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Postpartum Office Visit

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1341. Measles, Mumps and Rubella (MMR) Vaccination

are seronegative for rubella and who are not currently pregnant, should be given the vaccine. Other unimmunised groups: Healthcare workers - should be given the vaccine for their own benefit and to protect vulnerable unimmunised patients and their own unimmunised partners. Unimmunised seronegative postpartum women should be offered the vaccine a few days after delivery. Children arriving from developing countries after school age of immunisation are particularly likely to require immunisation. During outbreaks (...) 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 ; Measles, mumps and rubella (MMR) vaccination has no effect on cognitive development in children - the results of the Polish prospective cohort study. Vaccine. 2013 May 2431(22):2551-7

2008 Mentor

1342. Maternal Mortality

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 ; National Audit Office (2013) ; Maternal mortality: only 42 days? BJOG. 2003 Nov ; MBRRACE-UK, Dec (...) Guidelines. You may find one of our more useful. In this article In This Article Maternal Mortality In this article Defined as death of either a pregnant woman or death of a woman within 42 days of delivery, miscarriage, termination or ectopic pregnancy providing the death is associated with pregnancy or its treatment. [ ] In the UK, maternal mortality rates can be calculated in two ways: Through official death certification to the Registrars General (the Office for National Statistics and its

2008 Mentor

1343. Malaria in Pregnancy

films is more difficult. [ ] Treatment can be more difficult due to restrictions on anti-malarial agents. Many are unlicensed in pregnancy, due to lack of clinical trials involving this important population, for fear of damaging the fetus. There is frequently a lack of good post-marketing surveillance where these drugs are routinely used in pregnancy. However, data support the safety of artemisinin-combined drugs (ACDs) and their advent has provided a useful therapeutic option. With regard (...) of infection and adverse effects. Second trimester carries the highest risk of infection. Some studies suggest the increased risk disperses quickly after delivery, others that the first two months postpartum continue to carry an increased risk of infection. Presentation [ ] Atypical presentation of malaria is common in pregnancy , particularly in the second and third trimesters, so a high index of suspicion should be maintained in susceptible pregnant mothers. A travel history should be taken in any

2008 Mentor

1344. Multiple Sclerosis

over time. Women with MS who wish to become pregnant should be advised that the risk of relapse decreases during pregnancy and increases transiently postpartum. Diagnosis There is no single specific diagnostic test available. The diagnosis can be made clinically (by a consultant neurologist) in most people and an MRI scan should not be used in isolation to make the diagnosis. [ ] If there is doubt about the diagnosis, further investigation should be used to exclude an alternative diagnosis or find (...) issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; NICE Quality Standard (January 2016) ; Incidence and prevalence of multiple sclerosis in the UK 1990-2010: a descriptive study in the General Practice Research Database. J Neurol Neurosurg Psychiatry. 2014 Jan85(1):76-84. doi: 10.1136/jnnp-2013-305450. Epub 2013 Sep 19. ; NICE clinical guideline (October 2014) ; Diagnostic criteria for multiple sclerosis: 2010

2008 Mentor

1345. Neonatal Jaundice

neonatal jaundice Onset less than 24 hours: Haemolytic disease: eg, , ABO incompatibility, glucose-6-phosphate dehydrogenase deficiency, spherocytosis. (eg, toxoplasmosis, rubella, cytomegalovirus (CMV), herpes simplex, syphilis) or postnatal infection. Increased haemolysis due to haematoma. Maternal autoimmune : eg, systemic lupus erythematosus. or . . Prolonged jaundice Jaundice lasting for longer than 14 days in term infants and 21 days in preterm infants: Infection - eg, urinary tract infection (...) [ ] . Bilirubin level [ ] : Use a transcutaneous bilirubinometer in babies with a gestational age of 35 weeks or more and postnatal age of more than 24 hours. If a transcutaneous bilirubinometer is not available, measure the serum bilirubin. If a transcutaneous bilirubinometer measurement indicates a bilirubin level greater than 250 μmol/L check the result by measuring the serum bilirubin. Always use serum bilirubin measurement to determine the bilirubin level in babies: With jaundice in the first 24 hours

