256–258, 256t–258t preterm labor and birth with interventions for, 460 pathogenesis of, 529–531, 531f, 558 rates of, 460, 546, 547f, 558, 559f, 559t pump, 467 selective termination of anomalous fetus with, 469–470 third, 56 twin reversed arterial perfusion sequence in, 64–65, 65f, 66f, 467–468 twin-to-twin transfusion syndrome in, 61–64, 61f–63f, 463–466, 463f types of, 55–56 ultrasonography of, 455–457, 456f, 456t vanishing, 469 velamentous insertion of umbilical cord and vasa praevia in, 59, 60f vertex-nonvertex, 462 vertex-vertex, 462 Twin reversed arterial perfusion (TRAP) sequence, 64–65, 65f, 66f, 467–468 invasive fetal therapy for, 439–440 Twin studies, 26 Twinning impetus, 56 Twin-peak sign, 456 Twin-to-twin transfusion syndrome (TTTS), 61– 64, 463–466 background of, 463 clinical and sonographic features of, 61f–63f, 463f, 464 diagnosis of, 436, 464 etiology and pathogenesis of, 61–64, 62f, 436, 463–464 fetal loss due to, 625 hydrops fetalis due to, 510 incidence of, 436, 463 invasive fetal therapy for, 434t, 436–439, 438f, 439t management of, 464–466 staging of, 436, 436t Type I error, 213, 214 Type II error, 213–214 U U antigen, 498 UDCA (ursodeoxycholic acid), for intrahepatic cholestasis of pregnancy, 1061 1280 INDEX Ulcer(s), peptic, 1045–1046, 1045f Ulcerative colitis, 1047–1049 clinical characteristics of, 1047–1048, 1048f, 1048t diagnostic testing for, 1048, 1048f, 1049f effect of pregnancy on, 1048 effect on pregnancy of, 1048 treatment of, 1048–1049, 1049t Ultralente insulin, 977f Ultrasound of abruptio placentae, 732 of adnexal masses, 1140, 1140t, 1141f, 1142f of appendicitis, 1046–1047, 1047t of breast cancer, 892 of cervical insufficiency, 588–589, 588f of cervix, 583–584, 584f, 585f of deep venous thrombosis, 856–858, 858f Doppler application of, 378–379, 379f fetal, 371–377 and frequency of biophysical profile scoring, 371, 372t with intrauterine growth restriction, 644–645 of middle cerebral artery, 374–375, 375f in Rh-immunized pregnancy, 485–488, 485f, 486f, 490 of umbilical artery, 175, 372–374, 373f, 374f, 374t venous studies in, 375–377, 376f, 377f maternal, 377–378, 378f, 379f patterns of deterioration in, 378–379, 379f, 380f dynamic, of fetal anomalies, 275–276, 276f endoscopic, 1053 of intrauterine growth restriction, 642, 643f to monitor Rh-immunized pregnancies, 484– 486, 485f, 486f of multiple gestation, 455–457, 456f, 456t of neural tube defects, 235, 236f of nonimmune hydrops, 506, 506f, 507f of placenta accreta, 728–729, 728f of placenta previa, 726, 726f of preterm labor, 560 of uterine myomas, 1137, 1138f of vasa previa, 729, 730f Ultrasound Doppler velocimetry application of, 378–379, 379f fetal, 371–377 and frequency of biophysical profile scoring, 371, 372t of middle cerebral artery, 374–375, 375f of umbilical artery, 175, 372–374, 373f, 374f, 374t venous studies in, 375–377, 376f, 377f maternal, 377–378, 378f, 379f patterns of deterioration in, 378–379, 379f, 380f Ultrasound screening first-trimester, 227–229, 228f, 228t, 229f, 230– 231, 231f second-trimester, 225–227, 225t–228t value of, 236–237, 237t Umbilical artery(ies), 40 anatomy and physiology of, 372 Doppler ultrasound velocimetry of, 175, 372– 374, 373f, 374f, 374t with intrauterine growth restriction, 644 single, and intrauterine growth restriction, 638 Umbilical artery resistance, 372, 373f, 374f Umbilical blood flow, 188, 399 nicotine and, 355, 355f Umbilical