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Fetal Scalp pH

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41. Twin delivery

twins, the risk of adverse neonatal outcome is higher for the smaller fetus and especially if this fetus is SGA ( 1500 gr), from GA 32+0 there is no evidence that elective C/S is protective (for adverse neonatal outcome) compared with elective vaginal twin birth 1b TV-B > TV-A (> 25%) is associated with a slightly increased risk of C/S delivery of TV-B 2c Significance of choriocity No significant difference in perinatal outcome (pH GA 32 weeks. 1b In MCDA-pregnancies complicated by sFGR, TAPS, TTTS (...) is vertex and estimated fetal weight estimate (both) is > 1500 gr and 25% difference), especially when TV-B > TV-A and TV-B is in non-vertex presentation elective C/S delivery should be considered · Twin pregnancies complicated by IUGR and compromised fetus(es) should be delivered by C/S on the same indications as singletons D Twin delivery Danish Society of Obstetrics and Gynecology 2020 Page 3 of 60 Mode of delivery and criteria for vaginal twin birth at GA > 32+0 MCDA pregnancies, where early TTTS

2020 Nordic Federation of Societies of Obstetrics and Gynecology

42. Monogenic cerebral small-vessel diseases

carriers clinically una?ected but also as autosomal dominant mutations, with heterozygous carriers being clinically a?ected 4.23 84.6 Skin biopsy examination does not show GOM typical of CADASIL 5 100 Premature di?use scalp alopecia is seen in the majority of patients 4.85 100 The diagnosis CARASIL should be considered in any patient with early-onset premature scalp alopecia, severe spondylosis and unexplained early lacunar strokes and/or symmetrical WMHs 4.92 100 White matter changes in the anterior (...) with COL4A1/2 cSVD 4.78 92.8 A Caesarean section should be considered in women giving birth where the fetus contains a COL4A1/2 mutation 4.78 100 Mutations of COL4A1 at the binding site of MIR-29 gene can cause a distinct ischaemic cSVD with early onset in adults called PADMAL 4.86 92.8 CARASAL CARASAL manifests clinically not only in the central nervous system but also in other organs/tissues 4.46 84.6 Dystonia is a rare phenotypic feature of CARASAL 4.23 92.8 Extensive subcortical and brainstem

2020 European Academy of Neurology

43. Early onset Group B streptococcal disease

positive • Provided women with GBS risk factors are treated with IAP, there is insufficient evidence to recommend either avoidance of, or alterations of technique, in obstetric procedures (e.g. membrane sweeping, amniotomy, fetal scalp blood sampling or fetal scalp electrode) on the basis of positive GBS status 24,37 Chorioamnionitis • Do not inhibit labour, but consider hastening birth under broad spectrum intravenous antibiotic cover o Collect low and high vaginal swabs for culture o Recommend IOL (...) to the rapidity of some labours, especially in multiparous women, it can be difficult to confidently estimate the time-to-birth interval • Four hours prior to birth is commonly recommended as the interval required for adequate prophylaxis 3,4,24 but there is evidence that adequate fetal concentrations may be reached earlier (within 1–2 hours) 15,44-46 • In order to maximise the window for administration of IAP, this guideline recommends aiming for administration at least 4 hours prior to birth while

2020 Queensland Health

44. Labor Dystocia

will eventually have at least one child, 1 and the majority of these women will undergo labor. “Labor dystocia”— difficult or obstructed labor 2 —encompasses a variety of concepts, ranging from “abnormally” slow dilation of the cervix or descent of the fetus during active labor 3 to entrapment of the fetal shoulders after delivery of the head (“shoulder dystocia,” an obstetric emergency). For the purposes of this systematic review, we assume that “labor dystocia” refers to “abnormal” labor progression during (...) strategies for treating labor dystocia in women with otherwise uncomplicated pregnancies. Strategies assessed include amniotomy, supportive care measures, epidural analgesia, frequency of cervical examination, intrauterine pressure catheters, high- versus low-dose oxytocin protocols, electronic fetal monitoring or intermittent auscultation during augmentation with oxytocin, and delayed or Valsalva pushing. Key Messages • Use of partograms did not impact important maternal or neonatal outcomes

