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227 results for

Fetal Scalp Stimulation

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181. Meconium Aspiration Syndrome (Diagnosis)

gastrointestinal (GI) tract, usually due to fetal hypoxic stress. As the fetus approaches term, the GI tract matures, and vagal stimulation from head or spinal cord compression may cause peristalsis and relaxation of the rectal sphincter, leading to meconium passage. The effects of meconium in amniotic fluid are well documented. [ ] Meconium directly alters the amniotic fluid, reducing antibacterial activity and subsequently increasing the risk of perinatal bacterial infection. In addition, meconium (...) A, Tigaizin A, Bricou A, et al. Should fetal scalp blood sampling be performed in the case of meconium-stained amniotic fluid?. J Matern Fetal Neonatal Med . 2016 Dec. 29 (23):3875-8. . Liu J, Cao HY, Fu W. Lung ultrasonography to diagnose meconium aspiration syndrome of the newborn. J Int Med Res . 2016 Nov 1. . American College of Obstetricians and Gynecologists. ACOG Committee opinion no 579: definition of term pregnancy. Obstet Gynecol . 2013 Nov. 122 (5):1139-40. . American College of Obstetricians

2014 eMedicine Pediatrics

182. Lyme Disease (Diagnosis)

by erythematous skin lesions. In the United States, Lyme disease was not recognized until the early 1970s, when a statistically improbable cluster of pediatric arthritis cases occurred in the region around Lyme, Connecticut. This outbreak was investigated by Allen Steere, MD, and others from Yale and stimulated intense clinical and epidemiologic research that led to the discovery of the causative agent and its ecology and an expanding geographic range and list of clinical manifestations. The recognition (...) and that it is not directly responsible for adverse fetal outcomes. Post-treatment Lyme disease syndrome Lingering symptoms, which may persist for more than 6 months, affect 10-20% of patients who receive recommended treatment for Lyme disease. [ ] Common complaints include cognitive disturbances, fatigue, joint or muscle pain, headaches, hearing loss, vertigo, mood disturbances, paresthesias, and difficulty sleeping. This condition is often termed chronic Lyme disease, but is more appropriately called post-treatment

2014 eMedicine Pediatrics

183. Abnormal Neonatal EEG (Diagnosis)

it difficult to interpret EEG results, which can discourage the use of EEG testing. Given the close relationships between certain morphological aspects of the developing brain and EEG results, gestational age can be reliably estimated (to ±1 wk) by EEG criteria. In fact, CNS development of the immature brain proceeds at about the same rate during fetal development as in the postnatal environment. The physiological substrate for these early EEG patterns is unknown, but is probably derived from cortical (...) generators that are strongly influenced by subcortical (primarily thalamic) afferent input. Rapid maturation of these structures (and not the corpus callosum) is most likely responsible for the interhemispheric synchrony that occurs close to full-term gestational age; in particular, rapid dendritic spine development and synaptogenesis are typical of the last month of fetal development. The complex development of cerebral sulci during this same period is probably responsible for the neonatal EEG results

2014 eMedicine.com

184. Extremely Low Birth Weight Infant (Treatment)

, including chronic oxygen dependency. Immediately after birth, the infant should be dried and placed on a radiant warmer, and a hat or another covering should be placed on his or her head, as the scalp is a site of large heat loss. Studies have shown that placing a plastic film over the baby immediately after drying or placing the infant on a warming mattress can further minimize evaporative and convective heat losses. [ , ] For transport to the neonatal intensive care unit (NICU) from the delivery room (...) . Although chemical heating pads are commonly used to provide a warm surface on which to place the baby, the unregulated heat source may burn the very fragile skin of the infant; therefore, such pads are not recommended. Caution is due when using any of the currently available methods to prevent hypothermia; frequent monitoring of temperature is necessary to prevent overheating given any combination of approaches. Hypoglycemia Fetal euglycemia (maintenance of normal blood glucose levels) is maintained

