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Fetal Tachycardia

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102. Fetoscopic Fetal Transesophageal Electrocardiography: A Minimally Invasive Tool for Cardiac Monitoring, Diagnostics, and Intervention in Human Fetuses. (PubMed)

Fetoscopic Fetal Transesophageal Electrocardiography: A Minimally Invasive Tool for Cardiac Monitoring, Diagnostics, and Intervention in Human Fetuses. Therapy-refractory supraventricular tachycardias commonly result in hydrops and death in human fetuses. Fetal transesophageal electrocardiography may aid in understanding its underlying electrophysiological mechanism and allow stimulation. Percutaneous fetoscopic deployment of an electrode catheter into the fetal esophagus by way of a single (...) trocar was performed in a human fetus and permitted the recording of a fetal transesophageal electrocardiogram at 35 + 6 weeks of gestation. Fetal transesophageal electrocardiography can be achieved in human fetuses by way of a minimally invasive percutaneous fetoscopic approach and carries the potential to improve diagnosis and management of therapy-refractory supraventricular tachycardias in human fetuses.

2010 Pediatric Cardiology

103. Hepatic venous Doppler in the evaluation of fetal extrasystole. (PubMed)

Hepatic venous Doppler in the evaluation of fetal extrasystole. To evaluate the use of fetal hepatic venous Doppler in the diagnosis of fetal extrasystoles, to estimate the prevalence and persistence of extra atrial and ventricular heart beats throughout pregnancy, labor and delivery, and to estimate the frequency of coexisting congenital heart disease.This was a retrospective study of 256 singleton pregnancies attending our hospital as outpatients due to fetal extrasystoles. Hepatic venous (...) Doppler and detailed fetal echocardiography were performed. Information on fetal heart rate patterns during labor and neonatal conditions was collected. Congenital heart malformations and the frequency and persistence of fetal extrasystoles were noted.On venous Doppler examination, 228 (89%) of the fetuses showed signs of supraventricular extrasystoles (SVES) and 28 (11%) had ventricular extrasystoles (VES). One fetus with SVES developed atrial flutter during pregnancy and another case developed

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2010 Ultrasound in Obstetrics and Gynecology

104. Alterations of the Uteroplacental and Fetal Pulmonary Circulation Following Amnioinfusion

that make the intervention riskful; 5. No active premature labor (shortened cervix <15 mm, <3 cm of cervical dilatation; >6/hour uterine contractions) after 24 weeks of gestation; 6. Cervical cerclage in place; 7. Clear signs of maternal or fetal infection (2 or more of the following: maternal tachycardia >100/min, maternal temperature >38°C, maternal white blood count cells (WBC) >15,000/ml, maternal C-reactive protein (CRP) >20 mg/l, uterine tenderness, foul-smelling vaginal discharge, fetal (...) tachycardia >160 bpm); 8. Suspicion of placental abruption (uterine tenderness and bleeding episodes); 9. Previous invasive procedure in the pregnancy; 10. Fetal condition mandating immediate delivery; 11. Severe bleeding at present; 12. Maternal HIV and HBV/HCV infection; 13. Multiple gestation. Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided

2010 Clinical Trials

105. Emergency therapy of maternal and fetal arrhythmias during pregnancy (PubMed)

Emergency therapy of maternal and fetal arrhythmias during pregnancy Atrial premature beats are frequently diagnosed during pregnancy (PR); supraventricular tachycardia (SVT) (atrial tachycardia, AV-nodal reentrant tachycardia, circus movement tachycardia) is less frequently diagnosed. For acute therapy, electrical cardioversion with 50-100 J is indicated in all unstable patients (pts). In stable SVT, the initial therapy includes vagal maneuvers to terminate tachycardias. For short-term (...) management, when vagal maneuvers fail, intravenous adenosine is the first choice drug and may safely terminate the arrhythmia. Ventricular premature beats are also frequently present during PR and benign in most of the pts; however, malignant ventricular tachyarrhythmias (sustained ventricular tachycardia [VT], ventricular flutter [VFlut] or ventricular fibrillation [VF]) may occur. Electrical cardioversion is necessary in all pts who are in hemodynamically unstable situation with life-threatening

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2010 Journal of Emergencies, Trauma and Shock

