Obstetric Guidelines and Labour Ward Protocols
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First Trimester Anomaly Scan Using Virtual Reality (VR FETUS Study): Study Protocol for a Randomized Clinical Trial C
Pietersma et al. BMC Pregnancy and Childbirth (2020) 20:515 https://doi.org/10.1186/s12884-020-03180-8 STUDY PROTOCOL Open Access First trimester anomaly scan using virtual reality (VR FETUS study): study protocol for a randomized clinical trial C. S. Pietersma1, A. G. M. G. J. Mulders1, L. M. Moolenaar1, M. G. M. Hunink2,3,4, A. H. J. Koning5, S. P. Willemsen6, A. T. J. I. Go1, E. A. P. Steegers1 and M. Rousian1* Abstract Background: In recent years it has become clear that fetal anomalies can already be detected at the end of the first trimester of pregnancy by two-dimensional (2D) ultrasound. This is why increasingly in developed countries the first trimester anomaly scan is being offered as part of standard care. We have developed a Virtual Reality (VR) approach to improve the diagnostic abilities of 2D ultrasound. Three-dimensional (3D) ultrasound datasets are used in VR assessment, enabling real depth perception and unique interaction. The aim of this study is to investigate whether first trimester 3D VR ultrasound is of additional value in terms of diagnostic accuracy for the detection of fetal anomalies. Health-related quality of life, cost-effectiveness and also the perspective of both patient and ultrasonographer on the 3D VR modality will be studied. Methods: Women in the first trimester of a high risk pregnancy for a fetus with a congenital anomaly are eligible for inclusion. This is a randomized controlled trial with two intervention arms. The control group receives ‘care as usual’: a second trimester 2D advanced ultrasound examination. The intervention group will undergo an additional first trimester 2D and 3D VR ultrasound examination. -
GMEC) Strategic Clinical Networks Reduced Fetal Movement (RFM
Greater Manchester & Eastern Cheshire (GMEC) Strategic Clinical Networks Reduced Fetal Movement (RFM) in Pregnancy Guidelines March 2019 Version 1.3a GMEC RFM Guideline FINAL V1.3a 130619 Issue Date 15/02/2019 Version V1.3a Status Final Review Date Page 1 of 19 Document Control Ownership Role Department Contact Project Clinical Lead Manchester Academic Health [email protected] Science Centre, Division of Developmental Biology and Medicine Faculty of Biology, Medicine and Health, The University of Manchester. Project Manager GMEC SCN [email protected] Project Officer GMEC SCN [email protected] Endorsement Process Date of Presented for ratification at GMEC SCN Maternity Steering Group on:15th February ratification 2019 Application All Staff Circulation Issue Date: March 2019 Circulated by [email protected] Review Review Date: March 2021 Responsibility of: GMEC Maternity SCN Date placed on March 2019 the Intranet: Acknowledgements On behalf of the Greater Manchester and Eastern Cheshire and Strategic Clinical Networks, I would like to take this opportunity to thank the contributors for their enthusiasm, motivation and dedication in the development of these guidelines. Miss Karen Bancroft Maternity Clinical Lead for the Greater Manchester & Eastern Cheshire SCN GMEC RFM Guideline FINAL V1.3a 130619 Issue Date 15/02/2019 Version V1.3a Status Final Review Date Page 2 of 19 Contents 1 What is this Guideline for and Who should use it? ......................................................................... 4 2 What -
ANC Level 1 2Nd Edition.Pdf
