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Postpartum Office Visit

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1461. 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

1462. HELLP Syndrome

racial origin. Antiphospholipid syndrome (APS) - 10.5% of patients with HELLP syndrome have APS. [ ] Presentation [ ] HELLP syndrome is a serious complication of pregnancy and may present at any time in the last half of pregnancy. 70% of cases present before delivery, peaking between 27 and 37 weeks of gestation but it can occur earlier or later. 30% of women with HELLP syndrome present postpartum, usually within 48 hours of delivery. Symptoms of HELLP syndrome are usually nonspecific. Onset (...) and coagulation tests. Postpartum HELLP syndrome may be treated with plasma exchange. Blood pressure control is essential. Women with severe liver damage may need liver transplantation. Prognosis If HELLP syndrome is not treated early, up to 25% of women may develop serious complications. Without treatment there is a significant mortality. The mortality rate among babies born to mothers with HELLP syndrome varies and depends mainly on gestation and birth weight. Complications [ ] Maternal: - 4-9%. - 9-20

2008 Mentor

1463. Haemolytic Disease of the Newborn

of the population who are RhD negative. This varies within ethnic minorities but, in the UK, it is highest in the Caucasian population (approximately 16%). Before immunoprophylaxis was available, HDN affected 1% of all newborns and was responsible for the death of one baby in every 2,200 births. [ ] Anti-D prophylaxis (mostly administered postnatally) and advances in neonatal care have reduced the frequency of HDN by almost a factor of 10 to 1 in 21,000 births. [ ] Deaths attributed to RhD alloimmunisation fell (...) of the condition is the presence of anti-D antibodies in the mother as detected by the indirect . All rhesus-negative women have this test performed in the UK at the first antenatal visit. Routine ultrasound screening may detect hydrops fetalis (see below) or polyhydramnios. Infants born to alloimmunised mothers may appear clinically normal in mild cases. Diagnostic findings include jaundice (yellow amniotic fluid, yellow vermix, yellow skin), pallor and hepatosplenomegaly. Kernicterus (bilirubin

2008 Mentor

1464. Gynaecology History and Examination

. Dyspareunia - superficial or deep. Urinary symptoms Leakage. Cloudiness. Haematuria. Hesitancy. Dysuria. Frequency. Strangury. Stress or urge incontinence. Obstetric history Number of children, details of pregnancy, labour and delivery, birth weights, complications. Miscarriages/terminations. Any postnatal problems - eg, depression. Conception difficulties/subfertility. Contraception Contraceptive history. Any recent unprotected intercourse. Reliability of method and user. Potential contra-indications (...) 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 ; Urinary incontinence in women. BMJ. 2014 Sep 15349

2008 Mentor

1465. Exomphalos and Gastroschisis

and postnatal period. [ ] Gastroschisis Scheduled preterm delivery may improve postoperative outcome. [ ] Some patients can be managed by plastic closure (vigorous stretching of the abdominal wall with gradual decompression of the abdominal contents from a temporary silo into the abdomen). In the majority of patients, however, primary closure of the defect is the main objective. This may need to be delayed if the intestines are too inflamed and hence too enlarged to be replaced in the abdominal cavity. Too (...) 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 ; The embryologic origin of ventral body wall defects. Semin Pediatr Surg. 2010 Aug19(3):209-14. ; Gastroschisis Embryology, Pathogenesis, Epidemiology. NeoReviews, Nov 2005 6

2008 Mentor

1466. Growth and Failure to Thrive

abnormalities. IUGR often produces a small but hungry and eager baby. However, a combination of preterm and is more likely to cause difficulties. Toxins in utero may include tobacco, drugs of abuse (especially amfetamines and cocaine) and alcohol. may occur or the incomplete fetal alcohol effects. Infection in utero may include , and Postnatal causes include lack of adequate intake of nutrition: Lack of appetite may occur with , cental nervous system (CNS) pathology and chronic infection. Inability to suck (...) ? 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

2008 Mentor

1467. Gravidity and Parity Definitions (and their Implications in Risk Assessment)

for the possibility of postpartum haemorrhage. Good physiotherapy and postnatal follow-up for urogynaecological problems. 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 ; The interpretation and clinical application of the word 'parity': a survey. BJOG. 2007 Oct114(10):1295-7. ; Office for National Statistics ; Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ. 2016 Apr 19353:i1753. doi: 10.1136/bmj.i1753. ; Incidence and outcomes

2008 Mentor

1468. 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

1469. 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

1470. The Latin American trial of psychosocial support during pregnancy: a social intervention evaluated through an experimental design. (Abstract)

. The main foci of the intervention were determined after an ethnographic study was carried out to identify stress-producing situations and needs for support during pregnancy. Besides the home visits, the program also offered a hot-line, an office in the hospital, a specially designed poster and booklet, and a 'guided tour' of the health institution. Since this was a multicenter trial, the program's standardization was a crucial methodological aspect that was achieved through the training course (...) for the home-visitors team. Biological and psychosocial outcomes were measured in both experimental and control groups at the 36th week of gestational age, post-partum and at the 40th day after delivery. The attributes of the multicenter population showed an important variability, reflecting differences in the countries or hospitals' population prevalent attributes. The results of the program's implementation were analyzed, demonstrating that home visitors adapted topics discussed during the interviews

1993 Social Science & Medicine Controlled trial quality: uncertain

1471. 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

1472. High Risk Pregnancy: Detection and Management Full Text available with Trip Pro

High Risk Pregnancy: Detection and Management Risk in pregnancy relates to events which lead to perinatal morbidity and mortality. Numerous risk scoring systems have been devised to bring attention to risk factors so that problems can be prevented, identified and treated. However, by carrying out very few fundamental assessments at regular antenatal office visits: checking blood pressure, testing urine for protein, measuring the symphysis to fundus height and carefully establishing the expected (...) necessary intrapartum and neonatal care, to minimize the risk of adverse outcome: postnatal transfer of the deteriorating, sick, small neonate is at best hazardous.

