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Fetal Foot Measurement

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841. Growth and Failure to Thrive

and often involve problems with diet and feeding behaviour that usually respond to simple targeted advice. Only about 5% of young children whose weight/growth falters will have an organic root to the problem. More rarely, weight faltering may be associated with neglect or maternal mental health problems or addiction. Assessing normality When assessing growth in all children, both height and weight should be considered. Repeated measurements of height and weight showing changes of centiles on charts (...) are much more important than a single measurement. To diagnose weight and growth faltering, it is imperative to understand normal growth and variation. For example, it is normal for a baby to lose up to 10% of body weight in the first few days of life. This is rapidly regained but more slowly in breast-fed babies. Premature babies For premature babies a 'corrected age' should be used, based on time since birth minus degree of prematurity. Thus, a baby who was born 12 weeks previously at 32 weeks

2008 Mentor

842. Exomphalos and Gastroschisis

cause of abdominal wall defects. This starts with an accidental break in the inner amniotic membrane which results in the fetus being exposed to fibrous amniotic bands. The appearance may be similar to gastroschisis but a scan may demonstrate the atypical location of the defect and contiguity with amniotic membranes. Extrophy of the urinary bladder . This appears on a scan, in female babies, as a mass superior to the fetal genitalia. Serial scans subsequently fail to demonstrate the presence (...) be administered to prevent infection. Parenteral nutrition should be provided via a central venous line, the baby should be catheterised to measure urine output and digital examination should be performed to dilate the rectum. The gastroschisis sac will require temporary protection in a silo. Recently a spring-loaded silo has been used to good effect. [ ] Unlike exomphalos, evidence derived from a review of the literature is more definitive in finding no difference between immediate repair and delayed closure

2008 Mentor

843. Flying with Medical Conditions

below. Physiology during flight [ ] Modern aircraft are not pressurised to sea level equivalent. Cabin altitude equivalent is usually between 5,000 and 8,000 feet which means that there is a reduction in barometric pressure and a reduction in the partial pressure of alveolar oxygen (P a O 2 ). Sometimes during flight, although not usually for long periods, oxygen saturation levels can fall to around 90%. A healthy individual can usually tolerate this with no problems but it may not be the same (...) of the increased risk. The risk also increases significantly in the presence of other known risk factors for VTE (obesity, extremes of height, use of oral contraceptives and the presence of prothrombotic blood abnormalities). The absolute risk of VTE per flight longer than four hours in a cohort of healthy individuals was 1 in 6,000. Effective preventative measures will comprise phase II of the WRIGHT project. Risk factors for DVT include [ ] : Thrombophilia enhancing clotting activity. Recent major surgery

2008 Mentor

844. Female Infertility

restriction and even delayed reading ability (at least to the age of 7). [ ] Women who are trying to become pregnant should be informed that drinking no more than one or two units of alcohol once or twice per week and avoiding episodes of intoxication reduce the risk of harming a developing fetus. Excessive alcohol consumption impairs sperm quality in men and may affect fertility in women. [ , ] There is currently insufficient evidence for a strong association between excessive caffeine consumption (...) and poor pregnancy outcomes, including infertility. [ ] Illicit drugs should be avoided. Some have adverse effects on fertility or the fetus or both and, for most, the question of teratogenicity has not been adequately addressed. Cannabis can impair ovulation and cocaine can cause tubal infertility. There is also reason to be concerned about the effect these drugs may have in pregnancy. Sexual history Enquire about frequency of coitus (ideally two to three times a week) and any prolonged or recurrent

2008 Mentor

845. Gestational Trophoblastic Disease (GTD)

the chromosomes come from the mother and half from the father. In complete molar pregnancies , all the genetic material comes from the father. An empty oocyte lacking maternal genes is fertilised. Most commonly (75-80%) this arises from a single sperm duplicating within an empty ovum [ ] . Less often an empty ovum is fertilised by two sperm. There is no fetal tissue. In partial molar pregnancies , the trophoblast cells have three sets of chromosomes (triploid). Two sperm are believed to fertilise the ovum (...) at the same time, leading to one set of maternal and two sets of paternal chromosomes. Around 10% of partial moles are tetraploid or mosaic in nature. There is usually evidence of fetal tissue or fetal blood cells in a partial molar pregnancy. An embryo may be present at the start. An invasive mole develops from a complete mole and invades the myometrium. Choriocarcinoma most often follows a molar pregnancy but can follow a normal pregnancy, ectopic pregnancy or abortion, and should always be considered