2014 eMedicine Pediatrics

185. Histiocytosis (Overview)

macrophages. Normal histiocytes originate from pluripotent stem cells, which can be found in bone marrow. [ ] Under the influence of various cytokines (eg, stem cell factor [SCF], granulocyte colony-stimulating factor [G-CSF], granulocyte-macrophage colony-stimulating factor [GM-CSF], tumor necrosis factor-alpha [TNF-alpha], interleukin [IL]-3, IL-4, and others), histiocytes can become committed, differentiating into specific groups of specialized cells. Committed histiocytes can mature into one of two (...) lymphocytes has been increasingly recognized. Dendritic cells appear to develop in several pathways. [ ] Immature dendritic cells respond to GM-CSF (not to macrophage colony-stimulating factor [M-CSF]) and become committed to generating dendritic cells, which are “professional” antigen-presenting cells (APCs). [ ] These cells can capture antigen and migrate to lymphoid organs, where they present the antigens to naive T cells. [ ] Dendritic cells are also efficient stimulators of B-cell lymphocytes

2014 eMedicine Pediatrics

186. Graves Disease (Treatment)

, liver transplantation, or both has been reported with PTU, and prompted a label warning by the US Food and Drug Administration (FDA) since May 2010. Less significant adverse effects include ageusia or dysgeusia. PTU is the drug of choice in pregnant women with Graves disease. Methimazole has been associated with fetal scalp aplasia cutis. Methimazole also crosses to the fetus much more easily than PTU and, therefore, is more likely to be a fetal goitrogen, even when cautiously used. The FDA had (...) of thyroid hormone levels in the high range typical of pregnancy. Overtreatment can lead to fetal hypothyroidism and goiter, with concomitant poor intellectual outcome. Undertreatment can lead to fetal loss. Surgery also can lead to fetal loss and should be carried out only if absolutely necessary. Assess adolescent girls treated for Graves disease for pregnancy risk and start contraception if indicated. Do not administer RAI therapy to a sexually active adolescent girl until she is known to have

2014 eMedicine Pediatrics

187. Human Immunodeficiency Virus Infection (Treatment)

Flucytosine Amphotericin Sulfonamides Trimethoprim, trimethoprim-sulfamethoxazole Pyrimethamine Pentamidine Infectious agents such as parvovirus B19 can cause myelosuppression, as can invasive neoplastic processes of the marrow. Granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) are used to treat neutropenia and to promote granulocyte production and function. GM-CSF has more adverse effects than G-CSF, and it promotes viral replication. However, GM (...) in poor nutritional intake. Appetite stimulants can be useful. High-energy, high-protein nutritional supplements are commonly needed. Caretakers must be instructed to avoid giving the child any food or water that has a high risk of being contaminated with any infectious agent. HIV and accompanying opportunistic infections can worsen GI symptoms. Nasogastric, nasojejunal, and/or gastrostomy tubes may be needed to support the patient's nutritional and fluid status. Gastrostomy tubes are well tolerated

2014 eMedicine Pediatrics

188. Labor and Delivery, Normal Delivery of the Newborn

, especially during contractions. Persistence of a fetal heart rate lower than 120 bpm defines fetal bradycardia; in labor, a heart rate >100 bpm with reassuring variation is not considered an emergency. Persistence of a rate >160 bpm is called fetal tachycardia. Internal fetal heart rate monitor (fetal scalp electrode) An internal fetal heart rate monitor may be placed to more accurately assess fetal heart rate patterns when the external monitor tracing may be inaccurate or difficult to trace. A small (...) electrode is passed through the cervix, after the membranes have ruptured, and placed on the fetal scalp. Intrauterine pressure catheter (IUPC) External monitoring of contractions only measures the timing of contractions. The strength of contractions can only be measured with an IUPC. This catheter is placed in the uterus transcervically, next to the fetal head. It allows for more accurate measurement of strength and timing of contractions. Delivery assistance (operative vaginal delivery) See the list

