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Postpartum Office Visit

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1441. Ganser Syndrome (Pseudodementia)

or fabricated cognitive dysfunction. [ ] Look for signs of self-inflicted injury. Differential diagnosis [ ] Acute psychotic illness such as . . . . . . . Drug intoxication. Malingering. Associated diseases [ ] Ganser's syndrome has been reported in the following: Neurosyphilis Epilepsy Post-stroke Meningiomas Post-anoxia Postpartum psychosis Traumatic brain injuries Infections Various dementias Investigation [ ] No investigation is diagnostic but a number may be performed to exclude other pathology (...) 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 ; Ganser's syndrome in a man with AIDS. Psychosomatics. 2003 Jul-Aug44(4):342-5. ; whonamedit.com ; ICD10 Data.com ; Ganser's syndrome

2008 Mentor

1442. Female Genital Abnormalities

the best imaging technique for uterine abnormalities. Complications: Dysmenorrhoea. Haematometra. Complications during pregnancy and labour: late miscarriage, uterine rupture, premature labour, malpresentation, obstructed labour, retained placenta, postpartum haemorrhage. Fertility is usually unaffected. Management: Decision for surgical intervention will depend on the effect of the abnormality on enabling a viable pregnancy. A septate vagina and the rudimentary horn of a bicornuate uterus are usually (...) 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 ; Endocrine Society Clinical Practice Guideline ; Update on disorders of sex development. Curr Opin Endocrinol Diabetes Obes. 2012 Feb19(1):28-32. ; A review of the management of intersex. Neonatal Netw. 2012 Mar-Apr31(2):97-103. doi

2008 Mentor

1443. Female Barrier Methods of Contraception

cautions include: Anatomical constraints - inadequate retropubic ledge, or uterovaginal prolapse. However, cervical/vault caps may be possible. Also, markedly anteverted cervix or septate vagina, or severe obesity. Woman unable to insert or remove the device. Cervical cancer or cervical intraepithelial neoplasia (applies to caps only). Do not fit diaphragms/caps until six weeks postnatal to allow anatomy to be restored to normal. Fitting and follow-up: caps and diaphragms Initial visit Counsel fully (...) it easier to squat and others to lie down for insertion. To insert a cap, squeeze the sides of the cap together and hold between the thumb and first two fingers, allowing it to "suction" neatly over the cervix. The woman goes home with a practice device. She must be aware not to rely on it for contraception until after the second visit. Second visit The woman should return with the device in situ to enable the positioning and size of the device to be checked. Any problems the woman has encountered

2008 Mentor

1444. Female Infertility

of ). This is the cause of the vast majority of ovulation disorder. Group III : ovarian failure. As above, PCOS is responsible for the majority of ovulation disorders. Others include: can displace or destroy normal tissue and the production of follicle-stimulating hormone (FSH) and luteinising hormone (LH) is often the first to be affected. Panhypopituitarism is also called Simmonds' disease. is pituitary infarction following postpartum haemorrhagic shock. may present with galactorrhoea or amenorrhoea. The control (...) to the tubes may occur as a result of infection: A history of is highly suggestive of damage to tubes. Severe pelvic infection following illegal abortion is rarely seen in this country but still occurs in places where termination of pregnancy is illegal or difficult to secure. Even a legal or can lead to infection of retained products of conception. Postpartum infection can also affect fertility. may cause infertility, largely through associated PID. and are the most important. Infection may be less direct

2008 Mentor

1445. Factor V Leiden Mutation Causing Thrombophilia

. The absolute risk of VTE increases in women with FVL mutation during COCP use. However, this risk is still lower than the absolute risk during the pregnancy postpartum period. Asymptomatic women with a family history of venous thrombosis should be tested if a thromboembolic event in a first-degree relative was unprovoked, or provoked by pregnancy, COCP exposure or a minor risk factor. The result will be more informative if the first-degree relative has a known thrombophilia. [ ] Most women with a previous (...) . Local guidelines should be followed. [ ] Those considered to be in need of anticoagulation should usually receive warfarin or heparin for at least six weeks postpartum, when the risk of VTE is high. It is safe to breast-feed whilst taking warfarin. Pregnancy loss Carriers of FVL have double the risk of experiencing recurrent miscarriage compared with women without this thrombophilic mutation. [ ] One study clearly demonstrated a a positive correlation between recurrent pregnancy loss and FVL gene

