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Antepartum Depression

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81. Premature newborn care

preterm premature rupture of membranes (PPROM) pre-eclampsia/pregnancy-induced hypertension abruption/antepartum haemorrhage abnormal amniotic fluid volume severe bacterial vaginosis multiple gestation previous preterm birth fetal abnormality cervical incompetence/uterine abnormality gestational diabetes maternal surgery during pregnancy chronic maternal illness short inter-pregnancy time interval drug use (tobacco, cocaine, heroin) maternal pregnancy body mass index <19 or >35 stress/depression non

2019 BMJ Best Practice

83. Macrosomia

plexus palsy resolve without permanent dis- ability. Other large case series confirm that 80–90% of cases of brachial plexus palsy will resolve by age 1 year (72, 73). Persistent injury is more common with higher birth weights and, in particular, birth weights more than 4,500 g (74, 75). Macrosomia is associated with a number of other risks to the newborn, including increased risks of depressed 5-minute Apgar scores, hypoglycemia, respi- ratory problems, polycythemia, meconium aspiration

2020 American College of Obstetricians and Gynecologists

84. Pregnancy and Renal Disease

considerations Antihypertensive drugs (see section 4.4) Labetalol Safe Safe License for pregnancy. Avoid if asthmatic. No association with congenital abnormalities. Reduced birth weight in unadjusted observational data. Neonatal bradycardia (2%) and hypoglycaemia (5%). Safe 4-9 Nifedipine Safe Safe None No association with congenital abnormalities. Safe 7,8 Amlodipine Safe Limited data. None Limited data. No adverse effects reported. Safe 10,11 Methyldopa Safe Safe Avoid in depression or if risk (...) of depression. No association with congenital abnormalities. Avoid in all due to risk of postnatal depression. 7,8 Doxazosin Safe Limited data None No evidence of harm in animal studies 150µmol/L in pregnancy). None Levels in milk are low, infants receive 12 months and follicle-stimulating hormone level >40mIU/ml) with use of an LHRH analogue compared to that of age and dose-matched controls (5% versus 30%, respectively). (9) Most data come from populations treated with chemotherapy for breast cancer

2019 Renal Association

85. Prenatal Care

, congenital anomalies, and failure to thrive. Key Points: Prenatal care summary. Table 1 summarizes the main aspects of prenatal care from preconception through delivery (history and examination; testing and treatment; education and planning). Fetal surveillance. Table 2 shows the common indications for antepartum fetal surveillance with nonstress testing and amniotic fluid index (AFI), the gestational ages at which to initiate testing, and the frequency of testing. Referral. Table 3 summarizes (...) term risk for cancer and cirrhosis. -Screen all patients for depression during the third trimester. -Provide contraceptive counseling during the third trimester teaching. -Review future chronic disease risks with patients during pregnancy and at the postpartum visit. Progesterone therapy. Progesterone should be offered to patients who have a history of prior spontaneous preterm birth or who are found to have a shortened cervix on ultrasound [I-A]. STI testing. Test all women for sexually

2020 University of Michigan Health System

86. Maternal and Newborn Survival in Sub-Saharan Africa

Cchallenge 1: Better care during pregnancy 10 Current status The leading cause of maternal death is haemorrhage, which accounts for 27% of the global burden, followed by hypertensive disorders (14%) and sepsis (11%). 12 The causes of antepartum stillbirths remain largely unknown due to a lack of death registrations 13 and under-investigation. Infections and fetal growth restriction are leading causes with congenital abnormalities accounting for about 5%. 14 When seeking to work out how best to target (...) to screen for postnatal depression. Workshop participants stressed the need for medical students to gain experience of primary and community care as well as hospital care. Attendance: Postnatal care is poorly attended in many settings. Research on why this is could inform changes that might increase demand for services and improve outcomes. Workshop participants stressed the importance of asking women what care they want, and of providing context-specific options and solutions. Those from rural farming

2019 Academy of Medical Sciences

87. Covid-19: Recommendations for GDM screening and oral glucose tolerance test (OGTT) during pregnancy and postpartum

• There is limited evidence or consensus regarding specific antepartum tests or their frequency 54 • Monitoring type and frequency is influenced by the presence of other pregnancy complications (e.g. antepartum haemorrhage, preeclampsia, fetal growth restriction) as well as severity of maternal hyperglycaemia 24 • Fetal abdominal circumference (AC) greater than or equal to 75% for gestational age, measured at 29 to 33 weeks gestation, correlates with an increased risk for birth of an LGA infant 55 Fetal growth (...) for glycaemic management o Addition of pharmacologic therapy 3.3 Psychosocial support Table 14. Psychosocial support Aspect Consideration Context • Emotional well-being is an important part of diabetes care and self- management 8 • Rapport between the woman and the health care provider can enhance compliance 56 • Barriers to effective treatment response in women with GDM include depression, eating disorders, stress and anxiety 57 Information and education • Individualise the approach to management. Take