2014 eMedicine.com

189. Lyme Disease (Overview)

by erythematous skin lesions. In the United States, Lyme disease was not recognized until the early 1970s, when a statistically improbable cluster of pediatric arthritis cases occurred in the region around Lyme, Connecticut. This outbreak was investigated by Allen Steere, MD, and others from Yale and stimulated intense clinical and epidemiologic research that led to the discovery of the causative agent and its ecology and an expanding geographic range and list of clinical manifestations. The recognition (...) and that it is not directly responsible for adverse fetal outcomes. Post-treatment Lyme disease syndrome Lingering symptoms, which may persist for more than 6 months, affect 10-20% of patients who receive recommended treatment for Lyme disease. [ ] Common complaints include cognitive disturbances, fatigue, joint or muscle pain, headaches, hearing loss, vertigo, mood disturbances, paresthesias, and difficulty sleeping. This condition is often termed chronic Lyme disease, but is more appropriately called post-treatment

2014 eMedicine Pediatrics

190. Extremely Low Birth Weight Infant (Overview)

, including chronic oxygen dependency. Immediately after birth, the infant should be dried and placed on a radiant warmer, and a hat or another covering should be placed on his or her head, as the scalp is a site of large heat loss. Studies have shown that placing a plastic film over the baby immediately after drying or placing the infant on a warming mattress can further minimize evaporative and convective heat losses. [ , ] For transport to the neonatal intensive care unit (NICU) from the delivery room (...) . Although chemical heating pads are commonly used to provide a warm surface on which to place the baby, the unregulated heat source may burn the very fragile skin of the infant; therefore, such pads are not recommended. Caution is due when using any of the currently available methods to prevent hypothermia; frequent monitoring of temperature is necessary to prevent overheating given any combination of approaches. Hypoglycemia Fetal euglycemia (maintenance of normal blood glucose levels) is maintained

2014 eMedicine Pediatrics

191. Meconium Aspiration Syndrome (Treatment)

fluid. Obstet Gynecol . 2017 Mar. 129 (3):593-4. . Nangia S, Pal MM, Saili A, Gupta U. Effect of intrapartum oropharyngeal (IP-OP) suction on meconium aspiration syndrome (MAS) in developing country: A RCT. Resuscitation . 2015 Dec. 97:83-7. . Boujenah J, Oliveira J, De La Hosseraye C, Benbara A, Tigaizin A, Bricou A, et al. Should fetal scalp blood sampling be performed in the case of meconium-stained amniotic fluid?. J Matern Fetal Neonatal Med . 2016 Dec. 29 (23):3875-8. . Liu J, Cao HY, Fu W (...) . [ , ] In patients with meconium aspiration syndrome (MAS), a thorough cardiac examination and echocardiography are necessary to evaluate for congenital heart disease and persistent pulmonary hypertension of the newborn (PPHN). Quantifying the degree of pulmonary hypertension, prior to instituting therapy, is essential. Prevention of MAS Prevention of MAS is paramount. Obstetricians should closely monitor fetal status in an attempt to identify fetal distress. When meconium is detected, amnioinfusion with warm

2014 eMedicine Pediatrics

192. Meconium Aspiration Syndrome (Overview)

gastrointestinal (GI) tract, usually due to fetal hypoxic stress. As the fetus approaches term, the GI tract matures, and vagal stimulation from head or spinal cord compression may cause peristalsis and relaxation of the rectal sphincter, leading to meconium passage. The effects of meconium in amniotic fluid are well documented. [ ] Meconium directly alters the amniotic fluid, reducing antibacterial activity and subsequently increasing the risk of perinatal bacterial infection. In addition, meconium (...) A, Tigaizin A, Bricou A, et al. Should fetal scalp blood sampling be performed in the case of meconium-stained amniotic fluid?. J Matern Fetal Neonatal Med . 2016 Dec. 29 (23):3875-8. . Liu J, Cao HY, Fu W. Lung ultrasonography to diagnose meconium aspiration syndrome of the newborn. J Int Med Res . 2016 Nov 1. . American College of Obstetricians and Gynecologists. ACOG Committee opinion no 579: definition of term pregnancy. Obstet Gynecol . 2013 Nov. 122 (5):1139-40. . American College of Obstetricians

