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Thromboembolic Disease in Pregnancy

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81. Immediate delivery versus expectant monitoring for hypertensive disorders of pregnancy between 34 and 37 weeks of gestation (HYPITAT-II): an open-label, randomised controlled trial. (Abstract)

and 44 non-academic hospitals in the Netherlands. Women with non-severe hypertensive disorders of pregnancy between 34 and 37 weeks of gestation were randomly allocated to either induction of labour or caesarean section within 24 h (immediate delivery) or a strategy aimed at prolonging pregnancy until 37 weeks of gestation (expectant monitoring). The primary outcomes were a composite of adverse maternal outcomes (thromboembolic disease, pulmonary oedema, eclampsia, HELLP syndrome, placental abruption (...) Immediate delivery versus expectant monitoring for hypertensive disorders of pregnancy between 34 and 37 weeks of gestation (HYPITAT-II): an open-label, randomised controlled trial. There is little evidence to guide the management of women with hypertensive disorders in late preterm pregnancy. We investigated the effect of immediate delivery versus expectant monitoring on maternal and neonatal outcomes in such women.We did an open-label, randomised controlled trial, in seven academic hospitals

2015 Lancet Controlled trial quality: predicted high

82. Nausea/vomiting in pregnancy

examination. Goitre. Conditions causing nausea and vomiting in pregnancy: Genito-urinary conditions — urinary tract infection, uraemia, pyelonephritis, ovarian torsion, renal stones. Metabolic disorders and endocrine conditions — hypercalcaemia, thyrotoxicosis, diabetic ketoacidosis, Addison's disease. Gastrointestinal conditions — gastritis, gastroenteritis, peptic ulcer, pancreatitis, cholecystitis, bowel obstruction, hepatitis, cholelithiasis, appendicitis. Neurological disorders — vestibular disease (...) , migraine, central nervous system tumours. Other pregnancy-related conditions — acute fatty liver of pregnancy, pre-eclampsia. Drug-induced vomiting — for example iron or opioids. Psychological disorders — for example eating disorders. Basis for recommendation Basis for recommendation Findings suggesting an alternative diagnosis This information is based on a Royal College of Obstetricians and Gynaecologists (RCOG) guideline: The management of nausea and vomiting of pregnancy and hyperemesis gravidarum

2018 NICE Clinical Knowledge Summaries

83. Management of Sickle Cell Disease in Pregnancy

Management of Sickle Cell Disease in Pregnancy Management of Sickle Cell Disease in Pregnancy Green–top Guideline No. 61 July 2011RCOG Green-top Guideline No. 61 2 of 20 © Royal College of Obstetricians and Gynaecologists Management of Sickle Cell Disease in Pregnancy This is the first edition of this guideline. 1. Purpose and scope The purpose of this guideline is to describe the management of pregnant women with sickle cell disease (SCD). It will include preconceptual screening and antenatal (...) condition and there are recommendations for clinical care which apply to all patients, including women planning to become pregnant. 26 Women should be reviewed at least annually by a specialist sickle service for the monitoring of chronic disease complications and the imparting of information. 29 Information that is particularly relevant for women planning to conceive includes: ? the role of dehydration, cold, hypoxia, overexertion and stress in the frequency of sickle cell crises ? how nausea

2011 Royal College of Obstetricians and Gynaecologists

84. Cardiovascular Diseases during Pregnancy

are of relevance for the diagnosis and management of CVD in pregnancy. History and clinical investigation Many disorders can be identi?ed by taking a careful personal and family history, particularly cardiomyopathies, the Marfan syn- drome, congenital heart disease, juvenile sudden death, long QT syndrome, and catecholaminergic ventricular tachycardia (VT) or Brugada syndrome. It is important to ask speci?cally about possible sudden deaths in the family. The assessment of dyspnoea is important for diagnosis (...) factors—diabetes, hypertension, and obesity. Also the treatment of congenital heart disease has improved, resulting in an increased number of women with heart disease reaching childbearing age. 8 In western countries maternal heart disease is now the major cause of maternal death during pregnancy. 9 Hypertensive disorders are the most frequent cardiovascular events during pregnancy, occurring in 6–8% of all pregnancies. 10 In the western world, congenital heart disease is the most frequent

