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Cervical Examination in Labor

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1061. Maternal Chorioamnionitis (Overview)

of the presence of amniotic fluid 'sludge' in asymptomatic patients at high risk for spontaneous preterm delivery. Ultrasound Obstet Gynecol . 2007 Oct. 30(5):706-14. . Rizzo G, Capponi A, Vlachopoulou A, Angelini E, Grassi C, Romanini C. Ultrasonographic assessment of the uterine cervix and interleukin-8 concentrations in cervical secretions predict intrauterine infection in patients with preterm labor and intact membranes. Ultrasound Obstet Gynecol . 1998 Aug. 12(2):86-92. . Reilly SD, Faye-Petersen OM (...) . Laboratory studies for asymptomatic pregnant mothers who present with premature labor or PROM include the following: Examination of amniotic fluid Maternal blood studies Maternal urine studies Maternal group B streptococcal (GBS) screening test Testing in febrile pregnant women with suspected chorioamnionitis may include the following: White blood cell (WBC) counts C-reactive protein (CRP) levels Alpha1-proteinase inhibitor (A1PI) complex measurement Serum interleukin-6 (IL-6) or ferritin levels Studies

2014 eMedicine Pediatrics

1062. Birth Trauma (Treatment)

and neurologic evaluation of the infant to establish whether additional injuries are present. Symmetry of structure and function should be assessed, the cranial nerves should be examined, and specifics such as individual joint range of motion and scalp/skull integrity should be evaluated. Next: Etiology The birth process is a blend of compression, contractions, torques, and traction. When fetal size, presentation, or neurologic immaturity complicates this event, such intrapartum forces may lead to tissue (...) damage, edema, hemorrhage, or fracture in the neonate. The use of obstetric instrumentation may further amplify the effects of such forces or may induce injury alone. Under certain conditions, cesarean delivery can be an acceptable alternative but does not guarantee an injury-free birth. Factors predisposing to injury include the following: Prima gravida Cephalopelvic disproportion, small maternal stature, maternal pelvic anomalies Prolonged or rapid labor Deep, transverse arrest of descent

2014 eMedicine Pediatrics

1063. Late Effects of Childhood Cancer and Treatment (Overview)

-induced cardiomyopathy usually present with symptoms of , which may develop spontaneously or may be initiated by stressors such as extreme exertion, as in weight lifting or difficult labor. Pericarditis may also be present, further compromising cardiac function. Additionally, ventricular arrhythmias may occur. Subclinical or mild toxic effects can be found in a significant number of treated children, depending on the methods used to assess damage. One study of children who received anthracyclines (...) fibrosis, interstitial pneumonitis, restrictive lung disease and/or obstructive lung disease. Symptoms include a dry hacking cough, dyspnea on exertion, shortness of breath, wheezing and/or exercise intolerance. Physical examination may reveal crackles in the lung bases and, rarely, a pleural friction rub. The chest radiograph may show infiltrates, though the findings are more often normal. Pulmonary function tests (PFTs) usually reveal evidence of restrictive lung disease with a decreased forced vital

2014 eMedicine Pediatrics

1064. Maternal Chorioamnionitis (Treatment)

. Ultrasonographic assessment of the uterine cervix and interleukin-8 concentrations in cervical secretions predict intrauterine infection in patients with preterm labor and intact membranes. Ultrasound Obstet Gynecol . 1998 Aug. 12(2):86-92. . Reilly SD, Faye-Petersen OM. Chorioamnionitis and funisitis. NeoReviews . Sept 2008. 9(9):e411-7. . Escobar GJ. The neonatal "sepsis work-up": personal reflections on the development of an evidence-based approach toward newborn infections in a managed care organization (...) rupture of membranes. J Matern Fetal Neonatal Med . 2017 Sep 22. 1-8. . Lee SE, Romero R, Park CW, Jun JK, Yoon BH. The frequency and significance of intraamniotic inflammation in patients with cervical insufficiency. Am J Obstet Gynecol . 2008 Jun. 198(6):633.e1-8. . Vaisbuch E, Hassan SS, Mazaki-Tovi S, et al. Patients with an asymptomatic short cervix (