1982 Canadian Family Physician

1473. 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

1474. Translating Research Into Practice for Postpartum Depression

Information provided by: Olmsted Medical Center Study Details Study Description Go to Brief Summary: This is a study to assess the impact of introducing screening and planned follow up for postpartum depression. All women ages 18 to 45 who speak English or Spanish who come to the enrolled community family medicine offices will either be given usual care or screened using the Edinburgh Postnatal Depression Screening tool. If the EDPS score is high the women will be given the PHQ-9 to more clearly identify (...) for Postpartum Depression (TRIPPD) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT00548743 Recruitment Status : Unknown Verified October 2007 by Olmsted Medical Center. Recruitment status was: Recruiting First Posted : October 24, 2007 Last Update Posted : December 4, 2007 Sponsor: Olmsted Medical Center

2007 Clinical Trials

1475. Age-17 Follow-up of Home Visiting Intervention

: Nurse Home Visiting Visits from nurses from mid-pregnancy to child age 2 years. Prenatal Nurse Home-Visiting The 230 families received: 1) free transportation for prenatal care; and 2) nurse home-visiting during pregnancy and postpartum (one visit). Nurse Home Visiting through Age 2 The 228 families: 1) free transportation for prenatal care; 2) nurse home-visiting during pregnancy and through child's second birthday; and 3) child developmental screening and referral. Behavioral: Nurse Home Visiting (...) Age-17 Follow-up of Home Visiting Intervention Age-17 Follow-up of Home Visiting Intervention - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Age-17 Follow-up of Home Visiting Intervention (MemphisY17

2008 Clinical Trials

1476. Efficacy of breastfeeding support provided by trained clinicians during an early, routine, preventive visit: a prospective, randomized, open trial of 226 mother-infant pairs. Full Text available with Trip Pro

Efficacy of breastfeeding support provided by trained clinicians during an early, routine, preventive visit: a prospective, randomized, open trial of 226 mother-infant pairs. Despite growing evidence of the benefits of prolonged breastfeeding for mother and infant health, the rate of breastfeeding at infant age of 6 months remains below the Healthy People 2010 goal. The greatest decrease in the breastfeeding rate occurs during the first 4 postpartum weeks. Mothers who discontinue breastfeeding (...) of this study was to determine whether attending an early, routine, preventive, outpatient visit delivered in a primary care physician's office would improve breastfeeding outcomes.The study was a prospective, randomized, parallel-group, open trial.Participants were recruited at a level 3 maternity facility, with an average of 2000 births per year, in France.A total of 231 mothers who had delivered a healthy singleton infant (gestational age: > or =37 completed weeks) and were breastfeeding on the day

2005 Pediatrics Controlled trial quality: predicted high

1477. Medicaid Enhanced Prenatal/Postnatal Services Using a Nurse-Community Health Worker Team

before adding more. Medicaid Enhanced Prenatal/Postnatal Services Using a Nurse-Community Health Worker Team The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT00536159 Recruitment Status : Completed First Posted : September 27, 2007 Last Update Posted : September 27, 2007 Sponsor: Michigan State (...) are pervasive in low income pregnant women and mothers with almost half screening positive for depressive symptoms and a quarter meeting diagnostic criteria for major or minor depression. While national home visiting models have demonstrated improvement in health, developmental, and parenting outcomes for women willing to participate, they have had less success in reducing depressive symptoms during pre and postnatal periods, and often programs struggle to engage women with unmet mental health needs. We

2007 Clinical Trials

1478. Extended Infant Post-exposure Prophylaxis With Antiretrovirals to Reduce Postnatal HIV Transmission

Extended Infant Post-exposure Prophylaxis With Antiretrovirals to Reduce Postnatal HIV Transmission Extended Infant Post-exposure Prophylaxis With Antiretrovirals to Reduce Postnatal HIV Transmission - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please (...) remove one or more studies before adding more. Extended Infant Post-exposure Prophylaxis With Antiretrovirals to Reduce Postnatal HIV Transmission The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT00115648 Recruitment Status : Completed First Posted : June 24, 2005 Last Update Posted : March 7, 2014

2005 Clinical Trials

1479. Effects of a law against early postpartum discharge on newborn follow-up, adverse events, and HMO expenditures. Full Text available with Trip Pro

Effects of a law against early postpartum discharge on newborn follow-up, adverse events, and HMO expenditures. Concern about harm to newborns from early postpartum discharges led to laws establishing minimum hospital stays in the mid-1990s. We evaluated the effects of an early-discharge protocol (a hospital stay of one postpartum night plus a home visit) in a health maintenance organization (HMO) and a subsequent state law guaranteeing a 48-hour hospital stay.Using interrupted-time-series (...) analysis and data on 20,366 mother-infant pairs with normal vaginal deliveries, we measured changes in length of stay, newborn examinations on the third or fourth day of life, and office visits, emergency department visits, and hospital readmissions for newborns. We also examined expenditures for hospitalizations and home-based care.The early-discharge program increased the rate of stays of less than two nights from 29.0 percent to 65.6 percent (P<0.001). The rate declined to 13.7 percent after

2002 NEJM

1480. Postpartum Haemorrhage

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

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