2020 Queensland Health

88. Management of Stillbirth

on having a stillbirth and in women with both comorbidities, an even higher risk has been reported . Numerous other medical conditions including systemic lupus erythematosus, renal disease, uncontrolled thyroid disease, and cholestasis of pregnancy have been associated with stillbirth . For guidance regarding antenatal fetal surveillance based on anticipated risk of stillbirth, refer to ACOG Practice Bulletin No. 145, Antepartum Fetal Surveillance . Acquired and Inherited Thrombophilias Antiphospholipid (...) of a genetic cause to 41.9% in all stillbirths, 34.5% in antepartum stillbirths, and 53.8% in stillbirths with anomalies . Microarray analysis was more likely than karyotype analysis to provide a genetic diagnosis, primarily because of its success with nonviable tissue, and it was especially valuable in analyses of stillbirths with congenital anomalies or when karyotype results could not be obtained. Thus, microarray analysis, incorporated into the stillbirth workup, improves the test success rate

2020 American College of Obstetricians and Gynecologists

89. AIM Clinical Appropriateness Guidelines for Pharmacogenetic Testing and Genetic Testing for Thrombotic Disorders

, and variability in study designs make direct comparisons difficult (Perterson et al. 2017; Rosenblat and McIntyre 2017; Solomon, Cates and Li 2018). While published results from a recent large patient-blinded randomized controlled trial, the Genomics Used to Improve DEpression Decisions (GUIDED) trial, revealed that patients reached secondary outcomes of improvements in response (26.0% versus 19.9%, p=0.036) and remission (15.3% versus 10.1%, p=0.007) rates compared to patients with treatment as usual (...) ; Ashraf et al. 2019). The population for which F2/F5 genetic testing results have direct implications for treatment is pregnant women with a previous history of VTE associated with a transient risk factor (e.g., surgery, trauma). These women would typically not be treated with antepartum anticoagulant prophylaxis unless they were found to have a genotype associated with a high risk of VTE recurrence (FVL homozygosity, F2 G20210A homozygosity, or compound heterozygosity for FVL and F2 G20210A). Genetic

2020 AIM Specialty Health

90. Management of Stillbirth

. Patient support should include emotional support and clear communication of test results. Referral to a bereavement counselor, peer support group, or mental health professional may be advisable for management of grief and depression. To read this article in full you will need to make a payment Already a print subscriber? Already an online subscriber? Register: Institutional Access: References MacDorman M.F. Gregory E.C. Fetal and perinatal mortality: United States, 2013. Natl Vital Stat Rep. 2015; 64 (...) : 1-24 National Center for Health Statistics Model state vital statistics act and regulations. Centers for Disease Control and Prevention , Atlanta (GA) 1992 ( Available at: ) Date accessed: September 16, 2019 Yudkin P.L. Wood L. Redman C.W. Risk of unexplained stillbirth at different gestational ages. Lancet. 1987; 1 : 1192-1194 Reddy U.M. Laughon S.K. Sun L. Troendle J. Willinger M. Zhang J. Prepregnancy risk factors for antepartum stillbirth in the United States. Obstet Gynecol. 2010; 116

2020 Society for Maternal-Fetal Medicine

91. Overview of pregnancy complications

be complete, partial, or marginal, and may resolve as pregnancy progresses. Symptomatic placenta praevia typically presents as second or third trimester painless vaginal bleeding. Sakornbut E, Leeman L, Fontaine P. Late pregnancy bleeding. Am Fam Physician. 2007;75:1199-1206. http://www.aafp.org/afp/2007/0415/p1199.html http://www.ncbi.nlm.nih.gov/pubmed/17477103?tool=bestpractice.com Magann EF, Cummings JE, Niederhauser A, et al. Antepartum bleeding of unknown origin in the second half of pregnancy (...) Resuscitation Program based on International Liaison Committee on Resuscitation Review. J Perinatol. 2008;28:S35-S40. http://www.ncbi.nlm.nih.gov/pubmed/18446175?tool=bestpractice.com Consultation with a neonatologist as soon as possible is recommended to reduce potential morbidity. The development of a depressive illness following childbirth may form part of a unipolar or, less frequently, a bipolar illness. It is not recognised by current classification systems as a condition in its own right

