Table of Contents

Companion Website details viii

Contributors ix

Acknowledgements xi

Acronyms, Abbreviations and Cardiac Terms xiii

Foreword xvii

Foreword to the First Edition xix

Preface xxi

1 Midwifery Care and Medical Disorders 1
S. Elizabeth Robson

Pre-conception Care 2

Antenatal Care 2

Intrapartum Care 5

Postnatal Care 6

General Considerations 7

Emergency Management 9

Preventing Maternal Mortality 9

Back to Basics Campaign 12

Patient Organisations and Essential Reading 13

References 14

Appendix 1.1 UK Maternal Deaths – Causes and Risk Factors 15

Appendix 1.2 Daily Vitamin and Mineral Dietary Intake for Pregnancy and Lactation 16

2 Skin Disorders 17
Catherine Gittins and Rhoda Cowell

2.1 Physiological Skin Changes in Pregnancy 18

2.2 Dermatoses Specifi c to Pregnancy 19

2.3 Eczema 20

2.4 Psoriasis 22

Patient Organisations and Essential Reading 24

References 25

Appendix 2.2.1 Emollients and Steroid Creams 26

3 Hypertensive Disorders 27
Sophia Webster, Claire Dodd and Jason Waugh

3.1 Chronic Hypertension 28

3.2 Pre-eclampsia 34

3.3 Severe Pre-eclampsia and Eclampsia 36

3.4 HELLP Syndrome 38

Patient Organisations and Essential Reading 40

References 41

4 Heart Disease 43
Moira McLean, Frances A. Bu’Lock and S. Elizabeth Robson

4.1 Mild Structural Heart Disease 44

4.2 Moderate Structural Heart Disease 48

4.3 Severe Structural Heart Disease 51

4.4 Rheumatic and Valvular Heart Disease 54

4.5 Marfan’s Syndrome 56

4.6 Functional Heart Disease: Cardiomyopathy 58

4.7 Functional Heart Disease: Arrhythmias 60

4.8 Ischaemic Heart Disease: Angina and Myocardial Infarction 62

4.9 Pulmonary Hypertension and Eisenmenger’s Syndrome 64

4.10 Heart Transplant 66

Patient Organisations and Essential Reading 68

References 69

Appendix 4.3.1 Drugs for Cardiac

Disease – An Overview for Midwives 74

5 Respiratory Disorders 75
Jane Scullion, Christopher Brightling and Michelle Goldie

5.1 The Breathless Pregnant Woman 76

5.2 Asthma 78

5.3 Pneumonia and Chest Infections 80

5.4 Tuberculosis 82

5.5 Cystic Fibrosis 84

5.6 Sarcoidosis 86

Patient Organisations and Essential Reading 88

References 89

Appendix 5.2.1 Asthma in Pregnancy:An Information Leaflet for Pregnant Women 90

6 Renal Disorders 91
Nigel J. Brunskill and Andrea Goodlife

6.1 Urinary Tract Infections 92

6.2 Chronic Kidney Disease 94

6.3 Dialysis in Pregnancy 96

6.4 Renal Transplantation 98

6.5 Nephrotic Syndrome 100

Patient Organisations and Essential Reading 102

References 103

Appendix 6.3.1 Replacement of Renal Function by Dialysis 104

7 Endocrine Disorders 105
Robert Gregory and Diane Todd

7.1 Hypothyroidism 106

7.2 Thyrotoxicosis 108

7.3 Type 1 Diabetes Mellitus 110

7.4 Type 2 Diabetes Mellitus 113

7.5 Gestational Diabetes Mellitus 115

7.6 Addison’s Disease (Adrenal Insuffi ciency) 118

7.7 Prolactinoma 120

Patient Organisations and Essential Reading 122

References 123

Appendix 7.3.1 Diabetes Mellitus 124

8 Neurological Disorders 125
Fionnuala McAuliffe, Eleanor Burns-Kent, Deborah Frost and Edmund S. Howarth

8.1 Migraine and Headaches 126

8.2 Epilepsy 128

8.3 Cerebrovascular Disease and Stroke 132

8.4 Bell’s Palsy 137

8.5 Carpal Tunnel Syndrome 140

8.6 Myasthenia Gravis 142

8.7 Multiple Sclerosis 144

Patient Organisations and Essential Reading 147

References 148

Appendix 8.2.1 Drugs Used for Neurological Conditions 152

9 Musculoskeletal Disorders 153
S. Elizabeth Robson, Marie C. Smith, Edmund S. Howarth and Javed Iqbal

9.1 Back and Pelvic Pain 154

9.2 Diastasis Recti Abdominis 156

9.3 Pregnancy Related Pelvic Girdle Pain 158

9.4 Hypovitaminosis D 160

9.5 Osteoporosis 163

Patient Organisations and Essential Reading 165

References 166

Appendix 9.1.1 Pain Therapy Ladder for Pregnancy 169

10 Gastrointestinal Disorders 171
Rosemary Lydall, Manjiri Khare, Caroline Farrar and S. Elizabeth Robson

10.1 Gastro-oesophageal Reflux and Hiatus Hernia 172

