Pregnant women are susceptible to any medical and surgical disorder that can affect women of childbearing age. Chronic illnesses often precede pregnancy, and an acute condition can complicate an otherwise normal pregnancy. Both chronic and acute disorders raise the risk for antepartum hospitalization. Approximately 10 per 100 pregnant women incur an antepartum admission, and one third are for nonobstetrical conditions that include renal, pulmonary, and infectious diseases (Gazmararian, 2002). The hospitalization rate due to trauma approximates 4 admissions per 1000 deliveries (Kuo, 2007). Those with intellectual and developmental disabilities have a higher incidence of hospitalization (Mitra, 2018). Last, 1 to 2 percent of pregnant women will undergo a nonobstetrical surgical procedure (Tolcher, 2018).
Obstetricians should have a working knowledge of the wide-ranging medical disorders common to childbearing-aged women. Many of these are within the purview of the general obstetrician. Other disorders, however, will warrant consultation with specialists in maternal-fetal medicine, and still others require a multidisciplinary team. The latter may include internists and medical subspecialists, surgeons, and anesthesiologists (Levine, 2016). The Society for Maternal-Fetal Medicine (2014) has redefined aspects of maternal care and proposed conditions requiring specialized care.
Treatment should never be withheld because a woman is pregnant. To ensure this and allow for individualized care, several questions must be addressed:
What management would be recommended if the woman were not pregnant?
If the proposed management is different because the woman is pregnant, can this be justified?
What are the risks and benefits to the mother and her fetus, and are they counter to each other?
Can an individualized management plan be devised that balances risks versus benefits?
MATERNAL PHYSIOLOGY AND LABORATORY VALUES
Pregnancy induces physiological changes in virtually all organ systems. Many of these are discussed in Chapter 4 and in the subsequent chapters in this section. In turn, numerous laboratory test results also are normally altered. Some values would be considered abnormal in the nonpregnant woman. Conversely, some may appear to be within a normal range but are decidedly abnormal for the gravida. These changes may complicate the evaluation of coexisting conditions. To aid interpretation, normal laboratory values in pregnancy are listed in the Appendix (p. 1227).
Fortunately, most medications needed to treat frequently encountered illnesses in pregnancy can be given with relative safety (Briggs, 2017). That said, notable exceptions are considered in Chapter 8 and throughout this text. The risks and benefits of medication use during pregnancy and lactation are outlined in drug labels using the Pregnancy and Lactation Labeling Rule (PLLR) requirement from the U.S. Food and Drug Administration (FDA).
The chances of adverse maternal and perinatal outcomes following nonobstetrical surgery during pregnancy are relatively low and cannot be separated from risks of the underlying ...