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Fetal Tachycardia

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121. Cardiovascular Considerations in Caring for Pregnant Patients: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

vascular resistance abruptly increases in the setting of high total body volume. Pregnancy in women with mechanical prosthetic heart valves is associated with increased risk of fetal and maternal morbidity and mortality. , , , Maternal risks include increased mortality, valve thrombosis–associated valvular dysfunction, heart failure, stroke, and maternal hemorrhage. Risks to the fetus include increased mortality, teratogenicity, and hemorrhage. , , The optimal strategy for maintenance (...) delivery for the indication of cardiac disease should be reserved for the most decompensated women for whom delivery needs to be achieved in the shortest time possible and for women who are fully anticoagulated with vitamin K antagonists in order to protect the fetus from hemorrhagic complications. The timing of delivery may be a contentious topic because the care team is often weighing maternal, obstetric, and fetal risks, and should include input from the cardio-obstetrics team. The ACOG recommends

2020 American Heart Association

122. Position Statement on the Management of Cardiac Electrophysiology and Cardiac Implantable Electronic Devices in Australia During the COVID-19 Pandemic: A Living Document Version 2

, are not uncommon. 18 There was no proven vertical transmission to the foetus among nine pregnant women with COVID 19, but symptomatic newborns as young as day 2 have been reported, some with typical features of respiratory distress syndrome (RDS) on chest X Ray, but with favourable outcome so far. 18 Cardiac effects in children Although tachycardia was documented in 40%, no cardiac effects have been described in children as of March 26 2020, aside from an elevated troponin in one 55-day old infant. 19 (However (...) ). • Classification of “semi-urgent” elective EP and CIED procedural indications where clinical judgement and collaboration with health care teams required before proceeding: (i) primary prevention defibrillator implants in patients at high risk of life threatening ventricular arrhythmias; (ii) cardiac resynchronization therapy (de-novo or upgrades); (iii) ventricular tachycardia ablation for medically refractory, recurrent ventricular tachycardia; (iv) CIED generator replacement for ERI battery status

2020 Cardiac Society of Australia and New Zealand

123. Obstetric Management of Patients with Spinal Cord Injuries

, and nasal obstruction, as well as twitching and increased spasticity in all limbs . The most common sign is systemic hypertension, which is variable in severity but can be severe. Reactive sinus bradycardia is common during acute autonomic dysreflexia; however, patients can display sinus tachycardia or cardiac arrhythmias including atrial fibrillation, premature ventricular contractions, or atrioventricular conduction abnormalities . Uteroplacental vasoconstriction may result in fetal hypoxia (...) an obstetrician with experience in caring for women with disabilities, maternal-fetal medicine subspecialists, anesthesiologists, spinal rehabilitation physicians, nurses, physiotherapists, occupational therapists, lactation consultants, pediatricians, and neonatologists . Common Complications Autonomic Dysreflexia Autonomic dysreflexia (sometimes called autonomic hyperreflexia) is the most serious medical complication that occurs in women with SCIs and is found in 85% of patients with lesions at or above T6

2020 American College of Obstetricians and Gynecologists

124. Early onset Group B streptococcal disease

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 (...) 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

2020 Queensland Health

125. Venous thromboembolism (VTE) prophylaxis in pregnancy and the puerperium

for complete drug information Queensland Clinical Guideline: VTE prophylaxis in pregnancy and the puerperium Refer to online version, destroy printed copies after use Page 9 of 25 1.5 Signs and symptoms of VTE Table 2. Signs and symptoms of VTE Type Clinical presentation Pulmonary embolism 11 • Dyspnoea (most common symptom of PE) • Palpitations • Chest pain • Haemoptysis • Hypoxia/Cyanosis • Tachycardia • Tachypnoea • Hypotension • Collapse Deep Vein Thrombosis • DVT in pregnancy is often proximal and may (...) modalities has been shown to reduce the incidence of DVT in high-risk non-pregnant patients 38 Pharmacological • Low molecular weight heparin (LMWH) o Agent of choice for antenatal thromboprophylaxis 2 o Does not cross placenta 2,9 o No evidence of teratogenicity or increased risk of fetal bleeding 2 o Associated with fewer bleeding episodes compared with Unfractionated Heparin (UFH) 13 o Risk of HIT lower with LMWH than with UFH 2 o Risk of osteoporosis lower with LMWH than UFH 2 o Refer to Department

2020 Queensland Health

126. 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

127. 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

128. Nausea and vomiting in pregnancy

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 (...) 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

2018 BMJ Best Practice

129. 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

130. 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

131. 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

133. Axicabtagene ciloleucel (Yescarta) - diffuse large B-cell lymphoma (DLBCL); primary mediastinal large B-cell lymphoma (PMBCL)

. There are insufficient exposure data to provide a recommendation concerning duration of contraception following treatment with YESCARTA. Pregnancy There are no available data with YESCARTA use in pregnant women. No reproductive and developmental toxicity animal studies have been conducted with YESCARTA to assess whether it can cause foetal harm when administered to a pregnant woman (see section 5.3). It is not known if YESCARTA has the potential to be transferred to the foetus. Based on the mechanism of action (...) , if the transduced cells cross the placenta, they may cause foetal toxicity, including B-cell lymphocytopenia. Therefore, YESCARTA is not recommended for women who are pregnant, or for women of childbearing potential not using contraception. Pregnant women should be advised on the potential risks to the foetus. Pregnancy after YESCARTA therapy should be discussed with the treating physician. Assessment of immunoglobulin levels and B-cells in newborns of mothers treated with YESCARTA should be considered. Breast

