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Headache in Pregnancy

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121. CRACKCast E177 – Acute Complications of Pregnancy

) Serum creatinine >97.2 micromol/L or doubling of the creatinine concentration in the absence of other renal disease Liver transaminases at least twice the upper limit of the normal concentrations Pulmonary edema Cerebral or visual symptoms (eg, new-onset and persistent headaches not responding to usual doses of analgesics* ; blurred vision, flashing lights or sparks, scotomata) 6) Why are pregnant patients at increased risk of VTE? They have the trifecta of virchow! Pregnancy is a hypercoagulable (...) check out EM Cases Rapid Reviews Videos on Shownotes – Key Points You know a chapter is gargantuan when the summary points are two pages long….so here we go. We’ll cover the key, key concepts Ectopic pregnancy Bleeding in late pregnancy Hypertension in pregnancy AF Embolism Rh immunization Abd pain in pregnancy N/V in pregnancy VTE in pregnancy Vaginal and UTIs Thyroid disease Ectopic Pregnancy An ectopic pregnancy can masquerade as a threatened miscarriage in the early stages of pregnancy

2018 CandiEM

122. Nausea/vomiting in pregnancy: What else might it be?

Nausea/vomiting in pregnancy: What else might it be? Differential diagnosis | Diagnosis | Nausea/vomiting in pregnancy | CKS | NICE Search CKS… Menu Differential diagnosis Nausea/vomiting in pregnancy: What else might it be? Last revised in February 2020 What else might it be? Findings which may suggest an alternative diagnosis include: Onset of symptoms after 11 weeks of gestation. Abdominal pain or tenderness (more than mild epigastric tenderness after retching). Fever. Headache or abnormal (...) neurological examination. Goitre. Conditions causing nausea and vomiting in pregnancy: Genito-urinary conditions — urinary tract infection, uraemia, pyelonephritis, ovarian torsion, renal stones. Metabolic disorders and endocrine conditions — hypercalcaemia, thyrotoxicosis, diabetic ketoacidosis, Addison's disease. Gastrointestinal conditions — gastritis, gastroenteritis, peptic ulcer, pancreatitis, cholecystitis, bowel obstruction, hepatitis, cholelithiasis, appendicitis. Neurological disorders

2018 NICE Clinical Knowledge Summaries

123. Nausea/vomiting in pregnancy: Scenario: Management

, unstoppable vomiting. Inability to keep down food or fluids for 24 hours. Severe headache, visual problems, severe pain below the ribs, sudden swelling of the face, hands, or feet (symptoms of pre-eclampsia). Offer additional support for women experiencing nausea and vomiting in pregnancy, such as: Self-help information, for example that offered by the NHS on ; or the Royal College of Obstetricians and Gynaecologists on . Support groups such as Pregnancy sickness support ( ). Best use of medicines (...) loss, abdominal pain). Any co-existing conditions (for example diabetes) which may be adversely affected by nausea and vomiting. The effect on the woman's life (for example work, home situation and support, ability to care for her family). The effect on the woman's mood, with further assessment if appropriate. If there are concerns that the woman is showing signs of depression, see the CKS topic on . Consider using a validated questionnaire to assess the severity of nausea and vomiting in pregnancy

2018 NICE Clinical Knowledge Summaries

124. Nausea/vomiting in pregnancy: Promethazine

Nausea/vomiting in pregnancy: Promethazine Promethazine | Prescribing information | Nausea/vomiting in pregnancy | CKS | NICE Search CKS… Menu Promethazine Nausea/vomiting in pregnancy: Promethazine Last revised in February 2020 Promethazine What dosage of promethazine should I prescribe? Promethazine is available as promethazine hydrochloride or promethazine teoclate. Either preparation may be used: Promethazine hydrochloride is available in two strengths — 10 mg or 25 mg tablets. Prescribe (...) up to 25 mg as one dose at bedtime, and repeat in the morning if necessary. Promethazine teoclate is available as 25 mg tablets. Prescribe 25 mg at bedtime. The dose may be increased to 100 mg daily. What are the adverse effects of promethazine? Adverse effects of promethazine include: Neurological — dizziness, confusion, headaches, nightmares, sedation which can persist for up to 12 hours (affected people should not drive or operate heavy machinery), muscle spasms and tic-like movements