106. Current Status of Fetal Cardiac Intervention (PubMed)

(18):e506 21041696 Aortic Valve surgery Bradycardia drug therapy Cardiac Surgical Procedures Extracorporeal Circulation Fetal Diseases therapy Fetal Heart physiology surgery Humans Hydrops Fetalis therapy Hypoplastic Left Heart Syndrome surgery Tachycardia drug therapy 73 2010 3 17 6 0 2010 3 17 6 0 2010 4 8 6 0 ppublish 20231543 121/10/1256 10.1161/CIRCULATIONAHA.109.870246 PMC4235260 NIHMS640931 Circulation. 2006 Mar 21;113(11):1401-5 16534003 Lancet. 2002 Nov 16;360(9345):1567-8 12443597 J Am (...) Current Status of Fetal Cardiac Intervention 20231543 2010 04 07 2018 11 13 1524-4539 121 10 2010 Mar 16 Circulation Circulation Current status of fetal cardiac intervention. 1256-63 10.1161/CIRCULATIONAHA.109.870246 McElhinney Doff B DB Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA. Tworetzky Wayne W Lock James E JE eng T32 HL007572 HL NHLBI NIH HHS United States Journal Article Review United States Circulation 0147763 0009-7322 AIM IM Circulation. 2010 Nov 2;122

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2010 Circulation

107. Diagnosis and Management of Acute Pulmonary Embolism

CYP3A4 Cytochrome 3A4 DAMOVES D-dimer, Age, Mutation, Obesity, Varicose veins, Eight [coagulation factor VIII], Sex DASH D-dimer, Age, Sex, Hormonal therapy DVT Deep vein thrombosis ECMO Extracorporeal membrane oxygenation ELISA Enzyme-linked immunosorbent assay EMA European Medicines Agency ERS European Respiratory Society ESC European Society of Cardiology FAST H-FABP, Syncope, Tachycardia (prognostic score) FDA US Food and Drug Administration GUSTO Global Utilization of Streptokinase and Tissue

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2019 European Society of Cardiology

108. Nausea and vomiting in pregnancy

of NVP and is characterised by persistent vomiting, volume depletion, ketosis, electrolyte disturbances, and weight loss. History and exam presence of risk factors first trimester of pregnancy weight loss of >5% absence of thyroid enlargement/nodules absence of central nervous system (CNS) signs dry mucous membranes postural dizziness tachycardia hypotension ketotic breath family history of hyperemesis gravidarum previous history of NVP multiple gestation or increased placental mass gestational (...) trophoblastic disease other causes of increased placental mass female fetus history of motion sickness history of migraine headache Diagnostic investigations full blood count basic metabolic panel serum liver function tests serum urea and creatinine serum thyroid-stimulating hormone (TSH) and free T4 urinalysis urine or serum ketones fetal ultrasound with nuchal translucency serum analytes Helicobacter pylori breath test urine culture serum amylase and lipase RUQ ultrasound renal ultrasound cranial CT

2018 BMJ Best Practice

109. Molar pregnancies

). Gestational trophoblastic disease includes tumours of fetal tissues, including hydatidiform moles, arising from placental trophoblasts. Syncytiotrophoblasts secrete human chorionic gonadotrophin and, therefore, this hormonal product is used as a tumour marker for the disease. History and exam presence of risk factors first trimester of pregnancy missed period vaginal bleeding unusually large uterus for gestational age headache and photophobia shortness of breath and respiratory distress severe nausea (...) and emesis tachycardia, tremor, insomnia, and diarrhoea hypertension pallor pelvic pain uterine bleeding peripheral oedema extremes of maternal age prior GTD blood group A, B, AB tobacco use diminished dietary fat and carotene Diagnostic investigations serum beta human chorionic gonadotrophin (hCG) FBC serum PT, PTT serum metabolic panel serum thyroid-stimulating hormone (TSH) blood type with antibody screen pelvic ultrasound CXR histological examination of placental tissue Treatment algorithm ACUTE

2018 BMJ Best Practice

110. Folate deficiency

metabolism are rare causes. In early disease, haemoglobin and MCV are normal. In severe disease, patients present with symptomatic anaemia and pancytopenia. Maternal folate deficiency is associated with fetal neural tube defects. Diagnosis is confirmed by the presence of low serum folate. Low RBC folate and elevated plasma homocysteine levels are helpful in situations of diagnostic difficulty. Vitamin B12 (cobalamin) deficiency must be ruled out before initiating folic acid therapy, as the therapy may (...) aggravate neurological manifestations of underlying vitamin B12 deficiency. Oral folic acid is usually considered sufficient therapy. Underlying cause should be identified and treated. Food fortification programmes instituted in some countries have decreased the incidence of folate deficiency and associated anaemia and fetal neural tube defects. Definition Megaloblastic anaemia without neuropathy is the classic manifestation of folate deficiency. Herbert V. Experimental nutritional folate deficiency