2011 European Society of Cardiology

85. Anaemia and iron deficiency in pregnancy and postpartum

studies. None of the clinical questions reached high evidence or strong recommendation. The majority of the recommendations were good clinical practice. Authors’ conclusion: It is good clinical practice to individualise the iron supplementation in pregnancy based on the level of haemoglobin and serum ferritin. There is at weak recommendation against routine iron supplementation to all pregnant women. First choice treatment is always oral iron unless there is failure of treatment or a known condition (...) with malabsorption. There is a weak recommendation against treatment with intra venous iron postpartum. Anaemia, iron deficiency and pregnancy 2016 2 Recommendations 1 It is good clinical practice to screen with haemoglobin and serum ferritin in the first trimester. v 2 There is weak/conditional recommendation against routine treatment with iron to all pregnant women from the first trimester (provided that recommendation 1 is followed). ? 3 It is good clinical practice to offer pregnant women in the second

2016 Nordic Federation of Societies of Obstetrics and Gynecology

86. Flowchart: Management of hypertension in pregnancy

investigations and fetal assessment Birth Inpatient or outpatient care Worsening maternal or fetal condition? Is birth indicated? Yes No No Yes Risk factors for preeclampsia • Previous history of preeclampsia • Family history of preeclampsia • Inter-pregnancy interval > 10 years • Nulliparity • Pre-existing medical conditions o APLS o Pre-existing diabetes o Renal disease o Chronic hypertension o Chronic autoimmune disease • Age > 40 years • BMI > 35 kg/m 2 • Multiple pregnancy • Elevated BP at booking (...) Flowchart: Management of hypertension in pregnancy Queensland Health State of Queensland (Queensland Health) 2016 http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Queensland Clinical Guidelines, Guidelines@health.qld.gov.au Queensland Clinical Guidelines www.health.qld.gov.au/qcg Management of hypertension in pregnancy Queensland Clinical Guidelines: Hypertensive disorders in pregnancy. Flowchart version: F15.13-2-V7-R20 Hypertension sBP = 140 mmHg and/or dBP = 90 mmHg Maternal

2016 Queensland Health

87. Management of systemic lupus erythematosus during pregnancy: challenges and solutions Full Text available with Trip Pro

Management of systemic lupus erythematosus during pregnancy: challenges and solutions Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease predominantly affecting women, particularly those of childbearing age. SLE provides challenges in the prepregnancy, antenatal, intrapartum, and postpartum periods for these women, and for the medical, obstetric, and midwifery teams who provide their care. As with many medical conditions in pregnancy, the best maternal and fetal (...) ), an individual management plan, regular reviews, and early recognition of flares and complications are all important. Women are at risk of lupus flares, worsening renal impairment, onset of or worsening hypertension, preeclampsia, and/or venous thromboembolism, and miscarriage, intrauterine growth restriction, preterm delivery, and/or neonatal lupus syndrome (congenital heart block or neonatal lupus erythematosus). A cesarean section may be required in certain obstetric contexts (such as urgent preterm

2017 Open access rheumatology : research and reviews

88. IBD: Pregnancy

Disease; In?ammatory Bowel Disease; Pregnancy; Postpartum; Breast-feeding; Lacta- tion; 5-Aminosalicylate; Corticosteroid; Thiopurine; Anti– Tumor Necrosis Factor. T he in?ammatory bowel diseases (IBDs)—ulcerative colitis (UC) and Crohn’s disease (CD)—are associ- ated with a substantial burden of illness, 1 particularly in Western nations including Canada, the United States, and Europe. 2 IBD during pregnancy poses a challenging circumstanceinwhichthehealthofboththemotherandthe fetus must (...) recommendationindicatesthatthestatementshouldbeapplied in most cases, whereas a conditional recommendation signi?es thatclinicians “.shouldrecognizethatdifferentchoiceswillbe appropriate for different patients and that they must help each patient to arrive at a management decision consistent with her or his values and preferences.” 19 March 2016 Clinical Practice Guidelines for In?ammatory Bowel Disease in Pregnancy 735Drs Nguyen and Seow drafted the initial manuscript, which wasthenreviewedandrevisedby thesteering committee,after which