2018 NICE Clinical Knowledge Summaries

125. Nausea/vomiting in pregnancy: Prochlorperazine

Nausea/vomiting in pregnancy: Prochlorperazine Prochlorperazine | Prescribing information | Nausea/vomiting in pregnancy | CKS | NICE Search CKS… Menu Prochlorperazine Nausea/vomiting in pregnancy: Prochlorperazine Last revised in February 2020 Prochlorperazine What dosage of prochlorperazine should I prescribe? Prescribe prochlorperazine: Oral tablets 5–10 mg up to three times a day. Buccal tablets 3–6 mg twice a day. [ ; ; ; ] What are the adverse effects of prochlorperazine? Extrapyramidal (...) , dizziness, headache, and confusion. Antimuscarinic effects — dry mouth, constipation, difficulty with micturition, blurred vision, and precipitation of angle-closure glaucoma (very rare). Skin and tissue disorders — photosensitization, contact sensitization, rashes, and purplish pigmentation of the skin. Hepatobiliary disorders — jaundice (including cholestatic). Eye disorders — corneal and lens opacities and purplish pigmentation of the cornea, conjunctiva, and retina. Others — nasal congestion

2018 NICE Clinical Knowledge Summaries

126. Nausea/vomiting in pregnancy: Ondansetron

are the adverse effects of ondansetron? The most common adverse effects of ondansetron include constipation, headache, and flushing. Other less common adverse effects include hiccups, hypotension, bradycardia, chest pain, arrhythmias, movement disorders, abnormal liver function tests, and seizures. [ ; ] What are the contraindications and cautions when prescribing ondansetron? Ondansetron is contraindicated for people with: Congenital long QT syndrome. Hereditary problems of galactose intolerance, Lapp (...) Nausea/vomiting in pregnancy: Ondansetron Ondansetron | Prescribing information | Nausea/vomiting in pregnancy | CKS | NICE Search CKS… Menu Ondansetron Nausea/vomiting in pregnancy: Ondansetron Last revised in February 2020 Ondansetron What dosage of ondansetron should I prescribe? For adults 18 years of age and older, prescribe oral ondansetron up to 8 mg twice a day for a maximum of 5 days. Note that the dose is based on that used for chemotherapy, so is for guidance only. [ ; ; ] What

2018 NICE Clinical Knowledge Summaries

127. Nausea/vomiting in pregnancy: Cyclizine

Nausea/vomiting in pregnancy: Cyclizine Cyclizine | Prescribing information | Nausea/vomiting in pregnancy | CKS | NICE Search CKS… Menu Cyclizine Nausea/vomiting in pregnancy: Cyclizine Last revised in February 2020 Cyclizine What dosage of cyclizine should I prescribe? Prescribe cyclizine 50 mg orally up to three times a day. [ ; ; ; ] What are the adverse effects of cyclizine? Drowsiness is a significant adverse effect with most of the older antihistamines (such as cyclizine), especially (...) with high doses or in the elderly. Other adverse effects include: Blood and lymphatic system disorders — agranulocytosis, leucopenia, haemolytic anaemia, and thrombocytopenia. Immune system disorders — hypersensitivity reactions, including anaphylaxis. Psychiatric disorders — disorientation, restlessness, nervousness, euphoria, insomnia, and auditory and visual hallucinations. Nervous system disorders — somnolence, headache, dystonia, dyskinesia, extrapyramidal motor disturbances, tremor, convulsions

2018 NICE Clinical Knowledge Summaries

128. Nausea/vomiting in pregnancy

pregnancy. Symptoms usually begin between the fourth and seventh weeks of gestation and usually resolve around the 20th week of pregnancy. Hyperemesis gravidarum is a diagnosis of exclusion characterized by prolonged and severe nausea and vomiting, dehydration, electrolyte imbalance, ketonuria, and body weight loss of more than 5% of pre-pregnancy weight. Findings which may suggest an alternative diagnosis include: Onset of symptoms after 11 weeks of gestation. Abdominal pain or tenderness (more than (...) Nausea/vomiting in pregnancy Nausea/vomiting in pregnancy | Topics A to Z | CKS | NICE Search CKS… Menu Nausea/vomiting in pregnancy Nausea/vomiting in pregnancy Last revised in February 2020 The majority of women vomit or feel nauseated in early pregnancy. Symptoms usually begin between the fourth and seventh weeks of gestation Diagnosis Management Prescribing information Background information Nausea/vomiting in pregnancy: Summary The majority of women vomit or feel nauseated in early

