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Postpartum Inpatient Management

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141. Clinical Challenges of Long-Acting Reversible Contraceptive Methods

gynecologic care provider, postpartum insertion, breastfeeding, and extreme anteflexion or retroflexion of the uterus ( ). A perforated IUD may be free floating in the abdomen or pelvis, encased in adhesions, or adherent to bowel or omentum. The most common management strategy for uterine perforation, recommended by the World Health Organization, is surgical removal preceded by ruling out pregnancy and initiating emergency oral contraception and alternative contraception. Laparoscopic surgery is preferred (...) fails to improve clinically after 48–72 hours, antibiotics should be continued and IUD removal considered (28). Tuboovarian Abscess The CDC does not make recommendations about the management of tuboovarian abscess in a woman with an IUD. There is little evidence on this topic. Current management protocols include inpatient treatment with intravenous antibiotics for tuboovarian abscess with consideration of IUD removal if no clinical improvement. Vaginosis The relationship between bacterial vaginosis

2016 American College of Obstetricians and Gynecologists

142. The Obstetric and Gynecologic Hospitalist

, to admitting and providing the full spectrum of labor and delivery and postpartum care for some or all obstetric patients. Depending on the hospital, ob-gyn hospitalists may directly supervise and teach residents and students; provide surgical and consultative support to certified nurse–midwives, certified midwives, and family physicians; or manage unassigned patients in the emergency department or medical floors. Other responsibilities may include assisting in cesarean or multiples’ deliveries, providing (...) coverage for precipitous births, managing obstetric emergencies such as postpartum hemorrhage, and providing coverage for obstetrician–gynecologists during scheduled clinic hours. The ob-gyn hospitalists also may provide assistance for scheduled operative cases and could support fatigued ob-gyn physicians. The ob-gyn hospitalists also may work with nursing leadership to ensure effective resource use and to monitor quality metrics, such as elective delivery before 39 weeks of gestation. It is estimated

2016 American College of Obstetricians and Gynecologists

143. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

School of Medicine, Internal Medicine, Endocrinology, Pediatrics, Pediatric Endocrinology, New Haven, Connecticut; 7 Walter Reed National Military Medical Center, Diabetes Obesity & Metabolic Institute, Bethesda, Maryland; 8 Assistant Clinical Professor, Mount Sinai School of Medicine, NY, ProHealth Care Associates, Division of Endocrinology, Lake Success, New York; 9 Center for Weight Management, Division of Endocrinology, Diabetes and Metabolism, Scripps Clinic, San Diego, California. Address (...) citations used in this CPG, 524 (29.3%) were based on strong (evidence level [EL] 1), 605 (33.8%) were based on intermediate (EL 2), and 308 (17.2%) were based on weak (EL 3) scientific studies, with 353 (19.7%) based on reviews and opinions (EL 4). Conclusion: The final recommendations recognize that obesity is a complex, adiposity-based chronic disease, where management targets both weight-related complica- tions and adiposity to improve overall health and quality of life. The detailed evidence-based

2016 American Association of Clinical Endocrinologists

144. Comparing variation in hospital rates of cesarean delivery among low risk women using 3 different measures

, Kowalewski L, Sappen?eld W, et al. A multistate quality improvement program to decrease elective deliveries before 39 weeks of gestation. Obstet Gynecol 2013;121: 1025-31. 16. Barber EL, Lundsberg LS, Belanger K, Pettker CM, Funai EF, Illuzi JL. Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol 2011;118:29-38. 17. Berthelsen CL. Evaluation of coding data quality of the HCUP Nationwide Inpatient Sample. Topics Health Inf Manage 2000;22: 10-4. 18. Robson M. Classi?cation (...) Stillborn x 646.0 PAPYRACEOUS FETUS Stillborn x 646.00 PAPYRACEOUS FETUS-UNSPEC Stillborn x 646.01 PAPYRACEOUS FETUS-DELIV Stillborn x 646.03 PAPYRACEOUS FET-ANTEPAR Stillborn x 648.51 CONGEN CV DIS-DELIVERED Maternal factors x 648.52 CONGEN CV DIS-DEL W P/P Maternal factors x 648.53 CONGEN CV DIS-ANTEPARTUM Maternal factors x 648.54 CONGEN CV DIS-POSTPARTUM Maternal factors x 648.6 OTHER CARDIOVASCULAR DISEASE Maternal factors x 648.60 CV DIS NEC PREG-UNSPEC Maternal factors x 648.61 CV DIS NEC PREG

