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Postpartum Office Visit

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1361. Depression in Pregnancy

Fetal Neonatal Med. 2007 Mar20(3):189-209. ; Is antenatal depression associated with adverse obstetric and perinatal outcomes? J Matern Fetal Neonatal Med. 2016 Mar29(6):863-7. doi: 10.3109/14767058.2015.1023708. Epub 2015 Apr 9. ; Centre for Maternal and Child Enquiries (CMACE), BJOG, Mar 2011 ; Leisure-time physical activity in pregnancy and risk of postpartum depression: a prospective study in a large national birth cohort. J Clin Psychiatry. 2009 Dec70(12):1707-14. hi...i have posted on here (...) Guidelines. You may find the article more useful, or one of our other . Women have a lifetime risk of depression of about 1 in 4 and it is most prevalent during their reproductive years. Much emphasis has been placed on the detection and treatment of postnatal depression because of the morbidity in mother and child. However, antenatal depression is actually more frequent and about half of postnatal depression appears to start antenatally. In this article In This Article Depression in Pregnancy

2008 Mentor

1362. Delay In Walking

inherited conditions in the family? A family history of muscular dystrophy or some other neurological disorder may be significant. Carer circumstances Has the mother been trying to get the baby to walk? An overprotective or immature mother may be treating the baby like a doll - just feeding, changing and keeping in the pram or cot. Has the baby had a chance to try to develop motor skills? Has the mother encouraged these? Is there untreated maternal postnatal depression to be considered? Examination (...) 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 ; Developmental assessment of children. BMJ. 2013 Jan 15346:e8687. doi: 10.1136/bmj.e8687

2008 Mentor

1363. 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

1364. Deafness in Children

sensorineural hearing loss in children is congenital or acquired perinatally, but may present at any age. Approximately 10-20% of all deafness is acquired postnatally, although some genetic causes of deafness result in hearing loss that begins during childhood or adolescence. Risk factors Family history of deafness. Infection: congenital (eg, rubella), mumps, meningitis. Ototoxic medications: in utero or postnatal. Low birth weight, prematurity, low birth Apgar scores, prolonged mechanical ventilation (...) include prematurity and/or low birth weight, birth asphyxia, severe hyperbilirubinaemia and sepsis. Postnatal causes (30%): childhood infections - eg, meningitis, encephalitis, head injury. Unknown causes: 20-30% of deaf children have no definite known aetiology. Presentation Presentation of hearing loss is dependent on the degree and patient age at onset of the hearing loss, the threshold for suspicion of parents and health care providers, and the presence of other identifiable risk factors. Always

2008 Mentor

1365. Dandy-Walker Syndrome

syndrome ( P osterior fossa anomalies as Dandy-Walker malformation (DWM); H aemangioma; A rterial lesions of the head and neck; C ardiac abnormalities as aortic coarctation; E ye abnormalities and S ternal defect). [ ] A large number of associated problems may also be present, such as hydrocephalus (often develops postnatally), atresia of the foramen of Magendie and atresia of the foramen of Luschka. Epidemiology Incidence is approximately 1 in 25-35,000 live births. [ ] It occurs slightly more (...) 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 ; Dandy-Walker malformation: prenatal

2008 Mentor

1366. Doctor's Bag - Contents

patients while out on home visits. Those working for out of hours organisations may have some, or all, of the necessary equipment and medications provided. General issues Some GPs may prefer to wear a jacket or coat with capacious pockets rather than carry a bag. Most GPs will use a bag of some variety and the following should be considered: The bag must be lockable and not left unattended. Most medicines should be stored between 4° and 25°C. A silver-coloured bag or cool bag is more likely to keep (...) ) recommends using an IV bolus (reteplase or tenecteplase) rather than an infusion for pre-hospital thrombolysis Atropine - 600 micrograms/ml injection for bradycardia. See also separate article. Acute left ventricular failure Furosemide - 10 mg/ml injection, 20-50 mg by slow IV injection. It is also useful to have 40 mg tablets available for less severe congestive cardiac failure. Postpartum haemorrhage [ ] Syntometrine® - ergometrine maleate 500 micrograms plus oxytocin 5 units/ml injection. Psychiatric

2008 Mentor

1367. Diabetic Retinopathy and Diabetic Eye Problems

of retinopathy. Pregnancy can be associated with a rapid progression of DR, particularly if: [ ] There is severe baseline retinopathy. There is poor glycaemic control at conception, during pregnancy or in the postpartum period. There is rapid improvement of diabetic control. The diabetes has been present for a long time. The patient is hypertensive (chronic or pregnancy-induced). Minority ethnic communities with type 2 diabetes in the UK are more prone to DR, including sight-threatening retinopathy (...) of age for both type 1 and type 2 diabetes. Consider referring children and young people with type 2 diabetes who are younger than 12 years to an ophthalmologist for retinal examination if blood glucose control is suboptimal. Investigations Fundus photography and examination are sufficient for most patients. However, optical coherence tomography is playing an increasingly important role in assessing the presence of macular oedema (and then recording its progression over several visits

