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POSTPARTUM CARE 323
10. Why does postpartum ovulation suppression occur?
Ovulation suppression is related to elevated prolactin and decreased estrogen levels. In lactating
women, increased prolactin can last up to 6 weeks post partum, whereas estrogen levels remain
low. In nonlactating women, prolactin normalizes by postpartum week 3 and estrogen rises, reaching
normal levels 2 to 3 weeks after delivery.
11. What type of care is required for perineal lacerations?
Spontaneous lacerations of the perineum or vagina are common during childbirth, and episiotomies
are sometimes performed. Routine cleansing is usually all that is necessary for uncomplicated
lacerations that do not extend beyond the transverse perineal muscle, do not have hematomas or
infection, and have been adequately repaired. Pain can usually be managed with ibuprofen. In patients
with third- or fourth-degree lacerations or episiotomy extensions, stronger pain medication is often
necessary. These women benefit from sitz baths as well as ice packs to reduce swelling, and they
should use stool softeners to promote a normal bowel regimen. Any patient experiencing an inordinate
amount of pain should have a physical examination to rule out hematoma or infection.
12. What is the definition of a postpartum fever?
A temperature of 100.4° F (38° C) or higher on two separate occasions, more than 24 hours after
delivery.
13. What is the differential diagnosis of postpartum fevers?
• Endometritis
• Urinary tract infection
• Wound infection
• Pulmonary infection
• Thrombophlebitis
• Mastitis
14. What is the most likely cause of infection in a patient with postpartum fevers?
Endometritis. Symptoms include fever, chills, lower abdominal pain, and malodorous vaginal
discharge. Patients have uterine tenderness on palpation, and the vaginal discharge is mucopurulent.
Treatment is usually with a combination of clindamycin and gentamicin to provide coverage for most
aerobic and anaerobic organisms. These organisms include group A Streptococcus, Bacteroides,
enterococci, Escherichia coli, Klebsiella, and Proteus. Blood cultures rarely influence clinical management,
but they should be obtained in cases of sepsis or poor response to treatment. Once symptoms have
subsided and the patient has been afebrile for 24 to 48 hours, intravenous antibiotic therapy can be
discontinued. It is not necessary to continue oral antibiotics.
15. What is septic pelvic thrombophlebitis?
Septic pelvic thrombophlebitis is a diagnosis of exclusion made when a patient who is receiving
antibiotics for endometritis has spiking temperatures and all other potential sources have been
excluded. Treatment consists of adding therapeutic doses of heparin to the patient’s medications.
Although magnetic resonance imaging (MRI) may show obstructed pelvic veins, it is usually not
necessary. Defervescence usually occurs within 72 hours of starting heparin, and most patients do
not need anticoagulation on discharge.
16. What are the maternal health benefits of breastfeeding?
Breastfeeding mothers experience decreased postpartum bleeding and more rapid uterine involution,
earlier return to prepregnancy weight, and decreased risk of breast and ovarian cancers.
17. Do breastfeeding women need additional nutrition?
A woman who is breastfeeding needs approximately 500 extra calories per day. With the exception
of zinc and calcium, almost all other nutrients necessary for breastfeeding can be obtained through a
balanced diet.
18. What is mastitis?
Mastitis is a localized infection of the breast that occurs in approximately 1% to 2% of breastfeeding
women. It can develop at any time, but it is most common between postpartum weeks 1 and 5.
Symptoms include a sore, erythematous area on one breast, which may become indurated. The
patient may also experience fevers, chills, and malaise; 3% to 4% of cases of mastitis progress to
abscess formation.
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324 LABOR, DELIVERY, AND POSTPARTUM
19. How is mastitis treated?
The most common cause of mastitis is Staphylococcus aureus. Other common causes include
Haemophilus influenzae, Klebsiella pneumoniae, E. coli, Enterococcus faecalis, and Enterobacter
cloacae. First-line treatment is dicloxacillin. If methicillin-resistant Staphylococcus aureus is a concern,
clindamycin or Bactrim can be used. Women who are allergic to penicillin should be given erythromycin.
