Oncology

Principles of managing cancer during pregnancy are described in this chapter. Subsequently, the background, clinical features, and management of breast and cervical cancer, melanoma, Hodgkin’s lymphoma, and acute leukaemia are separately covered. Preserving fertility, late effects on treatment, and neutropenic sepsis are also described.

Rheumatology

This chapter covers rheumatic diseases in the pregnant patient. It gives background, clinical features, and management in the pregnant patient for rheumatoid arthritis, Sjögren’s syndrome, psoriatic arthritis, systemic lupus erythematosus, antiphospholipid syndrome, and ankylosing spondylitis among others. It also covers systemic sclerosis, osteoporosis, and other musculoskeletal problems. Medications and the use of biologics in pregnancy are also discussed, with reference to breastfeeding.

Infectious diseases

This chapter covers a range of infectious diseases, including Ebola and Zika, and their associated risk to both the patient and the fetus in pregnancy. Management strategies are discussed. Management, counselling, and preconception advice for couples where one or both have HIV are covered extensively, and vaccination indications and contraindications are explained.

Diabetes mellitus

This chapter covers all issues of diabetes mellitus in relation to pregnancy. Type 1 and type 2 diabetes are defined, alongside gestational and monogenic diabetes. Advice for the pregnant patient with diabetes is given for every stage, from preconception to ante- and postnatal care. Practical aspects such as target capillary glucose levels, glucose monitoring, and types of insulin are all described. Complications and emergencies, including hypoglycaemia and diabetic ketoacidosis, are also explained, along with their management.

Neurology

This chapter considers the effects of neurological conditions in the pregnant patient. This includes epilepsy, the use of antiepileptic drugs and any contraindications and problems for the fetus, and the management of seizures both pre- and postnatally. Ischaemic stroke, intracranial and subarachnoid haemorrhage, cervical artery dissection, moyamoya, headaches, migraine, and neonatal effects of myasthenia gravis are all discussed, along with management strategies. Inherited and acquired neuropathies are also covered, along with other neurological conditions.

Cardiology

Pregnancy is associated with global haemodynamic changes, which occur early and gradually return to normal after delivery. This chapter covers the changes in physiological cardiac changes, before covering over 40 different cardiac conditions and syndromes, including inherited defects, problems arising from prosthetic heart valves, aortic pathologies, cardiomyopathies, as well as cardiac problems specific to the pregnant patient.

Perinatal mental health

This chapter covers perinatal mental health problems, both those that develop in pregnancy and those that may be encountered as pre-existing when a patient becomes pregnant. Specific phobias relating to the state of being pregnant (tocophobia) or issues encountered in pregnancy (blood, injury, and injection phobia), as well as depression, schizophrenia, eating disorders, self-harm, and substance abuse are covered. Treatment without consent and the role of the mother and baby unit are discussed.

Venous thromboembolism

Venous thromboembolism is a major cause of maternal mortality and morbidity. This chapter discusses thromboprophylaxis (including low-molecular-weight heparin and doses by patient weight), risk factors, deep vein thrombosis, pulmonary embolism, associated investigations, and management. Anticoagulants and bleeding while anticoagulated are both covered. Finally, superficial vein thrombosis in the first month postpartum is described.

Respiratory

This chapter describes the respiratory changes that take place in pregnancy, infections, and pre-existing conditions that may be exacerbated or changed prior to birth. Lung function tests, including spirometry, static lung volumes, and diffusion capacity, are all described. Diseases such as tuberculosis, bronchiectasis, cystic fibrosis, and so on are described, with evidence-based management strategies. Respiratory failure and lung transplantation as well as difficulties associated with pre-existing conditions in pregnancy are also covered.

Dermatology

This chapter covers the common skin changes in pregnancy, as well as atopic and polymorphic eruptions of pregnancy, pemphigoid gestationis, erythema nodosum, psoriasis, and more. For each condition, the background, symptoms, and potential effects on the fetus are described, as well as management strategies.