2020 Effective Health Care Program (AHRQ)

45. Care around stillbirth and neonatal death

regional differences exist. In New Zealand, perinatal death consists of fetal death (the death of a fetus of from 20 weeks gestation or weighing at least 400 grams if gestation is unknown 7 ) and early neonatal death (the death of a liveborn baby that occurs before the 7 th day of life 5 ). Perinatal related mortality is fetal and neonatal deaths (up to 28 days) at 20 weeks or beyond, or weighing at least 400g if gestation is unknown. Fetal death includes stillbirth and termination of pregnancy 8 (...) , giving a PMR of 11.2 per 1000 (8.1 and 3.1/1000 for fetal and neonatal death rates respectively) 5 . For Indigenous and other disadvantaged women in both settings (similar to other high income settings), the risk of perinatal death is around double 5,6,9,17 . Using the PSANZ classification system the leading causes of stillbirth are congenital anomaly and spontaneous preterm. However in approximately 20-30% of stillbirths, a cause is never identified. Similarly, for neonatal mortality, the main cause

2019 Centre of Research Excellence in Stillbirth

46. Prevention of Early-Onset Group B Streptococcal Disease in Newborns

Prevention of Early-Onset Group B Streptococcal Disease in Newborns Prevention of Early-Onset Group B Streptococcal Disease in Newborns - ACOG Menu ▼ Prevention of Early-Onset Group B Streptococcal Disease in Newborns Page Navigation ▼ Number 782 (Replaces No. 485, April 2011) Committee on Obstetric Practice The American Academy of Pediatrics, the American College of Nurse-Midwives, the Association of Women’s Health, Obstetric and Neonatal Nurses, and the Society for Maternal-Fetal Medicine (...) ). In the 1970s, GBS emerged as an important cause of perinatal morbidity and mortality in newborns (2, , ). Two distinct clinical syndromes of invasive GBS disease in the newborn exist. One is GBS EOD, which presents within 7 days after birth and occurs secondary to vertical transmission, fetal or neonatal aspiration during labor and birth, or both; it is characterized primarily by sepsis, pneumonia, or less frequently meningitis and is most likely to manifest within the first 12–48 hours after birth (1, 10

2019 American College of Obstetricians and Gynecologists

47. Operative vaginal delivery

sphincter injuries OA – Occiput anterior OP – Occiput posterior Procedure for ventouse/vacuum delivery Indications Foetal • Evident signs of asphyxia (scalp-pH 4.8 mmol/L, significant STAN-event during 2. Stage of labour, persistent bradycardia) • Suspicion of asphyxia Maternal • Failure to progress (dystocia) during 2. Stage of labour, when other treatment measures have been unsuccessful (Oxytocin-stimulation, change of position etc.) • Maternal exhaustion • Attempt to shorten 2. Stage of labour due (...) . • On maternal indication and with reassuring foetal heart rate, under normal circumstances, the baby should be delivered within 20 minutes. The number of pulls should not exceed 3 for descent of the caput and 3 for passing the perineum. • When the procedure is passed on to a more senior doctor the total time frame and/or number of pulls for safe delivery should not be exceeded. • The cup may be reapplied twice if detachment occurs on the condition that no foetal scalp injuries are present. Reconsider

2019 Nordic Federation of Societies of Obstetrics and Gynecology

48. Intrapartum fever

is recommended in case of intrapartum fever D Fetal scalp pH and -electrode should be used on regular obstetric indication. In case of specific infections where the potential risk of maternal- fetal transmission of infection is particularly relevant these monitoring modalities can be contraindicated. D We recommend ensuring progression in labor and delivery within hours in case of persistent fever. C-section on usual obstetric indications. C Since the rate of maternal complications increases with time after (...) urine dip-stick is of relevance in the acute phase. o Infection parameters can be considered, but are of limited diagnostic value in the acute phase. They might be valuable when monitoring development post partum. D Suspicion on intrauterine infection in case of intrapartum fever and at least one of the folowing: • Fetal tachycardia >160 beats per minute • Foul smelling vaginal discharge/amniotic fluid • Uterine tenderness The individual signs have low predictive value. B Continuous CTG

2019 Nordic Federation of Societies of Obstetrics and Gynecology

49. Management of Stroke in Neonates and Children Full Text available with Trip Pro

in the majority of neonates with hemorrhagic stroke, risk factors include postmaturity, emergency cesarean delivery, fetal distress, and male sex. , Mutations in COL4A1 should be considered in neonates with cerebral hemorrhage, porencephaly, glaucoma, or cataracts. , Some hemorrhagic lesions such as periventricular hemorrhagic venous infarction may actually represent hemorrhagic conversion of an arterial or venous infarction. Either acquired or congenital coagulopathy may lead to intracranial hemorrhage