2018 BMJ Best Practice

92. Premature newborn care

preterm premature rupture of membranes (PPROM) pre-eclampsia/pregnancy-induced hypertension abruption/antepartum haemorrhage abnormal amniotic fluid volume severe bacterial vaginosis multiple gestation previous preterm birth fetal abnormality cervical incompetence/uterine abnormality gestational diabetes maternal surgery during pregnancy chronic maternal illness short inter-pregnancy time interval drug use (tobacco, cocaine, heroin) maternal pregnancy body mass index <19 or >35 stress/depression non

2018 BMJ Best Practice

93. Overview of pregnancy complications

be complete, partial, or marginal, and may resolve as pregnancy progresses. Symptomatic placenta praevia typically presents as second or third trimester painless vaginal bleeding. Sakornbut E, Leeman L, Fontaine P. Late pregnancy bleeding. Am Fam Physician. 2007;75:1199-1206. http://www.aafp.org/afp/2007/0415/p1199.html http://www.ncbi.nlm.nih.gov/pubmed/17477103?tool=bestpractice.com Magann EF, Cummings JE, Niederhauser A, et al. Antepartum bleeding of unknown origin in the second half of pregnancy (...) Resuscitation Program based on International Liaison Committee on Resuscitation Review. J Perinatol. 2008;28:S35-S40. http://www.ncbi.nlm.nih.gov/pubmed/18446175?tool=bestpractice.com Consultation with a neonatologist as soon as possible is recommended to reduce potential morbidity. The development of a depressive illness following childbirth may form part of a unipolar or, less frequently, a bipolar illness. It is not recognised by current classification systems as a condition in its own right

2018 BMJ Best Practice

94. Care around stillbirth and neonatal death

in Section 2 of this guideline. 4 The classification should be included in the routine perinatal data collections across jurisdictions for every perinatal death to enable comprehensive reporting regionally and nationally including disaggregation and identification of timing of the death (i.e. antepartum, intrapartum, early and late neonatal deaths). 5 Following application of the PSANZ SB&ND system, mapping to ICD-PM categories should be undertaken to enable high quality global reporting. 22 Perinatal (...) and perinatal mortality in ten European regions: methodology and evaluation of an international audit. J Matern Fetal Neonatal Med 2003; 14(4): 267-76. 21. Gee V. Perinatal, Infant and Maternal Mortality in Western Australia, 2006-2010. Perth, Western Australia; 2013. 22. Draper ES KJ, Kenyon S. (Eds.) on behalf of MBRRACE-UK. MBRRACE-UK Perinatal Confidential Enquiry: Term, singleton, normally formed, antepartum stillbirth Leicester: The Infant Mortality and Morbidity Studies, Department of Health Sciences

2019 Centre of Research Excellence in Stillbirth

95. Clinical practice guideline for the care of women with decreased fetal movements for women with a singleton pregnancy from 28 weeks’ gestation

by pH. Amniotic fluid The fluid that surrounds the fetus within the amniotic sac. Antenatal The period of the pregnancy prior to the onset of labour. Antepartum Before the onset of labour. Apgar score A system to assess the status of the baby after birth. The Apgar score is recorded at 1 minute and 5 minutes after birth and is based on the following five variables: heart rate, respiratory effort, muscle tone, reflex irritability and colour, with a maximum score of 10. Body mass index (BMI (...) or doctor. If the CTG remains abnormal after 90 minutes, this requires urgent medical review. Although antenatal CTG has become part of clinical practice, a Cochrane review 118 comprising four trials and 1588 women did not confirm or refute any benefits for routine antepartum CTG monitoring of “at-risk” pregnancies. However, the authors acknowledge several limitations of this review, including the small numbers of women studied, methodological concerns, and also the fact that these trials were conducted

2019 Centre of Research Excellence in Stillbirth

96. Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic Full Text available with Trip Pro

that 21.6% of pregnant women enrolled in Medicaid receive a prescription for opioids. x 1 Desai, R.J., Hernandez-Diaz, S., Bateman, B.T., and Huybrechts, K.F. Increase in prescription opioid use during pregnancy among Medicaid-enrolled women. Obstet Gynecol . 2014 ; 123 : 997–1002 • From 2000–2009, antepartum maternal opiate use increased from 1.19 (95% confidence interval (CI), 1.01–1.35) to 5.63 (95% CI, 4.40–6.71) per 1000 hospital births per year. x 2 Patrick, S.W., Schumacher, R.E., Benneyworth (...) on epidemiology, prenatal screening, pain management, and treatment modalities of OUD in pregnancy, workshop participants were assigned to 1 of 3 breakout groups to discuss the following key issues in greater depth and to make preliminary recommendations: (1) screening and testing for substance use disorder, including OUD, in pregnancy; (2) pain management during the antepartum, intrapartum, and postpartum periods; and (3) management modalities for pregnant women with OUD. The following key findings emerged

