A Proposal for Standardized Management of FHR Patterns. Prior Approaches to Consensus
|
|
- Erik Bryant
- 5 years ago
- Views:
Transcription
1 A Proposal for Standardized Management of FHR Patterns J T Parer, MD, PhD Maternal Fetal Medicine Department of Obstetrics, Gynecology & Reprod Sci University of California San Francisco Obstetrics & Gynecology Update: What does the Evidence Tell us? San Francisco, California October 18, 2007 Prior Approaches to Consensus FIGO Workshop on FHR Guidelines. Int J Gyn & Ob, 1987 NICHD FHR Guidelines AJOG & JOGNN, 1997 RCOG Clin Effectiveness Support Unit. Use of EFM. RCOG Press, 2001 SOGC Policy Statement on Fetal Health Surveillance in Labour. JSOGC 1995 ACOG Practice Bull no 70. Intrapartum FHR Monitoring,
2 Quantitation of variable decelerations Chao,
3 Three aspects of FHRM are inadequately studied Paneth et al, 1993 Reliability of pattern interpretation: Is there adequate intra- & inter-observer agreement? Validity: Are certain patterns reliably related to adverse outcomes, eg, newborn metabolic acidemia? Utility: Can timely obstetric intervention avoid adverse outcomes in cases with evolving patterns suggestive of acidemia? CLINICAL OPINION Electronic fetal heart rate monitoring: Research guidelines for interpretation National Institute of Child Health and Human Development Research Planning Workshop The purpose of the National Institutes of Health research planning workshops is to assess the research status of clinically important areas. This article reports on a workshop whose meetings were held between May 1995 and November 1996 in Bethesda, Maryland, and Chicago, Illinois. Its specific purpose was to develop standardized and unambiguous definitions for fetal heart rate tracings. The recommendations for interpreting fetal heart rate patterns are being published here and simultaneously by the Journal of Obstetric, Gynecologic, and Neonatal Nursing. (Am J Obstet Gynecol 1997;177: ) Are there associations between FHR patterns and newborn acidemia? Parer et al, 2006 The presence of moderate FHR variability, even with decelerations, is 98% associated with absence of ph <7.15 or Apgar 5 Minimal or less FHRV with decelerations has a 23% association with ph <7.15 or Apgar 5 The liklihood of acidemia increases with depth of decelerations, especially with late decelerations, and with reduced FHRV Potentially hazardous acidemia develops over a period of 1 hr or more in a fetus whose pattern evolves from normal to decelerative with reduced FHRV 3
4 Interrelations between fetal ph, FHR variability, & depth of late decelerations Paul et al, 1975 Ruptured Uterus Observations Leung et al, 1993 What FHR Factors Contribute to Urgency of Delivery? Intact survival if the fetus is delivered in 18 min or less after the fetal bradycardia signaling the rupture If the bradycardia is preceded by decelerations, the required bradycardia to delivery time is shorter; the specific time is not yet established Risk of acidemia Probability of evolution of pattern to higher risk - type of deceleration - depth of deceleration - reduction of FHR variability 4
5 XVI. NICHD Statement on FHR Monitoring (1997) Standardized definitions of FHR characteristics. Consensus that the normal pattern predicts absence of acidemia with high degree of reliability. Consensus that absent variability in the presence of decelerations or substantial bradycardia is evidence of actual or impending potentially damaging acidemia. No consensus on virtually all other patterns (~50%) which are variants of the normal pattern, due to absence of sufficient data in the literature. XVI. NICHD Statement on FHR Monitoring (1997) Standardized definitions of FHR characteristics. Consensus that the normal pattern predicts absence of acidemia with high degree of reliability. Consensus that absent variability in the presence of decelerations or substantial bradycardia is evidence of actual or impending potentially damaging acidemia. No consensus on virtually all other patterns (~50%) which are variants of the normal pattern, due to absence of sufficient data in the literature. 5
6 XVI. NICHD Statement on FHR Monitoring (1997) Standardized definitions of FHR characteristics. Consensus that the normal pattern predicts absence of acidemia with high degree of reliability. Consensus that absent variability in the presence of decelerations or substantial bradycardia is evidence of actual or impending potentially damaging acidemia. No consensus on virtually all other patterns (~50%) which are variants of the normal pattern, due to absence of sufficient data in the literature. There are deep, late decelerations with considerable loss of beat-to-beat variability, mandating prompt intervention Implications of these observations for FHR pattern management They are mostly based on observational studies (Grade III evidence), and are preliminary findings until a prospectively gathered series in unselected patients is available Such a series will correlate FHR patterns up until the time of birth, to cord acid-base state The findings support a management approach which assumes a risk of fetal acidemia based on depth of decelerations, reduction of FHRV, and a period of evolution of a worsening FHR pattern of approximately 1 hr Threshold of Acceptable Acidemia in Umbilical Arterial Blood at Birth ph > 7.1 Base excess >-12 meq/lit Helwig et al, AJOG 6