2018 NICE Clinical Knowledge Summaries

129. Antenatal care - uncomplicated pregnancy: Scenario: Antenatal care - uncomplicated pregnancy

problems, such as blurred vision, flashing lights, double vision, or floating spots. Persistent new epigastric pain or pain in the right upper quadrant. Vomiting. Breathlessness. Sudden swelling of the face, hands, or feet. [ ] Basis for recommendation The information on managing pregnant women at each antenatal appointment is largely based on expert opinion in the National Institute of Health and Care Excellence (NICE) guideline Antenatal care for uncomplicated pregnancies [ ]. Further information (...) -Kell), and haemoglobinopathies (such as sickle cell disease and thalassaemias). Testing for red cell alloantibodies and haemoglobinopathies should be offered as early as possible in pregnancy (ideally by 10 weeks). The type of haemoglobinopathy screening depends on the local prevalence of the disorder. The advises that in high-prevalence areas (more than 1.5 infants born with sickle cell disease per 10,000 births): All pregnant women are offered screening for sickle cell disorders, thalassaemia

2019 NICE Clinical Knowledge Summaries

130. COVID-19 and Pregnant Patients

%) myalgia in 11 women (37.9%) headache in 8 women (27.6%) shortness of breath in 7 women (24.1%) chest pain in 5 women (17.2%) any combination of above symptoms in 26 women (89.7%) Reference - clinical presentation of COVID-19 pneumonia in case series of 9 pregnant women in Wuhan, China fever in 7 women (77.8%) cough in 4 women (44.4%) myalgia in 3 women (33.3%) sore throat in 2 women (22.2%) malaise in 2 women (22.2%) PubMed 32151335 Lancet (London, England) Lancet 20200307 395 10226 809-815 809 (...) for COVID-19 infection for COVID-19 in pregnant patients is similar to that in the general population follow in the management of pregnant women with suspected or confirmed COVID-19 management of infection in pregnancy in women with suspected or confirmed COVID-19 there is , but supportive care may help to relieve symptoms and should include support of vital organ functions in severe cases consider of pregnant women during COVID-19 pandemic during COVID-19 pandemic unless directed otherwise by local

2020 DynaMed Plus

131. Pre-Operative Pregabalin for Post-Operative Pain in Head and Neck Cancer Surgery

Pre-Operative Pregabalin for Post-Operative Pain in Head and Neck Cancer Surgery Pre-Operative Pregabalin for Post-Operative Pain in Head and Neck Cancer Surgery - 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 remove one or more studies before adding (...) more. Pre-Operative Pregabalin for Post-Operative Pain in Head and Neck Cancer Surgery The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT03714867 Recruitment Status : Enrolling by invitation First Posted : October 22, 2018 Last Update Posted : January 7, 2019 Sponsor: Augusta University Information

2018 Clinical Trials

132. Gabapentin, Methadone, and Oxycodone With or Without Venlafaxine Hydrochloride in Managing Pain in Participants With Stage II-IV Squamous Cell Head and Neck Cancer Undergoing Chemoradiation Therapy

Gabapentin, Methadone, and Oxycodone With or Without Venlafaxine Hydrochloride in Managing Pain in Participants With Stage II-IV Squamous Cell Head and Neck Cancer Undergoing Chemoradiation Therapy Gabapentin, Methadone, and Oxycodone With or Without Venlafaxine Hydrochloride in Managing Pain in Participants With Stage II-IV Squamous Cell Head and Neck Cancer Undergoing Chemoradiation Therapy - 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 remove one or more studies before adding more. Gabapentin, Methadone, and Oxycodone With or Without Venlafaxine Hydrochloride in Managing Pain in Participants With Stage II-IV Squamous Cell Head and Neck Cancer Undergoing Chemoradiation Therapy The safety and scientific validity of this study is the responsibility

