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Postpartum Office Visit

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1301. Six-week Review (CHS)

of development. An opportunity to give health promotion advice. An opportunity for the parent to express concerns. Physical examination The main purpose of this is to detect: . (DDH). . . The core examination is set out in National Institute for Health and Care Excellence (NICE) guidance 'Postnatal care up to 8 weeks after birth' [ ] . It should comprise: A weight check. Measurement of head circumference (and opportunity to palpate sutures and fontanelles, and assess head shape). A general assessment (...) * We'd love to send you our articles and latest news by email, giving you the best opportunity to stay up to date with expert written health and lifestyle content. By clicking 'Subscribe' you agree to our and . Subscribe Thanks for your feedback. if you would like to report a specific issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; Public Health England ; Public Health England (2013) ; Dept of Health

2008 Mentor

1302. Screening for Depression in Primary Care

situations. They include: Interview-based tools (such as Kiddie-Sads and Child and Adolescent Psychiatric Assessment) can be used for children and young adults suspected of having depressive illness. [ ] The Center for Epidemiologic Studies Depression (CES-D )Scale and Reynolds' Adolescent Depression Scale (RADS) are more suitable for adolescents. The Edinburgh Postnatal Depression Scale (EPDS) - a self-rating scale - is for puerperal depression. [ ] The is suitable for older patients. The Cornell Scale (...) opportunity to stay up to date with expert written health and lifestyle content. By clicking 'Subscribe' you agree to our and . Subscribe Thanks for your feedback. if you would like to report a specific issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; NICE Public Health Intervention Guidance (October 2008) ; Screening for child and adolescent depression in primary care settings: a systematic evidence review

2008 Mentor

1303. Scarlet Fever

, burns and postnatally (for example, surgical scarlet fever and puerperal scarlet fever). Pathophysiology GpA BHS are normally found in the nasopharynx but can cause disease - for example, pharyngitis, skin infections and pneumonia. [ ] In most cases scarlet fever evolves from a tonsillar or pharyngeal infection but the rash is uncommonly seen in 'strep throats'. [ ] GpA BHS secrete a variety of haemolysing enzymes and toxins including the erythrogenic toxins causing the characteristic rash (...) fever it does not prevent post-streptococcal glomerulonephritis. Medical treatment [ ] Antibiotics. Penicillin or azithromycin if penicillin-allergic are the treatments of choice given for a full 10 days. There are no documented penicillin-resistant GpA BHS infections. Amoxicillin can be used in children if compliance with penicillin is a problem. [ ] If there is high fever with marked systemic toxicity, the dose of antibiotic can be doubled or a second-line antibiotic (eg, a cephalosporin) used

2008 Mentor

1304. Russell-Silver Syndrome

Guidelines. You may find one of our more useful. In this article In This Article Silver-Russell Syndrome In this article Synonyms: Russell-Silver syndrome, Russell-Silver dwarfism, Silver's syndrome Definition Silver-Russell syndrome (SRS) is a clinically and genetically heterogeneous condition characterised by severe intrauterine and postnatal growth restriction, craniofacial disproportion and normal intelligence, downward curvature of the corner of the mouth, syndactyly and webbed fingers (...) of this condition are nonspecific, clinical diagnosis of SRS remains difficult [ ] . In general the features of the syndrome are most pronounced in young children and become less obvious as the patient becomes older. The face is characteristically small and triangular; however, the head circumference is usually normal for age. This, combined with short stature, gives the appearance of having a large head. Growth Birth weight less than 2 standard deviation (SD) from mean. Poor postnatal growth - less than 2 SD

2008 Mentor

1305. Rubinstein Taybi Syndrome

and European Guidelines. You may find one of our more useful. In this article In This Article Rubinstein-Taybi Syndrome In this article Rubinstein-Taybi syndrome (RSTS) is an extremely rare autosomal dominant genetic disorder characterised by: [ ] Dysmorphic facial features. Microcephaly. Broad thumbs and first toes. Intellectual disability. Postnatal growth restriction. It was first described in 1963 by Rubinstein and Taybi. [ ] In the past the diagnosis was made based on clinical and radiological (...) for your feedback. if you would like to report a specific issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; MedlinePlus ; Online Mendelian Inheritance in Man (OMIM) ; Rubinstein-Taybi syndrome: clinical features, genetic basis, diagnosis, and management. Ital J Pediatr. 2015 Jan 2041:4. doi: 10.1186/s13052-015-0110-1. Rubinstein JH, Taybi H; Broad thumbs and toes and facial abnormalities. Am J Dis Child 1963 105