2008 Mentor

1346. Neonatal Examination

Guidelines. You may find one of our more useful. In this article In This Article Neonatal Examination In this article All babies born in the UK should have an examination within the first few days of life. This includes specific checks of the hips, heart, eyes and, for boys, the testes. The examination usually takes place within 72 hours of birth and again at 6-8 weeks of age [ , , ] . Initial post-delivery examination A brief screening examination should be conducted checking the face, eyes, mouth (...) examination should be conducted as necessary according to any abnormalities that are detected, or suspicions of undetected illness in the baby. Record findings Always document the findings of the examination in the postnatal care plan and personal child health record. A proforma for the examination, kept within the notes, can save time and act as a prompt to ensure that no element of the examination is missed. Other screening tests See separate article. Common abnormalities detected in the newborn

2008 Mentor

1347. Nephrogenic Diabetes Insipidus

surgery. Head injury. Granulomata - sarcoidosis, tuberculosis (TB), granulomatosis with polyangiitis (Wegener's granulomatosis), histiocytosis. Infections - encephalitis, meningitis, cerebral abscess. Vascular disorders - haemorrhage/thrombosis, aneurysms, sickle cell disease, Sheehan's syndrome (postpartum pituitary necrosis). Post-radiotherapy. Inherited: Autosomal recessive combination of DI, diabetes mellitus, optic atrophy, deafness (DIDMOAD) - Wolfram's syndrome. [ ] Autosomal dominant mutations (...) of vasopressin gene. Nephrogenic DI Acquired nephrogenic DI : Idiopathic. Hypokalaemia. Hypercalcaemia. Chronic kidney disease. Other metabolic derangements. Drugs - eg, ofloxacin, orlistat, lithium. [ ] Renal tubular acidosis. Pregnancy (combined renal hyposensitivity to ADH, increased placental elimination of ADH, lowered thirst threshold and effect of fluid retention). [ ] Post-obstructive uropathy. Congenital/genetic nephrogenic DI : X-linked mutation in V2 ADH-receptor gene. [ ] Autosomal recessive

2008 Mentor

1348. Undescended and Maldescended Testes

three months of life, presumably as a consequence of a postnatal testosterone surge, with less than 1% remaining undescended by 1 year of age. [ ] Descent can be: Arrested - where descent is along the normal path but incomplete. The testis may be located near the pubic tubercle, in the inguinal canal (80%), or, uncommonly, in the abdomen. The testis is often small and abnormal with a short spermatic cord. There may be associated inguinal hernia. Ectopic - where descent deviates from the normal path (...) 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 ; Retractile testes: a review of the current literature. J Pediatr Urol. 2012 Feb8(1):2-6. doi: 10.1016/j.jpurol.2011.03.016. Epub 2011 Apr 16. ; Clinical and pathological features of ascending testis. Osaka City Med J. 2009 Dec55(2):81-7. ; Current referral patterns and means

2008 Mentor

1349. Toxoplasmosis

control of T.gondii infection in human villous explants [ ] . Many protocols also treat the child postnatally; usually for twelve months [ ] . Termination of pregnancy may be considered [ ] . Immunocompromised, pregnant women with previous infection [ ] Pregnant women who have HIV/AIDS with a pre-existing T. gondii infection risk developing severe toxoplasmosis and/or transmitting the infection to the fetus. Fetal transmission in this scenario is rare and there is little evidence regarding (...) is fairly good [ ] : The overall risk of vertical transmission with maternal seroconversion is 26%. Among infected children, 33% have retinal lesion(s) but bilateral visual impairment seems to be unusual; in one survey, no child was severely sight impaired [ ] . One expert suggested: "the biggest danger to the fetus is not the parasite but the mother's anxiety." [ ] The effectiveness of antenatal and postnatal treatment is still debated [ , ] . Prevention Hygiene measures, particularly for pregnant

