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Antepartum Depression

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101. 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

102. 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

103. 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

104. 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

105. 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

106. 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

107. Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic (Full text)

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 PubMed abstract

108. 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

109. 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

110. 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

111. 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

112. Management of Pregnancy

the past 25 years, maternal pregnancy-related mortality and morbidity have been increasing. Common complications that can occur during pregnancy include maternal obesity or excessive weight gain, mental health conditions (e.g., depression, anxiety, posttraumatic stress disorder [PTSD]), hyperemesis gravidarum, anemia, gestational diabetes mellitus (GDM), and hypertensive disorders of pregnancy (e.g., gestational hypertension, preeclampsia, eclampsia).[ ] 9 Pregnancy-related deaths (approximately 600 (...) decreased and the percentage of live births affected by obesity-related complications increased.[ ] 17 20 20 Pregnant Service Members and Veterans more commonly experience mental health issues than non- pregnant Service Members and Veterans or pregnant women in the general population. In a study of mental health concerns among women Veterans between 2008 and 2012, anxiety, depression, and PTSD were twice as likely among those receiving pregnancy care as those without a pregnancy.[ ] Being removed from

2018 VA/DoD Clinical Practice Guidelines

113. Mental health care in the perinatal period: Australian clinical practice guideline

is to support health professionals in providing evidence- based care. While the focus of the Guideline is on women, the effects of maternal mental health on infants and families and the emerging evidence on paternal perinatal mental health are acknowledged. The Guideline is relevant to the care of all women in the perinatal period. In addition to screening and psychosocial assessment, the Guideline provides guidance on care for women with depressive and anxiety disorders, severe mental illnesses (...) (schizophrenia, bipolar disorder and postpartum psychosis) and borderline personality disorder at this time. The Guideline includes discussion of: • supporting emotional health and wellbeing of women • screening for symptoms of depression and anxiety and assessment for psychosocial factors that affect mental health • assessing mother-infant interaction and the safety of the woman and infant • referral and care pathways for women who require further assessment or care • care planning for women with diagnosed

2018 Clinical Practice Guidelines Portal

114. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

. While the plasma half-life of thrombolytic drugs is only hours, it may take days for the thrombolytic effect to resolve; fibrinogen and plasminogen are maximally depressed at 5 hours after thrombolytic therapy and remain significantly depressed at 27 hours ( ). The decrease in coagulation factor levels is greater with streptokinase compared with t-PA therapy. However, the frequency of hemorrhagic events is similar. Importantly, original contraindications to thrombolytic therapy included surgery

2018 American Society of Regional Anesthesia and Pain Medicine

115. Neonatal stabilisation for retrieval

service capability · Seek advice: o Contact RSQ o Phone 1300 799 127 Maternal risk · Severe hypertensive disorder · Antepartum haemorrhage · Other care requirements beyond service’s CSCF Fetal risk · Threatened preterm birth · Fetal anomalies · FGR · Multiple pregnancy · Other care requirements beyond service’s CSCF Yes Yes No No CSCF: Clinical services capability framework; FGR: Fetal growth restriction; QCG: Queensland Clinical Guidelines; RSQ: Retrieval Services Queensland Queensland Clinical (...) kg per minute *Refer to current pharmacopeia Queensland Clinical Guideline: Neonatal stabilisation for retrieval Refer to online version, destroy printed copies after use Page 22 of 40 8 Encephalopathy Neonatal encephalopathy is characterised by disturbed neurological function in the early days of life that often presents as 60 : · Reduced level of consciousness · Seizures [refer to Section 8.2 Seizures] · Difficulty in initiating and maintaining respiration · Depression of tone and reflexes

2018 Clinical Practice Guidelines Portal

116. CRACKCast E180 – Labor & Delivery

CRACKCast E180 – Labor & Delivery CRACKCast E180 - Labor & Delivery - CanadiEM CRACKCast E180 – Labor & Delivery In by Adam Thomas May 24, 2018 This episode of CRACKCast covers Rosen’s Chapter 181, Labor and Delivery. This chapter covers the high risk realm of ED deliveries, including potential complications such as PROM, malpresentation and umbilical cord emergencies. Shownotes – Key Points All ED deliveries should be considered high risk . Antepartum hemorrhage, PROM, eclampsia, premature (...) out a baby! While deliveries in the ER are rare, they can be precipitous in a setting with little back up and missing equipment. To make matters worse we probably don’t know the woman’s gestational dates, placental anatomy and obstetric information! The perinatal mortality rate in ED births is 8-10%. This is probably because antepartum hemorrhage, premature rupture of membranes (PROM), eclampsia, premature labor, abruptio placentae, malpresentation, and umbilical cord emergencies