Encourage patients to stay well hydrated and use acetaminophen for discomfort and fever. Abscesses
may require drainage and inpatient treatment with intravenous antibiotics.
20. Is mastitis a contraindication to breastfeeding?
No. It is important to empty the affected breast, and patients should be encouraged to continue
breastfeeding or use a pump.
21. Do any contraindications to breastfeeding exist?
Yes. Although most women can breastfeed safely, exceptions include any who:
• Are infected with human immunodeficiency virus (HIV; in the United States)
• Have active, highly communicable infections such as untreated tuberculosis, varicella, or herpes
simplex with breast lesions
• Are taking antineoplastic, thyrotoxic, and immunosuppressive agents
• Use street drugs or abuse alcohol
• Have an infant with galactosemia
• Are undergoing treatment for breast cancer
22. How can patients suppress lactation if they do not plan on breastfeeding?
Breast support, ice packs, and analgesic medications are helpful to relieve breast engorgement.
Expression of milk or nipple stimulation should be avoided. Breast engorgement and pain usually
subside within a week.
23. What medications are contraindicated while breastfeeding?
For a full list, refer to the American Academy of Pediatrics Guidelines for Drugs and Breastfeeding.
Some important examples are bromocriptine, cyclophosphamide, cyclosporine, doxorubicin, ergota-
mine, lithium, methotrexate, phencyclidine, and radioactive iodine. “Lactmed (available at: http://
toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACTMED) is a valuable resource for up-to-date information
on the safety of medications in lactation.
24. Can breastfeeding women use birth control?
Yes. Although breastfeeding postpones the time to first ovulation, it should not be relied on for
contraception. The U.S. Centers for Disease Control and Prevention (CDC) recommends that estrogen-
containing contraceptives be avoided in women who are breastfeeding until at least 6 weeks post
partum because of an increased risk of venous thromboembolism. (For nonlactating patients, these drugs
are contraindicated for at least 3 weeks if no other risk factors are present.) Progestin-only methods can
be started immediately post partum. For more information on contraception, see Chapter 14. Data on the
effect of hormonal contraceptives on lactation and milk production are controversial.
25. What is an ideal interpregnancy interval?
The interpregnancy interval is defined as the time from delivery to conception of the next pregnancy.
Although the World Health Organization (WHO) recommends an interpregnancy interval of at least
24 months after a live birth to decrease the incidence of perinatal complications such as preterm
delivery and low birth weight in the subsequent pregnancy, more recent data suggest that an interval
of at least 18 months is sufficient.
26. What is postpartum thyroiditis?
Postpartum thyroid dysfunction is an autoimmune disorder characterized by destructive, lymphocytic
thyroiditis. Often underdiagnosed, it can be found in as many as 5% to 10% of postpartum women.
Symptoms usually begin 1 to 4 months post partum and include features of hypothyroidism,
hyperthyroidism, or both. Sometimes a goiter may be noted on examination. The diagnosis is
confirmed with thyroid function tests. The most common outcome is spontaneous resolution,
although 10% to 30% of patients will develop permanent hypothyroidism.
27. How common is postpartum depression?
The incidence of true postpartum depression is 10% to 15%; signs and symptoms are no different
from those in the rest of the population. Women with an earlier history of depression or a related
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POSTPARTUM CARE 325
mood disorder are more prone to postpartum depression, and it has a 50% to 100% recurrence rate
in subsequent pregnancies.
Approximately 70% of women experience a period of mood symptoms (also known as “baby
blues”) that begin during the first week after delivery and spontaneously resolve by postpartum day
10. These mood symptoms include tearfulness, anxiety, irritation, and restlessness. No treatment is
necessary, but emotional support and rest are beneficial.
28. What is the treatment for postpartum depression?
Depression is a serious illness, and medical treatment should be strongly considered. Serotonin
reuptake inhibitors such as fluoxetine, paroxetine, and sertraline have been found to be effective and
have few side effects. If symptoms do not response to monotherapy, consultation with a psychiatrist is
advised.