2016 Canadian Association of Gastroenterology

89. Guidelines for Weight Gain During Pregnancy: A Focused Practice Question

Types of Studies included ? Cohort studies (prospective or retrospective), case control studies, 21 descriptive studies and expert opinion from reports, respected authorities or expert committees. Outcomes Included Outcomes associated with maternal obesity Maternal: Spontaneous abortion, hypertensive disorders of pregnancy, gestational diabetes. Intrapartum: Macrosomia, shoulder dystocia, Caesarean section, Thromboembolism Infant: Stillbirth, childhood obesity (...) (BMI 25.0-29.0) prior to pregnancy, 7- 11.5 kg (15-25 lbs) is the recommended weight gain during pregnancy. o For women in the obese category (BMI = 30) prior to pregnancy, 5 - 9 kg (11- 20 lbs) is the recommended weight gain during pregnancy. 3. Provisional guidelines have been developed for gestational weight gain among women carrying multiples. 1 1. Issue & Context National data indicate that approximately half of women with a healthy weight when they become pregnant gain too much weight during

2016 Peel Health Library

90. SMFM State of Pregnancy Monograph

. Pregnancy after liver transplantation g. Pancreatitis h. Wilson’s disease7. Hematologic diseases a. Maternal anemia and hemoglobinopathies b. Sickle cell disease c. von Willebrand disease d. Thrombotic thrombocytopenia purpura/hemolytic uremic syndrome e. Care of the Jehovah’s Witness pregnant woman 8. Renal disease (includes renal transplantation) 9. Neurologic diseases: a. Seizure disorders b. Headache c. AV malformation/ berry aneurysm d. Multiple sclerosis e. Pseudotumor cerebri f. Myasthenia gravis (...) vaginal bleeding 9. Preeclampsia with severe elements/eclampsia with HELLP syndrome or end-organ damage 10. Severe postpartum hemorrhage 11. Cesarean hysterectomy 12. Acute fatty liver of pregnancy 13. Amniotic fluid embolism MATERNAL COMPLICATIONS 1. Hypertensive disorders 2. Cardiac disease a. Congenital heart disease b. Arrhythmias c. Valve disease d. Cardiomyopathy e. Pulmonary hypertension f. Coronary artery disease g. Heart transplant 3. Respiratory disease a. Asthma b. Pneumonia c. Restrictive

2015 Society for Maternal-Fetal Medicine

91. Management of Beta Thalassaemia in Pregnancy

for liver iron, cardiac iron and fructosamine ? thalassaemia intermedia pregnancy outcomes, especially indications for transfusion, management of maternal anaemia in nontransfused patients and FGR ? compliance with prophylaxis against venous thromboembolic disease in women who have undergone splenectomy. Evidence level 4 Evidence level 4 Evidence level 1++ D PReferences 1. Ryan K, Bain BJ, Worthington D, James J, Plews D, Mason A, et al.; British Committee for Standards in Haemotology. Significant (...) in Haematology has published guidelines for screening and diagnosis of thalassaemias. 1 2. Introduction and background epidemiology Haemoglobinopathies are one of the most common inherited disorders. More than 70 000 babies are born with thalassaemia worldwide each year 2 and there are 100 million individuals who are asymptomatic thalassaemia carriers. The basic defect in the thalassaemia syndromes is reduced globin chain synthesis with the resultant red cells having inadequate haemoglobin content

2014 Royal College of Obstetricians and Gynaecologists

92. Obesity in pregnancy

• Haemorrhage 14 • Chest, genital tract, wound and urinary infections 14 • Reduced rate of breastfeeding 14 • Postnatal depression 27 • Thromboembolic disease Neonatal/ childhood • Admission to neonatal intensive care units 14 • Macrosomia 14 • Congenital malformations 17 • Obesity 14 and metabolic syndrome 28 • Neurodevelopmental disorders (e.g. autism, developmental delays) 29 • Asthma 30 Queensland Clinical Guideline: Obesity in pregnancy Refer to online version, destroy printed copies after use Page 10 (...) (Gestational diabetes mellitus and Diabetes in Pregnancy ) 14 • Preeclampsia 14 • Obstructive sleep apnoea—may be related to adverse fetal outcomes 14 • Thromboembolic disease 14 • Cholecystitis 14 • Depression 4 • Difficulties with abdominal palpitation and obtaining adequate auscultation of fetal heart and cardiotocograph (CTG) • Suboptimal ultrasonography 5 • Diagnosis of congenital abnormality 17 • Preterm birth (PTB)—mostly associated with comorbidities 14,18 • Increased odds of dizygous twinning 19

