The purpose of this document is to review the etiology, evaluation, and management of postpartum hemorrhage. Although many risk factors have been associated with postpartum hemorrhage, it often occurs without warning. Attention to improving the hospital systems necessary for the care of women at risk for major obstetric hemorrhage is important in the effort to decrease maternal mortality from hemorrhage. The creation of a patient safety team that works to improve the hospital systems for caring for women at risk for major obstetric hemorrhage can help to identify and manage these situations and save lives. Development of clinical pathways, guidelines and protocols designed to provide early diagnosis of patients at risk for major obstetric hemorrhage and for streamlined care in emergency situations are essential. A multidisciplinary patient safety team that includes individuals from the Division of Obstetric Anesthesiology, Maternal Fetal Medicine, Neonatology, and the Blood Bank as well as Departments of Nursing, Communication, and Administration and quarterly mock drills of rapid response team, helps to respond to these situations effectively.

Without a doubt, nausea and vomiting are common side effects of pregnancy. Hyperemesis gravidarum is a rare and severe complication of pregnancy that requires appropriate diagnosis and management to improve the patient’s quality of life and provide best possible maternal and neonatal outcomes. Physicians must appreciate the magnitude of the condition given its widespread implications – economic costs, decreased quality of life, maternal psychological effects, and risks to mother and fetus. Common maternal complications include dehydration, weight loss, and nutrient deficiencies. Current strategies include dietary modification, antiemetic therapy, and in certain situations, alimentary support. Use caution when prescribing phenothiazines because dystonia and extrapyramidal symptoms can occur with prolonged use and high dose. Future strategies should include more randomized controlled trials therapies that are safe for both mother and fetus, and effective treatment to prevent hospitalization and offer alternatives for nutritional support.

Despite improvements in antenatal and intrapartum care, stillbirth, defined as in utero fetal death at 20 weeks of gestation or greater, remains and important, largely unstudied, and poignant problem in obstetrics. This review discusses known and suspected causes of stillbirth including genetic abnormalities, infection, fetal-maternal hemorrhage, and a variety of medical conditions in the mother. The proportion of stillbirths that have a diagnostic explanation is higher in centers that conduct a defined and systemic evaluation. The most important test in the evaluation of a stillbirth is fetal autopsy; examination of the placenta, cord and membranes; and karyotype evaluation. 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.

The aim of this review is to highlight exercise guidelines in pregnancy in concise format for obstetricians and gynecologists and other healthcare providers who provide prenatal and postpartum care. These recommendations provide evidence that increasing weekly physical-activity expenditure while incorporating vigorous exercise provides optimal health outcomes for pregnant women and their fetuses, and also suggest light strength training during the second and third trimesters does not negatively affect newborn body size and overall health. Women of childbearing age are at increased risk of gestational diabetes mellitus (GDM), which has been linked strongly to obesity. Weight gain during pregnancy can be excessive, and some women tend to retain that weight after delivery. Gaining excessive weight during pregnancy can result in obesity-associated comorbidities, which are a major health concern in the United States.

Recurrent pregnancy loss (RPL) is a frustrating problem for both the patients and physicians. Pregnancy is a complicated process involving many intricate interactions between the fetus and the maternal environment. Pregnancy loss can result from any number of genetic, anatomic, endocrine, immune, or thrombotic disorders, as well as from unknown causes. The purpose of this document is to outline the causes of recurrent pregnancy loss and their potential therapies, where applicable. Traditionally RPL refers to the loss of three or more consecutive pregnancies; however, many clinicians will begin the evaluation of RPL after two losses, because the risk of a third loss after two miscarriages is approximately 30%, whereas the risk after three losses is about 33%. This approach may be especially useful in older women. It is important to remember that couples who are being evaluated for RPL have high levels of depression and stress. Some studies have indicated that psychological support may decrease the rates of unexplained miscarriage. Finally, patients should be reassured that even without treatment, successful pregnancy occurs in the majority of cases. This review can serve as a useful resource when counseling patients regarding treatment options.

Maternal nutritional status not only influences fetal development and overall health but also significantly affects long-term risk for chronic childhood and adult diseases. Many pregnant and lactating women may not achieve optimum levels of important nutrients, as evidenced by the proportion of women throughout the US population and in the world, whose nutritional levels do not meet documented standards for many vitamins, minerals, and other essential nutrients. Women’s Health and Education Center (WHEC) places emphasis on specific nutrients essential for optimal fetal development, notably folic acid, calcium, vitamin D, and omega-3 fatty acids; these are often consumed at levels below the recommended requirements. Maternal/infant morbidity and mortality are age-old and worldwide problems. There are many factors that influence the ultimate outcome of pregnancy, including the absence or presence of access to prenatal care, maternal stress (physical and psychological), comorbid diseases, and maternal nutrition — both before and during pregnancy. Good nutrition is much more than just the food we eat.