blood sampling, percutaneous, 259 Umbilical circulation See Umbilical venous PO2 Umbilical cord(s) development of, 40 fetal echocardiography of, 310, 310f fusion of, 60 knots in, 40, 60 velamentous insertion of, 59, 60f Umbilical cord blood, acid-base analysis of, 402– 405, 403t–405t Umbilical cord compression, fetal heart rate with, 411t Umbilical cord occlusion, invasive fetal therapy for, 440 Umbilical vascular resistance, nicotine and, 355, 355f Umbilical vein, 40 fetal Doppler studies of, 377, 377f persistent, 318, 319f Umbilical venous oxygen saturation, of fetus, 187 Umbilical venous PO2, 182–186 developmental changes in, 185–186, 186f with intrauterine growth restriction, 185–186, 186f levels of, 182, 182t uterine and, 182–185, 183f, 184f Umbilical venous return, 159, 160f Undernutrition intrauterine growth restriction due to, 639–640 neonatal outcomes with, 1198 Underweight, 143–144 Unicornuate uterus, 1143, 1144t intrauterine growth restriction due to, 641 and pregnancy loss, 622t Uniparental disomy (UPD), 247, 254 Univariate data analysis, 213 uPA (urokinase-type plasminogen activator), in fibrinolysis, 828, 828f UPJ (uteropelvic junction) obstruction, 296, 296f Upper airway obstruction, neonatal, 1198t Upper gastrointestinal endoscopy, 1053 Urate clearance, in preeclampsia, 657, 657t, 664 Urea nitrogen, during pregnancy, 910 Ureaplasma urealyticum breastfeeding with, 136t and bronchopulmonary dysplasia, 1205 Ureteral dilation, during pregnancy, 105 Ureteric calculi, 913, 916t Urethral valves, posterior, 296, 297, 297f Uric acid clearance, in preeclampsia, 657, 657t, 664 Uric acid concentration, in preeclampsia, 657 Uric acid levels, during pregnancy, 106–107 Urinary concentrating capacity, in preeclampsia, 664 Urinary disorders, hydrops fetalis due to, 508t, 512 Urinary diversion, 914 Urinary incontinence, cesarean delivery to prevent, 708, 711 Urinary tract, during pregnancy, 105–107, 106f Urinary tract infection(s) (UTIs), 750–756, 905–907 acute pyelonephritis as, 754–756, 755t, 756t, 906–907 asymptomatic bacteriuria as, 750–753, 752t, 905–906 classification of, 750, 750t cystitis as, 753–754 diagnosis of, 905 epidemiology of, 750 treatment of, 906 Urinary tract obstruction, lower invasive fetal therapy for, 277t, 434t, 444–445, 445t pathophysiology of, 444 Urinary tract reconstruction, 914–915 Urinary tract surgery, previous, 914–915, 916t Urine, fetal output of, 47, 48–49 and intramembranous flow, 50, 51 Urine osmolality, during pregnancy, 1016, 1018f Urokinase-type plasminogen activator (uPA), in fibrinolysis, 828, 828f Urolithiasis, 913, 916t Ursodeoxycholic acid (UDCA), for intrahepatic cholestasis of pregnancy, 1061 Uterine activity detection of, 399 excessive, fetal heart rate with, 407f, 411t Uterine activity monitoring, for prevention of preterm labor and birth, with multiple gestation, 460 Uterine agenesis, 1143, 1144t Uterine anomalies, 1143–1144 cervical insufficiency due to, 586, 592–593 diagnosis of, 1144 epidemiology of, 1143 intrauterine growth restriction due to, 641 management of, 1144, 1144t pathogenesis of, 1143–1144, 1144t pregnancy loss due to, 622, 622t and preterm birth, 557 prevention of, 1144 Uterine artery(ies) Doppler studies of, 377, 378f in preeclampsia, 660, 660f Uterine artery ligation, for obstetric hemorrhage, 1183, 1184f Uterine atony, 698, 699, 1182–1184, 1183t, 1184f Uterine bleeding, from placental separation, 