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Fetal Abdominal Circumference

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241. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutritio

of regurgitation/vomiting>6 months or increasing/persisting>12–18 months of age Late onset as well as symptoms increasing or persisting after infancy, based on natural course of the disease, may indicate a diagnosis other than GERD Neurological Bulging fontanel/rapidly increasing head circumference May suggest raised intracranial pressure for example due to meningitis, brain tumor or hydrocephalus Seizures Macro/microcephaly Gastrointestinal Persistent forceful vomiting Indicative of hypertrophic pyloric (...) protein-induced gastroenteropathy z Rectal bleeding Indicative of multiple conditions, including bacterial gastroenteritis, in?ammatory bowel disease, as well as acute surgical conditions and food protein-induced gastroenteropathy rectal bleeding z (bleeding caused by proctocolitis) Abdominal distension Indicative of obstruction, dysmotility, or anatomic abnormalities GERD ¼ gastroesophageal re?ux disease; NSAID ¼ non-steroidal antiin?ammatory drugs. Especially with NSAID use. y Associated

2018 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

242. Guidelines on autopsy practice: Third trimester antepartum and intrapartum stillbirth

of guidelines to provide a list of potential conflicts of interest; these are monitored by the Clinical Effectiveness Department and are available on request. The authors have declared no conflicts of interest. 1 Introduction Post-mortem examination of a baby following an antepartum or intrapartum fetal death may provide a cause of death or at the least provide a partial explanation of the loss and information relevant to the management of subsequent pregnancies. 1-4 Autopsy is the single most useful (...) · provide information for audit purposes (e.g. antenatal diagnosis, pregnancy and intrapartum care) · provide information for national clinical outcome review programmes. 3 Pathology commonly encountered at autopsy · Hypoxia · Growth restriction: symmetric, asymmetric (nutritional) · Infection · Congenital malformation · Trauma: cranial, extracranial · Blood loss · Hydrops fetalis · Fetal conditions secondary to maternal disease e.g. diabetes, hypertension and pre-eclampsia · Placental and umbilical

2017 Royal College of Pathologists

243. AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol

). The diagnosis is made by the presence of any 3 of the following 5 risk factors: elevated waist circumference, elevated serum triglycerides, reduced HDL-C, elevated blood pressure, and elevated fasting glucose (Table S2 in the Web Supplement). Metabolic syndrome is closely linked to excess weight and particularly to abdominal obesity (S3.1.2-4). Therefore, the prevalence of metabolic syndrome has risen sharply among both adults and children as levels of overweight and obesity have risen. Metabolic syndrome (...) listed above) History of ischemic stroke Symptomatic peripheral arterial disease (history of claudication with ABI 30 years, MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT Grundy SM, et al. 2018 Cholesterol Clinical Practice Guidelines Page 27 male sex, history of ASCVD, high blood pressure, increased waist circumference, active smoking, Lp(a) =50 mg/dL, and LDL-C levels =100 mg/dL (=2.6 mmol/L) as independent predictors of incident ASCVD over a 5.5-year follow-up period (S4.2-14). Because other medical

2018 American College of Cardiology

244. Perinatal Mortality Guideline

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 APPENDIX A: PERINATAL MORTALITY FORM . . . . . . . . . . . . . . . 26 APPENDIX B: DIAGNOSIS OF FETAL ASPHYXIA (HYPOXIC ACIDAEMIA) . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 While every attempt has been made to ensure that the information contained herein is clinically accurate and current, Perinatal Services BC acknowledges that many issues remain controversial, and therefore may be subject to practice interpretation. © Perinatal Services BC, 2017 Perinatal Services BC West Tower (...) before, during or after birth, starting at greater than or equal to 20 weeks of gestation and ending 7 completed days after birth. Gestational Age – Fetal age or duration of pregnancy measured from the first day of the last normal menstrual period, and expressed in completed days or weeks. Gestation may be determined from LMP , data from early ultrasound, or from combining the two. The current BC recommendation is to use the first ultrasound after 7 weeks gestation to date the pregnancy unless timed

2017 British Columbia Perinatal Health Program

245. Ultrasound in Twin Pregnancies

) in absolute measurement in abdominal circumference or a difference of 20% in ultrasound-derived estimated fetal weight (II-2). 5. Although there is insufficient evidence to recommend a specific schedule for ultrasound assessment of twin gestation, most experts recommend serial ultrasound assessment every 2 to 3 weeks, starting at 16 weeks of gestation for monochorionic pregnancies and every 3 to 4 weeks, starting from the anatomy scan (18 to 22 weeks) for dichorionic pregnancies (II-1). 6. Umbilical (...) of the Maternal Fetal Medicine Committee and the Genetics Committee of the SOGC. The recommendations were made according to the guidelines developed by The Canadian Task Force on Preventive Health Care ( Table 1 ). Benefits, harms, and costs The benefit expected from this guideline is facilitation and optimization of the use of ultrasound in twin pregnancy. Summary Statements 1. There are insufficient data to make recommendations on repeat anatomical assessments in twin pregnancies. Therefore, a complete