2014 eMedicine Pediatrics

1065. Late Effects of Childhood Cancer and Treatment (Treatment)

-induced cardiomyopathy usually present with symptoms of , which may develop spontaneously or may be initiated by stressors such as extreme exertion, as in weight lifting or difficult labor. Pericarditis may also be present, further compromising cardiac function. Additionally, ventricular arrhythmias may occur. Subclinical or mild toxic effects can be found in a significant number of treated children, depending on the methods used to assess damage. One study of children who received anthracyclines (...) fibrosis, interstitial pneumonitis, restrictive lung disease and/or obstructive lung disease. Symptoms include a dry hacking cough, dyspnea on exertion, shortness of breath, wheezing and/or exercise intolerance. Physical examination may reveal crackles in the lung bases and, rarely, a pleural friction rub. The chest radiograph may show infiltrates, though the findings are more often normal. Pulmonary function tests (PFTs) usually reveal evidence of restrictive lung disease with a decreased forced vital

2014 eMedicine Pediatrics

1066. Maternal Chorioamnionitis (Follow-up)

. Ultrasonographic assessment of the uterine cervix and interleukin-8 concentrations in cervical secretions predict intrauterine infection in patients with preterm labor and intact membranes. Ultrasound Obstet Gynecol . 1998 Aug. 12(2):86-92. . Reilly SD, Faye-Petersen OM. Chorioamnionitis and funisitis. NeoReviews . Sept 2008. 9(9):e411-7. . Escobar GJ. The neonatal "sepsis work-up": personal reflections on the development of an evidence-based approach toward newborn infections in a managed care organization (...) rupture of membranes. J Matern Fetal Neonatal Med . 2017 Sep 22. 1-8. . Lee SE, Romero R, Park CW, Jun JK, Yoon BH. The frequency and significance of intraamniotic inflammation in patients with cervical insufficiency. Am J Obstet Gynecol . 2008 Jun. 198(6):633.e1-8. . Vaisbuch E, Hassan SS, Mazaki-Tovi S, et al. Patients with an asymptomatic short cervix (

2014 eMedicine Pediatrics

1067. The Fetus as a Patient: Prenatal Diagnosis and Fetal Therapy (Treatment)

, assessment of fetal well-being in the third trimester, when preterm birth appears imminent, and in labor may include the following diagnostic tests: Amniocentesis Nonstress test (NST) Biophysical profile test: Combines the NST with an assessment of amniotic fluid volume (AFV), fetal breathing movements, fetal activity, and fetal muscle tone Contraction stress test Doppler study: Assesses fetal umbilical arterial blood flow velocity or resistance to flow Radiologic studies Diagnostic imaging modalities (...) contemporaneously with the nuchal lucency assessment. Improved US resolution and technique have improved fetal visualization, and several series have shown first-trimester anatomic surveys to be as accurate in identifying anatomic abnormalities as the more traditional examinations at 18-22 weeks. Given the significance of many of the defects that can be identified, the advantages of earlier detection are apparent. Chorionic villous sampling Chorionic villous sampling (CVS) is the technique of choice

2014 eMedicine Pediatrics

1068. Birth Trauma (Follow-up)

and neurologic evaluation of the infant to establish whether additional injuries are present. Symmetry of structure and function should be assessed, the cranial nerves should be examined, and specifics such as individual joint range of motion and scalp/skull integrity should be evaluated. Next: Etiology The birth process is a blend of compression, contractions, torques, and traction. When fetal size, presentation, or neurologic immaturity complicates this event, such intrapartum forces may lead to tissue (...) damage, edema, hemorrhage, or fracture in the neonate. The use of obstetric instrumentation may further amplify the effects of such forces or may induce injury alone. Under certain conditions, cesarean delivery can be an acceptable alternative but does not guarantee an injury-free birth. Factors predisposing to injury include the following: Prima gravida Cephalopelvic disproportion, small maternal stature, maternal pelvic anomalies Prolonged or rapid labor Deep, transverse arrest of descent