2016 Society for Maternal-Fetal Medicine

145. Clinical Practice Guidelines on Obesity

facility capabilities including equipment and extra staffing when performing caesarean section and other surgeries. (pg 99) Grade B, Level 2 + Post-natal management: D Discuss healthy eating, physical activity and breastfeeding as strategies for returning to pre-pregnancy weight with all postpartum women. Women in a healthy pre-pregnancy BMI range should be advised of the importance of maintaining a healthy pre-pregnancy BMI between pregnancies. Overweight and obese women should be encouraged to lose (...) and patterns of care evolve. The contents of this publication are guidelines to clinical practice, based on the best available evidence at the time of development. Adherence to these guidelines may not ensure a successful outcome in every case. These guidelines should neither be construed as including all proper methods of care, nor exclude other acceptable methods of care. Each physician is ultimately responsible for the management of his/her unique patient, in the light of the clinical data presented

2016 Ministry of Health, Singapore

146. Smoking: acute, maternity and mental health services

is the basis of QS82 and QS43. Ov Overview erview This guideline covers helping people to stop smoking in acute, maternity and mental health services. It promotes smokefree policies and services and recommends effective ways to help people stop smoking or to abstain from smoking while using or working in secondary care settings. Who is it for? Health and social care professionals, including clinical leads in secondary care services and managers of clinical services Commissioners, leaders of the local (...) health and care system and Trust boards Estate managers and other managers People using secondary care services and their families and carers Smoking: acute, maternity and mental health services (PH48) © NICE 2019. All rights reserved. Subject to Notice of rights ( conditions#notice-of-rights). Page 5 of 66Introduction: scope and purpose of this guidance Introduction: scope and purpose of this guidance What is this guidance about? The guidance supersedes

2013 National Institute for Health and Clinical Excellence - Clinical Guidelines

147. #UnderstandingPsychosis?

of interest’ then that’s clearly nonsense as they are both invested in promulgating psychiatry’s hegemony . Secondly, the entire review is carried on psychiatries terms, i.e. its entirely positivist. The belief that investigations into humans where they are both object and subject can be objective is naive at best and delusional at worst. Thirdly (and most damningly) they are failing to see the wood for the trees. The fact is psychiatry has failed in managing and curing mental illness long term (...) experience).” – Exposing dangerous dogma – 4.1 The UP&S document had no mention of an important condition called postpartum psychosis. The facts of this condition are as follows. It occurs in about 1 in 1000 pregnancies. Women with bipolar disorder have a very high risk of postpartum psychosis, with over 60% being affected if un-medicated. Postpartum psychosis can be very severe and escalates quickly. About 40-50% of mothers will have delusions regarding their baby. In about 4% of cases

2017 The Mental Elf

148. Evidence-based guidelines for treating bipolar disorder

after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use (...) alongside NICE 2014 Bipolar Disorder: Assessment and Management (NICE2014) (https://, the recommendations from which are in places compared with our own. The quality of the evidence base Evidence categories (I to IV) traditionally imply a hierarchy from the best evidence, based on high-quality randomized trials, to the weakest, based on opinion/clinical impression (Shekelle et al., 1999). This approach explicitly downgrades non-experimental descriptive studies

2016 British Association for Psychopharmacology

149. Birth after Previous Caesarean Birth

is 72–75%. What factors determine the individualised likelihood of VBAC success? Women with one or more previous vaginal births should be informed that previous vaginal delivery, particularly previous VBAC, is the single best predictor of successful VBAC and is associated with a planned VBAC success rate of 85–90%. Previous vaginal delivery is also independently associated with a reduced risk of uterine rupture. Intrapartum management of planned VBAC What delivery setting is appropriate (...) incision in women undergoing ERCS. [New 2015] All women undergoing ERCS should receive thromboprophylaxis according to existing RCOG guidelines. [New 2015] Early recognition of placenta praevia, adopting a multidisciplinary approach and informed consent are important considerations in the management of women with placenta praevia and previous caesarean delivery. [New 2015] How should women in special circumstances be cared for? Clinicians should be aware that there is uncertainty about the safety

2015 Royal College of Obstetricians and Gynaecologists

150. Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death We use cookies to enhance your experience on our website. By continuing to use our website, you are agreeing to our use of cookies. You can change your cookie settings at any time. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death | European Heart Journal | Oxford Academic Search Account Menu Menu Navbar Search Filter Mobile Microsite Search Term Close (...) search filter search input Article Navigation Close mobile search navigation Article navigation 1 November 2015 Article Contents Article Navigation 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC) Endorsed by: Association for European Paediatric and Congenital

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2015 European Society of Cardiology