BiBliography
1. American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. Guidelines for Perinatal
Care. 7th ed. United States: American Academy of Pediatrics and the American College of Obstetricians and Gynecologists;
2012.
2. American College of Obstetricians and Gynecologists. Optimizing support for breastfeeding as part of obstetric practice.
ACOG committee opinion no. 658. Obstet Gynecol. 2016;127:e86–92.
3. American College of Obstetricians and Gynecologists. Thyroid disease in pregnancy. ACOG practice bulletin no. 148.
Obstet Gynecol. 2015;125:996–1055.
4. Centers for Disease Control and Prevention.. Update to CDC’s US medical eligibility criteria for contraceptive use 2010:
revised recommendations for the use of contraceptive methods during the postpartum period. MMWR Morb Mortal Wkly
Rep. 2011;60:878–883.
5. Katz VL. Postpartum care. In: Gabbe SG, Niebyl JR, Simpson JL, et al., eds. Obstetrics: Normal and Problem Pregnancies.
6th ed. Philadelphia: Saunders; 2012:517–532.
6. Shachar BZ, Lyell DJ. Interpregnancy interval and obstetrical complications. Obstet Gynecol. Surv. 2012;67:584–596.
KEY POINTS: POSTPARTUM CARE
1. The physiologic changes of pregnancy return to the prepregnancy state during the first 6 to 12 weeks
after delivery.
2. The most common cause of postpartum fever is endometritis.
3. Breastfeeding is associated with decreased postpartum bleeding, more rapid uterine involution, and
earlier return to prepregnancy weight. It has very few contraindications.
4. Women who are breastfeeding may experience prolonged ovulation suppression and amenorrhea,
although this should not be relied on as a form of contraception.
5. Estrogen-containing contraceptives should not be initiated until 6 weeks post partum because of an
increased risk of venous thromboembolism. Progestin-only contraceptives can be initiated at any time.
6. Postpartum depression is a serious illness that affects 10% to 15% of women and has an extremely
high recurrence rate.
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327
A
Abdomen, penetrating trauma in, 245
Abdominal circumference, fetal, 171, 172f
Abdominal pain, gastrointestinal causes, 72
Ablation, endometrial, 17
Abnormal axial lie, 310
Abortion
complete, following, 116
definition of, 113
diagnostic flowchart for, 115f
induced, 54–57, 57b
live birth in, chance of, 117
medical, 54, 55t
common regimens, 54–55, 55t
complications of, 55
contraindications to, 56
side effects of medications for, 55
percentage of, 54
pregnancies end in, 54
second trimester termination and, 56
spontaneous
causes of, 113–114, 114b
differential diagnosis of, in first trimester, 113
fetuses of, chromosomal anomalies in, 113
incidence of, 113
occurrence of, 113
recurrent pregnancy loss and, 113–117, 117b
risk of, 113–114
spontaneous, advanced maternal age and, 156
surgical, 54
different techniques in, 56
types of, 113
managing, 114, 115t
with vaginal bleeding, 114
workup needed in, 54
Abscesses
of Bartholin gland, 38, 39f
perinephric, as pelvic pain cause, 72
Absent end-diastolic velocity, 180
Abstinence, as contraception method, 58
Abuse
definition of, 249
domestic, cycle of, 89
Acceleration, 273
Active phase, of labor, 266
arrest of, 266
Acute battering, in domestic abuse, 89
Acute coronary syndrome, during pregnancy, 234
Acute pain, common causes of, 69
Addiction, definition of, 249
Adenocarcinoma
of cervical cancer, 131
considerations for, 134
vulvar Paget’ disease and, 128
Adenomyosis, 20b
definition of, 20
diagnosis of, 20
as pelvic pain cause, 70
physical findings of, 20
treatments for, 20
Adequate contraction pattern, 265
Adhesions, pelvic, as pelvic pain cause, 71, 71f
Adnexal masses
benign, 65–68, 68b
differentiated from malignant adnexal masses,
66, 66t
differential diagnosis of, 65, 65t
evaluation of, 65
laboratory tests in, 67
malignant, differentiated from benign adnexal masses,
66, 66t
patient-related characteristics, 65–66
in pregnancy, 243
surgical intervention for, 243
warrant surgical exploration, 68
Adnexal neoplasms, as pelvic pain cause, 71
Adnexal torsion, 243
Adnexectomy, 67
Adolescent pregnancy, nutritional concerns with, 166
Adolescents, abnormal uterine bleeding in, 16
Adrenal androgen-secreting tumors, as precocious
puberty cause, 93
Adrenal disorders, causing anovulation, 26
Adrenarche, 90
β-adrenergic antagonists
action mechanisms of, 298
as preterm labor treatment, 298
β-adrenergic drugs, as tocolytic drugs, 292
Aerobic exercise, 167
AFC. see Antral follicle count (AFC)
AFE. see Amniotic fluid embolism (AFE)
AFI. see Amniotic fluid index (AFI)
INDEX
Page numbers followed by “b”, “t”, and “f” refer to boxes, tables, and figures respectively.