2008 Mentor

1306. Pre-eclampsia and Eclampsia

in the UK. The incidence of severe pre-eclampsia is about 5/1,000 maternities. The incidence of eclampsia in the UK is around 5/10,000 pregnancies. 44% of seizures occur postnatally, the remainder being antepartum (38%) or intrapartum (18%). Deaths from eclampsia and pre-eclampsia in the UK and Ireland are now at their lowest ever recorded rate: between 2010-2012 there were nine deaths. This is a rate of 0.38 per 100,000 maternities (95% C.I. 0.18 - 0.71). [ ] 20% of neonatal stillbirths where (...) urgent referral and further investigation). Abnormal liver enzymes (ALT or AST rising to above 70 IU/L). Clonus. : H aemolysis, E levated L iver enzymes, L ow P latelets. Papilloedema. Fetal distress - reduced fetal movements. Small for gestational age infant. Approximately 45% of cases of eclampsia occur after delivery, most by four days postpartum but it can occur up to four weeks later. BP measurement Use a sitting or semi-reclining position so that the arm to be used is at the level of the heart

2008 Mentor

1307. Postmaturity (Prolonged Pregnancy) Full Text available with Trip Pro

effect on either mother or baby, including: Need for caesarean section. Prolonged labour. Postpartum haemorrhage. Traumatic delivery. Epidemiology The use of ultrasound in early pregnancy for precise dating is thought to reduce the number of post-term pregnancies compared to dating based on the LMP. [ ] 5-10% of pregnancies are prolonged beyond 42 weeks. [ ] Around 20% of pregnant women will need induction of labour - the majority for post-term pregnancy. [ ] Risk factors [ ] Previous post-term (...) Postmaturity (Prolonged Pregnancy) Post-term Pregnancy (Prolonged Pregnancy). Postmaturity | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Post-term Pregnancy Prolonged Pregnancy Authored by , Reviewed by | Last edited 3 May 2016 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based

2008 Mentor

1308. Pill Questions - What to Ask When Starting the OCP.

articles and latest news by email, giving you the best opportunity to stay up to date with expert written health and lifestyle content. By clicking 'Subscribe' you agree to our and . Subscribe Thanks for your feedback. if you would like to report a specific issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; Faculty of Sexual and Reproductive Healthcare (Apr 2017) ; Office for National Statistics ; Contraceptive (...) refer to them where necessary. They are a comprehensive list of relevant medical conditions which can be excluded by a thorough history and assessment. Some of the more common conditions which confer a UKMEC Category 3 or 4 risk for the COC pill, meaning the COC pill should probably not be prescribed, are: Age over 50 years. BMI of 35 kg/m 2 or more. In smokers aged 35 or more. Also those aged 35 or more who have smoked within the preceding year. Migraine with aura. Postnatal women who are breast

2008 Mentor

1309. Physiological Changes In Pregnancy

and cardiac output. This is relieved by lying in the left lateral position. Reduced cardiac output can compromise fetal blood supply. There is an increased risk of pulmonary oedema if there is an increase in blood volume, or increased pulmonary capillary permeability secondary to pre-eclampsia. The highest risk time is the second stage of labour or immediate postpartum period when cardiac output is high. Changes on examination and ECG below are caused by the physiological changes described above. Cardiac (...) content. By clicking 'Subscribe' you agree to our and . Subscribe Thanks for your feedback. if you would like to report a specific issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; Liver function test and pregnancy. J Matern Fetal Neonatal Med. 2009 Mar22(3):274-83. ; Anatomical, physiological and metabolic changes with gestational age during normal pregnancy: a database for parameters required

2008 Mentor

1310. Perinatal and Neonatal Infections

falciparum (malaria), rubella and cytomegalovirus (CMV). Ascending maternal infection and chorioamnionitis causing fetal infection, usually subsequent to prolonged rupture of membranes. Perinatal infection acquired during birth via the haematogenous or genital route. These include human immunodeficiency virus (HIV), herpes zoster virus (HZV), hepatitis B virus (HBV) and Chlamydia trachomatis . Postnatal infection transmitted via breast-feeding. Pre-pregnancy or routine antenatal screening can determine (...) neonatal (day 7 to day 27 completed days). Within the UK and the Crown Dependencies, infection accounted for 3.1% of stillbirths and 7.3% of neonatal deaths in 2014 [ ] . Congenital infections Rubella See separate article. HIV See separate article. CMV See separate article. Chickenpox [ ] See also separate article. Varicella infection of the newborn may result from maternal infection near the time of delivery or immediately postpartum, or from contact with a person other than the mother with chickenpox

