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Gestational Diabetes Insulin Management Intrapartum

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21. Management of Pregnancy

. Implementation 18 IV. Guideline Work Group 19 V. Algorithm 20 A. Algorithm Key 21 B. Actions at Every Visit 21 C. Interventions by Weeks Gestation 21 D. Standard of Pregnancy Care 23 a. Additional Information on Actions at Every Visit 23 b. Screenings 24 c. Time Sensitive Care 28 d. Summary 28 VA/DoD Clinical Practice Guideline for the Management of Pregnancy March 2018 Page 4 of 147 VI. Routine Pregnancy Care 29 VII. Recommendations 33 A. Care Throughout Pregnancy 36 a. Routine Care During Pregnancy 36 b (...) continues to develop throughout the course of the pregnancy, the gestational age at birth can help predict outcomes ( ).[ ] Table 1 2-4 While pregnancy and birth are normal physiological events, pregnancy is a period of increased risk for a range of conditions. It is also a time of great interaction with the healthcare system, affording an opportunity to optimally manage chronic health conditions and provide preventative care. The healthcare team’s goal is to maintain or improve the mother’s health

2018 VA/DoD Clinical Practice Guidelines

22. Gestational Diabetes Management

Gestational Diabetes Management Gestational Diabetes Management Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Gestational Diabetes (...) Management Gestational Diabetes Management Aka: Gestational Diabetes Management II. Indications: Gestational Diabetes Abnormal Preexisting III. Monitoring: Blood Glucose Frequency of therapy 4 times daily Diet control s 4 times on 2 days per week Increase monitoring if 2 values/week abnormal Target Levels Before Breakfast or early morning (2-6 am): 60 to 95 mg/dl Before Lunch,Dinner: 60 to 115 mg/dl One hour post prandial goal: under 140 mg/dl Two hour post prandial goal: under 120 mg/dl Check s in early

2015 FP Notebook

23. Intrapartum fetal surveillance

Fetal Growth Restriction; GDM Gestational Diabetes; IOL Induction of labour; MoM Multiples of Median; PaPP-A Pregnancy associated plasma protein-A; PROM Premature Rupture of Membranes; PTL Preterm labour; PV Per Vaginal; T Temperature; = greater than or equal to; Greater than; 4.8 Abnormal: urgent birth · pH 5.0 No Queensland Clinical Guidelines: Intrapartum Fetal Surveillance Guideline No: MN15.15-V4-R20 Confirmatory CTG Normal? Yes Normal CTG · Baseline FHR 110-160 bpm · Baseline variability 6-25 (...) or more of the following antenatal or intrapartum indications are present in labour, CEFM is recommended 2 because of the synergistic effect on the woman: · 41 to 41 + 6 weeks gestation · Gestational hypertension · Gestational Diabetes Mellitus (GDM) without complicating factors · Obesity (BMI 30–40 kg/m 2 ) · Maternal age greater than or equal to 40 and less than 42 years · Maternal pyrexia (temperature 37.8 o C or 37.9 o C) · Prior to epidural block to establish baseline features 2 3 Fetal heart

2010 Clinical Practice Guidelines Portal

24. Acute pain management: scientific evidence (3rd Edition)

Acute pain management: scientific evidence (3rd Edition) ? ? ? ? Acute Pain Management: Scientific Evidence Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine ? ? ? Endorsed by: Faculty?of?Pain?Medicine,?Royal?College?of? Anaesthetists,?United?Kingdom?? Royal?College?of?Anaesthetists,? United?Kingdom?? Australian?Pain?Society? Australasian?Faculty?of?Rehabilitation?Medicine? College?of?Anaesthesiologists,?? Academy?of?Medicine,?Malaysia? College (...) and New Zealand College of Anaesthetists, 630 St Kilda Road, Melbourne, Victoria 3004, Australia. Website: www.anzca.edu.au Email: ceoanzca@anzca.edu.au This document should be cited as: Macintyre PE, Schug SA, Scott DA, Visser EJ, Walker SM; APM:SE Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine (2010), Acute Pain Management: Scientific Evidence (3rd edition), ANZCA & FPM, Melbourne. Copyright information for Tables 11.1 and 11.2 The material

