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Gestational Diabetes Insulin Management Intrapartum


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41. Care around stillbirth and neonatal death

, such as Beckwith Wiedemann syndrome, should be investigated if there is no maternal or paternal diabetic history. 13 In the case of a suspected genetic metabolic disorder, Clinicians should discuss individual cases with their State Laboratory to identify the optimum tests to request and consult a clinical metabolic specialist if more expert guidance required. 14 All tissue samples should be stored and transported to a Specialist Metabolic Laboratory for investigation. 15 When a lethal genetic metabolic (...) and reporting processes across regions within ANZ make comparisons of perinatal mortality rates difficult, and it is hoped that these differences will be addressed by the various reporting agencies. In Australia, according to the Australian Institute of Health and Welfare (AIHW) 6 , perinatal deaths consist of stillbirths (the death of an unborn baby at 20 or more completed weeks gestation or at least 400 grams birthweight) and neonatal deaths (the death of a live born baby within 28 days of birth). However

2019 Centre of Research Excellence in Stillbirth

42. Standard care

use Page 11 of 21 4 Medication safety Standard 4: Medication safety which aims to ensure that clinicians are competent to safely prescribe, dispense and administer appropriate medicines, and monitor medicine use. It also aims to ensure that consumers are informed about medicines, and understand their own medicine needs and risks. 1 Table 10. Medication management Aspect Good practice point Context · QCG guidance regarding medications is based on the best available evidence, expert advice (...) § 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

2019 Queensland Health

43. 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

44. 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

45. 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

46. Hypertension in pregnancy

exhibited proteinuria without hypertension within 1 week of onset [ ]. In the absence of further guidance to inform management, CKS recommends seeking specialist advice if proteinuria persists, as specialist assessment and increased monitoring may be necessary. Seeking specialist advice in women with 2+ protein This recommendation is largely based on PRECOG guidelines that all women over 20 weeks' gestation with 2+ protein or more on dipstick testing should be referred for hospital assessment within 48 (...) is based on the National Institute for Health and Care Excellence (NICE) guidance Hypertension in pregnancy: the management of hypertensive disorders in pregnancy [ ] and covers the management and referral of women during pregnancy and in the postpartum period. This topic also covers the management of proteinuria after 20 weeks' pregnancy, which is based on the Pre-eclampsia community guideline [ ]. This CKS topic does not cover the secondary care management of hypertension in pregnancy

2019 NICE Clinical Knowledge Summaries

47. Polyhydramnios in singleton pregnancies

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 (...) . 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

2016 Nordic Federation of Societies of Obstetrics and Gynecology

48. 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

49. SMFM State of Pregnancy Monograph

” and SMFM Statements developed by SMFM committees that offer specific guidance regarding technical topics related to issues such as practice management, coding and billing and quality of care. SMFM also jointly publishes and endorses other documents with outside organizations like ACOG and AIUM. All current SMFM publications can be found at: publications. SMFM Outreach and Collaboration: Health Policy and Government Relations SMFM advances public policy related to maternal and child health (...) with a premature fetus (24 to 31 weeks of gestation) would result in a reduction in cerebral palsy. The MFMU Network also provided the first conclusive evidence that treating pregnant women who have even the mildest form of gestational diabetes can reduce the risk of common birth complications among infants, as well as blood pressure disorders among mothers. These findings have changed clinical practice and are leading to better outcomes for both mothers and babies. In 2011, SMFM joined the National Quality

2015 Society for Maternal-Fetal Medicine

50. WHO recommendations on interventions to improve preterm birth outcomes

is not separately presented.3 Maternal interventions Recommendations Strength of recommendation and quality of the evidence a Antenatal c o r t i c o ste r o i d s to improve newborn outcomes (continued) 1.7. Antenatal corticosteroid therapy is recommended for women at risk of imminent preterm birth of a growth- restricted fetus. Strong recommendation based on very low-quality evidence 1.8. Antenatal corticosteroid therapy is recommended for women with pre-gestational and gestational diabetes who are at risk (...) guidance as an essential component to be effective in delaying preterm birth; providing appropriate intrapartum interventions to reduce complications in the preterm newborn; and providing effective care to the preterm newborn to reduce risk of death and long-term disability. The purpose of this guideline is to provide evidence- based recommendations for interventions during pregnancy, labour and during the newborn period that are aimed at improving outcomes for preterm infants. Recommendations