2014 eMedicine Pediatrics

1069. Prematurity (Follow-up)

Health Information. Available at . May 8, 2013; Accessed: June 5, 2013. Dubowitz LM, Dubowitz V, Goldberg C. Clinical assessment of gestational age in the newborn infant. J Pediatr . 1970 Jul. 77 (1):1-10. . Hittner HM, Hirsch NJ, Rudolph AJ. Assessment of gestational age by examination of the anterior vascular capsule of the lens. J Pediatr . 1977 Sep. 91 (3):455-8. . Conde-Agudelo A, Romero R. Cervical phosphorylated insulin-like growth factor binding protein-1 test for the prediction of preterm (...) , for the Canadian Preterm Labour Nitroglycerin Trial Group. Randomized double-blind placebo-controlled trial of transdermal nitroglycerin for preterm labor. Am J Obstet Gynecol . 2007 Jan. 196 (1):37.e1-8. . Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev . 2004. 3:CD001069. . Stupin JH, David M, Siedentopf JP, Dudenhausen JW. Emergency cerclage versus bed rest for amniotic sac prolapse before 27 gestational weeks

2014 eMedicine Pediatrics

1070. Preeclampsia (Follow-up)

are suffering a recurrence of preeclampsia, findings on physical examination may include the following (see Prognosis): Altered mental status Decreased vision or scotomas Papilledema Epigastric or right upper quadrant abdominal tenderness Peripheral edema Hyperreflexia or clonus: Although deep tendon reflexes are more useful in assessing magnesium toxicity, the presence of clonus may indicate an increased risk of convulsions. Seizures Focal neurologic deficit Previous Next: Measurement of Hypertension (...) . The Korotkoff V sound should be used for the diastolic pressure. In cases in which the Korotkoff V sound is not present, the Korotkoff IV sound may be used, but it should be noted as such. The difference between the Korotkoff IV and V sounds may be as much as 10 mm Hg. When an automated cuff is used, it must be able to record the Korotkoff V sound. When serial readings are obtained during an observational period, the higher values should be used to make the diagnosis. Lack of hypertension on examination

2014 eMedicine Pediatrics

1071. Polyhydramnios and Oligohydramnios (Follow-up)

to enhance fetal lung maturity if preterm delivery is anticipated. Polyhydramnios Patients with polyhydramnios tend to have a higher incidence of preterm labor secondary to overdistention of the uterus. Schedule weekly or twice weekly perinatal visits and cervical examinations. Place patients on bed rest to decrease the likelihood of preterm labor. Perform serial ultrasonography to determine the amniotic fluid index (AFI) and document fetal growth. In cases of polyhydramnios associated with fetal hydrops (...) or cesarean delivery. If meconium is present during labor, administer amnioinfusion therapy to reduce the potential for fetal distress and prenatal aspiration. Transfer these pregnant women to a tertiary center when they have a high likelihood of maternal illness, preterm delivery, or infant problems that may require the resources of a tertiary care facility. Next: Medical Care The first step is identifying the etiology of the abnormal volume of amniotic fluid. Medical care includes the use of steroids

2014 eMedicine Pediatrics

1072. Maternal Chorioamnionitis (Diagnosis)

of the presence of amniotic fluid 'sludge' in asymptomatic patients at high risk for spontaneous preterm delivery. Ultrasound Obstet Gynecol . 2007 Oct. 30(5):706-14. . Rizzo G, Capponi A, Vlachopoulou A, Angelini E, Grassi C, Romanini C. Ultrasonographic assessment of the uterine cervix and interleukin-8 concentrations in cervical secretions predict intrauterine infection in patients with preterm labor and intact membranes. Ultrasound Obstet Gynecol . 1998 Aug. 12(2):86-92. . Reilly SD, Faye-Petersen OM (...) . Laboratory studies for asymptomatic pregnant mothers who present with premature labor or PROM include the following: Examination of amniotic fluid Maternal blood studies Maternal urine studies Maternal group B streptococcal (GBS) screening test Testing in febrile pregnant women with suspected chorioamnionitis may include the following: White blood cell (WBC) counts C-reactive protein (CRP) levels Alpha1-proteinase inhibitor (A1PI) complex measurement Serum interleukin-6 (IL-6) or ferritin levels Studies

