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Fetal Tachycardia

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142. Sodium zirconium cyclosilicate (Lokelma) - Hyperkalemia

weakness or signs of cardiac arrhythmias such as palpitations, bradycardia, or tachycardia. Hyperkalaemia is detected via blood testing, often during routine screening for a medical disorder or after complications (such as cardiac arrhythmias) have developed. Of greatest concern is the effect of hyperkalaemia on the cardiac system, where impairment of cardiac conduction sometimes leads to fatal cardiac arrhythmias such as asystole or ventricular fibrillation. Because of the potential for fatal cardiac

2018 European Medicines Agency - EPARs

143. 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

144. 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

145. Management of Infants at Risk for Group B Streptococcal Disease

and invasive infection of the fetus and/or fetal aspiration of infected amniotic fluid. This pathogenesis primarily occurs during labor for term infants, but the timing is less certain among preterm infants for whom intraamniotic infection may be the cause of PROM and/or preterm labor. Rarely, GBS EOD may develop at or near term before the onset of labor, potentially because of group B streptococci traversing exposed but intact membranes. GBS EOD also is associated with stillbirth. , Maternal colonization (...) be available at the time of delivery for infants born at or near term. Suspected intraamniotic infection is defined as a single maternal intrapartum temperature ≥39.0°C or maternal temperature of 38.0°C to 38.9°C in combination with 1 or more of maternal leukocytosis, purulent cervical drainage, or fetal tachycardia. Recognizing the uncertainties surrounding the diagnosis of intraamniotic infection, the ACOG recommends that intrapartum antibiotic therapy be administered whenever intra-amniotic infection

2019 American Academy of Pediatrics

146. Identifying Child Abuse Fatalities During Infancy

, liver, kidney, heart, muscle, adrenal gland, and/or pancreas for further analysis. In any case in which the medical examiner is unable to demonstrate an adequate reason for death, a blood sample can be retained for potential future analysis. More recently, it has been suggested that genetic mutations associated with cardiac rhythm disturbances, such as prolonged QT syndrome, catecholaminergic ventricular paroxysmal tachycardia, and others, are responsible for up to 10% of cases of sudden unexpected (...) for Medicolegal Death Investigation . Principles for Communicating with Next of Kin During Medicolegal Death Investigations . Washington, DC : National Institute of Justice ; 2012 . Available at: . Accessed January 23, 2018 Oyen N , Skjaerven R , Irgens LM . Population-based recurrence risk of sudden infant death syndrome compared with other infant and fetal deaths . Irgens LM , Skjaerven R , Peterson DR . Prospective assessment of recurrence risk in sudden infant death syndrome siblings . Irgens LM , Oyen N

2019 American Academy of Pediatrics

147. Guidelines for crises in anaesthesia - Quick Reference Handbook

are commonly simultaneous 2-1 Cardiac arrest (v.1) 2-2 Hypoxia/desaturation/cyanosis (v.1) 2-3 Increased airway pressure (v.1) 2-4 Hypotension (v.1) 2-5 Hypertension (v.1) 2-6 Bradycardia (v.1) 2-7 Tachycardia (v.1) 2-8 Peri-operative hyperthermia (v.1) Section 3: ‘Knowns’ Guidelines for crises where a known or suspected event requires treatment 3-1 Anaphylaxis (v.3) 3-2 Massive blood loss (v.2) 3-3 Can't intubate, can’t oxygenate (CICO) (v.1) 3-4 Bronchospasm (v.2) 3-5 Circulatory embolus (v.1) 3-6 (...) and APL valve (Box E) 100 bpm sinus rhythm, treat as hypovolaemia: give i.v fluid bolus. • If heart rate >100 bpm and non-sinus ? 2-7 Tachycardia. ? Depth • Ensure correct depth of anaesthesia AND analgesia (consider risk of awareness). ? Exclude potential surgical causes (Box D) – discuss with surgical team. ? Consider causes in Box E and call for help if problem not resolving quickly. 2-4 The Association of Anaesthetists of Great Britain & Ireland 2018. www.aagbi.org/qrh Subject to Creative Commons

2019 Association of Anaesthetists of GB and Ireland

148. Guidelines for the Administration of Electroconvulsive Therapy

be required to anaesthetic management to improve safety including left lateral or pel- vic wedge tilt, adequate pre-oxygenation, avoidance of hyperventilation, premedication with an antacid or H2 blocker and intubation. Close monitoring of mother and foetus is essential before, during and after ECT including consideration of foetal heart rate monitoring with Doppler or cardiotocography (CTG). ECT after 20 weeks gestation should only be administered in hospitals where obstetric support is available. Older (...) Australian & New Zealand Journal of Psychiatry, 00(0) Several systematic reviews have reported on the safety of ECT for the treatment of severe mental illness during pregnancy (Anderson and Reti, 2009; Leiknes et al., 2015; Miller, 1994; Sinha et al., 2017). Although the data are lim- ited, it seems that ECT is an effective treatment during pregnancy and that the risks to mother and foetus are rela- tively low. These risks should be carefully weighed against those of other treatments, or no treatment