2015 World Health Organisation Guidelines

51. Medical eligibility criteria for contraceptive use

generally outweigh the theoretical or proven risks 3 A condition where the theoretical or proven risks usually outweigh the advantages of using the method 4 A condition which represents an unacceptable health risk if the contraceptive method is used. Target audience The intended audience for this publication includes policy- makers, family planning programme managers and the scientific community. The MEC aims to provide guidance to national family planning and reproductive health programmes (...) – Rachel Baggaley Department of Management of Noncommunicable Diseases, Disability, Violence & Injury Prevention – Maria Alarcos Cieza Moreno2 | Medical eligibility criteria for contraceptive use - Executive summary Department of Maternal, Newborn, Child and Adolescent Health – Nigel Rollins Department of Reproductive Health and Research – Moazzam Ali, Keri Barnett-Howell (volunteer), Venkatraman Chandra- Mouli, Shannon Carr (volunteer), Monica Dragoman, Mario Festin, Mary Lyn Gaffield, Rajat Khosla

2015 World Health Organisation Guidelines

52. 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 (...) for the prevention and management of hypoglycaemia of the newborn. 2011 [cited 2013 April 02]. Available from: policies-and-guidelines/Best-practice-standards-for-neonatal-units/. 2. American Academy of Pediatrics, Adamkin DH, Committee on fetus and newborn. Clinical report – postnatal glucose homeostasis in late-preterm and term infants. Pediatrics. 2011 [cited 2013 April 02]; 127(3):575-9. Available from

2015 Queensland Health

53. Antenatal corticosteriods given to women prior to birth to improve fetal, infant, child and adult health

at term 7 Use of antenatal corticosteroids for fetal lung maturation given to women with diabetes in pregnancy or gestational diabetes: 7 Use of antenatal corticosteroids in women with a multiple pregnanacy (twins and higher order) 8 Summary of research recommendations 9 Use of a single course of antenatal corticosteroids for women at risk of preterm birth. 9 Repeat antenatal corticosteroids for women at risk of preterm birth 10 Use of antenatal corticosteroids for fetal lung maturation prior (...) or gestational diabetes at risk of preterm birth 210 14.8 Women with systemic infection at trial entry at risk of preterm birth 224 14.9 Women with pregnancy associated hypertension/pre-eclampsia at risk of preterm birth 226 14.10 Women with a fetus with intrauterine growth restriction at risk of preterm birth 238 Page 2 14.11 Women with ultrasound evidence of cervical shortening /funnelling 249 14.12 Fetal fibronectin test and the use of antenatal corticosteroids in women at risk of preterm birth . 251

2015 Clinical Practice Guidelines Portal

54. Comparing Outpatient to Inpatient Cervical Ripening Using Dilapan-S®

will be documented. Routine intrapartum care will be provided and relevant data collected by the subject's managing obstetrical team. Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Estimated Enrollment : 376 participants Allocation: Randomized Intervention Model: Parallel Assignment Intervention Model Description: Randomized controlled trial Masking: None (Open Label) Primary Purpose: Treatment Official Title: Induction of Labor in Women With Unfavorable Cervix (...) vertical pocket of < 2 cm) Fetal anomaly Need for inpatient care (e.g. hypertension, insulin-dependent diabetes) Poor or no access to a telephone and cannot be placed in the hotel Absence of support person ( no adult accompanying the subject during outpatient cervical ripening period) 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 by the sponsor

2018 Clinical Trials

55. Study on the Safety and Immunogenicity of Boostrix Vaccine in Pregnant Malian Women and Their Infants

: (a) gestational hypertension (well controlled history of essential or gestational hypertension, as evidenced by normal BPs as defined above, is allowed), (b) gestational diabetes not controlled by diet and exercise (the use of insulin or glyburide to control gDM, at the time of enrollment, is exclusionary), (c) current pre-eclampsia or eclampsia, (d) known current multiple gestation, (e)history of preterm delivery before EGA 35 weeks 0 days or current preterm labor, and/or (f) known intrauterine fetal growth (...) Study on the Safety and Immunogenicity of Boostrix Vaccine in Pregnant Malian Women and Their Infants Study on the Safety and Immunogenicity of Boostrix Vaccine in Pregnant Malian Women and Their Infants - Full Text View - Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please

