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Gestational Diabetes Insulin Management Intrapartum

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41. Medical eligibility criteria for contraceptive use

– 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 (...) 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

2015 World Health Organisation Guidelines

42. 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 (...) and policies related to interventions to improve preterm birth outcomes. It is not intended to provide a comprehensive practical guide for the management of preterm labour and preterm infants. 1.2 Scope of the guideline Populations of interest This guideline focuses on improving maternal and neonatal outcomes associated with preterm birth, 1. BACKGROUND 1. Background Preterm birth, defined as birth before 37 weeks of gestation, is the single most important determinant of adverse infant outcomes, in terms

2015 World Health Organisation Guidelines

43. SMFM State of Pregnancy Monograph

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 (...) lung disease d. Pulmonary edema e. Influenza f. Tuberculosis g. Cystic fibr osis 4. Obesity 5. Endocrinologic disorders a. Addison disease b. Diabetes, insulin-requiring/ dependent c. Thyroid disease d. Parathyroid disease e. Pheochromocytoma 6. Gastrointestinal Disease a. Nausea and vomiting in pregnancy; Hyperemesis gravidarum b. Eating disorders c. Intrahepatic cholestasis d. Inflammatory bowel disease (ulcerative colitis; Crohn’s disease) e. Gallbladder disease (cholecystitis, cholelithiasis) f

2015 Society for Maternal-Fetal Medicine

44. 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

45. Diagnosis and Treatment of Fetal Cardiac Disease

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

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2014 American Heart Association

46. Clinical practice guideline for care in pregnancy and puerperium

screening method for gestational diabetes testing? At what stage of pregnancy should gestational diabetes screening be done? What are the appropriate criteria to consider a pregnant woman gestational diabetic? 28. What is the purpose of universal screening for risk of preterm delivery and at what stage of pregnancy should it be done? 29. Is it beneficial to make a birth plan during pregnancy? Ultrasound scanning and prenatal diagnosis 30. In what week of pregnancy should the ultrasound scans be carried (...) women and their partners should be offered the opportunity to participate in a program of preparation for the birth in order to acquire knowledge and pregnancy-related skills, childbirth, care of the postpartum period, the newborn and during the breastfeeding period. Management of pregnancy from week 41 Weak We suggest offering to pregnant women the chance to induce labour at the time deemed most appropriate from the week before reaching weeks 41 and 42 of gestation, after reporting on the benefits

2014 GuiaSalud

47. 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 - ClinicalTrials.gov 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

48. 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

49. 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

2013 Clinical Practice Guidelines Portal

50. Antenatal care for uncomplicated pregnancies

-and- conditions#notice-of-rights). Page 7 of 47pregnancy-associated plasma protein-A) should be offered to screen for Down's syndrome between 11 weeks 0 days and 13 weeks 6 days. For women who book later in pregnancy the most clinically and cost-effective serum screening test (triple or quadruple test) should be offered between 15 weeks 0 days and 20 weeks 0 days. [2008] [2008] Screening for clinical conditions Screening for clinical conditions Screening for gestational diabetes using risk factors (...) is recommended in a healthy population. At the booking appointment, the following risk factors for gestational diabetes should be determined: body mass index above 30 kg/m 2 previous macrosomic baby weighing 4.5 kg or above previous gestational diabetes (refer to NICE's guideline on diabetes in pregnancy) family history of diabetes (first-degree relative with diabetes) family origin with a high prevalence of diabetes: South Asian (specifically women whose country of family origin is India, Pakistan

2008 National Institute for Health and Clinical Excellence - Clinical Guidelines

51. Normal and Abnormal Puerperium (Overview)

. 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

2014 eMedicine.com

52. Estimation of Fetal Weight (Overview)

birth weight Endogenous and extrinsic factors such as the following can affect fetal birth weight: Gestational age at delivery, fetal sex Maternal race, height, weight, parity, pregnancy weight gain and physical activity, hemoglobin concentration, tobacco use, uncontrolled diabetes, hypertension, preeclampsia Paternal height Ambient altitude Techniques to estimate fetal weight The accuracy of different methods for predicting fetal weight depends on the gestational age and the range of birth weights (...) ), [ , , , , , , , , , , , , ] paternal factors (eg, paternal height), [ , , , , , , , , ] environmental influences (eg, altitude, availability of adequate nutrition, degree of physical activity), [ , , , , , , , , , ] physiologic factors (eg, altered glucose metabolism, hemoglobin concentration, microvascular integrity), [ , , , , ] pathologic factors (eg, hypertension, uterine malformations), [ , , ] and complications of pregnancy (eg, gestational diabetes mellitus, preeclampsia). [ , , , , , , ] In a systematic review of 36