7 General hierarchy of interventions MD/CNMs: Inform< request presence at bedside< request MD able to do C/S or OVD Insert IV Conservative interventions Inform anesthetist, pediatrician OR availability Labour in OR Ancillary testing; stimulation testing, fetal blood sampling Five Gradations of Acidemia No acidemia No central fetal acidemia (adequate oxygen) No central fetal acidemia, but FHR pattern suggests intermittent reductions in O2 which may result in fetal O2 debt Fetus potentially on verge of decompensation Evidence of actual or impending damaging fetal asphyxia 7
8 Risk of Acidemia, Evolution of Patterns To More Serious, and Recommended Action Risk of Acidemia Risk of Evolution Action Green 0 Very low None Blue 0 Low Yellow 0 Moderate Orange Red Borderline/ acceptably low Unacceptably high High Not a consideration * CT = Conservative ameliorating techniques CT & begin preparation CT & increased surveillance CT & prep for urgent delivery Deliver Conservative Techniques to Ameliorate FHR Patterns Position change Hyperoxia Correct hypotension Adequate intravascular volume Correct excessive contractions (oxytocin?) Avoid constant pushing Tocolysis Amnioinfusion to correct amniotic fluid deficit 8
9 Proposed Management of the Colour Coded Categories Conservative Techniques Op Room Obstetrician Anesthetist Newborn Resuscitator Green No Patient Location Blue Yes available informed Yellow Yes available at bedside informed informed - Orange Yes immediately available at bedside present immediately available OR Red Yes open at bedside present present OR 9
10 A Proposal for Standardized Management of FHR Patterns J T Parer, MD, PhD Maternal Fetal Medicine Department of Obstetrics, Gynecology & Reprod Sci University of California San Francisco Seventh Annual University of Illinois at Chicago Wilson Perinatal Conference Chicago, Illinois October 19,
We are using the 3-tier NICHD FHR classification in our hospital: FHR Management: 3 vs 4 vs 5 Categories?
FHR Management: 3 vs 4 vs 5 Categories? J T Parer, MD, PhD Maternal Fetal Medicine University of California San Francisco We are using the 3-tier NICHD FHR classification in our hospital: 1. 3. I don t
More informationLates. Variables. Bradycardia A Common Language. Earlys. Fetal Heart Rate Monitoring The Things That Trip Us Up
Fetal Heart Rate Monitoring The Things That Trip Us Up Michael Fox RN, BSN, Director perinatal resource group for Obstetric and neonatal care Fetal Heart Rate Monitoring The Things That Trip Us Up Diagnostic
More informationFetal Heart Rate Monitoring Myths and Misperceptions s: Electronic Fetal Heart Rate Monitoring (EFM): Baseline Assumptions.
Can FHR Monitoring Prevent Hypoxic-Ischemic Encephalopathy in the Newborn? Fetal Heart Rate Monitoring Myths and Misperceptions 1. Yes 2. No 72% Tekoa L. King CNM, MPH June 6, 2008 28% Yes No Objectives
More informationAcid-base and Blood Gases in the Fetus
Acid-base and Blood Gases in the Fetus J T Parer, MD, PhD Maternal Fatal Medicine University of California San Francisco 40 th Meeting Antepartum and Intrapartum Management San Francisco, California June,
More informationFetal acidemia and electronic fetal heart rate patterns: Is there evidence of an association?
The Journal of Maternal-Fetal and Neonatal Medicine, May2006;19(5):289 294 Fetal acidemia and electronic fetal heart rate patterns: Is there evidence of an association? J. T. PARER 1,T.KING 1,S.FLANDERS
More informationFHR Monitoring: Maternal Fetal Physiology
FHR Monitoring: Maternal Fetal Physiology M. Sean Esplin, MD and Alexandra Eller, MD Maternal Fetal Medicine Intermountain Healthcare University of Utah Health Sciences Center Disclosures I have no financial
More informationResearch has confirmed that more births occur during
Research has confirmed that more births occur during periods of a full moon, likely related to shifts in barometric pressure. 1. True 2. False 0% 0% True False Cognitive Dissonance Cognitive dissonance
More informationBirth Asphyxia - Summary of the previous meeting and protocol overview
Birth Asphyxia - Summary of the previous meeting and protocol overview Dr Ornella Lincetto, WHO Geneve Milano, 11June 2007 Vilka är Personality egenskaper med den astrologiska Tvillingarna? Objective of
More informationAWHONN Oregon Section 2014