2017 Society of Obstetricians and Gynaecologists of Canada

246. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

With Obesity HTN prevalence ranges from 3.8% to 24.8% in youth with overweight and obesity. Rates of HTN increase in a graded fashion with increasing adiposity. – Similar relationships are seen between HTN and increasing waist circumference. , , Systematic reviews of 63 studies on BMI and 61 studies on various measures of abdominal adiposity have shown associations between these conditions and HTN. Obesity is also associated with a lack of circadian variability of BP, , with up to 50% of children who have (...) and outpatient settings. – Pediatric offices should have access to a wide range of cuff sizes, including a thigh cuff for use in children and adolescents with severe obesity. For children in whom the appropriate cuff size is difficult to determine, the midarm circumference (measured as the midpoint between the acromion of the scapula and olecranon of the elbow, with the shoulder in a neutral position and the elbow flexed to 90° , , ) should be obtained for an accurate determination of the correct cuff size

2017 American Academy of Pediatrics

247. High Blood Pressure in Adults: Guideline For the Prevention, Detection, Evaluation and Management

analysis,20mmHghigherSBPand10mmHghigher DBP were each associated with a doubling in the risk of death from stroke, heart disease, or other vascular dis- ease. In a separate observational study including >1 million adult patients $30 years of age, higher SBP and DBPwereassociatedwithincreased risk of CVDinci- dence and angina, myocardial infarction (MI), HF, stroke, peripheral artery disease (PAD), and abdominal aortic aneurysm, each evaluated separately (S2.1-2).An increased risk of CVD associated (...) asingleoccasion. 4.2. Out-of-Of?ce and Self-Monitoring of BP TABLE 9 Selection Criteria for BP Cuff Size for Measurement of BP in Adults Arm Circumference Usual Cuff Size 22–26 cm Small adult 27–34 cm Adult 35–44 cm Large adult 45–52 cm Adult thigh Adapted with permission from Pickering et al. (S4.1-2) (American Heart Association, Inc.). BP indicates blood pressure. Recommendation for Out-of-Of?ce and Self-Monitoring of BP References that support the recommendation are summarized in Online Data Supplement 3

2017 American College of Cardiology

248. Heart Disease and Stroke Statistics 2017 Update: A Report From the American Heart Association Full Text available with Trip Pro

circumference cut points in US guidelines underestimate obesity and CVD risk in Asian and South Asian populations. • Definitions of “metabolically healthy obesity” vary, and over time, a substantial proportion of those with metabolically healthy obesity transition to metabolically unhealthy. The risk of CVD events, particularly HF, may be increased with obesity even in the absence of metabolic risk factors. Family History and Genetics (Chapter 7) • Among adults =20 years of age, 12.2% reported having

2017 American Heart Association

249. Normal birth

, medical, surgical, social · Investigations and results · Medications and allergies · Pregnancy complications · Psychosocial, cultural and spiritual Contractions · Time commenced · Duration, strength, frequency and resting tone Maternal observations · Temperature, pulse, respiratory rate, BP · Urinalysis · Nutritional and hydration status · General appearance Abdominal assessment · Observation and palpation · Fundal height, lie, presentation, attitude, position, engagement/descent, liquor volume Fetal (...) ) assessment · Maternal and fetal condition · Progress and descent of the fetal head · FHR: every 15–30 minutes intermittent auscultation o Differentiate from maternal pulse · Temperature and BP: 4 hourly · Maternal pulse: every 30 minutes · Abdominal palpation: 4 hourly, prior to VE and as required to monitor progress · Contractions: every 30 minutes for 10 minutes · Vaginal loss: hourly · Offer VE: 4 hourly and if indicated · Nutrition as desired and encourage hydration · Bladder: monitor/encourage 2

2017 Queensland Health

250. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association Full Text available with Trip Pro

that is protective against future encounters with the KD agent. Pathology Although inflammation of the coronary arteries results in the most important clinical outcomes, KD is characterized by systemic inflammation in all the medium-sized arteries and in multiple organs and tissues during the acute febrile phase, leading to associated clinical findings: liver (hepatitis), lung (interstitial pneumonitis), gastrointestinal tract (abdominal pain, vomiting, diarrhea, gallbladder hydrops), meninges (aseptic (...) after fever onset, thrombocytosis is common. Other clinical findings may include the following: Cardiovascular Myocarditis, pericarditis, valvular regurgitation, shock Coronary artery abnormalities Aneurysms of medium-sized noncoronary arteries Peripheral gangrene Aortic root enlargement Respiratory Peribronchial and interstitial infiltrates on CXR Pulmonary nodules Musculoskeletal Arthritis, arthralgia (pleocytosis of synovial fluid) Gastrointestinal Diarrhea, vomiting, abdominal pain Hepatitis

