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Uterine Inversion

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122. Quality measures in high-risk pregnancies: Executive summary of a cooperative workshop of SMFM, NICHD, and ACOG (Full text)

VBAC rates inversely are correlated with total cesarean rates; repeat cesarean deliveries are associated with increased morbidity over time; VBAC counseling in?uences uptake of attempted trial of labor. Unclear VBACratedependsonaccess; many hospitals do not meet standards or have chosen not to offer VBAC for risk management reasons; potential for downstream complications if incentivized for VBAC success. Yes Can use administrative data for VBAC rate and VBAC success rate. No TOLAC counseling Yes (...) . Transabdominal evaluation of uterine cervical length during pregnancy fails to identify a substantialnumberofwomenwithashortcervix.JMaternFetalNeonatal Med 2012;25:1682-9. 23.Friedman A, Srinivas S, Elovitz M, Wang E, Schwartz N. Can trans- abdominalultrasoundbeusedasascreeningtestforshortcervicallength? Am J Obstet Gynecol 2013;208:190-7. 24.Meis PJ, Klebanoff M, Thom E, et al. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med 2003;348:2379-85. 25.Orsulak MK

2017 Society for Maternal-Fetal Medicine PubMed abstract

123. Normal birth

IM after birth of baby o Wait at least 1–3 minutes after birth or for cord pulsation to cease and then clamp and cut cord o Controlled cord traction and uterine guarding after signs of separation o Prolonged after 30 minutes · Physiological o Suitable for well women without risk factors o Placenta birthed by maternal effort/gravity o Oxytocin not administered o Clamp cord after pulsation ceased o No controlled cord traction o Prolonged after 60 minutes · If concern with cord integrity or FHR: o (...) · Provides mild analgesia and sedation 112 · Minimal toxicity · Fast acting with rapid elimination 112,114 · No effect on uterine contractility · No known fetal or neonatal effects 114,115 · Effective for labour pain 73,116 · Can assist relaxation (breathing techniques) Risk · Overdose causes respiratory depression o Risk increased when used with opioid · Associated with: o Vomiting, nausea, headache and dizziness 73,110,114,116 o Disorientation and claustrophobia 73 · Can be minimised by careful

2017 Queensland Health

125. Lymphangioleiomyomatosis Diagnosis and Management Part II: An Official ATS/JRS Clinical Practice Guideline

and diagnostic yield of these methodologies, however, is not well established and needs to be studied. Consultation with expert LAM centers is advised to individualize the approach to diagnosis in complex patients. On occasion, re-review of archival tissues from prior procedures by expert pathologists can revealthediagnosisofLAMandobviatethe need for biopsy. Examples include lung tissue obtained from prior bleb resections for pneumothorax or uterine and adnexal tissues from prior hysterectomies. Every (...) is required to optimize the safety and ef?cacy of this diagnostic approach. A recent study evaluating the role of transbronchial lung biopsy in 24 consecutive patients presenting toa LAMClinicrevealedadiagnosticyieldof 71%, which was inversely correlated with DL CO (43). Consultation with an expert centerbeforeundertakingtransbronchiallung biopsy, combined with a critical review of the tissue specimens by a pathologist with expertise in LAM, can help avoid false- negative test results and the need

2017 American Thoracic Society

126. Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association (Full text)

predictive indicator appears to be of most value. In 1 series, the negative predictive value of NT-pro-BNP <128 pg/mL at 20 weeks’ gestation exceeded 95%. Colloid Oncotic Pressure Circulating albumin concentrations fall 12% to 18% in pregnancy, with the lowest levels at ≈24 weeks’ gestation. The decline in colloid oncotic pressure, along with increased femoral venous pressure caused by uterine compression of the inferior vena cava, elicits the edema of pregnancy. , The fall in oncotic pressure can (...) of the first stage of labor, with further increases during uterine contractions. , , Uterine contractions augment maternal cardiac output as a result of enhanced sympathetic activity (via anxiety, pain) and expulsion of uterine blood into the central venous circulation. During a contraction, the uterus expels up to 400 mL blood into the central venous circulation, leading to a rise in central venous pressure, right atrial pressure, cardiac output, and arterial pressure. The labor-induced augmentation

2017 American Heart Association PubMed abstract

130. Relationship between behavioral indices of pain during labor pain with pain intensity and duration of delivery (Full text)

cervical dilatation of 3-5 centimeters until delivery, the Labor Pain Coping Behavior Observation Form (comprised of 6 sub-groups of facial expressions, verbal expressions, tone of voice, body movements, degree of relaxation, and respiratory function and severity and duration of pain) was completed during uterine contractions and every half an hour. Using the Inventory of Labor Information; vital signs, frequency of contractions, and duration of the first and second stages of labor were measured (...) . The findings also revealed that the duration of the active phase of the first stage of labor (p<0.001 and r=-0.453), the duration of the second stage of labor (p<0.012 and r=-0.146), and the severity of pain (p<0.001 and r=-0.450) were significantly and inversely correlated with behavioral indicators during labor pain; i.e. an increase in the mean score of behavioral indicators during labor pain could lead to a decline in the duration of stages of labor and severity of pain.It was concluded that behaviors

