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Fetal Scalp pH

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81. Zyclara - imiquimod

in accordance with Article 8(3) of Directive 2001/83/EC. The applicant applied for the following indication: topical treatment of clinically typical, visible or palpable actinic keratoses (AK) of the full face or balding scalp in adults. The legal basis for this application refers to: Hybrid application (Article 10(3) of Directive No 2001/83/EC). The application submitted is composed of administrative information, complete quality data and appropriate clinical data. Information on paediatric requirements (...) cells. The proposed indication for Zyclara 3.75% (imiquimod) cream is different from the reference product and includes topical treatment of clinically typical, nonhyperkeratotic, nonhyperpertrophic, visible or palpable actinic keratoses (AK) of the full face or balding scalp in immunocompetent adults. During assessment, and due to absence of active controlled studies, this indication was limited to second line treatment being the approved indication: Topical treatment of clinically typical

2012 European Medicines Agency - EPARs

82. Picato - ingenol mebutate

) Gel PD Pharmacodynamics PDCO Paediatric Committee Ph. Eur. European Pharmacopeia PK Pharmacokinetics PKC Protein kinase C PP Per protocol RCM Reflectance confocal microscopy RCT Randomised Control Trial RH Relative Humidity SAE Serious Adverse events SCC Squamous cell carcinoma SmPC Summary of Product Characteristics SOC System Organ Class T max Time to maximum concentration TPA 12-O-tetradecanoylphorbol-13-acetate; phorbol 12-myristate 13- acetate TSE Transmissible Spongiform Encephalopathy TSQM (...) histologically by atypical epithelial proliferation. Actinic keratosis usually develops on areas that are frequently exposed to the sun (e.g., face, lips, ears, scalp, neck, forearms and back of the hands). Actinic keratosis is a carcinoma in situ with progression to invasive squamous cell carcinoma (SCC). Histological evidence shows that contiguous AK is present in 97% of SCC lesions on sun-damaged skin. Actinic keratosis lesions are currently the most common epithelial premalignant lesions seen

2012 European Medicines Agency - EPARs

83. Mirabegron (Myrbetriq)

Trade and Generic Name} 19 4.3 Preclinical Pharmacology/Toxicology The product is designated a Pregnancy category C, wherein use is recommended in pregnancy only where the potential benefit would outweigh the risks to patient and fetus. Reproductive toxicology studies showed some fetal effects but only at substantial multiples of exposure (e.g., 22-fold and 36-fold exposures at the maximum recommended human dose). Mirabegron was neither genotoxic nor carcinogenic. There were no significant efficacy

2012 FDA - Drug Approval Package

84. British HIV Association guidelines for the management of HIV infection in pregnant women

Questions and PICO criteria A2.2 Search 1: safety and ef?cacy of antiretrovirals in pregnancy A2.3 Search 2: hepatitis viruses coinfection A2.4 Search 3: delivery, fetal monitoring and obstetric issues 88 BHIVA Writing Group © 2012 British HIV Association HIV Medicine (2012), 13 (Suppl. 2), 87–157A2.5 Search 4: paediatric issues A2.6 Search 5: investigations and monitoring in pregnancy Appendix 3: Search protocols (main databases search) A3.1 Search 1: when to initiate antiretroviral therapy A3.2 Search (...) 2: hepatitis coinfection A3.3 Search 3: fetal monitoring and obstetric issues A3.4 Search 4: paediatric issues A3.5 Search 5: investigations and monitoring in pregnancy Appendix 4 A4.1 Antiretroviral therapies for which suf?cient numbers of pregnancies with ?rst trimester exposure have been monitored to detect a two-fold increase in overall birth defects A4.2 Advisory Committee Consensus BHIVA guidelines for the management of HIV infection in pregnant women 2012 89 © 2012 British HIV Association

2012 The Children's HIV Association

85. The importance of the learning process in ST analysis interpretation and its impact in improving clinical and neonatal outcomes. Full Text available with Trip Pro

collected prospectively from labors monitored with ST analysis as an adjunct to conventional intrapartum fetal heart rate monitoring. Primary endpoints were the rates of metabolic acidosis (cord artery pH <7.05 and an extracellular fluid compartment base deficit >12.0 mmol/L), fetal scalp blood sampling, and operative deliveries. Comparisons of these outcomes were made between the initiation period (the first 2 years) and the subsequent usage period (the next 9 years).In the whole study population (...) the prevalence of cord pH <7.05 decreased from 1.5-0.81% (relative risk, 0.54; 95% confidence interval, 0.43-0.67), the rate of cesarean deliveries from 17.2-14.1% (relative risk, 0.82; 95% confidence interval, 0.89-0.97), and the rate of fetal scalp blood sampling from 1.75-0.82% (relative risk, 0.47; 95% confidence interval, 0.38-0.58) when the 2 study periods were compared. In the ST analysis group, the frequency of cord metabolic acidosis rate was reduced from 1.0-0.25% (relative risk, 0.33; 95