2015 National Health and Medical Research Council

25. Acute Pain Management: Scientific Evidence

Acute Pain Management: Scientific Evidence ACUTE PAIN MANAGEMENT: SCIENTIFIC EVIDENCE Fourth Edition 2015 Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine Edited by: Stephan A Schug Greta M Palmer David A Scott Richard Halliwell Jane T rinca© Australian and New Zealand College of Anaesthetists 2015 ISBN Print: 978-0-9873236-7-5 Online: 978-0-9873236-6-8 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced (...) and Faculty of Pain Medicine (2015), Acute Pain Management: Scientific Evidence (4th edition), ANZCA & FPM, Melbourne. Copyright information for Tables 10.1 and 10.2 The material presented in Table 10.1 and Table 10.2 of this document has been reproduced with permission from Prescribing Medicines in Pregnancy, 2015, Therapeutic Goods Administration. It does not purport to be the official or authorised version. © Commonwealth of Australia 2015 This work is copyright. You may download, display, print

2015 Clinical Practice Guidelines Portal

26. Management of Women with Obesity in Pregnancy

. Pre-pregnancy overweight and obesity were found to be significant risk factors for the development of type 2 diabetes in these women (aOR 2.0 (95% CI 1.1–3.4) and 2.6 (95% CI 1.5–4.5), respectively). Evidence level 2+ C D B CMACE/RCOG Joint Guideline: Management of Women with Obesity in Pregnancy Page 15 of 29 March 2010 All women with a booking BMI =30 who have been diagnosed with gestational diabetes should have annual screening for cardio-metabolic risk factors, and be offered lifestyle (...) consideration of these issues. The recommendations cover interventions prior to conception, during and after pregnancy. This guideline does not address the following areas: Management of pregnancy following bariatric surgery; anti- obesity drugs in pregnancy; technique and frequency of ultrasound scanning; gestational weight gain; dietary and exercise advice; and postnatal contraception. The National Institute for Health and Clinical Excellence (NICE) is currently developing a guideline on Weight Management

2010 Royal College of Obstetricians and Gynaecologists

27. Diabetes Mellitus and Pregnancy (Diagnosis)

lung profile if delivery is contemplated before 39 weeks’ gestation. Previous Next: Prepregnancy Management for Preexisting Diabetes In patients with preexisting diabetes, nutritional and metabolic intervention must be initiated well before pregnancy begins, because birth defects occur during the critical 3-6 weeks after conception. Insulin remains the standard medication for treatment of diabetes during pregnancy, but the oral agents glyburide and metformin are increasingly used. A study by Goh et (...) al found that, in routine practice, metformin use in gestational diabetes was associated with fewer adverse outcomes compared with insulin. [ ] Proper management can minimize the risks posed by glucose intolerance during pregnancy, but vigilance and meticulous monitoring is necessary. Therapeutic goals are best achieved through a team approach. To reduce diabetes-associated neonatal morbidity, counsel the patient before conception and perform a medical risk assessment in all women with overt

2014 eMedicine.com

28. Diabetes Mellitus and Pregnancy (Overview)

lung profile if delivery is contemplated before 39 weeks’ gestation. Previous Next: Prepregnancy Management for Preexisting Diabetes In patients with preexisting diabetes, nutritional and metabolic intervention must be initiated well before pregnancy begins, because birth defects occur during the critical 3-6 weeks after conception. Insulin remains the standard medication for treatment of diabetes during pregnancy, but the oral agents glyburide and metformin are increasingly used. A study by Goh et (...) al found that, in routine practice, metformin use in gestational diabetes was associated with fewer adverse outcomes compared with insulin. [ ] Proper management can minimize the risks posed by glucose intolerance during pregnancy, but vigilance and meticulous monitoring is necessary. Therapeutic goals are best achieved through a team approach. To reduce diabetes-associated neonatal morbidity, counsel the patient before conception and perform a medical risk assessment in all women with overt

