Medical Illness and Pregnancy: An Annotated Bibliography of Recent Literature
Authors: DIANE L. ELLIOT
Journal: Annals of Internal Medicine (1983)

The Literature of Medicine1 July 1983Medical Illness and Pregnancy: An Annotated Bibliography of Recent LiteratureDIANE L. ELLIOT, M.D., SUSAN W. TOLLE, M.D., J. PATRICK O'GRADY, M.D., JEAN-CLAUDE VEILLE, M.D.DIANE L. ELLIOT, M.D.Search for more papers by this author, SUSAN W. TOLLE, M.D.Search for more papers by this author, J. PATRICK O'GRADY, M.D.Search for more papers by this author, JEAN-CLAUDE VEILLE, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-99-1-131 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptImproved management of medical illness and advances in the monitoring of high-risk pregnancies and postnatal care have allowed successful pregnancy for women with complex medical problems. These advances have led to a large body of literature on these topics. The articles and books in this bibliography were selected as a guide for internists in their care of pregnant patients with medical problems.The literature was searched by reviewing subject headings inIndex Medicusand cross-referencing various medical diagnoses and pregnancy with the National Library of Medicine's MEDLARS program. The search was limited to items in English. Articles were selected in...General Works Drug Therapy and Addiction Cardiovascular Disease Thrombophlebitis and Anticoagulation Hypertension Renal Disease Diabetes Thyroid Disease Miscellaneous Endocrine Considerations Gastrointestinal Disease Hepatic Disease Hematologic and Oncologic Disease Infectious Disease Pulmonary Disease Rheumatologic Disease Neurologic Disease Psychiatric Illness Miscellaneous Considerations and Conditions1. BURROWFERRIS GT. Medical Complications During Pregnancy. Philadelphia: W. B. Saunders Co; 1982. Single best textbook on this topic. Recent edition has well-written discussions for a broad spectrum of medical conditions, and referencing is thorough and current. Also included are chapters on obstetric management of high-risk pregnancy and genetic disorders. Google Scholar2. BERKOWITZCOUSTANMOCHIZUKI RDT. Handbook for Prescribing Medications During Pregnancy. Boston: Little, Brown and Co; 1981. Important resource for anyone taking care of pregnant women. This small paperback lists prescribed drugs, vitamins, and drugs of abuse, and reviews implications for their use in pregnancy. Information on each drug is followed by references. Google Scholar3. SHEPARD T. Teratogenicity of therapeutic agents. Curr Probl Pediatr. 1979;10(2):1-43. Basic information on teratogenesis and detailed reviews of the proven, possible, and unproven human teratogens. CrossrefMedlineGoogle Scholar4. PLATZKERLEWSTEWART ACD. Drug 'administration' via breast milk. Hosp Pract. 1980;15:111-22. Breast feeding has become more popular in recent years; presently, over 50% of mothers nurse their infants. More than 200 common drugs and substances are tabulated as to excretion in breast milk and compatibility with breast feeding. CrossrefMedlineGoogle Scholar5. COLLINS E. Maternal and fetal effects of acetaminophen and salicylates in pregnancy. Obstet Gynecol. 1981; 58:57S-62S. Use of aspirin in the third trimester is associated with prolonged gestation and labor, increased blood loss at delivery, and increased perinatal mortality, its use should be avoided in the third trimester. No adverse effects of acetaminophen have been reported; however, no formal study of its use in pregnancy has been done. MedlineGoogle Scholar6. Caffeine and pregnancy. FDA Drug Bulletin. 1980; 10:19-20. Brief review of data on caffeine and pregnancy. The Food and Drug Administration advises elimination or limitation of caffeine consumption during pregnancy. Two recent articles (N Engl J Med. 1982;306:141-5; JAMA. 1982;247:1429-32) have not found an association between caffeine and birth defects. Further study of this topic is required. MedlineGoogle Scholar7. DANISNEWTONKEITH RNL. Pregnancy and alcohol. Curr Probl Obstet Gynecol. 