2008 Mentor

1446. Obstetric Shock

Apr120(5):621-7. doi: 10.1111/1471-0528.12120. Epub 2013 Jan 23. ; Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2008 Dec22(6):999-1012. doi: 10.1016/j.bpobgyn.2008.08.004. Epub 2008 Sep 25. ; NICE Clinical Guideline (Dec 2014) ; Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006 Jun107(6):1226-32. ; Recombinant Factor VIIa in Post-partum Hemorrhage: A New Weapon in Obstetrician's Armamentarium. N Am J Med (...) 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 ; British Committee for Standards in Haematology (Jul 2015) ; Centre for Maternal and Child Enquiries (CMACE), BJOG, Mar 2011 ; Outcomes of pregnancy following postpartum haemorrhage. BJOG. 2013

2008 Mentor

1447. Normal Menstruation

, which usually occurs 16-32 hours after the surge begins. The LH level falls a couple of days later. The oestrogen level from the ovaries increases gradually towards ovulation and peaks during the LH surge. The progesterone level starts to rise towards follicle release, preparing the endometrial lining of the uterus for implantation. Post-ovulation - the luteal phase - levels of LH and FSH decrease. The ruptured follicle closes (after releasing the egg) and forms a corpus luteum, which produces (...) with erratic menstruation. Treatment such as chemotherapy or pelvic irradiation may cause ovarian failure. Other factors that may affect the menstrual cycle Breast-feeding usually delays the return of normal menstruation postpartum, particularly if exclusive and may form the basis for the lactation amenorrhoea method (LAM) of contraception for the first six months of the baby's life. Rapid weight change - increase or decrease. Body weight below a certain level - eg, in eating disorders - particularly

2008 Mentor

1448. Normal Labour

[ ] . However, if ergometrine is used, there is an increased incidence of side-effects such as nausea, vomiting and hypertension; 10 IU of IM oxytocin are the preferred uterotonic [ ] . Active management should be offered routinely for vaginal deliveries in a hospital setting. However, a woman who is at low risk of postpartum haemorrhage and who requests physiological management, should have her request respected. Water births Good-quality studies have shown that water births may significantly shorten (...) 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 Guideline (Dec 2014, updated Feb 2017) ; Guideline Audit Implementation Network (Mar 2017) ; Health & Social Care Information

2008 Mentor

1449. Noonan's Syndrome

and a hearing test in infancy or at the time of diagnosis, with an annual hearing test throughout early childhood. Orthopaedic and dental issues - annual examination of the chest and back and careful oral examination at each visit. Lymphatic issues - those with peripheral lymphoedema should be referred to speciality lymphoedema clinics. Anaesthesia risk - Individuals with NS should be considered at risk of malignant hyperthermia when receiving general anaesthesia, and certain anaesthetic agents need (...) 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 ; Noonan syndrome. Am Fam Physician. 2014 Jan 189(1):37-43. ; Noonan syndrome. A review. Minerva Pediatr. 2008 Jun60(3):343-6. ; Noonan syndrome. J Paediatr Child

2008 Mentor

1450. Newborn Screening

-restricted diet, eliminating the severe neurocognitive and neuromotor impairment associated with untreated PKU. [ ] Early diagnosis and treatment reduce the risk of neurological handicap from 80-90% to 6-8% (population baseline risk 2%). [ ] : Incidence is approximately 1:3,000. Currently established on the same blood spot sample as above. Babies born at less than 32 weeks of gestation (less than or equal to 31 + 6 days) will need a repeat test. The repeat test should be done at 28 days of postnatal age (...) ? 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 ; UK National Screening Committee (policy decisions

2008 Mentor

1451. Neural Tube Defects

'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 ; Neural tube defects between folate metabolism and genetics. Indian J Hum Genet. 2011 Sep17(3):126-31. doi: 10.4103/0971-6866.92082. ; Epidemiology of neural tube defects. Am J Med Genet C Semin Med Genet. 2005 May 15135C(1):88-94. ; Neural tube defects (...) with review of literature. J Pediatr Neurosci. 2013 May8(2):154-7. doi: 10.4103/1817-1745.117855. ; Surgical Tutor ; Routine ultrasonography compared with maternal serum alpha-fetoprotein for neural tube defect screening. Obstet Gynecol. 2005 Oct106(4):747-52. ; Prenatal screening and diagnosis of neural tube defects. Prenat Diagn. 2009 Apr29(4):402-11. ; A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med. 2011 Mar 17364(11):993-1004. doi: 10.1056/NEJMoa1014379. Epub