2015 Queensland Health

93. Physical Activity and Exercise During Pregnancy and the Postpartum Period

training in pregnancy has been shown to increase aerobic capacity in normal weight and overweight pregnant women ( ). Temperature regulation is highly dependent on hydration and environmental conditions. During exercise, pregnant women should stay well-hydrated, wear loose-fitting clothing, and avoid high heat and humidity to protect against heat stress, particularly during the first trimester ( ). Although exposure to heat from sources like hot tubs, saunas, or fever has been associated (...) Institute for Occupational Safety and Health’s lifting equation to define recommended weight limits for a broad range of lifting patterns for pregnant women in an effort to define lifting thresholds that most pregnant workers with uncomplicated pregnancies should be able to perform without increased risk to maternal or fetal health ( ). The same authors identified lifting conditions that pose higher risk of musculoskeletal injury and suggested that obstetrician–gynecologists and other obstetric care

2015 American College of Obstetricians and Gynecologists

94. Management of AML in Pregnancy

lymphoblastic leukaemia representing approximately one‐third and acute myeloblastic leukaemia (AML) two‐thirds of cases (Hurley et al , ). Diagnosis of malignancy during pregnancy poses a huge challenge to the pregnant patient, her family and the medical team. The fact that optimal anti‐leukaemic treatment may be associated with adverse foetal outcomes including malformation or death raises a complicated maternal‐foetal conflict. The dilemma faced by women in pregnancy at gestations where delivery (...) is not an option is very real and patients need sufficient time and considerable support in making their decisions. Diagnosis Diagnosis of leukaemia in pregnancy is more challenging than in non‐pregnant individuals because anaemia, which can be multifactorial, is relatively common in pregnancy. Initial suspicion of a more serious cause for anaemia is usually triggered by an abnormal blood count and blood film appearances. Whilst both thrombocytopenia and anaemia are relatively common findings in pregnancy

2015 British Committee for Standards in Haematology

95. Contraception after pregnancy. Full Text available with Trip Pro

that this may not necessary, at least for healthy women <35 years old. Most contraceptive methods can be used after pregnancy regardless of the outcome. Because of an increased risk of venous thromboembolism associated with estrogen-containing contraceptives initiation of these methods should be delayed until 6 weeks after childbirth. More research is required to settle the questions over the use of combined hormonal contraception during breastfeeding, the use of injectable progestin-only contraceptives (...) before 6 weeks after childbirth and use of both hormonal and intrauterine contraception after gestational trophoblastic disease. The potential impact on the risk of ectopic pregnancy of certain contraceptive methods often confuses healthcare providers. The challenges involved in providing effective, seamless service provision of contraception after pregnancy are numerous, even in industrialised countries. Nevertheless, the clear benefits demonstrate that it is worth the effort. This article

2019 Acta Obstetricia et Gynecologica Scandinavica

96. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. Full Text available with Trip Pro

Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. Obesity is the most common medical condition in women of reproductive age. Obesity during pregnancy has short term and long term adverse consequences for both mother and child. Obesity causes problems with infertility, and in early gestation it causes spontaneous pregnancy loss and congenital anomalies. Metabolically, obese women have increased insulin resistance in early pregnancy, which (...) becomes manifest clinically in late gestation as glucose intolerance and fetal overgrowth. At term, the risk of cesarean delivery and wound complications is increased. Postpartum, obese women have an increased risk of venous thromboembolism, depression, and difficulty with breast feeding. Because 50-60% of overweight or obese women gain more than recommended by Institute of Medicine gestational weight guidelines, postpartum weight retention increases future cardiometabolic risks and prepregnancy

