具体描述
Hypertensive disorders remain one the major causes of maternal and fetal morbidity and death. It is also a leading cause of preterm birth now known to be a risk factor in remote cardiovascular disease. Despite this the hypertensive disorders remain marginally studied and management is often controversial. Chesley's Hypertensive Disorders in Pregnancy, remains one of the beacons to guide this field, recognized for its uniqueness and utility. The Third Edition continues this tradition, focusing on prediction, prevention, and management for clinicians, and is an essential reference text for clinical and basic investigators alike. Differing from other texts devoted to preeclampsia, it covers the whole gamut of high blood pressure, and not just preeclampsia.
NEW TO THE THIRD EDITION:
* New chapters focusing on recent discoveries in angiogenesis, auto-antibodies and other recent immunological findings, imaging in eclampsa, animal models - where considerable progress has emerged since the previous edition
* Extensive updates to chapters on epidemiology, etiological considerations, pathophysiology, prediction, prevention, and management
* Systematic reviews and metanalysis of trials regarding prediction and antihypertensive treatment
* Discussions on the emerging roles of metabolic syndrome and obesity and the increasing incidence of preeclampsia
* Epodemiological coverage of preeclampsia as a risk factor for future metabolic and cardiovascular disease that permits early intervention and life style changes
Pregnancy and Maternal Health: A Comprehensive Guide to Fetal Development and Postpartum Care Focusing on the physiological, psychological, and social aspects of the childbearing cycle, this comprehensive volume offers an in-depth examination of a healthy pregnancy journey from conception through the first year postpartum. This extensive text moves beyond the strict domain of specific pathological conditions to provide a holistic framework for understanding normal pregnancy progression, optimizing maternal wellness, and ensuring robust fetal development. It serves as an essential resource for obstetricians, midwives, maternal-fetal medicine specialists, nursing professionals, and advanced students seeking a detailed understanding of the entire perinatal continuum, emphasizing proactive health management and evidence-based care protocols. --- Part I: Preconception Health and Early Pregnancy Adaptations This initial section establishes the foundation for a healthy pregnancy by meticulously detailing preconception care strategies and the profound physiological adaptations that occur immediately following conception. Chapter 1: Optimizing Preconception Health and Readiness This chapter explores the critical window prior to conception, emphasizing the importance of preconception counseling. It addresses pre-existing chronic conditions (such as well-managed thyroid function, non-hypertensive cardiovascular disease managed optimally before conception, and stable diabetes mellitus managed through diet and non-insulin therapy pre-pregnancy), nutritional status optimization (including Vitamin D and folate levels assessment), genetic carrier screening for common inherited disorders unrelated to vascular complications, and lifestyle modifications such as smoking cessation and responsible medication review. Detailed protocols for identifying and managing environmental teratogen exposure are provided, focusing on environmental toxins rather than pregnancy-induced systemic disorders. Chapter 2: The Initial Physiological Cascade: Conception to Implantation A thorough exploration of early embryogenesis and implantation mechanics forms the core of this chapter. It details the hormonal milieu following successful fertilization, focusing on the roles of estrogen and progesterone in preparing the endometrium, without focusing on mechanisms of placental dysfunction related to elevated resistance. The chapter meticulously maps out the early cellular differentiation processes, the formation of the chorionic villi structure independent of abnormal remodeling, and the initiation of maternal circulatory changes that support the growing conceptus, such as early increases in plasma volume distinct from volume dysregulation associated with pathological states. Chapter 3: First Trimester Wellness and Diagnostic Screening This section focuses on maintaining wellness during the crucial first trimester. It covers standard prenatal assessments, dating ultrasound interpretation, and appropriate management of common, self-limiting first-trimester complaints like nausea and vomiting (hyperemesis gravidarum managed conservatively without reference to severe systemic sequelae). Screening methods are presented, including the interpretation of first-trimester biochemical markers (like PAPP-A and free $eta$-hCG) used strictly for chromosomal aneuploidy risk assessment, and the standardized nuchal translucency (NT) measurement