2008 Mentor

1368. Developmental Screening - 8 and 18 Month Checks

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 Paediatrics and Child Health, 2017 ; The Lullaby Trust ; Royal College of Physicians, March 2010 ; Department for Education ; GOV.UK ; Dept of Health ; NICE CKS, November 2012 (UK access only) ; Dept of Health and Dept of Education, March 2013 ; Cabinet Office, School Exclusion (...) to the pregnancy, the birth and the growing relationship with the baby. Listening to mothers and fathers carefully, encouraging them as necessary to find solutions for themselves. Empowering parents to develop effective strategies that build resilience, facilitate infant development and enable them to adapt to their parenting role. Enabling parents to recognise and use their own strengths and those of their informal networks, as well as formal services if appropriate. Screening Antenatal and postnatal differ

2008 Mentor

1369. Diabetes in Pregnancy

-eclampsia and preterm labour are more common in women with pre-existing diabetes. Diabetic retinopathy can worsen rapidly during pregnancy. Stillbirth, congenital malformations, macrosomia, birth injury, perinatal mortality and postnatal adaptation problems (eg, hypoglycaemia) are more common in babies born to women with pre-existing diabetes. Pre-conception care and good glucose control before and during pregnancy can reduce these risks. Increased risk of complications of diabetes may occur during (...) increased risk of stillbirth [ ] . can occur during labour. Congenital malformation: neurological and cardiac abnormalities are particularly common. A two-fold increased risk of congenital anomaly was found in the Confidential Enquiry [ ] . Fetal macrosomia and its associated complications can occur. Hypoglycaemia and postnatal adaptation complications are more common in babies born to mothers with pre-existing diabetes. is more likely. is more common. Birth injury: in the Confidential Enquiry, babies

2008 Mentor

1370. Electrical Injuries and Lightning Strikes

significant electrical injury - this occurs days to years later. Psychological sequelae: the degree is not necessarily related to the amount of physical injury and problems may last for years. Electrical shock in pregnancy [ ] General points : there is little information available about electric shocks during pregnancy and the accepted high rate of mortality may be due to publication bias. However, it is well documented that fetal skin is 200 times less resistant than the skin postnatally, so less (...) 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 ; ABC of burns: pathophysiology and types of burns. BMJ 2004328: 1427-1429. ; An evidence-based approach to electrical injuries in children. Pediatr Emerg Med Pract. 2013 Sep10(9):1-16 ; Electrocutions--treatment strategy (case presentation). J Med Life. 2014 Oct-Dec7(4):623-6. ; Paediatric Forensic Medicine and Pathology, Second Edition, 2008

2008 Mentor

1371. Ehlers-Danlos Syndrome

in the gene encoding filamin B, a cytoplasmic protein important in the cytoskeleton. It causes dislocation of the large joints, facial anomalies and a variety of cardiovascular and orthopaedic abnormalities. Management of aEDS Although no curative treatments exist, a prenatal or postnatal early diagnosis and appropriate early intervention can alleviate physical and psychological distress. The most important problems for children with aEDS are orthopaedic, in particular the bilateral congenital hip (...) , and is usually diagnosed before the age of 2 years. Fragility, bruising and sagging are severe, but healing is not impaired. Diagnosis requires extreme skin fragility and the characteristic craniofacial features, plus either one other major criterion or three minor criteria. Confirmatory testing is needed for diagnosis. Major criteria Extreme skin fragility with congenital or postnatal skin tears. Characteristic craniofacial features. Redundant, almost lax skin, with excessive skin folds at wrists and ankles

2008 Mentor

1372. Cornelia De Lange Syndrome

and postnatal growth restriction and hirsutism. Congenital anomalies include malformations of upper limbs, gastrointestinal malformations, diaphragmatic hernia, heart defects and genitourinary malformations. [ ] Besides the classical presentation, milder variants exist and clinical variability is well recognised. A classification dividing the disease into type 1 which is classical presentation and type 2 which is mild has been suggested. [ ] Most often there is no family history of the 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

1373. Contraception and Young People

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 ; Consent, competence, and confidentiality. BMJ. 2005 Feb 12330(7487):353-6. ; Office for National Statistics (ONS) Statistical Bulletin ; Faculty of Sexual and Reproductive Healthcare (2010) ; GOV.UK ; Information Services Division (ISD) NHS Scotland, 25 June 2013 ; Family Planning Association (FPA), 2010 ; Dept for Children (...) disadvantage. Women pregnant in their teens are more likely to suffer anaemia, eclampsia, puerperal endometritis and postnatal depression. [ ] The fetus is at risk of higher rates of perinatal mortality, low birth weight, sudden infant death syndrome and substance dependence. [ ] Pregnancy risk factors Rates of teenage pregnancy vary widely within the UK with much higher rates in areas of social deprivation. Teenage girls particularly at risk are those who: [ ] Have been, or are in care. Are homeless

