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E-grāmata: Obesity and Obstetrics

Edited by (Consultant Obstetrician and Gynaecologist, Victoria Hospital, Kirkcaldy and Clinical Senior Lecturer, University of St. Andrews, UK), Edited by (Professor Emeritus, Division of Obstetrics and Gynaecology, St Georges University of London, London,), Edited by
  • Formāts: PDF+DRM
  • Izdošanas datums: 06-Jun-2020
  • Izdevniecība: Elsevier Science Publishing Co Inc
  • Valoda: eng
  • ISBN-13: 9780128179222
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  • Formāts: PDF+DRM
  • Izdošanas datums: 06-Jun-2020
  • Izdevniecība: Elsevier Science Publishing Co Inc
  • Valoda: eng
  • ISBN-13: 9780128179222
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Obesity and Obstetrics, Second Edition, brings together experts to examine the issues and challenges of obesity and obstetrics, also discussing how obesity affects fertility, reproduction and pregnancy. Beginning with the worldwide epidemic of obesity, chapters then go on to review obesity and hyperglycemia of pregnancy, management of labor, interventions to improve care during pregnancy, and long-term impact of maternal obesity.

  • Provides an essential reference on the significant risk of complications during pregnancy, including early pregnancy loss, recurrent miscarriage and fetal developmental abnormalities
  • Builds foundational knowledge on how maternal obesity predisposes offspring to obesity, highlighting that the prevention of childhood obesity begins during pregnancy
  • Assembles critically evaluated chapters focused on obesity and obstetrics to meet the practical needs of obstetricians, endocrinologists and general practitioners

Recenzijas

"Such a task mentioned above is a set-up for monotonous reading. This text is anything but that! Indeed, I became "lost" in reading enjoyment. A search review found only one other title with a similar focus. Core texts, such as Williams Obstetrics, 25th edition, Cunningham et al. (McGraw Hill, 2018) necessarily only provide an overview of obesity and its impact on pregnancy. This book provides marvelous insight as a resource for the challenges of obesity in pregnancy. As a clinician who supervises a large university clinic for gestational and overt diabetes in pregnancy, I welcome this book into my library." --Doody Reviews

"This book is extremely useful to OB-GYNs on a daily basis. Obesity is a growing epidemic and we see these patients with increasing frequency. Every aspect of OB-GYN is covered in this book with relationship to obesity and I anticipate that a provider will use this book several times per day. There are no other well-known books that specifically evaluate the effects of obesity in so many aspects of OB-GYN. This is an evolving topic and further editions are certain to be desperately needed." --Doody

List of contributors
xv
About the editors xix
Preface---obesity in obstetrics xxi
Section 1 Epidemiology
1 Worldwide epidemic of obesity
3(6)
Rohana N. Haththotuwa
Chandrika N. Wijeyaratne
Upul Senarath
Introduction
3(1)
Definitions of overweight and obesity
3(1)
The extent of the problem
4(1)
Obesity in children and adolescents
4(1)
Temporal trends
5(1)
Factors associated with overweight and obesity
5(1)
Disease burden and impact on health and economy
6(1)
International response to the epidemic
6(1)
Conclusion
7(1)
References
7(2)
2 Social, ethnic, and environmental determinants of obesity
9(16)
Adi Katz
Sarah Pachtman Shetty
Richard A. Stein
Introduction
9(1)
Trends in obesity
9(1)
Health impact and burden of overweight and obesity
9(1)
Factors that contribute to disparities in obesity
10(7)
Conclusion
17(1)
References
17(8)
3 Obesity based on genetic and molecular influences
25(12)
Charles Savona-Ventura
Adnan Hasan
Tahir Mahmood
Introduction
25(1)
Genetic factors
25(1)
Molecular basis for energy intake regulation
26(3)
Control of energy expenditure and adipogenesis
29(2)
Metabolic programming
31(1)
Conclusion
32(1)
References
33(4)
4 The psychological basis of obesity
37(10)
Afework Tsegaye
Gyongyi Kokonyei
Alexander Baldacchino
Robert Urban
Zsolt Demetrovics
H.N. Alexander Logemann
General introduction
37(1)
Eating behavior
38(1)