AWHONN Oregon Section 2014 Carol J Harvey, MS, BSN, RNC-OB, C-EFM, CS Northside Hospital Atlanta Cherokee - Forsyth Hypertensive in Pregnancy Carol J Harvey, MS, RNC-OB, C-EFM Clinical Specialist Northside
More informationCMQCC Preeclampsia Tool Kit: Hypertensive Disorders Across the Lifespan
CMQCC Preeclampsia Tool Kit: Hypertensive Disorders Across the Lifespan Carol J Harvey, MS, BSN, RNC-OB, C-EFM, CS Northside Hospital Atlanta Cherokee - Forsyth New! Improving Health Care Response to Preeclampsia:
More informationPolicy REVISED: 6/30/2016 3:30 PM. Applies To: ObGyn Responsible Department: ObGyn Revised: June 30, 2016
Title: Antihypertensive Treatment for Severe Hypertension During Pregnancy Applies To: ObGyn Responsible Department: ObGyn Revised: June 30, 2016 Policy POLICY STATEMENT: Pregnant or postpartum patients
More informationPOLICY and PROCEDURE
Misericordia Community Hospital Administration of Intravenous FentaNYL During Labour POLICY and PROCEDURE Labour and Delivery Manual Original Date Revised Date Approved by: Director, Women s Health, Covenant
More informationStroke in Pregnancy. Stroke in Pregnancy 6/23/13
G5#$#Preven*ng#Maternal#Morbidity#and#Mortality#Via# Expanded#Scope#of#Nursing#Prac*ce#As#First#Responder# in#hypertensive#crisis#of#preeclampsia# The$presenter$reports$no$relevant,$influencing$financial$rela5onships.$
More informationGestational Diabetes. Gestational Diabetes:
Gestational Diabetes Detection and Management Steven Gabbe, MD The Ohio State University Medical Center Gestational Diabetes: Detection and Management Learning Objectives: At the conclusion of this presentation,
More informationMaternal & fetal outcomes after regional labour analgesia Ultra low dose epidurals to BUMPES. Dr Bernard J Norman November 2012
Maternal & fetal outcomes after regional labour analgesia Ultra low dose epidurals to BUMPES Dr Bernard J Norman November 2012 Mother Fetus Mother The Birth of Queen Victoria s Eighth Child, Prince Leopold,
More informationObjectives. Birth Depression Management. Birth Depression Terms
Objectives Birth Depression Management Regional Perinatal Outreach Program 2016 Understand the terms and the clinical characteristics of birth depression. Be familiar with the evidence behind therapeutic
More informationGUIDELINE PHYSIOLOGY OF BIRTH ASPHYXIA
GUIDELINE PHYSIOLOGY OF BIRTH ASPHYXIA The newborn is not an adult, nor a child. In people of all ages, death can occur from a failure of breathing and / or circulation. The interventions required to aid
More informationBasic Doppler Assessment of Fetal Distress
Basic Doppler Assessment of Fetal William J. Polzin, M.D. Co-Director, Fetal Care Center of Cincinnati Director, Division of Maternal-Fetal Medicine Good Samaritan Hospital Cincinnati, OH No Relevant Disclosures
More information39 th Annual Perinatal Conference Vanderbilt University December 6, 2013 IUGR. Diagnosis and Management
39 th Annual Perinatal Conference Vanderbilt University December 6, 2013 IUGR Diagnosis and Management Giancarlo Mari, M.D., M.B.A. Professor and Chair Department of Obstetrics and Gynecology University
More informationBIRTH TRAUMA LITIGATION: PROVING THE CAUSE OF NEWBORN NEUROLOGIC INJURY 1 By Richard C. Halpern
BIRTH TRAUMA LITIGATION: PROVING THE CAUSE OF NEWBORN NEUROLOGIC INJURY 1 By Richard C. Halpern Proving the cause of newborn neurologic injury in birth trauma litigation, an essential step to a successful
More informationNEONATOLOGY Healthy newborn. Neonatal sequelaes
NEONATOLOGY Healthy newborn. Neonatal sequelaes Ágnes Harmath M.D. Ph.D. senior lecturer 11. November 2016. Tasks of the neonatologist Prenatal diagnosed condition Inform parents, preparation of necessary
More informationNigeria s Federal Ministry of Health. Improving Quality of Maternal and Newborn Care in Ebonyi and Kogi States of Nigeria
Nigeria s Federal Ministry of Health Improving Quality of Maternal and Newborn Care in Ebonyi and Kogi States of Nigeria Dr B Onwe, MoH Ebonyi State Dr Ugo Okoli, MCSP Nigeria Nigeria Did Not Achieve Millennium
More informationMaternal and Fetal Physiology
Background Maternal and Fetal Physiology Anderson Lo, DO Fellow, Maternal-Fetal Medicine Wayne State University School of Medicine SEMCME Fetal Assessment Course July 20, 2018 Oxygen pathway Mother Placenta
More informationDiagnosis and Management of the Early Growth Restricted Fetus
11 th Congress of Maternal Fetal Medicine and Perinatology Society of Turkey Diagnosis and Management of the Early Growth Restricted Fetus Giancarlo Mari, MD, MBA, FACOG, FAIUM Professor and Chair Department
More informationLabor & Delivery Management for Women Living with HIV. Pooja Mittal, DO Lisa Rahangdale, MD
Labor & Delivery Management for Women Living with HIV Pooja Mittal, DO Lisa Rahangdale, MD Statistics for Perinatally Acquired HIV Timing of Perinatal HIV Transmission Most transmission occurs close to
