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Postpartum Office Visit

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1321. Placenta and Placental Problems

in the membrane some distance from the periphery of the main placenta. Occurs in 1.7% of pregnancies, two thirds of which also have velamentous cord insertion (see under 'Abnormalities of the cord', below). Large torn vessels within the fetal membranes but beyond the edge of the delivered placenta are suggestive of an undelivered lobe and the uterus should be further explored for retrieval. Succenturiate lobes are associated with retained placenta and increased risk of postpartum infection and haemorrhage (...) of the uterine wall. This is associated with antepartum and postpartum haemorrhage as well as retained placenta. Placenta in multiple pregnancy Fraternal twins have either two distinct placentas or a fused placenta but there are always two distinct chorions and amnions. With identical twins the situation depends upon the timing of the division of the fertilised ovum: they can have two distinct placentas and sets of membranes or many different types of fusion with possible interchange of blood supply

2008 Mentor

1322. Plasma Autoantibodies (Disease Associations)

thyroiditis, but also being highly prevalent in postpartum thyroiditis and Graves' disease [ ] . Antisperm antibodies Specific and characteristic of immunological infertility. Steroid cell antibodies Present in Addison's disease and autoimmune gonadal failure. Neurology : Acetylcholine receptor antibody is associated in most patients with myasthenia gravis [ ] . Antibodies in peripheral neuropathy: Ganglioside M1 (GM1): patients with multifocal motor neuropathy and less frequently in Guillain-Barré (...) ) is associated mainly with [ ] . Did you find this information useful? Thanks for your feedback! Why not subscribe 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

2008 Mentor

1323. Labyrinthitis

cause cochlear trauma, including vertebrobasilar ischaemia, meningitis, Ménière's disease and medication (eg, aminoglycoside) [ ] . It is worth noting that viral infections cause both congenital and acquired hearing loss (rubella and cytomegalovirus are viral causes of prenatal hearing loss). Postnatally, viral-induced hearing loss is usually due to mumps or measles. Viral infections are also implicated in idiopathic sudden sensorineural hearing loss (SNHL). Epidemiology [ , ] There is a wide (...) decade with women outnumbering men by about 2:1. Bacterial labyrinthitis is rare in the post-antibiotic era: Meningogenic suppurative labyrinthitis is most often seen in young children (under the age of 2 years), when children are at most risk of meningitis. Otogenic suppurative labyrinthitis can be observed in all ages and is almost always associated with cholesteatoma. Presentation [ , , ] History Patients with vertigo may find it difficult to describe their symptoms but clarifying the timing

2008 Mentor

1324. IUCD - Lost Threads and Other Problems

rate of uterine perforation due to the softness of the postpartum uterus. Expulsion of the device is more common for insertions after 48 hours post-delivery. [ ] Beyond 4 weeks postpartum, benefits outweigh risks, even if the woman is breast-feeding (there is no increased copper level in breast milk) and post-caesarean section mothers. Post-termination insertion Insertion after termination of pregnancy is safe and practical. It can often be a convenient time to perform the procedure and may avoid (...) in the menstrual cycle, as long as pregnancy can reasonably be excluded (see 'Excluding pregnancy', below). Documenting a negative pregnancy test may be sensible, if possible. The LNG-IUS (Mirena®) can be fitted at any time in the cycle as long as pregnancy can be reasonably excluded. The IUS is ideally inserted between day 1 and day 7 of the menstrual cycle. If it is fitted at any other time condoms are advised for the first seven days of use. Whilst postpartum contraception is a licensed indication

2008 Mentor

1325. Iron-Deficiency Anaemia (IDA)

. Oesophagitis and gastro-oesophageal reflux disease. Postpartum haemorrhage. Recurrent epistaxis. Malignancy of the renal tract. After major surgery or major trauma, if replacement has been inadequate. After blood donation. Dietary inadequacy Dietary iron deficiency is fairly uncommon. Meat tends to be more rich than vegetables in iron and so vegetarians are at greater risk. However, green vegetables are a good source of iron and a proper vegetarian diet should not lead to deficiency. Growing children (...) 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 ; Guideline Audit and Implementation Network (2015) ; World Health Organization ; Strategies to avoid the loss of developmental potential in more than 200 million Lancet. 2007 Jan 20369(9557):229-42. ; Iron

