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Fetal Abdominal Circumference

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261. Management of Pregnancies Diagnosed with Down Syndrome

is important with ultrasound monitoring of fetal growth every two weeks? If IUGR is: • Mild (AC 5 – 9 th percentile) – weekly NST, AFI and UA Doppler • Moderate (AC 1 – 4 th percentile) – two × week NST, AFI and UA Doppler • Severe (AC less than 1st percentile) – three × week NST, AFI and UA Doppler Definitions: AC – abdominal circumference; NST – non-stress test; AFI – amniotic fluid index; UA – umbilical artery?Perinatal Services BC Management of Pregnancies Diagnosed with Down Syndrome 8 Recommendations (...) ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 5 ASSESSMENT FOR THE PRESENCE OF FETAL STRUCTURAL ABNORMALITIES ? ? ? 6 Recommendations ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 6 ASSESSMENT FOR THE RISK OF PREMATURITY ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 6 Recommendations ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 6 ASSESSMENT FOR THE RISK OF IUGR ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 7 Incidence of SGA and % of SGA babies detected

2016 British Columbia Perinatal Health Program

262. CVD Prevention in Clinical Practice

risk charts CVD = cardiovascular disease; SCORE = Systematic Coronary RiskEstimation. The SCORE system estimates the 10 year risk of a first fatal atherosclerotic event. All International Classification of Diseases (ICD)codes that could reasonably be assumed to be atherosclerotic are included,including CAD, stroke and aneurysm of the abdominal aorta. Traditionallymost systems estimated CAD risk only; however, more recently a number ofrisk estimation systems have changed to estimate the risk

2016 European Society of Cardiology

263. Neofordex - dexamethasone. To treat adults with multiple myeloma

• 71% births were postmature (after Day 167 days) • Fetal death at >0.16 mg/kg/day • Delayed fetal growth and decreased thymus, spleen, and adrenal weights • Decreased brain weight, biparietal and occipitofrontal diameters and head circumference Poulain, 2012 Human 2, 10, or 50 µM 14 days • Decreased germ cell density in ovaries • Reduced expression of the pro-survival gene KIT. Peri and postnatal development (Ferguson, 001) Rats, 14M Subcutaneous ; 1.5 mg/kg BID PND 7 • Decreased body weight (...) ) Negative* * = Positive results observed were considered artefacts. Results were therefore negative. Carcinogenicity No carcinogenicity studies have been reported (see discussion on non-clinical aspects). Reproduction toxicity Reproductive and developmental toxicity studies (fertility and early embryonic development, embryo- fetal development, perinatal and postnatal development and juvenile toxicity studies) have been conducted in mice, rats, rabbits and monkeys. Table 8. Results of reproductive

2016 European Medicines Agency - EPARs

264. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting Full Text available with Trip Pro

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

2016 European Society of Human Reproduction and Embryology

265. The Role of Bariatric Surgery in Improving Reproductive Health

causes of abdominal pain in pregnancy in women who have undergone bariatric surgery need to be wider than usual and include, for example, band slippage or erosion, bowel herniation or intussusception. 91–93 8. Effect on neonates and infants Although there appears to be some clear benefits for women considering bariatric surgery to aid fertility and reproductive health, it remains debatable whether improved maternal and fetal outcomes following bariatric surgery are seen in all domains. Significant (...) influence the receptivity of the uterus. 11,12 Pregnancy in obese women can precipitate metabolic illness and is associated with obstetric risks. In the largest study of its kind of 16 000 women, 13 a maternal BMI of greater than 30 kg/m 2 was associated with an increased risk of gestational diabetes, gestational hypertension, pre-eclampsia and fetal macrosomia compared with women with a BMI of less than 30 kg/m 2 . Induced labour and caesarean delivery , anaesthetic complications, perioperative

2015 Royal College of Obstetricians and Gynaecologists

266. Newborn Nursing Care Pathway

physiologic stability following term vaginal delivery: • Respiratory rate between 40-60/ min • Axillary temperature of 36.5- to 37.4 C 10 and stable heart rate (100-160 bpm) 11 • Suckling/rooting efforts and evidence of readiness to feed • Physical examination reveals no significant congenital anomalies • No evidence of sepsis • No jaundice developing 12 – 24 hours >24 – 72 hours >72 hours – 7 days and beyond HeAd Assess: • Shape • Size • Fontanelles • Circumference prn Assess mother’s/family/ supports (...) Norm and Normal Variations • Refer to POS Parent education/ Anticipatory Guidance • Refer to >12 – 24 hr Norm and Normal Variations • Refer to POS • Moulding resolves ~ 3 days • Average head circumference 33 – 35 cm once moulding disappears (ensure consistent way of measuring) 14 Parent education / Anticipatory Guidance • Refer to >12 – 24 hr • Prevent plagiocephaly (flat spots on head) and strengthen neck muscles by placing baby on abdomen when awake (tummy time) for several short periods each day

2015 British Columbia Perinatal Health Program

267. Mysimba - naltrexone / bupropion

with the highest risk for cardiovascular disease and are also at greater risk of metabolic complications when compared to patients with lower body (gynoid) obesity with increased fat in the lower body segment, particularly the hips and thighs. Recently, waist Mysimba Assessment Report EMA/805547/2015 Page 11/132 circumference alone (measured at mid distance between the bottom of the rib cage and the iliac crest) has been found to be an integrated measure of obesity that is positively correlated with abdominal (...) and abdominal fat. An increase in intra-abdominal fat is associated with greater mortality in both younger and older adults, even when it is independent of overall adiposity. However, the effect of BMI on mortality seems to differ quantitatively between older and younger subjects and obesity may have less of an effect on mortality in older individuals than in younger individuals. In childhood, BMI is age and gender specific. Obesity is recognised as a chronic clinical condition that usually requires long

2015 European Medicines Agency - EPARs

269. Antenatal care - uncomplicated pregnancy

pregnancy is associated with adverse outcomes. To avoid sports that may cause abdominal trauma (for example vigorous racquet sports), falls, or excessive joint stress. Scuba diving should be avoided as it has been associated with an increased risk of birth defects and fetal decompression disease. Medicines and complimentary therapies What advice can I give regarding use of medicines and complementary therapies during pregnancy? Advise the woman to check with her GP or pharmacist before taking any: Over (...) are sufficient for a parous woman (having borne at least one viable offspring — usually after 24 weeks). Two ultrasound scans are usually offered during the course of an uncomplicated pregnancy: A dating scan (10–13 weeks). A fetal anomaly scan (18–20 weeks). Women with an uncomplicated pregnancy are usually offered screening for: Gestational diabetes. Hypertension in pregnancy and pre-eclampsia. Anaemia. Down's syndrome. Haemoglobinopathies (sickle cell disease and thalassaemia). Infections (asymptomatic

2019 NICE Clinical Knowledge Summaries

270. Bariatric Surgery in Improving Reproductive Health, The Role of

causes of abdominal pain in pregnancy in women who have undergone bariatric surgery need to be wider than usual and include, for example, band slippage or erosion, bowel herniation or intussusception. 91–93 8. Effect on neonates and infants Although there appears to be some clear benefits for women considering bariatric surgery to aid fertility and reproductive health, it remains debatable whether improved maternal and fetal outcomes following bariatric surgery are seen in all domains. Significant (...) influence the receptivity of the uterus. 11,12 Pregnancy in obese women can precipitate metabolic illness and is associated with obstetric risks. In the largest study of its kind of 16 000 women, 13 a maternal BMI of greater than 30 kg/m 2 was associated with an increased risk of gestational diabetes, gestational hypertension, pre-eclampsia and fetal macrosomia compared with women with a BMI of less than 30 kg/m 2 . Induced labour and caesarean delivery , anaesthetic complications, perioperative

2015 Royal College of Obstetricians and Gynaecologists

272. Genetics of Skin Cancer (PDQ®): Health Professional Version

and is occasionally associated with mast cell leukemia; cutaneous T-cell lymphoma is often confined to the skin throughout its course. Overall, 10% of leukemias and lymphomas have prominent expression in the skin.[ ] Epidermal appendages are also found in the dermal compartment. These are derivatives of the epidermal keratinocytes, such as hair follicles, sweat glands, and the sebaceous glands associated with the hair follicles. These structures are generally formed in the first and second trimesters of fetal (...) ,[ - ] craniopharyngiomas,[ ] fetal rhabdomyomas,[ ] leiomyomas,[ ] mesenchymomas,[ ] basaloid follicular hamartomas,[ ] and nasal dermoid tumors. Development of meningiomas and ependymomas occurring postradiation therapy has been documented in the general pediatric population; radiation therapy for syndrome-associated intracranial processes may be partially responsible for a subset of these benign tumors in individuals with BCNS.[ - ] In addition, radiation therapy of malignant medulloblastomas in the BCNS population

2018 PDQ - NCI's Comprehensive Cancer Database

273. Hypertensive disorders of pregnancy

stable then every 30 minutes • Respiratory rate and patellar reflexes hourly • Temperature 2nd hourly • Continuous CTG monitoring if > 24 weeks (interpret with caution if : greater than, 10 years • Nulliparity • Pre-existing medical conditions o APLS o Pre-existing diabetes o Renal disease o Chronic hypertension o Chronic autoimmune disease • Age > 40 years • BMI > 35 kg/m 2 • Multiple pregnancy • Elevated BP at booking • Gestational trophoblastic disease • Fetal triploidy Maternal investigations (...) • Urine dipstick for proteinuria • Spot urine protein to creatinine ratio if: o = 2+ or recurrent 1+ on dipstick • Full blood count • Urea, creatinine electrolytes and urate • LFT including LDH Fetal assessment • CTG • USS for fetal growth & wellbeing Initiate antihypertensives Commence if: • sBP = 160 or dBP = 100 mmHg Consider if: • sBP = 140 or dBP = 90 mmHg • Choice of antihypertensive drug as per local preferences/protocols Oral antihypertensive (initial dose – adjust as clinically indicated

2016 Queensland Health

274. Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

preferences Caregivers may report concern regarding some aspects of their infant’s sleep pattern that may influence the decision to perform polysomnography Exclusions None Strength Moderate recommendation Key reference Polysomnography consists of 8 to 12 hours of documented monitoring, including EEG, electro-oculography, electromyography, nasal/oral airflow, electrocardiography, end-tidal carbon dioxide, chest/abdominal excursion, and oximetry. Polysomnography is considered by many to be the gold standard

2016 American Academy of Pediatrics

275. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

and obesity? Q2.2. What are the best anthropomorphic criteria for defining excess adiposity in the diagnosis of overweight and obesity in the clinical setting? 34 Q2.3. Does waist circumference provide information in addition to body mass index (BMI) to indicate adiposity risk? 34 Q2.4. Do BMI and waist circumference accurately capture adiposity risk at all levels of BMI, ethnicity, gender, and age? 34 Q3. What are the weight-related complications that are either caused or exacerbated by excess adiposity (...) ; RR = rel- ative risk; RYGB = Roux-en-Y gastric bypass; SAD = sagittal abdominal diameter; SBP = systolic blood pres- sure; SCOUT = Sibutramine Cardiovascular Outcome Trial; SG = sleeve gastrectomy; SHBG = sex hormone- binding globulin; SIEDY = Structured Interview on Erectile Dysfunction; SNRI = serotonin-norepinephrine reuptake inhibitors; SOS = Swedish Obese Subjects; SS = surveillance study; SSRI = selective serotonin reuptake inhibitors; STORM = Sibutramine Trial on Obesity Reduction

2016 American Association of Clinical Endocrinologists

276. Optimizing natural fertility: a committee opinion

pregnancy, there were no observed differences between the two groups in gestational age at delivery or in infant weight, length, head circumference, or abdominal circumference (65). Overall, moderate caffeine consumption (1 to 2 cups of coffee per day or its equivalent) before or during pregnancy has no apparent adverse effects on fertility or pregnancy outcomes. In men caffeine consumption has no effect on semen parameters (55). OTHERCONSIDERATIONS The effects of marijuana and other recreational drugs (...) (59). Higher levels of alcohol consumption (>2 drinks/day, with 1drink>10 g of ethanol) probably are best avoided when at- tempting pregnancy, but there is limited evidence to indicate that more moderate alcohol consumption adversely affects fertility.Ofcourse,alcoholconsumptionshouldceasealtogether during pregnancy because alcohol has well-documented detri- mental effects on fetal development, and no ‘‘safe’’ level of alcoholconsumptionhasbeenestablished(60).Inmen, alcohol consumption has

2016 Society for Assisted Reproductive Technology

278. Gestational diabetes mellitus

• 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 (...) • Recommend lifelong screening for diabetes at least every 3 years • Early glucose testing in future pregnancy Postpartum care Queensland Clinical Guideline: Gestational diabetes mellitus Refer to online version, destroy printed copies after use Page 6 of 38 Abbreviations AC Abdominal circumference ADIPS Australasian Diabetes in Pregnancy Society BGL Blood glucose level BMI Body mass index CI Confidence interval CS Caesarean section GDM Gestational diabetes mellitus GI Glycaemic Index GWG Gestational

2015 Queensland Health

279. Cervical dilation before first-trimester surgical abortion (<14 weeks' gestation)

. The primary outcome was the ease of the procedure as reported by the provider. The 600-mcg dose of misoprostol was the most effective, with 23.3% of the cases rated as extremelyeasy,comparedwith10%inthe400-mcgarmand 0% in the 200-mcg arm. However, among the 27 women with an embryonic or fetal demise, 33.3% in the 400-mcg group and 77.7% in the 600-mcg group delivered prior to surgery. In addition, the incidence of each side effect examined — abdominal pain, vaginal bleeding, nausea, vomiting, chills (...) oftheinstrumentandcomesinsizesrangingfrom9to79F. For most pregnant women, dilation can be initiated easily with a 17-F dilator. Each French unit refers to the circumference of the dilator in millimeters. To obtain the diameter of the dilator in millimeters, the French unit is divided by Pi (approximately 3). By comparison, Hegar dilators(Fig.1b)haveabluntendandcomeinsizesranging from 1to 26mm in diameter.Hegardilators increaseinsize more rapidly than tapered dilators, potentially reducing the time necessary for dilation but also requiring

2015 Society of Family Planning

280. ASNC-SCCT-SNMMI Guideline for Cardiac SPECT/CT and PET/CT 1.0

on the interruption of breast feeding for various radio- pharmaceutical agents. C. Information pertinent to the procedure Detailed information pertinent to the procedures has been previously described (2,3,5,6,13,28,29). 1. History: A focused history should be obtained about po- tential contraindications (Table 2), including the presence of any metallic implants or devices, claustrophobia, body mass index, chest circumference, bra cup size, ability to lie still for the duration of the scan, and ability to raise (...) in Table 7. Whole-body 18 F-FDG imaging is performed from the cerebellum to the upper thigh to be able to assess 18 F- FDG uptake in extracardiac regions (neck, mediastinum, lungs, and abdominal lymph nodes). The rest myocardial perfusion and cardiac 18 F-FDG images are reconstructed and reoriented into standard cardiac planes (short axis, TABLE 4 Imaging Protocol for 82 Rb PET MPI Feature Technique Stress testing Pharmacologic agents Standard Tracer dose Standard 2-dimensional scanner 1,480–2,220 MBq

2015 Society of Nuclear Medicine and Molecular Imaging

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