2008 Mentor

1311. Problems in Small Babies

you the best opportunity to stay up to date with expert written health and lifestyle content. By clicking 'Subscribe' you agree to our and . Subscribe Thanks for your feedback. if you would like to report a specific issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; Royal College of Obstetricians and Gynaecologists Green-top guideline (Mar 2013) ; NICE Clinical Guideline (December 2014, updated February 2015 (...) ) ; Intrauterine Growth Restriction: Antenatal and Postnatal Aspects. Clin Med Insights Pediatr. 2016 Jul 1410:67-83. doi: 10.4137/CMPed.S40070. eCollection 2016. ; Small for gestational age: growth and puberty issues. Indian Pediatr. 2015 Feb52(2):135-40. ; Neurodevelopmental delay in small babies at term: a systematic review. Ultrasound Obstet Gynecol. 2012 Sep40(3):267-75. doi: 10.1002/uog.11112. Epub 2012 Aug 7. My little boy turn 8 months, and my baby start moving. He try to stand, he need strong support

2008 Mentor

1312. Prevention of Deep Vein Thrombosis

will depend on what risk factors are present (eg, age, weight, comorbidities, family history of thrombophilia). Women who have had a VTE before the current pregnancy should be considered for LMWH for six weeks postnatally. If they are receiving LMWH before pregnancy, preventative doses of LMWH should be given until six weeks postpartum. A postnatal risk assessment should then be made. Patients on long-term can recommence this when the risk of haemorrhage is low. Breast-feeding is no contra-indication (...) intake should be encouraged. Women with two or more risk-persisting risk factors should be considered for LMWH for seven days postnatally. Women with three or more such factors should be given graduated compression stockings as well as LMWH. Women with BMI >40 kg/m 2 should be considered for LMWH prophylaxis for seven days postnatally. GPs may find that women who have had an emergency or elective caesarean section are discharged on LMWH. The decision to initiate this and the duration of treatment

2008 Mentor

1313. Pre-pregnancy Counselling Full Text available with Trip Pro

in Southampton [ ] . This, and the haphazard seeking of pre-pregnancy advice by many patients, means that many opportunities for pre-pregnancy counselling are missed. By the first antenatal visit, organogenesis is well underway and interventions to avoid malformations may be too late. For example, folic acid supplementation before conception and during the first trimester prevents the majority of cases of neural tube defect (NTD) [ , ] . Similarly, control of glucose in women with diabetes both before (...) , deafness, cardiac abnormalities and intrauterine growth restriction. Infection in the first 8-10 weeks of pregnancy results in damage in up to 90% of infants [ ] . Defects are rare after 16 weeks of gestation. Whilst women are routinely screened during pregnancy for rubella, this cannot provide protection for the current pregnancy, as immunisation must wait until immediately postpartum. With the downturn in rates of measles, mumps and rubella (MMR) vaccination and increasing numbers of births to women

2008 Mentor

1314. Premature Rupture of Membranes

-hourly temperatures - may be possible for some women. Antibiotic administration: Prophylactic antibiotics for P-PROM appear to reduce complications due to preterm delivery and postnatal infection. [ ] However, there is no evidence of long-term safety from this strategy and benefits in a high-income healthcare setting may be small. [ ] In the UK, the National Institute for Health and Care Excellence (NICE) recommends the use of erythromycin 250 mg qds for 10 days (or until labour is established (...) to the newsletter? Email address * We'd love to send you our articles and latest news by email, giving you the best opportunity to stay up to date with expert written health and lifestyle content. By clicking 'Subscribe' you agree to our and . Subscribe Thanks for your feedback. if you would like to report a specific issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; NICE Clinical Guideline (Dec 2014) ; NICE Clinical

2008 Mentor

1315. Prenatal Diagnosis

. The following subsections cover the antenatal screening tests that are routinely offered. Screening for potential for neonatal infection Testing for hepatitis B, HIV and syphilis, and susceptibility to rubella, is offered to all women, in each pregnancy, at antenatal booking. This means that effective antenatal intrapartum and postnatal intervention can be offered to infected women to decrease the risk of mother-to-child-transmission. Screening for haemolytic disease of the newborn Maternal blood group (...) of a fetal abnormality should be considered on a case-by-case basis. Decisions about whether to terminate a pregnancy for fetal abnormalities are devastatingly difficult for couples on an individual level, and a source of debate for society as a whole. [ ] Other women prefer to have confirmation of an abnormality using prenatal diagnosis to allow them to prepare perinatally and postnatally. Prenatal diagnosis may allow potential in utero fetal treatment of the condition in some cases - for example