2008 Mentor

1326. Intrauterine Growth Restriction

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 ; MBRRACE-UK, 10 June 2015 ; MBRRACE-UK, Dec 2015 ; MBRRACE-UK, Dec 2014 ; Intrauterine Growth Restriction: Antenatal and Postnatal Aspects. Clin Med Insights Pediatr. 2016 Jul 1410:67-83. doi: 10.4137/CMPed.S40070. eCollection 2016 (...) synonymously. However, there is a difference in meaning [ ] : The SGA definition is based on the cross-sectional evaluation (either prenatal or postnatal) and this term has been used for those neonates whose birth weight is less than the 10th percentile for that particular gestational age or two standard deviations below the population norms on the growth charts. The definition considers only the birth weight without any consideration of the in-utero growth and physical characteristics at birth. IUGR

2008 Mentor

1327. Intrauterine Contraceptive Device (IUCD)

a prosthesis which could be compromised by blood-borne infection. 2 days to 4 weeks postpartum. Benign trophoblastic disease. Severe cervical stenosis. or congenital abnormality of uterus, but no marked distortion of the cavity. After endometrial ablation or resection. Between 48 hours and 4 weeks post termination: the chances of expulsion post insertion are slightly increased in this period. It is recommended that the IUCD/IUS should only be inserted at this time if the patient is at risk of pregnancy (...) concentration in cervical mucus is also substantial and inhibits sperm motility. The copper devices may also prevent implantation if fertilisation occurs. However, the studies suggesting this were of older devices with lower copper content, and there is no clear evidence that modern devices allow fertilisation to occur. The postcoital use of copper devices utilises this post-fertilisation contraceptive effect. Effectiveness Many factors determine efficacy in individual women, including sexual activity, age

2008 Mentor

1328. Intrapartum Fetal Monitoring

hypoxia: [ , ] Low gestational age (24-30 weeks) plus: postnatal dexamethasone use; patent ductus arteriosus; severe hyaline membrane disease; resuscitation in the delivery room; and intraventricular haemorrhage have all been shown to be associated with higher rates of cerebral palsy. Whereas antenatal corticosteroid use in very preterm infants is associated with a lower rate. [ ] There appears to be at best a tenuous connection between cardiotocographic findings, what they signify about the fetal (...) in labour. Did you find this information useful? Thanks for your feedback! Why not subscribe 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

2008 Mentor

1329. Inherited Kidney Diseases

, genetic counselling may be of less benefit. [ ] The role of prenatal interventions and postnatal therapies in cases of congenital kidney and urinary tract anomalies requires further research. [ ] Did you find this information useful? Thanks for your feedback! Why not subscribe 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 ; TRPC6 mutations in children with steroid-resistant nephrotic syndrome and atypical phenotype. Clin J Am Soc Nephrol. 2011 Jul6(7):1626-34. doi: 10.2215/CJN.07830910. ; Genetic kidney diseases. Lancet. 2010 Apr 10375(9722):1287-95. doi: 10.1016/S0140-6736(10)60236-X

2008 Mentor

1330. Infantile Intraventricular Haemorrhage

issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; Periventricular/Intraventricular Hemorrhage and Neurodevelopmental Outcomes: A Meta-analysis. Pediatrics. 2015 Dec136(6):1132-43. doi: 10.1542/peds.2015-0944. ; The diagnosis, management, and postnatal prevention of intraventricular hemorrhage in the preterm neonate. Clin Perinatol. 2008 Dec35(4):777-92, vii. ; Risk factors for intraventricular haemorrhage (...) , diagnosis or treatment. Registered number: 10004395 Registered office: Rawdon House, Green Lane, Yeadon, Leeds LS19 7BY. Patient is a UK registered trade mark. Connect with us close uses cookies to improve your experience and deliver personalised advertising. By using this site you agree to our use of cookies. You can opt out at any time or find out more by reading our . ACCEPT

