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Gestational Diabetes Insulin Management Intrapartum

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21. Management of Stillbirth

J Perinatol. 2011; 28 : 643-650 Martin J.A. Hamilton B.E. Osterman M.J. Driscoll A.K. Drake P. Births: final data for 2017. Natl Vital Stat Rep. 2018; 67 : 1-49 Casson I.F. Clarke C.A. Howard C.V. McKendrick O. Pennycook S. Pharoah P.O. et al. Outcomes of pregnancy in insulin dependent diabetic women: results of a five year population cohort study. BMJ. 1997; 315 : 275-278 Dunne F. Brydon P. Smith K. Gee H. Pregnancy in women with type 2 diabetes: 12 years outcome data 1990–2002. Diabet Med (...) . 2003; 20 : 734-738 Rosenstein M.G. Cheng Y.W. Snowden J.M. Nicholson J.M. Doss A.E. Caughey A.B. The risk of stillbirth and infant death stratified by gestational age in women with gestational diabetes. Am J Obstet Gynecol. 2012; 206 : 309.e1-309.e7 Browne K. Park B.Y. Goetzinger K.R. Caughey A.B. Yao R. The joint effects of obesity and pregestational diabetes on the risk of stillbirth. J Matern Fetal Neonatal Med. 2019; : 1-7 Starikov R. Dudley D. Reddy U.M. Stillbirth in the pregnancy complicated

2020 Society for Maternal-Fetal Medicine

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

are maternal diabetes mellitus and fetal anomalies, some of which are associated with genetic syndromes. Other causes of polyhydramnios include congenital infection and alloimmunization. The purpose of this document is to provide guidance on the evaluation and management of polyhydramnios. The following are Society for Maternal-Fetal Medicine recommendations: (1) we suggest that polyhydramnios in singleton pregnancies be defined as either a deepest vertical pocket of ≥8 cm or an amniotic fluid index of ≥24 (...) to suggest that induction of labor or preterm delivery are associated with an improved outcome in the setting of mild idiopathic polyhydramnios. We recommend that labor should be allowed to occur spontaneously at term for women with mild idiopathic polyhydramnios; that induction, if planned, should not occur at <39 weeks of gestation in the absence of other indications; and that mode of delivery should be determined based on usual obstetric indications (GRADE 1C). Intrapartum management There are limited

2019 Society for Maternal-Fetal Medicine

23. Management of Pregnancy

, sensory, or learning disabilities. Family involvement should be considered, if appropriate. This CPG is designed to assist providers in managing or co-managing pregnant women as well as co- occurring conditions (e.g., generalized anxiety disorder, PTSD, diabetes mellitus [DM]). Moreover, the patient population of interest for this CPG is pregnant women who are eligible for care in the VA and DoD healthcare delivery systems. It includes Veterans as well as deployed and non-deployed Active Duty Service (...) . 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

2018 VA/DoD Clinical Practice Guidelines

24. Monitoring of pregnancies at beyond 41+0 weeks of gestation

- the use and interpretation of cardiotocography in intrapartum fetal surveillance, Evidence-based Clinical Guideline Number 8. London: RCOG Press, 2001 24 56. ACOG practice bulletin. Antepartum fetal surveillance. Number 9, October 1999 (replaces Technical Bulletin Number 188, January 1994). Clinical management guidelines for obstetrician-gynecologists. Int. J gynaecol obstet 2000; 68:175 - 85. 57. NICE 2007 National Institute for Health and Clinical Excellence. Intrapartum care: care of the healthy (...) Monitoring of pregnancies at beyond 41+0 weeks of gestation Monitoring of pregnancies at beyond 41+0 weeks of gestation Approved by the Danish Society of Obstetrics and Gynecology at the obstetrical guideline-meeting in January 2015. Members of the guidelinegroup Bach, Diana; consultant Hvidovre Hospital Buchgreitz, Line; senior registrar, Roskilde Hospital Dahlgaard, Tullia; midwife, Odense Hospital Farlie, Richard; consultant, Herning Hospital Gommesen, Line; midwife, Odense Hospital Huusom

2015 Nordic Federation of Societies of Obstetrics and Gynecology

25. 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

26. 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

27. Guidance for maternal medicine in the evolving coronavirus (COVID-19) pandemic

and interpreting glucose readings • Provide website links or written information on diet, physical activity, gestational diabetes and glucose meter use Diabetes team to review blood glucose diary remotely If glucose targets met, manage in community 1 W eek If >3 or 10-15% of glucose measurements are above the target range: If metformin is required, this should be collect from the GP or hospital If insulin is required – a face-to-face appointment will be required with the diabetes MW/nurse Arrange a remote (...) the responsibility of contacting the diabetes team if their readings are outside of the specified targets. Although community midwives are not expected to routinely check the mother’s blood glucose readings, they should be provided with information on target blood glucose levels to help inform and support the mother, if 12 needed. GDM on metformin and / or insulin In women who have GDM and are taking metformin and/or insulin, offer obstetric review remotely at 28 and 32 weeks’ gestation to reassess the risk

