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Serial Third-Trimester Ultrasonography Compared With Routine Care in Uncomplicated Pregnancies: A Randomized Controlled Trial Among uncomplicated pregnancies, serial third-trimester ultrasound examinations identified significantly more cases with a composite of fetal growth or amniotic fluid abnormalities (27%) than did routine fundal height measurements (8%).Women without complications between 24 0/7 and 30 6/7 weeks of gestation were randomized (NCT0270299) to either routine care (control arm (...) %), cesarean delivery in labor (5% vs 6%), and prespecified composite maternal morbidity (9% in both groups) and composite neonatal morbidity (1% vs 4%).Among uncomplicated pregnancies between 24 0/7 and 30 6/7 weeks of gestation, serial third-trimester ultrasound examinations were significantly more likely to identify abnormalities of fetal growth or amniotic fluid than measurements of fundal height and indicated ultrasound examination. No differences in maternal and neonatal outcomes were noted, although
- Options for local implementation No QIPP indicators were found during the review of this topic. NICE quality standards NICE quality standards Women of childbearing potential with treated hypertension are given information annually about safe antihypertensive treatment during pregnancy. Pregnant women at increased risk of pre-eclampsia at the booking appointment are offered a prescription of 75–150 mg of aspirin to take daily from 12 weeks until birth. Pregnant women taking antihypertensive medication (...) have a blood pressure target of 135/85 mmHg or less. Pregnant women with severe hypertension are admitted for a full assessment, carried out by a healthcare professional trained in managing hypertension in pregnancy. Women with pre-eclampsia who have severe hypertension or are at a high risk of adverse events, or if there are any clinical concerns are admitted to hospital and monitored. Women with pre-eclampsia have a senior obstetrician involved in any decisions about the timing of birth. Women
pregnancy but should avoid scuba diving and sports that may cause abdominal trauma, falls, or excessive joint stress. Working — most women can continue working during pregnancy. To allow a pregnant woman to continue working after 33 weeks, her GP or midwife must inform her employer that she may continue to do so. The law states that a women is not allowed to return to employment in the 2 weeks following childbirth. Maternity benefits — including information on entitlement to take time off work (...) for antenatal care, maternity cover, and free prescriptions. Pregnant women should be offered vaccination against: Influenza during the flu season (October to January). Whooping cough (pertussis) from week 16 of pregnancy. Have I got the right topic? Have I got the right topic? From age 18 years to 40 years (Female). This CKS topic is based on the National Institute for Health and Care Excellence (NICE) guideline Antenatal care for uncomplicated pregnancies [ ] and The Pregnancy Book produced
recommend screening in children at increased risk for lead exposure. The American Academy of Family Physicians recommends against routine screening for elevated blood lead levels in pregnant women without symptoms. The CDC and the American College of Obstetricians and Gynecologists recommend targeted screening during pregnancy and lead testing in pregnant and lactating women with 1 or more risk factors for lead exposure, such as environmental or occupational exposures or pica. The US Preventive Services (...) Elevated Blood Lead Levels in Children and Pregnant Women: Screening Recommendation | United States Preventive Services Taskforce Toggle navigation Main navigation Main navigation Recommendation Pregnant persons The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic pregnant persons. I Children 5 years and younger The USPSTF concludes that the current evidence is insufficient
at the time of admission to a hospital or other delivery setting. Treatment and Interventions Interventions to prevent perinatal transmission of HBV infection include screening all pregnant women for HBV, vaccinating infants born to HBV-negative mothers within 24 hours of birth, and completing the HBV vaccination series in infants by age 18 months. For HBV-positive mothers, case management during pregnancy includes HBV DNA viral load testing and referral to specialty care for counseling and medical (...) in pregnant women is substantial. Patient Population Under Consideration This recommendation applies to all pregnant persons. Screening Tests The principal screening test for detecting maternal HBV infection is the serologic identification of HBsAg. Screening should be performed in each pregnancy, regardless of previous HBV vaccination or previous negative HBsAg test results. Screening Interval A test for HBsAg should be ordered at the first prenatal visit. Women with unknown HBsAg status or with new
of the measles-mumps-rubella (MMR) vaccine is safe and is 97% effective at preventing measles infection . Measles Infection during Pregnancy Measles infection in pregnant women is associated with several adverse events including increased risk of hospitalization and pneumonia . Measles infection during pregnancy is also associated with significant risks to the fetus , including: Miscarriage Stillbirth Low birth weight Increased risk of preterm delivery Recommendations The University of Washington has (...) developed a including algorithms for guidance in managing high risk pregnant patients—those living in, or traveling to, areas with an active outbreak. Providers who care for pregnant women are encouraged to refer to the recommendations and algorithms in this ACOG-Supported consensus statement for additional information . Selected points from the ACOG-supported University of Washington , ACOG, and the Centers for Disease Control and Prevention (CDC) are highlighted below. Women Considering Pregnancy