151. Evidence-based Guidelines for Treating Bipolar Disorder

after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use (...) alongside NICE 2014 Bipolar Disorder: Assessment and Management (NICE2014) (https://, the recommendations from which are in places compared with our own. The quality of the evidence base Evidence categories (I to IV) traditionally imply a hierarchy from the best evidence, based on high-quality randomized trials, to the weakest, based on opinion/clinical impression (Shekelle et al., 1999). This approach explicitly downgrades non-experimental descriptive studies

2016 British Association for Psychopharmacology

152. Yoga for the Treatment of Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Depression, and Substance Abuse

with postpartum depression, 28 and one study for women from the community with MDD or dysthymia. 29 The remaining RCT included adult patients with MDD from an inpatient hospital ward. 30 The yoga intervention took the form of gentle vinyasa flow yoga (60 min, 16 classes for eight weeks and home practice (30 min, one time per week using a DVD) for women with postpartum depression. 28 Vinyasa flow yoga involved a sequence of four categories of poses/techniques: I. breathing and centering techniques, II, Warm-up (...) pre and post-treatment. Mitchell et al. 18 also assessed outcomes at one- month follow-up. Based on the study by Mitchell et al., 18 additional outcome data such as PTSD screening, awareness and attentiveness, psychological flexibility, alcohol risk behaviours, substance use and dependence and symptom perception and management, was reported in two related follow-up studies 19,20 . Clinical effectiveness of yoga for adults with GAD Two systematic reviews were identified in the literature

2015 Canadian Agency for Drugs and Technologies in Health - Rapid Review

153. Provision of interventional radiology services

image processing software. IR units should have established links and access to day-case facilities. Many IR procedures can be performed as a day-case episode and IR offers an opportunity to deliver more cost-effective care when day-case and outpatient facilities are used appropriately. Interventional radiologists have specialist knowledge and experience of managing patients undergoing interventional procedures. To ensure the highest quality of inpatient care, interventional radiologists should (...) is the provision of one staff member experienced with the procedures and equipment as scrubbed assistant, with sedation and monitoring provided by a separate member of staff. Interventional radiologists play an increasingly clinical role and job plans should incorporate all aspects of activity, including the requirements to provide outpatient clinics and inpatient clinical support. Patients expect the procedure and their treatment to be explained by the clinician carrying them out. Interventional radiologists

2014 Royal College of Radiologists

154. Best Practice Guidelines for Mental Health Disorders in the Perinatal Period

the Perinatal Period . . . . . . . . 44 Table 9: Common Treatments for Bipolar Disorder in the Perinatal Period . . . . . . . . . . . . . . . . 48 Table 10: Guidelines for the Treatment of Bipolar Disorder . . . . . . . . . . . . . . . . . . . . . . . . . 50 Table 11: Guidelines for the Prevention/Management of Psychotic Disorders & Postpartum Psychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Table 12: General Responses to Identified Suicide (...) but risks and impacts can be successfully managed. Medications play a significant role in management but adding a psychosocial intervention can improve treatment outcomes, particularly during the depression phase of bipolar. See Section 5.3 for discussion of Treatment and Self-Management. Recommendations for bipolar disorder Promote early identification and treatment of bipolar disorder in perinatal women by enquiring about risk factors (personal or family history of bipolar disorder and/or postpartum

2014 British Columbia Perinatal Health Program

155. Development and implementation of a quality improvement toolkit, iron deficiency in pregnancy with maternal iron optimization (IRON MOM): A before-and-after study. (PubMed)

= 0.0214). Limitations of this study include the use of aggregate data extracted from the EPR, and lack of a control group.The introduction of a standardized toolkit including diagnostic and management pathways as well as other aids increased ferritin testing and decreased the incidence of anemia among women presenting for delivery at our site. This strategy also resulted in reduced proportions of women receiving RBC transfusion during pregnancy and in the first 8 weeks postpartum. The IRON MOM toolkit (...) priorities.In order to enhance screening and management of ID and IDA in pregnancy, we developed a novel quality-improvement toolkit: ID in pregnancy with maternal iron optimization (IRON MOM), implemented at St. Michael's Hospital in Toronto, Canada. It included clinical pathways for diagnosis and management, educational resources for clinicians and patients, templated laboratory requisitions, and standardized oral iron prescriptions. To assess the impact of IRON MOM, we retrospectively extracted

