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ErratumEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The author listing for the article, “Neurodevelopmental changes of fetal pain,” which was published in Seminars in Perinatology in 2007 (31[5]:275-82), was incomplete. Dr. Barbara Clancy contributed to the article and should have been listed as an author. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - November 16, 2009 Category: Perinatology & Neonatology Source Type: journals

Ethics and “Cesarean Delivery on Maternal Demand”Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
There is considerable ongoing debate about whether physicians should supply cesarean delivery to patients purely on the basis of maternal demand. This debate is marred by serious definitional problems. Although planned elective cesareans share a risk-profile with “cesarean delivery on maternal demand,” not every case of planned elective cesarean results from maternal demand. Ethical and practical considerations counsel using language that is more neutral on the question of the reason for, and process of decision-making leading to, cesarean delivery. Consideration of the risks and benefits of planned elective cesarean, ...
Source: Seminars in Perinatology - November 16, 2009 Category: Perinatology & Neonatology Authors: Stephen R. Latham, Errol R. Norwitz Source Type: journals

Ethics Education in Neonatal-Perinatal Medicine in the United StatesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Neonatology is one of the specialties that has immensely benefited from advances in medical technology in the last few decades. These advances have paralleled the rise of the civil rights movements and wider recognition of individual rights. As a result, ethical decision-making has become more complex, involving patients, parents, members of the health care team, and society in general. This has created a need for formal ethics education in neonatal-perinatal medicine fellowship programs. In this article, we briefly explore the current published data on ethics education in pediatric residency and neonatal-perinatal medicin...
Source: Seminars in Perinatology - November 16, 2009 Category: Perinatology & Neonatology Authors: Zeynep N. Inanc Salih, David W. Boyle Source Type: journals

Ethics of Research in Perinatal MedicineEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Ethics is an essential component of fetal research. From definitions of medical ethics and the ethical principles of beneficence and respect for autonomy, we identify the ethical concept of the fetus as a patient. We then identify major components of research ethics. On these 2 bases, we identify ethically justified criteria for initiating study of innovative fetal interventions, for randomized trials in fetal research, for making the clinical, scientific, and ethical judgment that fetal research has produced a new standard of care, and for stopping rules for fetal research. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - November 16, 2009 Category: Perinatology & Neonatology Authors: Frank A. Chervenak, Laurence B. McCullough Source Type: journals

The Texas Advance Directives Act—Is It a Good Model?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The Texas Advance Directives Act was first passed in 1999 to help resolve conflicts between families and physicians when disagreements exist over continuing or halting treatments of patients. When the physician feels that continued treatment is ethically or morally unjustified and seeks to end life support for a patient against the wishes of the family, it establishes a specific path that must be followed to afford legal protection to the physician and institution. Its proponents believe that it reduces morally unjustifiable treatment of terminal patients, while its opponents argue that it places too much power in the hand...
Source: Seminars in Perinatology - November 16, 2009 Category: Perinatology & Neonatology Authors: Harris C. Jacobs Source Type: journals

Neonatal EuthanasiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Despite advances in the care of infants, there remain many newborns whose medical conditions are incompatible with sustained life. At times, healthcare providers and parents may agree that prolonging life is not an appropriate goal of care, and they may redirect treatment to alleviate suffering. While pediatric palliative treatment protocols are gaining greater acceptance, there remain some children whose suffering is unrelenting despite maximal efforts. Due to the realization that some infants suffer unbearably (ie, the burdens of suffering outweigh the benefits of life), the Dutch have developed a protocol for euthanizin...
Source: Seminars in Perinatology - November 16, 2009 Category: Perinatology & Neonatology Authors: Alexander A. Kon Source Type: journals

Disputes Over Moral Standards Guiding Treatments for Imperiled InfantsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Two incompatible policies govern medical decision-making for infants aged < 1 year in the United States. One is the Best Interests Standard, which is the older policy, and the other is the Child Abuse Prevention and Treatment Act amendments widely known as the “Baby Doe” rules. The debate over which policy to adopt, however, is more far-reaching than treatment for one group in one country as it involves how to rank important medical values when they come into conflict. These are the values of prolonging biological life and of providing comfort and relief from pain and suffering for imperiled and incompetent persons. Fo...
Source: Seminars in Perinatology - November 16, 2009 Category: Perinatology & Neonatology Authors: Loretta M. Kopelman Source Type: journals