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328 INDEX
African Americans, sickle cell trait in, 159
Age
as cause of multiple gestation, 257
fecundity and, 102
gestational
determining, 157–159
fetal risk in, 245
in multiples gestations, 261
maternal, as information used in maternal serum
screening calculations, 175
AIS. see Androgen insensitivity syndrome (AIS)
Albumin, contraindication in neonatal resuscitation, 319
Alcohol, during pregnancy
abuse of, 249–254, 253b
screening of, tools for, 250
clinical importance of, 249
placental cross of, 250
safe amount of, 249
use of, 249
withdrawal of, 250
signs and symptoms of, 251
Alcohol-related birth defects (ARBDs), 250
Alcohol-related neurodevelopmental disorder (ARND), 250
Alloimmune thrombocytopenia, fetal and neonatal, 202
Alloimmunization, 201–202, 202b
definition of, 201
occur, 201
recommended timing of delivery for pregnancy
complicated by, 202
Amenorrhea, 96–101
athletic, 100
blood tests for, 96
causes of, 96
definition of, 96
duration of, after delivery, 322
hypothalamic, treatment of, 109
hypothalamic causes of, 98
Kallmann syndrome-related, 26
karyotype in, 100
medications causing, 100
menopause-related, 31
pituitary causes of, 98
primary, 98b
causes of, 96, 97t
definition of, 96
tests for, 98
workup for, 99f
rare enzyme defects causing, 100
secondary, 101b
causes of, 96, 97t
definition of, 96
Amniocentesis
genetic, 176
techniques in prenatal diagnosis, 175
Amnioinfusion, 277
Amniotic fluid
abnormal, significance of, 199
disorders of, 199–200, 200b
Amniotic fluid (Continued)
meconium-stained, 320
origin of, 199
prevention of, 199
Amniotic fluid embolism (AFE), 230
Amniotic fluid index (AFI), 171, 178–179, 179t
fetal well-being and, 179
validation, 199
Amniotic fluid volume, measurement of, 199
Amniotic septostomy, for twin-twin transfusion syndrome
treatment, 260
Ampicillin, for group B Streptococcus, 236
Amsel criteria, 42
Analgesia
combined spinal-epidural, 288, 289f
epidural, lumbar, 287–288, 288f, 293
complications of, 289–290
contraindications to, 290
and course of labor, 290
spinal, 288, 289f, 293
Androgen insensitivity syndrome (AIS), 97–98
Androgens
in follicular maturation, 8
modulators of, 118
production of, 118
excessive, by theca cells, 120
during puberty, 90
Androstenedione, production of, 118
Anesthesia
hemodynamic effects of, 232
obstetric, 284–294, 293b
for cesarean delivery, 291
general, 291–293
left uterine displacement during, 286
mortality rate related to, 291
regional, 289, 291–292
in pregnancy, risk for, 241
Anesthesiologist, obstetric, 284
Aneuploidy, 176
twins in, 257
Anosmia, Kallmann syndrome-related, 26
Anovulation, 25–27, 26b
basis for, 108
definition of, 25
as infertility cause, 106
menopause-related, 31
primary, 25
secondary, 25
symptoms of, 25
Anovulatory cycles, causes of, 16
Antenatal corticosteroids, for preterm labor treatment,
298
Antepartum fetal surveillance, 178–182, 182b
defined, 178
initiated with, 181
Antibody, screening of, 201
Antibody screening tests, prenatal care and, 159–160
Anticardiolipin antibodies, 220
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INDEX 329
Antiepileptic drugs
breastfeeding and, 225
levels of, 224
teratogenic effects of, 224, 225t
Anti-β
2
-glycoprotein antibodies, 220
Antimüllerian hormone (AMH), ovarian reserve and, 110
