Skip to main content
SpringerLink
Log in

Normal Pregnancy, Pregnancy Complications, and Obstetric Management

  • Chapter
  • First Online:
Contraception and Pregnancy in Patients with Rheumatic Disease

Abstract

Profound changes in maternal physiology occur during pregnancy to accommodate the growing fetus. Understanding these changes is fundamental to proper management of the obstetric patient and identification of pathologic changes. This chapter provides an overview of the obstetric patient and serves to familiarize the rheumatologist with pregnancy. First, we address normal fetal development followed by the various maternal physiologic changes that occur in major organ systems. Next we address antenatal care and fetal surveillance. Finally, we discuss common complications of pregnancy, some of which may mimic rheumatologic conditions or occur in greater frequency in the woman with underlying rheumatic disease. This chapter lays the foundation required to understand the nuances of pregnancy management in each specific rheumatologic disease.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Monga M. Maternal cardiovascular, respiratory, and renal adaptation to pregnancy. In: Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore TR, editors. Maternal-fetal medicine: principles and practice. 6th ed. Philadelphia: Saunders; 2009. p. 102.

    Google Scholar 

  2. Ueland K, Metcalfe J. Circulatory changes in pregnancy. Clin Obstet Gynecol. 1975;18:41–50.

    Article  PubMed  CAS  Google Scholar 

  3. Laird-Meeter K, Van de Ley G, Bom TH, et al. Cardiocirculatory adjustments during pregnancy—an echocardiographic study. Clin Cardiol. 1979;2:328–32.

    Article  PubMed  CAS  Google Scholar 

  4. James C, Banner T, Caton D. Cardiac output in women undergoing cesarean section with epidural or general anesthesia. Am J Obstet Gynecol. 1989;160:1178.

    Article  PubMed  CAS  Google Scholar 

  5. Crapo R. Normal cardiopulmonary physiology during pregnancy. Clin Obstet Gynecol. 1996;39:3–16.

    Article  PubMed  CAS  Google Scholar 

  6. Prowse CM, Gaensler EA. Respiratory and acid–base changes during pregnancy. Anesthesiology. 1965;26:381–92.

    Article  PubMed  CAS  Google Scholar 

  7. Elkus R, Popovich J. Respiratory physiology in pregnancy. Clin Chest Med. 1992;13:555–65.

    PubMed  CAS  Google Scholar 

  8. McAuliffe F, Kametas N, Costello J, et al. Respiratory function in singleton and twin pregnancy. BJOG. 2002;109:765–9.

    Article  PubMed  Google Scholar 

  9. Lucius H, Gahlenbeck H, Kleine H-O, et al. Respiratory functions, buffer system, and electrolyte concentrations of blood during human pregnancy. Respir Physiol. 1970;9:311–7.

    Article  PubMed  CAS  Google Scholar 

  10. Dunlop W. Serial changes in renal hemodynamics during normal human pregnancy. BJOG. 1981;88:1.

    Article  CAS  Google Scholar 

  11. Conrad KP, Lindheimer MD. Renal and cardiovascular alterations. In: Lindheimer MD, Roberts JM, Cunningham FG, editors. Chesley’s hypertensive disorders in pregnancy. 2nd ed. Stamford: Appleton and Lange; 1999. p. 263–326.

    Google Scholar 

  12. Davison J, Hytten F. The effect of pregnancy on the renal handling of glucose. Br J Obstet Gynaecol. 1975;82:374.

    Article  PubMed  CAS  Google Scholar 

  13. Fried A, Woodring JH, Thompson TJ. Hydronephrosis of pregnancy. J Ultrasound Med. 1983;2:255.

    PubMed  CAS  Google Scholar 

  14. Girling JC, Dow E, Smith JH. Liver function tests in pre-eclampsia: importance of comparison with a reference range derived for normal pregnancy. BJOG. 1997;104:246–50.

    Article  CAS  Google Scholar 

  15. Ensom M, Liu P, Stephenson M. Effect of pregnancy on bone mineral density in healthy women. Obstet Gynecol Surv. 2002;57:99.

    Article  PubMed  Google Scholar 

  16. Karlsson MK, Ahlborg HG, Karlsson C. Maternity and bone mineral density. Acta Orthop. 2005;76(1):2–13.

    Article  PubMed  Google Scholar 

  17. Keriakos R, Bhatta SR, Morris F, Mason S, Buckley S. Pelvic girdle pain during pregnancy and puerperium. J Obstet Gynaecol. 2011;31(7):572–80.

    Article  PubMed  CAS  Google Scholar 

  18. American College of Obstetricians and Gynecologists. ACOG practice bulletin 77: screening for fetal chromosomal abnormalities. Obstet Gynecol. 2007;109:217–27.

    Article  Google Scholar 

  19. Bianchi DW, Platt LD, Goldberg JD, Abuhamad AZ, Sehnert AJ, Rava RP, et al. Genome-wide fetal aneuploidy detection by maternal plasma DNA sequencing. Obstet Gynecol. 2012;119:890–901.