2008 Mentor

1350. Transposition of the Great Arteries

postoperative outcome. [ ] The prenatal detection rate of TGA on antenatal ultrasound has improved with inclusion of additional outlet views but still remains below 50%. [ ] Children diagnosed antenatally have improved cognitive skills when compared with those diagnosed postnatally in whom pre-operative acidosis and profound hypoxaemia are more common. [ ] Once fetal diagnosis has been made, a multidisciplinary team approach ensuring that the delivery is carried out in a unit with ability to provide (...) 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 ; Risk of congenital heart disease in relatives

2008 Mentor

1351. Stress and Post-traumatic Stress Disorder

Stress and Post-traumatic Stress Disorder Post-traumatic Stress Disorder. PTSD information | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Post-traumatic Stress Disorder Authored by , Reviewed by | Last edited 19 Jan 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 on research (...) evidence, UK and European Guidelines. You may find the article more useful, or one of our other . In this article In This Article Post-traumatic Stress Disorder In this article Stress is a feature of everyday life. Definitions vary but, in essence, it is the autonomic 'alarm' response to perceived threat in the environment, involving heightened arousal, adrenaline (epinephrine) production facilitating short-term 'fight-or-flight' resistance, followed by physical and mental exhaustion. Stress

2008 Mentor

1352. Stillbirth and Neonatal Death

rate : the number of stillbirths per thousand total births. Low birth weight : weight at birth under 2500 g. (The universally accepted definition.) Incidence [ ] According to the Office for National Statistics (ONS) in England and Wales, there were 3,558 stillbirths in 2012 - a stillbirth rate of 4.9 per 1,000 live births. This had dropped from 5.3 in 2011. There were 2,042 neonatal deaths - a rate of 2.8 per 1,000 live births - of which 2.2 were early neonatal deaths. Both rates have continued (...) . Bereavement care: Stillbirth is a devastating event for the parents and their family. The mother and father should be given time and space for reflection in a suitable environment away from the normal postnatal ward. They should be allowed to dress and spend time with their child. They may wish to take photos and make some memories to take with them: Most hospitals have protocols in place for dealing with stillbirths - eg, wrap the baby, offer to the mother to hold, and take photographs, hair and palm

2008 Mentor

1353. Tar Syndrome

, . Lower limb anomalies (47%) - knee subluxation, patellar dislocation, femoral or tibial torsion, fibula may be absent. Differential diagnosis [ ] Holt-Oram syndrome - abnormalities of the upper limbs and heart. RAPADILINO syndrome (relating to: radial hypoplasia/aplasia, patellar hypoplasia/aplasia, cleft or highly arched palate, diarrhoea, dislocated joints, small stature and other abnormalities). Roberts' syndrome - prenatal and postnatal growth restriction, craniofacial anomalies, limb (...) counselling process. [ ] 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

1354. Thyroid Disease In Pregnancy

, stillbirth, preterm delivery, intrauterine growth restriction, low birth weight, pre-eclampsia and fetal thyroid dysfunction. Overt hypothyroidism is associated with anaemia, pregnancy-induced hypertension, pre-eclampsia, placental abruption, postpartum haemorrhage, premature birth, low birth weight, intrauterine fetal death, increased neonatal respiratory distress and infant neurodevelopmental dysfunction. [ ] However, the adverse effect of subclinical hypothyroidism and thyroid antibody positivity (...) with: [ , ] An increased rate of pregnancy failure. An increased incidence of gestational thyroid dysfunction. A predisposition to postpartum thyroiditis. The need for screening of all women in early pregnancy, thyroid hormone placental physiology and thyroid hormone gestational reference ranges are areas of research which are currently being investigated. [ ] Editor's note January 2018 - Dr Hayley Willacy draws your attention to the American Thyroid Association's 2017 Guidelines for managing thyroid disease around