2014 eMedicine Pediatrics

1073. Late Effects of Childhood Cancer and Treatment (Diagnosis)

-induced cardiomyopathy usually present with symptoms of , which may develop spontaneously or may be initiated by stressors such as extreme exertion, as in weight lifting or difficult labor. Pericarditis may also be present, further compromising cardiac function. Additionally, ventricular arrhythmias may occur. Subclinical or mild toxic effects can be found in a significant number of treated children, depending on the methods used to assess damage. One study of children who received anthracyclines (...) fibrosis, interstitial pneumonitis, restrictive lung disease and/or obstructive lung disease. Symptoms include a dry hacking cough, dyspnea on exertion, shortness of breath, wheezing and/or exercise intolerance. Physical examination may reveal crackles in the lung bases and, rarely, a pleural friction rub. The chest radiograph may show infiltrates, though the findings are more often normal. Pulmonary function tests (PFTs) usually reveal evidence of restrictive lung disease with a decreased forced vital

2014 eMedicine Pediatrics

1074. Birth Trauma (Diagnosis)

and neurologic evaluation of the infant to establish whether additional injuries are present. Symmetry of structure and function should be assessed, the cranial nerves should be examined, and specifics such as individual joint range of motion and scalp/skull integrity should be evaluated. Next: Etiology The birth process is a blend of compression, contractions, torques, and traction. When fetal size, presentation, or neurologic immaturity complicates this event, such intrapartum forces may lead to tissue (...) damage, edema, hemorrhage, or fracture in the neonate. The use of obstetric instrumentation may further amplify the effects of such forces or may induce injury alone. Under certain conditions, cesarean delivery can be an acceptable alternative but does not guarantee an injury-free birth. Factors predisposing to injury include the following: Prima gravida Cephalopelvic disproportion, small maternal stature, maternal pelvic anomalies Prolonged or rapid labor Deep, transverse arrest of descent

2014 eMedicine Pediatrics

1075. Rehabilitation of Persons With Spinal Cord Injuries (Treatment)

thromboembolism (VTE) is likely due to venous stasis and hypercoagulability. Classic symptoms of DVT, such as calf tenderness, may be lacking, owing to sensory loss. Symptoms of PE, such as shortness of breath, may be wrongly attributed to concurrent problems such as atelectasis. DVT can present as fever of unknown origin, and PE can result in sudden death. The high incidence and unreliable presentation of DVT suggest that screening studies should be considered. For example, daily physical examination (...) complications were more common. Nonpharmacologic treatments were also reviewed, but limited evidence was found to support such treatments. [ ] Previous Next: Autonomic Dysfunction High thoracic and cervical SCI can cause loss of supraspinal control of sympathetic activity with dysregulation of functions normally impacted by sympathetic mechanisms. Baseline sympathetic activity following SCI is low, though there may be hyperresponsiveness of peripheral sympathetic receptors, perhaps as an adaptive response

2014 eMedicine Surgery

1076. Retropharyngeal Abscess (Overview)

, including fever, malaise, decreased appetite, irritability, sore throat, dysphagia, odynophagia, trismus, or torticollis. The overall presentation can be insidious, even stemming from a recent upper respiratory tract infection that has not completely resolved. In view of the clinical ambiguity, especially early in the infectious course, it is important to maintain a high index of suspicion. Physical examination findings that are commonly found in children with RPA include the following: Fever Toxic (...) may result in dysphagia, dysphonia, or respiratory compromise. If labored breathing or posturing is present, it is imperative to rule out airway obstruction and secure the airway if deemed clinically necessary. However, blind endotracheal intubation should be avoided because of the possibility of rupturing the abscess and causing either further airway obstruction or aspiration pneumonia. Diagnosis Upon initial evaluation, patients in whom there is concern about a possible RPA should be evaluated