2014 eMedicine.com

29. Diabetes Mellitus and Pregnancy (Treatment)

lung profile if delivery is contemplated before 39 weeks’ gestation. Previous Next: Prepregnancy Management for Preexisting Diabetes In patients with preexisting diabetes, nutritional and metabolic intervention must be initiated well before pregnancy begins, because birth defects occur during the critical 3-6 weeks after conception. Insulin remains the standard medication for treatment of diabetes during pregnancy, but the oral agents glyburide and metformin are increasingly used. A study by Goh et (...) al found that, in routine practice, metformin use in gestational diabetes was associated with fewer adverse outcomes compared with insulin. [ ] Proper management can minimize the risks posed by glucose intolerance during pregnancy, but vigilance and meticulous monitoring is necessary. Therapeutic goals are best achieved through a team approach. To reduce diabetes-associated neonatal morbidity, counsel the patient before conception and perform a medical risk assessment in all women with overt

2014 eMedicine.com

30. Diabetes Mellitus and Pregnancy (Follow-up)

lung profile if delivery is contemplated before 39 weeks’ gestation. Previous Next: Prepregnancy Management for Preexisting Diabetes In patients with preexisting diabetes, nutritional and metabolic intervention must be initiated well before pregnancy begins, because birth defects occur during the critical 3-6 weeks after conception. Insulin remains the standard medication for treatment of diabetes during pregnancy, but the oral agents glyburide and metformin are increasingly used. A study by Goh et (...) al found that, in routine practice, metformin use in gestational diabetes was associated with fewer adverse outcomes compared with insulin. [ ] Proper management can minimize the risks posed by glucose intolerance during pregnancy, but vigilance and meticulous monitoring is necessary. Therapeutic goals are best achieved through a team approach. To reduce diabetes-associated neonatal morbidity, counsel the patient before conception and perform a medical risk assessment in all women with overt

2014 eMedicine.com

31. Pregnancy and Renal Disease

], 2008, updated 2017. ? NICE: Vitamin D supplement use in specific population groups [PH56], 2017 ? NICE: Diabetes in Pregnancy: Management from Pre-conception to the Post-partum Period [NG3], 2015. ? NICE: Antenatal and postnatal mental health: clinical management and service guidance [CG192], 2014, updated 2018. ? NICE: Fertility: Assessment and Treatment for People with Fertility Problems, 2013. Renal Association Clinical Practice Guideline Pregnancy and Renal Disease – September 2019 5 ? NICE (...) . Pre-pregnancy care 3.1 Contraception 3.2 Fertility 3.3 Pre-pregnancy counselling and optimisation for pregnancy 4. Pregnancy care 4.1 Assessment of renal function in pregnancy 4.2 Antenatal care 4.3 Pre-eclampsia prophylaxis 4.4 Blood pressure management 4.5 Thromboembolism prophylaxis 4.6 Anaemia 4.7 Bone health 4.8 Renal biopsy 4.9 Peripartum care 4.10 Postnatal care 5. Specific conditions 5.1 Renal transplantation 5.2 Dialysis 5.3 Lupus 5.4 Diabetic nephropathy 5.5 Urinary tract infection (UTI

2019 Renal Association

32. Review of effective strategies to promote breastfeeding

in disaster and emergency events, such as during the Christchurch earthquake in New Zealand. 29 A recent report in South Australia also points to the applicability of such quality standards of care for all birthing dyads as a support for human rights where the mother is incarcerated. 30 Here the opportunity for ongoing breastfeeding may be denied due to institutional policy, or lack of prison nursery access. 31 More commonly, learning skills and techniques to manage separation from the infant during (...) the breastfeeding period is relevant for mothers of infants working outside the home. This highlights that Step 5 helps avoid early separation and supplementation in health facilities, but other approaches are needed to avoid and manage separation in other settings post-discharge (see ANBS-E Strategy 10: Other strategies below). In Australia, several studies have shown shorter and less exclusive breastfeeding duration among mothers employed during the first 12 months postnatally. 32-34 The type of childcare

