1. Angelini, Diane EdD, CNM, FACNM, FAAN
  2. Blackburn, Susan PhD, RN, C, FAAN

Article Content

This issue of JPNN (15:4) focuses on medical complications, specifically maternal implications and neonatal concerns.


Gallbladder disease and pancreatitis are two nonobstetric, abdominal-related complaints seen during pregnancy. Pancreatitis is seen less often, but its primary cause is also gallstone-related, as with gallbladder disease. Angelini reviews the clinical management of these disorders in pregnancy and applies current clinical options and techniques.


Poole and Thorsen discuss renal disease in pregnancy and review physiologic adaptations and alterations during pregnancy. Complications with diminished renal function are explored and perinatal morbidity and mortality effects presented.


A commonly seen chronic disease, asthma is the most common respiratory complication impacting pregnancy. Physiologic changes during pregnancy affect asthma management during various phases of gestation. Murdock explores treatments in current management and their implications in fetal compromise.


Curran discusses Multiple Organ Dysfunction Syndrome (MODS). This syndrome may be difficult to decipher from other conditions occurring during pregnancy. The exaggerated changes of pregnancy may cause functional changes that migrate into the dysfunctional realm with obstetric patients. MODS is a serious condition and has had poor outcomes. An exaggerated systemic inflammatory response occurs initially prior to multiple organ dysfunction syndrome. Current theories and treatment of MODS in the obstetric patient are presented.


The article by Mercer and Skovgaard does not discuss a medical complication per se, but rather presents a new paradigm for examining neonatal transitional physiology, one that may prevent complications in both healthy and compromised infants. Mercer and Skovgaard point out the lack of evidenced-based rationale to support the practice of early cord clamping and challenge assumptions that this practice is without harm. They present a cogent argument that delayed cord clamping may have significant benefits to the neonate and enhance the transition from fetal to extrauterine life. This paradigm might help to explain pathophysiologic processes seen during the transitional process and lead to more effective treatment.


The last article continues the examination of perinatal substance abuse begun in the first issue of this volume. Ballard describes a comprehensive approach to the management of women in a methadone maintenance program and their infants. The emphasis of this article is on prenatal counseling of the women regarding how the baby will be observed and on options for managing the newborn who manifests symptoms of neonatal abstinence syndrome. Ballard discusses the use of breastfeeding for mothers who are in a closely monitored methadone program and presents a promising new option for management of these infants in a controlled environment.