2019 American Heart Association

50. ShortGUIDE: Instrumental vaginal birth

station plus 2 cm and above the pelvic floor · Two subdivisions: o Rotation of 45º or less from the OA position o Rotation of more than 45º including the OP position Outlet · Fetal skull (not caput) has reached the pelvic floor · Fetal scalp visible without separating the labia · Sagittal suture is in the antero-posterior diameter or right or left OA or OP (rotation does not exceed 45º) Indications and contraindications for instrumental vaginal birth Aspect Consideration Indications · Women (...) with a live fetus with cephalic presentation in second stage labour where 2 : o There is inadequate progress in active second stage in the presence of adequate uterine activity [refer to Queensland Clinical Guideline: Normal birth 3 ] o Maternal effort is contraindicated (e.g. cardiac conditions, hypertensive crisis 4 ) o Fetal compromise is suspected 4,5 Contraindications · Head is above the ischial spines or 2/5th or more palpable abdominally above the symphysis pubis 1 · Known or suspected fetal bone

2019 Queensland Health

51. Pruritus

symptom in patients with Hodgkin’s lymphoma, occurring in more than 30% of this patient group (Weisshaar and Dalgard 2009). In a retrospective study on 139 patients with CP, most cases of severe and long-lasting itch were found in patients with multiple systemic diseases and in patients with pruritus of unknown origin, while pruritus of the scalp and face was often a presenting symptom of psychiatric disease (Ferm, Sterner et al. 2010). Only few studies have addressed the frequency of pruritus (...) and this has implications for the therapeutic approach (Evers, Schut et al. 2016). Symptoms of obsessive compulsive disorder can manifest with CP, as seen in patients with skin picking (Craig-Muller and Reichenberg 2015, Tomas-Aragones, Consoli et al. 2016). "Scalp itch" is often a symptom of depression or a precursor to psychosis. CP can be a symptom in psychotic patients, manifesting as delusional parasitosis, a rare condition that is challenging to treat both for dermatologists and for psychiatrists

2019 European Dermatology Forum

52. Fever during labor

tenderness The individual signs have low predictive value. B Continuous CTG is recommended in case of intrapartum fever D Fetal scalp pH and -electrode should be used on regular obstetric indication. In case of specific infections where the potential risk of maternal- fetal transmission of infection is particularly relevant these monitoring modalities can be contraindicated. D We recommend ensuring progression in labor and delivery within hours in case of persistent fever. C-section on usual obstetric (...) should be considered. D o All microbiotic tests may be valuable postpartum, but only urine dip-stick is of relevance in the acute phase. o Infection parameters can be considered, but are of limited diagnostic value in the acute phase. They might be valuable when monitoring development post partum. Suspicion on intrauterine infection in case of intrapartum fever and at least one of the folowing: • Fetal tachycardia >160 beats per minute • Foul smelling vaginal discharge/amniotic fluid • Uterine

2018 Nordic Federation of Societies of Obstetrics and Gynecology

53. Brodalumab (Kyntheum) - plaque psoriasis

contains 140 mg/mL brodalumab in glutamate, proline, and polysorbate 20, filled to deliver a volume of 1.5 mL to provide 210 mg of brodalumab. The main changes during the development of the 140 mg/mL PFS are the manufacturing site, the primary container (different syringes) and the manufacturing scale. Results of lot release and stability testing and additional characterisation studies were comparable for the commercial product. The container closure system complies with Ph. Eur. requirements (...) intermediates provided were supported by small-scale characterisation studies to evaluate the chemical stability. The Applicant’s approach as regards the pool holds which are controlled within the validated hold times but may be extended within the characterised acceptable hold times through additional validation studies, is considered acceptable. As per request, the maximal holding time for the low pH pool was reduced. Control of materials The presence of the heavy chain variant is one of the main

2017 European Medicines Agency - EPARs

54. Guselkumab (Tremfya) - Psoriasis

other week q4w every 4 weeks q8w every 8 weeks q12w every 12 weeks RA rheumatoid arthritis SAE serious adverse event SAP statistical analysis plan Assessment report EMA/692068/2017 Page 7/148 SC subcutaneous, subcutaneously SD standard deviation SEER Surveillance, Epidemiology, and End Results SF-36 Medical Outcomes Study 36-Item Short Form SIB suicidal ideation and behavior SOC system-organ class ss-IGA scalp-specific Investigator’s Global Assessment T 1/2 terminal half-life TB tuberculosis Th1 T (...) , indurated, erythematous plaques that are covered by friable, dry, white-silvery scale. Areas of the body that are frequently involved include the scalp, elbows, knees, buttocks, and genitalia. The extent of skin involved varies among affected individuals, and is a primary determinant of severity. Psoriasis typically follows a chronic relapsing and remitting course around an individual’s underlying baseline severity, with flare-ups occurring spontaneously or during times of illness, or psychological