2018 Clinical Trials

133. Efficacy of Fluoroscopic Guided Atlantoaxial Joint Injection on Head and Neck Pain and Sleep Quality in RA Patients

inflammation and failure of resolution after 2 weeks systemic steroid administration Exclusion criteria Coagulopathy, allergy to contrast material, pregnancy Interventional group (AS) group, received intra-articular steroid injection for atlantoaxial joint. , in addition to methotrexate and chloroquine 400 mg per day. Condition or disease Intervention/treatment Phase Pain, Head Sleep Disturbance Drug: Steroids Early Phase 1 Detailed Description: Efficacy of intra-articular steroid injection for inflamed (...) Efficacy of Fluoroscopic Guided Atlantoaxial Joint Injection on Head and Neck Pain and Sleep Quality in RA Patients Efficacy of Fluoroscopic Guided Atlantoaxial Joint Injection on Head and Neck Pain and Sleep Quality in RA Patients - 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

2018 Clinical Trials

134. Quality measures in high-risk pregnancies: Executive summary of a cooperative workshop of SMFM, NICHD, and ACOG Full Text available with Trip Pro

trials: re: prevention in pregnancy. Unclear International population- based cohort studies demonstrate improved maternal outcomes (decreased mortality rate). Yes Current infrastructure for risk assessment and monitoring has been implemented widely in hospitals for nonpregnant medical and surgical populations. Yes All pregnant women should undergo venous thromboembolism risk assessment and receive treatment if at increased risk; recommend tracking of prophylaxis rates, harms (wound infection, heparin (...) intensive care unit admissions. Yes Sepsis bundle associated with decreased mortality rates. Yes Early recognition and treatment associated with decreased mortality rate. Yes But need modi?ed scoring systems to identify pregnant women at increased risk. Yes Also recommend hospital-based internal quality review for initiation of management protocol andin-person provider evaluationin 1 previous pregnancy and who received outpatient daily low-dose aspirin prophylaxis before delivery No. of women who

2017 Society for Maternal-Fetal Medicine

135. Guideline Supplement: Early pregnancy loss

printed copies after use Page 5 of 16 Queensland Clinical Guideline Supplement: Early pregnancy loss 2.4.1 Keywords The following list of keywords was used in combination in the basic search strategy. Other keywords may have been used for specific aspects of the guideline. Key word/phrase Synonyms/Subject heading/Mesh term Early pregnancy loss “pregnancy loss” OR miscarriage OR ectopic OR “ectopic pregnancy” OR “threatened abortion” OR “threatened miscarriage” OR “missed abortion” OR “missed (...) . Table 6. Summary recommendations Recommendation Grading of evidence 1. Offer women experiencing early pregnancy loss, all options for care that are clinically appropriate to their individual circumstances Consensus 2. Perform a serum pregnancy test on all women of reproductive age presenting with a history of pain (abdominal, shoulder tip) and/or, PV bleeding Consensus 3. Register all women experiencing gestational trophoblastic disease with the Queensland Trophoblast Centre Consensus 4. Recommend

2017 Queensland Health

136. Hypertension in pregnancy: Scenario: Pre-eclampsia

onset of hypertension (over 140 mmHg systolic or over 90 mmHg diastolic) after 20 weeks of pregnancy and the coexistence of 1 or more of the following new-onset conditions: Proteinuria , or Other maternal organ dysfunction: Renal insufficiency (creatinine 90 micromol/litre or more, 1.02 mg/100 ml or more). Liver involvement (elevated transaminases [alanine aminotransferase or aspartate aminotransferase over 40 IU/litre] with or without right upper quadrant or epigastric abdominal pain). Neurological (...) with thrombophilia or uncontrolled blood pressure. There is no evidence that use of low-dose aspirin in pregnancy is associated with an increased risk of congenital abnormalities or other fetal complications. Offer advice about healthy lifestyle (including rest, work, exercise, and weight) as recommended for all pregnant women. For more information, see the CKS topic on . For all pregnant women, dipstick the urine for protein and measure blood pressure at each antenatal visit. If dipstick screening is positive