2008 Mentor

1452. Patau's Syndrome

screening tests. In a UK-based study from 2003, 44 cases of trisomy 13 and 88 cases of trisomy 18 were examined. 64% were first detected by chromosomal analysis because of abnormalities noted on fetal anomaly scanning in the second trimester. 3% of cases were detected through the serum screening programme currently offered for Down's syndrome. 11% of cases were detected postnatally. Of note, in the same study, 12% of couples chose to continue with the pregnancy after prenatal diagnosis [ ] . Prenatal (...) Bartholin in 1657 but he was unaware of the aetiology. 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

2008 Mentor

1453. Oral Anticoagulants

acute myocardial infarction) should also have this stopped if they develop an indication for warfarin. For patients who have had an acute coronary syndrome (ACS) within in the previous year: Those on a single antiplatelet agent should continue this even if they have to start oral anticoagulation. The antiplatelet agent should be stopped 12 months post-ACS. Those on dual antiplatelets following ACS or insertion of drug-eluting stents, who then need to start oral anticoagulants, should be assessed (...) surgery with risk of severe bleeding. Within 48 hours postpartum. Pregnancy (first and third trimesters, can cause congenital malformations and fetal death). Drugs where interactions may lead to a significantly increased risk of bleeding - eg, antiplatelet drugs, non-steroidal anti-inflammatory drugs (NSAIDs), selective serotonin reuptake inhibitors (SSRIs), venlafaxine or duloxetine. Uncorrected major bleeding disorder (eg, haemophilia, chronic kidney disease). Potential bleeding lesions - eg, active

2008 Mentor

1454. Oesophageal Atresia

% in one study. [ ] However, it does not allow for a definite diagnosis of oesophageal atresia/TOF. [ ] Associated ultrasound abnormalities may be present such as cardiac defects. The fetus is usually small for gestational age. can occur. Karyotyping should be carried out if suspected because of the high association with . Postnatally A baby with oesophageal atresia ± TOF classically presents with respiratory distress, choking, feeding difficulties and frothing in the first few hours after birth (...) mortality is usually due to respiratory complications. 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

2008 Mentor

1455. Pemphigoid Gestationis

and blisters. Sometimes urticarial plaques may never develop blisters. They differ from true urticaria because they are relatively fixed in nature. The rash spreads peripherally, often sparing the face, palms and soles. Mucosal lesions occur in fewer than 20% of cases. Symptoms remit in the weeks before delivery in 75% but dramatic flares can occur immediately postpartum. [ ] It usually resolves within weeks to months after delivery and possibly more quickly with breast-feeding. Disease persisting (...) . Affected patients are more likely to develop other autoimmune diseases - for example, and . [ ] Management Oral corticosteroids are safe and are the mainstay of treatment in pregnancy and postpartum. [ ] Prednisolone is usually started at a dose of 0.5-1 mg/kg/day. Antihistamines are also used. Plasmapheresis and immunophoresis have been used in difficult-to-treat cases. [ ] Shared care involving obstetrician, dermatologist and paediatrician is appropriate. Complications Premature labour in 20

2008 Mentor

1456. Ovarian Tumours and Fibroids in Pregnancy

, a Cochrane review failed to find evidence to confirm that myomectomy improves subsequent fertility, which is the usual indication for myomectomy at the time of caesarean section. [ ] Bilateral uterine artery embolisation (UAE) immediately after caesarean delivery may be effective in decreasing postpartum blood loss and minimising the risk of myomectomy or hysterectomy. [ ] Complications Ovarian masses [ ] Torsion presenting as acute abdomen. Rupture presenting as acute abdomen. Obstruction of labour (...) 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 ; Ovarian cancer. Lancet. 2009 Oct 17374(9698):1371-82. Epub 2009 Sep 28. ; Evaluation and management of adnexal masses during pregnancy. Clin Obstet Gynecol. 2006 Sep49(3):492-505. ; Adnexal masses in pregnancy: how often are they malignant? Gynecol Oncol. 2006 May101(2):315-21. Epub 2005