2018 Sax Institute Evidence Check

33. Standard care

§ Use clinical discretion and consider the individual patient when using the chart for patient medication management in acute care settings 25 § Digital medication chart (approved locally) · Document in the medical record: o Drug name and route of administration o Indication for the medication o Intended duration o Plan for review 50 · For babies, note: date of birth, weight, gestational age, basis for dose calculation (e.g. mg/kg–if appropriate) and dose in units of mass (e.g. 150 mg per dose (...) elements of standard practice and accepts that individual clinicians are responsible for: · Providing care within the context of locally available resources, expertise, and scope of practice · Supporting consumer rights and informed decision making in partnership with healthcare practitioners, including the right to decline intervention or ongoing management · Advising consumers of their choices in an environment that is culturally appropriate and which enables comfortable and confidential discussion

2019 Queensland Health

34. Stillbirth care

: · Hypertensive disorders of pregnancy 7 · Gestational diabetes in pregnancy 8 · Obesity if pregnancy 9 · Vaginal birth after caesarean 10 · Early onset Group B Streptococcal disease 11 · Venous thromboembolism 12 · Perinatal substance use: maternal 13 · Induction of labour (IOL) 14 · Intrapartum fetal surveillance 15 · Preterm labour and birth 16 · Trauma in pregnancy 17 1.2 Causes and risk factors Table 1. Causes Aspect Consideration Context · In Queensland (2004–2013) 5 stillbirths most frequently: o (...) ); notched uterine arteries § Suspected prenatally with small for gestational age biometry and increased pulsatility index (PI) (greater than 90th percentile) 28 at Doppler ultrasonography from second trimester 29 · Diabetes in Aboriginal and Torres Strait Islander women 6 and pre-existing maternal diabetes 19,27 Isoimmunisation · Reduced fetal movement history · Post-term pregnancy (greater than or equal to 42 weeks gestation) 25 · Intrapartum obstructed labour and fetal injury Lifestyle/pre- existing

2019 Queensland Health

35. Breastfeeding - Promoting and Supporting the Initiation, Exclusivity, and Continuation of Breastfeeding in Newborns, Infants and Young Children

Tongue Assessment Tool CASP Critical Appraisal Skills Program CIHI Canadian Institute for Health Information CPNP Canadian Prenatal Nutrition Program EBM expressed breast milk FDA Food and Drug Administration HATLFF Hazelbaker Assessment Tool for Lingual Frenulum Function GDM gestational diabetes mellitus HSV herpes simplex virus IBCLC ® International Board Certified Lactation Consultant ® IBLCE ® International Board of Lactation Consultant Examiners ® ILCA ® International Lactation Consultant (...) , Exclusivity, and Continuation of Breastfeeding for Newborns, Infants, and Y oung Children ABBREVIATION TERM LGBTQ+ lesbian, gay, bisexual, transgender, queer or questioning, and other LOA leave of absence NICU neonatal intensive care unit NQuIRE ® Nursing Quality Indicators for Reporting and Evaluation RNAO Registered Nurses’ Association of Ontario SIDS sudden infant death syndrome SUPC sudden unexpected postnatal collapse THC tetrahydrocannabinol T2DM type 2 diabetes mellitus UK United Kingdom of Great

2018 Registered Nurses' Association of Ontario

36. Obesity in pregnancy

in this guideline refers to “pre-pregnancy BMI”. This guideline has some overlap with other Danish national obstetric guidelines, e.g. “Gestational Diabetes Mellitus”, “Fetus Magnus Suspicious”, “Physical Activity in Pregnancy”, “Tromboprophylaxis”, “Vitamin D” and “Prolonged Pregnancy”. We therefore refer to these guidelines for further information. The recommendations in this guideline are in accordance with the recommendations from the Danish National Board of Health. Recommendations in pregnancy Strength (...) 2 should be screened for Gestational Diabetes Mellitus (GDM), in accordance with the Danish national guidelines on screening for gestational diabetes. D Pregnant women with BMI = 30 kg/m 2 should be assessed for the risk of tromboembolism. Antenatal and post-delivery tromboprophylaxis should be considered in accordance with the guidelines from the Danish Society of Thrombosis and Haemostasis (DSTH) from 2014. Induction of labour Strength Induction of labour is recommended at GA 41+0 for pregnant