Pregnancy & Childbirth Management Guidelines Level- 1 A Guide for Nurses, Midwives and Doctors Second Edition DEPARTMENT OF WOMAN &CHILD HEALTH DIRECTORATE GENERAL OF PRIMARY HEALTH CARE MINISTRY OF HEALTH SULTANATE OF OMAN 2016 ML- 60 Pregnancy & Childbirth Management Guidelines Level- 1 A Guide for Nurses, Midwives and Doctors Second Edition 2016 I II ACKNOWLEDGEMENT Acknowledgement with gratitude to all contributors & Reviewers for their effort in updating this guideline manual: Contributors from Woman & Child Health Department: • Dr. Jamila Al-Abri, Senior Specialist, Dept. of Woman & Child Health • Dr. Fatima Al Hinai, Senior Specialist, Director of Woman & Child Health Dept. • Dr. Nawal Al Rashdi, Senior Specialist, Dept. of Woman & Child Health • Dr. Salwa Jabbar Alshahabi, Specialist, Dept. of Woman & Child Health • Dr. Omaima Abdel Wahab, Senior Medical Officer, Dept. of Woman & Child Health. Contributors from Primary Health Care Institutions: • Dr. Nabila Al Wahaibi, Senior Consultant (FAMCO), Wadi Kabeer Health Centre. • Dr. Ahdab Abdul Hafeez, Specialist, Muscat Health Centre. • Dr. Imrana Masoud, Senior Medical Officer, Al Seeb Health Centre. Contributors from National Diabetic & Endocrine Centre & NCD department • Dr. Noor Al Busaidi, Senior Consultant, Director of National Diabetic & Endocrine Centre (NDEC) • Dr. Hilal Al Musailhi, Senior Consultant Adult Endocrinology, (NDEC). • Dr. Deepa Manoharan , Medical Officer, (NDEC). • Dr. Nada Hareb Al Sumri, Senior Specialist, Non Communicable Disease Dept • Dr. Suleiman Al Shereigi, Senior Specialist in Public Health Administration,(NDEC) Reviewers from Secondary & Tertiary Heath Care : • Dr. Tamima Al Dughaishi, Senior Consultant Obstetrics & Gynecology, SQUH • Dr. Bernadette Punnoose, Senior Consultant Obstetrics & Gynecology, Royal Hospital • Dr. Badrya Al Fahdi, Senior Consultant Obstetrics & Gynecology, Royal Hospital • Dr. Sumaya Al Amri, Senior Specialist Obstetrics & Gynecology, Royal Hospital • Dr. -
Postpartum Haemorrhage
Guideline Postpartum Haemorrhage Immediate Actions Call for help and escalate as necessary Initiate fundal massage Focus on maternal resuscitation and identifying cause of bleeding Determine if placenta still in situ Tailor pharmacological management to causation and maternal condition (see orange box). Complete a SAS form when using carboprost. Pharmacological regimen (see flow sheet summary) Administer third stage medicines if not already done so. Administer ergometrine 0.25mg both IM and slow IV (contraindicated in hypertension) IF still bleeding: Administer tranexamic acid- 1g IV in 10mL via syringe driver set at 1mL/minute administered over 10 minutes OR as a slow push over 10 minutes. Administer carboprost 250micrograms (1mL) by deep intramuscular injection Administer loperamide 4mg PO to minimise the side-effect of diarrhoea Administer antiemetic ondansetron 4mg IV, if not already given Prophylaxis Once bleeding is controlled, administer misoprostol 600microg buccal and initiate an infusion of oxytocin 40IU in 1L Hartmann’s at a rate of 250mL/hr for 4 hours. Flow chart for management of PPH Carboprost Bakri Balloon Medicines Guide Ongoing postnatal management after a major PPH 1. Purpose This document outlines the guideline details for managing primary postpartum haemorrhage at the Women’s. Where processes differ between campuses, those that refer to the Sandringham campus are differentiated by pink italic text or have the heading Sandringham campus. For guidance on postnatal observations and care after a major PPH, please refer to the procedure ‘Postpartum Haemorrhage - Immediate and On-going Postnatal Care after Major PPH 2. Definitions Primary postpartum haemorrhage (PPH) is traditionally defined as blood loss greater than or equal to 500 mL, within 24 hours of the birth of a baby (1). -
Ⅰ Obstetric Hemorrhage Safety Bundle Implementation in a Rural
Obstetric Hemorrhage Safety Bundle Implementation in a Rural CAH Dale C Robinson MD,FACOG Chief Ob/Gyn Grande Ronde Hospital La Grande Oregon S Planning for and Responding to Obstetric Hemorrhage California Maternal Quality Care Collaborative Obstetric Hemorrhage Version 2.0 Task Force This project was supported by Title V funds received from the California Department of Public Health; Maternal, Child and Adolescent Health Division 2 CMQCC S California Maternal Quality Care Collaborative S Multidisciplinary Task Force S Recommendations/ Obstetric Safety Bundle S Yellow/Blue Slides Maternal Mortality Rates, Moving