2018 Electronic physician PubMed abstract

131. Obtaining Valid Consent to Participate in Perinatal Research Where Consent is Time Critical

that may not apply to them. • For conditions with a suspected risk of occurrence of less than 1/100 (for example, shoulder dystocia, unexplained preterm labour or uterine inversion), careful consideration should be given to avoiding unnecessary physical and psychological stress by providing detailed information about scenarios and situations that are rare. Therefore, it is appropriate for summary information to be available antenatally and the full study information to be given if the event happens

2016 Royal College of Obstetricians and Gynaecologists

132. Duavive - oestrogens conjugated / bazedoxifene

of fracture. Duavive is indicated in postmenopausal women with a uterus (with 12 months since the last menses). When determining whether to use DUAVIVE or other therapies, including oestrogens, for an individual postmenopausal woman, consideration should be given to menopausal symptoms, effects on uterine and breast tissues, and cardiovascular risks and benefits (see sections 4.4 and 5.1). The legal basis for this application refers to: Article 10(b) of Directive 2001/83/EC – relating to applications (...) with an intact uterus, a progestin has to be added in order to prevent the increased risk of endometrial carcinoma associated with oestrogen alone HRT. Combinations of CE and MPA are approved and available in some EU countries. BZA has both tissue selective oestrogen receptor agonist and antagonist activity, with agonist activity on the skeletal system and antagonist activity in breast and uterine tissues. The multiple oestrogens in CE have tissue selective oestrogen receptor agonist activity. Measured

2015 European Medicines Agency - EPARs

133. Breastfeeding Healthy Term Infants

such as the eventual use of a supplemental nursing system if the mother’s milk supply does not increase to meet the infant’s nutritional needs • Discuss prenatal preparation of nipples: use of creams and lotions; and that Hoffman’s exercise and nipple “conditioning” is ineffective and not recommended: stimulation may cause uterine contractions, leading to premature labor 38,39 • Encourage parents to attend support groups and prenatal breastfeeding education sessions • Prenatal education includes: 1. Exploration (...) Perinatal Services BC • Facilitate mother-infant introduction to breastfeeding; keep them together, skin-to-skin allowing the infant to lick, suckle, and touch the nipple with his/her hand. 53 In the first hour after birth the infant’ s suckling r eflex is generally intense, infants are alert and awake, and mothers have a surge of oxytocin which is associated with milk-ejection, increasing uterine contractions, and enhancing mother-infant attachment 38,53 • Promote mother-infant togetherness: assess

2015 British Columbia Perinatal Health Program

134. Food Supplementation for Improving the Physical and Psychosocial Health of Socio?economically Disadvantaged Children Aged Three Months to Five Years: A Systematic Review (Full text)

interval. We entered the unadjusted SMD as the effect estimate in the generic inverse variance method, and then we inflated the standard error of the effect estimate by multiplying by the square root of the variance inflation factor, calculated as: 1 + ((M ‐ 1) multiplied by ICC), where M is the average cluster size. We calculated the standard error as the confidence interval divided by 3.92. 2. When the pooled estimate was the mean difference (MD), we used the variance inflation factor (VIF) to adjust (...) meta‐analysis, we reported studies narratively. In cases where studies provided insufficient data for meta‐analysis, we selected analyses of variance (ANOVA) as providing the better estimate of effect because they corrected for important covariates. We included one regression in a meta‐analysis using the generic inverse variance method. presented the regression coefficients of contrasts between groups over 24 months. We considered this contrast an effect size, and calculated the standard deviation

2015 Campbell Collaboration PubMed abstract

135. Developmental rheumatology in children. Scenario: Hypermobility in children

, if there is persistent pain and problems with footwear, although there is no gold standard approach to treatment. [ ] Flat feet Flat feet The prevalence of flat feet is inversely related to age [ ] — flat foot (pes planus) is common in infants and children (97% prevalence in children younger than 2 years of age) and has often resolved by adolescence. It is usually physiologic, that is flexible, painless, and of no functional consequence, but rarely it can become stiff, painful, or rigid. This may indicate underlying (...) fragility and complications such as stroke, aortic dissection, and bowel rupture). Family history of sudden early death from aortic aneurysmal dissection/rupture (suggestive of Marfan's syndrome), or spontaneous arterial rupture or uterine rupture in childbirth (suggestive of vascular type Ehlers-Danlos syndrome). Symptoms that do not improve with rest, and resting leads to 'gelling' or stiffness (indicative of an inflammatory condition). Basis for recommendation Basis for recommendation Community