Cognition
38(1)
Stigma and discrimination
39(1)
Stress and mood disorders
39(1)
Personality traits
40(1)
Emotion regulation
40(1)
Summary
41(1)
Acknowledgments
41(1)
References
41(6)
Section 2 Planning for Pregnancy in Obese Women
5 Preconception and antepartum care in overweight and obese women
47(6)
Amos Grunebaum
Joachim Dudenhausen
Frank A. Chervenak
Introduction
47(1)
Epidemiology of obesity and overweight in pregnancy or reproductive age women
47(1)
Impact of overweight/obesity on female and male (plus age) on fertility
47(1)
Morbidity and mortality of overweight/obesity in pregnancy
47(1)
Preconception care of overweight/obesity
48(1)
Early pregnancy in overweight and obese women
48(1)
Recommended and optimal weight gain in pregnancy
48(1)
Lifestyle and nutrition recommendations for pregnant obese women
49(1)
Antepartum care of overweight and obese women
49(1)
Obesity and gestational diabetes mellitus
50(1)
Obesity and hypertension
50(1)
Obesity, preterm birth, and neonatal mortality
50(1)
Intrapartum care and prevention of postpartum risks in obese patients
50(1)
Managing weight postpartum
51(1)
Conclusion
51(1)
References
51(2)
6 Management of pregnancy in women with history of weight loss surgery
53(8)
Matthew Brown
Leonie Penna
Obesity and bariatric surgery
53(1)
Types of bariatric surgery
54(1)
Restrictive procedures
54(1)
Malabsorptive procedures
55(1)
Complications of bariatric surgery
55(1)
Reproductive health after bariatric surgery
55(1)
Preconception counseling
56(1)
Antenatal management
57(1)
Recommended investigations in pregnancy after bariatric surgery
57(1)
Nutrition and treatment of possible deficiencies
57(2)
Management of acute attendance during pregnancy
59(1)
Postpartum management
59(1)
References
59(2)
7 Ultrasound scanning in early pregnancy and fetal abnormality screening in obese women
61(8)
Victoria Mumford
Asma Khalil
Key points for clinical practice
61(1)
Introduction
61(1)
Excess fetal risks associated with obesity
62(1)
Ultrasound assessment in obesity
63(2)
Fetal growth assessment
65(1)
Technical tips for ultrasound in obese women
65(1)
Financial issues
65(1)
Medicolegal litigations
66(1)
Interventions
66(1)
Conclusion
67(1)
References
67(2)
8 Challenges of third-trimester screening in obese women
69(6)
Moti Gulersen
Frank A. Chervenak
Selecting optimal site for measurements
69(1)
Estimation of Foetal birth weight
69(1)
Accuracy of Foetal weight estimation near term
70(1)
Limitation of ultrasound estimation of weight
71(1)
Optimal timing for sonographic assessment
71(1)
Assessment of amniotic fluid volume
71(1)
Summary
72(1)
References
72(3)
9 An overview of complications associated with obesity during pregnancy
75(8)
Tahir Mahmood
Introduction
75(1)
Pathophysiological changes among obese women during pregnancy
75(1)
Obesity in pregnancy
75(1)
Gestational diabetes
76(1)
Preeclampsia and pregnancy-induced hypertension
76(1)
Maternal venous thromboembolism
77(1)
Congenital abnormalities and obesity
77(1)
Macrosomia and obesity
77(1)
Obesity and risk of preterm rupture of membranes
78(1)
Stillbirth and obesity
78(1)
Obesity and induction of labor
78(1)
Place of birth
78(1)
Obesity and mode of delivery
78(1)
Obesity and obstetrics anesthetics
79(1)
Postpartum complications
79(1)
Breastfeeding
79(1)
Postnatal depression
79(1)
Perinatal outcome
80(1)
Conclusion
80(1)
Conflict of interest
80(1)
References
80(3)
10 Obesity and adolescent pregnancy
83(8)
Manasi Patil
Hilda Yenuberi
Matthews Mathai
Introduction
83(1)
Adolescent pregnancy
83(2)
Adolescent Obesity
85(1)
Pregnancy in obese adolescents
86(1)
Interventions
86(2)
References
88(3)
11 Algorithmic approach to antenatal care for women with obesity
91(14)
Shiri Shinar
Dan Farine
Cynthia Maxwell
Review of guidelines for antepartum care
91(2)
Prepregnancy care and recommendations
93(1)
Antenatal care
94(1)
Antenatal fetal screening---special considerations
95(1)
Planning for labor and birth
96(1)
Intrapartum care and anesthetic considerations
97(4)
Summary
101(1)
References
101(4)
12 Antenatal care for postbariatric women
105(12)
Natalie Meirowitz
Ruchira Sharma
Andrew C. Rausch
Key points
105(1)
Is there an optimal time to conceive a pregnancy after bariatric surgery?
