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Antepartum Depression

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101. 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

102. 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

103. 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

104. 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

105. 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

106. 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

107. Management of specific situations in polycythaemia vera and secondary erythrocytosis

, 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

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2018 British Committee for Standards in Haematology

108. 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

110. Epilepsy in Pregnancy

reduce the risk of accidents and minimise anxiety. Healthcare professionals should acknowledge the concerns of WWE and be aware of the effect of such concerns on their adherence to AEDs. Antepartum management What are the recommended models for antenatal care of WWE and what are the benefits of joint obstetrics and neurology clinics? Pregnant WWE should have access to regular planned antenatal care with a designated epilepsy care team. © Royal College of Obstetricians and Gynaecologists 3 of 33 RCOG (...) of serum AED levels in pregnancy is not recommended although individual circumstances may be taken into account. What are the adverse effects of AEDs in pregnancy on the mother and how can they be minimised? Healthcare professionals should be alert to signs of depression, anxiety and any neuropsychiatric symptoms in mothers exposed to AEDs. What are the risks of obstetric complications in pregnant WWE, including those taking AEDs? Healthcare professionals need to be aware of the small but significant

2016 Royal College of Obstetricians and Gynaecologists

111. BTS guideline for oxygen use in adults in healthcare and emergency settings.

of the BTS/Intensive Care Society (ICS) . Oxygen Use During Pregnancy (see section 8.14 in the original guideline document) Women who suffer from major trauma, sepsis or acute illness during pregnancy should receive the same oxygen therapy as any other seriously ill patients, with a target oxygen saturation of 94% to 98%. The same target range should be applied to women with hypoxaemia due to acute complications of pregnancy (e.g., collapse related to amniotic fluid embolus, eclampsia or antepartum (...) as it may delay the recognition of respiratory failure ( grade D ). Constant clinical assessment of the patient is crucial at all stages of conscious sedation procedures and monitoring of capnography or transcutaneous carbon dioxide levels may be a useful adjunct to identify early respiratory depression ( grade D ). During the recovery period after procedures requiring conscious sedation, supplemental oxygen should be titrated to achieve target saturations of 94% to 98% in most patients and 88% to 92

2017 National Guideline Clearinghouse (partial archive)

112. Clinical Practice Guideline for the Care of Women with Decreased Fetal Movements

the fetus within the amniotic sac. Antenatal The period of the pregnancy before birth 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) A person's weight in kilograms divided by the square of height in meters (...) . • Blood pressure and temperature. Risk factors for stillbirth • Previous stillbirth • Fetal growth restriction and Small for gestational age • Antepartum haemorrhage • Diabetes • Hypertension • Parity of 0 or >3 • Advanced maternal age (>35 years) • IVF • Indigenous ethnicity • Maternal obesity (BMI >25) • Smoking or illicit drug use • Low socioeconomic status • Low socioeconomic status Advice to pregnant women • Be aware of baby’s movements daily • Provide PSANZ patient information brochure (https

2017 Clinical Practice Guidelines Portal

113. Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association

undergo significant physiological alterations during pregnancy. The following sections highlight the physiological changes that have particular relevance to the management of gravidas with CHD. Antepartum Blood Volume Maternal blood volume begins to increase with the early hormonal changes of conception. Overall, pregnancy increases maternal blood volume by ≈40% for a singleton and 67% for twins, with peak values at ≈32 weeks of gestation , ( ). Both plasma volume and red cell mass contribute (...) the increase in resting heart rate. Nonspecific ST abnormalities, including segment depression or flattened and inverted T waves in lead III, occur frequently. Arterial Vasculature The vascular tree undergoes remodeling to accommodate increased blood volume. Along with the hyperkinetic circulation, structural alterations increase the risk of aortic root enlargement and dissection, particularly in gravidas with aortopathies such as Marfan or Turner syndrome. Pulmonary vascular resistance (PVR) declines