protocol, emphasizing the procedural accuracy and interpretation for genetic risk stratification, irrespective of vascular complications. --- Part II: The Second Trimester: Growth, Anatomy, and Maternal Adaptation The middle trimester is characterized by significant fetal growth and maternal accommodation. This section details the expected anatomical milestones and the complex adaptations of maternal organ systems under normal physiological load. Chapter 4: Fetal Growth Trajectory and Biometry This chapter provides precise measurements and expected growth curves for the developing fetus between 14 and 27 weeks of gestation. It details advanced ultrasound techniques for assessing fetal structure, including detailed cardiac anatomy, brain morphology (excluding fetal neurological consequences of placental insufficiency), and musculoskeletal development. Growth restriction, when discussed, is framed purely in terms of constitutional small-for-gestational-age factors or known fetal anomalies, rather than being linked to uteroplacental hemodynamics. Chapter 5: Maternal Cardiovascular and Renal Adjustments (Physiological Load) A comprehensive review of the normal physiological demands placed on the maternal system. This includes the expected fractional increase in cardiac output, the physiological lowering of systemic vascular resistance, and the necessary increases in renal plasma flow and glomerular filtration rate (GFR). The focus remains on the body's successful homeostatic response to the increased metabolic and circulatory demands of pregnancy, contrasting this successful adaptation with pathological failure states. Chapter 6: Psychological Adaptation and Psycho-Social Support Systems Addressing the non-physical dimensions of pregnancy, this chapter explores the expected psychological transitions, attachment formation, and the impact of pregnancy on maternal identity. It provides practical guidance on facilitating supportive social networks, managing expected mood fluctuations, and establishing clear communication channels between expectant parents and healthcare providers. Topics include sleep hygiene, stress management techniques applicable to any pregnant woman, and partner involvement strategies. --- Part III: The Third Trimester and Preparation for Birth This final section covers the final stages of fetal maturation, the planning necessary for a safe delivery, and the immediate transition to the postpartum period. Chapter 7: Fetal Lung Maturation and Term Readiness Detailed discussion on the final organ system maturation occurring late in gestation, with a specific focus on pulmonary surfactant production and lung mechanics preparation for air breathing. This section also reviews standardized methods for assessing fetal well-being in uncomplicated pregnancies, such as non-stress tests (NSTs) and modified biophysical profiles (BPPs) used to confirm fetal reserve in low-risk situations. Chapter 8: Labor Physiology, Induction Protocols, and Pain Management An in-depth analysis of the physiological process of labor, including the roles of oxytocin and prostaglandins in initiating and sustaining uterine contractions. It provides clear, protocol-driven guidance on elective labor induction and ripening agents (e.g., prostaglandins, mechanical methods) when indicated for reasons unrelated to impending systemic decompensation. Comprehensive management strategies for labor analgesia, including epidural techniques, systemic agents, and non-pharmacological comfort measures, are covered thoroughly. Chapter 9: Immediate Postpartum Period and Neonatal Transition This chapter focuses strictly on the care of the birthing parent and the newborn immediately following delivery (the first 24 hours). It details fundal checks, lochia assessment, management of expected uterine involution, basic breastfeeding initiation support, and standard newborn procedures like APGAR scoring, cord care, and the administration of prophylactic treatments (e.g., Vitamin K, erythromycin ointment). Emphasis is placed on recognizing normal postpartum bleeding patterns and establishing early bonding opportunities. Chapter 10: The Extended Postpartum Period: Recovery and Wellness Concluding the cycle, this chapter addresses maternal recovery from six weeks to one year postpartum. It covers ongoing nutritional needs, appropriate physical activity guidelines for different delivery types, monitoring for subtle changes in mood (excluding severe complications), and guidelines for resuming sexual activity. The focus remains on long-term maternal physical and psychological reintegration into family life following a generally uncomplicated childbirth experience. --- This volume offers a robust, evidence-based anchor for managing the expected course of pregnancy, birth, and postpartum recovery, grounded entirely in the physiological norms and proactive health management strategies that support optimal outcomes across the entire perinatal period.
