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The average human gestation is 280 d (40 wk), as counted from the first day of the last menstrual period (LMP). During this time, a woman undergoes a multitude of normal physiological changes and can be subject to a variety of pregnancy-specific diseases. Furthermore, there are a number of diseases that can affect the unborn fetus, and the physiological status of the fetus can affect the mother. Taken...
Human chorionic gonadotropin (hCG) is a glycoprotein composed of two dissimilar subunits, α- and β-subunit, held together by charge interactions. hCG is produced by trophoblastic cells of the placenta in both pregnancy and gestational trophoblastic diseases. It is a remarkable glycoprotein in that up to 35% of the molecular weight (MW) is from oligosaccharide side chains. hCG is sometimes considered...
Preterm birth is a major public health problem in the United States. It is the most common reason for both neonatal mortality and serious long-term morbidity after congenital birth defects (1). Preterm birth, as defined by the World Health Organization (WHO), is the delivery of an infant prior to 37 wk and greater than 20 wk gestational age. Preterm birth arises from three major problems: 50% arise...
Fetal organ development occurs in the first trimester of pregnancy and major growth occurs in the second. In the third trimester, the fetal organs mature, although at differing rates. The production of adequate pulmonary surfactant is one of the last developments. This critical process, termed fetal lung maturity (FLM), can be accelerated or delayed by a number of fetal and maternal conditions.
Even before a woman becomes pregnant, the parents-to-be wonder about the health of their future child. This natural concern is why prenatal screening for fetal disorders has attracted considerable attention over the past two decades or more. The interest is both professional and personal. The promise of foretelling the health of the developing baby puts new demands on laboratorians, clinicians, and...
Prenatal diagnosis for chromosome anomalies is an important aspect of preventive medicine. Historically, amniocentesis, a procedure to collect fetal amniotic fluid (AF) by transcervical or transabdominal puncture, has been practiced since the 1930s. It was demonstrated in the mid- 1960s that human amniotic cells can be cultured and used for chromosome analysis and that the optimal timing for amniocentesis...
Vaginal bleeding during the first half of pregnancy is considered a threatened abortion. This occurs in 30–40% of all pregnancies with approx 50% of these pregnancies eventually progressing to spontaneous abortion. If sensitive assays for human chorionic gonadotropin (hCG) are used, more than half of all pregnancies have been shown to end in abortion. Most of these abortions will not be recognized...
Because of the normal physiologic changes associated with pregnancy, maternal thyroid status is often difficult to assess. This chapter focuses on the evaluation of the mother and examines changes that occur both in normal pregnancy and thyroid disease states during pregnancy. A careful clinical review of the patient’s history, symptoms, and laboratory measurements will aid the physician in an accurate...
Fetal thyroid metabolism depends on normal fetal thyroid development and hormonogenesis as well as normal maternal thyroid physiology. Thyroid hormone production has been detected in the fetus as early as 10 wk gestation, and thyroid follicles have been identified histologically by 12 wk (1,2) From the 13th wk of gestation until the third trimester, there are increases in fetal serum concentrations...
Numerous hematologic and hemostatic changes occur during an uncomplicated pregnancy. Presumably, these alterations have been selected for because they are beneficial to both the mother and the fetus. Plasma expansion in excess of increased red cell production leads to the anemia of pregnancy, and fetal and placental demands tax a mother’s iron and folate stores. Hemostatic changes are associated with...
Hemolytic disease of the newborn (HDN) is characterized by the destruction of fetal red blood cells by maternal immunoglobulin G (IgG) directed against antigens present on fetal erythrocytes. These paternally inherited antigens are not present on maternal cells and can stimulate the maternal immune system to produce antibodies when antepartum or intrapartum fetomaternal hemorrhage occurs. Maternal...
Infections acquired prior to or during pregnancy can profoundly impact fetal and postnatal development. Most infections acquired during pregnancy affect the maternal upper respiratory or gastrointestinal tract, and resolve without adverse impact on the mother or fetus. Of concern are infections with pathogens that enter the circulation and have the capacity to actively or passively traverse the placenta...
Streptococcus agalactiae (group B streptococcus [GBS]), colonizes the vagina and rectum in 25–30% of pregnant women (1–5). GBS infection can cause septic abortion, premature rupture of amniotic membranes, chorioamnionitis, postpartum endometritis, neonatal pneumonia, meningitis, and sepsis. The gastrointestinal tract, in particular the rectum, serves as the natural reservoir for GBS and...
Obstetricians and reproductive immunologists have long recognized that the mother’s immune response is significantly affected by pregnancy. Immunologic diseases of pregnancy are known to impact maternal, fetal, and neonatal well-being. Effective management of human pregnancy requires an understanding of both the normal maternal adaptations to pregnancy and immune-related disorders associated with...
Normal human reproduction is an inefficient process with only 22.8% of conceptive matings resulting in live birth (Fig. 1) (1,2). Miscarriages are the most common complication of pregnancy, affecting 15% of women (3). Loss of pregnancy is a physically and emotionally challenging ordeal. When pregnancy loss is repetitive, these feelings are magnified and the result is a distressing and frustrating...
Multifetal pregnancies are high-risk pregnancies—a sweeping statement underlying the day-to-day challenge of caring for the mother and her multiples. Remarkable changes have occurred in the clinical picture and outcomes of multiple gestations during the past 25 yr. First and foremost, the frequency of multifetal pregnancies, primarily attributed to infertility treatment, has reached epidemic dimensions...
With the advent of injectable insulin in the 1920s, physicians were finally given the ability to treat the symptoms of diabetes mellitus (DM). Despite this success, the lack of rapid-acting insulin and self-blood glucose monitoring meant that the available insulin therapy could do little to maintain glucose at physiological concentrations. The effects of large glycemic excursions were readily seen...
Hypertensive disorders of pregnancy complicate approx 10% of pregnancies and are leading causes of maternal mortality (1–3). Although preeclampsia occurs in 5 to 8% of pregnancies, it is a major contributor of premature deliveries and neonatal morbidity in the United States (4). Despite the recognition of eclampsia since ancient times, it was not until the late 1800s when an association between hypertension,...
Understanding physiological changes that take place in the hepatobiliary system during gestation is obligatory for diagnosis and treatment of pregnant women with diseases of the liver and gallbladder. Because liver test abnormalities may occur during normal pregnancies as well as in pregnancy-specific nonhepatic diseases, caution during interpretation of these tests is warranted. Liver size, anatomy,...
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