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Uterine Inversion

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141. Genetics of Breast and Gynecologic Cancers (PDQ®): Health Professional Version

at an earlier age, with the median age at diagnosis of 48 years.[ ] Family history including inherited cancer genes Although the hyperestrogenic state is the most common predisposing factor for endometrial cancer, family history also plays a significant role in a woman’s risk for disease. Approximately 3% to 5% of uterine cancer cases are attributable to a hereditary cause,[ ] with the main hereditary endometrial cancer syndrome being Lynch syndrome, an autosomal dominant genetic condition with a population (...) lymphocytes, undifferentiated tumor histology, lower uterine segment origin, and synchronous tumors. Considerations in Risk Assessment and in Identifying a Family History of Breast and Ovarian Cancer Risk The accuracy and completeness of family histories must be taken into account when they are used to assess risk. A reported family history may be erroneous, or a person may be unaware of relatives affected with cancer. In addition, small family sizes and premature deaths may limit the information obtained

2018 PDQ - NCI's Comprehensive Cancer Database

142. Propofol-induced death in children: at a Univ. Hospital

events was inversely related to trough dabigatran concentrations (p=0.045), with age and previous stroke (both p < 0.0001) as significant covariates. Multiple logistic regression showed major bleeding risk increased with dabigatran exposure (p < 0.0001), age (p < 0.0001), ASA use (p < 0.0003), and diabetes (p = 0.018) as significant covariates. The authors concluded that ischemic stroke and bleeding outcomes were correlated with dabigatran plasma concentrations and individual benefit–risk might (...) increased spontaneous abortion (resorption) at doses as low as one fifth the clinical dose. The mechanism by which the drug induces abortion/resorption can be explained by its effect as a prostaglandin and ClC-2 agonist on the uterine muscle. In addition, dyspnea occurred in 2% to 3% of patients treated with lubiprostone; this is unacceptable for the treatment of constipation. Finally, the drug is very expensive. We conclude that lubiprostone is not appropriate for use as a laxative. Too harmful

2015 Med Check - The Informed Prescriber

143. 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

145. The Acute Management of Thrombosis and Embolism during Pregnancy and the Puerperium

CTPA or V/Q scanning. Ideally, informed consent should be obtained before these tests are undertaken. In the diagnosis of PE in the nonpregnant individual, both the electrocardiogram (ECG) and arterial blood gas (ABG) measurement are of limited diagnostic value. 19,20 However, in pregnancy and the puerperium, one study found that the ECG was abnormal in 41% of women with acute PE; the most common abnormalities were T wave inversion (21%), S 1 Q 3 T 3 pattern (15%) and right bundle branch block (18

2015 Royal College of Obstetricians and Gynaecologists

146. Breast Cancer Prevention (PDQ®): Health Professional Version

in young parous women.[ ] Numerous observational studies on the relationship between the level of physical activity and breast cancer risk have shown an inverse relationship.[ ] The average RR reduction is 30% to 40%, but confounding variables—such as diet or a genetic predisposition to breast cancer—have not been addressed. A prospective study of more than 25,000 Norwegian women found that heavy manual labor or at least 4 hours of exercise per week is associated with decreased breast cancer risk (...) who were monitored for a mean of 3.9 years. Invasive breast cancer incidence was approximately the same for both drugs, but there were fewer noninvasive cancers in the tamoxifen group. Adverse events of uterine cancer, venous thrombolic events, and cataracts were more common in tamoxifen-treated women, and there was no difference in ischemic heart disease events, strokes, or fractures.[ ] Treatment-associated symptoms of dyspareunia, musculoskeletal problems, and weight gain occurred less

2018 PDQ - NCI's Comprehensive Cancer Database

148. Core Competencies for Management of Labour

movement and auscultate FHR Assess fetal heart rate and response to contractions Assess contractions for onset, strength, length and frequency, including resting tone Perform a vaginal examination unless contraindicated Active First Stage of Labour – Ongoing Assessment Initiate BC Labour Partogram Commence one-to-one care Check FHR q 15 - 30 min (see DST FHS) Palpate contractions q 15 - 30 min for frequency, strength, length of contractions, and uterine resting tone Check pulse, BP, respirations, temp (...) , reassess in 1 hour Support non-directed pushing Check FHR q 15 min until pushing then increase to q 5 min or after each contraction Palpate contractions q 15 min for frequency, intensity, length of contractions, and uterine resting tone Check maternal VS q1 h Perform a VE once hourly only if indicated Assess the progress of fetal descent Assess bladder emptying, encourage voiding q1h Consider hydration and pain relief needs Encourage frequent position changes Provide support and encouragement Assist

