Updates in Medical and Surgical Weight Loss.

The number of individuals with obesity is at an all-time high, and the rate of obesity continues to climb each year. Obesity is a chronic disease with widespread effects throughout the body. Midwives and perinatal care providers need an understanding of the etiology, pathophysiology, and interventions for obesity. A review of evidence-based diet and lifestyle modifications, medications, and surgical procedures is presented.

Effects of Climate Change and Air Pollution on Perinatal Health.

Climate change is often framed as an environmental concern; however, the burning of fossil fuels both directly and indirectly impacts air quality and, thus, human health. Gas byproducts of combustion lead to increased levels of atmospheric ozone and carbon dioxide, which in turn elevate surface temperatures of the earth. This process exposes individuals to respiratory irritants and contributes to increased frequency of natural disasters such as wildfires, negatively impacting respiratory health. Normal physiologic changes in the respiratory system make pregnant people particularly vulnerable to the effects of air pollution. Asthma and allergic rhinitis are 2 common respiratory diseases that can be triggered by poor air quality. Solutions to limit the impact of climate change on respiratory disease include risk mitigation and reduction of fossil fuel consumption on individual, organization, and community levels. Midwives are well positioned as clinicians to educate people about individual strategies to reduce environmental exposure to respiratory irritants and advocate for policy changes to limit future health effects of climate change.

Preeclampsia and future stroke risk in women: What NPs need to know.

Preeclampsia is a complication of pregnancy that affects approximately 4% of pregnancies. Preeclampsia is defined as new-onset hypertension after 20 weeks gestation often accompanied by new-onset proteinuria. Women who experience preeclampsia during pregnancy are at an increased risk for hypertension and stroke later in life. Healthcare providers should screen women appropriately to minimize risk.

Pregnancy-Associated Stroke.

Cerebrovascular accident, or stroke, is the fourth leading cause of death for all women and the eighth leading cause of pregnancy-associated death. The physiologic changes of pregnancy increase the risk of cerebrovascular accident for women. With current incidence rates, a facility with 3300 births per year can anticipate caring for one woman with a pregnancy-related stroke at least every 2 years. All maternity care providers must be able to assess women experiencing stroke-like symptoms and initiate timely care to mitigate brain tissue damage, decrease long-term morbidity, and prevent mortality. The 2 main types of stroke, ischemic and hemorrhagic, have similar presenting symptoms but very different pathophysiology and treatment. This article reviews assessment and initial treatment of pregnant and postpartum women experiencing stroke and provides guidance for subsequent maternity and primary care to assist front-line perinatal care providers who may be the first to treat affected women or may resume primary care after diagnosis.

Allergic bronchopulmonary aspergillosis causing total lung collapse.

Allergic bronchopulmonary aspergillosis (ABPA) is commonly associated with underlying respiratory disease. The authors present the case of a 68-year-old non-smoker, admitted with a possible acute coronary syndrome, who deteriorated in hospital secondary to total left lung collapse as demonstrated on chest radiograph. There was no significant history of respiratory disease. Histology from bronchoscopy and lavage indicated lung carcinoma; however biopsy and CT staging demonstrated APBA. This is the first report of lung collapse secondary to ABPA in which initial bronchoscopy suggested underlying carcinoma.