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The most important tests in the evaluation of a stillbirth are fetal autopsy; examination of the placenta, cord, and membranes; and karyotype evaluation. The results of the autopsy, placental examination, laboratory tests, and cytogenetic studies should be communicated to the involved physicians and to the family of the deceased infant in a timely manner. Sensitivity is needed when discussing evaluation of a stillborn fetus with the family. Patient support should include emotional support and clear communication of test results. Referral to a bereavement counselor, religious leader, peer support group, or mental health professional may be advisable for management of grief and depression. In low-risk women with unexplained stillbirth the risk of stillbirth recurrence after 20 weeks of gestation is estimated at 7. Rates of the recurrence of fetal loss are higher in women with medical complications, such as diabetes or hypertension, or in those with obstetric problems with a significant recurrence risk, such as placental abruption. Despite reassurances, the patient is likely to be anxious and to require ongoing support. Prevalence of overweight, obesity, and extreme obesity among adults: United States, trends 1960-1962 through 2007-2008. Chapter 8 Care of the Newborn ^16^24^46^161^199^202 All newborns should be cared for by a team of expert physicians and trained health care providers in the context of a family-centered environment. At birth, infants are quickly stabilized and assessed to determine the level of care required. Individuals trained in neonatal resuscitation are present in the delivery room and are ready to perform timely resuscitation, if needed. All infants undergo an identification process, and copies of both maternal and newborn medical records are transferred from the obstetric to the neonatal care teams. Infants who are healthy and stable should remain with their mother during this period. The infant should be kept warm and assessed by a detailed clinical examination that includes intrauterine growth status, evaluation for gestational age, and a comprehensive risk assessment for neonatal conditions that require additional monitoring or intervention. Shortly after birth, all infants are weighed; receive eye prophylaxis, parenteral vitamin K, skin care, and umbilical cord care; and are bathed and clothed. Initiation of breastfeeding should take place soon after birth, with continued monitoring of the breastfed newborn until discharge and then after by the newborn care provider. In the event breastfeeding is disrupted, breast milk may be collected and stored or pasteurized banked donor milk may serve as an alternative. Preventive newborn care includes attention to hygiene and asepsis; hepatitis immunization; and screening for genetic and metabolic conditions, hearing impairment, critical congenital heart disease, risk of hyperbilirubinemia, and developmental hip dysplasia.
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Care systems for survivors should be designed discharge, malodor, or itching is present. Implications of commonly encountered sexually transmitted diagnosis, only tests with high specificities should be used. Because of the legal implications of a diagnosis of If a child has symptoms, signs, or evidence of an infection N. Because inadequate to evaluate prepubertal children for gonorrhea of the legal and psychosocial consequences of a false-positive and should not be used to diagnose or exclude gonorrhea. Such concerns might be recommended for children of either sex because the an appropriate indication for presumptive treatment in some likelihood of recovering chlamydia is low, perinatally settings and might be considered after all relevant specimens acquired infection might persist beyond infancy, and for diagnostic tests have been collected. All If no infections were identified at the initial examination specimens should be retained for additional testing. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of assailant(s) (890). Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually potential benefit of treating a sexually abused child should be transmitted diseases: a randomized controlled trial. The real problem with male condoms vaccination: recommendations of the Advisory Committee on Immunization is nonuse. Barrier contraceptives trial on the effectiveness of counseling messages for avoiding unprotected and sexually transmitted diseases in women: a comparison of femalesexual intercourse during sexually transmitted infection and reproductive dependent methods and condoms. Association between serosorting and hours after intercourse for emergency contraception. N Engl J Med effectiveness of an expedited partner therapy program in an urban clinic. Viral hepatitis treatment for Trichomonas vaginalis infection: a randomized controlled in pregnancy. Identifying likely syphilis Neisseria gonorrhoeae transmission from the oropharynx to the urethra transmitters: implications for control and evaluation.