Ethical Issues in Research Involving InfantsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The future health of infants and children is dependent on the performance of clinical research in which infants participate. Achieving a proper balance between this social good and the obligation to protect infants who participate in research is a significant challenge. As investigators design and implement research protocols, they should be aware of the ethical and legal requirements that govern research with infants. For research to satisfy ethical and legal requirements it must be scientifically sound and significant, subject selection must be fair, approaching families for enrollment must avoid pressure, the risks to p...
Source: Seminars in Perinatology - November 16, 2009 Category: Perinatology & Neonatology Authors: Douglas S. Diekema Source Type: journals

The Ethics of Newborn ResuscitationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
It is widely believed in neonatology and obstetrics that there are situations in which it is inappropriate to attempt newborn resuscitation, and other times when newborn resuscitation is obligatory despite parental refusal. In each case, an ethical justification for the decision needs to be identified. This essay is intended to provide guidance in deciding when resuscitation should be attempted, and in identifying ethical considerations that should be taken into account. It specifically addresses the issue of extreme prematurity, including an analysis of current recommendations, the data, relevant rights of patient and par...
Source: Seminars in Perinatology - November 16, 2009 Category: Perinatology & Neonatology Authors: Mark R. Mercurio Source Type: journals

Introduction: Taking the Time for Medical EthicsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In considering our approach to ethical problems in medicine, a good place to start is our approach to other decisions in this same arena. Most decisions that we face in the clinical setting are addressed based on some combination of personal experience, education, professional guidelines, standard of care, understanding of physiology, and scientific evidence. The ongoing emphasis on evidence-based medicine, however, rightly suggests that these factors should not be given equal weight. That is, good clinical trials should count for more than personal opinion, or how one was trained years ago. Moreover, if there is a clinica...
Source: Seminars in Perinatology - November 16, 2009 Category: Perinatology & Neonatology Authors: Mark R. Mercurio Source Type: journals

Table of ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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Source: Seminars in Perinatology - November 16, 2009 Category: Perinatology & Neonatology Source Type: journals

Topics for 2008Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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Source: Seminars in Perinatology - November 16, 2009 Category: Perinatology & Neonatology Source Type: journals

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Source: Seminars in Perinatology - November 16, 2009 Category: Perinatology & Neonatology Source Type: journals

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Source: Seminars in Perinatology - November 16, 2009 Category: Perinatology & Neonatology Source Type: journals

Prevention of Preterm Birth Based on Short Cervix: Symptomatic Women With Preterm Labor or Premature Prelabor Rupture of MembranesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The diagnosis of preterm labor (PTL) is challenging, especially in women whose cervical dilatation is (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - September 30, 2009 Category: Perinatology & Neonatology Authors: Amen Ness Source Type: journals

Alternative Treatment for a Short Cervix: The Cervical PessaryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Preterm birth is the leading cause of perinatal morbidity and mortality in the United States. The risk of preterm birth is inversely proportional to the length of the cervix on transvaginal sonography. The traditional treatment for a short cervix has been cerclage and recently there are newer trials using progesterone for this same indication. This manuscript reviews the published data regarding the use of an old method for the treatment of cervical insufficiency, “The Cervical Pessary.” A MEDLINE search was performed and articles published since 1959 regarding the use of pessary for cervical insufficiency were identif...
Source: Seminars in Perinatology - September 30, 2009 Category: Perinatology & Neonatology Authors: Vanita B. Dharan, Jack Ludmir Source Type: journals

Prevention of Preterm Birth Based on Short Cervix: ProgesteroneEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Preterm delivery, which occurs in about 5%-13% of pregnancies in most countries, is the main cause of neonatal morbidity and mortality. Symptomatic treatment of pregnancies presenting in preterm labor with corticosteroids has improved perinatal outcome but has not reduced the incidence of preterm delivery. Recent evidence suggests that the rate of preterm delivery may be reduced by the prophylactic use of progesterone in women with a history of preterm delivery and in those with a short cervical length identified by routine transvaginal sonography. This review summarizes the evidence (level A evidence) of the effectiveness...
Source: Seminars in Perinatology - September 30, 2009 Category: Perinatology & Neonatology Authors: Eduardo B. da Fonseca, Rievani Damião, Kypros Nicholaides Source Type: journals