2018 American Journal of Obstetrics and Gynecology

86. Routine newborn assessment

Routine 5-7 days & 6 weeks • Chart head circumference, length, weight on centile charts • Head shape, size • Scalp, fontanelles, sutures • Eye size, position structure • Nose, position, structure • Ear position, structure • Mouth, palate, teeth, gums tongue, frenulum • Jaw size • Size, shape, symmetry, movement • Breast tissue, nipples • Heart sounds, rate, pulses • Breath sounds, resp rate • Pulse oximetry (optional) • Ortolani and Barlow’s manoeuvres • Leg length, proportions, symmetry and digits (...) of non-reassuring fetal status in labour (e.g. cord gases) o Presentation and mode of birth o Apgar scores and resuscitation at birth o Medication since birth (e.g. Vitamin K, Hepatitis B immunoglobulin/vaccine, antibiotics) • Gestational age • Observations since birth o Axillary temperature, o Weight o Urine/meconium o Finnegan score (if relevant) • Feeding since birth (e.g. suck behaviour, mode of feeding) Explanation • Introduce yourself to the parents with an explanation of the purpose, procedure

2014 Queensland Health

87. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants

: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants Catherine a . Mazzola , M.D., 1 a si M F. Chou Dhri , M.D., 2,3 Kurtis i. a uguste , M.D., 4 Davi D D. l i Mbri CK Jr ., M.D., Ph .D., 5 Marta r ogi Do , M.D., 6 l aura Mit Chell , M.a ., 7 an D a nn Marie Flannery , M.D. 8 1 Division of Pediatric Neurological Surgery, Goryeb Children’ s Hospital, Morristown, New Jersey; 2 Departments of Radiology and Neurosurgery (...) . Fewer shunt revi- sions in both groups compared to control group. Lam & Heil- man, 2009 Single-institution, retrospective historical cohort study of 32 preterm infants w/ PHH. This study compared 2 cohorts of infants: those treated w/ VAD/Ommaya placement vs those treated w/ VSG shunts. There were no statistical differences in age or birth weight of the infants in the 2 groups. The groups were studied for IVH grade, need for daily CSF withdrawal, CSF leak from the scalp, CSF infection, & need

2014 Congress of Neurological Surgeons

88. Safe Prevention of the Primary Cesarean Delivery

elements of the Category II tracing or provide reassurance of fetal well-being. Scalp stimulation to elicit a fetal heart rate acceleration is an easily employed tool when the cervix is dilated and can offer clinician reassurance that the fetus is not acidotic. Spontaneous or elicited heart rate accelerations are associated with a normal umbilical cord arterial pH (7.20 or greater) (54, ). Recurrent variable decelerations, thought to be a physiologic response to repetitive compression of the umbilical (...) or reduce cesarean delivery rates ( , ). Despite the evidence that fetal scalp sampling reduces the risk of cesarean delivery ( , ) and the poor ability of electronic fetal heart rate monitoring patterns to predict pH, intrapartum fetal scalp sampling has fallen out of favor in the United States. This predominantly is due to its invasive nature, the narrow clinical presentations for which it might be helpful, and the need for regulatory measures to maintain bedside testing availability. Currently

2014 American College of Obstetricians and Gynecologists

89. Routine newborn assessment

Routine 5-7 days & 6 weeks • Chart head circumference, length, weight on centile charts • Head shape, size • Scalp, fontanelles, sutures • Eye size, position structure • Nose, position, structure • Ear position, structure • Mouth, palate, teeth, gums tongue, frenulum • Jaw size • Size, shape, symmetry, movement • Breast tissue, nipples • Heart sounds, rate, pulses • Breath sounds, resp rate • Pulse oximetry (optional) • Ortolani and Barlow’s manoeuvres • Leg length, proportions, symmetry and digits (...) of non-reassuring fetal status in labour (e.g. cord gases) o Presentation and mode of birth o Apgar scores and resuscitation at birth o Medication since birth (e.g. Vitamin K, Hepatitis B immunoglobulin/vaccine, antibiotics) • Gestational age • Observations since birth o Axillary temperature, o Weight o Urine/meconium o Finnegan score (if relevant) • Feeding since birth (e.g. suck behaviour, mode of feeding) Explanation • Introduce yourself to the parents with an explanation of the purpose, procedure

