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Gestational Diabetes Insulin Management Intrapartum

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41. 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

42. 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

43. 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

44. 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

45. 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: www.smfm.org/ 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

46. 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

47. 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

48. 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: http://www.unicef.org.uk/BabyFriendly/Resources/Guidance-for-Health-Professionals/Writing- 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

49. 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

50. 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

51. 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

52. 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

53. 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

54. 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: http://www.unicef.org.uk/BabyFriendly/Resources/Guidance-for-Health-Professionals/Writing- 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

55. 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

56. 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

57. 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

58. Liver Disease and Pregnancy (Overview)

, 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

59. 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

60. 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

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