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Latest & greatest articles for pregnancy
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influenza infection. Pregnancy itself is a high-risk condition, making the potential adverse effects of influenza particularly serious in pregnant women. If a pregnant woman has other underlying health conditions, the risk of adverse effects from influenza is even greater. Antiviral treatment is necessary for all pregnant women with suspected or confirmed influenza, regardless of vaccination status. Obstetrician–gynecologists and other obstetric care providers should promptly recognize the symptoms (...) that postexposure antiviral chemoprophylaxis can be considered for pregnant women and women who are up to 2 weeks postpartum (including after pregnancy loss) who have had close contact with infectious individuals. Recommendations Obstetrician–gynecologists and other obstetric care providers should promptly recognize the symptoms of influenza, adequately assess severity, and readily prescribe safe and effective antiviral therapy for pregnant women with suspected or confirmed influenza. Obstetrician–gynecologists
Asymptomatic Bacteriuria in Pregnancy Canadian Task Force on Preventive Health Care | Asymptomatic Bacteriuria in Pregnancy (2018) English Menu Get Involved Asymptomatic Bacteriuria in Pregnancy (2018) Asymptomatic Bacteriuria in Pregnancy (2018) Click to view article Tools Additional Documents Click to see additional documents Endorsements This Clinical Practice Guideline has been endorsed by the Nurse Practitioners’ Association of Canada (NPAC). This Clinical Practice Guideline has been (...) ) are available on QxMD. Click to download the app. Summary of recommendations for clinicians and policy-makers Recommendations were based on the overall balance between possible benefits and harms of screening, weighing the potential benefits against any harms. Overall, very low-quality evidence from four cohort studies (n=7,611) was found for the benefits and harms of screening for asymptomatic bacteriuria (ASB) in pregnancy. There were few events, effect estimates were highly imprecise and we are uncertain
women and poor sleep: medication is rarely the right solution In the case of poor sleep during pregnancy, sedatives are rarely the right solution. Non-drug measures are preferable. When a pregnant woman is troubled by poor sleep, preference should be given to non-drug measures: avoid consumption of stimulants and heavy meals and follow the usual advice such as physical activity in the run-up to bedtime, going to bed only when sleepy, getting up at the same time every day. At present, given what (...) and third trimesters, provided that it is in the form of low-concentration aqueous or hydroalcoholic extract. In general, it is preferable to avoid taking concentrated plant extracts repeatedly for medicinal purposes during pregnancy, due to uncertainties about their effects. Some drugs with an adverse harm-benefit balance for pregnant women or the unborn child should be ruled out. These include alimemazine and promethazine; fast-acting benzodiazepines such as flunitrazepam and triazolam; melatonin
Evaluating Womenâ€™s Preferences for Hepatitis C Treatment During Pregnancy There is a rising prevalence of hepatitis C (HCV) among women of child-bearing age nationally, which prompted a recommendation by national guidelines to screen all women for HCV during pregnancy. Women with HCV during pregnancy are at risk of perinatal transmission of HCV. Directly acting antiviral (DAA) therapy during pregnancy can potentially reduce the risk of perinatal transmission as well as cure women while (...) they are engaged in antenatal care. However, data on the safety and efficacy of DAAs during pregnancy are limited. We aimed to evaluate the preferences of women with HCV regarding potential DAA treatment during pregnancy. We conducted a survey of women with a history of HCV followed in the University of California, San Francisco HCV clinic and in the Women's Interagency HIV Study (most of whom are coinfected with HIV) to determine their preferences for DAA treatment during pregnancy. A total of 141 women
