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Pruritus in Pregnancy

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181. Care around stillbirth and neonatal death

in Queensland, Australia: A population-based study. Aust N Z J Obstet Gynaecol 2017; 57(1): 33-9. 4. Kerber K, Mathai M, Lewis G, et al. Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby. BMC Pregnancy and Childbirth 2015; 15 (Suppl 2). 5. Perinatal and Maternal Mortality Review Committee. Tenth annual report of the Perinatal and Maternal Mortality Review Committee: Reporting mortality: Reporting mortality 2014. Wellington (...) investigated or classified in terms of their cause, with around 50% at term classified as “unexplained” 3 . The lack of a diagnosis adds to parents’ distress, as they struggle to understand “what went wrong” and “will it happen again” in a subsequent pregnancy. In 20-30% of stillbirths, deficiencies in the quality of care are implicated. National perinatal mortality audit programs can help to reduce these deaths 4,5 . This update of the guideline has been undertaken through a partnership between PSANZ

2019 Centre of Research Excellence in Stillbirth

182. British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis

regimen (recurrent VVC in pregnancy): • Induction: topical imidazole therapy can be increased to 10-14 days according to symptomatic response (Grade 2C) • Maintenance: Clotrimazole pessary 500mg intravaginally weekly (1C) Recommended regimens (acute and recurrent VVC in breastfeeding): • Treatment regimens using topical imidazoles should be as per the recommendations listed above for non-pregnant women with acute and recurrent VVC. General considerations: • Asymptomatic colonisation with Candida (...) in 4 pregnant women was significantly associated with shorter anogenital distance suggesting a potential anti-androgenic effect. 117 • It is important to note that exposure to standard dose fluconazole at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy or any additional foetal monitoring. 118 VVC and pregnancy outcome: • Previous studies did not find evidence of an association between Candida colonisation and premature delivery or low birth

2019 British Association for Sexual Health and HIV

183. Perioperative Anaphylaxis Management Guidelines

and I.V. fluids. The adrenaline should be continued when these agents are added. 3.7 High airway pressure is less likely to be the predominant feature of anaphylaxis. Alternative treatments for resistant bronchospasm may be used where clinically appropriate. Alternative causes of high airway pressure such as airway device or circuit malfunction and tension pneumothorax should be sought and eliminated as the cause. 3.8 Management of perioperative anaphylaxis in the pregnant patient includes manual left (...) uterine displacement to minimise aortocaval compression. It may also require a perimortem caesarean delivery in order to facilitate resuscitation of the mother. 4. POST CRISIS MANAGEMENT – See card 6 4.1 Steroids have been of benefit in the management of other allergic diseases and they are recommended as part of secondary management. They may be useful in cases where there is a protracted reaction. 4.2 Antihistamines are useful for the symptomatic treatment of urticaria, angioedema and pruritus. 4.3

2019 Australian and New Zealand College of Anaesthetists

184. Management of Atopic Eczema

). Prevalence of schizophrenia and affective disorders are also higher in AE compared with control (1.2% vs 0.5% and 7.7% vs 4.5% respectively). 23, level II-2 Prevalence of AE is increased with exposure to active and passive smoking. However, it is not associated with maternal smoking during pregnancy. 24, level II-2 • Co-morbidities e.g. skin infection, atopic disease, food allergy, cardiovascular disease, psychological and psychosocial dysfunction may co-exist in AE.7 Management of Atopic Eczema 5 (...) . AGGRAVATING/TRIGGERING FACTORS There are many potential aggravating factors which can worsen flares in AE, either independently or in combination. Potential aggravating/ triggering factors include the following: • aeroallergen • physical irritants • environmental factors • food • microbial colonisation/infection • patient factors (e.g. pregnancy) 5.1 Aeroallergen House dust worsens itch in AE. 25, level III Severity of skin symptoms is associated with indoor house dust mites levels (p 50% deteriorate

2019 Ministry of Health, Malaysia

185. BSG and UK-PSC guidelines for the diagnosis and management of primary sclerosing cholangitis

be actively sought and treated (strength of recommendation: STRONG; quality of evidence: LOW). 22. We suggest that cholestyramine (or similar) is first-line medical treatment for pruritus. Rifampicin and naltrexone are second-line treatments (strength of recommendation: WEAK; quality of evidence: LOW). 23. We suggest that an elevated CA19.9 may support a diag- nosis of suspected cholangiocarcinoma but has a low diag- nostic accuracy. Routine measurement of serum CA19.9 is not recommended for surveillance (...) ). We suggest that those without IBD may benefit from less frequent 5-year colonoscopy or earlier in the advent of new symptoms (strength of recom- mendation: WEAK; quality of evidence: VERY LOW). 28. We suggest that in the presence of cirrhosis, hepatocellular carcinoma surveillance should be carried out in accordance with international guidelines (strength of recommendation: WEAK; quality of evidence: LOW). 29. We recommend that because pregnancy in cirrhotic patients carries a higher risk