2017 American Heart Association

251. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

associated with increased risk of CVD incidence and angina, myocardial infarction (MI), HF, stroke, peripheral artery disease (PAD), and abdominal aortic aneurysm, each evaluated separately. An increased risk of CVD associated with higher SBP and DBP has been reported across a broad age spectrum, from 30 years to >80 years of age. Although the relative risk of incident CVD associated with higher SBP and DBP is smaller at older ages, the corresponding high BP–related increase in absolute risk is larger

2017 American Heart Association

252. Methods for Estimating the Due Date

and cavum septi pellucidi; the cerebellar hemispheres should not be visible in this scanning plane) the femur length (measured with full length of the bone perpendicular to the ultrasound beam, excluding the distal femoral epiphysis) the abdominal circumference (measured in symmetrical, transverse round section at the skin line, with visualization of the vertebrae and in a plane with visualization of the stomach, umbilical vein, and portal sinus) (8) Other biometric variables, such as additional long (...) Methods for Estimating the Due Date Methods for Estimating the Due Date - ACOG Menu ▼ Methods for Estimating the Due Date Page Navigation ▼ Number 700, May 2017 (Replaces Committee Opinion Number 611, October 2014) Committee on Obstetric Practice American Institute of Ultrasound in Medicine Society for Maternal-Fetal Medicine This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice, in collaboration with members Christian M

2017 American College of Obstetricians and Gynecologists

253. Management of Diabetes Mellitus in Primary Care

/m 2 in Asian Americans) 1 • Abdominal obesity 1 • Women with polycystic ovary syndrome (PCOS) 1 • History of GDM or history of delivering babies weighing > 9 lbs (about 4 kg) • Other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans) • Physical inactivity/sedentary lifestyle • Patients using antipsychotics or statins B. Epidemiology and Impact The prevalence of diabetes is increasing around the world, mostly due to the increase in obesity

2017 VA/DoD Clinical Practice Guidelines

254. First Trimester Vaginal Bleeding

for a nonviable IUP, and in these situations, follow-up US in correlation with serial quantitative serum beta hCG measurements is often useful. Subchorionic hematomas are not an infrequent finding during the first trimester. They are usually small and not thought to substantially increase the risk of a nonviable pregnancy. Large (two-thirds or more of the gestational sac circumference) subchorionic hematomas may be associated with an increased risk of nonviable pregnancy [30]. Ectopic pregnancy Whenever (...) mass is inside the ovary or outside the ovary. Gentle pressure with the transvaginal transducer, and sometimes also with the examiner’s hand on the lower anterior abdominal wall, may help demonstrate whether the mass and the ovary move together or separately, potentially distinguishing the intraovarian location of a corpus luteum from the extraovarian location of a tubal pregnancy. Although visualization of an extrauterine gestational sac with a live embryo is 100% specific for an ectopic pregnancy

2017 American College of Radiology

255. Multiple Gestations

the twins, or a discordant fetal abdominal circumference of >10% would be acceptable to make the diagnosis [75]. The growth restriction can occur at any time during the pregnancy, and correlation with Doppler studies of the umbilical cord artery can help predict the outcome. Selective IUGR has been classified into three types based on Doppler findings in the growth restricted twin: type 1 shows constant EDF in the umbilical artery, type 2 shows constant absent or reversed EDF, and type 3 shows (...) [89,90]. Detection of growth restriction is important and relies on EFW percentile or measurement of the abdominal circumference and comparison to the expected for gestational age [91-98]. Significant discordancy in EFW is the most widely accepted method to determine differences in twin size, and the most commonly used threshold when estimated weights are discordant by 20% or more [5]. Some authors suggest that discordance should be defined as mild if weight estimates for the twins are 15% different

2017 American College of Radiology

256. Obesity in pregnancy

Women with BMI = 30 kg/m 2 , are advised to take the same vitamin supplementation as recommended for all pregnant women, before and during pregnancy. Due to an increased risk of fetal congenital malformations, consumption of 400 micrograms folic acid, one month before planned pregnancy and continuing during first trimester is particularly important. A Vitamin pills recommended for daily ingestion during pregnancy (Gravitamin®) contains 10 micrograms vitamin D, and there is no evidence for advising (...) 30-60 minutes of daily moderate physical activity. B/C It is recommended that women with BMI = 35 kg/m 2 have at least one consultation with an obstetrician during pregnancy. Risk for complications should be assessed, and pregnant women with BMI = 40 kg/m 2 should be referred to an antenatal consultation with an anesthetist. D Pregnant women with BMI = 35 kg/m 2 can be referred to ultrasound examination in GA 35-38 for assessment of fetal weight and position. D Pregnant women with BMI = 27 kg/ m