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Pregnancy, Childbirth, and the Newborn Pregnancy, Childbirth, and the Newborn Intervention/how it is done Benefts and/or purposes Risks and/or disadvantages Comments Fetal heart rate monitoring Enables accurate assessRequires rupture of memSometimes, a combination ment of how contractions branes. During conintensity and frequency of varies among practitioners; outcome, except for labors in tractions, the increase in intrauterine presuterine contractions. During a vaginal exam, caregiver present condition; not how temporary shortage of oxypresses on or scratches fetal scalp. The reSometimes prevents an unlong the fetus will be able to gen caused by contractions) sponse of the fetal heart rate to stimulation necessary cesarean birth if handle the stress. If the Rapid and reliable test that heart rate is not reactive, fetus probably is can be repeated whenever not compensating well. Fetal oxygen saturation testing Had initially shown promise Expensive, diffcult to adminRarely used. Pregnancy, Childbirth, and the Newborn Intervention/how it is done Benefts and/or purposes Risks and/or disadvantages Comments Episiotomy Enlarges birth canal. Some of the disadvantages of episiotomy also occur with Provides a straight incision, May disturb early mothera spontaneous tear. Howwhich is easier to repair than infant interaction as episiotever, when an episiotomy is some large tears (however, it omy is repaired. Serious tears of the perineum Healing from a tear is more are more likely with episiotrapid and postpartum pain is omy than without. You may be asked to push contractions, the caregiver pulls on a hanstation than is safe for use of as hard as you can while forceps. The doctor turns and/or pulls on the handles when anesthesia is used or to aid rotation and descent. Used only in bearing-down efforts are Usually requires regional or Forceps are used much less in second stage when the baby is at a low insuffcient. Fewer doctors May be used to facilitate May bruise or tear vaginal are trained in their use. If forceps attempts are unsuccessful, a cesarean is done to Speeds delivery if fetus is in ensure the health of the baby.
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To prevent pregnancy-related listeria infections, pregnant women are advised not to eat unpasteurized dairy products, undercooked foods, or unwashed fresh fruits and vegetables. Listeria monocytogenes can be recovered on blood agar media from cultures of usually sterile body sites (eg, blood or cerebrospinal fluid). Special techniques may be needed to recover L monocytogenes from sites with mixed flora (eg, vagina, rectum). Because of morphologic similarity to diphtheroids and streptococci, a culture isolate of L monocytogenes mistakenly can be considered a contaminant or saprophyte. Prompt diagnosis and antibiotic treatment of maternal listeriosis may prevent fetal or perinatal infection. Listeria monocytogenes is uniformly sensitive to ampicillin, but there may be a synergistic benefit from adding gentamicin. Therapy with intravenous ampicillin and an aminoglycoside is recommended for neonatal infections. Complications in adults include pneumonia, sleep disturbance, rib fracture, and incontinence. In the first 6 months of life, illness is more severe, and infant complications include pneumonia, seizures, encephalopathy, and death. Newborns are thought to be protected from infection if high concentrations of passively transferred pertussis-specific antibodies are present. Immunization During Pregnancy Universal immunization is recommended to prevent transmission of pertussis. Women should ideally receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) before conception. However, there is no Perinatal Infections 423 evidence that antenatal vaccination with Tdap causes any adverse effects specific to pregnancy. Moreover, immunization with Tdap during pregnancy has been associated with an increase in diphtheria and pertussis antibody levels in newborns of vaccinated mothers. Health care providers should administer Tdap during pregnancy, preferably during the third trimester or late second trimester (ie, after 20 weeks of gestation). Alternatively, if not administered during pregnancy, Tdap should be administered immediately postpartum to ensure pertussis immunity and reduce the risk of transmission to the newborn. Additional guidelines for the administration of Tdap during pregnancy are outlined in the following paragraphs. Extensive information for health care providers and consumers about Tdap and other vaccines can be obtained at To ensure protection against maternal and neonatal tetanus, pregnant women who never have been vaccinated against tetanus should receive three vaccinations containing tetanus and reduced diphtheria toxoids during pregnancy. Ideally, these adolescents and adults should receive Tdap at least 2 weeks before they have contact with the infant.
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While some states have absolute gender-neutral rules of construction, others limit gender-neutrality such that the masculine includes the feminine but the feminine does not include the masculine. In addition, use of specifically gendered 2342 the nature of parenthood Consider S. Critically, though, this shif would be consistent with equality commitments that already have reshaped other aspects of family law, and it would eradicate some of the asymmetries that continue to pervade parentage law. Voluntary Acknowledgments of Parentage While the marital presumption addresses children born inside marriage, states maintain statutory frameworks to recognize the parents of nonmarital terms like mother, father, husband, and wife may be seen to carry their gendered connotations. They contended, against the allegation of the birth mother, that they had arranged for the birth mother to act as a surrogate. The identification of a second legal parent alleviates some of the burdens experienced by nonmarital children. Accordingly, they efectively facilitate parental recognition on purely social grounds. Nonbiological fathers can deploy their heterosexual relationship to achieve parentage, while nonbiological mothers are excluded. Lawmakers in these states have used the concept of consent to build statutory frameworks that open paths to nonadoptive parentage based on social, and not simply biological, grounds. Approaches to both donor insemination and gestational surrogacy illustrate this point. In every state, the man married to a woman who conceives with donor sperm is treated as the legal father. While this presents obstacles to diferent-sex couples, its greatest impact has been on same-sex couples, who rely more heavily on donor insemination to have children and historically were excluded from marriage.
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