1981;4:5-48 The Surgeon General (FDA Drug Bull. 1981;11:9-10) advises woman who are pregnant not to drink alcohol; this is an extensive review of the issues surrounding the adverse effects of alcohol on pregnancy and offspring. Google Scholar8. ABEL E. Smoking during pregnancy: a review of effects on growth and development of offspring. Human Biol. 1980;52:593-625. Smoking, which (probably) causes fetal hypoxia, has significant adverse effects; they include growth retardation, an increase in spontaneous abortions, perinatal mortality, and malformations. MedlineGoogle Scholar9. FINNEGAN L, ed. Drug Dependence in Pregnancy: Clinical Management of Mother and Child. Washington, D.C.: U. S. Department of Health, Education and Welfare; 1979. Monograph on management of drug problems, primarily heroin addiction, in pregnancy. Chapters on therapy for the pregnant addict, management of labor and delivery, and care of the newborn are included. Especially helpful are discussions of the psychological and legal issues. Google Scholar10. MCANULTYMETCALFEUELAND JJK. General guidelines in the management of cardiac disease. Clin Obstet Gynecol. 1981;24:773-88. Best review article on this topic. The authors discuss general considerations and briefly outline the common categories of cardiac disease and pregnancy. In the same issue, an article by these authors reviews general cardiovascular physiology during pregnancy. In addition, these authors have an excellent chapter on this topic in: HURST JW, ed. The Heart. New York: McGraw-Hill Book Co.; 1982:1521-40. CrossrefMedlineGoogle Scholar11. UELANDMCANULTYUELANDMETCALFE KJFJ. Special considerations in the use of cardiovascular drugs. Clin Obstet Gynecol. 1981;24:809-23. Well-referenced summary of drugs used in the treatment of cardiovascular disease and cardioversion during pregnancy. Particularly useful are the sections on use of anticoagulants, propranolol, and thiazide diuretic agents. CrossrefMedlineGoogle Scholar12. BARRETTVAN HOOYDONKBOEHM JJF. Pregnancy-related rupture of arterial aneurysms. Obstet Gynecol Surv. 1982;37:557-66. Discussion of cerebral and aortic aneurysms and pregnancy; other sites of arterial rupture associated with gestation are also reviewed. CrossrefMedlineGoogle Scholar13. RAYBURNFONTANA WM. Mitral valve prolapse and pregnancy. Am J Obstet Gynecol. 1981;141:9-11. Outcomes of 42 pregnancies in patients with mitral valve prolapse shown by echocardiography. All patients with isolated mitral valve prolapse tolerated pregnancy without complications. The use of peripartum antibiotic prophylaxis remains controversial (see also reference 11, above); all but two patients in this series received antibiotic agents for endocarditis prophylaxis. CrossrefMedlineGoogle Scholar14. PYERITZ R. Maternal and fetal complications of pregnancy in the Marfan syndrome. Am J Med. 1981;71:784-90. Comparison of the experience from the Medical Genetics Clinic at Johns Hopkins University with that reported in the literature. Unlike previous published reports, data presented suggest women with minimal cardiovascular involvement from Marfan's syndrome, after careful clinical and echocardiographic assessment, can have safe pregnancies. CrossrefMedlineGoogle Scholar15. DEMAKISRAHIMTOOLA JS. Peripartum cardiomyopathy. Circulation. 1971;44:964-8. Brief summary of the clinical features, natural history, and treatment of this rare condition. Recently, results of endomyocardial biopsy in three patients with this disorder have shown an inflammatory myocarditis that responded to immunosuppressive therapy (N Engl J Med. 1982;307:731-4), and this diagnostic maneuver should be considered in these patients. CrossrefMedlineGoogle Scholar16. CHESLEY L. Severe rheumatic cardiac disease and pregnancy: the ultimate prognosis. Am J Obstet Gynecol. 1980;136:552-8. Follow-up from 1931 through 1943 of 134 pregnant women with rheumatic heart disease. Provided the women survived pregnancy, the course of their cardiac diseases was unaffected, and no delayed effect on life expectancy was seen. CrossrefMedlineGoogle Scholar17. GLEICHERMIDWALLHOCHBERGERJAFFIN NJDH. Eisenmenger's syndrome and pregnancy. Obstet Gynecol Surv. 1979;34:721-41. Report of two successfully managed patients and literature review. Because of associated maternal mortality of 30%, this and primary pulmonary hypertension are medical indications for therapeutic abortion. CrossrefMedlineGoogle Scholar18. IBARRA-PEREZAREVALO-TOLEDOALVAREZ-DE LA CADENANORIEGA-GUERRA CNOL. The course of pregnancy in patients with artificial heart valves. Am J Med. 1976;61:504-12. Women with prosthetic heart valves can be managed through pregnancy. However, a high rate of spontaneous abortion and increased maternal morbidity were shown. The authors report their experience with 28 pregnancies, therapeutic considerations, and outcomes. CrossrefMedlineGoogle Scholar19. BORTOLOTTIMILANOMAZZUCCO UAA. Pregnancy in patients with a porcine bioprosthesis. Am J Cardiol. 