2008 Mentor

846. Normal Labour

of established first stage of labour varies between women, first labours last on average 8 hours (unlikely ≥18 hours). Second and subsequent labours last on average 5 hours (unlikely ≥12 hours). However if the first stage does not appear to be progressing, the cause needs to be determined. Management [ ] Reassure and advise the patient on how her labour is progressing. Measure pulse hourly and temperature and blood pressure 4-hourly. Monitor frequency of contractions half-hourly The fetal heart rate (FHR (...) with regular contractions (when the fetal presenting part has descended into the true pelvis), or on admission to hospital with obvious signs of labour. The first stage ends when the cervix is fully dilated (10 cm). First stage can be divided into: Latent or quiet phase: Contractions are not particularly painful and at 5- to 10-minute intervals. Contractions become stronger with shorter intervals, although the cervix is still dilating relatively slowly, with membranes possibly breaking later in this phase

2008 Mentor

847. Patau's Syndrome

-trimester multiple marker screening (that which is currently offered for Down's syndrome screening) may also help to identify a fetus with trisomy 13 or 18. Markers can include maternal age, nuchal translucency measurement, pregnancy-associated plasma protein A (PAPPA) and human chorionic gonadotrophin (hCG). Ultrasound at that time may also show fetal anomalies. Second-trimester screening tests can be offered if the mother presents later. See the separate article for more details about second-trimester (...) findings may suggest trisomy 13 and subsequent cytogenetic studies may therefore be indicated. Findings include increased nuchal translucency, cardiac defects, neural tube defects, facial clefting, renal abnormalities and omphalocele A study from Kings College Hospital showed that at the 11- to 13(+6)-week scan, the measurement of fetal nuchal translucency and fetal heart rate and fetal examination for holoprosencephaly, exomphalos and megacystis can identify >90% of fetuses with trisomy 13 [ ] . First

2008 Mentor

848. Paracetamol Poisoning

if vomiting occurs after discharge. Late presentation The treatment of patients presenting more than 24 hours after ingestion is controversial. Management is detailed on Toxbase® and is similar to presentation between 8 and 24 hours after the overdose. Measure INR, creatinine, ALT and venous blood acid/base balance or bicarbonate. If any of these is abnormal discuss with your nearest National Poisons Information Centre (0870 600 6266). Until concerns about the evidence base are resolved, it makes sense (...) . A measurable paracetamol concentration more than 24 hours after ingestion either indicates a very large overdose, or suggests a mistake in time of ingestion, or a staggered overdose. A full course of antidotal therapy should normally be given to patients in whom paracetamol is detected. Paracetamol overdose during pregnancy Paracetamol is the most common drug taken in overdose during pregnancy [ ] . The resulting toxic metabolites can cross the placenta and lead to hepatocellular necrosis of maternal

2008 Mentor

849. Obstetric Ultrasound

[ ] . This is essential for intervention of post-maturity, and for accurate serum screening for . Determine viability - to confirm the presence of a heartbeat and exclude and . Determine fetal number and, in , the chorionicity/amnionicity [ ] . Detect gross fetal abnormalities. Procedure Measurement of crown-rump length accurately measures gestational age if performed before 13 weeks. After 13 weeks, the fetus becomes increasingly flexed so results are inaccurate. Alternatives that can be used after this include bi (...) to see if this is persisting. Transvaginal scanning is preferred over transabdominal for this indication. To confirm that fetal growth is appropriate. Procedure Assess growth by the measurement methods below: Bi-parietal diameter (most accurate for dating up to 20 weeks). Head circumference. Femur length. Abdominal circumference. Look at the head shape and internal structures: Cavum septum pellucidum. Cerebellum. Ventricular size at atrium (<10 mm). Minimum standards: Spine: longitudinal