2014 eMedicine Pediatrics

1077. Prematurity (Diagnosis)

, Goldberg C. Clinical assessment of gestational age in the newborn infant. J Pediatr . 1970 Jul. 77 (1):1-10. . Hittner HM, Hirsch NJ, Rudolph AJ. Assessment of gestational age by examination of the anterior vascular capsule of the lens. J Pediatr . 1977 Sep. 91 (3):455-8. . Conde-Agudelo A, Romero R. Cervical phosphorylated insulin-like growth factor binding protein-1 test for the prediction of preterm birth: a systematic review and metaanalysis. Am J Obstet Gynecol . 2016 Jan. 214 (1):57-73. . Conde (...) , infection, and congenital malformation. Signs and symptoms Confirmation of gestational age is based on physical and neurologic characteristics. The Ballard Scoring System remains the main tool clinicians use after delivery to confirm gestational age by means of physical examination. [ ] The major parts of the anatomy used in determining gestational age include the following: Ear cartilage (eg, a preterm infant at 28 weeks’ gestation has a small amount of ear cartilage and/or a flattened pinna) (See

2014 eMedicine Pediatrics

1078. Preeclampsia (Diagnosis)

are suffering a recurrence of preeclampsia, findings on physical examination may include the following (see Prognosis): Altered mental status Decreased vision or scotomas Papilledema Epigastric or right upper quadrant abdominal tenderness Peripheral edema Hyperreflexia or clonus: Although deep tendon reflexes are more useful in assessing magnesium toxicity, the presence of clonus may indicate an increased risk of convulsions. Seizures Focal neurologic deficit Previous Next: Measurement of Hypertension (...) . The Korotkoff V sound should be used for the diastolic pressure. In cases in which the Korotkoff V sound is not present, the Korotkoff IV sound may be used, but it should be noted as such. The difference between the Korotkoff IV and V sounds may be as much as 10 mm Hg. When an automated cuff is used, it must be able to record the Korotkoff V sound. When serial readings are obtained during an observational period, the higher values should be used to make the diagnosis. Lack of hypertension on examination

2014 eMedicine Pediatrics

1079. Prematurity (Overview)

, Goldberg C. Clinical assessment of gestational age in the newborn infant. J Pediatr . 1970 Jul. 77 (1):1-10. . Hittner HM, Hirsch NJ, Rudolph AJ. Assessment of gestational age by examination of the anterior vascular capsule of the lens. J Pediatr . 1977 Sep. 91 (3):455-8. . Conde-Agudelo A, Romero R. Cervical phosphorylated insulin-like growth factor binding protein-1 test for the prediction of preterm birth: a systematic review and metaanalysis. Am J Obstet Gynecol . 2016 Jan. 214 (1):57-73. . Conde (...) , and congenital malformation. Signs and symptoms Confirmation of gestational age is based on physical and neurologic characteristics. The Ballard Scoring System remains the main tool clinicians use after delivery to confirm gestational age by means of physical examination. [ ] The major parts of the anatomy used in determining gestational age include the following: Ear cartilage (eg, a preterm infant at 28 weeks’ gestation has a small amount of ear cartilage and/or a flattened pinna) (See the following image

2014 eMedicine Pediatrics

1080. Preeclampsia (Overview)

are suffering a recurrence of preeclampsia, findings on physical examination may include the following (see Prognosis): Altered mental status Decreased vision or scotomas Papilledema Epigastric or right upper quadrant abdominal tenderness Peripheral edema Hyperreflexia or clonus: Although deep tendon reflexes are more useful in assessing magnesium toxicity, the presence of clonus may indicate an increased risk of convulsions. Seizures Focal neurologic deficit Previous Next: Measurement of Hypertension (...) . The Korotkoff V sound should be used for the diastolic pressure. In cases in which the Korotkoff V sound is not present, the Korotkoff IV sound may be used, but it should be noted as such. The difference between the Korotkoff IV and V sounds may be as much as 10 mm Hg. When an automated cuff is used, it must be able to record the Korotkoff V sound. When serial readings are obtained during an observational period, the higher values should be used to make the diagnosis. Lack of hypertension on examination

2014 eMedicine Pediatrics

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