105(1)
Nutritional considerations
106(1)
Gestational weight gain
107(1)
Gestational diabetes: risk, screening, and management
108(1)
Nonobstetric complications in the postbariatric gravida
109(2)
Pregnancy outcomes after bariatric surgery
111(2)
References
113(4)
13 Obesity, hypertension, and preeclampsia
117(8)
Fiona Broughton-Pipkin
Pamela Loughna
Introduction
117(1)
Definitions
117(1)
Blood pressure measurement
117(1)
Urine testing
118(1)
Changing incidence of obesity
118(1)
Does obesity predispose to preeclampsia?
118(1)
Potential mechanisms
119(1)
Adipokines
120(1)
Is "preeclampsia" in the obese really underlying chronic (essential) hypertension?
121(1)
Final considerations
122(1)
References
123(2)
14 Obesity and venous thromboembolism and management plan
125(12)
Joanne Ellison
Andrew Thomson
Introduction
125(1)
Epidemiology, prevalence, and trends
125(1)
Obesity, pregnancy, and venous thromboembolism risk: underlying mechanisms
126(1)
Prevention of venous thromboembolism in obese women during pregnancy
127(2)
Care of individuals identified as at higher risk of venous thromboembolism
129(2)
Investigation of suspected venous thromboembolism in obese pregnant women
131(1)
Summary
131(1)
References
132(5)
Section 3 Obesity and hyperglycaemia of pregnancy
15 Pregnancy and metabolic syndrome of obesity
137(12)
Sarah Barr
Scott M. Nelson
Shahzya S. Huda
Introduction
137(1)
Lipid metabolism and fat deposition in lean pregnancy
137(1)
Lipid metabolism and fat deposition in obese women
138(1)
Glucose metabolism in lean and obese pregnancy
139(1)
Adiposity, obesity and insulin resistance: potential mechanisms
139(1)
Adiposity and pregnancy-specific insulin resistance: potential mechanisms
140(1)
Adiposity, obesity and hypothalamic---pituitary---adrenal axis activity: potential mechanisms
141(1)
Amino acid metabolism in lean and obese pregnancy
141(1)
Preeclampsia, obesity, and metabolic syndrome of pregnancy
141(1)
Intervention strategies in maternal obesity and effects on metabolism
142(1)
Intervention strategies: lifestyle
142(1)
Intervention strategies: pharmacological
143(1)
Conclusion
144(1)
References
144(5)
16 Maternal obesity and developmental priming of risk of later disease
149(16)
Ronald Ching Wan Ma
Peter D. Gluckman
Mark A. Hanson
Introduction
149(1)
Epidemiological observations on maternal obesity, macrosomia, and neonatal adiposity
149(1)
Maternal obesity and childhood obesity
150(1)
Maternal pregnancy weight gain and childhood obesity
150(1)
Maternal diabetes, gestational diabetes, and glucose effects
151(1)
Relationship between maternal hyperglycemia and neonatal adiposity
152(1)
Maternal hyperglycemia and childhood obesity
152(1)
GDM and cardiometabolic diseases in the offspring
152(1)
Maternal insulin resistance, hyperinsulinemia, and fetal growth
153(1)
Glucose metabolism and fetal growth
154(1)
Maternal lipid supply and fetal growth
154(1)
Amino acid metabolism and insights from metabolomics studies
154(1)
Effects on vascular function
154(1)
Animal models using maternal obesity
155(1)
Neurohormonal changes
156(1)
Intestinal inflammation and gut microbiota
156(1)
Placenta, fetal programming, and fetal development
156(1)
Epigenetics as the unifying mechanism in fetal priming of noncommunicable disease risk
156(1)
Implications for public health intervention
157(1)
Acknowledgments
158(1)
References
158(7)
17 Universal testing for hyperglycemia in pregnancy
165(8)
Anil Kapur
Tahir Mahmood
Rising burden of disability and hyperglycemia in pregnancy
165(1)
Short- and long-term consequence of hyperglycemia in pregnancy
166(2)
Should all pregnant women be tested for hyperglycemia in pregnancy?
168(1)
Should all women be subjected to a 75 goral glucose tolerance test?
168(1)
Is global consensus on diagnostic cutoff values possible?