2008 Mentor

850. Behavioural Consequences of Frontal Cortex Grafts and Enriched Environments after Sensorimotor Cortex Lesions (Full text)

-graft testing, but relative to intact controls a persistent deficit in foot slip errors occurred in all lesion groups. Irrespective of graft status, postoperative enrichment prevented the occurrence of severe foot slips, especially early in retraining. The frontal grafts, however, enhanced beam-walking recovery by reducing the overall frequency of foot slips on early post-grafting sessions, an effect we suggest is related to graft-derived trophic influences, but this measure was not significantly (...) received multiple suspension grafts of (E20) fetal frontal cortex, placed adjacent to the lesion cavity, and 8 days later recovery of beam-walking skills was examined for a six-week period. The grafts survived in all cases with an appropriate lesion, a notable result given the one month lesion-graft delay, but graft volume was not influenced by postoperative environment. The substantial lesion-induced deficits evident just prior to differential housing showed a marked reduction by the start of post

1994 Journal of neural transplantation & plasticity PubMed abstract

851. Comparison of Externally and Self-Initiated Movements

- Body movement training Participants will train to do three different body movements involving the hands and feet. The movements will either be self-initiated or in response to a stimulus, such as a visual or auditory trigger. Part 2 - Magnetic resonance imaging Participants will do one or more of the trained movements, with or without a triggering stimulus, during MRI scanning. MRI is a diagnostic procedure that uses a magnetic field and radio waves to produce images of brain structure and activity (...) brain area for the categorized movements. By obtaining functional magnetic resonance imaging (fMRI) signals during triggered movement tasks designed from 3 input triggers of different modalities (visual, auditory, and somatosensory) and 3 output movements of different body parts (right hand, left hand, and right foot), we will determine the brain regions specially devoted for each input or output, and commonly devoted for triggered movements. By obtaining fMRI signals during spontaneous voluntary

2001 Clinical Trials

852. Routine ultrasound screening in pregnancy and the children's subsequent handedness. (Abstract)

Routine ultrasound screening in pregnancy and the children's subsequent handedness. To study a possible association between ultrasound screening in early pregnancy and altered cerebral dominance measured by the prevalence of non-right handedness among children, particularly boys.Follow-up of 8 to 9 year old children to women who participated in a randomised controlled trial on ultrasound screening during pregnancy in 1985-87. The children were followed up through a questionnaire sent (...) to their mothers. The dominant hand of the child was assessed by eleven questions. The dominant foot by one question.No differences were found in non-right handedness between children in the screening and non-screening group. In separate analyses on ultrasound exposure and non-right handedness among boys a significant difference was found (odds ratio 1.33; 95% confidence interval 1.02-1.74).This study could not rule out a possible association between non-right handedness among boys and ultrasound exposure

1998 Early human development Controlled trial quality: uncertain

853. MRI for the detection of foetal abnormalities

to the foetus. Patients are scanned in the supine or the left-lateral position to avoid aorta-caval compression. Those patients suffering from claustrophobia can enter the scanner feet first. To maximise image signal capture, a combination of coils may be placed over the pelvis or pregnant uterus and the lower spine. The average duration of a foetal MRI ranges between 10 to 35 minutes (Cannie et al 2006; Levine 2005; Prayer et al 2004; Roorda 2004; Sandrasegaran et al 2006). Most units used to conduct (...) Health Information Service 2007). In addition, some foetal anomalies may be detected through analytes in the maternal serum at approximately 15-20 weeks of gestation. For example, the South Australian Maternal Serum Antenatal Screening Programme measures four analytes in maternal serum ( a-fetoprotein, free alpha subunit ( a-hCG) and free beta subunit ( ß-hCG) of chorionic gonadotropin, and unconjugated oestriol), which are normally produced by, or in support of, a foetus and its placenta

2007 Australia and New Zealand Horizon Scanning Network

854. Measuring Cardiac Output and Stroke Volume Using the Physioflow Impedance Device in Pregnant Patients

Measuring Cardiac Output and Stroke Volume Using the Physioflow Impedance Device in Pregnant Patients Measuring Cardiac Output and Stroke Volume Using the Physioflow Impedance Device in Pregnant Patients - Full Text View - Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please (...) remove one or more studies before adding more. Measuring Cardiac Output and Stroke Volume Using the Physioflow Impedance Device in Pregnant Patients The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. Identifier: NCT00573274 Recruitment Status : Completed First Posted : December 14, 2007 Last Update Posted : July 30