1982;50:1051-4. Eight pregnancies in patients with porcine valves not anticoagulated were unaccompanied by thromboembolic events. However, two patients developed valvular calcifications. Porcine valves may be the most desirable prosthesis in women who plan pregnancy, but their natural history in these patients is undefined. CrossrefMedlineGoogle Scholar20. MOSELEYKERSTEIN PM. Pregnancy and thrombophlebitis. Surg Gynecol Obstet. 1980;150:593-9. Synopsis of the risk factors for thrombosis associated with pregnancy and a brief guide to diagnosis and treatment. MedlineGoogle Scholar21. HALLPAULIWILSON JRK. Maternal and fetal sequelae of anticoagulation during pregnancy. Am J Med. 1980;68:122-40. Detailed compilation of the literature. Based on the data for warfarin and heparin, recommendations for anticoagulant use in pregnancy are reviewed. The article cited in reference 11, above, discusses why data on the heparin complication rate may be criticized. Anticoagulation during pregnancy is an area of controversy requiring individualization of therapy. CrossrefMedlineGoogle Scholar22. CHESLEY L. The control of hypertension in pregnancy. Obstet Gynecol Annu. 1981;10:69-106. Well-written article by an expert. The prognosis and management of preeclampsia-eclampsia and its relation to chronic hypertension are discussed. MedlineGoogle Scholar23. LINDHEIMERKATZ MA. Pathophysiology of preeclampsia. Annu Rev Med. 1981;32:273-89. The pathogenesis of preeclampsia-eclampsia is still elusive. Possible causes include decreased uteroplacental perfusion associated with platelet aggregation and decreased prostacyclin production, immunologic abnormalities, and a genetic disorder. CrossrefMedlineGoogle Scholar24. GANTWORLEY NR. Hypertension in Pregnancy. New York: Appleton-Century-Crofts;1980. Brief text includes chapters on pathophysiology and consequences of hypertension to the mother and fetus, and practical recommendations for evaluation and management of pregnancy-induced hypertension. A case-presentation format is included. Google Scholar25. FISHERLUGERSPARGOLINDHEIMER KABM. Hypertension in pregnancy: clinical-pathological correlations and remote prognosis. Medicine. 1981;60:267-76. A study of renal biopsies done 1 week postpartum on patients with hypertension during pregnancy confirms that clinical differentiation of preeclampsia, nephrosclerosis, and chronic glomerulonephritis is difficult. Women with pathologically documented preeclampsia were not at increased risk for development of hypertension. CrossrefMedlineGoogle Scholar26. BERKOWITZ R. Anti-hypertensive drugs in the pregnant patient. Obstet Gynecol Surv. 1980;35:191-204. Well-referenced article that examines antihypertensive drugs in general and relates that information to their use in pregnancy. Therapeutic plans for chronic hypertension in pregnancy and preeclampsia are presented. CrossrefMedlineGoogle Scholar27. RUBIN P. Beta-blockers in pregnancy. N Engl J Med. 1981;305:1323-6. Because of adverse effects on the neonate, the use of beta-blockers has been avoided during pregnancy. The author reviews data on beta-blocker use and concludes their risk may have been overestimated. Controlled trials comparing beta-blockers versus more standard therapies (hydralazine or alpha methyldopa) are advocated. Letters-to-the-editor on this controversial topic followed (N Engl J Med. 1981;306:810-1). CrossrefMedlineGoogle Scholar28. KATZDAVISONHAYSLETTLINDHEIMER AJJM. Effect of pregnancy on the natural history of kidney disease. Contrib Nephrol. 