10.2 Coeliac Disease 176

10.3 Ulcerative Colitis 178

10.4 Crohn’s Disease 180

10.5 Irritable Bowel Syndrome 182

10.6 Haemorrhoids 184

10.7 Anal Sphincter Disorders 186

10.8 Obstetric Cholestasis 188

10.9 Gall Bladder and Pancreatic Disease 190

Patient Organisations and Essential Reading 192

References 193

Appendix 10.3.1 Care of a Stoma 197

Appendix 10.5.1 Management Algorithm of Irritable Bowel Syndrome 198

11 Autoimmune Disorders 199
S. Elizabeth Robson and Julie Goddard

11.1 Rheumatoid Arthritis 200

11.2 Raynaud’s Phenomenon 202

11.3 Systemic Lupus Erythematosus 204

11.4 Antiphospholipid (Hughes) Syndrome 206

Patient Organisations and Essential Reading 209

References 210

Appendix 11.1.1 Drugs for Autoimmune Disease – An Overview for Midwives 213

12 Infectious Conditions 215
Karen Watkins, Veronica Johnson-Roffey, Juliet Houghton and S. Elizabeth Robson

12.1 Viral Hepatitis 216

12.2 Human Immunodefi ciency Virus 218

12.3 Malaria 220

12.4 Chickenpox 223

12.5 Toxoplasmosis 226

12.6 Listeriosis 228

12.7 Herpes Simplex Virus 230

12.8 Streptococcal Sepsis 232

Patient Organisations and Essential Reading 234

References 235

Appendix 12.1.1 The ABC of Hepatitis 238

Appendix 12.2.1 Other Infectious Viral Diseases 239

Appendix 12.2.2 Other Infectious Bacterial Diseases 240

13 Metabolic Disorders 241
Rowena Doughty and Jason Waugh

13.1 Obesity 242

13.2 Phenylketonuria 244

13.3 Hyperemesis Gravidarum 246

13.4 Acute Fatty Liver of Pregnancy 248

Patient Organisations and Essential Reading 250

References 251

Appendix 13.1.1 Body Mass Index 253

14 Haematological Disorders 255
Abena Addo, Christina Oppenheimer and S. Elizabeth Robson

14.1 Iron Deficiency Anaemia 256

14.2 Megaloblastic Anaemia 260

14.3 Disseminated Intravascular Coagulation 262

14.4 Von Willebrand’s Disease and

Other Bleeding Disorders 264

14.5 Thrombocytopenia in Pregnancy 266

14.6 Thalassaemia 268

14.7 Sickle Cell Disorders 270

Patient Organisations and Essential Reading 273

References 274

Appendix 14.1.1 Blood and Blood Products Overview 277

15 Thrombo-embolic Disorders 279
Daksha Elliott and Sue Pavord

15.1 Thrombophilia and Inherited Clotting Disorders 280

15.2 Deep Vein Thrombosis 282

15.3 Pulmonary Embolism 287

15.4 Thromboprophylaxis 290

Patient Organisations and Essential Reading 294

References 295

Appendix 15.4.1 Thrombo-embolic Disease Stockings 297

16 Addictive Disorders 299
Paul Moran and Madeleine Findlay

16.1 Substance Misuse 300

16.2 Alcohol Addiction 302

16.3 Tobacco and Cannabis Use 304

16.4 Cocaine Addiction 306

16.5 Opiate Addiction 308

16.6 Stimulant Addiction 310

Patient Organisations and Essential Reading 312

References 313

Appendix 16.1.1 Applying a Formal Assessment Framework 315

Appendix 16.3.1 Preventing SIDS: Advice to Parents 316

Appendix 16.4.1 Care of the Baby who Experiences Withdrawal 317

17 Psychiatric Disorders 319
Renuka Lazarus and Kathryn Gutteridge

17.1 Antenatal Psychiatric Disorders 320

17.2 Postnatal Psychiatric Disorders 322

17.3 Eating Disorders 324

17.4 Post-Traumatic Stress Disorder 326

Patient Organisations and Essential Reading 328

References 329

Appendix 17.1 Treatment Guidance for Depression 331

18 Neoplasia 333
Caroline Farrar and Francis J. E. Gardner

18.1 Gestational Trophoblastic Disease (Hydatidiform Mole and Choriocarcinoma) 334

18.2 Cervical Cancer 336

18.3 Cervical Screening 340

18.4 Breast Cancer 342

18.5 Non-Hodgkin’s Lymphoma 344

18.6 Hodgkin’s Lymphoma 346

18.7 Ovarian Neoplasia 348

18.8 Malignant Melanoma 351

Patient Organisations and Essential Reading 354

References 355

Index 357

About the Author