2017 Nordic Federation of Societies of Obstetrics and Gynecology

257. European Society of Endocrinology Clinical practice guidelines for the care of girls and women with Turner syndrome

against routine oocyte retrieval for fertility preservation of young TS girls before the age of 12 years (⨁◯◯◯). R 3.4. We recommend considering oocyte donation for fertility, only after thorough screening and appropriate counseling (⨁⨁⨁⨁). R 3.5. We recommend that management of pregnant women with TS should be undertaken by a multidisciplinary team including maternal–fetal medicine specialists and cardiologists with expertise in managing women with TS (⨁⨁⨁◯). R 3.6. We suggest that other options (...) of a dilated aorta with rapid increase in diameter (⨁◯◯◯). R 3.16. We suggest that in case of an acute ascending AoD before the fetus is viable, to perform emergency aortic surgery understanding that fetal viability may be at risk. If the fetus is viable, it is reasonable to perform cesarean section first, followed by aortic surgery, which should be performed under near-normothermia, pulsatile perfusion, high pump flow and avoidance of vasoconstrictors (⨁◯◯◯). R 3.17. We suggest that exercise testing

2017 European Society of Endocrinology

258. The Association of Coloproctology of Great Britain and Ireland Consensus Guidelines in Surgery for Inflammatory Bowel Disease Full Text available with Trip Pro

around a 2.85 times excess risk of thromboembolic events . Venous thromboembolism remains a significant cause of excess mortality in patients with IBD ; this is of particular importance when coupled with the additional excess risk associated with surgical intervention. In a retrospective study of just under 9000 patients who had undergone abdominal and pelvic surgery for IBD, the 30‐day postoperative venous thromboembolic rate was 2.7%, giving an odds ratio (OR) of 1.26 (95% CI: 1.021–1.56) compared (...) thromboembolism prophylaxis - , along the same lines as in current standard practice for patients undergoing colorectal cancer resection. Statement 1.10 Venous thromboembolic prophylaxis should be optimized in all patients requiring abdominal surgery for IBD. Extended prophylaxis with 28 days of low‐molecular‐weight heparin may be advisable. Level of evidence: II Grade of recommendation: B Consensus: 93.9% (SA 60.6%, A 33.3%) Audit of surgical outcomes and key performance indicators The auditing of outcomes

2018 Association of Coloproctology of Great Britain and Ireland

259. Intrapartum care for healthy women and babies

tr ansferred (% of total transferred from each ansferred from each setting) setting) F From home rom home (n=3,529) (n=3,529) F From a freestanding rom a freestanding midwifery unit (n=2,457) midwifery unit (n=2,457) F From an alongside rom an alongside midwifery unit midwifery unit (n=4,401) (n=4,401) Delay during first or second stage of labour 1,144 (32.4%) 912 (37.1%) 1,548 (35.2%) Abnormal fetal heart rate 246 (7.0%) 259 (10.5%) 477 (10.8%) Request for regional analgesia 180 (5.1%) 163 (6.6 (...) on ultrasound) Abnormal fetal heart rate/doppler studies Ultrasound diagnosis of oligo-/polyhydramnios Intrapartum care for healthy women and babies (CG190) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 13 of 89Previous gynaecological history Myomectomy Hysterotomy T T able able 8 Medical conditions indicating individual assessment when planning place of 8 Medical conditions indicating individual assessment when planning

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

260. Standards for obstetrical ultrasound assessments

)? Appendix 6 www.perinatalservicesbc.ca/NR/rdonlyres/1AF7DA89-95D7-4195-9284- 46B6CBADE3A4/0/CRLChart.pdf FETAL ANATOMIC MEASUREMENTS* The recommended reference charts for measurement of head circumference (HC), femur length (FL), biparietal diameter (BPD), abdominal circumference (AC) and thorax circumference (TC) are: ? ? Lessoway V, Schulzer M, Wittmann B, et al? Ultrasound fetal biometry charts for a North American Caucasian population? J Clin Ultrasound 1998 Nov-Dec;26(9):433–53 (...) / absence of yolk sac or embryo ? ? Fetal number: ? ? if multiple – chorionicity and amnionicity ? ? Location of gestational sac ? ? Cardiac activity: ? ? Presence / absence ? ? Fetal Heart Rate (FHR) ? ? Crown rump length (CRL) ? ? Maternal pelvic anatomy (adnexa, ovaries, cervix) ? ? Head circumference (HC) ? ? Biparietal diameter (BPD) ? ? Choroid plexus filled ventricles ? ? Stomach ? ? Symmetrical lung fields ? ? Presence of 4 limbs, each with 3 segments ? ? Abdominal wall cord insertion ? ? NT

2016 CPG Infobase

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