2014 eMedicine.com

53. Fetal Growth Restriction (Overview)

rates in association with determinants of small for gestational age fetuses: population based cohort study. BMJ . 1998 May 16. 316(7143):1483-7. . Gardosi J, Francis A. Controlled trial of fundal height measurement plotted on customised antenatal growth charts. Br J Obstet Gynaecol . 1999 Apr. 106(4):309-17. . Hales CN, Barker DJ. Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia . 1992 Jul. 35(7):595-601. . Hepburn M, Rosenberg K. An audit (...) the following: Placental abnormalities Chronic abruption Abnormal cord insertion Cord anomalies Multiple gestations IUGR occurs when gas exchange and nutrient delivery to the fetus are not sufficient to allow it to thrive in utero. This process can occur primarily because of maternal disease causing decreased oxygen-carrying capacity (eg, cyanotic heart disease, smoking, hemoglobinopathy), a dysfunctional oxygen delivery system secondary to maternal vascular disease (eg, diabetes with vascular disease

2014 eMedicine.com

54. Polyhydramnios and Oligohydramnios (Follow-up)

=aHR0cHM6Ly9yZWZlcmVuY2UubWVkc2NhcGUuY29tL2FydGljbGUvOTc1ODIxLXRyZWF0bWVudA== processing > Polyhydramnios and Oligohydramnios Treatment & Management Updated: Sep 20, 2017 Author: Brian S Carter, MD, FAAP; Chief Editor: Dharmendra J Nimavat, MD, FAAP Share Email Print Feedback Close Sections Sections Polyhydramnios and Oligohydramnios Treatment Approach Considerations In women with polyhydramnios or oligohydramnios, note the following: Consider hospitalizing and thoroughly evaluating the mother in cases diagnosed after 26-33 weeks' gestation. If the fetus does not have (...) secondary to fetal anemia, the direct intravascular transfusion of erythrocytes (or infusion into the fetal abdomen) may improve the fetal hematocrit and fetal congestive heart failure, thereby allowing prolongation of the pregnancy and improving survival. In cases of polyhydramnios in which maternal diabetes is suspected, perform a glucose tolerance test. If the test results are positive, treat the mother with an American Diabetes Association (ADA) diet. Insulin is rarely needed. Oligohydramnios

2014 eMedicine Pediatrics

55. 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

2014 eMedicine.com

56. 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

2014 eMedicine.com

57. Fetal Growth Restriction (Diagnosis)

rates in association with determinants of small for gestational age fetuses: population based cohort study. BMJ . 1998 May 16. 316(7143):1483-7. . Gardosi J, Francis A. Controlled trial of fundal height measurement plotted on customised antenatal growth charts. Br J Obstet Gynaecol . 1999 Apr. 106(4):309-17. . Hales CN, Barker DJ. Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia . 1992 Jul. 35(7):595-601. . Hepburn M, Rosenberg K. An audit (...) the following: Placental abnormalities Chronic abruption Abnormal cord insertion Cord anomalies Multiple gestations IUGR occurs when gas exchange and nutrient delivery to the fetus are not sufficient to allow it to thrive in utero. This process can occur primarily because of maternal disease causing decreased oxygen-carrying capacity (eg, cyanotic heart disease, smoking, hemoglobinopathy), a dysfunctional oxygen delivery system secondary to maternal vascular disease (eg, diabetes with vascular disease

2014 eMedicine.com

58. Estimation of Fetal Weight (Diagnosis)

birth weight Endogenous and extrinsic factors such as the following can affect fetal birth weight: Gestational age at delivery, fetal sex Maternal race, height, weight, parity, pregnancy weight gain and physical activity, hemoglobin concentration, tobacco use, uncontrolled diabetes, hypertension, preeclampsia Paternal height Ambient altitude Techniques to estimate fetal weight The accuracy of different methods for predicting fetal weight depends on the gestational age and the range of birth weights (...) ), [ , , , , , , , , , , , , ] paternal factors (eg, paternal height), [ , , , , , , , , ] environmental influences (eg, altitude, availability of adequate nutrition, degree of physical activity), [ , , , , , , , , , ] physiologic factors (eg, altered glucose metabolism, hemoglobin concentration, microvascular integrity), [ , , , , ] pathologic factors (eg, hypertension, uterine malformations), [ , , ] and complications of pregnancy (eg, gestational diabetes mellitus, preeclampsia). [ , , , , , , ] In a systematic review of 36

2014 eMedicine.com

59. Normal and Abnormal Puerperium (Treatment)

. 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

2014 eMedicine.com

60. Macrosomia (Overview)

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

2014 eMedicine.com

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