Diagnosis and management of a heterotopic pregnancy and ruptured rudimentary uterine horn Heterotopic pregnancies implanted in a rudimentary uterine horn account for 1 in 2-3 million gestations, and confer significant risk of morbidity due to uterine rupture and hemorrhage.A 34-year-old nullipara presented with acute pelvic pain at 17 weeks of gestation with dichorionic-diamniotic twins, one in each horn of an anomalous uterus first diagnosed in pregnancy as bicornuate. Three-dimensional (...) ultrasound and MRI revealed myometrial disruption in the left rudimentary uterine horn, and the patient underwent an uncomplicated abdominal hemi-hysterectomy. Fourteen days later, an uncomplicated dilation and curettage was performed for a fetal anomaly in the remaining twin in the right unicornuate uterus.This case demonstrates the utility of magnetic resonance imaging and three-dimensional ultrasound in the assessment of myometrial integrity in a gravid patient with a heterotopic pregnancy
) scan. She has normal bilateral lower extremity compression ultrasounds. Hb is 98, platelets 156, creatinine 80. How will you manage her tonight? Main Text Question 1: Which anticoagulants can be used safely during pregnancy? If you feel stressed about managing clots during pregnancy, you are not alone! Deciding how to anticoagulate pregnant patients is challenging as we need to think about both the mom’s health and the teratogenic risks for the baby. The bottom line is that Warfarin and DOACs (...) . Warfarin should not be used during pregnancy for the treatment of acute VTE . Direct oral anticoagulants (“DOACs” – Dabigatran, Rivaroxaban, Apixaban, Edoxaban) likely cross the placenta, and their effects on the developing fetus are unknown. Pregnant women were excluded from clinical trials evaluating the efficacy and safety of these drugs. So, DOACs should NOT be used during pregnancy as we don’t have enough clinical evidence about whether they lead to bleeding or teratogenicity. Heparins
Outcomes of Pregnancy in Mothers With Cirrhosis: A National Populationâ€Based Cohort Study of 1.3 Million Pregnancies There are limited data on pregnancy outcomes in women with cirrhosis. To address this gap, we examined the records of singleton births from Sweden's National Patient Register (NPR), Cause of Death Register (CDR), and Medical Birth Register (MBR) between 1997 and 2011 to assess exposure and pregnancy-related and liver-related outcomes of pregnant women with cirrhosis. Exposure (...) (36% versus 16%, respectively; adjusted RR [aRR], 2.00; 95% confidence interval [CI], 1.47-2.73), low birth weight (15% versus 3%; aRR, 3.87; 95% CI, 2.11-7.06), and preterm delivery (19% versus 5%; aRR, 3.51; 95% CI, 2.16-5.72). Rates of maternal mortality during pregnancy (no cases), gestational diabetes, preeclampsia, small for gestational age, congenital malformations, and stillbirth were not increased when compared to the pregnant women without cirrhosis. There were 12 hospitalizations during
Understanding premarital pregnancies among adolescents and young women in Ouagadougou, Burkina Faso In developing countries, young women between 15 and 24 years of age account for more than 40% of unsafe abortions due to the high number of unwanted and/or out-of-wedlock pregnancies. However, much about the profile of adolescents and young women who usually experience premarital pregnancies remains unknown. This study sought to understand the risk of pregnancy before marriage among adolescents (...) the need for a multipronged approach to sexual and reproductive health for young people. Efforts against premarital pregnancies among adolescents and young women would be more effective if they were based on participatory approaches, incorporating actions at both community and institutional levels, as suggested by the recent Global Accelerated Action for the Health of Adolescents logical framework.