2014 eMedicine Pediatrics

193. Tick-Borne Diseases, Lyme (Diagnosis)

by erythematous skin lesions. In the United States, Lyme disease was not recognized until the early 1970s, when a statistically improbable cluster of pediatric arthritis cases occurred in the region around Lyme, Connecticut. This outbreak was investigated by Allen Steere, MD, and others from Yale and stimulated intense clinical and epidemiologic research that led to the discovery of the causative agent and its ecology and an expanding geographic range and list of clinical manifestations. The recognition (...) and that it is not directly responsible for adverse fetal outcomes. Post-treatment Lyme disease syndrome Lingering symptoms, which may persist for more than 6 months, affect 10-20% of patients who receive recommended treatment for Lyme disease. [ ] Common complaints include cognitive disturbances, fatigue, joint or muscle pain, headaches, hearing loss, vertigo, mood disturbances, paresthesias, and difficulty sleeping. This condition is often termed chronic Lyme disease, but is more appropriately called post-treatment

2014 eMedicine Emergency Medicine

194. Pathology: Basal Cell Carcinoma

. [ ] The image below depicts BCC of the right lower lid. Basal cell carcinoma of the right lower lid. See , , and , Critical Images slideshows, to help correctly identify various lesions. Signs and symptoms Approximately 85% of BCCs occur on the face, head (scalp included), and neck; others appear on the trunk or extremities; rarely, they may occur on the hands. [ , ] Other characteristic features of BCC tumors include the following: Waxy papules with central depression Pearly appearance Erosion (...) tissues during fetal development. After embryogenesis, it continues to function in regulation of cell growth and differentiation. Loss of inhibition of this pathway is associated with human malignancy, including BCC. The hedgehog gene encodes an extracellular protein that binds to a cell membrane receptor complex to start a cascade of cellular events leading to cell proliferation. Of the 3 known human homologues, sonic hedgehog (SHH) protein is the most relevant to BCC. Patched (PTCH) is a protein

2014 eMedicine Surgery

195. Normal Labor and Delivery (Diagnosis)

cardiotocography. This review concluded that continuous cardiotocography during labor is associated with a reduction in neonatal seizures but not cerebral palsy or infant mortality; however, continuous monitoring is associated with increased cesarean and operative vaginal deliveries. [ ] If nonreassuring fetal heart rate tracings by cardiotography (eg, late decelerations) are noted, a fetal scalp electrode may be applied to generate sensitive readings of beat-to-beat variability. However, a fetal scalp (...) be accomplished with blood sampling from fetal scalp capillaries. This procedure allows for a direct assessment of fetal oxygenation and blood pH. A pH of < 7.20 warrants further investigation for the fetus' well-being and for possible resuscitation or surgical intervention. Routine laboratory studies of the parturient, such as complete blood cell (CBC) count, blood typing and screening, and urinalysis, are usually performed. Intravenous (IV) access is established. Previous Next: Intrapartum Management

2014 eMedicine.com

196. Paraneoplastic Diseases (Diagnosis)

have papillomatous thickening of the oral mucosa. Patients who have AN associated with malignancies also have skin changes involving the scalp, areolae, and eyelids. The appearance of paraneoplastic AN usually coincides with the presence of malignancy, but it can precede or follow the diagnosis of cancer and thus may signal a relapse in patients with a history of cancer. Diagnosis The diagnosis of AN is based on clinical findings alone and can be supported by the histopathologic changes (...) include symmetrical, scaly, violaceous plaques on the acral surfaces, with severe forms progressing to bullae. The lesions predominantly occur on the hands, feet, ear helices, nose tip, and scalp. Skin changes may spread to involve the knees, elbows, and malar surface of the face. [ ] Bazex syndrome occurs more commonly in men older than 40 years. [ ] Alopecia and nail changes are common and can be early findings. Subungual hyperkeratosis, onychodystrophy, and white flaking of the nail surface