Antiphospholipid antibodies, mechanisms of, in recurrent
pregnancy loss, 117
Antiphospholipid syndrome (APS), 220–221, 220t
treatment of, 117
Antral follicle count (AFC), 110
Anxiety, as factor in labor pain, 285
Aortic stenosis, 233
management of, 234
Aortocaval compression, 285–286
Apgar score, 319, 319t
in determination of need for resuscitation, 319
normal, 319
in small-for-gestational age infants, 197
Apnea
primary, 317
secondary, 317
Apology, from perpetrator, in domestic abuse, 89
Apoptosis, follicles and, 9
Appendicitis
as pelvic and abdominal pain cause, 72
in pregnancy
diagnosis of, 242
signs and symptoms of, 242
ARBDs. see Alcohol-related birth defects (ARBDs)
ARND. see Alcohol-related neurodevelopmental disorder
(ARND)
Aromatase inhibitors, 109
Arousal, normal physiologic changes in, 28
Arrest of descent, of labor, 266
Arrhythmias, during pregnancy, 234
AR T. see Assisted reproductive technologies (ART)
Arterial blood gas, umbilical
mean values for, 320
and morbidity and mortality, values associated with, 320
Asphyxia, birth, 320
Aspiration, during general anesthesia, 291
prevention of, 291
Assisted reproductive technologies (ART), 106–107, 110
as cause of multiple gestation, 257
Asthma, during pregnancy, 227
Asynclitism, 269
Athletic amenorrhea, 100
Atrophic vaginitis, 42
Auscultation, intermittent, 272
compared to electronic fetal monitoring, 272
Autoantibodies, autoimmune diseases and, 220t
Autoimmune diseases, 220–223, 220t, 223b
Autosomal chromosomal disorders, 184t
Autosomal disorders, appear with increased frequency,
186
Autosomal dominant disorders, 186
newborn with unaffected parents, 186
Autosomal recessive disorders, 186
Average maternal weight gain, during pregnancy, 164
Azoospermia, in in vitro fertilization, 111
B
Bacterial vaginosis, 41t, 42
Bacteriuria, during pregnancy, 203
Bariatric surgery
in pregnancy, 166–167
for pregnant obese women, 256
Bartholin abscesses, 38, 39f
Bartholin cyst, 44
Bartholin gland, carcinoma of, 126
Basal body temperature, as ovulation indicator, 103
Baseline, 273
abnormalities in, causes of, 273
normal, 273
Baseline end-organ damage, 206
Battering, in domestic abuse, 89
Battledore placenta, 153
β-Blocker therapy, for mitral stenosis, 233
Biliary system, progesterone on, 150
Biochemical marker screening, 161–162
Biochemical markers, in maternal serum screening, 175
Biophysical profile (BPP), 178–179, 179t
false-positive rate in, 178
modified, 178–179
score influence management, 180
Biopsy
of breast masses, 86
endometrial, 17, 135–136
vulvar, 126
Biparietal diameter (BPD), fetal, 171, 172f
Birth, preterm, incidence of, 295
consequences of, 295–296, 296f
Birth control
abortion and, 56
use of, during breastfeeding, 324
Birth defects, children born with, 183
Birth weight
effect of maternal weight on, 196
large for gestational age, 197
Bishop score, 263, 263t
Bisphosphonates, as osteoporosis treatment, 34t
Bladder
normal capacity of, 75
overdistention of, 74
in pregnant trauma patients, 246t
Blastocyst, 152
Blood count, during pregnancy, 159
Blood flow
pulmonary, neonatal increase in, 315
uterine, hypovolemic shock in, 247
uteroplacental, in pregnant trauma patients, 246t
Blood pressure, in pregnant trauma patients, 246t
Blood transfusion, for postpartum hemorrhage, 313
Blood type, prenatal care and, 159
Bloody nipple discharge, 84