More informationPreeclampsia: What s old is new again. Gene Chang, MD Maternal Fetal Medicine
Preeclampsia: What s old is new again Gene Chang, MD Maternal Fetal Medicine Objectives Define Preeclampsia Review current guidelines Role of proteinuria Timing of delivery Seizure prevention Severe Hypertension
More informationIntrapartum and Postpartum Management of the Diabetic Mother and Infant
Intrapartum and Postpartum Management of the Diabetic Mother and Infant Intrapartum Management Women with gestational diabetes who maintain normal glucose levels during pregnancy on diet and exercise therapy
More informationEarly seizures indicate quality of perinatal care
Archives of Disease in Childhood, 1985, 6, 89-813 Early seizures indicate quality of perinatal care R J DERHAM, T G MATTHEWS, AND T A CLARKE Rotunda Hospital, Dublin, Ireland SUMMARY An analysis of antepartum,
More informationEQUIPMENT: Nitrous Oxygen Delivery System:
Policy: Nitrous Oxide Use in the Intrapartum and Immediate Postpartum Period for Obstetrical Patients in the Family Birth Place Approvers: CEO. CNO, Medical Staff President, Anesthesia Chair, OB Medical
More informationDOWNLOAD OR READ : PERINATAL EVENTS AND BRAIN DAMAGE IN SURVIVING CHILDREN BASED ON PAPERS PRESENTED AT AN INTERNATIONA PDF EBOOK EPUB MOBI
DOWNLOAD OR READ : PERINATAL EVENTS AND BRAIN DAMAGE IN SURVIVING CHILDREN BASED ON PAPERS PRESENTED AT AN INTERNATIONA PDF EBOOK EPUB MOBI Page 1 Page 2 perinatal events and brain damage in surviving
More informationPIAF study: Placental insufficiency and aortic isthmus flow Jean-Claude Fouron, MD
Dear colleagues, I would like to thank you very sincerely for agreeing to participate in our multicentre study on the clinical significance of recording fetal aortic isthmus flow during placental circulatory
More informationSwings... Page 15 BTLG Newsletter July 2015
Page 15 BTLG Newsletter July 2015 Swings... By James P. Fitzgerald, John M. Daly, Randy B. Nassau, and Margaret Johnson-Pertet, Yonkers, New York Introduction In March 2014, the American College of Obstetrics
More informationMODULE VII. Delivery and Immediate Neonatal Care
MODULE VII Delivery and Immediate Neonatal Care NEONATAL ASPHYXIA About one million deaths per year In Latin America 12% of newborns suffer some degree of asphyxia Main cause of perinatal and neonatal
More informationGuslihan Dasa Tjipta Division of Perinatology Department of Child Health Medical School University of Sumatera Utara
Guslihan Dasa Tjipta Division of Perinatology Department of Child Health Medical School University of Sumatera Utara 1 Definition Perinatal asphyxia is a fetus/newborn, due to: is an insult to the Lack
More information5 Million neonatal deaths each year worldwide. 20% caused by neonatal asphyxia. Improvement of the outcome of 1 million newborns every year
1 5 Million neonatal deaths each year worldwide 20% caused by neonatal asphyxia Improvement of the outcome of 1 million newborns every year International Liaison Committee on Resuscitation (ILCOR) American
More informationRunning head: THERAPEUTIC HYPOTHERMIA AND TRANSPORT 1
Running head: THERAPEUTIC HYPOTHERMIA AND TRANSPORT 1 Therapeutic Hypothermia for Neonatal Encephalopathy: Preparation for Transport to Cooling Center Teresa Z. Baker, DNP-S Annie L. Addison, FNP-S NURS
More informationETIOLOGY AND PATHOGENESIS OF HYPOXIC-ISCHEMIC ENCEPHALOPATHY
ETIOLOGY AND PATHOGENESIS OF HYPOXIC-ISCHEMIC ENCEPHALOPATHY HYPOXIC-ISCHEMIC ENCEPHALOPATHY Hypoxic-İschemic Encephalopathy Encephalopathy due to hypoxic-ischemic injury [Hypoxic-ischemic encephalopathy
More informationBirth Asphyxia. Perinatal Depression. Birth Asphyxia. Risk Factors maternal. Risk Factors fetal. Risk Factors Intrapartum 2/12/2011
Birth Asphyxia Perinatal Depression Sara Brown, ARNP Children s Hospital and Regional Medical Center May occur in utero, during labor/delivery or during the neonatal period Condition of impaired blood
More informationNeonatal Encephalopathy and Neurologic Outcome, Second Edition
Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children STATEMENT OF ENDORSEMENT Neonatal Encephalopathy and Neurologic Outcome, Second Edition
More informationNeonatal Resuscitation. Dustin Coyle, M.D. Anesthesiology
Neonatal Resuscitation Dustin Coyle, M.D. Anesthesiology Recognize complications Maternal-fetal factors Maternal DM PIH Chronic HTN Previous stillbirth Rh sensitization Infection Substance abuse/certain
More informationThe Ever-Changing Approaches to Diabetes in Pregnancy
The Ever-Changing Approaches to Diabetes in Pregnancy Kirsten E. Salmeen, MD Assistant Professor Obstetrics, Gynecology & Reproductive Sciences Maternal-Fetal Medicine I have nothing to disclose. Approaches
More informationPurpose: The goal of epidural anesthesia is to reduce or eliminate pain in the laboring patient.