1981;25:53-60. A retrospective and prospective review from three medical centers of the effect of pregnancy on renal disease. In general, patients with minimal initial impairment in the glomerular filtration rate do well, although proteinuria and hypertension may increase. Overall, the natural history of the disease did not appear to be adversely affected by pregnancy. Similar data of these authors are presented in Kidney Int. 1980;18:192-206. CrossrefMedlineGoogle Scholar29. GRUNFELDGANEVALBOURNERIAS JDF. Acute renal failure in pregnancy. Kidney Int. 1980;18:179-91. Well referenced overview of the causes of acute renal failure in pregnancy and their clinical manifestations and pathogenesis. The authors critically review the literature on bilateral cortical necrosis and idiopathic postpartum acute renal failure. CrossrefMedlineGoogle Scholar30. COEPARKSLINDHEIMER FJM. Nephrolithiasis during pregnancy. N Engl J Med. 1978;298:324-6. Except for an increased rate of urinary tract infections, women with a past history of nephrolithiasis do well. The rate of stone passage is unchanged by pregnancy. CrossrefMedlineGoogle Scholar31. PENNMAKOWSKIHARRIS IEP. Parenthood following renal transplantation. Kidney Int. 1980;18:221-33. Data on pregnancies of 37 women who had renal transplants are discussed. If renal function was normal before conception, the pregnancy was tolerated well, except for an increased incidence of preeclampsia. However, morbidity and mortality of offspring were increased. Data on offspring of male transplant recipients are also discussed. CrossrefMedlineGoogle Scholar32. NOTELOVITZQUINLAN MR. Diabetes and pregnancy—theory and practice. Curr Probl Obstet Gynecol. 1980;3:4-58. A long article, but the best overall summary of the topic. The authors cover all aspects of pathophysiology and management. Google Scholar33. GABBE S. Diabetes mellitus in pregnancy: have all the problems been solved? Am J Med. 1981;70:613-8. Concise summary of the new information available on management of diabetes during pregnancy, as well as discussion of areas for further research. CrossrefMedlineGoogle Scholar34. MERKATZADAM IP. The Diabetic Pregnancy: A Perinatal Perspective. New York: Grune & Stratton, Inc.; 1979. Well-written book divided into three sections: considerations for the mother, effects on the placenta and fetus, and implications for the neonate. Particularly useful is the discussion of nutritional management of the mother. Google Scholar35. JOVANOVICDRUZIMPETERSON LMC. Effect of euglycemia on the outcome of pregnancy in insulin-dependent diabetic women as compared with normal control subjects. Am J Med. 1981;71:921-7. CrossrefMedlineGoogle Scholar36. COUSTAN D. Recent advances in the management of diabetic pregnant women. Clin Perinatol. 1980;7:299-311. Representative recent articles showing that improved glucose control and close fetal surveillance decrease perinatal mortality. The second article further outlines the methods used at Yale University to achieve improved control, as well as methods of fetal monitoring and the use of constant-infusion insulin during labor and delivery. CrossrefMedlineGoogle Scholar37. MILLERHARECLOHERTY EJJ. Elevated maternal hemoglobin A1c in early pregnancy and major congenital anomalies in infants of diabetic mothers. N Engl J Med. 1981;304:1331-4. Children of diabetic mothers have an increase in congenital anomalies. This article suggests that the incidence is correlated with glucose control in early pregnancy as shown by hemoglobin A1c levels. The implication of their findings is that improved control before conception and in early pregnancy may decrease the incidence of congenital anomalies. CrossrefMedlineGoogle Scholar38. KITZMILLERAIELLOKALDANYYOUNGER JLAM. Diabetic vascular disease complicating pregnancy. Clin Obstet Gynecol. 1981;24:107-23. From a symposium on diabetes in pregnancy. Diabetic women with nephropathy, cardiac disease, or retinopathy present unique problems in management. The special considerations in these groups of patients are discussed. CrossrefMedlineGoogle Scholar39. MESTMAN J. Management of thyroid disease in pregnancy. Clin Perinatol. 1980;7:371-85. Best overall review article on this topic. Thyroid function testing, hypo- and hyperthyroidism, goiter, and thyroid nodules are discussed. Concise rational recommendations for management are presented. Burrow's chapter on this subject in the book cited in reference 1, above, is also excellent. CrossrefMedlineGoogle Scholar40. MESTMAN J. Diagnosis and management of hyperthyroidism in pregnancy. Curr Probl Obstet Gynecol. 