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Uterine Inversion

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81. Premature newborn care

with a neonatologist as soon as possible is recommended to provide expertise to reduce potential morbidity. Gestational age determination done within hours of birth is important for designating further care of the premature newborn. The risk of adverse outcomes varies inversely with gestational age. The New Ballard Score uses measurements of neuromuscular and physical maturity to complement the maternal history and ultrasonographic findings to estimate gestational age, although a first-trimester ultrasound remains (...) to the uterine fundus infant physical maturity score infant neuromuscular maturity score combined physical/neuromuscular score <10: gestational age <28 weeks combined physical/neuromuscular score 11 to 19: gestational age 29 to 31 weeks combined physical/neuromuscular score 20 to 24: gestational age 32 to 33 weeks combined physical/neuromuscular score 25 to 33: gestational age 34 to 36 weeks infant birth weight (appropriate for gestational age infants, AGA) spontaneous preterm labour intra-uterine infection

2018 BMJ Best Practice

83. A life threatening uterine inversion and massive post partum hemorrhage caused by placenta accrete during Caesarean section in a primigravida: a case report (PubMed)

A life threatening uterine inversion and massive post partum hemorrhage caused by placenta accrete during Caesarean section in a primigravida: a case report A 32-year-old Caucasian primigravida was admitted for elective Caesarean Section at 36 weeks and 6 days with the diagnosis of preeclampsia.Traction of the umbilical cord after delivery of a healthy baby resulted in uterine inversion. The placenta was found to be densely adherent to the posterior uterine wall. Piecemeal excision (...) of the placenta as close as possible to the uterine lining was then performed.In this way we were able to control a massive post partum hemorrhage and preserve the fertility of the patient.

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2009 Cases journal

84. The Vienna consensus: report of an expert meeting on the development of art laboratory performance indicators

. There are studies showing an increased likelihood of embryo aneuploidy in connection with aggressive ovarian stimulation, even in patients younger than 35 years, including post zygotic segregation errors and maternal segregation errors ( ; ), as well as having a negative impact on the maintenance of genomic imprints during early embryogenesis ( ; ; ). It has been shown that in patients belonging to either high or low strata of antimüllerian hormone levels an inverse correlation exists between the daily dose (...) is defined as the number of gestational sacs observed divided by the number of embryos (cleavage-stage or blastocysts) transferred ( ), or as the proportion of fetal hearts relative to the number of embryos transferred ( ). Implantation rate reflects the efficiency of the whole culture system, but it can be influenced by uterine receptivity, and by different policies for embryo transfer in different centers. LBR may be considered as the ultimate KPI for checking IVF clinic performance and defined

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2018 European Society of Human Reproduction and Embryology

88. Overweight, Obesity and Contraception

studies Some pharmacokinetic studies have shown an inverse relationship between body weight and ENG serum levels, 84,85 raising concerns about the effectiveness of the method in women with raised BMI, and the duration for which the method is effective in women with high BMI. Evidence level 2-10 Copyright ©Faculty of Sexual & Reproductive Healthcare 2019 FSRH guideline: Overweight, Obesity and Contraception In one small pharmacokinetic study 85 of the ENG implant in the first 6 months of use

2019 Faculty of Sexual & Reproductive Healthcare

89. An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of PCOS in Adolescence

a number of miRNAs dysregulated in women with PCOS. These miRNA species are involved in glycometabolism and ovarian follicle development pathways [ , ]. Interestingly, miRNA-592 has been shown to be downregulated and to be inversely related to LHCGR levels in PCOS patients [ ]. 6. Altered Sympathetic Nerve Activity An alteration in sympathetic nerve activity has been proposed to contribute to the etiology of PCOS. Indeed, many of the common clinical symptoms of PCOS, including central obesity (...) for more than 3 months), or primary amenorrhea in girls with completed puberty may suggest androgen excess [ , ]. Ovulatory dysfunction may also present as dysfunctional uterine bleeding (cycles shorter than 21 days or lasting more than 7 days) [ - ]. These menstrual disturbances may all be reflective of androgen excess [ ]. One should keep in mind that age at menarche may differ in girls with PCOS due to variable presentation, including early puberty and primary amenorrhea. Age at menarche may