2019 British Society of Gastroenterology

186. British Association for Sexual Health and HIV national guideline for the management of infection with Neisseria gonorrhoeae

twice daily 4.4 Pregnancy and breastfeeding 85-87 Pregnant and breastfeeding individuals should not be treated with quinolone or tetracycline antimicrobials. Pregnancy does not diminish treatment efficacy. Ceftriaxone 1g intramuscularly as a single dose (Grade 1A) or Spectinomycin 2g intramuscularly as a single dose (Grade 1A) o Spectinomycin is in the FDA pregnancy category B and therefore not expected to be harmful and can be used if no suitable alternatives. It is not known if it is excreted (...) Sluis WB, Bouman MB, Gijs L, et al. Gonorrhoea of the sigmoid neovagina in a male-to-female transgender. Int J STD AIDS 2015;26(8):595-8. doi: 10.1177/0956462414544725 41. Bodsworth NJ, Price R, Davies SC. Gonococcal infection of the neovagina in a male-to-female transsexual. Sex Transm Dis 1994;21(4):211-2. 42. Haustein UF. [Pruritus of the artificial vagina of a transsexual patient caused by gonococcal infection]. Hautarzt 1995;46(12):858-9. 43. Public Health England. Key findings from

2019 British Association for Sexual Health and HIV

187. Guideline regarding treatment of haemorrhoids

8.6 Coagulation disorder 63 8.6.1GRADE 64 5 8.6.2Recommendation 65 8.7 Pregnant women 65 8.7.1GRADE 66 8.7.2Recommendation 67 9 Other surgical techniques 67 9.1 Open haemorrhoidectomy versus the closed haemorrhoidectomy 67 9.4.1 Grade 71 9.2 Harmonic R scalpel versus haemorrhoidectomy 72 9.2.1GRADE 72 9.3 Ligasure R with the Ferguson (closed) haemorrhoidectomy 74 9.3.1GRADE 75 9.4 Laser 76 9.4.1GRADE 77 9.5 Stapled Trans Anal Rectal Resection (STARR R ) 77 9.5.1Complications 79 9.5.2Conclusion 79 (...) generally not be considered (expert opinion). Anticoagulant patients ? If an outpatient procedure and/or surgical procedure is scheduled, appropriate cessation of anticoagulant therapy should be followed according to national guidance (very low level of evidence, upgraded by guideline development group). Pregnant and post-partal women ? In pregnant and post-partal women basic treatment (i.e. laxatives, topical treatments, phlebotonics and analgesics) should be used (expert opinion, upgraded

2019 Palliative Care Evidence Review Service (PaCERS)

188. ASCIA Guidelines: Chronic Spontaneous Urticaria (CSU)

- Leukotriene receptor antagonists (LTRAs) 10 - Omalizumab 10 - Ciclosporin 13 - Dapsone 14 - Hydroxychloroquine 14 - Corticosteroids 14 - Anticoagulants 14 - Thyroxine 14 - Other treatments 14 • Drug treatment in paediatric populations 15 • Drug availability in New Zealand • PBS requirements in Australia • Non-drug management • Management of CSU in pregnancy and lactation 16 16 17 18 3. Treatment algorithms 19 • Australia • New Zealand 4. References 21 ASCIA INFORMATION FOR HEALTH PROFESSIONALS 3 1 (...) of Urticaria: The 2017 Revision and Update (Zuberbier et al, 2018). Urticaria is characterized by: 1. wheals of variable size, surrounded by erythema. 2. pruritus of variable severity, or sometimes a burning sensation. 3. a transient nature with the skin returning to normal, usually within 30 minutes to 24 hours. Angioedema is characterised by: 1. a sudden, pronounced swelling of the deeper dermis or mucus membranes. 2. painful or uncomfortable, rather than pruritic. 3. resolution slower than for urticaria

2019 Australasian Society of Clinical Immunology and Allergy

189. ASCIA Guidelines - Adrenaline (epinephrine) autoinjector prescription

ASCIA Guidelines - Adrenaline (epinephrine) autoinjector prescription ASCIA Guidelines for adrenaline autoinjector prescription - Australasian Society of Clinical Immunology and Allergy (ASCIA) | | ASCIA Guidelines for adrenaline autoinjector prescription This document has been updated to emphasise the importance of not walking patients who are experiencing anaphylaxis, to address dose issues for infants and pregnant women and to incorporate the word 'epinephrine', which is a new TGA (...) and/or cardiovascular involvement: Skin: Generalised pruritus Generalised Urticaria/erythema Angioedema Gastrointestinal: Abdominal pain Vomiting Loose stools Note: While vomiting and abdominal pain are common features of mild to moderate allergic reactions to food, they are signs of a severe allergic reaction to insect stings and tick bites. © ASCIA 2019 ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand. ASCIA resources are based on published literature