698 Uterine blood flow, during pregnancy, 69, 102 Uterine circulation, oxygen pressures in See Uterine venous PO2 Uterine contractions, 76–82 defined, 522 in diagnosis, 70 effectiveness of, 522 fetal heart rate with, 410f, 411t hormonal regulation of, 79–81, 79f, 80t during labor, 522–523 measurement of, 399 mechanics of, 76–79, 78f in pregnancy, 691 and preterm birth, 558, 560 regulation of electrical activity in, 76, 77f Uterine factors, and preterm birth, 558–560, 559f, 560f Uterine fibroids See Uterine leiomyomas Uterine hypoplasia, 1143 Uterine inversion, 699–700 Uterine leiomyomas, 1135–1139 and cesarean section, 1137 classification of, 1137 degenerated, 1137, 1138f diagnosis of, 1137, 1138f effect of pregnancy on, 1135 effects on pregnancy of, 1135–1137, 1136t epidemiology of, 1135 and fetal malpresentation, 1137 infected, 1138 and infertility, 1135–1136, 1138 and labor complications, 1137 management of, 1138–1139 pathogenesis of, 1135–1137, 1136t pedunculated, 1137, 1138f and perinatal outcome, 1137 and placenta previa, 1137 and placental abruption, 1136–1137 and postpartum hemorrhage, 1137 INDEX Uterine leiomyomas (Continued) and pregnancy loss, 622, 1136, 1138 and preterm delivery, 1136, 1136t syndrome of painful, 1138 Uterine myomas See Uterine leiomyomas Uterine overdistention, preterm labor due to, 529–531, 531f Uterine relaxants, 80–81, 80t Uterine rupture in trial of labor after cesarean delivery, 710, 712 uterine anomalies and, 1144 Uterine stimulants, 80, 80t Uterine synechiae, and pregnancy loss, 622 Uterine venous blood, oxygen saturation of, 186–187 Uterine venous PO2, 182–187 factors that determine, 186–187, 186f, 187f with intrauterine growth restriction, 186–187, 186f levels of, 182, 182t umbilical vs., 182–185, 183f, 184f Uterine volume with multiple gestation, 454 and preterm birth, 558 Uteropelvic junction (UPJ) obstruction, 296, 296f Uteroplacental blood flow, intrauterine growth restriction due to deficits in, 640–641 Uteroplacental vascular disease, preterm labor due to, 527–529, 529f Uterus as immune privileged site, 88–90, 89f, 90f inversion of, 699–700 oxygen transport to, 181, 182f, 182t oxygen uptake by, 181–187, 182f during pregnancy, 69 regulation of electrical activity within, 76, 77f Uterus didelphys, and pregnancy loss, 622t UTIs See Urinary tract infection(s) (UTIs) V VACTERL association, 291 Vacuum extraction, 714–715 Vaginal birth after cesarean (VBAC), 708, 711–712 with multiple gestation, 461, 463 Vaginal bleeding See Bleeding Vaginal fluid specimens, assessment of fetal pulmonary maturity from, 423 Vaginitis Gardnerella vaginalis See Bacterial vaginosis (BV) Haemophilus vaginalis See Bacterial vaginosis (BV) monilial, 739–741, 740t nonspecific See Bacterial vaginosis (BV) Vaginosis, bacterial, 741–742, 742f, 742t, 743t and premature rupture of the membranes, 599 and preterm birth, 556, 568, 570, 741, 742, 742t Vagus nerve, in fetal heart rate, 397 Valacyclovir (Valtrex), for genital herpes, 770 Valproic acid (Depakote) dosage of, 1116t as teratogen, 348, 351t, 352, 1117 Valve replacement, pregnancy after, 819–820, 820t, 864 Valvular aortic stenosis, 330, 330f maternal, 805–806, 806f, 813, 813f anesthesia with, 1155 Valvular heart disease fetal aortic stenosis as, 330, 330f invasive fetal therapy for, 277t, 445, 446t pulmonary stenosis as invasive fetal therapy for, 277t, 445, 446t tetralogy of Fallot with, 324f, 