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330 INDEX
Blunt trauma, 245
laparotomy after, 247
BMD. see Bone mineral density (BMD)
Body hair, types of, 118
Bone, effects of estrogen on, 94
Bone age, in precocious puberty, 93
Bone mineral density (BMD), 32
Bowel obstruction, as pelvic and abdominal pain cause, 72
BPP. see Biophysical profile (BPP)
Brachytherapy, for cervical cancer, 133
BRCA genes, 85
Breast
cyst of, 86
development of, 90, 91t
disease of, 84–87, 87b
examination of, 84
fibrocystic changes of, 84
mass in
characteristics of, 85
description of, 84
diagnostic step for, 85
differential diagnosis of, 84
evaluation of, 85
during menstrual cycle, 84
primary amenorrhea and, 97t
Breast cancer
fertility treatment and, 111
hormone therapy and, 32, 85
oral contraceptive agents as risk factor for, 61
during pregnancy, 243
reducing risk of, 85
risk factors for, 85
screening guidelines for, 85, 86t
types of, 87
Breastfeeding
additional nutrition for, 323
antiepileptics safety during, 225
contraindications to, 324
mastitis as, 324
drug abuse and, 253
maternal health benefits of, 323
medications contraindicated by, 324
therapeutic iodine treatments, 218
thioamides, 218
and use of birth control, 324
Breech/breech twins, delivery of, 261
Breech presentation, 309, 309f
singleton, management of, 310
Breech/vertex twins, delivery of, 261
Bulb suctioning, intrapartum, 320
Bupropion, 253
Burch colposuspension, 76, 77f
Burn victims, in pregnancy, 247
C
CA-125, 67
as epithelial ovarian cancer markers, 141–142
as ovarian cancer marker, 67
Caffeine
effect on fertility, 102
during pregnancy, 167
as spinal headache treatment, 290
Calcitonin, as osteoporosis treatment, 34t
Calcium, during pregnancy, 165
Calcium channel blocker
mechanisms of, 298
as preterm labor treatment, 298
Calculations, in maternal serum screening, 175–176
Cancer, incidence of, 243
Candidiasis, 41t
vulvovaginal, 40
Carbamazepine
breastfeeding and, 225
malformation rates associated to, 224, 225t
Carbohydrate metabolism, pregnancy in, 150
Cardiac output
during labor and delivery, 232
during pregnancy, 285–286
in pregnant trauma patients, 246t
Cardiac testing, in preconception counseling, 155
Cardinal movements, of labor, 267, 268f
Cardiomyopathy
hypertrophic, 234
peripartum, in contraindications to pregnancy, 156
Cardiopulmonary resuscitation (CPR), left uterine
displacement during, 248
Cardiovascular disease, in pregnancy, 232–235, 235b
Cardiovascular system
changes in, during pregnancy, 149
pregnancy-related changes in, 287t
Carrier screening, recommendations for, 183t
Category D, fetal risk in, 232
Category X, fetal risk in, 232
CBAVD. see Congenital bilateral absence of the vas
deferens (CBAVD)
Cefazolin, for group B Streptococcus, 236
Cell free fetal DNA, techniques in prenatal diagnosis, 175
Cephalic presentations, 309
Cerclage, 190, 192b
cervical, 191f
contraindications to, 191
effective, 191
indications of, 190
removal of, 192
risks involved with, 191
types of, 190
Cervical cancer, 61, 131–134, 134b
cause of, 131
cervical dysplasia and, difference between, 131
diagnosis of, 131, 243
fertility in, 133
histologic types of, 131
incidence of, 131
management of, 243
screening tests for, 123
staging of, 131–132, 132t
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INDEX 331