2008 Mentor

1355. Thrombotic Thrombocytopaenic Purpura

and nonogenarians. The peak occurs in the fourth decade of life. It is more common in females than in males; the ratio is 3:2. Aetiology Pregnancy and the postpartum state account for 10-25% of cases of TTP. The course of the syndrome is not altered by termination of pregnancy. It occurs in greater frequency in patients with HIV infection and may be the initial presenting syndrome. TTP may also be associated with autoimmune disease and cancer. Presentation There may be a prodrome resembling a flu-like illness (...) 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 ; Online Mendelian Inheritance in Man

2008 Mentor

1356. Thyroid Function Tests

in the healthy adult population is not warranted but more limited screening should be performed in: Neonates, with the heel prick test for congenital hypothyroidism. All patients with diabetes (types 1 and 2) at the time of diagnosis. Women with type 1 diabetes pre-conception, at booking and three months postpartum. Surveillance Surveillance of certain groups is advocated: Women with a history of postpartum thyroiditis (annual TFTs, prenatally and postnatally in future pregnancies). Patients with (annual (...) with low radio-iodine uptake: Transient thyroiditis (postpartum, post-viral, De Quervain's thyroiditis). Rare with a low radio-iodine uptake: Thyroxine ingestion. Ectopic thyroid tissue. Iodine-induced. Amiodarone therapy. Rare with a positive pregnancy test: Gestational thyrotoxicosis with hyperemesis gravidarum. Hydatiform mole. Rare : Familial TSH receptor mutation. Low TSH Normal FT3 or FT4 Common causes : Subclinical hyperthyroidism. Thyroxine ingestion. Rare causes : Steroid therapy. Dopamine

2008 Mentor

1357. Thrombocytopenia

-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

1358. Thrombophilia

the absolute risk is low). The risk begins in the first trimester and is greater postpartum than antenatally, particularly during the first postnatal week. Women with thrombophilia have a further increased risk (the magnitude of increased risk depending on the specific diagnosis). Royal College of Obstetricians and Gynaecologists (RCOG) Green Top Guidelines give detailed guidance for reducing VTE risk in all pregnant and postnatal women, including those with known or suspected thrombophilia or a past (...) of the other heritable thrombophilias mentioned above. Test details are given in 2010 guidelines [ ] . Management of thrombophilia See also 'Pregnancy and postnatal' section, below. Management of acute VTE See separate , and articles. Minimising VTE risk See also separate article. Patients should be aware of their condition and how to recognise symptoms of VTE. Ensure mobility and adequate hydration. Extra precautions and short-term thromboprophylaxis may be needed at times of increased risk - eg, surgery

2008 Mentor

1359. Spinal Muscular Atrophy

syndrome Age of onset : 20-40 years. Features : bulbar and lower motor neurone weakness. Muscle cramps, facial fasciculations, hand tremor. Associated with and infertility. Differential diagnosis Primary lateral sclerosis Congenital myopathies Disorders of carbohydrate metabolism ( ) Investigations Blood tests Creatine kinase: usually normal in SMA type I; normal or slightly raised in other types. Genetic testing Can be carried out prenatally or postnatally. Electrophysiology testing Shows diminished (...) ! 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 ; Current status

2008 Mentor

1360. Treacher Collins' Syndrome

and ) are infrequent. In severely affected patients the airway is compromised by the mandibular deficiency, glossoptosis and . and may occur. Differential diagnosis Oculo-auriculovertebral dysplasia Goldenhar's syndrome. Nager's acrofacial dysostosis (similar facial features). [ ] Investigations The earliest possible diagnosis is by (if there is a family history). Diagnosis may also be made at midtrimester antenatal ultrasound. [ ] Postnatally, diagnosis is essentially made on clinical features. A thorough (...) history of Treacher Collins' syndrome. 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

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