S. Elizabeth Robson is Principal Lecturer in Midwifery atDe Montfort University, Leicester, UK. With 25 years of experienceas a midwifery lecturer, she leads a module on medical disordersfor student midwives with a particular interest in immunology. Herlink lecturer areas comprise a high-risk maternity ward andcommunity team. She has presented nationally, and has a number ofpublications. Jason Waugh is Consultant in Obstetrics and MaternalMedicine at the Royal Victoria Infirmary, Newcastle Upon Tyne, UK.He has published extensively in the fields of hypertension andrenal and cardiovascular disease in pregnancy as well as producingnational guidelines for the management of pre-eclampsia and renaldisease. He is President of the UK s Macdonald ObstetricMedicine Society.

Reviews

Reviews of 1st edition:"The important facts are laid out concisely, primarily focusing onmanagement and using evidence-based guidelines for best midwiferypractice." ( The Obstetrician & Gynaecologist, 2010) "A strength of this book is that it has an unashamedly simpleat-a-glance format, easy to get used to. The chapters are based onthe traditional systems approach with sections dealing withdisorders and diseases...the important facts are laid outconcisely, primarily focusing on management, using evidence basedguidelines for best midwifery practice." (RCGP Journal,April 2010) This is an excellent book for use in the clinical arenaby nurse midwives, nurses, and other healthcare practitionerscaring for women with preexisting medical problems. (Doody's Reviews, June 2009) "The editors highlight recognition of deviation from the normalas an essential component of midwifery and have provided a manualthat will be appreciated by midwives in all areas of practice andwill be of great value to students studying high-risk modules."(Midwives, April/May 2009) "This book is a must have for any midwife, particularly thoseworking in the community, clinics and in high-risk areas... Thisbook is an extremely useful reference tool. For students midwivesit is an essential read when undertaking the 'complications' moduleof their course." (MIDIRS Midwifery Digest, January2009) I am currently a final year student midwife and can confidentlysay that this book has a simple with easy to read definitions ofeach disorder. It has clear details on the management in pregnancy,labour and following birth from a midwifery perspective - a mustfor any student midwife and a fantastic reference for all qualifiedmidwives. (5 Amazon Review ) "This book is a long awaited text providing a comprehensive lookat many of the medical conditions encountered by women duringchildbirth. Other texts with similar content have been recentlyproduced but this text has the advantage of the information beingpresented in tabular format, thus making it easy to follow and anideal reference tool. The care for each condition is broken downinto pregnancy, labour and postnatal aspects and then presentsexpected care from the medical and midwifery perspective, althoughthe reader will naturally have to apply any local policy for morespecific care. The conditions are divided under logical headingsand have been written by experienced professionals who havespecialist knowledge in the field they are covering. There is alsoa welcome addition of a chapter covering addictive disorders andpsychiatric disorders, both currently high on the agenda." Alison Edwards, Senior Midwifery Lecturer, BirminghamCity University. "Comprehensive coverage - systematic layout - extremelyinformative - simple and easy to understand language." Aine Kothari, Senior Lecturer, Anglia RuskinUniversity "Easy to use and informative. Content relevant and up to date.Covers more topics than standard textbooks for midwives. Highlyrecommended." Lesley Daniels, Midwifery Lecturer, LeedsUniversity "A long-awaited text, providing succinct outlines of corerequired for wide range of commonly occurring conditions." Alison Edwards, Midwifery Lecturer, Birmingham CityUniversity "Excellent book - contemporary, well organized and informativechapters well supported by tables. An excellent resource formidwives and students." Alison James, Midwifery Lecturer, PlymouthUniversity