2018 CandiEM

117. Resuscitation - neonatal

· Abnormal fetal presentation · Prolapsed cord · Prolonged first or second stage of labour · Precipitate labour · Antepartum haemorrhage (e.g. abruption, placenta praevia, vasa praevia) · Meconium in the amniotic fluid · Narcotic administration to mother within 4 hours of birth · Assisted vaginal birth–forceps or vacuum (ventouse) · Maternal general anaesthesia Queensland Clinical Guideline: Neonatal resuscitation Refer to online version, destroy printed copies after use Page 10 of 38 3 Preparation (...) Babies born to febrile women (temperature greater than 38 °C) are at increased risk of death, perinatal respiratory depression, neonatal seizures and cerebral palsy 1 · Induced hypothermia for hypoxic ischaemic encephalopathy (HIE): o Refer to Queensland Clinical Guideline: Hypoxic ischaemic encephalopathy (HIE) 3 · Do not apply hot water bottles or heat packs/stones directly to a baby and only use to warm linen when no other means available Delayed cord clamping 1,5,11 · Insufficient evidence

2018 Queensland Health

118. Management of Neonates Born at ?34 6/7 Weeks’ Gestation With Suspected or Proven Early-Onset Bacterial Sepsis

Blood Cell Count The white blood cell (WBC) count, differential (immature-to-total neutrophil ratio), and absolute neutrophil count are commonly used to assess risk of EOS. Multiple clinical factors can affect the WBC count and differential, including gestational age at birth, sex, and mode of delivery. – Fetal bone marrow depression attributable to maternal preeclampsia or placental insufficiency, as well as prolonged exposure to inflammatory signals (such as PROM), frequently result in abnormal (...) is not warranted and may be harmful. Nonetheless, 1% to 2% of E coli cases were resistant to both ampicillin and gentamicin in recent surveillance studies by the Centers for Disease Control and Prevention, and B fragilis is not uniformly sensitive to these medications. , Therefore, among preterm infants who are severely ill and at the highest risk for Gram-negative EOS (such as infants with VLBW born after prolonged PROM and infants exposed to prolonged courses of antepartum antibiotic therapy

2018 American Academy of Pediatrics

119. Management of specific situations in polycythaemia vera and secondary erythrocytosis (Full text)

, intrauterine death or stillbirth, pre‐eclampsia) Commence IFN Once daily prophylactic dose LMWH (e.g. enoxaparin 40 mg od) Aspirin from confirmation of pregnancy LMWH increasing to twice daily from 16 to 20 weeks’ gestation Continue once daily prophylactic dose LMWH (e.g. enoxaparin 40 mg od) and Aspirin Decision to continue IFN based on individual patient discussion Previous history of haemorrhage due to PV or significant antepartum or postpartum haemorrhage requiring transfusion Commence IFN Addition (...) ) Pruritus Pruritus is common in PV, occurring in up to 85% of patients (Mesa et al , ). Pruritus can predate or accompany the diagnosis of PV (Le Gall‐Ianotto et al , ). It can occur spontaneously or be precipitated by water or changes in temperature and can have a significant negative impact on quality of life, affecting sleep, participation in social activities and bathing (Siegel et al , ). The intensity of pruritus varies but can be severe causing emotional depression, anxiety and even suicide

2018 British Committee for Standards in Haematology PubMed abstract

120. Optimizing Postpartum Care

with primary care or subspecialist health care providers, as indicated Health maintenance • Review vaccination history and provide indicated immunizations, including completing series initiated antepartum or postpartum 17 • Perform well-woman screening, including Pap test and pelvic examination, as indicated 18 Abbreviations: ASCVD, arteriosclerotic cardiovascular disease; GDM, gestational diabetes mellitus; LARC, long-acting reversible contracep- tive. 1 Screening for perinatal depression. Committee (...) depression, birth spacing, healthy eating, the importance of exercise, or changes in their sexual response and emotions (12). Of note, anticipatory guidance improves maternal well- being: In a randomized controlled trial, 15 minutes of anticipatory guidance before hospital discharge, fol- lowed by a phone call at 2 weeks, reduced symptoms of depression and increased breastfeeding duration through 6 months postpartum among African American and Hispanic women (13, 14). Prenatal Preparation To optimize

2018 American College of Obstetricians and Gynecologists

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