Mothers’ going-to-sleep position in late pregnancy POSITION STATEMENT Mothers’ going-to-sleep position in late pregnancy Endorsed by: Please note: This is a position statement and should not replace local guidelines. It is intended to provide a consensus view and a current summary of available evidence in an area of uncertainty. Suggested citation: Perinatal Society of Australia and New Zealand and Centre of Research Excellence Stillbirth. Position statement: Mothers’ going-to-sleep position (...) in late pregnancy. Centre of Research Excellence in Stillbirth, Brisbane, Australia, September 2019. Key messages 1. Stillbirth is a serious public health problem with far reaching psychosocial and financial burden for families and society, and with little improvement in rates in Australia and New Zealand for more than two decades. 2. Better attention to modifiable risk factors may reduce the risk of late pregnancy stillbirth (=28 weeks’ gestation). 3. Supine going-to-sleep position in late pregnancy
Detection and management of women with Fetal Growth Restriction in singleton pregnancies POSITION STATEMENT Detection and management of women with Fetal Growth Restriction in singleton pregnancies Endorsed by: Please note: This is a position statement and should not replace local guidelines. It is intended to provide a consensus view and a current summary of available evidence in an area of uncertainty. Suggested citation: Perinatal Society of Australia and New Zealand and Centre of Research (...) Excellence Stillbirth. Position statement: detection and management of fetal growth restriction in singleton pregnancies. Centre of Research Excellence in Stillbirth. Brisbane, Australia, September 2019. Key messages ? Improving detection of Fetal Growth Restriction (FGR) is an important strategy to reduce stillbirths ? Risk assessment for FGR should be undertaken in early pregnancy and at each antenatal visit (see Figure 1). ? Where modifiable risk factors for FGR exist, provide advice and support
the element of care: supporting women to stop smoking in pregnancy. The purpose of this statement is to summarise what is known about the risks of smoking in pregnancy and how best to help pregnant women (and their partners) stop smoking. Smoking rates in pregnancy in Australia and New Zealand About 1 in 10 pregnant women smoke in Australia, with a rate of 1 in 8 in New Zealand. In Australia, 44% of Aboriginal and Torres Strait Islander women smoke in pregnancy 1 and in New Zealand, 35% of Maori women (...) birthweight and small for gestational age babies, as well as later impairments of child growth and development, and increased risk of chronic diseases later in life. 7,8 4 Exposure to second-hand smoke, also known as “passive smoking” from any type of smoke (e.g. shisha/hookah/nargile, cigarettes, cigars, bidis, marijuana leaf), and the use of smokeless tobacco and e-cigarettes also pose serious health risks to pregnant women and children. 6,9,10 Influences on smoking in pregnancy Women who smoke
Clinical practice guideline for the care of women with decreased fetal movements for women with a singleton pregnancy from 28 weeks’ gestation Clinical practice guideline for the care of women with decreased fetal movements for women with a singleton pregnancy from 28 weeks’ gestation Endorsed by: Version 2.3 September 2019 i Produced by: This is the third version of the clinical guideline produced by a multidisciplinary working group led by the Centre of Research Excellence in Stillbirth (...) Australia; Australian National Council for Stillbirth and Neonatal Death Support (SANDS); Red Nose; Women’s Healthcare Australasia; and Still Aware. Suggested citation: Perinatal Society of Australia and New Zealand and Centre of Research Excellence Stillbirth. Clinical practice guideline for the care of women with decreased fetal movements for women with a singleton pregnancy from 28 weeks’ gestation. Centre of Research Excellence in Stillbirth. Brisbane, Australia, September 2019. Acknowledgments: We
is 20% or higher among pregnant women, and (ii) anaemia is a severe public health problem, with a prevalence of 40% or higher among pregnant women, in order to reduce the worm burden of hookworm and T. trichiura infection (WHO, ). For Schistosomiasis, annual treatment with praziquantel in high risk communities (>50% prevalence) and once every 2 years in medium risk (>10% and <50% prevalence) is recommended and women can be treated with praziquantel at any stage of pregnancy and lactation (WHO (...) and environment factors. IPD meta‐analysis would explore the question of whether mass deworming during pregnancy is more effective for subgroups of women defined by characteristics such as nutrition status and infection intensity. This understanding could help develop targeted strategies to reach pregnant women with deworming and guide policy regarding mass deworming. A companion review using IPD and network meta‐analysis to explore whether the effects of different types and frequency of deworming drugs
HIV infection in pregnancy HIV infection in pregnancy - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search HIV infection in pregnancy Last reviewed: February 2019 Last updated: December 2018 Important updates 18 Dec 2018 Dolutegravir should not be used during the first trimester of pregnancy The US Department of Health and Human Services has updated its guidance on the management of pregnant women living with HIV (...) infection. The guideline has been revised to include interim recommendations regarding the use of dolutegravir in pregnancy and at the time of conception due to concerns about a possible increased risk of neural tube defects in the fetus. Recommendations Do not use dolutegravir during the first trimester of pregnancy, in non-pregnant women who want to become pregnant or who are trying to conceive, or in women who cannot consistently use effective contraception. Perform a pregnancy test before starting