2017 BMJ

97. Endogenous sex hormones and risk of venous thromboembolism in young women. Full Text available with Trip Pro

Endogenous sex hormones and risk of venous thromboembolism in young women. the risk of venous thromboembolism (VTE) in young women can predominantly be attributed to exogenous hormone use. The influence of (abnormalities in) endogenous sex hormones, as in polycystic ovary syndrome (PCOS) or primary ovarian insufficiency (POI) on VTE risk is uncertain.assess the association between endogenous sex hormone levels and VTE risk.women aged ≤45 years from the MEGA case-control study who provided (...) a blood sample in absence of exogenous hormone exposure or pregnancy were included. Sex-hormone binding globulin (SHBG), estradiol, follicle stimulating hormone (FSH) and testosterone were measured. The free androgen index (FAI) and estradiol to testosterone ratio (E:T) were calculated. VTE risk was assessed according to quartiles (Q) of levels and clinical cut-offs as proxies for PCOS (FAI>4.5) and POI (FSH>40U/L). Logistic regression models were used to estimate adjusted odds ratios (OR) with 95

2019 Journal of Thrombosis and Haemostasis

98. Sex matters: Practice 5P's when treating young women with venous thromboembolism. Full Text available with Trip Pro

Sex matters: Practice 5P's when treating young women with venous thromboembolism. Sex matters when it comes to venous thromboembolism (VTE). We defined 5P's - period, pill, prognosis, pregnancy, and post-thrombotic syndrome - that should be discussed with young women with VTE. Menstrual blood loss (Period) can be aggravated by anticoagulant therapy. This seems particularly true for direct oral anticoagulants. Abnormal uterine bleeding can be managed by hormonal therapy, tranexamic acid (...) is incorporated as predictor in recurrent VTE risk assessment models. However, current guidelines do not propose using these to guide treatment duration. Pregnancy increases the risk of VTE by 4 to 5-fold. Thrombophilia and obstetric risk factors further increase the risk of pregnancy-related VTE. In women with a history of VTE, the risk of recurrence during pregnancy or postpartum appears to be influenced by risk factors present during the first VTE. In most women with a history of VTE, antepartum

2019 Journal of Thrombosis and Haemostasis

99. Venous Thromboembolism Among Women Initiating Depot Medroxyprogesterone Acetate Immediately Postpartum. (Abstract)

. Diagnosis, procedure, and drug codes were used to identify contraception, VTE, and potential confounding chronic or pregnancy-related conditions. Women who initiated DMPA during days 0 through 7 postpartum were compared with women who did not initiate hormonal contraception during days 0 through 7 postpartum. Women were followed from date of delivery through 12 weeks postpartum for the occurrence of VTE, with censoring at hormonal contraception initiation or prescription, hysterectomy, sterilization (...) ratio for VTE was 2.87 (95% CI 2.05-4.03) among women in the immediate postpartum DMPA group compared with women in the control group, adjusting for age alone. After adjusting for age and pregnancy-related and chronic conditions, the adjusted incidence rate ratio for VTE was 1.94 (95% CI 1.38-2.72) among women in the immediate postpartum DMPA group compared with women in the control group.Initiation of DMPA immediately postpartum is associated with a low incidence but an increased relative risk

2019 Obstetrics and Gynecology

100. Thromboembolic Disease in Pregnancy

Thromboembolic Disease in Pregnancy Thromboembolic Disease in Pregnancy Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Thromboembolic (...) Disease in Pregnancy Thromboembolic Disease in Pregnancy Aka: Thromboembolic Disease in Pregnancy , Deep Vein Thrombosis in Pregnancy , Deep Venous Thrombosis During Pregnancy , DVT in Pregnancy , DVT Prophylaxis in Pregnancy II. Epidemiology Venous Thrombosis risk: 0.5 to 3 per 1000 pregnancies risk is increased 5 fold in pregnancy DVT occurs equally in all trimesters (but increases with each trimester and especially postpartum) III. Pathophysiology Hypercoagulation in pregnancy Procoagulants

2015 FP Notebook

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