2019 Australasian Society of Clinical Immunology and Allergy

190. ASCIA Guide - Aeroallergen Immunotherapy

in atopic dermatitis is of limited benefit. • Oral allergy syndrome (OAS), also known a pollen food syndrome: AIT is not currently recommended. • Nasal polyposis: there is no evidence that inhalant AIT alters the natural history of nasal polyposis, although co-existing allergic rhinitis may benefit. CONTRAINDICATIONS AND PRECAUTIONS Absolute contraindications • Inability for patient or child’s parent/guardian to give informed consent. • Current or planned pregnancy (contraindication to initiation of AIT (...) only). ­ The major reason for not initiating AIT is the risk of anaphylaxis, which could be dangerous to the foetus (hypotension with reduced placental perfusion, uterine contractions). ­ SCIT is considered to pose a higher risk than SLIT. One trial reported that initiation of SLIT in pregnancy was safe, but this is not yet considered standard of care. ­ Enquiries should be made in all female patients of child-bearing age regarding their plans for pregnancy prior to initiation of AIT. ­ Pregnancy

2019 Australasian Society of Clinical Immunology and Allergy

191. Paediatric Urology

of erythropoietin during testicular torsion of the rats. World J Urol, 2007. 25: 531. 185. Lian, B.S., et al. Factors Predicting Testicular Atrophy after Testicular Salvage following Torsion. Eur J Pediatr Surg, 2016. 26: 17. 186. Philip, J., et al. Mumps orchitis in the non-immune postpubertal male: a resurgent threat to male fertility? BJU Int, 2006. 97: 138. 187. Gielchinsky, I., et al. Pregnancy Rates after Testicular Torsion. J Urol, 2016. 196: 852. 188. Bergman, J.E., et al. Epidemiology of hypospadias

2019 European Association of Urology

192. Urological Infections

. Antimicrob Agents Chemother (Bethesda), 1966. 6: 142. 36. Gold, E.M., et al. Asymptomatic bacteriuria during pregnancy. Obstet Gynecol, 1966. 27: 206. 37. Kass, E.H. Pyelonephritis and bacteriuria. A major problem in preventive medicine. Ann Intern Med, 1962. 56: 46. 38. Kincaid-Smith, P., et al. Bacteriuria in Pregnancy. Lancet, 1965. 1: 395. 39. Little, P.J. The incidence of urinary infection in 5000 pregnant women. Lancet, 1966. 2: 925. 40. Mulla, N. Bacteriuria in pregnancy. Obstet Gynecol, 1960. 16 (...) in pregnancy: a single dose of 3 g amoxicillin versus a 4-day course of 3 doses 750 mg amoxicillin. Gynecol Obstet Invest, 1989. 27: 84. 58. Olsen, L., et al. Single-dose versus six-day therapy with sulfamethizole for asymptomatic bacteriuria during pregnancy. A prospective randomised study. Dan Med Bull, 1989. 36: 486. 59. Thoumsin, H., et al. Single dose fosfomycin trometamol versus multiple dose nitrofurantoin in pregnant women with bacteriuria: preliminary results. Infection, 1990. 18 Suppl 2: S94. 60

2019 European Association of Urology

194. Stillbirth care

tests · Anticardiolipin antibodies · Lupus anticoagulant · Anti-B2 glycoprotein-1 antibodies Placental abruption/infarction Pruritus (without rash) in pregnancy and/or Risk factors for obstetric cholestasis LFTs Bile acids Personal/family history of VTE APS** tests LGA HbA1c SGA HbA1c CMV APS** tests Hydropic Anaemic Jaundiced Infections as indicated: · Rubella · Syphilis · Zika · Malaria Check: · Blood group and antibody screen · Kleihauer/flow cytometry result · Parvovirus Fetal anomalies Check (...) : Investigations · Discuss with parents Subsequent pregnancy care · Consider preconception advice/genetic counselling · Offer continuity of care and carer · Detailed history (obstetric, medical, previous stillbirth, family tree) · Lifestyle advice (e.g. smoking, alcohol, drugs, weight loss) · USS–dating and anomaly screeing · Individualise management based on investigations and findings · Consider facility level for anomaly screening · Consider serial growth monitoring (USS) from 28 weeks or earlier