Prevention of Preterm Birth Based on a Short Cervix: CerclageEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In an attempt to prevent preterm birth, clinicians have recommended cerclage for women with shortened cervical length and other worrisome sonographic cervical features in the mid-trimester, although randomized trials have not supported this practice. Emerging data suggest that preterm birth is a complex and poorly understood syndrome comprising several anatomic and functional components. As a result, preventive efforts have been mostly empiric and generally ineffective. Plausibly, effective preterm birth therapies exist, but matching the effective treatment with the correct patient has been problematic. Mid-trimester cervi...
Source: Seminars in Perinatology - September 30, 2009 Category: Perinatology & Neonatology Authors: Melissa S. Mancuso, John Owen Source Type: journals

Prediction of Preterm Birth: Cervical SonographyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The cervix has to open to allow vaginal birth. Ultrasound has now shown that this lower part of the uterus begins to show changes weeks before eventual birth. Only transvaginal ultrasound should be used to evaluate the cervix for prediction of preterm birth (PTB). The shortest best cervical length (CL) is the most effective measurement for clinical use. Proper technique is paramount for accurate results. The risk of PTB increases with ever shorter CL ( (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - September 30, 2009 Category: Perinatology & Neonatology Authors: Maria Teresa Mella, Vincenzo Berghella Source Type: journals

Prediction of Preterm Birth: Nonsonographic Cervical MethodsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A short cervix in the second trimester is a powerful predictor of preterm birth risk. Multiple cervical length screens for patients in midpregnancy will likely become the standard of obstetrical care as a result of the development of effective methods (eg, cerclage, progesterone) to prevent early delivery in patients with a short cervix. Because of the high cost and infrastructure requirements, providing multiple cervical length evaluations through transvaginal ultrasound will likely be a significant barrier to universal screening. A cost-effective, low-technology method of cervical length screening is necessary to impleme...
Source: Seminars in Perinatology - September 30, 2009 Category: Perinatology & Neonatology Authors: Michael G. Ross, Marie H. Beall Source Type: journals

Genetics of the Cervix in Relation to Preterm BirthEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Preterm birth is the most significant problem encountered in obstetrics in the developed world. Genetic factors are thought to play a role in a proportion of preterm births, and candidate genes have been studied in several areas relevant to parturition. Abnormal cervical function, a clinical spectrum, including cervical insufficiency (CI), is a contributing factor to the overall problem of preterm birth. There are many risk factors and etiologies for CI. However, it is becoming clear that, at least in part, a genetic predisposition to CI plays a role in the condition. Specifically, genes related to connective tissue metabo...
Source: Seminars in Perinatology - September 30, 2009 Category: Perinatology & Neonatology Authors: Jennifer E. Warren, Robert M. Silver Source Type: journals

Relationships Between Mechanical Properties and Extracellular Matrix Constituents of the Cervical Stroma During PregnancyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The objective of this review is to discuss relationships between biochemical constituents and macroscopic mechanical properties. The individual constituents of the ECM will be discussed, especially in regard to collagen remodeling during pregnancy. In addition, the macroscopic mechanical properties of cervical tissue will be reviewed. An improved understanding of the biochemistry of cervical “strength” will shed light on how the cervix maintains its shape in normal pregnancy and shortens in preterm birth. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - September 30, 2009 Category: Perinatology & Neonatology Authors: Michael House, David L. Kaplan, Simona Socrate Source Type: journals

IntroductionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
I thank Drs D'Alton and Gross for providing me with the opportunity to edit this issue of Seminars in Perinatology. It is an honor. Preterm birth remains the biggest reason for perinatal morbidity and mortality. It occurs in over 500,000 women every year in the United States, accounting for almost 13% of total births. Many of these preterm neonates either die or suffer, at times for life, of the complications of being born too early. The Center for Disease Control has calculated that, in years-of-life-lost, preterm birth is the biggest killer among any other conditions, including heart disease or cancer. In fact, for the ...
Source: Seminars in Perinatology - September 30, 2009 Category: Perinatology & Neonatology Authors: Vincenzo Berghella Source Type: journals

Topics for 2008Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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Source: Seminars in Perinatology - September 30, 2009 Category: Perinatology & Neonatology Source Type: journals

Table of ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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Source: Seminars in Perinatology - September 30, 2009 Category: Perinatology & Neonatology Source Type: journals