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2017 American Heart Association

114. Early pregnancy loss

of revealed or concealed antepartum haemorrhage o External cephalic version (performed or attempted) o Miscarriage or termination of pregnancy Quantifying FMH • If gestation less than 12+6 weeks, quantification of FMH is not required after a sensitising event 69 • If gestation 13 weeks or more, quantify the magnitude of the FMH with the Kleihauer test to ensure an adequate dose of RhD-Ig is offered o Each 100 IU of RhD-Ig protects against 1 mL fetal red cells (2 mL whole blood) 70 • If the Kleihauer test (...) is an experience common to many women, and yet it is simultaneously an intensely personal, private, intimate and individual experience. 80 It is important for longer term health and wellbeing, that a woman’s psychological needs are not overlooked, and that any symptoms of grief, depression and anxiety are recognised and acknowledged by health professionals. 81 9.1 Context and experience of early pregnancy loss Table 23. Context and experience of early pregnancy loss Aspect Consideration Context • Approximately

2017 Queensland Health

115. Normal birth

· Provides mild analgesia and sedation 112 · Minimal toxicity · Fast acting with rapid elimination 112,114 · No effect on uterine contractility · No known fetal or neonatal effects 114,115 · Effective for labour pain 73,116 · Can assist relaxation (breathing techniques) Risk · Overdose causes respiratory depression o Risk increased when used with opioid · Associated with: o Vomiting, nausea, headache and dizziness 73,110,114,116 o Disorientation and claustrophobia 73 · Can be minimised by careful (...) the number of VE to a minimum 19 · To assist in decision making, recommend VE: o Within four hours of presentation o Offer every four hours in active labour 40 o If clinical concerns identified Contraindication · Maternal consent not obtained · Antepartum haemorrhage · Ruptured membranes and not in labour · Placenta praevia · Placental position unknown · Suspected preterm labour Prior to VE 97 · Consider 40 : o Is a VE necessary? o Will a VE aid clinical decision making? · Review history and most recent

2017 Queensland Health

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

for thrombophilias. ACMG and ACOG have recommended testing for F2 and F5 in certain scenarios, while the Evaluation of Genomic Applications and Prevention Working Group (EGAPP) found insufficient evidence to perform this testing for any indication. 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 (...) Working Group: testing for cytochrome P450 polymorphisms in adults with nonpsychotic depression treated with selective serotonin reuptake inhibitors. Genet Med. 2007 Dec;9(12):819-25. Flockhart DA, O'Kane D, Williams MS, et al. Pharmacogenetic testing of CYP2C9 and VKORC1 alleles for warfarin. Genet Med. 2008 Feb;10(2):139-50. Grody WW, Griffin JH, Taylor AK, et al. American College of Medical Genetics consensus statement on Factor V Leiden mutation testing. Genet Med. 2001 Mar-Apr;3(2):139-48. Hicks

2017 AIM Specialty Health

117. Opioid Use and Opioid Use Disorder in Pregnancy

( ). In a study looking at hospital discharge diagnostic codes, antepartum maternal opioid use increased nearly fivefold from 2000 to 2009 ( ). The rising prevalence of opioid use in pregnancy has led to a sharp increase in neonatal abstinence syndrome from 1.5 cases per 1,000 hospital births in 1999 to 6.0 per 1,000 hospital births in 2013, with an associated $1.5 billion in related annual hospital charges. States with the highest rates of opioid prescribing also have the highest rates of neonatal abstinence (...) and the formulation; however, all have the potential for causing respiratory depression, overdose, and death. The risk of respiratory depression, overdose, and death is greater for full opioid agonists (such as fentanyl) than for partial agonists (such as buprenorphine). Injection of opioids also carries the risk of cellulitis and abscess formation at the injection site, sepsis, endocarditis, osteomyelitis, hepatitis B, hepatitis C, and HIV infection. Sharing of snorting implements also has been identified