2019 Queensland Health

195. Grazoprevir with elbasvir (Zepatier): fixed-dose combination for chronic hepatitis C genotypes 1 and 4

of medicine interactions, contraindications and precautions. Pregnancy category B1 There are no adequate or well-controlled studies of GRZ/EBR in pregnant women. GRZ/EBR should only be used in pregnancy if the potential benefit justifies the potential risk to the fetus. There is also a lack of information on whether GRZ/EBR is excreted in human breast milk, which requires careful consideration of benefits and risks. Reason for PBS listing The PBAC recommended the Authority required listing of grazoprevir (...) events such as fatigue, nausea, accidental overdose, anaemia and pruritus were reported to be more common in the groups receiving ribavirin-containing treatment than in those without ribavirin. There was a low incidence of serious adverse events across studies, occurring at similar rates between patients receiving the ribavirin-containing and ribavirin-free regimens (1% to 3.1%). , , , Few patients discontinued treatment due to adverse events (1% to 1.7%). , , , For information about reporting

2018 National Prescribing Service Limited (Australia)

196. Urinary Tract Infection (Cystitis) - acute, uncomplicated

UTIs in men are considered complicated Symptoms persisting longer than two weeks Renal impairment Spinal cord injury Asymptomatic bacteriuria : when a urine culture shows significant presence of bacteria in the urine but with no presenting symptoms. It is not necessary to treat unless the patient is pregnant or immunocompromised (these patients should be referred to their MD) Recurrent UTI : defined as at least two culture positive episodes in 6 months or 3 culture positive episodes in one year (...) the ribs) Vaginal discharge or irritation Urine culture is not recommended except in the following circumstances: Failure to respond to appropriate empiric therapy Relapse (recurrence within 2 to 4 weeks) following therapy Uncertainty about diagnosis Pregnant patient Women can accurately self-diagnose a recurrent UTI based on symptoms 85 to 95% of the time; presumptive diagnosis can be made based on presence of dysuria and urinary frequency and urgency and absence of vaginal symptoms (abnormal

2018 medSask

197. Conjunctivitis: Bacterial, Viral and Allergic

eyelashes A) Bacterial Warm compresses to unstick eyelids in morning Irrigate with sterile saline or eye wash to remove secretions and provide relief B) Viral Cold compresses to relieve irritation, redness C) Allergic Allergen avoidance if possible Avoid rubbing eyes Sunglasses reduce exposure outdoors Cold compresses over eye to relieve pruritus, swelling 2) Pharmacologic – OTC options Lubricating drops or ointments for all types A) Acute Bacterial Polymyxin B-gramicidin eye drops, 4-6 times per day (...) in patients ≥ 4 years old Slow onset: 5 to 14 days; option for prophylaxis for seasonal allergies – begin therapy 2 to 4 weeks before allergen season Adverse effects – well tolerated, < 1% of patients report adverse effects. 4) Pregnancy Preferred therapy: non-pharmacologic measures, artificial tears Second line: Lack of data on use of pharmacologic agents during pregnancy Antihistamines not expected to cause toxicity Short-term use of decongestants (avoid in 1 st trimester) Mast cell stabilizers

2018 medSask

198. Guidelines for the Management of Genital Herpes in New Zealand

Episode Genital Herpes: Third Trimester Acquisition 23 Management of Pregnant Women with Recurrent Genital Herpes 24 Treatment algorithm – Management of Women with History of Genital Gerpes Prior to Pregnancy and Women with First Clinical Episode Greater than 6 Weeks Prior to Delivery 25 NEONATAL HSV INFECTION 25 Transmission to the Fetus and Newborn 26 Disease Classification 26 Table 2: Classification of Neonatal HSV Infection46 27 Management of Neonatal HSV Infection 29 Guidelines for Talking (...) 2017 Only available online at 2. Sexually Transmitted Infections – Summary of Guidelines 2017 Patient information pamphlets 1. The Facts: A guide for people with Herpes Simplex Includes – Genital Herpes – The Facts Herpes and Relationships Herpes and Pregnancy Facial Herpes 2. Herpes: Myth vs Facts Helpline Website Resources New Zealand Sexual Health Society (NZSHS) resources Comprehensive STI Management Guidelines and Patient Information handouts are available on

2017 New Zealand Sexual Health Society

200. Lichen Sclerosus

? • This guideline was developed by an international, multidisciplinary panel of experts in LS • It aims to highlight potential triggers for LS • Advice on initial management • Advice on current treatment options with best long-term outcome for females and males • Future research strategies. What is the goal of the treatment in Lichen sclerosus? Females: • Currently, treatment mainly aims for suppression of symptoms like pruritus and signs such as pallor, erythema and fissures in vulval LS. • Ideally treatment (...) or calcineurin inhibitors (Virgili 2012)to suppress symptoms like pruritus and invisible/not symptomatic inflammation at any time • What is the risk of long-term treatment? ? There is an intrinsic risk in LS to develop anogenital malignancies. ? There is no evidence from the literature that there is an increased risk of anogenital malignancies after long-term treatment (either with steroids nor for calcineurin inhibitors, however very long term follow up studies are not available). • Is there a good

2018 European Dermatology Forum

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