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Therapeutic Problems in Pregnancy PDF

165 Pages·1977·3.289 MB·English
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Therapeutic Problems in Pregnancy Therapeutic Problems in Pregnancy EDITED BY P. J. Lewis Clinical Pharmacology Unit, Institute of Obstetrics and Gynaecology, Queen Charlotte's Hospitalfor Women, London University Park Press Baltimore Puhlished in USA and Canada b! Un i \'ersi t J Pa r k Press. Chamher of CommCl"ce Building. Baltimore. Maryland ::1::0:: Puhlished in UK by MTP Press Limited 5t Lconard's House. Lancaster. Lancs. Copyright I 1977 MTP Press Limited Softeover reprint of the hardcover 1st edition 1977 No part of this book may he reproduced in any form without permission from the puhlishers. except for the quotation of brief passages for the purpose of re\'iew. Library of Congrl'ss Cataloging in Publication Data Therapeutic prohlems in pregnancy. I. Pregnancy. Complications of. ::. Pregnancy. Complications of .. Chemotherapy. 3. Fetus. Effect of drugs on the. I. Lewis. P. J. RG:"7::.T-I:" 61lU'061 77-6317 ISBN 978-94-011-7929-4 ISBN 978-94-011-7927-0 (eBook) DOl 10.1007/978-94-011-7927-0 Contents List of Contributors VB Foreword: C. J. Dewhurst IX PART 1: HYPERTENSION IN PREGNANCY The use of antihypertensive drugs in pregnanC'y: L. J. Beilin and C. W. G. Redman 2 Antihypertensive drugs and uterine blood flow: D. F. Hawkins 19 3 The effect of antihypertensive drugs on the fetus: G. S. Dawes 35 ..j. Fetal outcome in pregnancies complicated by severe hypertension treated with propranolol: G. M. Stirrat and B. A. Lieberman 45 5 The management of hypertension in the pregnant woman: P. J. Lewis, M. de Swiet, G. V. P. Chamberlain and C. J. Bulpitt 53 PART 2: CARDIOVASCULAR THERAPY 6 Heart disease, parturition and antibiotic prophylaxis: Rosalinde Hurley 69 7 Drug treatment and prophylaxis of thromboembolism in preg- nancy: M. de Swiet, Elizabeth Letsky and Heather J. Mellows 81 PART 3: MEDICAL DISORDERS 8 Thyroid therapy in pregnancy: I. D. Ramsay 93 v CONTENTS 9 The drug treatment of epilepsy in pregnancy: A. Hopkins 103 10 Epilepsy, anticonvulsants and abnormal babies: S. R. Meadow 109 11 Diabetic therapy and pregnancy: Nina Essex 117 PART 4: DRUGS AND THE FETUS 12 Maternal drug therapy and enzyme induction in the fetus and newborn: D. S. Davies and A. R. Boohis 127 13 Maternal drug therapy and neonatal jaundice: Louise A. Friedman and P. 1. Lewis 141 14 The influence of maternal drug administration on human fetal breathing movements in utero: K. Boddy 153 Index 163 VI List of Contributors L. J. BEILIN, MD, FRCP C. J. DEWHURST, FRCS Ed, PRCOG Reader in Clinical Medicine, Professor of Obstetrics and Gynaecology, Department of the Regius Professor Institute of Obstetrics and Gynaecology, Medicine, Queen Charlotte's Hospital for Women, Radcliffe Infirmary, London Oxford NINA ESSEX, MB, MRCP K. BODDY, MB, MRCOG Clinical Assistant, Senior Lecturer in Obstetrics and Diabetic Department, Gynaecology, King's College Hospital, University of Edinburb!1 London LOUISE A. FRIEDMAN, BSe A. R. BOOBIS, BSe, PhD Research Assistant in Clinical Pharmacology, MRC Research Fellow, Institute of Obstetrics and Gynaecology, Clinical Pharmacology Department, Queen Charlotte's Hospital for Women, Royal Postgraduate Medical School, London London D. F. HAWKINS, DSc, FRCOG C. J. BULPITT, M.Se, MD, MRCP Reader in Obstetric Therapeutics, Senior Lecturer in Epidemology, Institute of Obstetrics and Gynaecology, London School of Hygiene and Tropical Hammersmith Hospital, Medicine, London London A. HOPKINS, MD, FRCP G. V. P. CHAMBERLAIN, MD, FRCS, Physician in Charge, FRCOG Department of Neurological Sciences, Consulting Obstetric Surgeon, St Bartholomew's Hospital, Queen Charlotte's Hospital for Women, London London ROSALINDE HURLEY, MD, FRCPath D. S. DAVIES, BSe, PhD Professor of Microbiology, Reader in Biochemical Pharmacology, Institute of Obstetrics and Gynaecology, Clinical Pharmacology Department, Queen Charlotte's Hospital for Women, Royal Postgraduate Medical School, London London ELIZABETH LETSKY, MB, BS, G. S. DAWES, DM, FRS MRCPath Director, Consultant Haematologist, Nuffield Institute for Medical Research, Queen Charlotte's Hospital for Women, University of Oxford London vii LIST OF CONTRIBUTORS P. J. LEWIS, MD, PhD, MRCP I. D. RAMSAY, MD, MRCP, MRCPE Senior Lecturer in Clinical Pharmacology, Consultant