Development and evaluation of a novel Vital Signs Alert device for use in pregnancy in low-resource settings Haemorrhage, hypertension, sepsis and abortion complications (often from haemorrhage or sepsis) contribute to 60% of all maternal deaths. Each is associated with vital signs (blood pressure (BP) and pulse) abnormalities, and the majority of deaths are preventable through simple and timely intervention. This paper presents the development and evaluation of the CRADLE Vital Signs Alert (...) (VSA), an accurate, low-cost and easy-to-use device measuring BP and pulse with an integrated traffic light early warning system. The VSA was designed to be used by all cadres of healthcare providers for pregnant women in low-resource settings with the aim to prevent avoidable maternal mortality and morbidity.The development and the mixed-methods clinical evaluation of the VSA are described.Preliminary fieldwork identified that introduction of BP devices to rural clinics improved antenatal
Overview of pregnancy complications Overview of pregnancy complications - Summary of relevant conditions | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Overview of pregnancy complications Last reviewed: February 2019 Last updated: September 2018 Introduction Complications in pregnancy can result from conditions that are specifically linked to the pregnant state as well as conditions that commonly arise or occur incidentally in women who are pregnant (...) need for folate. Complications include neural tube defects, spontaneous abortion, and placental abruption. Goh YI, Koren G. Folic acid in pregnancy and fetal outcomes. J Obstet Gynaecol. 2008;28:3-13. http://www.ncbi.nlm.nih.gov/pubmed/18259891?tool=bestpractice.com In pregnant women, iron deficiency anaemia is defined as haemoglobin below 110 g/L (<11 g/dL). Goddard AF, James MW, McIntyre AS, et al; British Society of Gastroenterology. Guidelines for the management of iron deficiency anaemia. Gut
A Pre-Pregnancy Biomarker Risk Score Improves Prediction of Future Gestational Diabetes Previous studies have not examined the ability of multiple preconception biomarkers, considered together, to improve prediction of gestational diabetes mellitus (GDM).To develop a preconception biomarker risk score and assess its association with subsequent GDM.A nested case-control study among a cohort of women with serum collected as part of a health examination (1984 to 1996) and subsequent pregnancy (...) (1984 to 2009). Biomarkers associated with GDM were dichotomized into high/low risk.Integrated health care system.Two controls were matched to each GDM case (n = 256 cases) on year and age at examination, age at pregnancy, and number of pregnancies between examination and index pregnancy.GDM.High-risk levels of sex hormone-binding globulin (SHBG; <44.2 nM), glucose (>90 mg/dL), total adiponectin (<7.2 μg/mL), and homeostasis model assessment-estimated insulin resistance (>3.9) were independently
Effect of high dose folic acid supplementation in pregnancy on pre-eclampsia (FACT): double blind, phase III, randomised controlled, international, multicentre trial. To determine the efficacy of high dose folic acid supplementation for prevention of pre-eclampsia in women with at least one risk factor: pre-existing hypertension, prepregnancy diabetes (type 1 or 2), twin pregnancy, pre-eclampsia in a previous pregnancy, or body mass index ≥35.Randomised, phase III, double blinded international (...) , multicentre clinical trial.70 obstetrical centres in five countries (Argentina, Australia, Canada, Jamaica, and UK).2464 pregnant women with at least one high risk factor for pre-eclampsia were randomised between 2011 and 2015 (1144 to the folic acid group and 1157 to the placebo group); 2301 were included in the intention to treat analyses.Eligible women were randomised to receive either daily high dose folic acid (four 1.0 mg oral tablets) or placebo from eight weeks of gestation to the end of week 16
Effect of fish oil supplementation in pregnancy on bone, lean, and fat mass at six years: randomised clinical trial. To examine the effect of supplementation with n-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) in pregnancy on anthropometry and body composition in offspring.Double blinded, randomised controlled trial.Copenhagen Prospective Studies on Asthma in Childhood2010 cohort.736 pregnant women and their offspring.n-3 LCPUFA (fish oil) or control (olive oil) daily from pregnancy (...) (98.9 to 462.4) g; P=0.002), a higher bone mineral content (10.3 (2.3 to 18.1) g; P=0.01), and a non-significantly higher fat mass (116.3 (-92.9 to 325.5) g; P=0.28), but no differences were seen in total body fat or lean mass percentage.Fish oil supplementation from the 24th week of pregnancy led to a higher BMI in the offspring from 0 to 6 years of age but not an increased risk of obesity at age 6. The body composition at age 6 years in children given fish oil supplementation was characterised
Screening for Syphilis Infection in Pregnant Women: US Preventive Services Task Force Reaffirmation Recommendation Statement. Untreated syphilis infection in pregnant women can be transmitted to the fetus (congenital syphilis) at any time during pregnancy or at birth. Congenital syphilis is associated with stillbirth, neonatal death, and significant morbidity in infants (eg, bone deformities and neurologic impairment). After a steady decline from 2008 to 2012, cases of congenital syphilis (...) adverse pregnancy outcomes, with small associated harms, providing an overall substantial health benefit. Therefore, the USPSTF reaffirms its previous conclusion that there is convincing evidence that screening for syphilis infection in pregnant women provides substantial benefit.The USPSTF recommends early screening for syphilis infection in all pregnant women. (A recommendation).