Cervical cancer (Continued)
survival rates for, 132
treatment of
chemotherapy for, 133
options for, 132
radiation therapy for, 133
surgical procedure of, 133
Cervical caps, 62
Cervical cerclage, 191f
Cervical insufficiency, 189, 192b
common, 189
diagnosis of, 189
risk factors for, 189
screened for, 189
treatment of, 192
women with, 189
Cervical length measurement, 189
Cervical mucus, during menstrual cycle, 10
Cervical ripening
contraindications for, 263–264
methods for, 263
Cervix
cervical dysplasia in, development of, 123
dilation of, 266
incidental short, treatment for, 189
infertility and, 106
length of, measurement of, 297, 297f
Cesarean delivery, 279–283
anesthesia for, 291
blood loss during, 280
for breech/breech and breech/vertex twins, 261
in breech deliveries, 310
complications of, 280
definition of, 279
elective or elective repeat, in pregnancy with poor
dating, 282
for higher-order multiples, 261
indications for, 279
intrauterine fetal demise for, 248
during laparotomy, 247–248
by maternal request, in absence of indications, 280
obesity and, 255
perimortem, 248
postoperative pain control after, 293
as postpartum hemorrhage cause, 312
recommendation, 198
risks and benefits of, 280
in subsequent pregnancies, 280
uterine incisions used in, 279–280
CF. see Cystic fibrosis (CF)
Chancroid, 37
Chemotherapy
for cervical cancer, 133
for epithelial ovarian cancer, 141
during pregnancy, 243
single-agent, for gestational trophoblastic neoplasia
(GTN), 147
for vulvar cancer, 127
Chest compressions, in neonatal resuscitation
indications for, 318
ratio of, to ventilation, 318
Childbirth training, 285
Chlamydia infection, 43, 237
in pelvic inflammatory disease, 46–47
tests for, in pregnant women, 160
treatment of, 238
Cholecystitis, in pregnant women, 242
Chorioamnionitis, 236–237
gonococci causing, 160
risk factors for, 237
Choriocarcinoma, 143
Chorionic villus sampling (CVS), 175–176
Chorionicity
diagnosis of, 257
in multiple gestations, 171, 173f
Chromopertubation, 103
Chromosomal abnormalities, 184
diagnosis of, 186
risk factors for, 184
Chromosomal anomalies, in spontaneously aborted
fetuses, 113
Chromosomal translocation, 185
Chronic hypertension (CHTN)
definition of, 211
hypertension, 214
managed during pregnancy, 214
Chronic pelvic pain (CPP), 73b
causes of, 71t
common, 70
definition of, 70
differential diagnosis of, 70
dysmenorrhea and, 12
psychiatric considerations and, 73
Chronic renal disease, 204
Chronic vascular diseases, 196
CHTN. see Chronic hypertension (CHTN)
Cirrhosis, hepatitis B and, 160
Clindamycin, for group B Streptococcus, 236
Clomiphene, for ovulation induction, 108
dosage of, 109
Coagulation factors, in pregnant trauma patients,
246t
Coagulation parameters, during pregnancy, 151
Cocaine, in pregnancy, 251
Colon cancer, hormone therapy-related, 32
Colpocleisis, 81
Colposcopy, 123
Comorbidities, maternal, 229
Comparative genomic hybridization (CGH), array, 186
Complete mole, 146, 147f
Compound presentation of, 311
Computed tomography (CT), for trauma evaluation, 246
Conceiving, after delivery, 322
Condoms, 58
female, 62
Condyloma acuminatum, 37
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332 INDEX
Congenital adrenal hyperplasia (CAH)
as amenorrhea cause, 100
as precocious puberty cause, 93
Congenital anomalies
methadone and, 252
in twin pregnancies, 259
