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Neurological illness in pregnancy: Principles and practice
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This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.
Gender-specific approach to medical disorders is gaining its rightful place in the medical practice globally. The incidence of a variety of neurological disorders, clinical profile, complication pattern and choice of therapy are greatly influenced by the sex of the individual. Reproductive age and pregnancy are the two important aspects that distinguish women from men with regard to medical disorders. The biological changes including hormonal, metabolic and immunological during pregnancy set the stage for these differences. Pharmacotherapy and other modalities of treatment during pregnancy also need to be tailored to suit the safety of mother and unborn baby.
This monograph fills in a major gap in the specific area of managing neurological disorders during pregnancy. Late Autumn Klein was a pioneer in the field of women's neurology. The team she put-together carefully has comprehensively reviewed the common neurological disorders from a pregnancy perspective.
This book has 18 chapters. The first four chapters deal with clinical evaluation, hormonal and physiological changes during pregnancy, neuroimaging and neurological complications of anaesthesia. There are dedicated chapters for most of the common neurological disorders encountered during pregnancy. The chapters on stroke in pregnancy and puerperium provide a wide discussion on various vascular disorders specific for pregnancy such as reversible cerebral vasoconstriction syndrome, posterior reversible encephalopathy, amniotic fluid embolism and cerebral venous sinus thrombosis. The specific issues of various antiplatelet drugs, heparin and anticoagulants have been discussed briefly.
The chapter on epilepsy and pregnancy covers a wide range of topics related to epilepsy and reproductive issues including fertility, infant mortality and seizure control during pregnancy. This chapter also extensively discusses the risk of major congenital malformation and neurocognitive developmental problems related to antenatal exposure to antiepileptic drugs.
The brief chapter on neurourology of pregnancy has succinctly described the basic neuroanatomy and physiology of urinary bladder and the urethra in health and disease. Specific disorders related to protracted labour, parturition and caesarean delivery are also discussed well.
The authors have reviewed most of the current literature on the respective topics and have provided a balanced interpretation of the data in most situations. Additional reference to the guidelines brought out by the American Academy of Neurology (AAN), The National Institute for Health and Care Excellence (NICE) or The Scottish Intercollegiate Guidelines Network (SIGN) also would have been helpful to the practitioners.
Overall this monograph is well written and edited. It could have been organized better by segregating neurological disorders from pituitary disorders, contraception and other issues. It would have been greatly helpful to the reader if the editors had included a couple of dedicated chapters on topics such as eclampsia and in vitro fertilization were also included. More flow diagrams and charts would have also added value.
This book would be a good choice for practitioners who are specifically called on to manage neurological problems in women of reproductive age. Residents and young consultants would also find this useful. It can be a good reference book in the medical libraries.