168(1)
References
169(4)
18 Metformin use in gestational diabetes
173(6)
Ian W. Campbell
Introduction
173(1)
Efficacy of metformin in gestational diabetes
173(1)
Safety of metformin in gestational diabetes
174(1)
Clinical practice guidelines for metformin and gestational diabetes
174(1)
Metformin in overweight and obese pregnant women
175(1)
Metformin therapy after gestational diabetes
175(1)
Metformin in the future
176(1)
Acknowledgments
177(1)
References
177(2)
19 Management of gestational diabetes mellitus to optimize outcomes
179(12)
Yoel Toledano
Eran Hadar
Moshe Hod
Adverse pregnancy outcomes associated with gestational diabetes
179(1)
Gestational diabetes mellitus treatment
180(1)
Glycemic targets and monitoring
180(1)
Diet and lifestyle
181(1)
Pharmacologic therapy---Oral
182(1)
Insulin analogs
183(1)
New technologies
184(1)
Obstetric considerations and monitoring
184(2)
References
186(5)
20 Obesity, insulin resistance, and placental dysfunction---fetal growth
191(10)
Mariam Al Beloushi
Anjum Doshani
Justin C. Konje
Introduction
191(1)
Obesity and the endocrine environment
192(1)
Placenta and insulin resistance
192(1)
Placental size
193(1)
Placental transporter system
193(1)
Placenta and inflammatory response
194(1)
Prothrombotic state
194(1)
Diabetes and the placenta
194(1)
The intrauterine growth---restricted fetus
195(1)
Conclusion
195(1)
References
196(5)
Section 4 Management of labour
21 Induction of labor in obese women
201(6)
Andrew P. Brown
Carolyn Chiswick
Fiona C. Denison
Background
201(1)
Indications for induction of labor
201(2)
Women with a previous caesarean section
203(1)
Assessment prior to induction of labor
204(1)
Methods of inducing labor
204(1)
Fetal well-being
204(1)
Summary
205(1)
References
205(2)
22 Intrapartum care for obese and morbidly obese women
207(12)
Lindsay Edwards
Boon H. Lim
Introduction
207(1)
Preterm and postterm pregnancy
207(1)
Induction of labour
207(1)
Place of delivery
208(1)
Equipment required
208(1)
Labour and intrapartum monitoring
208(1)
Labour dystocia
209(1)
Second-stage progress
210(1)
Caesarean section in the obese woman
211(2)
Macrosomia and shoulder dystocia
213(1)
Postpartum care
213(1)
Perinatal morbidity
214(1)
Risks in subsequent pregnancy
214(1)
Conclusion
215(1)
References
215(4)
23 Anesthetic issues during labor in obese women
219(10)
Alistair Milne
Alistair Lee
Introduction Physiology of Obesity and Pregnancy
219(1)
Anesthetic considerations
220(1)
The anesthetic clinic
221(1)
The labor ward
222(1)
The operating theater
223(2)
The postoperative period
225(1)
Conclusion
226(1)
References
226(3)
24 Obesity, diabetes, placental pathology, and fetal malformations
229(10)
Margaret J. Evans
Introduction
229(1)
Obesity, diabetes, and the umbilical cord coiling
230(2)
Obesity, diabetes, and the placenta
232(1)
Obesity and other placental changes
233(1)
Obesity, diabetes, and fetal pathology
233(2)
Obesity, diabetes, and disease in childhood
235(1)
Conclusion
236(1)
References
236(3)
25 Maternal obesity and the risk of stillbirth
239(8)
Lisa Scott
Mairead Black
Background
239(1)
Epidemiology
239(1)
Pathophysiology
240(1)
Direct risk factors
240(1)
Gestational diabetes
240(1)
Hypertensive disorders
240(1)
Vascular pathology and placental dysfunction
240(1)
Metabolic syndrome
241(1)
Previous obstetric history
241(1)
Fetal abnormalities
241(1)
Sleep disorders
241(1)
Failed antenatal screening
241(1)
Postmaturity
241(1)
Indirect risk factors
241(1)
Age
241(1)
Parity
241(1)
Social class and dietary habits
242(1)
Ethnicity
242(1)
Obesity as an independent risk factor
242(1)
Management
242(1)
Prevention
242(1)
Public health implication
243(1)
References
244(3)
26 Cesarean delivery technique in obese women
247(14)
Rebekah Jo Mccurdy
Vincenzo Berghella
Key points
247(1)
Preoperative preparation
247(1)