2017 American College of Obstetricians and Gynecologists

118. Intrapartum fetal surveillance – Indications

antepartum fosterdød. 3 Associationen mellem GBS og perinatale outcomes som asfyksi og neonatal hypoksi er dårligere belyst, ligesom der er sparsomme data angående indikation for fosterovervågning under fødslen. GBS og obstetriske og/eller neonatale komplikationer: • Et retrospektivt israelsk kohortestudie fra 2012 4 inkluderede 218.402 singleton-fødsler over en 11-årig periode. Af disse havde 1,4 % (n=3009) en positiv GBS-dyrkning fra 21 vagina og 1,04 % (n=2270) en positiv urindyrkning for GBS. Gruppen (...) ST segment forandringer I det føtale EKG hos foster født af mødre med diabetes eller gestational diabetes. Indikation for STAN var forskellige: Høj-risiko gravide, afvigende eller patologisk CTG, mekonium tilblandet fostervand, inducerede fødsler vestimulation med syntocinon. Resultater: ST depression i foster EKG var signifikant hyppigere hos fostre født af mødre med diabetes, sandsynligvis ikke som tegn på hypoxi men en ændring i myocardiets respons på stress.24 Der var ingen forskel i

2017 Nordic Federation of Societies of Obstetrics and Gynecology

119. Obesity in pregnancy

og neonatale risici ved svær overvægt i graviditeten: Svært overvægtige vs. Normalvægtige OR (95% CI) Referencer: Maternelle komplikationer Spontan abort Habituelle aborter Spontan præterm fødsel ** Præeklampsi GDM Venøs Tromboemboli Mental health - Depression 1.89 (1.14-3.13) 2.60 (2.47-2.73) 2.68 (2.40-3.0) 1.62 (1.15-2.26) 7.54 (7.09-8.09) 3.76 (3.31-4.28) 5.30 (2.1-13.5) 2.5 (1.8-3.5) 1.43 (1.27-1.61) Metwally et al. Fertil Steril 2008(13) Ovesen et al. AJOG 2011(9) Wang et al. Obes Rev 2013 (...) flyveture på > 4 timer og i forbindelse med kirurgi og traumer. Prægravid BMI = 30 kg/m 2 betragtes som en risikofaktor som medfører let øget risiko, der sammen med andre faktorer indgår i vurderingen af om der skal gives tromboseprofylakse både antepartum og postpartum. Dosering af LMWH (low molecular weight heparin) ved profylaktisk behandling: DSTH (Dansk Selskab for trombose og Hæmostase) anbefaler at dosis ved profylaktisk behandling med LMWH er vægtbaseret: Prægravid vægt: 50-90 kg: 4.500 iE

2017 Nordic Federation of Societies of Obstetrics and Gynecology

120. Activity restriction for prevention of preterm birth

rest from the perspective of the high-risk pregnant woman. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN / NAACOG. 1997;26(4):423-30. Aflastning i graviditeten 2017 21 22. Maloni JA, Brezinski-Tomasi JE, Johnson LA. Antepartum bed rest: effect upon the family. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN / NAACOG. 2001;30(2):165-73. 23. Brown WJ, Ford JH, Burton NW, Marshall AL, Dobson AJ. Prospective study of physical activity and depressive symptoms in middle (...) 2B 10% af kvinder bliver under indlæggelse diagnosticeret med GDM (for hver dag den gravide er indlagt øges risikoen for GDM med en faktor 1,04) 2B Aflastning kan medføre psykiske symptomer og øger risikoen for postpartum depression 3-4 Forkortelser AR Activity restriction BMD Bone mineral density GA Gestationsalder GDM Gestationel diabetes mellitus NAR No activity restriction OGTT Oral glucose tolerance test PPI Partus præmaturus imminens PPROM Preterm prelabour rupture of membranes Indledning

2017 Nordic Federation of Societies of Obstetrics and Gynecology

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