2018 European Medicines Agency - EPARs

134. Management of Cardiovascular Diseases during Pregnancy Full Text available with Trip Pro

and offspring complications 3174 3.3.3 Pregnancy heart team 3176 3.4 Cardiovascular diagnosis in pregnancy 3176 3.4.1 Electrocardiography 3176 3.4.2 Echocardiography 3176 3.4.3 Exercise testing 3177 3.4.4 Ionizing radiation exposure 3177 3.4.5 Chest radiography and computed tomography 3177 3.4.6 Cardiac catheterization 3177 3.4.7 Magnetic resonance imaging 3177 3.5 Genetic testing and counselling 3177 3.5.1 Pre-natal diagnosis 3178 3.6 Foetal assessment 3178 3.6.1 Screening for congenital heart disease 3178 (...) 3.6.2 Assessing foetal wellbeing 3178 3.7 Interventions in the mother during pregnancy 3178 3.7.1 Percutaneous therapy 3178 3.7.2 Cardiac surgery with cardiopulmonary bypass 3178 3.8 Timing and mode of delivery: risk for mother and child 3179 3.8.1 Timing of delivery 3179 3.8.2 Labour induction 3179 3.8.3 Vaginal or caesarean delivery 3179 3.8.4 Delivery in anticoagulated women (not including mechanical valve; see section 5) 3179 3.8.5 Urgent delivery on therapeutic anticoagulation 3179 3.8.6

2018 European Society of Cardiology

135. 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

137. Neratinib (Nerlynx) - Breast cancer, breast neoplasms

. Reductions in body weight and embryo- foetal viability were noted in the 6 mg/kg/day treatment group. Foetal changes were notable in the 20 mg/kg/day group, 10 foetuses experienced flexure/rotation anomalies, 3 foetuses from 1 litter displayed anasarca (generalised oedema) and 3 foetuses from another litter had abdominal discolouration and distention. In the 6 mg/kg/day group 1 foetus displayed a flexure/rotation anomaly which given the findings seen in the higher dose this can be considered (...) rats were detected in dosing up to 12 mg/kg/day. Assessment report EMA/CHMP/525204/2018 Page 28/169 Neratinib has been studied in embryo-foetal developmental oral toxicity studies in both rats and rabbits. In the definitive studies, pregnant rats were administered up to 15 mg/kg/day from gestation day 7 to 17 (GD7 to GD17), and pregnant rabbits were administered up to 9 mg/kg/day from GD7 to GD19. In rats, no changes in embryo-foetal viability were detected and there was no evidence

2018 European Medicines Agency - EPARs

138. Ocrelizumab (Ocrevus) - multiple sclerosis

Units F/T Freeze/Thaw; Assessment report EMA/790835/2017 Page 5/180 Fab Antigen Binding Portion Of Immunoglobulin Molecule FBS Fetal Bovine Serum Fc Fragment crystallisable Fc?RIIIa Fc gamma receptor IIIa FcRn neonatal Fc receptor FTIR Fourier Transform Infrared Spectroscopy FVIP filtered viral inactivation pool GPMF Genentech Production Manufacturing Facility HC Heavy Chain; HCCF Harvested Cell Culture Fluid HCP Host Cell Protein HEPES 4-(2-hydroxyethyl)-1-piperazine ethane sulfonic acid HMWS High

2018 European Medicines Agency - EPARs

139. Semaglutide (Ozempic) - Diabetes Mellitus

with a larger impact on low concentrations leading to underestimation of semaglutide exposures (rat, rabbit, monkey). For this reason, the plasma assay in rat and monkey was replaced by LC-MS/MS and ELISA. In the rabbit embryo-foetal development study (207360), measured concentration were below 200 nM, where Hook effect occurred and the values for dose-normalized average concentrations (Cavg) did not deviate from the other tests. Ozempic Assessment report EMA/CHMP/715701/2017 Page 24/156 The methods

2018 European Medicines Agency - EPARs

140. Rucaparib camsylate - Ovarian Neoplasms

repeat-dose study. At 75 mg/kg, the C max of 1680 and 2460 ng/mL for male and female dogs, respectively, was similar to the C max bound plasma concentration (1940 ng/mL) observed in patients treated with 600 mg BID rucaparib. Conversely, when rucaparib was given IV at 40 mg/kg for 5 days, ECG abnormalities described as persistent sinus tachycardia, atrioventricular nodal rhythm, were recorded in the dog. From the ECG tracings, the veterinary cardiologist concluded that nodal and ventricular (...) to a mean C max of 2070 ng/mL (C max of 1680 and 2460 ng/mL for male and female dogs, respectively). Measurements of external ECGs, as well as vital signs (heart rate, body temperature, pulse oximetry, and respiratory rate), were also evaluated in the 91-day repeat-dose study in dog, with no findings at doses up to 20 mg/kg/day (C max of 416 and 377 ng/mL for males and females, respectively). ECG abnormalities described as persistent sinus tachycardia and atrioventricular nodal rhythm were recorded when

2018 European Medicines Agency - EPARs

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