2014 British Columbia Perinatal Health Program

149. Perinatal Management of Pregnant Women at the Threshold of Infant Viability? the Obstetric Perspective

In births before 34 weeks of gestation, second born twins delivered by caesarean section had a lower risk of neonatal death than those delivered vaginally (2.1 versus 9.0%, adjusted OR 0.40, 95% CI 0.17, 0.95) but this study had only low numbers of extremely preterm infants (1.2–1.4% were < 28 weeks of gestation). The rate of classical caesarean section is inversely related to the gestation. In one cohort study where a classical incision was performed in 1% of all caesarean sections, 20% of incisions (...) during labour. Intrapartum continuous fetal heart rate monitoring would seem appropriate during labour for those pregnancies in which active obstetric intervention, such as emergency caesarean section in the presence of a pathological cardiotocography (CTG), and full neonatal support is planned. 2.5.3 Management during labour and obstetric emergencies Analgesia in labour is an important consideration. Labour at the threshold of viability can occasionally progress rapidly with minimal painful uterine

2014 Royal College of Obstetricians and Gynaecologists

150. Diagnosis and Management of Acute Pulmonary Embolism

in acute PE, but up to 40% of the patients have normal arterial oxygen saturation and 20% a normal alveolar-arterial oxygen gradient. 87,88 Hypocapnia is also often present. The chest X-ray is frequently abnormal and, al- though its ?ndings are usually non-speci?c in PE, it is useful forexclud- ing other causes of dyspnoea or chest pain. 89 Electrocardiographic changes indicative of RV strain, such as inversion of T waves in leads V1–V4, a QR pattern in V1, S1Q3T3 pattern, and incomplete or complete

2014 European Society of Cardiology

151. Hypertrophic Cardiomyopathy

between HCM and cardiac amyloidosis is aided by measuring the ratio between QRS voltages and LV wall thickness. Extreme superior (“North West”) QRS axis deviation Seen in patients with Noonan syndrome who have severe basal hypertrophy Giant negative T wave inversion (>10 mm) Giant negative T wave inversion in the precordial and/or inferolateral leads suggests involvement of the LV apex. Abnormal Q waves =40 ms in duration and/or =25% of the R wave in depth and/or =3 mm in depth in at least two

2014 European Society of Cardiology

152. Infertility

% after 2 years and 93% after 3 years. It is estimated that one in seven UK couples has difficulty conceiving (approximately 3.5 million people). In the UK: The main causes of infertility are ovulatory disorders (25% of couples), tubal damage (20% of couples), male infertility (30% of couples), and uterine or peritoneal disorders (10% of couples). There is no identifiable cause of infertility in about 25% of couples. The presence of disorders in both the man and the woman has been reported in about 40 (...) of infertility What are the causes of infertility? In the UK [ ] : The main causes of infertility are ovulatory disorders (25% of couples), tubal damage (20% of couples), male infertility (30% of couples), and uterine or peritoneal disorders (10% of couples). Gamete or embryo defects, uterine or endometrial factors, and pelvic conditions, such as endometriosis, may also be of significance. There is no identifiable cause of infertility in about 25% of couples. The presence of disorders in both the man

2018 NICE Clinical Knowledge Summaries

153. Outcomes of operative vaginal delivery managed by residents under supervision and attending obstetricians: a prospective cross-sectional study. (PubMed)

with attending obstetricians and obstetric residents. Severe maternal morbidity was defined as third- or fourth-degree perineal laceration, perineal hematoma, cervical laceration, extended uterine incision for cesareans, postpartum hemorrhage > 1500 ml, surgical hemostatic procedures, uterine artery embolization, blood transfusion, infection, thromboembolic events, admission to the intensive care unit, or maternal death; severe neonatal morbidity was defined as a 5-minute Apgar score < 7, umbilical artery pH (...) was significantly and inversely associated with severe neonatal but not maternal morbidity. After propensity score matching, delivery managed by a resident was not significantly associated with severe maternal morbidity (adjusted OR: 0.74, 95% CI: 0.39-1.38) and was no longer associated with neonatal morbidity (adjusted OR: 0.51, 95% CI: 0.25-1.04).Management of attempted operative vaginal deliveries by residents under the supervision of attending obstetricians, compared with by the attending obstetricians

2019 American Journal of Obstetrics and Gynecology

154. Exploring telomere length in mother-newborn pairs in relation to exposure to multiple toxic metals and potential modifying effects by nutritional factors. (PubMed)

Exploring telomere length in mother-newborn pairs in relation to exposure to multiple toxic metals and potential modifying effects by nutritional factors. The uterine environment may influence telomere length at birth, which is essential for cellular function, aging, and disease susceptibility over the lifespan. However, little is known about the impact of toxic chemicals on early-life telomeres. Therefore, we assessed the potential impact of multiple toxic metals on relative telomere length (...) , and urine were positively associated with placental rTL, about 0.2 SD by doubled arsenic. In the cord blood (n = 88), only lead was associated with rTL (inversely), particularly in boys (p for interaction 0.09). Stratifying by newborn sex showed ten times stronger association in boys (about 0.6 SD) than in girls. The studied antioxidants did not modify the associations, except that with antimony.Elevated exposure to boron, lithium, arsenic, and antimony was associated with maternal or newborn rTL

