Neisseria gonorrhoeae typically causes lower genital tract infection in pregnancy. It also may cause septic arthritis (Bleich, 2012). Risk factors for gonorrhea are similar to those for chlamydial infection. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (2017) recommend that pregnant women with risk factors or those living in an area of high N gonorrhoeae prevalence be screened at the initial prenatal visit and again in the third trimester. Treatment is given for gonorrhea and simultaneously for possible coexisting chlamydial infection (Chap. 65, p. 1240). Test of cure is also recommended following treatment.
Many factors can adversely afect maternal and fetal well-being. Some are evident at conception, but many become apparent during the course of pregnancy. The designation of "high-risk pregnancy" is overly vague for an individual woman and probably is best avoided if a more specific diagnosis can be assigned.
TABLE 9-3. Conditions for Which Maternal-Fetal Medicine Consultation May Be Beneficial
Cardiac disease-moderate to severe disorders
Diabetes mellitus with evidence of end-organ damage or uncontroiled hyperglycemia Family or personal history of genetic abnormalities
Renal insuficiency if associated with significant proteinuria (::500 mg/24 hour), serum creatininel::1.5 mg/dL, or hypertension Pulmonary disease if severe restrictive or obstructive, including severe asthma Human immunodeficiency virus infection Prior embolus or deep-vein thrombosis Severe systemic disease, including autoimmune conditions Bariatric surgery Epilepsy if poorly controlled or requires more than one anticonvulsant Cancer, especially if treatment is indicated in pregnancy
CDE (Rh) or other blood group alloimmunization (excluding ABO, Lewis) Prior or current fetal structural or chromosomal abnormality
Periconceptional exposure to known teratogens
Infection with or exposure to organisms that cause congenital infection Higher-order multifetal gestation
Severe disorders of amnionic fluid volume
Some common risk factors for which consultation is recommended by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (2017) are shown in Table 9-3. Some conditions may require the involvement of a maternal-fetal medicine subspecialist, geneticist, pediatrician, anesthesiologist, or other medical specialist in the evaluation, counseling, and care of the woman and her fetus.
hese are traditionally scheduled at 4-week intervals until 28 weeks, then every 2 weeks until 36 weeks, and weekly thereafter. Women with complicated pregnancies-for example, with twins or diabetes-often require return visits at 1-to 2-week intervals (Luke, 2003; Power, 2013). In 1986, the Department of Health and Human Services convened an expert panel to review the content of prenatal care. his report was subsequently reevaluated and revised in 2005 (Gregory, 2006). he panel recommended, among other things, early and continuing risk assessment that is patient speciic. It also endorsed lexibility in clinical visit spacing; health promotion and education, including preconceptional care; medical and psychosocial interventions; standardized documentation; and expanded prenatal care objectives-to include family health up to 1 year after birth.