2008 Mentor

1331. Inflammatory Retinal Diseases

on the underlying cause, the severity of the vasculitis and the presence/severity of any complications. Parasitic infections Ocular toxoplasmosis [ ] Infection with the intracellular protozoan Toxoplasma gondii is the most frequent cause of infectious retinitis in immunocompetent individuals. Presentation is usually following reactivation of a prenatal infestation but the infection can also be acquired postnatally. It can cause a variety of types of retinitis, the end point of which is scarring. Depending (...) 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 ; Toxoplasmosis. Semin Ophthalmol. 2005 Jul-Sep20(3):129

2008 Mentor

1332. Infantile Colic

be sought in an acute situation, although many parents usually present with a history of inconsolable crying in an infant who appears to be thriving and content. In an acute situation when faced with a distressed infant, consider: Physical discomfort - cold, wet, hungry. Severe . from the infant's nails. . . . . . When the history is over a longer period of time, consider: . . . Cow's milk protein allergy. Parenting skills and experience of parents. Maternal postnatal depression. Gastro-oesophageal (...) 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 ; Looking for new treatments of Infantile Colic. Ital J Pediatr. 2014 Jun 540:53. doi: 10.1186/1824-7288-40

2008 Mentor

1333. Infant Feeding

of treatment, for most women, initial nipple pain reduces to mild levels after 7-10 days postpartum [ ] . Blocked duct and breast engorgement These are caused by poor drainage of the breast. The breasts feel swollen, hard and painful. There may be redness or systemic symptoms. The nipples cannot protrude to allow the baby to 'latch on', and feeding becomes difficult. Common causes are: pressure on the breast (from, for example, a poorly fitting bra or a seatbelt) and prolonged gaps between feeds. Advise (...) as when it is introduced [ ] . Did you find this information useful? Thanks for your feedback! Why not subscribe 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

2008 Mentor

1334. Infant Respiratory Distress Syndrome

, or they may be spontaneous. Any infection may cause respiratory distress and may co-exist with IRDS; rapid diagnosis and treatment of any infection are essential. is often due to group B beta-haemolytic streptococci and often co-exists with IRDS. Aspiration of amniotic fluid, blood, or may occur. It is usually seen in term or post-mature infants. Transient tachypnoea of the newborn usually occurs in term or near-term infants and usually after caesarean delivery. Congenital anomalies of the lungs (eg (...) . Discontinue antibiotics after three to five days if cultures are negative. Support of parents and family: keep the parents well informed. Encourage parents to visit frequently and stay with their baby. Complications Acute complications These include the following: Complications related to procedures - eg, trauma to vocal cords from tracheal intubation; infection, embolism or thrombosis from venous or arterial catheterisation. Alveolar rupture: pneumothorax, pneumomediastinum, pneumopericardium

2008 Mentor

1335. Menopause and its Management

concentration [ ] . Mood changes These may include anxiety, nervousness, irritability, memory loss and difficulty concentrating. Perimenopause is accompanied by an increased risk of new and recurrent depression [ ] . There is some evidence that those women who have a history of premenstrual and postnatal depression have a higher risk of depression during their menopause [ ] . These women are typically well during pregnancy. Loss of libido This can be caused by a number of hormonal factors; oestrogen (...) that condition. Did you find this information useful? Thanks for your feedback! Why not subscribe 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