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2019 Pediatric Endocrine Society

90. Primary postpartum haemorrhage

3.5.1 Genital trauma 22 3.5.2 Cervical trauma 22 3.5.3 Uterine rupture 23 3.5.4 Uterine inversion 24 3.6 Tissue 25 3.7 Thrombin 26 3.7.1 Target results 26 3.7.2 Coagulopathy principles 27 3.7.3 Cross matched RBC not available 27 4 Massive haemorrhage 28 5 Postnatal care after PPH 29 References 30 Appendix A: Uterine atonia interventions 33 Appendix B: PPH drug and blood products 34 Acknowledgements 35 List of Tables Table 1. Postpartum haemorrhage definitions 7 Table 2. Incidence of PPH (...) during PPH 18 Table 18. Oxytocin 19 Table 19. Ergometrine 19 Table 20. Misoprostol 19 Table 21. 15-methyl prostaglandin F2 alpha (carboprost) 20 Table 22. Intractable bleeding 21 Table 23. Genital trauma 22 Table 24. Cervical trauma 22 Table 25. Uterine rupture 23 Table 26. Uterine inversion 24 Table 27. Tissue 25 Table 28. Blood products 26 Table 29. Laboratory values 26 Table 30. Coagulopathy principles 27 Table 31. Blood cell replacement 27 Table 32. Example MHP bleeding protocol 28 Table 33

2019 Queensland Health

91. Muscle-invasive and Metastatic Bladder Cancer

, and late gadolinium-enhanced imaging. Radiology, 1994. 193: 239. 103. Kim, J.K., et al. Bladder cancer: analysis of multi-detector row helical CT enhancement pattern and accuracy in tumor detection and perivesical staging. Radiology, 2004. 231: 725. 104. Yang, W.T., et al. Comparison of dynamic helical CT and dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma. AJR Am J Roentgenol, 2000. 175: 759. 105. Kim, S.H., et al. Uterine cervical carcinoma: evaluation of pelvic lymph (...) node metastasis with MR imaging. Radiology, 1994. 190: 807. 106. Kim, S.H., et al. Uterine cervical carcinoma: comparison of CT and MR findings. Radiology, 1990. 175: 45. 107. Oyen, R.H., et al. Lymph node staging of localized prostatic carcinoma with CT and CT-guided fine-needle aspiration biopsy: prospective study of 285 patients. Radiology, 1994. 190: 315. 108. Barentsz, J.O., et al. MR imaging of the male pelvis. Eur Radiol, 1999. 9: 1722. 109. Dorfman, R.E., et al. Upper abdominal lymph nodes

2019 European Association of Urology

92. Levels of Maternal Care

, are managed in a high-volume hospital ( , ). It also has been noted that maternal mortality is inversely related to the population density of maternal–fetal medicine subspecialists at the state level ( ), although other factors, such as the presence of obstetrician–gynecologists, nurses, and anesthesiologists who have experience in high-risk maternity care, also may contribute to this trend. Although these findings provide support for an association between availability of resources and favorable maternal (...) . Examples of appropriate patients (not requirements) Any patient appropriate for level I care, plus higher-risk conditions such as severe preeclampsia placenta previa with no prior uterine surgery Level III (Subspecialty Care) Definition Level II facility plus care of more complex maternal medical conditions, obstetric complications, and fetal conditions Capabilities Level II facility capabilities plus advanced imaging services available at all times. ability to assist level I and level II centers

2019 American College of Obstetricians and Gynecologists

93. WHO guidelines for the use of thermal ablation for cervical pre-cancer lesions

baseline risk, typically the pooled proportion of the event without the treatment across studies. When studies with one group receiving an intervention were included (e.g., case series), a pooled proportion of an event (and confidence intervals) was calculated across the studies using the generic inverse variance. For continuous outcomes, a mean difference or a standardized mean difference (when studies used different scales to measure an outcome) was calculated. For screen-and-treat recommendations

