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Endocrine and autoimmune disorders Mirjana Kendrisic and Borislava Pujic Print Publication Year: 2016 Published Online: Oct 2016 ISBN: 9780198713333 eISBN: 9780191819759 Item type: chapter
Publisher: Oxford University Press DOI: 10.1093/med/9780198713333.003.0047
Advanced maternal age and increasing numbers of women of childbearing age with endocrine and autoimmune disorders have become the challenge for both anaesthetists and obstetricians. Genetic studies have provided new insight into underlying causes of endocrine disorders and prenatal prediction of inheritance. The expression of endocrine disease may influence the interpretation of diagnostic laboratory testing during pregnancy. Better understanding of the pathophysiological mechanisms enables new therapeutic approaches which can compromise pregnancy outcome. Although only a small number of drugs have been shown through clinical studies to be safe for use in pregnancy, intensive therapy for chronic disease is usually needed. Thus, anaesthetic management of women with endocrine disorders in pregnancy has become more complex. The most frequently encountered endocrine disorders during pregnancy include gestational diabetes mellitus and thyroid and adrenal disorders. Gestational diabetes has become increasingly common in pregnant women. Not only does it influence pregnancy outcome, but it also carries a risk for mother and offspring of developing type 2 diabetes later in life. Intensive glucose control may prevent maternal and fetal complications and improve long-term outcome. Pregnancy itself has been found to influence the course of autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus. However, autoimmune diseases may have adverse consequences for maternal, fetal, and neonatal health. There is a relative paucity of literature concerning anaesthetic management of autoimmune diseases. Early recognition and immediate treatment of the common complications have been the key elements to achieving the ultimate goal—good pregnancy outcome.
Substance abuse Ross Junkin and Elizabeth M. McGrady Print Publication Year: 2016 Published Online: Oct 2016 ISBN: 9780198713333 eISBN: 9780191819759 Item type: chapter
Publisher: Oxford University Press DOI: 10.1093/med/9780198713333.003.0051
Substance abuse in pregnancy is a cause of maternal and neonatal morbidity and mortality. It can lead to a wide range of health, social, and psychological problems. Many of these mothers are young, single, socially deprived, and often present late for antenatal care. Page 1 of 5 PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy). date: 14 January 2017
The prevalence is unclear as substance abuse is often concealed, but it is most common in young adults, and may be around 4% in the United Kingdom and 6% in the United States. It is estimated that 200,000–300,000 children living in England and Wales have one or both parents with a drug problem. Patterns and prevalence of substance abuse vary between and within countries, but polysubstance abuse is common. Obstetric anaesthetists may be involved in care of mothers who have known or covert substance abuse. Common problems include poor nutrition, dentition, difficult intravenous access, immunosuppression, and altered drug metabolism. Use of some illicit drugs can cause obstetric complications, and others can mimic serious issues such as pre-eclampsia. The incidence of emergency caesarean delivery is higher. Neonates tend to be premature, small for gestational age, at risk of withdrawal, and have ongoing health issues throughout life. Healthcare workers should enquire about tobacco, alcohol, and illicit drug use early in pregnancy as advice and support may motivate women to alter their lifestyle. The impact of tobacco, caffeine, alcohol, marijuana, solvents, opioids, cocaine, and amphetamine use on the mother and fetus, and the implications for the obstetric anaesthetist, are presented.
Obstetric haematology Sapna Ladani, Beverley J. Hunt, and Sue Pavord Print Publication Year: 2016 Published Online: Oct 2016 ISBN: 9780198713333 eISBN: 9780191819759 Item type: chapter
Publisher: Oxford University Press DOI: 10.1093/med/9780198713333.003.0048
This chapter aims to cover aspects of haematology of pregnancy, delivery, and postpartum that are not addressed in other chapters. Obstetric haematology is a vast and complex area, the importance of which has promoted the development of this as a unique subspecialty. Thrombosis and bleeding, anaemia, haemoglobinopathies, and microangiopathies still account for significant morbidity and mortality in pregnancy, despite improvements in recognition, prevention, and management. Anaemia, due to iron deficiency, is highly prevalent in the pregnant population, but with early recognition and treatment, morbidity and need for unnecessary blood transfusion can be avoided. The management of women with thrombocytopenias and inherited bleeding disorders can be complex because of the haemostatic challenges of pregnancy. Pregnancies in women with haematological disorders need to be carefully managed to reduce mortality and morbidity in the mother and fetus. This chapter addresses the management of anaemia, haemoglobinopathies (mainly sickle cell disease), thrombocytopenia, microangiopathies, and the inherited bleeding disorders.
Interstitial Cystitis/Bladder Pain Syndrome Meredith T. Robbins and Timothy J. Ness Print Publication Year: 2013 Published Online: Aug 2013 Publisher: Oxford University Press ISBN: 9780199796410 eISBN: 9780199352999 DOI: 10.1093/med/9780199796410.003.0018 Item type: chapter
The primary focus of this chapter will be a specific pelvic pain disorder, interstitial cystitis/ bladder pain syndrome (IC/BPS), a chronic, debilitating visceral pain syndrome that Page 2 of 5 PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy). date: 14 January 2017
is characterized by lower abdominal, pelvic and/or vulvar pain, urinary urgency and frequency, and nocturia. The lack of a validated IC/BPS-specific marker and questions regarding etiology and pathophysiology have not only made the diagnosis and optimal management of IC/BPS particularly challenging but also made its prevalence difficult to determine. Some have put forward the concept of excluding “confusable diagnoses” as a necessary step to the assignment of the diagnosis of IC/BPS, but others have accepted that what is called IC/BPS is a symptomatic descriptive diagnosis that may have multiple etiologies.