2019 Society for Maternal-Fetal Medicine

97. AIM Clinical Appropriateness Guidelines for Pharmacogenetic Testing and Genetic Testing for Thrombotic Disorders

for treatment is pregnant women with a previous history of VTE associated with a transient risk factor (e.g., surgery, trauma). These women would typically not be treated with antepartum anticoagulant prophylaxis unless they were found to have a genotype associated with a high risk of VTE recurrence (FVL homozygosity, F2 G20210A homozygosity, or compound heterozygosity for FVL and F2 G20210A). Genetic testing for these patients is indicated. There may also be benefit to screening pregnant women (...) /NBK84174/ Duhl AJ, Paidas MJ, Ural SH, et al. Antithrombotic therapy and pregnancy: consensus report and recommendations for prevention and treatment of venous thromboembolism and adverse pregnancy outcomes. Am J Obstet Gynecol. 2007;197:457. PubMed PMID: 17980177. Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group. Recommendations from the EGAPP Working Group: testing for cytochrome P450 polymorphisms in adults with nonpsychotic depression treated with selective

2019 AIM Specialty Health

98. ShortGuide: Fetal movements

of maternal stress, depression and anxiety on fetal neurobehavioral development. Clinical Obstetrics and Gynecology 2009;52(3):425-40. 19. DiPietro J, Irizarry R, Costigan K, Gurewitsch E. The psychophysiology of the maternal–fetal relationship. Psychophysiology 2004;41:510-20. 20. Fretts, R, Barghelia V, Barss V. Decreased fetal movement: Diagnosis, evaluation, and management. UpToDate. 2018 [cited 2018 April 19]. 21. Sheikh M, Hantoushzadeh S, Shariat M. Maternal perception of decreased fetal movements (...) '-Reasons for consulting care due to decreased fetal movements. Women and Birth 2017;30(5):376-81. 25. Scala C, Bhide A, Familiari A, Pagani G, Khalil A, Papageorghiou A, et al. Number of episodes of reduced fetal movement at term: association with adverse perinatal outcome. American Journal of Obstetrics and Gynecology 2015;213(5):678.e1-.e6. 26. Moore T, Piacquadio K. A prospective evaluation of fetal movement screening to reduce the incidence of antepartum fetal death. International Journal

2019 Queensland Health

99. Primary postpartum haemorrhage

(which includes antepartum haemorrhage) was responsible for 12 (11%) of Australian maternal deaths in 2008–2012 (a maternal mortality ratio of 0.8 per 100,000). 8 1.1 Definition Although there is no single definition, PPH is termed as excessive bleeding in the first 24 hours post birth. In an emergent situation, diagnosis most commonly occurs through estimation of blood loss volume and changes in the haemodynamic state. Table 1. Postpartum haemorrhage definitions Aspect Definition Blood loss volume (...) technology IVF/ICSI 2.92 2.18 to 3.92 22 — Diabetes Gestational diabetes 1.56 1.05 to 2.31 22 Tone Multiple pregnancy 3.74 2.64 to 5.29 22 Tone Polyhydramnios 1.9 1.2 to 3.1 24 Tone Antepartum haemorrhage Placenta praevia/abruption 3.8 3.0 to 4.8 24 Tissue Tone Thrombin Drug induced atonia Magnesium sulphate Serotonergics Nifedipine Not available Tone Intrapartum risk factor Detail of study OR 95% CI Aetiology Induction of labour 1.17 1.04 to 1.3 6 Tone Prolonged second stage Failure to progress 1.9 1.2

2019 Queensland Health

100. Stillbirth care

if evidence of FGR · Antepartum fetal surveillance from 32 weeks including CTG · Discuss awareness of fetal movement · Consider timing of birth Post birth Investigations following birth · History focused · Refer to Flowchart: Investigations Autopsy considerations · Involve experienced staff · Discuss reasons/location for autopsy · Offer to all parents · Obtain consent · If autopsy declined: limited autopsy may be an option Postnatal care · Consider the setting for care · Facilitate the creation (...) · Offer smoking cessation program and support 49 · Offer referral and support for substance use (alcohol and drugs) Complications of pregnancy · Manage complications of pregnancy including fetal growth restriction, pre- eclampsia, antepartum haemorrhage and reduced fetal movements 19 · Advise low dose aspirin to women at high risk of abnormal placentation including pre-eclampsia 19,50,51 · Provide obstetric ultrasound assessment of fetal growth and umbilical artery Doppler studies to women with high

2019 Queensland Health

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