Does supportive legislation guarantee access to pregnancy termination and postabortion care services? Findings from a facility census in Central Province, Zambia Zambia is one of the few countries in Africa to permit termination of pregnancy (TOP) on a wide range of grounds. However, substantial barriers remain to TOP and postabortion care (PAC).We conducted a census of 153 facilities between March and May 2016. We defined facilities according to whether they met basic and/or comprehensive
Risk of Spontaneous Abortion After Inadvertent Human Papillomavirus Vaccination in Pregnancy To evaluate the risk of spontaneous abortion after quadrivalent human papillomavirus (4vHPV) vaccination before and during pregnancy across seven integrated health systems within the Vaccine Safety Datalink.Within a retrospective observational cohort, we compared risks for spontaneous abortion after 4vHPV in three exposure windows: distal (16-22 weeks before the last menstrual period [LMP (...) ]), peripregnancy (within 6 weeks before the LMP), and during pregnancy (LMP through 19 weeks of gestation). Women 12-27 years of age with a pregnancy between 2008 and 2014, with continuous insurance enrollment 8 months before and through pregnancy end, and with a live birth, stillbirth, or spontaneous abortion were included. Pregnancies were identified through validated algorithms. Spontaneous abortions and stillbirths were verified by chart review with spontaneous abortions adjudicated by clinical experts. We
Health System,” by facilitating the development of clinical practice guidelines (CPGs) for the VA and DoD populations.[ ] This CPG is intended to provide healthcare providers with a framework by which to evaluate, treat, and manage the individual needs and preferences of pregnant women, thereby leading to improved clinical outcomes. 1 In 2009, the VA and DoD published a CPG for the Management of Pregnancy (2009 Pregnancy CPG), which was based on evidence reviewed through December 2007. Since (...) the release of that guideline, a growing body of research has expanded the general knowledge and understanding of pregnancy and its management. Consequently, a recommendation to update the 2009 Pregnancy CPG was initiated in 2016. The updated CPG includes objective, evidence-based information on the management of pregnancy. It is intended to assist healthcare providers in all aspects of care for a pregnant woman. The system-wide goal of developing evidence-based guidelines is to improve patients' health
proportion of positive urine screens for THC (11.8% to 18%) following legalization of recreational cannabis (Merritt, Wilkinson, & Chervenak, 2016). In Canada, approximately 16.9% of women of childbearing age (i.e., 15–44 years) reported past-year use of cannabis in 2015 (Statistics Canada, 2016a), a statistically significant increase from 12.6% in 2013 (Statistics Canada, 2015). The 2008 Canadian Perinatal Health Report noted that 5% of pregnant women reported illicit drug use during pregnancy; however (...) , it did not specify the actual percentage that had used cannabis (Ordean & Kahan, 2011). A report from the Reproductive Health Working Group (2006) in Alberta indicated that 2.3% of women who gave birth in 2006 reported using street drugs while pregnant, with cannabis being the most commonly used substance. Similarly, in Southwestern Ontario, the prevalence of women who reported using cannabis during pregnancy at the London Health Science Centre was 2.2% for births between February 2009 and February