2017 European Medicines Agency - EPARs

55. Neonatal stabilisation for retrieval

service capability · Seek advice: o Contact RSQ o Phone 1300 799 127 Maternal risk · Severe hypertensive disorder · Antepartum haemorrhage · Other care requirements beyond service’s CSCF Fetal risk · Threatened preterm birth · Fetal anomalies · FGR · Multiple pregnancy · Other care requirements beyond service’s CSCF Yes Yes No No CSCF: Clinical services capability framework; FGR: Fetal growth restriction; QCG: Queensland Clinical Guidelines; RSQ: Retrieval Services Queensland Queensland Clinical (...) acidosis– pH 60 mmHg · Increasing apnoea and/ or bradycardia · Consider total clinical presentation Signs of CPAP failure? Yes No Contact Retrieval Services Queensland for advice or retrieval activation at any time Phone 1300 799 127 Yes Assess and monitor clinical condition Surfactant · Baby with HMD requiring intubation and ventilation from birth · Up to 24 hours of age · Continue IPPV Surfactant indicated/available? Wait for retrieval · Continue ongoing care as indicated · Discuss changes

2018 Clinical Practice Guidelines Portal

56. Perineal care

floor muscle training OASIS Obstetric anal sphincter injury or injuries OR Odds ratio OT Operating theatre PR Per rectum RCT Randomised controlled trial RR Relative risk USS Ultrasound scan Definition of terms Accoucheur Clinician directly assisting with birth of baby. Anal manometry A test which measures the pressures of the anal sphincter muscles. Crowning When the widest part of the fetal head (biparietal diameter) has passed through the pelvic outlet. Deinfibulation A surgical procedure to cut (...) is not used routinely during spontaneous vaginal birth but only for specific conditions (e.g. selective use in instrumental deliveries or if fetal compromise). Sitz bath Warm bath to which salt has been added. Slow birth of fetal head Refers to measures taken to prevent rapid head expulsion at the time of crowning (e.g. counter pressure to the head (as needed) and minimising active pushing; it does not include measures such as fetal head flexion or the Ritgen manoeuvre). Queensland Clinical Guideline

2018 Queensland Health

57. Biologic therapy for psoriasis

SPCs) quantified · that maternal IgG, and therefore biologic drugs currently licensed for psoriasis, are actively transferred to the developing fetus during the second and third trimester and that the impact of this on fetal and neonatal development and risk of infection has not been adequately studied · that live vaccines must be avoided in infants born to mothers taking biologic therapy beyond 16 weeks gestation · relevant patient information resources X R29 Advise women of child-bearing (...) at localised sites and associated with significant functional impairment and/or high levels of distress (for example nail disease or involvement of high-impact and difficult-to-treat sites such as the face, scalp, palms, soles, flexures and genitals) áá R5 Consider biologic therapy earlier in the treatment pathway (for example, if methotrexate has failed, is not tolerated or is contra-indicated) in people with psoriasis that fulfils the disease severity criteria and who also have active psoriatic arthritis

2017 British Association of Dermatologists

58. Interventions Targeting Sensory Challenges in Children with Autism Spectrum Disorder - An Update

-42. doi: 10.1177/1362361309353613. PMID: 20923890.X-1 723. Leupen A. Helium and autism. Homoeopathic Links. 2011 2011 Summer;24(2):106- 1p. doi: 10.1055/s- 0030-1271051. PMID: 108231917. Language: English. Entry Date: 20110729. Revision Date: 20150712. Publication Type: Journal Article. Journal Subset: Alternative/Complementary Therapies.X-1, X-2 724. Li N, Jin BX, Li JL, et al. [Treatment of autism with scalp acupunctur]. Zhongguo Zhen Jiu. 2011 Aug;31(8):692-6. PMID: 21894689. X-1 725. Lim HA

2017 Effective Health Care Program (AHRQ)

60. MASAC Guidelines for Perinatal Management of Women with Bleeding Disorders and Carriers of Hemophilia A and B

and fetal risks of a vaginal delivery versus a planned caesarean delivery; the option of a planned caesarean delivery should be recommended when an affected or potentially affected male infant is anticipated.(9) (Grade B, Level III) In Those women who elect vaginal delivery, forceps and vacuum extraction, interventions that triple the risk of intracranial hemorrhage in affected male infants, should be avoided, as should fetal scalp electrode monitoring during labor. Umbilical Cord Blood Sampling (...) with bleeding disorders and possible carriers who plan to pursue a pregnancy. Women and their families should be acquainted with the various methods of diagnosing a potentially affected infant prior to delivery and the associated risks of each. Methods include preimplantation diagnosis, invasive prenatal diagnosis (chorionic villus sampling, amniocentesis, and cordocentesis), and ultrasound determination of fetal gender.(1-3) (Grade C, Level IV)* Pregnancy Management Pregnancy should be managed

2017 National Hemophilia Foundation

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