2019 PLoS medicine

156. What are the recommended clinical assessment and screening tests during pregnancy?

. INTRODUCTION 1.1. Background Each year, more than 125 000 births are registered in Belgium. 1 An early, adequate and continuous prenatal care with timely identification and management of risk factors is fundamental for a good pregnancy outcome. To avoid consequences of malpractice, inappropriate use of resources and inequality between patients, prenatal care should be based on the best scientific evidence. In 2004, the KCE had published a clinical guideline for antenatal care (KCE Report 6). 2 However (...) , since 2004, the health professionals who are involved in the management of pregnant women face new scientific evidence and emerging issues (e.g. lower threshold for the diagnosis of gestational diabetes 3 or new screening tests for preeclampsia risk). Furthermore, it appears that some laboratory tests that were not recommended in 2004 continue to be broadly prescribed in Belgium. 4 This observation can indicate a possible overuse of the screening tests with a risk of misallocation of resources

2015 Belgian Health Care Knowledge Centre

157. BladderScan BVI 9400 3D portable ultrasound scanner for measuring bladder volume

volume in people with chronic neurological conditions such as cerebral palsy or spinal dysraphism. Bladder care is an important aspect of management in the postpartum period. Postpartum voiding dysfunction occurs in a significant number of women after giving birth. Standard bladder scanners may measure uterine debris as bladder volume. The NeuralHarmonics technology within the BladderScan BVI 9400 potentially allows more accurate non-invasive bladder volume measurement in women who have recently (...) of rights ( conditions#notice-of-rights). Page 16 of 26Kuppusamy S, Gillatt D (2011) Managing patients with acute urinary retention. Practitioner 255: 21–3 Marciano A, Capitanucci M, Mariani S et al. (2013) Accuracy of BladderScan BVI9400 compared to transurethral catheterization in evaluating bladder volume in children. Neurourology and Urodynamics 32: S43–4 Mulder FEM, Schoffelmeer MA, Hakvoort RA et al. (2012) Risk factors for postpartum urinary retention

2016 National Institute for Health and Clinical Excellence - Advice

158. Suicide during the perinatal period

represents the leading cause of maternal mortality in developed nations (Oates, 2003), principally as more physiological causes of maternal death, such as haemorrhage, obstetric embolisms, and pre-eclampsia/eclampsia, have become rarer with the routine health screening and care that pregnant women in developed nations now receive (Palladino et al, 2011). Around one-quarter (24%) to just under one-half (49%) of UK women referred to psychiatric services for postpartum depression have a history (...) information on all UK residents aged 10 or older who have been in receipt of psychiatric care (e.g., outpatient, day, inpatient, or crisis home treatment) in the 12 months preceding a death by suicide or homicide perpetration. Inquiry data is collected in 3 stages: Data on all suspected suicides in the UK (e.g., deaths recorded as either a suicide or an open verdict following a coroner’s inquest) are collected from the national registries in England and Wales, Scotland, and Northern Ireland; Psychiatric

2016 The Mental Elf

159. Task Force 6: Pediatric Cardiology Fellowship Training in Adult Congenital Heart Disease

1 clinic per week, although more may be necessary. • Experience a range of diagnostic and therapeutic methods used in the care of adults with CHD, including direct experience in echocardiography, magnetic resonance imaging, computed tomography, diagnostic catheterization, and exercise testing. • Participate in the perioperative evaluation of adults with CHD for both cardiac and noncardiac procedures and observe operative repairs. • Participate in outpatient evaluation and inpatient management (...) of pregnancy in women with CHD. • Participate in inpatient and outpatient management of adults with CHD and heart failure and/or pulmonary arteriolar hypertension. Participate in medical management of these patients, as well as exposure to discussion/ implementation of mechanical circulatory support and transplant as options for treatment. • Participate in the diagnosis and management of the arrhythmic complications seen in adults with CHD, both medical therapy and interventional options. • For those

2015 American Heart Association

160. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

-related exclusion criteria for alteplase that are considered standard of care and are listed in the AHA/ASA acute stroke management guidelines ( ). Table 4. Inclusion and Exclusion Characteristics of Patients With Ischemic Stroke Who Could Be Treated With Intravenous rtPA Within 3 Hours From Symptom Onset Inclusion criteria Diagnosis of ischemic stroke causing measurable neurological deficit Onset of symptoms <3 h before treatment begins Age ≥18 y Exclusion criteria Significant head trauma or prior (...) Koennecke et al, 2001 Berlin, Germany Single academic center 504 13 32 8 20 40 Azzimondi et al, 1997 Bologna, Italy Single teaching hospital 204 NR 40 12 31 9 7 NIHSS indicates National Institutes of Health Stroke Scale; and NR, not reported. The current exclusion criteria listed in the AHA/ASA 2013 acute stroke management guidelines remain based largely on the criteria listed in the pivotal National Institute of Neurological Disorders and Stroke (NINDS) alteplase trial published in 1996, with a few

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2015 American Heart Association

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