2017 Nordic Federation of Societies of Obstetrics and Gynecology

37. Polyhydramnios in singleton pregnancies

. The purpose of these guidelines is to suggest recommendations for the management of polyhydramnios in singleton pregnancies. Polyhydramnios, guideline DSOG, January 21 st , 2016 page 2 Guidelines: 1. An ultrasound should be performed in the following situations: 1) when there is clinical suspicion of polyhydramnios or 2) when there are conditions known to be predisposed to polyhydramnios, such as: pregestational diabetes, GDM, misuse of medicine or narcotics, rhesus immunization, malformations and fetal (...) hybridisering CMV: Cytomegalovirus CNS: Centralnervesystemet CTG: Cardiotocografi DARE: Database of Abstracts of Reviews of Effects DM: Diabetes mellitus DVP: Deepest vertical pocket GA: Gestations alder GDM: Gestationel diabetes mellitus GFR: Glomerulær filtrationsrate GI: Gastrointestinal 2 HFUPR: Hourly fetal urine production rate HSP: Hindesprængning IUGR: Intra uterine growth retardation LGA: Large for gestationel age NEC: Nekrotiserende enterocolit NS: Navlesnor OGTT: Oral glucose tolerance test

2016 Nordic Federation of Societies of Obstetrics and Gynecology

38. Clinical Practice Guidelines on Obesity

are in puberty or = 10 years old, and have any one of these risk factors: Family history of Type 2 diabetes mellitus in first- or second-degree relatives, maternal gestational diabetes, and features of insulin resistance (acanthosis nigricans, hypertension, dyslipidaemia, non-alcoholic fatty liver disease, polycystic ovarian syndrome). Repeat screening with fasting glucose or oral glucose tolerance test can be offered every 2 years if excessive adiposity persists. (pg 87) Grade D, Level 413 GPP The vast (...) is 27.5–29.9 kg/m 2 in Asians with comorbidities or complications of obesity such as hypertension, Type 2 diabetes mellitus. (pg 65) Grade C, Level 2 + A Phentermine and mazindol may be used for weight management for the short-term (6–12 months). Liraglutide may be used for weight management up to 2 years while orlistat may be used as an anti-obesity drug for long-term therapy (up to 4 years). (pg 70) Grade A, Level 1 + B Acupuncture by trained/qualified professionals may be considered as short-term

2016 Ministry of Health, Singapore

39. Hypertension in pregnancy

who have had hypertension in pregnancy have a plan for ongoing antihypertensive management included in their postnatal care plan, which is communicated to their GP when they are transferred to community care after the birth. Women who have had gestational hypertension or pre-eclampsia discuss future pregnancy and lifetime cardiovascular risks during a medical review at their 6–8 week postnatal medical check. Background information Background information Definition What is it? The National (...) population in women who have no hypertension or proteinuria 6–8 weeks after birth [ ]. Management Management : covers the identification and management of women who are at high risk of pre-eclampsia. : covers the assessment and management of women with pre-existing chronic hypertension. : covers the assessment and management of women over 20 weeks' gestation who develop hypertension. : covers the management of new proteinuria in pregnant women who do not have hypertension. : covers antenatal follow-up

2019 NICE Clinical Knowledge Summaries

40. Newborn hypoglycaemia

Gestational age o Symptoms if present o Primary and/or provisional clinical diagnosis and indication for investigation o As well as requesting each individual test, mark ‘Neonatal hypoglycaemia screen’ Queensland Clinical Guideline: Newborn hypoglycaemia Refer to online version, destroy printed copies after use Page 15 of 21 6.1.2 Interpretation of results • A hypoglycaemic screen may indicate a metabolic or endocrine disorder. If further investigation and management required, seek advice from: o (...) . National Institute for Health and Care Excellence. Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. CG63. London: National Institute for Health and Care Excellence; 2008. 19. Queensland Maternity and Neonatal Clinical Guidelines Program. Breastfeeding initiation. Guideline No. MN10.19-V2-R15. Queensland Health. 2010. 20. Eidelman AI. Hypoglycemia and the breastfed neonate. Pediatric Clinics of North America. 2001; 48(2):377-87. 21. Van Howe

2015 Queensland Health

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