    Article  PubMed  CAS  Google Scholar 

  20. Alfirevic Z, Stampalija T, Gyte GML. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database Syst Rev. 2010;(1), Art. No: CD007529. doi:10.1002/14651858.CD007529.pub2

  21. Norwitz ER, Schust DJ, Fisher SJ. Implantation and the survival of early pregnancy. N Engl J Med. 2001;345:1400–8.

    Article  PubMed  CAS  Google Scholar 

  22. Simpson JL, Mills JL, Holmes LB, et al. Low fetal loss rates after ultrasound-proved viability in early pregnancy. JAMA. 1987;258:2555–7.

    Article  PubMed  CAS  Google Scholar 

  23. MacDorman MFL, Kirmeyer SE, Wilson EC. Fetal and perinatal mortality, United States, 2006. Natl Vital Stat Rep. 2012;60(8).

    Google Scholar 

  24. The Stillbirth Collaborative Research Network Writing Group. Causes of death among stillbirths. JAMA. 2011;306:2459–68.

    Article  Google Scholar 

  25. Alexander JM, Bloom SL, McIntire DD, Leveno KJ. Severe preeclampsia and the very low birth weight infant: is induction of labor harmful? Obstet Gynecol. 1999;93(4):485.

    Article  PubMed  CAS  Google Scholar 

  26. Nassar AH, Adra AM, Chakhtoura N, Gómez-Marín O, Beydoun S. Severe preeclampsia remote from term: labor induction or elective cesarean delivery? Am J Obstet Gynecol. 1998;179(5):1210.

    Article  PubMed  CAS  Google Scholar 

  27. Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: clinical issues and management. A review. BMC Pregnancy Childbirth. 2009;9:8.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Williamson C, Mackillop L. Diseases of the liver, biliary system, and pancreas. In: Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore TR, editors. Maternal-fetal medicine: principles and practice. 6th ed. Philadelphia: Saunders; 2009. p. 1059–77.

    Google Scholar 

  29. Woudstra DM, Chandra S, Hofmeyr GJ, Dowswell T. Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy. Cochrane Database Syst Rev 2010;(9):CD008148.

    Google Scholar 

  30. Duley L, Gulmezoglu AM, Henderson-Smart DJ. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev. 2010;11:CD000025.

    PubMed  Google Scholar 

  31. Jewell D, Young G. Interventions for nausea and vomiting in early pregnancy (Cochrane review). In: The Cochrane library, issue 4. Chichester: Wiley; 2003.

    Google Scholar 

  32. Saleh M, Abdo K. Intrahepatic cholestasis of pregnancy: review of the literature and evaluation of current evidence. J Womens Health. 2007;16(6):833–41.

    Article  Google Scholar 

  33. Williamson C, Gorelik J, Eaton BM, et al. The bile acid taurocholate impairs rat cardiomyocyte function: a proposed mechanism for intra-uterine fetal death in obstetric cholestasis. Clin Sci (Lond). 2001;100(4):363–9.

    Article  CAS  Google Scholar 

  34. Gorelik J, Harding SE, Shevchuk AI, et al. Taurocholate induces changes in rat cardiomyocyte contraction and calcium dynamics. Clin Sci (Lond). 2002;103(2):191–200.

    Article  CAS  Google Scholar 

  35. Williamson C, Miragoli M, Sheikh Abdul Kadir S, Abu-Hayyeh S, Papacleovoulou G, Geenes V, Gorelik J. Bile acid signaling in fetal tissues: implications for intrahepatic cholestasis of pregnancy. Dig Dis. 2011;29(1):58–61.

    Article  PubMed  Google Scholar 

  36. Kenyon AP, Percy CN, Girling J, et al. Obstetric cholestasis, outcome with active management: a series of 70 cases. BJOG. 2002;109(3):282–8.

    Article  PubMed  Google Scholar 

  37. Gorelik J, Shevchuk A, de Swiet M, et al. Comparison of the arrhythmogenic effects of tauro- and glycoconjugates of cholic acid in an in vitro study of rat cardiomyocytes. BJOG. 2004;111(8):867–70.

    Article  PubMed  CAS  Google Scholar 

  38. Williamson C, Hems L, Goulis D, et al. Clinical outcome in a series of cases of obstetric cholestasis identified via a patient support group. BJOG. 2004;111(7):676–81.

    Article  PubMed  Google Scholar 

  39. Sibai BM. Imitators of severe pre-eclampsia. Semin Perinatol. 2009;33:196–205.

    Article  PubMed  Google Scholar 

  40. Vigil-DeGracia P, Lavergue JA. Acute fatty liver of pregnancy. Int J Gynecol Obstet. 2001;72:193–5.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Health Care, 30 North 1900 East, Room 2B200 SOM, Salt Lake City, UT, 84132, USA

    D. Ware Branch M.D.

  2. Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT, USA

    Luchin F. Wong M.P.H., M.D.

Authors
  1. D. Ware Branch M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luchin F. Wong M.P.H., M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Ware Branch M.D. .

Editor information

Editors and Affiliations

  1. Division of Rheumatology, Hospital for Special Surgery Weill Cornell Medical College, New York, New York, USA

    Lisa R. Sammaritano

  2. Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Bonnie L. Bermas

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Branch, D.W., Wong, L.F. (2014). Normal Pregnancy, Pregnancy Complications, and Obstetric Management. In: Sammaritano, L., Bermas, B. (eds) Contraception and Pregnancy in Patients with Rheumatic Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0673-4_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-0673-4_2

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-0672-7

  • Online ISBN: 978-1-4939-0673-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation