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Fetal Abdominal Circumference

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281. Male Hypogonadism

., et al. The androgen receptor of the urogenital tract of the fetal rat is regulated by androgen. Mol Cell Endocrinol, 1994. 105: 21. 17. Singh, J., et al. Induction of spermatogenesis by androgens in gonadotropin-deficient (hpg) mice. Endocrinology, 1995. 136: 5311. 18. Sun, Y.T., et al. The effects of exogenously administered testosterone on spermatogenesis in intact and hypophysectomized rats. Endocrinology, 1989. 125: 1000. 19. McLachlan, R.I., et al. Hormonal regulation of spermatogenesis (...) . 182. Gagnon, D.R., et al. Hematocrit and the risk of cardiovascular disease--the Framingham study: a 34-year follow-up. Am Heart J, 1994. 127: 674. 183. Boffetta, P., et al. A U-shaped relationship between haematocrit and mortality in a large prospective cohort study. Int J Epidemiol, 2013. 42: 601. 184. McMullin, M.F., et al. Guidelines for the diagnosis, investigation and management of polycythaemia/erythrocytosis. Br J Haematol, 2005. 130: 174. 185. Budoff, M.J., et al. Testosterone treatment

2018 European Association of Urology

282. Management of Pregnancy

complications and morbidity • Emphasize the use of patient-centered care (PCC) II. Background A. Description of Pregnancy Pregnancy is the reproductive time during which a developing fetus grows inside of the uterus. It is a time of dramatic change for a developing fetus and a woman’s body. Most pregnancies are uncomplicated and labor results in a normal vaginal birth with a healthy mother and baby. Rarely, complications arise, which have the potential to lead to lifelong implications. As the fetus (...) may be planned for breech presentation, prior uterine surgery, or as a response to unexpected maternal or fetal complications such as abnormal labor or a concerning fetal heart rate.[ ] Cesarean delivery is a major surgery with associated risks (e.g., risk of infection, hemorrhage). Cesarean delivery requires a longer period for maternal recovery than vaginal birth and has also been associated with neonatal complications, primarily respiratory.[ ] There has been a downward trend in cesarean births

2018 VA/DoD Clinical Practice Guidelines

283. Nusinersen sodium (Spinraza) - Spinal Muscular Atrophy

in the presence of drug, thereby allowing these to be called fixation-induced vacuoles. Vacuolation in the inferior hippocampus was absent in tissues immersion-fixed in Carnoy’s or perfusion-fixed with Karnovsky’s fixative. Results of the two developmental and reproductive toxicity studies were negative for drug- related effects on fertility and embryo-fetal development. Biodistribution results indicated that nusinersen did not cross the placenta and, therefore, maternal exposure does not lead to any (...) toxicologically relevant exposure in the developing fetus. Nusinersen was non-genotoxic when tested in the bacterial reverse mutagenesis assay, in vitro chromosomal aberration assay in CHO cells and the in vivo mouse micronucleus assay. Therefore, nusinersen was interpreted to be neither mutagenic nor clastogenic. Carcinogenicity studies have not been conducted with nusinersen. Nusinersen is not genotoxic and does not have a direct mechanism for tumor induction. There is no reason to believe

2017 European Medicines Agency - EPARs

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

at full autopsy: 8 CEff 150617 9 V1 Draft · thymus · heart (septum and free walls) · lungs (right and left each lobe) · liver (both major lobes) · pancreas · spleen · adrenal glands · kidneys · muscle and diaphragm · stomach, small and large bowels · larynx/trachea and thyroid · bone: rib including growth plate in stillbirth; long bone (including growth plate), vertebral body and skull mandatory for suspected skeletal dysplasia · brain: if preservation allows include cerebral cortex (...) . The perinatal necropsy. In: Khong TY, Malcomson RDG (eds). Keeling s Fetal and Neonatal Pathology (5 th edition). London: Springer, 2015. 3. Bove KE. Practice guidelines for autopsy pathology the perinatal and pediatric autopsy. Arch Pathol Lab Med 1997;121:368 376. 4. Gilbert-Barness E, Kapur RP, Oligny LL, Siebert JR (eds). Potter s Pathology of the Fetus, Infant and Child (2 nd edition). Philadelphia: Mosby, 2007. CEff 150617 13 V1 Draft 5. Baergen RN. Manual of Pathology of the Human Placenta (2 nd

2017 Royal College of Pathologists

285. 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 the symptoms and the lack of a clear way to prove that symptoms are actually related to movement of gastric contents from the stomach into the esophagus. However, because these symptoms are a frequent cause for referral and parental concern, the literature is reviewed and presented narratively, whenever possible. Full-text articles assessed for eligibility (n = 22) Full-text articles excluded, with reasons (n = 18) Conference abstract n=1 Not in children n=3 No GERD n=7 No prospective study n=5 Studies (...) 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

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

286. 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 (...) . population. These so-called population cohort equations have been validated in a large community- based U.S. population (S2.1.3-3). Initially, data from the Women’s Health Initiative, a contemporary multiethnic cohort of postmenopausal women, appeared to indicate that these pooled cohort equations overestimated ASCVD risk. However, when event surveillance was improved by data from Centers for Medicare & Medicaid Services, the authors found that the equations discriminated risk well (S2.1.3-4). Several

2018 American College of Cardiology

287. Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease Full Text available with Trip Pro

acidosis, renal insufficiency, gut ischemia and feeding intolerance, or ECG changes consistent with coronary ischemia. 23,24 The risk of high Qp:Qs is increased in patients with a large shunt size relative to body weight. In the vulnerable patient, any increase in SVR can cause rapid deterioration from a state of ade- quate circulatory balance to one of extreme pulmonary overcirculation and shock. In these patients, high SVR will in turn cause increased Qp:Qs, and the resulting fall in SBF causes (...) , there appears to be no benefit from routine use of the angiotensin-converting enzyme inhibitor enalapril. 64 The risk of high Qp:Qs is present with both the RVPAS and the MBTS. 65 If the patient with deteriorating SBF caused by a large or inadequately restrictive shunt is not responsive to medical management, consider emergent shunt revision or stabilization with ECLS. Dis- tal arch obstruction will mimic elevated SVR by increas- ing Qp:Qs, especially in those patients with an MBTS; even mild arch

2018 American Heart Association

289. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency Full Text available with Trip Pro

specific treatment protocols. (Ungraded Good Practice Statement) 2.2 In pregnant women at risk for carrying a fetus affected with CAH and who are considering prenatal treatment, we recommend obtaining prenatal therapy only through protocols approved by Institutional Review Boards at centers capable of collecting outcomes from a sufficiently large number of patients, so that risks and benefits can be defined more precisely. (1|⊕⊕⊕○) 2.3 We advise that research protocols for prenatal therapy include (...) should be performed to confirm diagnosis prior to initiation of corticosteroid treatment. Prenatal treatment of congenital adrenal hyperplasia 2.1 We advise that clinicians continue to regard prenatal therapy as experimental. Thus, we do not recommend specific treatment protocols. (Ungraded Good Practice Statement) 2.2 In pregnant women at risk for carrying a fetus affected with congenital adrenal hyperplasia and who are considering prenatal treatment we recommend obtaining prenatal therapy only

2018 Pediatric Endocrine Society

290. Baricitinib (Olumiant) - rheumatoid arthritis

in modern rheumatology practice. In DMARD-naive patients, the initial choice of DMARD is commonly methotrexate (MTX), used as monotherapy or in combination with other cDMARDs and/or low doses of corticosteroids. Tolerability issues are well-described for MTX; approximately 40% of patients receiving MTX experience gastrointestinal symptoms (nausea, vomiting, and abdominal pain, while hepatotoxicity is observed frequently and pulmonary toxicity is observed occasionally. Patients responding insufficiently (...) granulocyte-colony stimulating factor EMA/13493/2017 Page 6/132 GI gastrointenstinal GGT gamma-glutamyl transferase GM-CSF granulocyte macrophage colony-stimulating factor HAQ-DI Health Assessment Questionnaire-Disability Index. Higher scores indicate greater disability. Hb haemoglobin HBcAb hepatitis B core antibody HBV hepatitis B viral HDL-C high-density lipoprotein cholesterol HPLC high performance liquid chromatography hsCRP high sensitivity C-reactive protein ICH International Council

2017 European Medicines Agency - EPARs

291. Perinatal Mortality Guideline

, and autopsy results). The examination of the stillborn can be divided into five segments, and each segment requires separate and systematic examination. 1. General Global evaluation of the following parameters: ? State of preservation: fresh or macerated, degree of maceration, intact, evidence of interventions required to effect delivery ? Weight; estimate gestational age; size for gestational age ? Measurements: circumference of head, chest and abdomen; lengths of crown-heel (with leg fully extended (...) space; poly/syndactyly and rocker-bottom deformity 3. Investigation and Assessment of Stillbirth, cont’d.13 Perinatal Mortality Guideline Stillbirth Autopsy and Request: Information for Practitioners What the Requesting Practitioner Can Expect From a Stillbirth Autopsy A stillbirth autopsy is meant to examine for anatomical causes of death or disease states based on fetal and placental examination and may not be definitive in situations where the underlying cause is external to the fetus or placenta

2017 British Columbia Perinatal Health Program

292. Gynecologic Care for Adolescents and Young Women With Eating Disorders

progression or improvement of a patient’s eating disorder. Pregnancy Prevention Sexually active patients with eating disorders require individualized counseling for pregnancy prevention. Fertility rates among patients with anorexia nervosa are debated in the literature, but it is clear that patients with eating disorders can become pregnant. Pregnancy in patients with an eating disorder carries risks, including small fetal head circumference and increased rates of maternal postpartum depression (...) a female’s lifespan (3, 4). Historically, eating disorders have been considered a disease of white, affluent females. However, it is now understood to affect females and males across all racial, ethnic, and socioeconomic categories. A large population- based study found that Hispanic, Asian, and Native American girls reported similar, if not more, concerns and behaviors related to weight as their white counter- parts; African American girls reported the lowest level of concern (5). Binge eating

2018 American College of Obstetricians and Gynecologists

293. Second Trimester Detailed Anatomic Study

tracts: left/right ventricular outflow tract (LVOT / RVOT) o Three vessel view o Observe fetal cardiac motion and rhythm, and record fetal heart rate. ? Demonstrate intact right and left diaphragm and normal/symmetric lung echogenicity. Fetal abdomen ? Survey the position, presence and situs of the stomach. ? Demonstrate intact abdominal wall with a normal umbilical cord insertion ? Identify the number of umbilical cord vessels using color Doppler at the level of the fetal bladder, and (if abnormal (...) Optimized Practice Ultrasound for Twin and Multiple Pregnancies CPG. o Fetal viability and heart rate o Ultrasound assessment of fetal size by gestation age (+/- estimated fetal weight when =21 weeks size) o Fetal Biometry: ? Biparietal diameter (BPD) ? Head circumference (HC) ? Abdominal circumference (AC) ? Femur length (FL) ? Humerus length (HL) Second Trimester Detailed Anatomic Study | June 2018 Clinical Practice Guideline Page 4 of 10 Recommendations Standard Ultrasound Report Checklist 1

2018 Accelerating Change Transformation Team

294. Comparative impact of pharmacological treatments for gestational diabetes on neonatal anthropometry independent of maternal glycaemic control: A systematic review and meta-analysis Full Text available with Trip Pro

) with a nonsignificant reduction in macrosomia risk (OR 0.32, 95% CI 0.08-1.19, I2 = 0%, p = 0.09) versus glyburide-exposed neonates. Glyburide-exposed neonates had a nonsignificant increase in total fat mass (103.2 g, 95% CI -3.91 to 210.31, p = 0.06) and increased abdominal (0.90 cm, 95% CI 0.03-1.77, p = 0.04) and chest circumferences (0.80 cm, 95% CI 0.07-1.53, p = 0.03) versus insulin-exposed neonates. Metformin-exposed neonates had decreased ponderal index (-0.13 kg/m3, 95% CI -0.26 to -0.00, p = 0.04 (...) in heavier neonates with a propensity to increased adiposity versus insulin- or metformin-exposed groups. Metformin-exposed neonates were lighter with reduced lean mass versus insulin- or glyburide-exposed groups, independent of maternal glycaemic control. Oral anti-hyperglycaemics cross the placenta, so effects on fetal anthropometry could result from direct actions on the fetus and/or placenta. We highlight a need for further studies examining the effects of intrauterine exposure to antidiabetic agents

2020 EvidenceUpdates

295. Obesity in pregnancy

in this guideline refers to “pre-pregnancy BMI”. This guideline has some overlap with other Danish national obstetric guidelines, e.g. “Gestational Diabetes Mellitus”, “Fetus Magnus Suspicious”, “Physical Activity in Pregnancy”, “Tromboprophylaxis”, “Vitamin D” and “Prolonged Pregnancy”. We therefore refer to these guidelines for further information. The recommendations in this guideline are in accordance with the recommendations from the Danish National Board of Health. Recommendations in pregnancy Strength (...) 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

2017 Nordic Federation of Societies of Obstetrics and Gynecology

297. Assessing and managing children at primary health-care facilities to prevent overweight and obesity in the context of the double burden of malnutrition

-for-age, weight-for-length/height, body mass index (BMI)-for-age, or mid-up- per arm circumference. The nutritional status of children is classified based on the anthropometric measures in the Table 1 below. Table 1. World Health Organization (WHO) classification of nutritional status of infants and children Nutritional status Age: birth to 5 years Indicator and cut-off value compared to the median of the WHO child growth standards a Obese Weight-for-length/height b or BMI-for-age >3 standard (...) nutritional status was weight-for-age + weight- for-length/height + mid-upper arm circumference, whereas in previous versions only assessments of weight-for-age were included. Clinical signs were used more frequently than anthropometric measurements to define acute malnutrition; “visible severe wasting” is still being used as a criterion in 39 countries despite no longer being recommended by WHO since 2013. A separate growth-monitoring programme is carried out in 39 countries, mostly together with routine

2017 World Health Organisation Guidelines

298. 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

299. 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

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

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 (...) 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

2017 American College of Cardiology

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