2019 American Psychiatric Association

149. Intrapartum fever

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 (...) of >38.0ºC 30 minutes apart or 1 rectal temperature measurement of = 39°C B Temperature should be measured during labor in the following circumstances: • Suspicion of fever • PROM • ROM = 18 hours • Dystocia • Foul-smelling vaginal discharge/amniotic fluid • FHR > 150 beats per minute or rising baseline • Maternal tachycardia =100 beats per minute • Placement of epidural analgesia (before and after placement) • Threatening preterm labor/PPROM B-C Temperature measurement during labor is recommended every

2019 Nordic Federation of Societies of Obstetrics and Gynecology

150. Evaluation and management of polyhydramnios Full Text available with Trip Pro

lesions; severe cardiac abnormalities, such as Ebstein anomaly or tetralogy of Fallot with absent pulmonary valve, cardiomyopathy, supraventricular tachycardia, and complete heart block; or fetal thyrotoxicosis. In addition, polyhydramnios may be caused by anomalies that cause fetal urine overproduction, such as ureteropelvic junction obstruction (termed “paradoxical” polyhydramnios). Small placental chorioangiomas are relatively common and rarely cause pregnancy complications, but large (≥5 cm (...) anomaly severe enough to cause hydrops may result in polyhydramnios, as these entities are often associated with each other. In addition to maternal diabetes, other potential causes of apparently isolated polyhydramnios in a structurally normal fetus include alloimmunization and congenital infection. With diabetes, it is hypothesized that maternal hyperglycemia leads to fetal hyperglycemia, with subsequent osmotic diuresis into the amniotic fluid compartment. This hypothesis is supported

2019 Society for Maternal-Fetal Medicine

151. Management of Major Depressive Disorder (2nd Ediiton)

Psychologist Universiti Putra Malaysia, Selangor Professor Dr. Hatta Sidi Senior Lecturer & Senior Consultant Psychiatrist Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur Dr. Idayu Maarof Registered Medical Practitioner (General Practitioner) & Patient Advocate Shah Alam, Selangor Professor Dr. Mohamad Hussain Habil Senior Lecturer & Senior Consultant Psychiatrist MAHSA University, Selangor Dr. Muniswaran a/l Ganesham @ Ganeshan Maternal-Fetal Medicine Specialist & Ostetrician

2019 Ministry of Health, Malaysia

152. Management of Heart Failure (4th Edition)

terms or free text terms were used either singly or in combination: “Heart Failure”, “Congestive Cardiac Failure”, “Acute Heart Failure, “Chronic Heart Failure” “Right Heart Failure”, “Left Heart Failure” [MeSH], “Heart Failure Reduced Left Ventricular Function”, Heart Failure Preserved Left Ventricular Function” [MeSH], Acute decompensated heart failure, tachycardia-induced cardiomyopathy, heart failure mid-range, refractory heart failure, terminal heart failure, end stage heart failure, cardio (...) defibrillator (ICD) is indicated for secondary prevention in: ? Patients resuscitated from sudden cardian death (SCD) due to ventricular fibrillation or haemodynamically unstable sustained ventricular tachycardia. ? Prior MI and LVEF = 40% with non-sustained VT AND inducible sustained VT or VF during an an electrophysiology (EP) study. ? Patients with chronic HF and LVEF = 35% who experience syncope of unclear origin. ? Surgery For HF ? Coronary revascularisation (by either coronary artery bypass graft

2019 Ministry of Health, Malaysia

155. 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 (...) ShortGUIDE: Preterm prelabour rupture of membranes (PPROM) z Available from: www.health.qld.gov.au/qcg Effective: December 2018 | Review: December 2023 | Doc No: MN18.48-V1-R23 Queensland Clinical Guidelines short GUIDE Queensland Health Preterm prelabour rupture of membranes (PPROM) IMPORTANT: Consider individual clinical circumstances. Read the full disclaimer at www.health.qld.gov.au/qcg Aspect Consideration Relevant to: · Women with a live, singleton fetus with cephalic presentation between