2008 Mentor

1336. Mendelson's Syndrome

(particularly in patients at risk of having a caesarean section), before caesarean section and postpartum (for example, with anaesthesia for retained placenta) and include: Avoidance of general anaesthesia where possible, particularly for high-risk patients - for example, by use of regional anaesthesia, epidurals, etc. [ ] Oral alkalis in labour to reduce pH of stomach contents. Different drugs and preparations have been used alone or in combination, with the aim of raising pH above 2.5 and reducing volume (...) of patients at risk of aspiration. [ ] Did you find this information useful? Thanks for your feedback! Why not subscribe 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

2008 Mentor

1337. Nausea and Vomiting in Pregnancy - Including Hyperemesis

neuropathies. Mallory-Weiss tears of the oesophagus due to repeated vomiting. Retinal haemorrhages. Splenic avulsion. Pneumothorax. Postpartum complications: persistence of symptoms and food aversions, postpartum gallbladder dysfunction and symptoms of post-traumatic stress disorder. Fetal complications [ ] There is evidence that hyperemesis gravidarum is associated with a higher incidence of low birth weight (small-for-gestational-age and premature babies). Little is known about the long-term health (...) 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) ; Hyperemesis gravidarum: current perspectives. Int J Womens Health. 2014 Aug 56:719-25. doi: 10.2147/IJWH.S37685. eCollection 2014. ; Pregnancy Sickness Support and British Pregnancy Advisory Service (BPAS). April 2015 ; NICE CKS, June 2013 (UK access only) ; Management of nausea and vomiting in pregnancy. BMJ. 2011

2008 Mentor

1338. Multiple Pregnancy

is relatively constant at 3.5 per 1,000 births; however, the rate of dizygous twins varies with the age, parity and ethnicity of the mother, and the use of assisted reproductive techniques. According to the Office for National Statistics, the rate of multiple pregnancy in England and Wales in 2014 was 16 per 1,000 births. [ ] Of these multiple pregnancies, 98.6% were twin pregnancies, 1.3% were triplets, and there were only two women who had quadruplets or above. Figures from the Northern Survey of Twin (...) of the following risk factors for hypertension: First pregnancy. Age 40 years or older. Pregnancy interval of more than 10 years. BMI of 35 kg/m 2 or more at first visit. Family history of pre-eclampsia. Because of the extra load on the heart, previously women were recommended bed rest. However, there is no clear evidence to support this. [ ] Timing of delivery [ ] Women with uncomplicated monochorionic twin pregnancies should be offered elective birth from 36 weeks 0 days, after a course of antenatal

2008 Mentor

1339. Managing Depression

of depression. NICE issued specific guidance regarding depression in adults with a chronic physical health problem [ ] . Risk factors Female gender - in almost all studies, women have a higher prevalence, incidence and morbidity associated with depressive disorders compared with men. The gender difference is likely to be due to a complex interaction between biological, psychological and sociocultural vulnerabilities. There is an increased incidence of depression during pregnancy and in the postnatal period (...) 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 ; Exploring thoughts of suicide. BMJ. 2017 Mar 30356:j1128. doi: 10.1136/bmj.j1128. ; NICE Interventional Procedure Guidance, December 2015 ; Modafinil Improves Episodic Memory and Working Memory

2008 Mentor

1340. Management of HIV in Pregnancy

with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; Incident HIV during pregnancy and postpartum and risk of mother-to-child HIV transmission: a systematic review and meta-analysis. PLoS Med. 2014 Feb 2511(2):e1001608. doi: 10.1371/journal.pmed.1001608. eCollection 2014 Feb. ; British HIV Association (2008) ; British HIV Association (2010) ; Transplacental transmission of HIV: a potential role for HIV binding lectins. Int J (...) and European Guidelines. You may find the article more useful, or one of our other . In this article In This Article Management of HIV in Pregnancy In this article in young children most commonly arises as a result of mother-to-child transmission (MTCT). It is thought that only 1.5-2% of MTCT occurs transplacentally during pregnancy. [ ] The vast majority occurs due to maternofetal transmission of blood during parturition or postnatal breast-feeding. All pregnant women are recommended screening for HIV

2008 Mentor

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