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2019 BMC Medicine

155. Cervical modifications after pessary placement in singleton pregnancies with maternal short cervical length: 2D and 3D ultrasound evaluation. (PubMed)

group (-2.56 mm). These inverse trends were statistically significant (P = .006).Cervical pessary reduces both uterocervical angles and corrects cervical angulation by pushing the cervix up toward the uterus. Maintaining the cervix aligned to the uterine axis leads to reduced cervical tissue stretch, so avoiding further cervical shortening. All these changes were present after pessary placement; however, the clinical implications of these findings remain unknown.© 2019 Nordic Federation of Societies

2019 Acta Obstetricia et Gynecologica Scandinavica

156. Does nifedipine improve outcomes of embryo transfer?: Interim analysis of a randomized, double blinded, placebo-controlled trial. (PubMed)

Does nifedipine improve outcomes of embryo transfer?: Interim analysis of a randomized, double blinded, placebo-controlled trial. Implantation failure is the main factor affecting the success rate of in vitro fertilization (IVF) procedures. Studies have reported that uterine contractions (UC) at the time of embryo transfer (ET) were inversely related to implantation and pregnancy rate, hence reducing the success of IVF treatments. Various pharmacological agents, with the exception of calcium

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2019 Medicine Controlled trial quality: predicted high

157. Does nifedipine improve outcomes of embryo transfer?: Interim analysis of a randomized, double blinded, placebo-controlled trial. (PubMed)

Does nifedipine improve outcomes of embryo transfer?: Interim analysis of a randomized, double blinded, placebo-controlled trial. Implantation failure is the main factor affecting the success rate of in vitro fertilization (IVF) procedures. Studies have reported that uterine contractions (UC) at the time of embryo transfer (ET) were inversely related to implantation and pregnancy rate, hence reducing the success of IVF treatments. Various pharmacological agents, with the exception of calcium

2019 Medicine Controlled trial quality: predicted high

158. Placenta Accreta Spectrum (PAS) disorders: incidence, risk factors and outcomes of different management strategies in a tertiary referral hospital in Minia, Egypt: a prospective study. (PubMed)

(CS) with cervical inversion and ligation of both uterine arteries and group (C), (n = 16): the placenta was left in place.The incidence of PAS disorders during the study period was 9 / 1000 maternities (0.91%). The mean age of cases was 32.4 ± 4.2 years, 60% of them had a parity ≥3 and 82% of them had ≥2 previous CSs. Also, 1/3 of them had previous history of placenta previa. Estimated blood loss (EBL) and blood transfusion in group A were significantly higher than other groups. Group (C) had (...) higher mean hospital stay duration. Group A was associated with significantly higher complication rate.The incidence of PAS disorders was 0.91%. Maternal age > 32 years, previous C.S. (≥ 2), multiparity (≥ 3) and previous history of placenta previa were risk factors. The management of PAS disorders should be individualized. Women with PAS disorders who completed their family should be offered cesarean hysterectomy. Using the cervix as a tamponade combined with bilateral uterine artery ligation

2019 BMC Pregnancy and Childbirth

159. The pubertal development mode of Chinese girls with turner syndrome undergoing hormone replacement therapy. (PubMed)

), whereas the uterine volume of the control group was inversely greater than that of the TS group among those who reached stages B4 and 5 (P = 0.034). During HRT, the uterine volume grew significantly from all previous stages except for breast stage 5 (B3 vs.2: Z = - 2.031; P = 0.042; B4 vs. 3: Z = - 2.273; P = 0.023; B5 vs. 4: Z = - 1.368; P = 0.171). The paired data of 27 girls with TS showed that the uterine volume (17.93 ± 9.31 ml vs. 13.75 ± 6.67 ml) and width (2.54 ± 0.66 cm vs. 2.22 ± 0.36 cm (...) a retrospective, longitudinal study over the past two decades at The First Affiliated Hospital, Sun Yat-sen University.Seventy-one patients with TS and two groups of normal Chinese girls.The total investigation time was 3.00 (2.00, 4.66) years. The interval of each stage was significantly longer (P < 0.001) in the girls with TS than that in the normal Chinese girls, except for B2-3 (P = 0.011). The uterine volumes of the girls with TS in stages B2 and 3 were greater than those of the control group (P = 0.046

2019 BMC Endocrine Disorders

160. Cigarette Smoking: Health Risks and How to Quit (PDQ®): Health Professional Version

of this summary is on clinical interventions by health professionals that decrease the use of tobacco. Effects of Smoking Cessation Based on solid evidence, cigarette smoking causes cancers of the lung, oral cavity and pharynx, larynx, esophagus, bladder, kidney, pancreas, stomach, uterine cervix, and acute myeloid leukemia.[ ] Smoking avoidance and smoking cessation result in decreased incidence and mortality from cancer. Description of the Evidence Study Design : Evidence obtained from a randomized (...) inversely with education, and was highest among adults who had earned a General Educational Development diploma (43.0%) and generally decreased with increasing years of education.[ ] ( ) From 2011 to 2014, significant declines occurred in the use of cigarettes among middle school (4.3% to 2.5%) and high school (15.8% to 9.2%) students.[ ] Cigarette smoking prevalence among male and female high school students increased substantially during the early 1990s in all ethnic groups, but in 2016, it declined

2017 PDQ - NCI's Comprehensive Cancer Database

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