2019 Queensland Health

156. Syphilis in pregnancy

infections (STI) 12 · Although estimates vary, approximately 50% of women with syphilis requiring treatment in pregnancy suffer adverse pregnancy outcomes 13,14 · In the absence of effective treatment 15,16 maternal/fetal impacts include: o 25% of pregnancies result in a second trimester miscarriage or stillbirth o 11% of pregnancies result in a neonatal death at term o 13% of pregnancies result in a preterm or low birth weight infant Fetus/baby · Placental infiltration reduces blood flow to the fetus (...) , 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

2019 Queensland Health

157. Neonatal seizures

and hypsarrhythmia 36 • Occur rarely but carry worst prognosis 35,36 Subtle • More common in term babies 36 but also found with preterm babies 35 • May have 10,36 : o Ocular–tonic horizontal eye deviation or sustained eye opening with ocular fixation or cycle fluttering o Oral-facial-lingual movements–chewing movements, tongue thrusting, lip smacking o Limb movements–cycling, paddling, boxing jabs o Autonomic CNS phenomena–tachycardia, bradycardia o Apnoeic spells: ? Area rare manifestation of seizures (...) change 7 • Tremulousness of all limbs or just one limb • May also have a pathological basis • Commonly seen in many of the same conditions that are associated with neonatal seizures, e.g. drug withdrawal (from maternal drug ingestion), HIE, hypocalcaemia, and hypoglycaemia • Can clinically differentiate from seizures by disappearance with physical restraint (by holding the baby) and also a lack of associated features e.g. tachycardia or apnoea 10 Excessive startles • Markedly excessive startles

2019 Queensland Health

158. Primary postpartum haemorrhage

(e.g. rudimentary horn) Presentation · Intrapartum—act to rapidly deliver baby and placenta · Signs of uterine rupture may include 37 : o Maternal: tachycardia and signs of shock, sudden shortness of breath, constant abdominal pain, possible shoulder tip pain, uterine/suprapubic tenderness, change in uterine shape, pathological Bandl’s ring, incoordinate or cessation of contractions, frank haematuria, abnormal vaginal bleeding, abdominal palpation of fetal parts, absent presenting part o Fetal (...) · After vaginal birth: 500 mL or more 4 · After caesarean section (CS): 1000 mL or more 9 · Severe: 1000 mL or more 10,11 · Very severe: 2500 mL or more 10 · Queensland perinatal data collection, categorises PPH blood volume as 500–999 mL, 1000–1499 mL, 1500 mL or more Haemodynamic compromise · Due to frequent underestimation of blood loss 11 , PPH may first be detected through haemodynamic compromise 3 o Manifests as increasing tachycardia and hypotension · A healthy pregnant woman will only show

2019 Queensland Health

159. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures

/files/lipid-guidelines.pdf and www.lipid.org/recommendations) (Grade D). R17. (2013*). Candidates for bariatric procedures should avoid pregnancy pre- procedure and for 12 to 18 months post-procedure (Grade D). Women who become pregnant after bariatric procedures should be counseled and monitored for appropriate weight gain, nutritional supplementation, and fetal health (Grade C; BEL 3). All women DOI:10.4158/GL-2019-0406 © 2019 AACE. 30 of reproductive age should be counseled on contraceptive (...) , and copper (Grade D). Patients who become pregnant post-laparoscopic adjustable gastric band should have band adjustments as necessary for appropriate weight gain for fetal health (Grade B; BEL 2). R18. (2008*). Estrogen therapy should be discontinued before a bariatric procedure (1 cycle of oral contraceptives in premenopausal women; 3 weeks of hormone replacement therapy in postmenopausal women) to reduce the risks for post-procedure thromboembolic phenomena (Grade D). R19. (2008*). Women should

2019 American Association of Clinical Endocrinologists

160. Use of Human Induced Pluripotent Stem Cell–Derived Cardiomyocytes in Preclinical Cancer Drug Cardiotoxicity Testing: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

differentiated hiPSC-CMs is reflected in their transcriptome that most closely matches that of a first-trimester fetus. For in vivo implantation, the immature characteristics of hypoxia resistance and residual proliferative activity may prove advantageous. However, they become disadvantages when in vitro model systems are expected to resemble adult human cardiomyocytes in form and function. Because of this, efforts are ongoing to push these cells toward a more mature phenotype. The main markers of success (...) of TdP, a rare polymorphic ventricular tachycardia characterized by “twisting of the points” morphology that may degenerate to ventricular fibrillation. A number of oncology drugs are associated with QT prolongation, a surrogate marker of proarrhythmia, although the incidence of TdP is rare. Despite the putative electrophysiological immaturity of 2D sheets of hiPSC-CMs, recent efforts have demonstrated their ability to detect concentration-dependent delayed repolarization using either extracellular

2019 American Heart Association

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