2020 NICE Clinical Knowledge Summaries

137. Hypertension in pregnancy: Nifedipine

Hypertension in pregnancy: Nifedipine Nifedipine | Prescribing information | Hypertension in pregnancy | CKS | NICE Search CKS… Menu Nifedipine Hypertension in pregnancy: Nifedipine Last revised in October 2019 Nifedipine Contraindications and cautions Nifedipine is not specifically licensed for the treatment of hypertension in pregnancy. Nifedipine should not be prescribed to people with: Cardiogenic shock. Clinically significant aortic stenosis. Unstable or acute angina. Recent history (...) (within 4 weeks) of myocardial infarction. Nifedipine should be used with caution in people with: Severe hypotension (systolic blood pressure less than 90 mm Hg). Hepatic impairment. Poor cardiac reserve. Diabetes mellitus — may require adjustment of diabetes treatment as nifedipine can affect blood sugar. [ ; ] Adverse effects Adverse effects of nifedipine include: Neurological — headache, migraine, paraesthesia, tremor, asthenia, vertigo, visual disturbance. Cardiac — vasodilation, hypotension

2020 NICE Clinical Knowledge Summaries

138. Hypertension in pregnancy: Methyldopa

Hypertension in pregnancy: Methyldopa Methyldopa | Prescribing information | Hypertension in pregnancy | CKS | NICE Search CKS… Menu Methyldopa Hypertension in pregnancy: Methyldopa Last revised in October 2019 Methyldopa Contraindications and cautions Methyldopa is not specifically licensed for the treatment of hypertension in pregnancy. However, the manufacturer states that methyldopa can be used during pregnancy if there is no safer alternative available. Methyldopa should not be prescribed (...) . Neurological — sedation (usually transient), headache, paraesthesia, Parkinsonism, Bell's palsy, involuntary choreoathetotic movements, impaired mental acuity, dizziness, light headedness, symptoms of cerebrovascular insufficiency, asthenia or weakness. Gastrointestinal — gastrointestinal disorders, dry mouth, sore or 'black' tongue, pancreatitis, hepatitis, jaundice. Skin — rashes (including toxic epidermal necrolysis), lupus-like syndrome, angioedema, urticaria. Neuropsychiatric — nightmares, reversible

2020 NICE Clinical Knowledge Summaries

139. Dyspepsia - pregnancy-associated: Scenario: Management

have not been found to cause teratogenic effects in animal studies [ ] and calcium, aluminium, and magnesium-containing preparations (except magnesium trisilicate) are thought to be safe in pregnancy at the usual doses [ ; ]. The British National Formulary does not list pregnancy as a contraindication or caution to antacid use [ ]. For alginates, the manufacturer of Gaviscon ® Advance cites data from clinical studies (including more than 500 pregnant women) and post-marketing experience which does (...) on World Gastroenterology Organisation global guidelines: Global perspective on gastroesophageal reflux disease [ ], and expert opinion in review articles [ ; ; ], and the British National Formulary [ ]. CKS did not find any controlled studies on the effectiveness of omeprazole in pregnant women with dyspepsia, and the authors of a Cochrane systematic review noted the need for future research on the use of proton pump inhibitors (PPIs) for the treatment of heartburn in pregnancy [ ]. However, trials

2020 NICE Clinical Knowledge Summaries

140. Pregnancy, Birth, Neonatal, and Postnatal Neurological Outcomes After Pregnancy With Migraine. (Abstract)

seizures (aRR: 1.27 [95% CI: 1.03-1.57), but not of death (aRR: 0.67 [95% CI: 0.43-1.04]) and cerebral palsy (aRR: 1.00 [95% CI: 0.51-1.94]).Women with migraine and their offspring have greater risks of several adverse pregnancy outcomes than women without migraine.© 2019 American Headache Society. (...) Pregnancy, Birth, Neonatal, and Postnatal Neurological Outcomes After Pregnancy With Migraine. Prevalence of migraine is high during the reproductive age. Although migraine often improves during pregnancy, the risk of adverse pregnancy, birth, neonatal, and neurological outcomes in mother and offspring remains poorly understood.To investigate the associations between maternal migraine and risks of adverse pregnancy outcomes in the mother, and birth, neonatal and postnatal outcomes

2019 Headache

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