2020 Royal College of Obstetricians and Gynaecologists

28. 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

29. Perinatal Management of Pregnant Women at the Threshold of Infant Viability? the Obstetric Perspective

Perinatal Management of Pregnant Women at the Threshold of Infant Viability? the Obstetric Perspective Perinatal Management of Pregnant Women at the Threshold of Infant Viability (The Obstetric Perspective) Scientific Impact Paper No. 41 February 2014Perinatal Management of Pregnant Women at the Threshold of Infant Viability (The Obstetric Perspective) 1. Background Delivery at the threshold of viability (23 +0 weeks to 24 +6 weeks of gestation) is a major medical and ethical challenge (...) . It should be preceded by the best possible advice from a multidisciplinary neonatal and obstetric team, which informs parents fully, seeks to achieve a consensus on the best way forward, and provides the best care for the mother and neonate. There is international consensus that at 22 weeks of gestation there is no hope of survival, and that up to 22 +6 weeks is considered to be the cut–off of human viability and for week 25 +0 onwards there is also a general agreement that active management should

2014 Royal College of Obstetricians and Gynaecologists

30. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum

with a significant risk of malfor- mations should be offered detailed ultrasound scanning for fetal abnormalities as early in gestation as such scan- ning is possible, if they choose. • Monitor for excessive weight gain, and ensure this is man- aged in line with appropriate guidance (e.g. (NICE, 2010c)). Also monitor for gestational diabetes, particularly for women on a second generation antipsychotic (SGA), (request an oral glucose tolerance test) and ensure this is managed in line with appropriate guidance (...) ; ‘Benefits and harms associated with individual medications’ reviews the risks associ- ated with specific psychotropic medications; ‘Recommendations for the pharmacological management of specific disorders’ pro- vides guidance on the management of psychiatric disorders in the perinatal period. The guideline uses the convention of presenting summary conclusions and recommendations at the end of subsections in the form of bullet points in italics. Note that sections on ‘Recommended principles

2017 British Association for Psychopharmacology

31. 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

32. 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 (...) , and Gestational Diabetes Mellitus. Pediatrics 2005;115(3):e290-296. 25. Villamor E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. The Lancet 2006;368(9542):1164-1170. 26. Glazer NL, Hendrickson AF, Schellenbaum GD, Mueller BA. Weight change and the risk of gestational diabetes in obese women. Epidemiology 2004;15(6):733-737. 27. Carmichael SL, Shaw GM, Schaffer DM, Laurent C, Selvin S. Dieting behaviors and risk of neural tube defects. American

2010 Royal College of Obstetricians and Gynaecologists

33. 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

34. 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

35. 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

36. 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

37. Macrosomia

of birth weight, newborns of women with diabetes have an increased risk of shoulder dys- tocia, clavicular fracture, and brachial plexus palsy (2, 24–26). Gestational diabetes and hyperglycemia often occur in conjunction with prepregnancy obesity and excessive gestational weight gain making it difficult to distinguish the independent contributions of each to macrosomia. Furthermore,GDMandobesitysharecommonmetabolic characteristics such as increased insulin resistance, hyperglycemia (...) glucose management is recommended for pregnancies complicated by diabe- tes. One clinical trial suggests that the addition of insulin to diet therapy may benefit women at risk of LGA newborns diagnosed between 29 weeks of gestation and 33 weeks of gestation (110). This study randomized 98 women with GDM and a fetal abdominal circumference exceeding the 75th percentilefor gestational age to either diet therapy alone or diet therapy with twice-daily insu- lin. The addition of insulin therapy decreased

2020 American College of Obstetricians and Gynecologists

38. 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 (...) -making, and the surveillance and management of women before, during, and after pregnancy. Existing guidance on the management of CKD in pregnancy includes the UK Consensus Group on Pregnancy in Renal Disease (ISBN 978-1107124073) and expert review. Neither Kidney Disease Outcomes Quality Initiative (KDOQI) or National Institute of Health and Care Excellence (NICE) have produced specific guidance on the management of renal disease in pregnancy. Published guidance containing information relevant

2019 Renal Association

39. Covid-19: Recommendations for GDM screening and oral glucose tolerance test (OGTT) during pregnancy and postpartum

with GDM) • Previous macrosomia (birth weight > 4500 g or > 90 th percentile • Previous perinatal loss • Polycystic Ovarian Syndrome • Medications (corticosteroids, antipsychotics) • Multiple pregnancy Flow Chart: Screening and diagnosis of GDM Queensland Clinical Guideline: Gestational diabetes mellitus Refer to online version, destroy printed copies after use Page 4 of 38 Flowchart: Intrapartum management for GDM requiring Insulin and/or Metformin Metformin • Cease when labour established Insulin (...) 27 5.1 Pharmacotherapy as birth approaches 28 5.2 Intrapartum monitoring 28 5.3 Intrapartum BGL management 29 5.3.1 Insulin infusion 29 6 Postpartum care 30 6.1 Newborn care 30 6.2 Breastfeeding 31 6.3 Discharge planning 31 References 32 Appendix A: Antenatal schedule of care 36 Appendix B: Physical activity 37 Acknowledgements 38 Queensland Clinical Guideline: Gestational diabetes mellitus Refer to online version, destroy printed copies after use Page 8 of 38 List of Tables Table 1. Diabetes

2020 Queensland Health

40. Review of effective strategies to promote breastfeeding

with the WHO International Code has also been identified as a crucial management practice in a 2018 WHO guidance document on BFHI. 44 There is a substantial literature base establishing that quality of care practices to support breastfeeding in maternal and newborn care facilities based on the BFHI Ten Steps program are effective. The research identified in this Evidence Check also shows that if more of the Ten Steps are implemented, improvements in breastfeeding are greater. Foundational evidence (...) 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

2018 Sax Institute Evidence Check

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