1981;4:5-50. Well-written, current review. The literature relevant to the controversies in managing pregnant patients with hyperthyroidism is critically reviewed. Google Scholar41. CHERONKAPLANLARSENSELENKOWCRIGLER RMPHJ. Neonatal thyroid function after propylthiouracil therapy for maternal Graves' disease. N Engl J Med. 1981;304:525-8. Thyroid function studies of 11 mothers treated with propylthiouracil (with and without thyroid hormone supplementation) and their infants. Although the mothers were shown chemically to be euthyroid, evidence of transient hypothyroidism was found in their infants. The researchers emphasize the need to use the lowest dose of propylthiouracil possible in treating hyperthyroidism during pregnancy. CrossrefMedlineGoogle Scholar42. MONTOROCOLLEAFRASIERMESTMAN MJSJ. Successful outcome of pregnancy in women with hypothyroidism. Ann Intern Med. 1981;94:31-4. Outcome of 11 pregnancies in 9 women who were hypothyroid during the first and second trimester; most women were euthyroid on replacement therapy during the third trimester. Unlike previous studies, the infants did well. The independent development of thyroid function in the fetus seems to protect against adverse affect of maternal hypothyroidism. LinkGoogle Scholar43. AMINOMIYAIKURO NKR. Transient postpartum hypothyroidism: fourteen cases with autoimmune thyroiditis. Ann Intern Med. 1977;87:155-9. Description of a form of autoimmune thyroiditis that seems to have a postpartum "flare". Patients developed a diffuse goiter, high-titer antithyroid microsomal antibodies, and hypothyroidism 3 to 5 months after delivery. Recovery occurred by 10 months postpartum. LinkGoogle Scholar44. CROSIGNANIFERRARISCARDUELLIPICCIOTTICALDARAMALINVERNI PCCMRA. Spontaneous and induced pregnancies in hyperprolactinemic women. Obstet Gynecol. 1981;58:708-13. Report on the successful use of bromocriptine to allow pregnancy in women with small adenomas. Interestingly, many women had a clinical and biochemical improvement after pregnancy. A large surveillance study of the drug's effects on pregnancy and the fetus (JAMA. 1982;247:1589-91) has not shown any adverse effects of its use early in pregnancy. MedlineGoogle Scholar45. SCHENKERCHOWERS JI. Pheochromocytoma and pregnancy. Obstet Gynecol Surv. 1971;26:739-47. Pheochromocytomas are rare during pregnancy, but carry high mortality for both mother and fetus. Their presentation may resemble preeclampsia. The diagnosis should be considered in patients with "essential hypertension" occurring before or early in pregnancy. CrossrefMedlineGoogle Scholar46. SHANGOLDDORWELTFLEISCHMANCRENSHAW MNSAM. Hyperparathyroidism and pregnancy: a review. Obstet Gynecol Surv. 1982;37:217-28. Hyperparathyroidism increases perinatal morbidity and mortality, primarily due to neonatal tetany. Second-trimester parathyroidectomy has been the therapy of choice, but earlier detection and better medical management may make acute surgery unnecessary. CrossrefMedlineGoogle Scholar47. SALLEBERTHEZENEGLORIEUX BFF. Hypoparathyroidism during pregnancy: treatment with calcitriol. J Clin Endocrinol Metab. 1981;52:810-3. Successful treatment of a woman with idiopathic hypoparathyroidism with calcitriol (1, 25-(OH)2D); the infants had no evidence of hyperparathyroidism. Dosage requirements during pregnancy are presented, and their implications discussed. CrossrefMedlineGoogle Scholar48. DEVORE G. Acute abdominal pain in the pregnant patient due to pancreatitis, acute appendicitis, cholecystitis, or peptic ulcer disease. Clin Perinatol. 1980;7:349-69. A concise review of the incidence, clinical presentation, differential diagnosis, and management of these conditions during pregnancy. CrossrefMedlineGoogle Scholar49. MOGADAMDOBBINSKORELITZAHMED MWBS. Pregnancy in inflammatory bowel disease: effect of sulfasalazine and corticosteroids on fetal outcome. Gastroenterology. 