Alaska Native Medical Center: Mother Baby Unit Subject: Epidural Anesthesia/PCEA in Laboring Patients Guideline: Epidural Anesthesia in Laboring Patients REVISION DATE: March 2013 REPLACES: L&D Epidural
More informationIn the first edition of this report, the Task Force on Neonatal
Neonatal Encephalopathy and Neurologic Outcome, Second Edition Report of the American College of Obstetricians and Gynecologists Task Force on Neonatal Encephalopathy Executive Summary In the first edition
More informationSeverity of Hypoxic Ischaemic Encephalopathy in Neonates with Birth Asphyxia
Journal of Rawalpindi Medical College (JRMC); 2007; (): 8-22 Severity of Hypoxic Ischaemic Encephalopathy in Neonates with Birth Asphyxia Rubina Zulfiqar, Samiya Naeemullah Department of Paediatrics, Holy
More informationManagement of IUGR Prof. Dr. Acar KOÇ
Management of IUGR Prof. Dr. Acar KOÇ Ankara University School of Medicine Department of OB&GYN Department of Perinatology Definition and Diagnosis: SGA IUGR EFW: < 10th percentile EFW: < 10th percentile
More informationMerja Kokki MD, PhD Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, School of Medicine, University of Eastern Finland
Long-acting opioids in obstetric analgesia and the newborn Merja Kokki MD, PhD Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, School of Medicine, University of Eastern Finland
More informationHypothermia in Neonates with HIE TARA JENDZIO, DNP(C), RN, RNC-NIC
Hypothermia in Neonates with HIE TARA JENDZIO, DNP(C), RN, RNC-NIC Objectives 1. Define Hypoxic-Ischemic Encephalopathy (HIE) 2. Identify the criteria used to determine if an infant qualifies for therapeutic
More informationLabour Epidurals and Maternal Pyrexia
Labour Epidurals and Maternal Pyrexia Katherine W. Arendt, MD Associate Professor of Anesthesiology Mayo Clinic, Rochester, Minnesota Obstetric Anaesthetists Association November 2, 2015 2013 MFMER slide-1
More information1.3 Sample Standard of Care from the Medical University of South Carolina
1.3 Sample Standard of Care from the Medical University of South Carolina Vitamin D Testing and Treatment Protocol MUSC Department of Ob-Gyn, Maternal-Fetal Medicine Division BACKGROUND: A rapidly evolving
More informationMODULE VII. Delivery and Immediate Neonatal Care
MODULE VII Delivery and Immediate Neonatal Care NEONATAL ASPHYXIA About one million deaths per year In Latin America 12% of newborns suffer some degree of asphyxia A major cause of perinatal and neonatal
More informationCOMET CROWN PERISTAT - INOSS SOPHIE ALEXANDER EPEN MEETING GLASCOW 19 NOVEMBER 2014
COMET CROWN PERISTAT - INOSS SOPHIE ALEXANDER EPEN MEETING GLASCOW 19 NOVEMBER 2014 Outline 1. A few words of information and links 1. COMET 2. CROWN 2. Should we (EURO-PERISTAT) take action? With INOSS?
More informationSwiss Association of Obstetric Anesthesia Swiss Association of Anesthesia & Resuscitation Satellite Meeting Interlaken, Switzerland 2007 Lawrence C.
CSE s for Labor Analgesia PRO! Swiss Association of Obstetric Anesthesia Swiss Association of Anesthesia & Resuscitation Satellite Meeting Interlaken, Switzerland 2007 Lawrence C. Tsen, MD Director of
More informationPhysicians Professional Responsibili3es in Abor3on Care. Jody Steinauer, MD, MAS Associate Clinical Professor University of California, San Francisco
Physicians Professional Responsibili3es in Abor3on Care Jody Steinauer, MD, MAS Associate Clinical Professor University of California, San Francisco Physicians Professional Responsibili3es in Abor3on Care
More informationAnal Sphincter Injuries: Acute Management
Anal Sphincter Injuries: Acute Management Dr Stephen Jeffery Urogynaecology Consultant Department of Obstetrics & Gynaecology Groote Schuur Hospital Colorectal Surgeons Gynaecologists Gynaecologists Colorectal
More informationI have no financial interests in any product I will discuss today.