Physician, Institute of Obstetrics and Gynaecology, Regional Endocrine Centre, Queen Charlotte's Hospital for Women, North Middlesex Hospital, London London B. A. LIEBERMAN, MRCOG c. W. G. REDMAN, BM, MRCP Senior Lecturer in Obstetrics and Lecturer in Obstetric Medicine, Gynaecology, Department of Obstetrics and Gynaecology, St Mary's Hospital Medical School, John Radcliffe Hospital, University of London Oxford S. R. MEADOW, FRCP G. M. STIRRAT, MD, MRCOG Senior Lecturer, Clinical Reader, Department of Paediatrics and Child Health, Department of Obstetrics and Gynaecology, University of Leeds John Radcliffe Hospital, Oxford HEATHER J. MELLOWS, MB, 13S Resident Medical Officer, M. de SWIET, MD, MRCP Queen Charlotte's Hospital for Women, Consultant Physician, London Queen Charlotte's Hospital for Women, London VIII Foreword The image of obstetrics as a largely manipulative art has changed radically in recent years. The risk to a healthy mother of pregnancy and labour has been markedly reduced and morbidity not mortality is the yardstick by which the quality of maternal care is judged. We are now able to devote far more attention to the fetus whose growth patterns and behaviour in utero can be studied in detail by modern and sophisticated technical aids with a resultant improvement in perinatal mortality. A patient with a pre-existing general disease, however, still presents a problem which is best managed by close co-operation between obstetrician and physician. Essential hypertension, diabetes, heart disease, thyroid disease and epilepsy are examples of disorders which require great care throughout pregnancy and during labour if good maternal and fetal results are to be obtained. There are many questions still to be answered. What is the place of hypotensive therapy in essential hypertension complicating pregnancy? When should delivery take place in the pregnant diabetic? How should the patient be delivered? What should be her management during labour? What is the risk of fetal abnormality in the epileptic patient who becomes pregnant whilst on anti-epileptic drugs? These questions and others have been the subject of a recent symposium in the Institute of Obstetrics and Gynaecology. The proceedings of that symposium have been brought together and ampli fied in this volume as an admirable survey of this field which is both a guide to modern therapy and a pointer to developments in the future. C. J. Dewhurst President of the Royal College of Obstetricians and Gynaecologists IX Part 1 Hypertension in Pregnancy 1 The Use of Antihypertensive Drugs in Pregnancy L. J. BEILIN and C. W. G. REDMAN Hypertension in pregnancy is generally due to one of two causes, either it is specifically induced by pregnancy, in which case it is always part of a complex disorder (pre-eclampsia, toxaemia) constituting some risk to the fetus; or a woman with pre-existing chronic hypertension may become pregnant. As chronic hypertension predisposes to the development of pre-eclampsia, the two conditions frequently co-exist. Many mothers with chronic hypertension have pregnancies that are other wise uncomplicated. The onset of pre-eclampsia is often insidious, whether or not it is preceded by chronic hypertension, and in its early stages is characterized by a rising plasma urate (Redman et al., 1976) and falling platelet count (Redman et al. ,1976) (Figure 1.1). The blood-pressure is easily controlled at this stage, but as the condition develops, hypertension becomes more severe and nocturnal hypertension may occur (Redman et al., 1976; Beilin et al., 1974). The glomerular filtration rate declines, proteinuria may appear and the platelet count falls further. The fetus is often small and the mother may cease to gain weight, or alternatively, gain excessively due to fluid retention. The final, and often terminal, stage is augured by oliguria, rapid accumulation of fluid, uncontrollable hypertension, eclamptic fits and death of the fetus and/or mother. This sequence may evolve over a period of weeks or months, but the final phase is often rapid. Thus Figure 1.2 shows an example of how the disorder can progress over a matter of hours, in association with a retroplacental haemorrhage. The use of antihypertensive drugs has to be considered in the context of this complex and variable natural history of hypertensive pregnancies. The

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