Intraoperative technique
248(2)
Delivery of the baby and delayed umbilical cord clamping
250(1)
Prophylaxis of postpartum hemorrhage and placental delivery
251(1)
Closure of the uterus and abdomen
252(2)
Postcesarean delivery care
254(1)
References
255(6)
27 Sepsis in obese pregnant women
261(18)
Ailie Grzybek
Patrick Chien
Katrine Orr
Introduction
261(1)
Epidemiology of obesity and sepsis
261(1)
Immunology
262(1)
Specific infections
263(2)
Viral infections
265(1)
Sepsis
266(3)
Comorbidities
269(1)
Intrapartum care
269(1)
Operative issues
270(1)
Cesarean sections
270(1)
Preoperative considerations
270(1)
Antibiotic prophylaxis
271(1)
Incision
271(1)
Specialized retractors
272(1)
Closure
272(1)
Postoperative care
272(1)
Care in wound dehiscence
273(1)
Summary
273(1)
Practice points
273(1)
Research agenda
274(1)
Conflict of interest
274(1)
References
274(5)
28 Multimodal framework for reducing obesity-related maternal morbidity and mortality
279(14)
Leroy C. Edozien
Introduction
279(1)
Obesity in women of reproductive age
279(1)
Obesity-related maternal mortality
280(1)
Obesity-related maternal morbidity
280(1)
The concept of a multimodal framework
281(1)
Primary prevention of obesity-related maternal mortality and morbidity
282(1)
Secondary prevention of obesity-related maternal mortality and morbidity
283(1)
Dedicated clinic
283(1)
The booking visit and follow-up arrangements
283(1)
Anesthetic consultation
284(1)
Facilities
284(1)
Staff
284(1)
Weight control in pregnancy
284(1)
Intrapartum care
285(1)
Cesarean section
285(1)
Thromboembolism prophylaxis
285(1)
Breastfeeding
285(1)
Postnatal care
285(1)
Tertiary prevention of obesity-related maternal mortality and morbidity
285(1)
Vaginal birth after cesarean section
285(1)
Pregnancy after bariatric surgery
286(1)
Conclusion
286(1)
References
286(7)
Section 5 Interventions to improve care of women during pregnancy
29 Eating behavior and lifestyle issues in women --- implications for obesity development and prevention
293(8)
Nicola Heslehurst
Annie S. Anderson
Angela M. Craigie
Introduction
293(1)
Current diet and lifestyle issues
293(1)
Sociocultural influences on eating and lifestyle behaviors
294(2)
Individual-level influences
296(1)
Conclusion
297(1)
Acknowledgment
297(1)
References
297(4)
30 Antiobesity drugs for obese women planning pregnancy
301(6)
Hang Wun Raymond Li
Karen Siu Ling Lam
Pak Chung Ho
Introduction
301(1)
Classification of antiobesity drugs
301(1)
Drugs for weight reduction in reproductive age women: pharmacology and clinical efficacy
301(3)
Pharmacological antiobesity treatment in women contemplating pregnancy
304(1)
Concluding remarks
305(1)
References
305(2)
31 Weight-reducing surgery for women planning pregnancy: where are we now?
307(10)
Siara Teelucksingh
Lorenzo Gonzales
Surujpal Teelucksingh
Introduction
307(1)
Background
307(2)
The pros and cons of bariatric surgery
309(1)
How does bariatric surgery affect sexuality and sexual function?
309(1)
Should the desire of fertility be a prime indication for bariatric surgery?
310(1)
A case of spontaneous conception following weight-reducing surgery
310(1)
What is the optimum timing for planning a pregnancy after weight-reducing surgery?
311(1)
Special precautions after weight-reducing surgery
311(1)
Nutrition
311(1)
Anemia
311(1)
Gastrointestinal symptoms
311(1)
Monitoring of fetal growth
311(1)
Pregnancy outcomes after weight-reducing surgery
312(1)
Continued need to screen for gestational diabetes mellitus and hypertension after weight-reducing surgery
312(1)
Postpartum considerations
313(1)
Future work
313(1)
Conclusion
313(1)
References
313(4)
32 Developing standards of care for obese women during pregnancy
317(10)
Chu Lim
Tahir Mahmood
Sabaratnam Arulkumaran
Introduction
317(1)
The development of standard of care
317(1)
How to develop standards?