Advancing Fetal Brain MRI: Targets for the FutureEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Fetal MRI is becoming an increasingly powerful imaging tool for studying brain development in vivo. Until recently, the application of advanced magnetic resonance imaging techniques was limited by motion in the nonsedated fetus. Extensive research efforts currently underway are focusing on the development of dedicated magnetic resonance imaging sequences and sophisticated postprocessing techniques that are revolutionizing our ability to study the healthy and compromised fetus. The ongoing refinement of these magnetic resonance imaging techniques will undoubtedly lead to the development of cornerstone biomarkers that will p...
Source: Seminars in Perinatology - July 24, 2009 Category: Perinatology & Neonatology Authors: Catherine Limperopoulos, Cedric Clouchoux Source Type: journals

The Emerging Role of Functional MRI for Evaluating Fetal Brain ActivityEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Although functional magnetic resonance imaging is a technique that is widely used in adult populations, its use within a fetal environment has been extremely limited. Problems associated with movement and technical scanning issues have limited its effectiveness in providing reliable and spatially accurate details of fetal brain activity. However, initial research has indicated that it is a viable tool for assessing functional maturation in the fetus, and recent advances in echo-planar imaging sequences on the abdomen at 3-T provide the potential for more reliable activation detection and higher resolution spatial informati...
Source: Seminars in Perinatology - July 24, 2009 Category: Perinatology & Neonatology Authors: Jon Fulford, Penny A. Gowland Source Type: journals

Placental Morphologic and Functional Imaging in High-Risk PregnanciesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The placenta is vital for fetal growth and development. Improvement in ultrasound and magnetic resonance imaging have improved our understanding of placental morphology that can be important as in the case of placental accrete/percreta. Functional imaging is presently mainly performed by the use of Doppler ultrasound and can give information on placental perfusion, which can be vital for clinical diagnosis. This review summarizes the present knowledge on placental imaging and it's clinical value in high-risk pregnancies. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - July 24, 2009 Category: Perinatology & Neonatology Authors: Saemundur Gudmundsson, Mariusz Dubiel, Povilas Sladkevicius Source Type: journals

Evaluation of Fetal Cerebrovascular Circulation and Brain Development: The Role of Ultrasound and DopplerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The human fetal brain is protected from pressure changes by autoregulation of the cerebral circulation. However, antenatal intrauterine cerebrovascular events are found to play an important role in the pathogenesis of perinatal brain damage. Changes in placental vascular resistance, cardiac contractibility, vessel compliance, and blood viscosity alter the normal dynamics of fetal cerebral circulation. The introduction of various sonographic techniques and the collection of data from the arterial and venous cerebral circulation provide a powerful tool for the evaluation of physiological and pathological hemodynamic events. ...
Source: Seminars in Perinatology - July 24, 2009 Category: Perinatology & Neonatology Authors: Shimon Degani Source Type: journals

Diagnostic Pitfalls in Fetal Brain MRIEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Recent technological advances in fetal magnetic resonance imaging (MRI) and increased reliability of MRI in depicting abnormalities and lesions, especially in the central nervous system, are increasingly bringing up challenging issues with regard to accurate diagnosis. There are also pitfalls not only attributable to image acquisition but also in clinical interpretation. The misinterpretation of findings because of insufficient knowledge about fetal brain development as visualized by MRI may also be regarded as an important limitation of fetal MRI. We provide an overview of the most common pitfalls experienced in fetal MRI...
Source: Seminars in Perinatology - July 24, 2009 Category: Perinatology & Neonatology Authors: Ali Al-Mukhtar, Gregor Kasprian, Maria T. Schmook, Peter C. Brugger, Daniela Prayer Source Type: journals

Fetal Magnetic Resonance Imaging of Acquired and Developmental Brain AnomaliesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
During the last decade, increasing interest in magnetic resonance imaging has emerged for the evaluation of fetal abnormalities detected on ultrasound. The advent of single-shot rapid acquisition sequences has greatly facilitated our ability to obtain detailed imaging information of the fetal brain. To date, fetal magnetic resonance imaging has shown to have an important role in the investigation of cerebral abnormalities suspected by sonography, and in the detection of subtle brain anomalies associated with high-risk pregnancies. Magnetic resonance imaging has proved to be a useful adjunct to sonography during the prenata...
Source: Seminars in Perinatology - July 24, 2009 Category: Perinatology & Neonatology Authors: Nadine Girard, Kathia Chaumoitre, Frederique Chapon, Sandrine Pineau, Marie Barberet, Herve Brunel Source Type: journals

