The physiologic changes that occur in pregnancy may exceed the patient’s underlying compensatory mechanisms, resulting in initial symptom onset or rapid decompensation of medical illness during pregnancy. Certain chronic medical conditions also pose a serious threat to the mother’s health or result in a poor fetal outcome. Finally, some medical illnesses result in a difficult delivery or the need for special resuscitation measures in the neonate.
The incidence of pregnancy in chronically ill patients is increasing because of improved survival of patients with diseases such as diabetes, epilepsy, renal failure, and various cancers. Also, the demographics of pregnancy are changing in that maternal age at the time of first pregnancy is increasing. Advances in assisted reproduction, including in vitro fertilization and oocyte donation, have made it possible for older women—including those who are postmenopausal—to become pregnant. Older pregnant women experience an increased rate of antepartum and intrapartum complications and are more likely to have comorbid conditions such as cardiovascular disease.
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