Cervical Cancer Screening Update and Implications for Annual Exams George F. Sawaya, MD Professor Department of Obstetrics, Gynecology and Reproductive Sciences Department of Epidemiology and Biostatistics
More information1st Department of Obstetrics and Gynecology, Alexandra Maternity Hospital, National and Kapodistrian University of Athens, Athens, Greece.
HJOG An Obstetrics and Gynecology International Journal HJOG 2019, 18 (1), 21-25 Christos Kalantzis, Kalliopi Pappa 1st Department of Obstetrics and Gynecology, Alexandra Maternity Hospital, National and
More informationNEONATAL HYPOXIC-ISCHAEMIC ENCEPHALOPATHY (HIE) & COOLING THERAPY
Background NEONATAL HYPOXIC-ISCHAEMIC ENCEPHALOPATHY (HIE) & COOLING THERAPY A perinatal hypoxic-ischaemic insult may present with varying degrees of neonatal encephalopathy, neurological disorder and
More informationGestational Diabetes: An Update on Testing. Kimberlee A McKay, M.D. Avera Medical Group Ob/GYN
Gestational Diabetes: An Update on Testing Kimberlee A McKay, M.D. Avera Medical Group Ob/GYN Gestational Diabetes Increased risks of: Still Birth Hydramnios Should Dystocia Prolonged Labor Preeclampsia
More informationVishwanath Pattan Endocrinology Wyoming Medical Center
Vishwanath Pattan Endocrinology Wyoming Medical Center Disclosure Holdings in Tandem Non for this Training Introduction In the United States, 5 to 6 percent of pregnancies almost 250,000 women are affected
More informationHyaline membrane disease. By : Dr. Ch Sarishma Peadiatric Pg
Hyaline membrane disease By : Dr. Ch Sarishma Peadiatric Pg Also called Respiratory distress syndrome. It occurs primarily in premature infants; its incidence is inversely related to gestational age and
More informationcardiovascular events when in use in these indications and the outcome of the review is summarised below.
Annex II Scientific conclusions and grounds for revocation or variation as applicable to the terms of the marketing authorisations and detailed explanation for the differences from the PRAC recommendation
More informationThe Hep B Moms Program: A Primary Care Model for Management of Hepatitis B in Pregnancy
The Hep B Moms Program: A Primary Care Model for Management of Hepatitis B in Pregnancy Janice Lyu, MS Senior Hepatitis B Program Associate Charles B. Wang Community Health Center (CBWCHC) Charles B Wang
More informationDrugs used in obstetrics
Drugs used in obstetrics Drugs used in obstetrics Drugs may be used to modify uterine contractions. These include oxytocic drugs used to stimulate uterine contractions both in induction of labour and to
More informationSWISS SOCIETY OF NEONATOLOGY. Peripartal management of a prenatally diagnosed large oral cyst
SWISS SOCIETY OF NEONATOLOGY Peripartal management of a prenatally diagnosed large oral cyst May 2007 2 Fontana M, Berger TM, Winiker H, Jöhr M, Nagel H, Neonatal and Pediatric Intensive Care Unit (FM,
More informationObstetrical Anesthesia. Safe Pain Relief for Childbirth
Obstetrical Anesthesia Safe Pain Relief for Childbirth Introduction Pain relief (analgesia) for labor and delivery is now safer than ever. In the United States approximately two-thirds of all women receive
More informationMercy San Juan Medical Center. Preeclampsia and Other Hypertensive Disorders of Pregnancy
SUBJECT: Preeclampsia and Other Hypertensive Disorders of Pregnancy DEPARTMENTS: FBC, Emergency Department PURPOSE: To outline the nursing management of inpatients who have preeclampsia or other hypertensive
More informationAppendix 1. Causes of Neonatal Deaths. Interval between. Gestation at birth. birth and death. Allocation. (weeks +days ) Cause of death.
