tailieunhanh - Critical Care Obstetrics part 68

Critical Care Obstetrics part 68 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | The Organ Transplant Patient in the Obstetric Critical Care Setting born to immunosuppressed mothers have had relatively uncomplicated courses. Respiratory distress syndrome RDS increased susceptibility to infection hypoglycemia hypocalcemia adrenal insufficiency thymic atrophy bone marrow hypoplasia transient leucopenia reduced levels of IgM and IgG and transiently elevated serum creatinine levels have all been reported but these conditions are also commonly present in premature infants not exposed to these drugs. Most neonates have also progressed normally through infancy and childhood 30 but as they reach adulthood there are concerns about the possibility of delayed adverse effects 31 . Fetal exposure to immunosuppressive agents could be associated with later development of fertility problems autoimmune disease and neoplasia 32-34 . With newer agents it may be even more difficult to accurately identity a cause and effect. It is hoped that lower dosages now possible with drug combinations resulting in less exposure to each specific drug will decrease the potential for teratogenesis. However potentiating effects among drugs as well as unknown interactions in multiple drug regimens could also result in as yet unrecognized adverse fetal effects. Thus it is important that all offspring exposed to these agents have long-term follow-up. Renal transplantation Approximately 1 in 20 women of childbearing age with a functioning renal allograft become pregnant 2 and it is estimated that more than 10000 pregnancies have now occurred. Many women have now had more than one pregnancy and some have successfully delivered twins and triplets. One patient has had five live births and one spontaneous abortion with no evident deleterious effect on the kidney evident 25 years after transplantation 34 Figure . If preconception graft function is adequate as evidenced by a plasma creatinine mg dL and a rate of urinary protein excre- Figure Two generations following renal .