2008 Mentor

1457. Postnatal care up to 8 weeks after birth

on the woman's care of herself or baby, underlying physical, psychological or social causes should be evaluated. [2006] [2006] 1.2.45 If a woman has sustained a postpartum haemorrhage, or is experiencing persistent fatigue, her haemoglobin level should be evaluated and if low, treated according to local policy. [2006] [2006] Back Backache ache 1.2.46 Women experiencing backache in the postnatal period should be managed as in the general population. [2006] [2006] Constipation Constipation 1.2.47 Women should (...) to be present during any physical examination of their baby to promote participation of both parents in the care of their baby and enable them to learn more about their baby's needs. [2006] [2006] P Parenting and emotional attachment arenting and emotional attachment 1.4.5 Assessment for emotional attachment should be carried out at each postnatal contact. [2006] [2006] 1.4.6 Home visits should be used as an opportunity to promote parent- or mother-to-baby emotional attachment. [2006] [2006] 1.4.7 Women

2006 National Institute for Health and Clinical Excellence - Clinical Guidelines

1458. Epidemiologic Study of Reproductive Outcome in Women With Systemic Lupus Erythematosus

postpartum, and visit 5 at 6 months postpartum. Visits 4 and 5 include an infant exam for growth and morphologic parameters; these visits occur on the same schedule if there is a miscarriage or stillbirth. Patients not currently pregnant are randomly chosen to be followed as controls. These patients undergo a review of current pregnancy status and measures of disease activity, including SLAM, every 3 months for 5 visits. Study Design Go to Layout table for study information Study Type : Observational (...) Information Go to Layout table for additonal information ClinicalTrials.gov Identifier: Other Study ID Numbers: 199/11926 NU-501 First Posted: February 25, 2000 Last Update Posted: June 24, 2005 Last Verified: July 2004 Keywords provided by Office of Rare Diseases (ORD): arthritis & connective tissue diseases immunologic disorders and infectious disorders rare disease systemic lupus erythematosus Additional relevant MeSH terms: Layout table for MeSH terms Lupus Erythematosus, Systemic Connective Tissue

2000 Clinical Trials

1459. Reducing maternal smoking and relapse: long-term evaluation of a pediatric intervention. Full Text available with Trip Pro

Reducing maternal smoking and relapse: long-term evaluation of a pediatric intervention. Pediatric well-care visits provide a clinical opportunity to counsel new mothers about their smoking and the deleterious effects of environmental tobacco smoke (ETS) on infant health.Forty-nine Oregon pediatric offices enrolled 2,901 women who were currently smoking or had quit for pregnancy, using a brief survey at the newborn's first office visit. Randomly assigned offices provided advice and materials (...) to mothers at each well-care visit during the first 6 months postpartum to promote quitting or relapse prevention.The intervention reduced smoking (5.9% vs 2.7%) and relapse (55% vs 45%) at 6-month follow-up, but logistic regression analysis at 12 months revealed no significant treatment effect. The intervention had a positive effect on secondary outcome variables, such as readiness to quit and attitude toward and knowledge of ETS. Multiple logistic regression analysis indicated that husband/partner

1997 Preventive Medicine Controlled trial quality: uncertain

1460. Commentary from Coeur d'Alene: one baby-or two? Full Text available with Trip Pro

, the reimbursement for maternity care is cut to the minimum, and there is no paid-for postpartum vacation. If a 3rd pregnancy occurs, community pressure is brought to bear and there must be an abortion with a permanent sterilization to follow. This approach can be successful in a communist nation where the government controls the pursestrings and writes the paychecks. In the Philippines the efforts have been directed toward a positive program of conception control. A Barangay Supply Point Officer (BSPO) works (...) . An instructive example of how to enforce population control is China. Their solution aims at the pocketbooks of the Chinese workers. When a couple marries, a government representative visits and advises that the good of the country lies in the careful limitation of family size. During the 1st pregnancy, all care is free, and the mother is given a generous amount of time off with full pay. If a 2nd pregnancy occurs, an abortion is urged. Should the couple choose to go through with the pregnancy

1983 Western Journal of Medicine

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