,CASE FILES ®
High-Risk Obstetrics
Eugene C. Toy, MD
The John S. Dunn Senior Academic Chair and Program Director
Obstetrics and Gynecology Residency Program
Vice Chair of Academic Affairs
Department of Obstetrics and Gynecology
The Methodist Hospital-Houston
Clerkship Director and Clinical Professor
Department of Obstetrics and Gynecology
University of Texas Medical School at Houston
Houston, Texas
Edward Yeomans, MD
Professor, Chairman, and Residency Program Director
Robert H. Messer, MD Endowed Chair
Texas Tech University Health Sciences Center
Department of Obstetrics and Gynecology
Lubbock, Texas
Linda Fonseca, MD
Assistant Professor of Maternal-Fetal Medicine
Northwestern University Feinberg School of Medicine
Chicago, Illinois
Joseph M. Ernest, MD
Chair, Department of Obstetrics and Gynecology
Carolinas Medical Center
Clinical Professor, University of North Carolina at Chapel Hill
Professor Emeritus, Wake Forest University School of Medicine
Charlotte, North Carolina
New York Chicago San Francisco Lisbon London Madrid Mexico City
Milan New Delhi San Juan Seoul Singapore Sydney Toronto
,Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under the
United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any
form or by any means, or stored in a database or retrieval system, without the prior written permission of
the publisher.
ISBN: 978-0-07-160544-1
MHID: 0-07-160544-4
The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-160543-4,
MHID: 0-07-160543-6.
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every
occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trade-
mark owner, with no intention of infringement of the trademark. Where such designations appear in this
book, they have been printed with initial caps.
McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or
for use in corporate training programs. To contact a representative please e-mail us at bulksales@mcgraw-
hill.com.
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge,
changes in treatment and drug therapy are required. The authors and the publisher of this work have checked
with sources believed to be reliable in their efforts to provide information that is complete and generally in
accord with the standards accepted at the time of publication. However, in view of the possibility of human
error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been
involved in the preparation or publication of this work warrants that the information contained herein is in
every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the
results obtained from use of the information contained in this work. Readers are encouraged to confirm the
information contained herein with other sources. For example and in particular, readers are advised to check
the product information sheet included in the package of each drug they plan to administer to be certain that
the information contained in this work is accurate and that changes have not been made in the recommended
dose or in the contraindications for administration. This recommendation is of particular importance in con-
nection with new or infrequently used drugs.
TERMS OF USE
This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGrawHill”) and its licensors re-
serve all rights in and to the work. Use of this work is subject to these terms. Except as permitted under the
Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile,
disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute,
disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent. You
may use the work for your own noncommercial and personal use; any other use of the work is strictly pro-
hibited. Your right to use the work may be terminated if you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARAN-
TEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RE-
SULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT
CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESS-
LY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO
IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will
meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill nor its
licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in
the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any
information accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be
liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the
use of or inability to use the work, even if any of them has been advised of the possibility of such damages.
This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises
in contract, tort or otherwise.
, DEDICATION
To Terri, my lovely wife of 25 years, my best friend, my biggest encourager and
supporter. It is her sacrifice and inspiration that allowed me to succeed in writing
and teaching.
— ECT
To an entire generation of residents, medical students,
and fellows who made teaching such a gratifying endeavor.
— ERY
To my parents and siblings,
who together laid down the foundation for my future;
to John, for his enduring support and encouragement;
and my colleagues/friends,
for their contributions to this textbook.
— LF
To all students, residents, fellows, and most importantly patients,
who have taught me what is important about medicine,
health, and life...
— JME
High-Risk Obstetrics
Eugene C. Toy, MD
The John S. Dunn Senior Academic Chair and Program Director
Obstetrics and Gynecology Residency Program
Vice Chair of Academic Affairs
Department of Obstetrics and Gynecology
The Methodist Hospital-Houston
Clerkship Director and Clinical Professor
Department of Obstetrics and Gynecology
University of Texas Medical School at Houston
Houston, Texas
Edward Yeomans, MD
Professor, Chairman, and Residency Program Director
Robert H. Messer, MD Endowed Chair
Texas Tech University Health Sciences Center
Department of Obstetrics and Gynecology
Lubbock, Texas
Linda Fonseca, MD
Assistant Professor of Maternal-Fetal Medicine
Northwestern University Feinberg School of Medicine
Chicago, Illinois
Joseph M. Ernest, MD
Chair, Department of Obstetrics and Gynecology
Carolinas Medical Center
Clinical Professor, University of North Carolina at Chapel Hill
Professor Emeritus, Wake Forest University School of Medicine
Charlotte, North Carolina
New York Chicago San Francisco Lisbon London Madrid Mexico City
Milan New Delhi San Juan Seoul Singapore Sydney Toronto
,Copyright © 2011 by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under the
United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any
form or by any means, or stored in a database or retrieval system, without the prior written permission of
the publisher.
ISBN: 978-0-07-160544-1
MHID: 0-07-160544-4
The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-160543-4,
MHID: 0-07-160543-6.
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every
occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trade-
mark owner, with no intention of infringement of the trademark. Where such designations appear in this
book, they have been printed with initial caps.
McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or
for use in corporate training programs. To contact a representative please e-mail us at bulksales@mcgraw-
hill.com.
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge,
changes in treatment and drug therapy are required. The authors and the publisher of this work have checked
with sources believed to be reliable in their efforts to provide information that is complete and generally in
accord with the standards accepted at the time of publication. However, in view of the possibility of human
error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been
involved in the preparation or publication of this work warrants that the information contained herein is in
every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the
results obtained from use of the information contained in this work. Readers are encouraged to confirm the
information contained herein with other sources. For example and in particular, readers are advised to check
the product information sheet included in the package of each drug they plan to administer to be certain that
the information contained in this work is accurate and that changes have not been made in the recommended
dose or in the contraindications for administration. This recommendation is of particular importance in con-
nection with new or infrequently used drugs.
TERMS OF USE
This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGrawHill”) and its licensors re-
serve all rights in and to the work. Use of this work is subject to these terms. Except as permitted under the
Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile,
disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute,
disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent. You
may use the work for your own noncommercial and personal use; any other use of the work is strictly pro-
hibited. Your right to use the work may be terminated if you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARAN-
TEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RE-
SULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT
CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESS-
LY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO
IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will
meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill nor its
licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in
the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any
information accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be
liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the
use of or inability to use the work, even if any of them has been advised of the possibility of such damages.
This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises
in contract, tort or otherwise.
, DEDICATION
To Terri, my lovely wife of 25 years, my best friend, my biggest encourager and
supporter. It is her sacrifice and inspiration that allowed me to succeed in writing
and teaching.
— ECT
To an entire generation of residents, medical students,
and fellows who made teaching such a gratifying endeavor.
— ERY
To my parents and siblings,
who together laid down the foundation for my future;
to John, for his enduring support and encouragement;
and my colleagues/friends,
for their contributions to this textbook.
— LF
To all students, residents, fellows, and most importantly patients,
who have taught me what is important about medicine,
health, and life...
— JME