2019 NICE Clinical Knowledge Summaries

136. Developmental rheumatology in children. Scenario: In-toeing gait in children

, if there is persistent pain and problems with footwear, although there is no gold standard approach to treatment. [ ] Flat feet Flat feet The prevalence of flat feet is inversely related to age [ ] — flat foot (pes planus) is common in infants and children (97% prevalence in children younger than 2 years of age) and has often resolved by adolescence. It is usually physiologic, that is flexible, painless, and of no functional consequence, but rarely it can become stiff, painful, or rigid. This may indicate underlying (...) fragility and complications such as stroke, aortic dissection, and bowel rupture). Family history of sudden early death from aortic aneurysmal dissection/rupture (suggestive of Marfan's syndrome), or spontaneous arterial rupture or uterine rupture in childbirth (suggestive of vascular type Ehlers-Danlos syndrome). Symptoms that do not improve with rest, and resting leads to 'gelling' or stiffness (indicative of an inflammatory condition). Basis for recommendation Basis for recommendation Community

2019 NICE Clinical Knowledge Summaries

137. Developmental rheumatology in children. Scenario: Heel pain in children

pain and problems with footwear, although there is no gold standard approach to treatment. [ ] Flat feet Flat feet The prevalence of flat feet is inversely related to age [ ] — flat foot (pes planus) is common in infants and children (97% prevalence in children younger than 2 years of age) and has often resolved by adolescence. It is usually physiologic, that is flexible, painless, and of no functional consequence, but rarely it can become stiff, painful, or rigid. This may indicate underlying foot (...) fragility and complications such as stroke, aortic dissection, and bowel rupture). Family history of sudden early death from aortic aneurysmal dissection/rupture (suggestive of Marfan's syndrome), or spontaneous arterial rupture or uterine rupture in childbirth (suggestive of vascular type Ehlers-Danlos syndrome). Symptoms that do not improve with rest, and resting leads to 'gelling' or stiffness (indicative of an inflammatory condition). Basis for recommendation Basis for recommendation Community

2019 NICE Clinical Knowledge Summaries

138. Pulmonary embolism

for PE, but might be useful in the differential diagnosis Chest X-ray features that may be present include atelectasis, pleural effusion, or elevation of a hemidiaphragm. ECG signs that may be present include sinus tachycardia, non-specific ST-segment and T-wave abnormalities, right axis deviation, incomplete or complete right bundle-branch block, and, less commonly, T-wave inversion in leads V1–V3, P pulmonale, or the classical S1, Q3, T3 (S wave in lead 1, Q wave in lead 3, and T-wave inversion (...) (for example intracranial, intraspinal, intraocular, retroperitoneal, intra-articular or pericardial, intra-uterine, or intramuscular with compartment syndrome). Causes a fall in haemoglobin level of 20 g/L (1.24 mmol/L) or more. Leads to transfusion of 2 or more units of whole blood or red blood cells. Septic endocarditis. For more detailed information on prescribing tinzaparin, including cautions, adverse effects, drug interactions, and monitoring requirements, see the British National Formulary

2019 NICE Clinical Knowledge Summaries

139. Developmental rheumatology in children. Scenario: Delayed walking in children

, if there is persistent pain and problems with footwear, although there is no gold standard approach to treatment. [ ] Flat feet Flat feet The prevalence of flat feet is inversely related to age [ ] — flat foot (pes planus) is common in infants and children (97% prevalence in children younger than 2 years of age) and has often resolved by adolescence. It is usually physiologic, that is flexible, painless, and of no functional consequence, but rarely it can become stiff, painful, or rigid. This may indicate underlying (...) fragility and complications such as stroke, aortic dissection, and bowel rupture). Family history of sudden early death from aortic aneurysmal dissection/rupture (suggestive of Marfan's syndrome), or spontaneous arterial rupture or uterine rupture in childbirth (suggestive of vascular type Ehlers-Danlos syndrome). Symptoms that do not improve with rest, and resting leads to 'gelling' or stiffness (indicative of an inflammatory condition). Basis for recommendation Basis for recommendation Community

2019 NICE Clinical Knowledge Summaries

140. Developmental rheumatology in children. Scenario: Knock knees in children

, if there is persistent pain and problems with footwear, although there is no gold standard approach to treatment. [ ] Flat feet Flat feet The prevalence of flat feet is inversely related to age [ ] — flat foot (pes planus) is common in infants and children (97% prevalence in children younger than 2 years of age) and has often resolved by adolescence. It is usually physiologic, that is flexible, painless, and of no functional consequence, but rarely it can become stiff, painful, or rigid. This may indicate underlying (...) fragility and complications such as stroke, aortic dissection, and bowel rupture). Family history of sudden early death from aortic aneurysmal dissection/rupture (suggestive of Marfan's syndrome), or spontaneous arterial rupture or uterine rupture in childbirth (suggestive of vascular type Ehlers-Danlos syndrome). Symptoms that do not improve with rest, and resting leads to 'gelling' or stiffness (indicative of an inflammatory condition). Basis for recommendation Basis for recommendation Community

2019 NICE Clinical Knowledge Summaries

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