331–332, 332f maternal, 797, 798t anesthesia in, 1154–1156 aortic regurgitation as, 813–814 aortic stenosis as, 805–806, 806f, 813, 813f anesthesia with, 1155 artificial valves for, 819–820, 820t, 864 drug-induced, 814 mitral regurgitation as, 812, 812f, 813 anesthesia with, 1155–1156 mitral stenosis as, 805, 811–812, 811f anesthesia with, 1154–1155 mitral valve prolapse as, 812, 812f anesthesia with, 1156 pulmonic stenosis as, 806–807, 806f, 807f Valvuloplasty, fetal, 445, 446t Vancomycin for group B Streptococcus infection, 768 for mastitis, 764 for pelvic abscess, 762 Vanillylmandelic acid, in pheochromocytoma, 1030 Vanishing twin, 469 Vaqta (hepatitis A vaccine), 785 Variable decelerations, in fetal heart rate, 406, 409–410, 410f, 411t Variable expressivity, 23 Variable number tandem repeats, 33 Varicella, 783–784 Varicella pneumonia, 930, 932–933, 933f Varicella vaccine (Varivax), 784, 933 Varicella zoster immune globulin (VZIG), 783 Varicella-zoster virus (VZV), 783–784 Varices, esophageal, 1070, 1071 VAS (vibroacoustic stimulation), 382–383 Vasa previa, 59, 60f, 729–730, 730f Vascular anomalies, and nervous system, 1098–1099 Vascular changes in placental site, in preeclampsia, 660–661, 660f in pregnancy, 1123–1124 Vascular disease, maternal, intrauterine growth restriction due to, 640–641 Vascular endothelial growth factor (VEGF) in implantation, 113t and intramembranous flow, 51 Vascular pressures, fetal, 162, 163f Vascular reactivity, in preeclampsia, 1147–1148 Vasculitis, 1085 Vasomotor centers, in fetal heart rate, 398 Vasopressin deficiency in, 1024–1025 in fetal cardiovascular regulation, 165 during pregnancy, 1016, 1018f Vasoreactivity, in preeclampsia, 1147–1148 Vasospasm, in preeclampsia, 662, 662f, 1172 VBAC (vaginal birth after cesarean), 708, 711–712 with multiple gestation, 461, 463 VDRL (Venereal Disease Research Laboratory) test, 779 Vecuronium, for intrauterine transfusion, 491 Vegetables, in diet, 147 Vegetarian diet, 146t, 147–148 VEGF (vascular endothelial growth factor) in implantation, 113t and intramembranous flow, 51 1281 Velamentous insertion, 40 Venereal Disease Research Laboratory (VDRL) test, 779 Venlafaxine (Effexor), dosage of, 1117t Venous anomalies pulmonary, 321–322, 321f systemic, 318–320, 319f–321f Venous circulation, fetal, with intrauterine growth restriction, 644–645 Venous compliance, during pregnancy, 103 Venous Doppler studies, fetal, 375–377, 376f, 377f Venous drainage, fetal echocardiography of, 311– 312, 312f Venous equilibration model, of transplacental exchange, 183–184, 183f Venous occlusive disease, intracranial, 1096, 1096f, 1097f Venous return, fetal, 159–160, 160f, 161f Venous thromboembolism (VTE), 855–865 diagnosis and evaluation of, 856–862 for acute pulmonary embolus, 858–862, 859t, 861f for deep venous thrombosis, 856–858, 856t, 858f epidemiology of, 855 pregnancy and risk of, 829 prevention of, 835–837, 864–865 risk factors for, 855–856, 856t due to thrombophilia See Thrombophilia(s) treatment of, 862–864, 862t Venous thrombosis due to central venous catheters, 1170 deep See Deep venous thrombosis (DVT) intracranial, 1096, 1096f, 1097f Venous ultrasonography (VUS) of deep venous thrombosis, 856–858, 858f for pulmonary embolus, 861–862, 861f Venous vascular bed, during pregnancy, 103 Ventilation-perfusion (V/Q) scanning, for pulmonary embolus, 859–860, 861f, 862 Ventricles, fetal echocardiography of, 313, 