2018 BMJ Best Practice

111. Meconium aspiration syndrome

tachypnoea cyanosis systolic murmur chest wall asymmetry with decreased air entry barrel-shaped chest grunting chest retractions rales rhonchi tachycardia hypotension gestational age >42 weeks maternal history of hypertension, pre-eclampsia, eclampsia, smoking, substance abuse fetal distress oligohydramnios thick meconium Apgar score <7 chorioamnionitis caesarean delivery black or East Asian ancestry male sex Diagnostic investigations CXR FBC CRP blood culture dual pulse oximetry ABG (pH, PaO₂, PaCO (...) in the presence of maternal and fetal risk factors. Soon after birth, infants present with respiratory distress (tachypnoea, chest retractions, and hypoxia). Some may be asymptomatic and apparently vigorous at birth, and develop severe respiratory distress hours later. Signs of post-maturity, a strong risk factor, include green/yellow-coloured skin; long, stained nails; and dry, scaling skin. Diagnosis is confirmed by chest x-ray. Management is largely supportive. Infants should be monitored closely to ensure

2018 BMJ Best Practice

112. Placenta praevia

with an abnormally adherent placenta, where the placenta attaches to the myometrial layer of the uterus. Vasa praevia, where the fetal vessels lie over the internal cervical os, is an associated condition. In this topic we refer to all varieties of invasive placentation as abnormally adherent placenta. There are three commonly defined variants: placenta accreta (where chorionic villi attach to the myometrium, rather than being restricted within the decidua basalis), placenta increta (where the chorionic villi (...) invade into the myometrium), and placenta percreta (where the chorionic villi invade through the myometrium and sometimes into adjoining tissue). Publications Committee, Society for Maternal-Fetal Medicine, Belfort MA. Placenta accreta. Am J Obstet Gynecol. 2010 Nov;203(5):430-9. https://www.ajog.org/article/S0002-9378(10)01159-2/fulltext http://www.ncbi.nlm.nih.gov/pubmed/21055510?tool=bestpractice.com Although these distinctions are important to consultants, they do not change management decisions

2018 BMJ Best Practice

113. Diagnosis and management of epilepsy in adults

ContentsDiagnosis and management of epilepsy in adults Diagnosis and management of epilepsy in adults 5.6 Fetal, neonatal and childhood outcomes 43 5.7 Postpartum advice for mothers 47 5.8 Advice about breastfeeding 48 5.9 Menopause and epilepsy 49 6 Psychiatric comorbidity 50 6.1 Screening 50 6.2 Treatment options 52 7 Sleep 54 7.1 Sleep deprivation and sleep hygiene 54 7.2 Obstructive sleep apnoea and epilepsy 54 7.3 Sudden unexpected death in epilepsy and sleep 54 8 Mortality 55 8.1 Sudden unexpected death

2018 SIGN

115. Propranolol

to complete an . A corresponding patient information leaflet on is available at . Summary Propranolol is a non-selective beta-adrenoceptor blocking drug (...) propranolol exposure and women should be made aware of this lack of data. Studies of beta-blockers as a class have not, to date, provided conclusive evidence that use during pregnancy is associated with an increased risk of fetal structural malformations. Although some studies have suggested a possible increased risk of congenital heart defects (...) 02 20 2090-6668 2015 2015 Case reports in neurological medicine Case Rep Neurol Med Propranolol for Paroxysmal Sympathetic Hyperactivity with Lateralizing Hyperhidrosis after Stroke. 421563 10.1155/2015/421563 Brain injury can lead to impaired cortical inhibition of the hypothalamus, resulting in increased sympathetic nervous system activation. Symptoms (...) of paroxysmal sympathetic hyperactivity may include hyperthermia, tachycardia, tachypnea, vasodilation, and hyperhidrosis. We report