Congenital bicuspid valve, 233
Congenital bilateral absence of the vas deferens (CBAVD),
111
Congenital defect, in preconception counseling, 155
Congenital heart disease, 232
Contraception, 58–64, 63b
barrier methods of, 58, 62
emergency, 58, 61–62
hormonal, 61
methods of, 58
percentage of women, 58, 58t–59t
Contraction stress test (CST), 179–180
Contractions
normal, 265
uterine, 264–265
Control blood pressure, 213
Core biopsy, of breast mass, 86
Coronary atherosclerosis, 234
Corpus luteum, 9
Couvelaire uterus, 307
CPP. see Chronic pelvic pain (CPP)
CRAFFT, for alcohol abuse screening, 250
Creatinine, pregnancy-related increase in, 203
Crown-rump length (CRL)
fetal, 170f
for gestational age, 158–159
CST. see Contraction stress test (CST)
CVS. see Chorionic villus sampling (CVS)
Cystic fibrosis (CF), 230
carrier screening for, 183
Cystitis, as pelvic pain cause, 72
Cystocele, 79t
Cystometrogram, 75
Cysts
benign-appearing, 66
of breast, aspiration of, 86
chocolate (endometriomas), 18
follicular, 66
functional ovarian follicular, as precocious puberty
cause, 93
theca lutein, 67
Cytomegalovirus (CMV), during pregnancy, 239
D
Danazol, as endometriosis treatment, 19
D&C. see Dilation and curettage (D&C)
Deceleration, 273
early, 273, 274f
late, 273, 274f
prolonged, 275, 275f
variable, 273, 275f
Deepest vertical pocket (DVP), 178
Dehydroepiandrosterone (DHEA), production of, 118
Dehydroepiandrosterone sulfate (DHEA-S), production
of, 118
Delivery
breech, 309, 309f
singleton, management of, 310
vaginal, 310
cardiac physiology during, 232
in eclamptic patients, 213
of growth-restricted fetus, 197
of multiple gestations, 261
operative, 269
in preeclampsia patients, 213
Depot medroxyprogesterone acetate, 61
Depression, postpartum, 324–325
treatment of, 325
Desire, normal physiologic changes in, 28
Detrusor overactivity (DO), 74
Diabetes mellitus
gestational, 206–210, 209b
in preconception counseling, 155
pregestational, 206–210, 208b
incidence of, 206
during pregnancy, obesity-related, 164
Diabetic ketoacidosis (DKA), 207
fetal mortality rate in, 208
in pregnancy, 207–208
typical presentation of, 207
Diagnostic peritoneal lavage (DPL), 246
Diagonal conjugate, of pelvic inlet, 264
Dialysis, complications in pregnant patient, 204
Diaphragm (contraceptive device), 62
Diet
optimal, during pregnancy, 164–165
during pregnancy, 165
unusual, women with, 166
Diethylstilbestrol (DES), as ectopic pregnancy risk factor, 49
Dihydrotestosterone (DHT), production of, 118
Dilation and curettage (D&C), 52
Dipstick urine analysis, during prenatal course, 160
Discordance, in multiple gestation, 261
Discriminatory zone, 116
Disseminated intravascular coagulation, preeclampsia-
related, 212, 292
Distal tubal disease, treatment of, 104
Diuretics, as mitral stenosis treatment, 233
Diverticulitis, as pelvic and abdominal pain cause, 72
DKA. see Diabetic ketoacidosis (DKA)
DNA testing, use in prenatal diagnosis, 176
DO. see Detrusor overactivity (DO)
Domestic abuse, cycle of, 89
Dopamine, cocaine use and, 251
Dopamine antagonists, as amenorrhea cause, 100
Doppler ultrasound, during pregnancy, 171
Doppler velocimetry, 180, 197, 202
Doxylamine, as nausea and vomiting of pregnancy
treatment, 194
DPL. see Diagnostic peritoneal lavage (DPL)
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