[Hydroxychloroquine to obtain pregnancy without adverse obstetrical events in primary antiphospholipid syndrome: French phase II multicenter randomized trial, HYDROSAPL]. Antiphospholipid syndrome is defined by the presence of thrombosis and/or obstetrical adverse events (≥3 recurrent early miscarriage or fetal death or a prematurity<34 weeks of gestation) associated with persistent antiphospholipid antibodies. The pregnancy outcome has been improved by the conventional treatment (aspirin 100mg (...) /day with low molecular weight heparin [LMWH] from 30 to 75% of uncomplicated pregnancies. In PROMISSE study, 19% of pregnancies had at least one obstetrical adverse event despite treatment (maternal, fetal or neonatal complications) in relation with APS. In the European registry of babies born from APS mothers, maternal and foetal adverse events were observed in 13% of cases, with prematurity in 14% despite treatment. The presence of lupus erythematosus, a history of thrombosis, presence of lupus
Prediction of Severe Maternal Outcome Among Pregnant and Puerperal Women in Obstetric ICU World Health Organization recommends the use of maternal near miss as a tool to monitor and improve quality of obstetric care. Severe maternal outcome corresponds to the sum of maternal near miss and maternal death cases. This study was aimed at validating Acute Physiology and Chronic Health Evaluation II and IV, Simplified Acute Physiology Score III, and Sequential Organ Failure Assessment in pregnant
and no proof of immunization against rubella (III-B). 2 Since the effects of rubella infection in pregnancy vary with the gestational age at the time of infection, accurate gestational dating should be established, as well as timing of rubella infection, as they are critical to counselling (II-3A). 3 In a pregnant woman exposed to rubella or who develops signs or symptoms of rubella or whose fetus presents ultrasound anomalies compatible with congenital rubella syndrome, serological testing for rubella (...) (i.e., systemic immunosuppression). Consider delaying vaccination if the woman received any immunoglobulin-containing preparations, including Rh immunoglobulin or intravenous immune globulin, or blood products during pregnancy or the peripartum period, as there is potential for reduced vaccine effectiveness (III-B). 6 Women who have been inadvertently vaccinated in early pregnancy or who become pregnant immediately following vaccination can be reassured that there have been no cases of congenital
Management of Pregnancy Subsequent to Stillbirth No. 369-Management of Pregnancy Subsequent to Stillbirth - Journal of Obstetrics and Gynaecology Canada Email/Username: Password: Remember me Search Terms Search within Search Volume 40, Issue 12, Pages 1669–1683 No. 369-Management of Pregnancy Subsequent to Stillbirth x Noor Niyar N. Ladhani , MD Toronto, ON x Megan E. Fockler , RN Toronto, ON x Louise Stephens , RM Manchester, UK x Jon F.R. Barrett , MD Toronto, ON x Alexander E.P. Heazell (...) , PhD Manchester, United Kingdom No. 369, December 2018 DOI: To view the full text, please login as a subscribed user or . Click to view the full text on ScienceDirect. Abstract Objective The primary objective of this consensus statement is to develop consensus statements to guide clinical practice and recommendations for antenatal care, intrapartum care, and the psychosocial considerations necessary in the care of pregnant women with a history of stillbirth. Intended users Clinicians involved
and France: the recommendation to use valproic acid in girls and pregnant women or women of childbearing age only in the absence of a therapeutic alternative; improved information on the need for effective contraception; initial prescription restricted to paediatricians, neurologists and psychiatrists, with the obligation for both the prescriber and the patient to sign a care agreement informing on the risks in case of pregnancy. Some of these measures are the result of campaigning by APESAC (Association (...) of Parents of Children with Anticonvulsant Syndrome). In mid-2018, these measures were reinforced at the EU level. Valproic acid is now contraindicated in epilepsy in pregnant women, except in exceptional circumstances. It is also contraindicated in women of childbearing age, unless all the conditions of the "pregnancy prevention programme" are met: pregnancy tests before and during treatment, consultation with the prescriber to discuss treatment options when pregnancy is desired. In France, by the end
What care should be provided in the primary care setting to women of childbearing age with obesity who wish to become pregnant? Primary care services should ensure that all women of childbearing age have the opportunity to optimise their weight before pregnancy. Advice on weight and lifestyle should be given during preconception counselling or contraceptive consultations. Weight and BMI should be measured to encourage women to optimise their weight before pregnancy. P Women of childbearing age (...) after caesarean (VBAC) section. B What nutritional supplements should be recommended to women with obesity who wish to become pregnant? Women with a BMI 30 kg/m 2 or greater wishing to become pregnant should be advised to take 5 mg folic acid supplementation daily, starting at least 1 month before conception and continuing during the ?rst trimester of pregnancy. D Obese women are at high risk of vitamin D de?ciency. However, although vitamin D supplementation may ensure that women are vitamin D