2019 World Health Organisation Guidelines

94. Postoperative adhesions in gynecologic surgery: a committee opinion

. Theonlystudytoassessadhesiolysisandinfertilityisasmall retrospective review. Among infertile women with otherwise unexplained infertility diagnosed with adnexal adhesions at laparoscopy, pregnancy rates after subsequent adhesiolysis bylaparotomywere32%at12monthsand45%at24months compared with 11% at 12 months and 16% at 24 months in womenleftuntreated(15).Inwomenfollowedforanaverage of 49 months after tubal surgery, term pregnancy rates were inversely correlated with adhesion scores at the time of the surgical procedure, as assigned using (...) Gynecol 2006;107: 263–8. 33. Buttram VC, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 1981;36:433–45. 34. Berkeley AS, DeCherney AH, Polan ML. Abdominal myomectomy and sub- sequent fertility. Surg Gynecol Obstet 1983;156:319–22. 35. Tulandi T, Murray C, Guralnick M. Adhesion formation and reproductive outcome after myomectomy and second-look laparoscopy. Obstet Gynecol 1993;82:213–5. 36. Tulandi T, Hum HS, Gelfand MM. Closure of laparotomy incisions

2019 Society for Assisted Reproductive Technology

96. Erenumab (Aimovig) - Migraine

related to immune function, primarily infections in the future PSURs. An enhanced pre- postnatal development study was performed in cynomolgus monkey. It was agreed that this study did not identify any concerns for use during pregnancy. However, CGRP may be of importance to regulate uterine vascular resistance during pregnancy. There is a theoretical risk that CGRP inhibition may be a risk in pregnant women with risk factors for eclampsia. Based on such theoretical concerns, and also a more general

2018 European Medicines Agency - EPARs

97. Ertugliflozin l-pyroglutamic acid / metformin hydrochloride (Segluromet) - Diabetes Mellitus, Type 2

and in vitro in liver microsomes and hepatocytes from rats, dogs, and humans. The potential for in vivo chiral inversion of ertugliflozin was also assessed in pooled plasma samples and the obtained data suggest that ertugliflozin does not undergo chiral inversion in humans. Metabolite profiles were qualitatively similar in all species with no unique human metabolites observed. Overall, glucuronidation on the hydroxy groups of the modified glucose moiety was the major metabolic pathway of ertugliflozin

2018 European Medicines Agency - EPARs

99. Clinical Appropriateness Guidelines: Radiation Oncology Brachytherapy, intensity modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS) treatment guidelines

fields/arcs, via narrow spatially and temporally modulated beams, binary, dynamic MLC, per treatment session G6016 Compensator-based beam modulation treatment delivery of inverse planned treatment using 3 or more high resolution (milled or cast) compensator

2018 AIM Specialty Health

100. CRACKCast E180 – Labor & Delivery

events and possible subsequent medicolegal judgments. Most ED deliveries require only basic equipment to cut and clamp the umbilical cord and dry and suction the infant. However, the ED should have additional equipment and trained staff available to care for a newborn requiring further resuscitation. Maternal complications of labor and delivery include obstetric trauma, postpartum hemorrhage, uterine inversion and rupture, amniotic fluid embolism, coagulation disorders, and infections. Many (...) % of cases) Requires a thorough, well lit exam: look in the vagine and rectal area. Look for uterine inversion, consider whether uterine rupture may have occurred. Tears and lacerations may involve the perineum, rectum, cervix, vagina, vulva, and urethra. ● Continue supportive care as above ● Repair any lacerations/tears Coagulopathy Usually is the case in women with severe hemorrhage despite investigating and treating the above causes. should be evaluated for disseminated intravascular coagulation (DIC

2018 CandiEM

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