2014 Clinical Practice Guidelines Portal

90. HIV, viral hepatitis and STIs - a guide for primary care

are absent or greatly reduced and large numbers of gram-variable, small, mostly anaerobic micro-organisms including Gardnerella vaginalis, Atopobium vaginae, Mobiluncus sp, and Prevotella sp replace them. Some of these organisms are highly motile and tend to cluster around shed epithelial cells in vaginal fluid. Microscopists describe such cells as ‘clue cells’ and they are a hallmark of bacterial vaginosis. The normal acidic milieu of the vagina is lost with the pH rising to 7 or above. The cause

2014 Clinical Practice Guidelines Portal

91. Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery Full Text available with Trip Pro

fluoroquinolone if the patient is β-lactam allergic). e Prophylaxis should be considered for patients at highest risk for postoperative gastroduodenal infections, such as those with increased gastric pH (e.g., those receiving histamine H 2 -receptor antagonists or proton-pump inhibitors), gastroduodenal perforation, decreased gastric motility, gastric outlet obstruction, gastric bleeding, morbid obesity, or cancer. Antimicrobial prophylaxis may not be needed when the lumen of the intestinal tract (...) for postoperative gastroduodenal infections, such as those with increased gastric pH (e.g., those receiving histamine H 2 -receptor antagonists or proton-pump inhibitors), gastroduodenal perforation, decreased gastric motility, gastric outlet obstruction, gastric bleeding, morbid obesity, or cancer. Antimicrobial prophylaxis may not be needed when the lumen of the intestinal tract is not entered. f Consider additional antimicrobial coverage with infected biliary tract. Seethe biliary tract procedures section

2013 Infectious Diseases Society of America

92. Diagnosis and Management of Hepatitis C Infection in Infants, Children, and Adolescents

pregnancy or because infants of HIV-positive mothers may be born somewhat prematurely (43). High maternal HCV viral load (>600,000 IU/mL) appears to favor mother-to-infant HCV transmission (44–46). Internal monitoring of the fetus (‘‘fetal scalp vein monitoring’’) (10), prolonged rupture of membranes (10,43), and fetal anoxia around the time of delivery, as indicated by decreased cord blood pH (46), may enhance the risk of infection. The role of amniocent- esis on the risk of mother-to-infant HCV (...) there are presently no effective strategies to prevent perinatal HCV transmission, universal screening of pregnant women is not recommended (91) Obstetrical-perinatal factors Vertical transmission of HCV is similar between infants born by C-section or vaginally; however, prolonged rupture of membranes and the use of fetal scalp probes are associated with increased HCV transmission rates and should be avoided (1B; AII) (92–94) Postnatal period The rate of vertical transmission is similar between breast- and bottle

2012 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

93. The Misoprostol Vaginal Insert for Labour Induction

= 69) or adjusted (MVI-10, n = 69) criteria. Main outcome measures: The primary outcomes were the time from induction to delivery and the caesarean section rate. The secondary outcomes included the need for additional measures to induce labour, uterine tachysystole, tocolysis, fetal scalp blood testing, meconium-stained amniotic fluid, umbilical arterial pH, and Apgar score. Condition or disease Intervention/treatment Labour Induction Drug: Misoprostol vaginal insert Study Design Go to Layout table (...) and the postpartum fetal pH-value [ Time Frame: August 2016 ] Eligibility Criteria Go to Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Layout table for eligibility information Ages Eligible for Study: 18 Years

2017 Clinical Trials

94. Childhood Vascular Tumors Treatment (PDQ®): Health Professional Version

are most commonly coarctation of the aorta (coarctation is more proximal and affects longer segments), complex aortic arch anomalies, and ventricular and atrial septal defects. - E ye abnormalities. Ophthalmologic anomalies can include microphthalmos, retinal vascular abnormalities, persistent fetal retinal vessels, exophthalmos, coloboma, and optic nerve atrophy. These abnormalities are rare and occur in 7% to 10% of patients.[ ] Diagnosis of PHACE requires clinical examination, cardiac evaluation

2016 PDQ - NCI's Comprehensive Cancer Database

95. Eclamptic Seizure Management

in best option for control Concurrent anticonvulsant depresses respiration Avoid if possible Consider anticonvulsant if prolonged (caution adverse fetal effects) Amobarbital 250 mg IV in 10cc NS over 3 minutes 5-10 mg IV slow push 125mg IV Airway and respiratory management Protect airway from aspiration Place patient in left lateral decubitus position Suction oral secretions Anesthesia or other skilled clinician (e.g. emergency medicine) at bedside for possible intubation Consider Avoid unless pH (...) <7.10 Prevent injury Padding on side rails of bed Other post- measures Internal fetal monitor (Internal Scalp electrode) Consider catheter Single does not mandate cesarean delivery IV. Complications Maternal mortality Mortality in U.S.: 0.4% of cases Mortality in Mexico: 14% of ecamplsia cases : 5.5 to 23% of cases Fetal anoxia with severe neurologic deficits: 7% V. References Fontaine (2000) in ALSO, B:1-36 Sibai in Gabbe (2002) Obstetrics, p. 945-74 Images: Related links to external sites (from

