Update on Medical Disorders in Pregnancy
William F. Rayburn, MD, MBA Consulting Editor
This issue of Obstetrics and Gynecology Clinics of North America, with Dr Judith Hibbard as Guest Editor, provides a timely update on topics pertaining to medical disorders in pregnancy. It is important that obstetricians have working knowledge of medical diseases common to women of childbearing age. It is difficult, however, to quantify accurately the broad range of medical illnesses that complicate pregnancy. Estimates have been derived from conditions warranting hospitalization. One study reported an overall antenatal hospitalization rate of 10 per 100 deliveries in their managed-care population of more than 46,000 pregnant women. About one third of those admissions were for nonobstetric conditions, such as renal, gastrointestinal, pulmonary, and infectious diseases. The care for some of these women warrants a team effort between obstetricians and specialists in either maternal-fetal medicine or internal medicine. It is essential to be familiar with pregnancy-induced physiologic changes. Even during normal pregnancy, virtually every organ system undergoes anatomic and functional changes that can alter criteria for diagnosis and treatment of medical complications. Without such knowledge, it is nearly impossible to understand how a disease process can threaten a woman and her fetus. On review of these articles, several fundamental principles apply to the rational approach for managing and prescribing drugs during pregnancy. (1) A woman should not be penalized for being pregnant. (2) What management plan would be recommended if she were nonpregnant? (3) What justifications are there to change such therapy because of pregnancy? (4) Individualization of care is especially important during pregnancy. (5) The healthiest mother is likely to deliver the healthiest fetus. Practice guidelines offered here result from a formal synthesis of evidence, developed according to a rigorous research and review process. The authors’ contributions offer a better understanding of evidence-based medicine, particularly as they relate to the development of guidelines. As evidence-based medicine continues to be integrated into clinical practice, an understanding of its basic elements is critical in translating the peer-reviewed literature into appropriate management of these medical
Obstet Gynecol Clin N Am 37 (2010) xv–xvi doi:10.1016/j.ogc.2010.03.002 obgyn.theclinics.com 0889-8545/10/$ – see front matter ª 2010 Elsevier Inc. All rights reserved.
conditions. The emphasis on evidence-based medicine has taken on even more importance with the accessibility of information being easier for both obstetricians and their patients. This issue provides a fresh perspective to the treatment of commonly seen, chronic medical illnesses during pregnancy. It is our desire that this timely review activates attention to issues about such conditions in pregnancy. It is hoped that the practical information provided herein by this distinguished group of clinicians aids in the evaluation and treatment of medical complications to optimize favorable outcomes for both mother and fetus. William F. Rayburn, MD, MBA Department of Obstetrics and Gynecology University of New Mexico School of Medicine MSC 10 5580, 1 University of New Mexico Albuquerque, NM 871310001, USA E-mail address: email@example.com