2008 Mentor

1374. Congenital HIV Infection and its Prevention

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 Congenital HIV and Childhood AIDS In this article See also separate article . HIV infection 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 (...) and the pregnancy, in order to reduce the likelihood of MTCT. Testing a child for HIV has large implications for the family, as most cases involve vertical transmission. Information given should be culturally appropriate and interpreters used as needed. See also separate article . Diagnostic tests Early diagnosis of HIV infection is crucial and ideally should occur rapidly postnatally where mothers are known to be HIV-positive, as this allows for prophylaxis against and early detection of and treatment

2008 Mentor

1375. Congenital Infections in Neonates

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

1376. Congenital Deafness

sensorineural hearing loss in children is congenital or acquired perinatally, but may present at any age. Approximately 10-20% of all deafness is acquired postnatally, although some genetic causes of deafness result in hearing loss that begins during childhood or adolescence. Risk factors Family history of deafness. Infection: congenital (eg, rubella), mumps, meningitis. Ototoxic medications: in utero or postnatal. Low birth weight, prematurity, low birth Apgar scores, prolonged mechanical ventilation (...) include prematurity and/or low birth weight, birth asphyxia, severe hyperbilirubinaemia and sepsis. Postnatal causes (30%): childhood infections - eg, meningitis, encephalitis, head injury. Unknown causes: 20-30% of deaf children have no definite known aetiology. Presentation Presentation of hearing loss is dependent on the degree and patient age at onset of the hearing loss, the threshold for suspicion of parents and health care providers, and the presence of other identifiable risk factors. Always

2008 Mentor

1377. Childhood AIDS

and European Guidelines. You may find the article more useful, or one of our other . In this article In This Article Congenital HIV and Childhood AIDS In this article See also separate article . HIV infection 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. A negative (...) the likelihood of MTCT. Testing a child for HIV has large implications for the family, as most cases involve vertical transmission. Information given should be culturally appropriate and interpreters used as needed. See also separate article . Diagnostic tests Early diagnosis of HIV infection is crucial and ideally should occur rapidly postnatally where mothers are known to be HIV-positive, as this allows for prophylaxis against and early detection of and treatment of, opportunistic infection in neonates

2008 Mentor

1378. Child Health Surveillance Programme

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 Paediatrics and Child Health, 2017 ; The Lullaby Trust ; Royal College of Physicians, March 2010 ; Department for Education ; GOV.UK ; Dept of Health ; NICE CKS, November 2012 (UK access only) ; Dept of Health and Dept of Education, March 2013 ; Cabinet Office, School Exclusion (...) to the pregnancy, the birth and the growing relationship with the baby. Listening to mothers and fathers carefully, encouraging them as necessary to find solutions for themselves. Empowering parents to develop effective strategies that build resilience, facilitate infant development and enable them to adapt to their parenting role. Enabling parents to recognise and use their own strengths and those of their informal networks, as well as formal services if appropriate. Screening Antenatal and postnatal differ

2008 Mentor

1379. Child - Parent Relationship and Potential Problems

a survey email to confirm your preferences. Further reading and references ; Office for National Statistics ; Office for National Statistics ; Office for National Statistics ; Fathers and the well-child visit. Pediatrics. 2006 Apr117(4):e637-45. ; Examining the association between parenting and childhood anxiety: a meta-analysis. Clin Psychol Rev. 2007 Mar27(2):155-72. Epub 2006 Nov 16. ; The role of perceived parenting in familial aggregation of anxiety disorders in children. J Anxiety Disord. 2009 (...) the Office for National Statistics: 10% of children aged 5-16 in Great Britain had a clinically diagnosed mental disorder: 4% had an emotional disorder, 6% had a conduct disorder, 2% had a hyperkinetic disorder and 1% had a less common disorder such as an autistic spectrum disorders, tics, etc. Some children had more than one type of disorder. 16% of children from single-parent families experienced a mental health problem compared with 8% from two-parent families. Mental disorders were more common

2008 Mentor

1380. Bronchopulmonary Dysplasia

; or Breathing room air by 56 days of postnatal age, or discharge (whichever comes first) for babies born after 32 weeks of gestation. Moderate BPD Need for <30% oxygen at 36 weeks of postmenstrual age, or discharge (whichever comes first) for babies born before 32 weeks of gestation; or Need for <30% oxygen to 56 days pf postnatal age, or discharge (whichever comes first). Severe BPD Need for >30% oxygen, with or without positive pressure ventilation or continuous positive airway pressure (CPAP) at 36 weeks (...) of postmenstrual age, or discharge (whichever comes first) for babies born before 32 weeks of gestation; or Need for >30% oxygen with or without positive pressure ventilation or CPAP at 56 days of postnatal age, or discharge (whichever comes first) for babies born after 32 weeks of gestation. The NIH's recommended severity-based definition has been found to offer a better description of underlying lung disease and correlate well with infant maturity, growth and severity of illness. [ ] A physiological

2008 Mentor

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