Appendix 1. Causes of Neonatal Deaths Interval between Gestation at birth birth and death Allocation (weeks +days ) (days) Cause of death Amnioinfusion 25 +1/7 20 Respiratory and circulatory insufficiency
More informationRemifentanil by Patient Controlled Analgesia Compared with Epidural Analgesia for Pain Relief in Labour
4 Remifentanil by Patient Controlled Analgesia Compared with Epidural Analgesia for Pain Relief in Labour M.E. Rabie 1, H.H. Negmi 1, A.M. Moustafa 1, H. Al Oufi 1 1 Anesthesia Department, King Faisal
More informationA retrospective review of tracheal suction at birth in neonates with meconium aspiration syndrome
A retrospective review of tracheal suction at birth in neonates with meconium aspiration syndrome D. Manickam MBBS, DCH, MRCP, MIAC, Paediatric Department, Penang General Hospital, 10450 Pulau Pinang Summary
More informationToo Cool? Hypoxic Ischemic Encephalopathy and Therapeutic Hypothermia. Lauren Sacco DNP, ARNP, NNP-BC
Too Cool? Hypoxic Ischemic Encephalopathy and Therapeutic Hypothermia Lauren Sacco DNP, ARNP, NNP-BC Pathophysiology of HIE Occurs in two energy failure phases: First phase happens during the initial insult
More informationClinical and Biochemical Asphyxia in Meconium Stained Deliveries
INDIAN PEDIATRICS VOLUME 35-APRIL 1998 Clinical and Biochemical Asphyxia in Meconium Stained Deliveries Piyush Gupta M.M.A. Faridi Dheeraj Behl * Neera Agarwal Presence of thick meconium in the amniotic
More informationThe Effect of Valvular Heart Diseases on Maternal and Fetal Outcome of Pregnancy Nada Salih Ameen*,Nawfal Fawzi Anwer**
THE VALVULAR IRAQI POSTGRADUATE HEART DISEASES MEDICAL AND JOURNAL PREGNANCY The Effect of Valvular Heart Diseases on Maternal and Fetal Outcome of Pregnancy Nada Salih Ameen*,Nawfal Fawzi Anwer** ABSTRACT:
More informationClinical features. Abnormal vasculogenesis and angiogenesis and releasing of antiangiogenic
Clinical features Abnormal vasculogenesis and angiogenesis and releasing of antiangiogenic factors results in Vasospasm Endothelial dysfunction Etiology of various clinical signs and symptoms So, Preeclampsia
More informationOverview. In Vitro Fertilization: a Success Story
Does IVF cause adverse perinatal outcomes? Paolo Rinaudo *, MD PhD Rebecca A. Jackson %, MD Departments of Ob/Gyn & *Center for Reproductive Sciences & % Epi/Biostats University of California, San Francisco
More informationCardiovascular Effects of Anesthesia for Cesarean Delivery in the Cardiac Patient
Cardiovascular Effects of Anesthesia for Cesarean Delivery in the Cardiac Patient Katherine W. Arendt, M.D. Associate Professor of Anesthesiology Mayo Clinic, Rochester, Minnesota Cardiac Problems in Pregnancy
More informationResuscitation efforts for Mom & Baby
Resuscitation efforts for Mom & Baby Beth Ann Clayton, CRNA, MS AmSol Obstetric Anesthesia CRNA Educator Obstetric Anesthesia Clinical Coordinator Mercy Health-Fairfield Hospital Assistant Professor, University
More informationDr Laura Byrne. UCL Institute of Child Health, London
Dr Laura Byrne UCL Institute of Child Health, London RCOG, London Elimination of vertical transmission in the UK: what is left to do? Results of the NSHPC audit of perinatal HIV since 2006 Laura Byrne,
More informationTorri Metz, MD Maternal-Fetal Medicine December 15, 2017
Torri Metz, MD Maternal-Fetal Medicine December 15, 2017 I have no relevant financial relationships to disclose or conflicts of interest to resolve. Describe public health impact of expanding marijuana
More informationStudy of renal functions in neonatal asphyxia
Original article: Study of renal functions in neonatal asphyxia *Dr. D.Y.Shrikhande, **Dr. Vivek Singh, **Dr. Amit Garg *Professor and Head, **Senior Resident Department of Pediatrics, Pravara Institute
More informationA Challenging Case: Von Willebrand Disease and Pulmonary Hypertension in Pregnancy
A Challenging Case: Von Willebrand Disease and Pulmonary Hypertension in Pregnancy Diana S. Wolfe, MD, MPH Assistant Professor Department of Obstetrics & Gynecology and Women s Health Associate Fellowship
More informationHYPOXIC ISCHEMIC ENCEPHALOPATHY AND THE OBSTETRICIAN
HYPOXIC ISCHEMIC ENCEPHALOPATHY AND THE OBSTETRICIAN DISCLOSURE I have nothing to disclose and have no real or potential conflicts with this presentation and its content. Michael P. Nageotte, M.D. CASE:
More informationMaternal Collapse Guideline
Maternal Collapse Guideline Guideline Number: 664 Supersedes: Classification Clinical Version No: Date of EqIA: Approved by: Date Approved: Date made active: Review Date: 1 Obstetric Written Documentation
More informationStudy of the role of low dose magnesium Sulphate in Hypertensive Disorders of Pregnancy 1 2
ORIGINAL ARTICLE J Pub Health Med Res 2015;3(2):31-37 Study of the role of low dose magnesium Sulphate in Hypertensive Disorders of Pregnancy 1 2 Shubha C.R. Vailaya, Naveena Kumari M. 1 Chief Consultant
More informationDespite continuing advances in obstetric
INFECTIOUS DISEASE New guidance this year: We need to be more vigilant for group B strep and influenza in pregnancy and give prophylactic antimicrobials before the incision for cesarean delivery Alan T.