2007 Clinical Trials

855. Fetal, infant and childhood growth: relationships with body composition in Brazilian boys aged 9 years. (Full text)

Fetal, infant and childhood growth: relationships with body composition in Brazilian boys aged 9 years. Early growth rate has been linked to later obesity categorised by body mass index (BMI), but the development of body composition has rarely been studied.We tested the hypotheses that (1) birthweight and weight gain in (2) infancy or (3) childhood are associated with later body composition, in 172 Brazilian boys followed longitudinally since birth. Growth was assessed using measurements (...) of weight and height at birth, 6 months, and 1 and 4 y. Measurements at 9 y comprised height, weight and body composition using foot-foot impedance.Birthweight was associated with later height and lean mass (LM), but not fatness. Weight gain 0-6 months was associated with later height and LM, and with obesity prevalence according to BMI, but not with fatness. Weight gain 1-4 y was associated with later fatness and LM. Weight gain 4-9 y was strongly associated with fatness but not LM. Early growth rate

2005 International Journal of Obesity PubMed abstract

856. Correlation between first trimester fetal bone length and maternal serum pregnancy-associated plasma protein-A (PAPP-A). (Full text)

between late first trimester fetal bone length and maternal serum levels of PAPP-A.In a cross-sectional observational study, ultrasound measurements of fetal long bones and fluorimetric immunoassays for maternal serum PAPP-A were performed in 514 singleton pregnancies at 10-14 weeks of gestation.There were 501 uncomplicated pregnancies. There were significant correlations between PAPP-A values and length of humerus, femur and tibia [r values 0.12 (P = 0.01), 0.11 (P = 0.01) and 0.10 (P = 0.03 (...) ), respectively]. The association with the length of ulna and foot did not reach statistical significance (r values 0.08 and -0.03, respectively).Maternal serum PAPP-A levels at 10-14 weeks of gestation are significantly associated with the length of fetal long bones such as humerus, femur and tibia. This provides further evidence that PAPP-A may be involved in the regulation of bone development.

2006 Human Reproduction PubMed abstract

857. Hand Foot and Mouth Disease

and European Guidelines. You may find the article more useful, or one of our other . In this article In This Article Hand, Foot and Mouth Disease In this article Hand, foot and mouth disease (HFMD) is a viral illness which commonly causes lesions involving the mouth, hands and feet. However, it may also affect other areas such as the buttocks and genitalia. The most common causes of HFMD are Coxsackievirus A16 (CA16) and enterovirus 71 (EV71). It is normally a mild, self-limiting illness but occasionally (...) of time. [ ] There is no need to isolate a child with HFMD and it is not notifiable. Advise on general hygiene measures (see 'Prevention', below). Advice for pregnant women There are no known adverse consequences for the fetus if a pregnant woman is in contact with HFMD. Seek specialist advice if a woman develops HFMD within three weeks of expected delivery, as there may be a risk of passing the infection to the newborn. In rare cases this can lead to severe infection in the neonate, although usually

2008 Mentor

858. Improving the accuracy of fetal foot length to confirm gestational duration. (Abstract)

Improving the accuracy of fetal foot length to confirm gestational duration. To establish normative fetal foot length ranges using last menstrual period (LMP) and ultrasound dating by biparietal diameter and to examine variations in these ranges by ethnicity.A consecutive series of 1,099 eligible subjects receiving abortions had fetal foot lengths measured directly. Models of fetal foot length were developed by using assessment of gestational duration by LMP alone, ultrasonography alone (...) alone produced a better model fit than duration by LMP alone. Regressions by ethnicity were not significantly different compared with the simple regression, regardless of method used to determine gestational duration.A reconsideration of fetal foot length measurements to confirm gestational duration is important. More accurate tables of these measurements allow for greater precision in correlating gestational duration and foot length. Fetal foot length tables using ultrasonographically confirmed

2005 Obstetrics and Gynecology

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