2018 FP Notebook

96. Amnioinfusion

Related Chapters II. Indications Oligohydramnios with or without Preterm prolonged Recurrent s Cephalic presentation Thick particulate Meconium staining of amniotic fluid III. Contraindication Amnioinfusion should not delay definitive management (e.g. , ) Scalp pH < 7.20 s Uterine anomaly Undiagnosed IV. Efficacy Heavy meconium stained fluid Improved perinatal outcome Reduced risk Decreased NICU admissions Decreased risk of Cord Compression suspected Reduces s Lowers rate of ceserean sections V (...) . Technique Cervical exam Evaluate dilation and presentation Evaluate for Place fetal scalp electrode Place double lumen intrauterine pressure catheter Initial Bolus Warmed at 10-20 ml/minute Stop bolus at 250 to 500 cc Maintenance infusion of warmed Rate: 3 cc/min or 50 to 60 cc/hour Document intrauterine pressure continuously Goal: Maintain amniotic fluid index of 8-12 cm VI. Adverse Effects Uterine scar rupture VII. References Images: Related links to external sites (from Bing) These images

2018 FP Notebook

97. Childhood Soft Tissue Sarcoma Treatment (PDQ®): Health Professional Version

in children, adolescents, and young adults: experiences of the CWS and COSS study groups. Cancer 112 (11): 2424-31, 2008. [ ] Steelman C, Katzenstein H, Parham D, et al.: Unusual presentation of congenital infantile fibrosarcoma in seven infants with molecular-genetic analysis. Fetal Pediatr Pathol 30 (5): 329-37, 2011. [ ] Evans HL: Low-grade fibromyxoid sarcoma: a clinicopathologic study of 33 cases with long-term follow-up. Am J Surg Pathol 35 (10): 1450-62, 2011. [ ] Alaggio R, Collini P, Randall RL

2016 PDQ - NCI's Comprehensive Cancer Database

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

, and the sebaceous glands associated with the hair follicles. These structures are generally formed in the first and second trimesters of fetal development. These can form a large variety of benign or malignant tumors with diverse biological behaviors. Several of these tumors are associated with familial syndromes. Overall, there are dozens of different histological subtypes of these tumors associated with individual components of the adnexal structures.[ ] Finally, the subcutis is a layer that extends below (...) benign neoplasms include gastric hamartomatous polyps,[ ] pulmonary cysts,[ ] cardiac fibromas,[ ] meningiomas,[ - ] 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

2016 PDQ - NCI's Comprehensive Cancer Database

99. Operative Vaginal Delivery

scalp visible without separating the labia Fetal skull has reached the pelvic floor Sagittal suture is in the anterio-posterior diameter or right or left occiput anterior or posterior position (rotation does not exceed 45º) Fetal head is at or on the perineum Low Leading point of the skull (not caput) is at station plus 2 cm or more and not on the pelvic floor Two subdivisions: • rotation of 45º or less from the occipito-anterior position • rotation of more than 45º including the occipito-posterior (...) there is an increased chance of fetal abrasion or scalp trauma and to avoid fetal scalp clips or blood sampling during labour. 29 Vacuum extractors are contraindicated with a face presentation. It has been suggested that vacuum extractors should not be used at gestations of less than 36 weeks because of the risk of subgaleal and intracranial haemorrhage. 30,31 One case–control study suggests that this restriction may be unnecessary, but this study was small and undertaken outside the UK. 32 Below 34 weeks +0 days

2011 Royal College of Obstetricians and Gynaecologists

100. Fetal ST Segment and T Wave Analysis in Labor

concerns with the application of the technology to the United States. None of the randomized trials were performed in the United States where patient case-mix and obstetrical practice, such as the use of fetal scalp pH, differ from Europe, which may affect the impact of this technology on perinatal outcomes. Moreover, the results of the European studies are not uniformly positive. This protocol describes a randomized controlled trial of the STAN technology as an adjunct to electronic fetal heart rate (...) to Primary Outcome Measures : Number of Participants With Primary Composite Outcome [ Time Frame: From Delivery through 1 month of age ] Composite primary outcome of intrapartum fetal death, neonatal death, Apgar score <=3 at 5 minutes, neonatal seizure, umbilical artery blood pH <= 7.05 with base deficit >=12 mmol/L in extra-cellular fluid, intubation for ventilation at delivery, neonatal encelphalopathy Number of Intrapartum Fetal Deaths (Primary Outcome Component) [ Time Frame: During labor

2010 Clinical Trials

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