More informationTRAINING NEONATOLOGY SILVANA PARIS
TRAINING ON NEONATOLOGY SILVANA PARIS RESUSCITATION IN DELIVERY ROOM INTRODUCTION THE GLOBAL RESUSCITATION BURDEN IN NEWBORN 136 MILL NEWBORN BABIES EACH YEAR (WHO WORLD REPORT) 5-8 MILL NEWBORN INFANTS
More informationHSV Screening: Are Wesley Obstetricians Following the Guidelines? Dawn Boender, PGY4 Taylor Bertschy, PGY3
HSV Screening: Are Wesley Obstetricians Following the Guidelines? Dawn Boender, PGY4 Taylor Bertschy, PGY3 Goals To increase obstetrician knowledge regarding HSV screening Institute clinical changes at
More informationhttps://www.lucidoc.com/cgi/doc-gw.pl?ref=overlake_p:53602
Page 1 of 6 Protocol : Severe Hypertension in Obstetrics: Emergent Treatment DocID: 53602 Revision: 7 Status: Official Department: Women's and Infants' Admin Manual(s): Labor and Delivery Mother Baby Unit
More informationIncrease your chance of IVF Success. PGT-A Preimplantation Genetic Testing for Aneuploidy (PGS 2.0)
Increase your chance of IVF Success PGT-A Preimplantation Genetic Testing for Aneuploidy (PGS 2.0) What is PGT-A? PGT-A, or Preimplantation Genetic Testing for Aneuploidy (PGS 2.0), is a type of genomic
More informationTLC March 27, Shawn Hollinger-Neonatal Fellow CHEO
TLC March 27, 2013 Presented/Prepared by: Shawn Hollinger, PGY5 Neonatal-Perinatal Medicine Resident - University of Ottawa With slides/images from Dr. Brigitte Lemyre Associate Professor of Pediatrics
More informationCombined spinalepidural. epidural analgesia in labour (review) By Neda Taghizadeh
Combined spinalepidural versus epidural analgesia in labour (review) By Neda Taghizadeh Cochrane review Cochrane collaboration was founded in 1993 and is named after Archie Cochrane (1909-1988), British
More informationDiagnosis of gestational diabetes mellitus: comparison between National Diabetes Data Group and Carpenter Coustan criteria
Asian Biomedicine Vol. 8 No. 4 August 2014; 505-509 Brief communication (Original) DOI: 10.5372/1905-7415.0804.320 Diagnosis of gestational diabetes mellitus: comparison between National Diabetes Data
More informationAddendum to the NRP Provider Textbook 6 th Edition Recommendations for specific modifications in the Canadian context
Addendum to the NRP Provider Textbook 6 th Edition Recommendations for specific modifications in the Canadian context A subcommittee of the Canadian Neonatal Resuscitation Program (NRP) Steering Committee
More informationExample Clinical Guideline for Immediate Postpartum LARC Insertion
Example Clinical Guideline for Immediate Postpartum LARC Insertion RATIONALE Delay in contraceptive provision until the six week postpartum appointment can leave some women at risk for rapid repeat pregnancy.
More informationCurrent Trends in Diagnosis and Management of Gestational Diabetes
Current Trends in Diagnosis and Management of Gestational Diabetes Shreela Mishra, MD Assistant Clinical Professor UCSF Fresno Medical Education Program 2/2/2019 Disclosures No disclosures 2/2/19 Objectives
More informationAPEC Guidelines Gestational Diabetes Mellitus
Gestational diabetes mellitus (GDM) is defined as insulin resistance of variable severity with onset or first recognition during pregnancy. The prevalence of diabetes mellitus (DM) in the US is growing
More informationRETIRED: REVIEWED/Revised: 12/14; 10/15; 1/16; 9/16, 10/16, 5/17, 5/18, 9/18
PAGE: 1 of 9 Scope Louisiana Healthcare Connections (LHCC) Medical Department Purpose To provide medical necessity criteria for obstetrical Home Health programs offered by vendors such as Optum Obstetrical
More informationUmbilical cord blood acid-base analysis and the development of significant hyperbilirubinemia in near-term and term newborns: a cohort study
Zanardo et al. Italian Journal of Pediatrics (2017) 43:67 DOI 10.1186/s13052-017-0382-8 RESEARCH Umbilical cord blood acid-base analysis and the development of significant hyperbilirubinemia in near-term
More informationAppendix A01. EMS License Renewal Request. Name (as written on license): License Held: License Number: Expiration Date: Agency:
Appendix A01 EMS License Renewal Request Name (as written on license): License Held: License Number: Expiration Date: Agency: Category EMR ECRN EMD LI BLS ILS ALS Airway, including skills lab 2 0 0 4 4
More informationTocolytics. Tocolytics (terbutaline, magnesium sulfate injection) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.06 Subject: Tocolytics Page: 1 of 5 Last Review Date: September 15, 2016 Tocolytics Description Tocolytics
More information