1981;80:72-6. Results of a national survey of gastroenterologists. Data suggest disease was not adversely affected by pregnancy. If disease was quiescent or mild before pregnancy, in approximately 75% of patients it remained quiescent during pregnancy. If disease was active before pregnancy, it stayed active in 50% of the patients. Data suggest use of corticosteroids and sulfasalazine for ulcerative colitis is unlikely to increase fetal morbidity or mortality. CrossrefMedlineGoogle Scholar50. WILLOUGHBYTRUELOVE CS. Ulcerative colitis and pregnancy. Gut. 1980;21:469-74. Data from a large clinic population of women with ulcerative colitis, and a literature survey. Fertility, incidence of congenital abnormalities, and perinatal mortality were normal. If disease activity was controlled before pregnancy, 70% of patients remained in remission. Most patients who relapsed did so in the first trimester. If pregnancy occurred during a period of disease activity, the disease was difficult to control. Treatment with corticosteroids and sulfasalazine did not appear to have adverse effects on the infants. CrossrefMedlineGoogle Scholar51. HOLZBACH R. Jaundice in pregnancy—1976. Am J Med. 1976;61:367-76. Review of three causes of jaundice during pregnancy: recurrent cholestasis of pregnancy, viral hepatitis, and acute fatty liver of pregnancy. Although some information is now outdated, the article provides a nice overview of these topics. CrossrefMedlineGoogle Scholar52. RIELY C. Acute hepatic failure at term. Postgrad Med. 1980;68:118-27. Clinically useful article discussing the management of fatty liver of pregnancy and its differentiation from other causes of third-trimester jaundice (viral hepatitis, biliary tract disease, benign cholestasis of pregnancy, and the Budd-Chiari syndrome). CrossrefMedlineGoogle Scholar53. TONGTHURSBYRAKELAMCPEAKEDWARDSMOSLEY MMJCVJ. Studies of the maternal-infant transmission of the viruses which cause acute hepatitis. Gastroenterology. 1981;80:999-1004. Infants were unaffected by maternal hepatitis A, and no prophylactic treatment is recommended. Hepatitis B transmission occurred in 76% of infants of mothers HBsAg positive at the time of delivery. As estimated by follow-up of infants' liver functions, non-A non-B hepatitis also appeared to be transmitted in the third trimester. CrossrefMedlineGoogle Scholar54. BEASLEYHWANGLIN RLC. Hepatitis B immune globulin (HBIG) efficacy in the interruption of perinatal transmission of hepatitis B virus carrier state: initial report of a randomized double-blind placebo-controlled trial. Lancet. 1981;2:388-93. Detectable hepatitis B surface antigenemia in the last trimester (due to acute infection or carrier state) puts the infant at risk for vertical transmission of infection. This prospective randomized trial suggests infants born to HBsAg-positive mothers should receive hepatitis B immune globulin. Treatment reduced persistent HBsAg positivity by 75% in the infants. (See recommendations for hepatitis B immune globulin use from the Centers for Disease Control in Ann Intern Med. 1982;96:193-7.) These infants are also candidates for inactivated hepatitis B vaccine (Morbid Mortal Weekly Rep. 1982;31:317-28). CrossrefMedlineGoogle Scholar55. WEINSTEIN L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol. 1982;142:159-67. Severe preeclampsia may present with epigastric pain, nausea, vomiting, right upper quadrant tenderness, and hypertension. Also associated with the syndrome are microangiopathic hemolytic anemia, thrombocytopenia, and elevated hepatocellular enzymes. The syndrome, which may be as common as viral hepatitis in pregnancy, may be misdiagnosed as a primary gastrointestinal disorder and requires prompt recognition and appropriate treatment for preeclampsia. CrossrefMedlineGoogle Scholar56. SCHREYERCASPIEL-HINDIESHCHAR PEJJ. Cirrhosis-pregnancy and delivery: a review. Obstet Gynecol Survey. 1982;37:304-12. Literature review of cirrhotic patients who became pregnant. Reporting bias may overestimate risk; however, maternal mortality, mainly due to peripartum gastrointestinal bleeding, and neonatal mortality were significantly increased. CrossrefMedlineGoogle Scholar57. LIPTONAYROMLOOICOLLER RJB. Severe von Willebrand's disease during labor and delivery. JAMA. 1982;248:1355-7. No single good clinical review is available on this topic. These brief case reports and synopsis of considerations provide a useful guide to management. CrossrefMedlineGoogle Scholar58. MORRISONPROPSTBLAKE JMP. Sickle hemoglobin and the gravid patient: a management controversy. Clin Perinatol. 