313f Ventricular function, in pregnancy-induced hypertension, 1172, 1172f Ventricular septal defect (VSD) fetal, 313–314, 322–324, 323f, 324f epidemiology of, 278 maternal, 802–803, 803f anesthesia with, 1156–1157 Ventricular septum, fetal echocardiography of, 309, 313–314, 314f Ventricular tachycardia, in fetus, 340, 340f Ventriculomegaly, 279–280 and aneuploidy, 227t diagnosis of, 279–280, 279f, 280f invasive fetal therapy for, 277t, 280 prognosis for, 280 Verapamil, during pregnancy, 801t Vernix caseosa, in amniotic fluid, 420 Vertex-breech twins, 462 Vertex-nonvertex twins, 462 Vertex-transverse twins, 462 Vertex-vertex twins, 462 Very low birth weight (VLBW) defined, 545 incidence of, 546 and survival and morbidity with preterm birth, 550–551, 551f, 553t Viability, 521, 1200–1202 Vibroacoustic stimulation (VAS), 382–383 Videx (didanosine), for HIV infection, 772t Villous capillaries, 41–42 Viracept (nelfinavir), for HIV infection, 772t 1282 INDEX Viral hepatitis, 785–786, 787t breastfeeding with, 135–137, 136t Viral infections, in neonatal period, 1217–1219 Viral influenza, 784–785 Viral pneumonias, 932–933 Viramune (nevirapine), for HIV infection, 772t Viread (tenofovir), for HIV infection, 772t Virilization, in pregnancy, 1031–1032, 1031t Visceroatrial situs, fetal echocardiography of, 307, 310–311, 311f Visual complications, of prematurity, 1199t Vital capacity, during pregnancy, 105t Vitamin A, as teratogen, 353 Vitamin B6 for nausea and vomiting, 1042, 1042t for tuberculosis, 936 Vitamin B12 in anemia, 870, 870t in pregnancy, 872 Vitamin B12 deficiency, 1101 megaloblastic anemia due to, 874 Vitamin C, for prevention of preeclampsia, 675 Vitamin D in calcium metabolism, 1032 for hypoparathyroidism, 1035 Vitamin D2 (1α,25-dihydroxycholecalciferol), 1032 Vitamin D3 (25-hydroxycholecalciferol), 1032 Vitamin deficiencies, after bariatric surgery, 1051, 1051t Vitamin E, for prevention of preeclampsia, 675 Vitamin K antagonists, as teratogens, 348, 351– 352, 351t Vitamin K1, with anticonvulsants, 1091 Vitamin supplementation, during pregnancy, 146, 146t Vitelline vessels, 40 Vivactil (protriptyline), dosage of, 1117t VLBW (very low birth weight) defined, 545 incidence of, 546 and survival and morbidity with preterm birth, 550–551, 551f, 553t VO2 See Oxygen consumption (VO2) Volume depletion, intravascular, in preeclampsia, 1147 Volume expansion, during pregnancy, 101, 107 Volume homeostasis, during pregnancy, 107 Volume regulation, during pregnancy, 1016, 1018f Volume replacement, for hemorrhagic shock, 1180–1182, 1180t–1182t Volume resuscitation, for septic shock, 1176 Vomiting, 1041–1042, 1042t nutrition with, 148 von Willebrand disease (vWD), 843–845, 844t–846t von Willebrand factor (vWF) deficiency in, 843 in platelet plug formation, 825 V/Q (ventilation-perfusion) scanning, for pulmonary embolus, 859–860, 861f, 862 VSD (ventricular septal defect) fetal, 313–314, 322–324, 323f, 324f epidemiology of, 278 maternal, 802–803, 803f anesthesia with, 1156–1157 VTE See Venous thromboembolism (VTE) Vulvovaginal candidiasis (VVC), 739–741, 740t VUS (venous ultrasonography) of deep venous thrombosis, 856–858, 858f for pulmonary embolus, 861–862, 861f vWD (von Willebrand disease), 843–845, 844t–846t vWF (von Willebrand factor) deficiency in, 843 in platelet plug formation, 825 VZIG (varicella zoster immune globulin), 783 VZV (varicella-zoster virus), 783–784 W