2014 eMedicine.com

197. Teratology and Drug Use During Pregnancy (Diagnosis)

with clinically significant risks in pregnancy. In rare cases, promotility agents can be prescribed, though the risks and benefits must carefully be discussed with the patients before the drugs are started. A physician caring for a pregnant patient who requires medication should take care in choosing dosages and types of drugs that maximize effectiveness while minimizing fetal risk. It is essential to understand the effect of medications and to know the point in fetal development when drugs are most toxic (...) and which fetal organs are most susceptible. In addition, healthcare providers who treat pregnant women must be familiar with methods of gathering information about drugs, and they must be aware of online databases that are most useful for this purpose. Several resources are available to expand one’s knowledge of teratology. Teratogen Information System (TERIS) and Reprotox are Internet databases that cover this subject. The Organization of Teratology Information Specialists is a network of risk

2014 eMedicine.com

198. Postterm Pregnancy (Diagnosis)

be reviewed. Finally, intrapartum fetal surveillance in an attempt to document fetal intolerance to labor before it leads to acidosis is critical. Whether continuous fetal monitoring or intermittent auscultation is used, interpretation of the results by a well-trained clinician is of paramount importance. If the fetal heart rate tracing is equivocal, fetal scalp stimulation and/or fetal scalp blood sampling may provide the reassurance necessary to justify continuing the induction of labor (...) management of the pregnancy, or (3) antenatal testing. Each of these 3 options may be used at any particular time during this 2-week period. Note that if the pregnancy is at risk for an adverse outcome from an underlying condition, either maternal or fetal, inducing labor may proceed without documented lung maturity. Also, an elective induction of labor may proceed at or after 39 weeks of gestation in the absence of documented lung maturity provided that 36 weeks have elapsed since documentation

2014 eMedicine.com

199. Platelet Disorders (Diagnosis)

the presence of petechiae and ecchymoses. The presence of lymphadenopathy or suggests other secondary causes of thrombocytopenia rather than ITP. The peripheral smear shows a decreased number of platelets. Often, the smear shows giant platelets, which is a reflection of increased thrombopoietin-induced stimulation of the bone marrow (see images below). Examination of the peripheral smears in immune thrombocytopenic purpura often shows giant platelets. These platelets reflect the increased megakaryocytic (...) mass in the marrow. Peripheral smear of a patient with Bernard-Soulier syndrome showing giant platelets. These platelets are not counted as platelets in most particle counters. At times, the smear may show eosinophilia and lymphocytosis, possibly reflecting hypersensitivity to the inciting viral antigens. The bone marrow shows an increase in the number of megakaryocytes and signs of thrombopoietin-induced megakaryocyte stimulation (increase in number and ploidy, decrease in cytoplasm), resulting

2014 eMedicine.com

200. Preoperative Evaluation and Management (Diagnosis)

controlled, and the insulin doses should be adjusted as needed. Management of hypoglycemic agents and different types of insulin can be pivotal. [ ] Hypertension A history of hypertension should alert the physician to check the patient's blood pressure. Patients with elevated pressures may bleed profusely. This is especially true when working on larger areas of the body or in highly vascular regions, such as the scalp. Hypertension is an important cause of perioperative bleeding and hematoma formation (...) , can cause bone growth retardation and staining of dental enamel in the fetus. Lidocaine also appears to be safe in low doses, although excessive amounts can cause fetal CNS and cardiac depression. Acetaminophen (Class B) is routinely used during pregnancy despite its ability to cross the placenta. [ ] Drugs should also be selected carefully during lactation. [ ] Snoring/sleep apnea Eighty percent of patients with breathing problems related to sleep disorders are male. Conscious sedation may

2014 eMedicine.com

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