1980;7:273-84. CrossrefMedlineGoogle Scholar59. CHARACHESCOTTNIEBYLBONDS SJJD. Management of sickle cell disease in pregnant patients. Obstet Gynecol. 1980;55:407-10. Management of sickle cell disease during pregnancy is an area of controversy. The first article reviews pathophysiology, outlines considerations for therapy, and expands on areas of controversy: iron supplementation, analgesia, method of delivery, and the use of prophylactic transfusions. The authors explain their rationale for transfusions and the protocol used. The second article makes the case against prophylactic transfusions; their use is reserved for sickle cell crisis, low hematocrit with dyspnea, or general anesthesia. Data to resolve this controversy from a current randomized trial of this therapy will be available later this year (1983). MedlineGoogle Scholar60. KOCHENOURBEESON NJ. The use of Rh-immune globulin. Clin Obstet Gynecol. 1982;25:283-91. CrossrefMedlineGoogle Scholar61. WEINSTEIN L. Irregular antibodies causing hemolytic disease of the newborn: a continuing problem. Clin Obstet Gynecol. 1982;25:321-32. Although the management of isoimmunization is usually left to the obstetrician, patients often consult their primary physician with questions about these problems. These articles from a recent symposium provide an update on management. CrossrefMedlineGoogle Scholar62. PERKINS R. Thrombocytopenia in obstetric syndromes: a review. Obstet Gynecol Surv. 1979;34:101-14. Overview of the causes of thrombocytopenia during pregnancy, with case reports. CrossrefMedlineGoogle Scholar63. THIAGARAJAHHARBERTCAUDLESTURGILL SGMB. Thrombotic thrombocytopenic purpura in pregnancy: a reappraisal. Am J Obstet Gynecol. 1981;141:20-4. Thrombotic thrombocytopenic purpura and preeclampsia share may clinical similarities; the pathophysiology of each is unknown. This article points out the difficulties in differentiation and their implications for management. CrossrefMedlineGoogle Scholar64. CARLOSSMCMILLANCROSBY HRW. Management of pregnancy in women with immune thrombocytopenic purpura. JAMA. 1980;244:2756-8. Many articles are available on this topic; this is a concise summary. There is controversy as to the safest way to manage delivery. These authors present the rationale for their recommendations, and other viewpoints are cited in their references (see also reference 65, below). CrossrefMedlineGoogle Scholar65. CINESDUSAKTOMASKIMENNUTISCHREIBER DBAMA. Immune thrombocytopenic purpura and pregnancy N Engl J Med. 1982;306:826-31. The results of a recent prospective study that found a correlation between maternal circulating antiplatelet antibody and neonatal platelet count. Neonatal thrombocytopenia did not correlate with maternal platelet count or maternal platelet bound antiplatelet antibody. The discrepancy between maternal platelet count and circulating antibody was greatest in mothers treated with steroids or splenectomy. If confirmed, this could be an important advance in the peripartum management of patients with immune thrombocytopenic purpura. CrossrefMedlineGoogle Scholar66. BLATTMULVIHILLZIEGLERYOUNGPOPLACK JJJRD. Pregnancy outcome following cancer chemotherapy. Am J Med. 1980;69:828-32. CrossrefMedlineGoogle Scholar67. BARBER H. Fetal and neonatal effects of cytotoxic agents. Obstet Gynecol. 1981;58:41S-7S. The first article reports on 30 patients from the National Cancer Institute, and the second is a literature review of the effects of individual cytotoxic agents. Data suggest that most patients who receive chemotherapy in other than the first trimester have normal offspring. MedlineGoogle Scholar68. O'DELL R. Leukemia and lymphoma complicating pregnancy. Clin Obstet Gynecol. 1979;22:859-70. Well-referenced article that briefly summarizes disease manifestations, effects on the fetus, and treatment for acute leukemias, chronic myelocytic leukemia, Hodgkin's disease, and the non-Hodgkin's lymphomas. CrossrefMedlineGoogle Scholar69. JACOBSDONALDSONROSENBURGKAPLAN CSSH. Management of the pregnant patient