2018 Clinical Trials

56. Diagnosis and Treatment of Fetal Cardiac Disease Full Text available with Trip Pro

the normal range (mean, 6.4%) were associated with a significantly increased risk of cardiac malformation of 2.5% to 6.1% in offsprings. Therefore, it appears that although the risk may be highest in those with HbA 1c levels >8.5%, all pregnancies of pregestational diabetic women are at some increased risk. Given this information, a fetal echocardiogram should be performed in all women with pregestational DM. Insulin resistance acquired in the third trimester, or gestational DM, does not appear to confer (...) hypertrophy in the third trimester Gestational diabetes mellitus with HbA 1c <6% <1 1 III/B If HbA 1c >6%, fetal echocardiography in the third trimester may be considered to assess for ventricular hypertrophy Phenylketonuria (preconception metabolic control may affect risk) 12–14 10–15 I/A 18–22 wk Only if periconception phenylalanine level >10 mg/dL Lupus or Sjögrens only if SSA/SSB autoantibody positive Note: increased risk with maternal hypothyroidism or maternal vitamin D deficiency With prior

2014 American Heart Association

57. 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 (...) for the prevention and management of hypoglycaemia of the newborn. 2011 [cited 2013 April 02]. Available from: policies-and-guidelines/Best-practice-standards-for-neonatal-units/. 2. American Academy of Pediatrics, Adamkin DH, Committee on fetus and newborn. Clinical report – postnatal glucose homeostasis in late-preterm and term infants. Pediatrics. 2011 [cited 2013 April 02]; 127(3):575-9. Available from

2013 Clinical Practice Guidelines Portal

58. Normal and Abnormal Puerperium (Diagnosis)

. These individuals should be appropriately counselled on lifestyle interventions or medical management options (i.e. metformin, insulin) to optimize their glycemic control. Those who have a normal postpartum glucose tolerance test should be appropriately counselled that there is still a 7 fold risk of developing type 2 diabetes later in life and up to 50% of women with GDM will develop diabetes over 20 years after her pregnancy. [ ] Therefore the American Diabetes Association (ADA) recommends patients with GDM (...) scheduled for a routine comprehensive postpartum evaluation between 4 to 6 weeks after delivery. Earlier postpartum follow-up is recommended in women at high risk of postpartum complications who require problem-oriented visits for closer management of hypertensive issues, postpartum depression, wound infections, lactation difficulties, or comorbidities that require postpartum medication changes (i.e. seizure disorder, diabetes). [ ] The postpartum visit is also an important time to identify


59. Liver Disease and Pregnancy (Diagnosis)

, nephrolithiasis, ovarian torsion, hyperthyroidism, diabetic ketoacidosis, and migraines. Risk factors Risk factors for hyperemesis gravidarum include past history of the disease, hyperthyroidism, psychiatric illness, molar pregnancy, preexisting diabetes, multiple gestations, multiparity, increased body mass index, and high daily intake of saturated fat before pregnancy. One study also identified female sex of the fetus as a risk factor. [ ] An association between Helicobacter pylori infection and hyperemesis (...) insulin sensitivity and increased baseline cortisol levels in the children of mothers with severe hyperemesis compared to those in the control group. [ ] The lifelong effect of this difference in still unknown, but it may place these children at higher risk for type 2 diabetes and cardiovascular disease. Previous Next: Acute Fatty Liver of Pregnancy The prevalence of , in which microvesicular fatty infiltration of the liver can lead to liver failure, [ ] is 1 per 10,000-15,000 pregnancies. This life


60. Macrosomia (Diagnosis)

at the greatest risk for macrosomia with some degree of accuracy. Maternal, fetal, and neonatal consequences of macrosomia are also discussed, with specific attention to the potential etiology of macrosomia. See the image below. Photograph of a macrosomic newborn soon after birth. Factors associated with fetal macrosomia include genetics; duration of gestation; presence of gestational diabetes; high pre-pregnancy body mass index (BMI); excessive gestational weight gain; and class A, B, and C diabetes mellitus (...) : Pathophysiology The pathophysiology of macrosomia is related to the associated maternal or fetal condition that accounts for its development. In general, poorly controlled diabetes, maternal obesity, and excessive maternal weight gain are all associated with macrosomia and have intermittent periods of hyperglycemia in common. Hyperglycemia in the fetus results in the stimulation of insulin, insulinlike growth factors, growth hormone, and other growth factors, which, in turn, stimulate fetal growth


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