2018 Trip Latest and Greatest

117. Management of Cardiovascular Diseases during Pregnancy

pregnancy 3199 8.3.2 Bromocriptine and peripartum cardiomyopathy 3201 8.3.3 Devices and transplantation 3201 8.3.4 Anticoagulation 3201 8.3.5 Delivery and breastfeeding 3201 8.4 Hypertrophic cardiomyopathy 3201 8.4.1 Management 3201 8.4.2 Delivery 3202 8.5 Recommendations 3202 9. Arrhythmias 3203 9.1 Introduction 3203 9.2 Maternal risk 3203 9.3 Obstetric and offspring risk 3203 9.4 Supraventricular tachycardia 3203 9.5 Atrial fibrillation and atrial flutter 3203 9.5.1 Anticoagulation 3203 9.6 (...) Ventricular tachycardia 3203 9.7 Bradyarrhythmias 3204 9.7.1 Sinus node dysfunction 3204 9.7.2 Atrioventricular block 3204 9.8 Interventions 3204 9.8.1 Electrical cardioversion 3204 9.8.2 Catheter ablation 3204 9.8.3 Implantable cardioverter-defibrillator and pacing 3204 9.9 Recommendations 3206 10. Hypertensive disorders 3207 10.1 Diagnosis and risk assessment 3207 10.1.1 Blood pressure measurement 3207 10.1.2 Laboratory tests 3207 10.2 Definition and classification of hypertension in pregnancy 3207 10.3

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2018 European Society of Cardiology

118. ShortGUIDE: Preterm prelabour rupture of membranes (PPROM)

—if no local protocol CTG if greater than 28–30 weeks · Fetal tachycardia may indicate infection 20 Ultrasound scan · Serial second weekly as indicated · If greater than 23 weeks Pathology Full blood count · If indicated · Limited evidence for detection of uterine infection and/or improving maternal and neonatal outcomes 15 Urine MC&S · If indicated High/low vaginal swab · If indicated Outcomes for planned birth versus expectant management (24–37 weeks gestation) Any planned birth compared to expectant (...) week and 75% within two weeks 4 · Advise women to present for assessment when PPROM is suspected Aim of care · Maximise benefits of increasing fetal maturity in-utero while minimising potential risks 2 o Care recommendations are therefore based on gestational age and individual maternal and fetal circumstances Initial assessment · Review history and time of fluid loss (sudden gush of fluid or continued leakage of fluid per vagina) · Conduct a clinical assessment [refer to Queensland Clinical

2019 Queensland Health

119. Syphilis in pregnancy

, transient accentuation of cutaneous lesions 47 , hypotension and tachycardia 38,40 · May precipitate uterine contractions (56–67%), decreased fetal movements (67%) and abnormal fetal heart rate (FHR) tracings (50%) 24 · In severely affected pregnancies preterm birth and stillbirth have been reported 24 Management · Do not delay treatment due to concerns about adequacy of monitoring · Offer information to women about JHR o Refer to Queensland Clinical Guideline Parent information · Advise women to: o (...) Abbreviations CSF Cerebrospinal fluid FHR Fetal heart rate GP General Practitioner HIV Human immunodeficiency virus IgM Immunoglobulin M IV Intravenous JHR Jarisch Herxheimer Reaction PCR Polymerase Chain Reaction POC Point of care QSSS Queensland Syphilis Surveillance Service SOP Standard operating procedure STI Sexually transmitted infection USS Ultrasound VDRL Venereal Diseases Research Laboratory Definition of terms Adequate treatment In a pregnant woman, treatment may be considered adequate if a stage

2019 Queensland Health

120. Thyroid Function Testing in the Diagnosis and Monitoring of Thyroid Function Disorder

• Anxiety, irritability, restlessness • Fatigue, restless sleep • Increased appetite • Decreased attention span Neuromuscular • Physical tiredness • Paresthesia • Hypokinesis • Hyporeflexia • Tremors • Proximal muscle weakness • Hyperreflexia Physical Appearance/ Voice • Weight gain A • Coarse, dry skin • Periorbital edema • Hoarseness • Weight loss • Hair loss Cardiovascular • Bradycardia • Isolated diastolic hypertension • Palpitations, tachycardia • Atrial fibrillation • Isolated systolic (...) in the levothyroxine dose that they received during pregnancy. TSH should be evaluated 6 weeks after the dose change. 14 Hyperthyroidism in Pregnancy and Postpartum Hyperthyroid patients should have appropriate specialist consultation (endocrinologist or maternal-fetal medicine (e.g., obstetric internal medicine)) when contemplating pregnancy or during pregnancy. In the course of a normal pregnancy, TSH may be low in the first trimester, when human chorionic gonadotropin (hCG) peaks. Pathological causes of low TSH

2018 Clinical Practice Guidelines and Protocols in British Columbia

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