Insights From In Vitro Fetal Magnetic Resonance Imaging of Cerebral DevelopmentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The development of the cerebral cortex, white matter microstructure, and the basal ganglia can be well characterized using structural magnetic resonance imaging (MRI). In this review, we analyzed structural in vitro MRI studies of transient cellular cerebral zones that are sites of neurogenetic events (proliferation, migration, cell aggregation, growth of axonal pathways, myelinization, and synaptogenesis). During early fetal life, from 9-13 postconceptional weeks, a thick, densely packed cellular ventricular/subventricular zone and ganglionic eminence indicate intensive proliferation of neuroepithelial stem cells. During ...
Source: Seminars in Perinatology - July 24, 2009 Category: Perinatology & Neonatology Authors: Ivica Kostovic, Lana Vasung Source Type: journals

Normal Development of the Fetal Brain by MRIEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article will review techniques of fetal MRI as well as several key aspects of brain development and their appearance on MRI. An understanding of normal fetal brain development is essential to correctly identifying developmental abnormalities. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - July 24, 2009 Category: Perinatology & Neonatology Authors: Orit A. Glenn Source Type: journals

IntroductionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This issue of Seminars in Perinatology is devoted to fetal neuroimaging. During the last decade, significant advances have been made in the care of the developing brain. However, our understanding of the dynamic and elaborate development of the central nervous system in utero had been impeded by a lack of reliable and clinically applicable neuroimaging benchmarks. The selected topics addressed in this issue illustrate how recent advances in neuroimaging techniques are providing us with the unprecedented opportunity to study, in intricate detail, the developing nervous system of the healthy and compromised fetus. (Source: S...
Source: Seminars in Perinatology - July 24, 2009 Category: Perinatology & Neonatology Authors: Catherine Limperopoulos Source Type: journals

Topics for 2008Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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Source: Seminars in Perinatology - July 24, 2009 Category: Perinatology & Neonatology Source Type: journals

Table of ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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ErratumEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Seminars in Perinatology has made a minor revision in editorial policy. The contact information for guest editors will now appear in the Introduction to the issue. Dr. Edmund F. La Gamma's contact information was not included in the November-December 2008 entitled “Transient Hypothyroximemia of Prematurity” (Volume 32, Number 6, pages 377-446); it is provided below: (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 24, 2009 Category: Perinatology & Neonatology Source Type: journals

Imitators of Severe Pre-eclampsiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
There are many obstetric, medial, and surgical disorders that share many of the clinical and laboratory findings of patients with severe pre-eclampsia–eclampsia. Imitators of severe pre-eclampsia–eclampsia are life-threatening emergencies that can develop during pregnancy or in the postpartum period. These conditions are associated with high maternal and perinatal mortalities and morbidities, and survivors may face long-term sequelae. The pathophysiologic abnormalities in many of these disorders include vasospasm, platelet activation or destruction, microvascular thrombosis, endothelial cell dysfunction, and reduced ti...
Source: Seminars in Perinatology - May 24, 2009 Category: Perinatology & Neonatology Authors: Baha M. Sibai Source Type: journals

Abruptio Placentae and Disseminated Intravascular CoagulopathyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abruptio placentae is an important cause of vaginal bleeding in the latter half of pregnancy. The key factor in the pathophysiology is hemorrhage at the decidual–placental interface. Small episodes may escape clinical detection, but severe grades impact significantly on fetal and maternal morbidity and mortality, with the most frequent complications being fetal death, severe maternal shock, disseminated intravascular coagulopathy, and renal failure. Important risk factors for the development of abruptio placentae are previous abruption, hypertensive diseases, abdominal trauma, growth restriction, and smoking. The diagnos...
Source: Seminars in Perinatology - May 24, 2009 Category: Perinatology & Neonatology Authors: David R. Hall Source Type: journals

Gastrointestinal Complications of Pre-eclampsiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Gastrointestinal complications of pre-eclampsia can occur and have the risk of being life-threatening for the mother and fetus. Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome has been recognized as a complication of pre-eclampsia for decades. Pregnancies complicated by this syndrome require a well-formulated management plan, including assessing and stabilizing the maternal condition as well as evaluating fetal well-being. Patients with HELLP syndrome should receive anti-seizure prophylaxis with magnesium sulfate, treatment for severe hypertension, and correction of coagulopathy, if present. The poten...
Source: Seminars in Perinatology - May 24, 2009 Category: Perinatology & Neonatology Authors: John R. Barton, Baha M. Sibai Source Type: journals