Wakefulness, fetal, 171–174 animal studies of, 171–172, 172f developmental changes in, 173–174, 173t effect of hypoxia and intrauterine growth restriction on, 174, 174f human studies of, 172–173, 173f Warfarin (Coumadin) during pregnancy, 801t with prosthetic heart valves, 819–820, 820t, 864 for rheumatic disease, 1082t as teratogen, 351–352, 351t Warfarin embryopathy syndrome, 800 Warts, genital, 748, 749, 750 Water channels, 51 Wegener granulomatosis, renal dysfunction in, 914 Weight gain, during pregnancy, 143, 145–146, 145t, 146t inadequate, intrauterine growth restriction due to, 639 with multiple gestation, 455 Wellbutrin (bupropion), dosage of, 1117t Wernicke encephalopathy, 1107 West Nile virus (WNV), breastfeeding with, 135 Wet lungs, 1202–1203, 1203f WGAS (whole-genome association studies), 26 White classification, of diabetes in pregnancy, 954, 954t White, Priscilla, 953 Whole blood, for hemorrhagic shock, 1181 Whole blood clotting time, in abruptio placentae, 733t Whole-genome association studies (WGAS), 26 Williams syndrome, 13f Wilson disease, 1070, 1102 Window of receptivity, 37 WinRHO-SDF, 480 Wireless capsule endoscopy, 1053 Wiskott-Aldrich syndrome, 846, 846t WNV (West Nile virus), breastfeeding with, 135 Woods maneuver, for shoulder dystocia, 697 Work, and preterm birth, 555 Wound hematomas, postcesarean, 709 Wound infection, 761–762 due to burns, 1187–1188 Wurm cerclage, 593 X X cells, 43, 43f X chromosome, 7, 19 aneuploidies of, 19–20, 20t X inactivation, 19, 24 Xiphopagus, 468 XIST gene, 19 X-linked dominant inheritance, 25, 25f X-linked inheritance, 24–25, 25f X-linked recessive inheritance, 24–25, 25f X-rays, during pregnancy, 889–890, 890t Y Y chromosome, 7, 19 Yolk sac, 38–39, 39f Yolk sac tumors, 886 Z Zafirlukast (Accolate), for asthma, 940t, 942 Zalcitabine (ddC, Hivid), for HIV infection, 772t ZAM (zone of altered morphology), in decidual/ membrane activation, 523 Zanamivir, for influenza, 785 Zavanelli maneuver, for shoulder dystocia, 697 Zerit (stavudine), for HIV infection, 772t Ziagen (abacavir), for HIV infection, 772t Zidovudine (AZT, Retrovir), for HIV infection, 771, 772t, 773 Zidovudine + lamivudine + abacavir (Trizivir), for HIV infection, 772t Zidovudine and lamivudine (Combivir), for HIV infection, 771–772, 772t Zinc, and intrauterine growth restriction, 639 Zinc supplementation, during pregnancy, 146t Ziprasidone (Geodon), dosage of, 1116t Zoloft (sertraline), dosage of, 1117t Zona pellucida, 37 Zone of altered morphology (ZAM), in decidual/ membrane activation, 523 ZPI (protein Z–dependent protease inhibitor), in anticoagulant system, 828, 828f ZPI (protein Z-dependent protease inhibitor) deficiency, 835 Zygonema, 8f, Zygosity, identification of, 66–67, 67f Zygotene, 8f Zyprexa (olanzapine) dosage of, 1116t risks of, 1116 ... Maternal- fetal medicine 5th ed c2004 Includes bibliographical references and index ISBN 97 8-1 -4 16 0-4 22 4-2 Obstetrics Perinatology I Creasy, Robert K II Maternal- fetal medicine III Title: Creasy and. .. pattern in R banding is opposite to that in G and Q banding; light bands produced on G and Q banding are dark on R banding, and dark bands on G and Q banding are light on R banding T bands are the... palindromic site 5′-GAATTC-3′ between the G and the A: Target DNA sequence 5′-GAATTC-3′ 5′-G + AATTC-3′ → 3′-CTTAAG-5′ 3′-CTTAA + G-5′ After digestion with restriction enzymes, DNA is size-fractionated