2008 Mentor

1316. Premenstrual Syndrome

mastalgia, dysmenorrhoea or migraine have not responded to self-management. Difficult interpersonal relationships with a spouse or children may also precipitate a consultation. The risk of perimenopausal and postnatal depression as well as anxiety disorders, appears to be higher amongst women with PMD. [ ] Psychosexual problems, loss of libido and dyspareunia may be reported but usually have to be specifically asked about. There are no specific signs of the syndrome, so the problem is best delineated (...) Thanks for your feedback. if you would like to report a specific issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; Royal College of Obstetricians and Gynaecologists (2016) ; Royal College of Obstetricians and Gynaecologists (December 2007) ; Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health. 2011 Feb14(1

2008 Mentor

1317. Progestogen-only Injectable Contraceptives

weeks postpartum if the patient is not breastfeeding. If the patient is breastfeeding, FSRH advises it should ideally be delayed until day 21 postpartum, although this is outside of the product licence which advises waiting for 6 weeks. After first- or second-trimester abortion it can be given immediately. If delayed, additional precautions are required for 7 days. The SPCs of IM DMPA (Depo-Provera®) and SC DMPA (Sayana Press®) advise dosing intervals of 12 and 13 weeks respectively but the SPC (...) news by email, giving you the best opportunity to stay up to date with expert written health and lifestyle content. By clicking 'Subscribe' you agree to our and . Subscribe Thanks for your feedback. if you would like to report a specific issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; NHS Employers ; Pharmacia Limited, electronic Medicines Compendium, April 2015 ; Pharmacia Limited, electronic Medicines

2008 Mentor

1318. Platelet Function Disorders

-zoster, Epstein-Barr, rubella, enterovirus, mumps, hepatitis, HIV. . Marrow infiltration by a malignancy - eg, , , , . Drugs - eg, chemotherapy. Alcohol. . Megaloblastic anaemia. . Miliary tuberculosis. Decreased platelet survival Immune - , , , , . Post-transfusion thrombocytopenic purpura (PTTP): Antigens on transfused platelets can lead to destruction of not just the transfused platelets but the patient's own platelets too. It starts about 10 days after transfusion but can last several weeks (...) . [ ] History Epistaxis, particularly if excessive, frequent or prolonged. Bleeding gums or bleeding from tooth extractions. Haemoptysis, haematemesis, haematuria, haematochezia (passage of bright red blood with bowel movements) and melaena - not usually seen in the initial stages, but a bleeding disorder can exacerbate them if there is any secondary pathology. Metromenorrhagia - especially seen in vWD and is often made worse when an NSAID is given to treat dysmenorrhoea. Postpartum haemorrhage. Excessive

2008 Mentor

1319. Premature Babies and their Problems

infants born at less than 33 weeks of gestation, more than 90% of whom survived the immediate postpartum period [ ] . Simply labelling all babies born before 37 weeks as premature fails to illustrate the marked gradation in terms of severity of the problem with increasing prematurity: A baby born at 36 weeks will probably be a little slow to feed. A baby born before 33 weeks will have more serious problems including, possibly, immature lungs. Birth before 28 weeks causes very significant problems (...) recognised [ ] . Parental support When a baby is in the SCBU it is a very emotional and traumatic time for any parent. They should be encouraged to visit and stay with the baby as much as possible. Breast-feeding may be rather difficult but it should be encouraged. Breast milk is the best food for any baby but especially premature babies. Mothers who are producing more than their own baby's needs should be encouraged to donate to the local SCBU as it is always welcome. The baby is attached to monitors

2008 Mentor

1320. Placenta Praevia

is delivered urgently whatever its gestational age. Hysterectomy should also be considered in severe cases. If immediate delivery is not likely, maternal steroids may be indicated in order to promote fetal lung development and reduce the risk of respiratory distress syndrome and intraventricular haemorrhage [ ] . Complications Potentially fatal hypovolaemic shock resulting from severe antepartum, intrapartum or postpartum bleeding. Venous thromboembolism is associated with prolonged inpatient care (...) and the hazards of prophylactic anticoagulation in women at high risk of bleeding. Rare: Fetal haemorrhage, prematurity, intrauterine asphyxia or birth injury. Prognosis A prospective study of 328 European women demonstrated the high maternal and neonatal morbidity associated with placenta praevia [ ] : 42.3% antepartum haemorrhage. 7.1% postpartum haemorrhage. 30% maternal anemia. 4% co-existing placenta accreta. 5.2% hysterectomy. 54.9% preterm birth. 35.6% low birth weight <2500 g. 1.5% fetal mortality

2008 Mentor

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