317(1)
The obesity epidemic
318(1)
Prepregnancy care
318(1)
Interventions for the management of obesity before and during pregnancy
319(1)
Antenatal care
320(3)
Conclusion
323(1)
References
323(4)
33 Planning for the future: maternity services in 2035
327(8)
Hajeb Kamali
Sophie Moloney-Geany
Tim Draycott
Tahir Mahmood
Projected prevalence of obesity in 2035
327(2)
Current model of care
329(1)
Future model of care
329(3)
How can we deliver this care?
332(1)
Research needed to inform future planning
332(1)
Summary
332(1)
References
332(3)
34 Maternal obesity and stigma
335(8)
Ellinor K. Olander
Introduction to chapter
335(1)
Stigma
335(1)
Pregnant women's experiences of obesity stigma
335(1)
Obesity stigma and its influence on - maternal health
336(1)
Health-care professionals' attitudes toward and experiences of caring for pregnant women with obesity
337(1)
Reducing weight stigma within maternity services
338(1)
Summary
339(1)
References
340(3)
Index 343
Tahir Mahmood, CBE, MD, FRCPI, FFRSH, MBA, FACOG, FRCPE, FEBCOG, FRCOG Consultant Gynecologist and Clinical Director Women , Children and Clinical Services Directorate , Victoria Hospital, NHS Fife, Kirkcaldy, Scotland, UK Past Vice-President Standards, Royal College of Obstetricians and Gynecologists (2007-2010); President, European Board and College of Obstetrics and Gynecology (EBCOG, 2014-2017); Past President of Edinburgh Obstetrical Society ( 2012-2014); Past President of the Northern Obstetrical and Gynaecological Society of Scotland ( 1999-2011), National Lead for Heavy Menstrual Bleeding Audit in England and Wales (2010-2015), FIGO Hyperglycaemia in Pregnancy Working Group ( 2014-2016); and is currently International UNFPA Consultant for EECA Region, Chair of EBCOG Standards of Care and Position Statements Group, and Life Trustee Lindsay Stewart R&D Foundation of the Royal College of Obstetrician and Gynaecologists. In the recent past, he has held honorary senior Clinical Lectureships at the Universities of Edinburgh, Dundee and St. Andrews in Scotland. He has edited 10 manuscripts and has published more than 200 research papers and chapters. He was appointed as Commander of the order of the British Empire (CBE) in the New Years honours list (2012) by Her Majesty Queen Elizabeth, the 2nd Sir Sabaratnam Arulkumaran, PhD, DSc, FRCOG, FRCS, FACOG, Emeritus Professor of Obstetrics and Gynaecology (O&G) of St. Georges University, London; Foundation Professor of O&G, University of Nicosia, Visiting Professor, Institute of Global Health Innovation, Imperial College, London; Past President of the Royal College of Obstetricians and Gynaecologists (2007-2010); President: International Federation of Obstetrics & Gynaecology (FIGO) 2012-2015; Head, Dept. of Obstetrics & Gynaecology, St Georges University Hospital, London, UK (1997-2013). National award recipient of Knight Bachelor in the UK and Sri Lanka Ranjana in Sri Lanka for services to Medicine. Frank A. Chervenak, MD, MMM currently serves as Chair of Obstetrics and Gynecology, Lenox Hill Hospital; Chair of Obstetrics and Gynecology and Associate Dean of International Medicine, Zucker School of Medicine at Hofstra/Northwell. He has published 327 papers in peer review literature and has co-authored or co-edited 38 textbooks. Research interests include ultrasound and ethics in obstetrics & gynecology and physician leadership. He has been named a member of The National Academy of Medicine of the National Academies. Dr. Chervenak has served on the Board of Governors of the American Institute in Ultrasound and Medicine and the Society of Perinatal Obstetricians. He has served as President of the World Association of Perinatal Medicine, International Fetal Medicine in Surgery Society, the New York Perinatal Society and the New York Academy of Medicine Section of Obstetrics and Gynecology, and the New York Obstetrical Society. Currently, Dr. Chervenak serves as President of the International Society of the Fetus as a Patient, Vice-president of the International Academy of Perinatal Medicine, and Co-director of The Ian Donald Inter-University School of Medicine and Ultrasound. He has been awarded doctor honoris causae from 11 International Universities. He has been admitted as a fellow ad eundem of the Royal College of Obstetricians and Gynaecologists of Great Britain and as a Foreign Member of the Russian Academy of Sciences. He has been named an Honorary Member of the Mexican Academy of Pediatrics and a Knight of Medicine” by the University of Georgia.