Pre-eclampsia and the KidneyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Pre-eclampsia is a multisystem disorder that is unique to pregnancy, affecting at least 5% of all gravidas. The mainstay of this diagnosis is a combination of new-onset hypertension and proteinuria. The kidney deserves particular attention because of the physiologic as well as pathologic changes that can affect this vital organ in pregnancy. In fact, there is a major interplay between renal disease and pre-eclampsia. Proteinuria is universal to all cases of pre-eclampsia, yet some cases can progress to acute renal failure. Furthermore, it is well-established that the latter is more frequent in women with underlying renal d...
Source: Seminars in Perinatology - May 24, 2009 Category: Perinatology & Neonatology Authors: Fadi G. Mirza, Kirsten Lawrence Cleary Source Type: journals

Neurologic Complications of Pre-eclampsiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Pre-eclampsia is mainly responsible for the world's large maternal mortality rates, mostly due to acute cerebral complications. This review provides insight into the pathogenesis of the neurologic complications of hypertensive disease in pregnancy. In addition, practical relevance for clinical care is highlighted. Pertaining to pregnancy, the blood pressure level at which cerebral autoregulation operates and possible deregulation occurs is unknown, but is likely to be variable. From clinical observation, eclampsia may occur despite a mild clinical picture and before the development of hypertension or proteinuria. Furthermo...
Source: Seminars in Perinatology - May 24, 2009 Category: Perinatology & Neonatology Authors: Gerda G. Zeeman Source Type: journals

Cardiopulmonary Complications of Pre-eclampsiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article aims to review complications of pre-eclampsia as they impact on the cardiovascular and pulmonary systems. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 24, 2009 Category: Perinatology & Neonatology Authors: Samuel Thomas Bauer, Kirsten Lawrence Cleary Source Type: journals

Predicting Adverse Outcomes in Women with Severe Pre-eclampsiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The reason pre-eclampsia matters so much to maternity care providers is that adverse maternal and perinatal events cluster around the diagnosis of proteinuric gestational hypertension. While that is true, most pre-eclampsia is mild and evanescent, resolving rapidly postpartum. Therefore, every effort must be made to identify those women at greatest personal risk, and those bearing fetuses at greatest risk, so that they can be offered closer surveillance and lower thresholds for the use of effective interventions, such as delivery and the use of MgSO4. Conversely, as delivery remote from term can increase perinatal risks an...
Source: Seminars in Perinatology - May 24, 2009 Category: Perinatology & Neonatology Authors: Peter von Dadelszen, Jennifer M. Menzies, Beth Payne, Laura A. Magee, PIERS (Pre-eclampsia Integrated Estimate of RiSk) Study Group Source Type: journals

Expectant Management in Pregnancies with Severe Pre-eclampsiaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The main objective of expectant management in women with severe pre-eclampsia (PE) remote from term is to improve neonatal outcome. Maternal conditions, however, may worsen during expectant management. This highlights the importance of balancing the risks between maternal and perinatal outcomes. Traditionally, women with severe PE remote from term are delivered expeditiously, regardless of gestational age. We here have reported several retrospective, case-control, observational, prospective, or randomized trials in which expectant management in women with severe PE was feasible in well-selected patients without prejudicing...
Source: Seminars in Perinatology - May 24, 2009 Category: Perinatology & Neonatology Authors: Bassam Haddad, Baha M. Sibai Source Type: journals

The Management of Severe HypertensionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Although definitions of severe hypertension vary, thresholds of ≥160-170 mm Hg systolic and/or ≥110 mm Hg diastolic are in most common usage. A recent focus has been placed on systolic hypertension given the increased pulse pressure in these women. In pregnancy, there is a general consensus that severe hypertension should be treated. Among woman with pre-eclampsia, attention must be paid to other end organ dysfunction, as blood pressure (BP) management is but one aspect of care. The urgency of antihypertensive therapy will depend primarily on the absolute level of BP. However, most clinicians will also consider both th...
Source: Seminars in Perinatology - May 24, 2009 Category: Perinatology & Neonatology Authors: Laura A. Magee, Peter von Dadelszen Source Type: journals