Coexisting Disease and Other Issues Michael J. Paech Print Publication Year: 2011 Published Online: Aug 2013 Publisher: Oxford University Press ISBN: 9780199733804 eISBN: 9780199352982 DOI: 10.1093/med/9780199733804.003.0171 Item type: chapter
In chapter 10 we discuss Coexisting Disease and Other Issues, including an introduction, Cardiac Disease, Diabetes, Pulmonary Disease, Neurosurgery and Neurological Disease, Renal Disease, Hepatic Disease, Muscle, Neuromuscular and Musculoskeletal Disease, Autoimmune or Connective Tissue Disease, Hematologic Disease, Psychiatric Disease, Management of the Drug-Dependent Pregnant Woman, Management of the Anticoagulated Pregnant Woman.
Management of Later Complications of Obstetric Anesthesia and Analgesia Michael J. Paech Print Publication Year: 2011 Published Online: Aug 2013 Publisher: Oxford University Press ISBN: 9780199733804 eISBN: 9780199352982 DOI: 10.1093/med/9780199733804.003.0220 Item type: chapter
In chapter 13 we discuss Management of Later Complications of Obstetric Anesthesia and Analgesia, including an Post-Dural Puncture Headache, Back Pain, Infection, Vertebral and Intracranial Hematoma and Vascular Events, Neurological Deficit, Thrombosis and Pulmonary Embolism, Medicolegal Considerations
Fibromyalgia and Chronic Fatigue Syndrome Alethia Baldwin Sellers and Daniel Clauw Print Publication Year: 2013 Published Online: Aug 2013 Publisher: Oxford University Press ISBN: 9780199796410 eISBN: 9780199352999 DOI: 10.1093/med/9780199796410.003.0015 Item type: chapter
This chapter provides an overview of some important aspects of fibromyalgia (FM) and chronic fatigue syndrome (CFS). These conditions are known to be closely associated with each other, as at least half of the individuals that meet diagnostic criteria for one of these conditions will also have met criteria for the other, and both entities are similarly related
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to conditions such as irritable bowel syndrome, interstitial cystitis, temporomandibular disorder, and headache.
Vulvodynia Ursula Wesselmann and Peter Czakanski Print Publication Year: 2013 Published Online: Aug 2013 Publisher: Oxford University Press ISBN: 9780199796410 eISBN: 9780199352999 DOI: 10.1093/med/9780199796410.003.0012 Item type: chapter
This chapter will discuss the neurobiology, etiology, clinical presentation, diagnosis, and clinical management of vulvodynia, a chronic vulvar pain syndrome. Chronic nonmalignant pain syndromes (longer than 6 months duration) of urogenital origin are well described but poorly understood focal pain syndromes.1 In the female patient these pain syndromes include vulvar dysesthesia, clitoral pain, urethral syndrome, coccygodynia, and generalized perineal pain, and the “counterparts” in the male patient are orchialgia, prostatodynia, and chronic penile pain, as well as coccygodynia and generalized perineal pain. While the focus of the chapter is on vulvodynia, it is important to recognize that chronic vulvar pain is one of the clinical presentations of the chronic nonmalignant urogenital pain syndromes. This concept will guide the health care provider in making the diagnosis of a chronic pain syndrome and the researcher in understanding vulvodynia in the context of complex changes in pain modulation.
Anaesthesia for non-obstetric surgery Vegard Dahl and Ulrich J. Spreng Print Publication Year: 2016 Published Online: Oct 2016 ISBN: 9780198713333 eISBN: 9780191819759 Item type: chapter
Publisher: Oxford University Press DOI: 10.1093/med/9780198713333.003.0010
Anaesthesia for non-obstetric reasons is performed in 1–2% of all pregnant women. Although the chances of complications like miscarriage, preterm labour, and abortion are higher when surgery is performed during gestation, careful evaluation, preparation, and a multidisciplinary approach will minimize these risks. There are no methods of anaesthesia that are preferable to others during pregnancy. The most important preventive measure is to maintain maternal haemodynamic stability and normoventilation in order to ensure fetal well-being. Extensive knowledge of the profound anatomical and physiological changes that a pregnancy induces is mandatory for the team when operating on a pregnant woman. Short time exposure to anaesthetic agents in clinically relevant doses during surgery has never been demonstrated to have teratogenic effects. Lately, focus has been made on the possible behavioural teratogenic properties of anaesthesia, especially on the use of NMDA receptor antagonists and GABA receptor agonists. Emergency diagnostic imaging during pregnancy is considered safe and should be performed if necessary. Electroconvulsive therapy for the treatment of serious psychiatric disorders during pregnancy is a possibility that should be considered if necessary. Electric cardioversion seems safe for the fetus if life-threatening arrhythmias occur during pregnancy. Trauma is one of the leading non-obstetric causes of Page 4 of 5 PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy). date: 14 January 2017
maternal mortality and morbidity. When treating a traumatized pregnant woman one should initially focus on the mother’s safety and haemodynamic stability.
Cardiac Pain in Women Eileen Handberg and Marian Limacher Print Publication Year: 2013 Published Online: Aug 2013 Publisher: Oxford University Press ISBN: 9780199796410 eISBN: 9780199352999 DOI: 10.1093/med/9780199796410.003.0020 Item type: chapter
This chapter reviews the epidemiology of cardiovascular disease in women, describes the cardiac conditions that elicit symptoms, identifies what differences may exist in the symptoms affecting women and men, offers suggestions for the underlying etiology for symptoms, and lists steps for addressing the diagnosis and management of cardiac symptoms.
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