Average, California Residents; 1999-2010 16 14 14.0 12.2 13.5 13.2 12 12.7 11.6 12.1 11.5 10 9.4 10.2 8 6 4 Maternal Deaths per 100,000 Live Births 2 0 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010 Three-Year Moving Average SOURCE: State of California, Department of Public Health, California Birth and Death Statistical Master Files, 1999-2010. Maternal mortality for California (deaths ≤ 42 days postpartum) was calculated using ICD-10 cause of death classification (codes A34, O00-O95,O98-O99) for 1999-2010. On average, the mortality rate increased by 2% each year [(95% CI: 1.0%, 4.2%) p=0.06. Poisson regression] for a statistically significant increasing trend from 1999-2010 (p=0.001 one-sided Cochran-Armitage, based on individual year data). Produced by California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division, December, 2012. North Carolina: Mortality Mostly Preventable Cause of Death (n=108) % of All Deaths % Preventable Cardiomyopathy 21% 22% Hemorrhage 14 93 PIH 10 60 CVA 9 0 Chronic condition 9 89 AFE 7 0 Infection 7 43 Pulmonary embolism 6 17 Berg CJ, Harper MA, Atkinson SM, et al. -
Prenatal Ultrasonography of Craniofacial Abnormalities
Prenatal ultrasonography of craniofacial abnormalities Annisa Shui Lam Mak, Kwok Yin Leung Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong SAR, China REVIEW ARTICLE https://doi.org/10.14366/usg.18031 pISSN: 2288-5919 • eISSN: 2288-5943 Ultrasonography 2019;38:13-24 Craniofacial abnormalities are common. It is important to examine the fetal face and skull during prenatal ultrasound examinations because abnormalities of these structures may indicate the presence of other, more subtle anomalies, syndromes, chromosomal abnormalities, or even rarer conditions, such as infections or metabolic disorders. The prenatal diagnosis of craniofacial abnormalities remains difficult, especially in the first trimester. A systematic approach to the fetal Received: May 29, 2018 skull and face can increase the detection rate. When an abnormality is found, it is important Revised: June 30, 2018 to perform a detailed scan to determine its severity and search for additional abnormalities. Accepted: July 3, 2018 Correspondence to: The use of 3-/4-dimensional ultrasound may be useful in the assessment of cleft palate and Kwok Yin Leung, MBBS, MD, FRCOG, craniosynostosis. Fetal magnetic resonance imaging can facilitate the evaluation of the palate, Cert HKCOG (MFM), Department of micrognathia, cranial sutures, brain, and other fetal structures. Invasive prenatal diagnostic Obstetrics and Gynaecology, Queen Elizabeth Hospital, Gascoigne Road, techniques are indicated to exclude chromosomal abnormalities. Molecular analysis for some Kowloon, Hong Kong SAR, China syndromes is feasible if the family history is suggestive. Tel. +852-3506 6398 Fax. +852-2384 5834 E-mail: [email protected] Keywords: Craniofacial; Prenatal; Ultrasound; Three-dimensional ultrasonography; Fetal structural abnormalities This is an Open Access article distributed under the Introduction terms of the Creative Commons Attribution Non- Commercial License (http://creativecommons.org/ licenses/by-nc/3.0/) which permits unrestricted non- Craniofacial abnormalities are common. -
Fetal Medicine August 2010
Advanced Training Skills Module – Fetal Medicine August 2010 Fetal Medicine This module is designed to prepare the future consultant for dealing with congenital abnormalities detected during pregnancy. This includes the organisation and supervision of screening programmes for structural and chromosomal anomalies. Many of these cases need to be managed within a multidisciplinary team which includes clinical geneticists and fetal medicine subspecialists. Apart from a sound knowledge of embryology and fetal physiology, clinicians working in this field must be competent in the prenatal diagnosis of common abnormalities. They also require a sound working knowledge of clinical and laboratory genetics in order that they can investigate and, where appropriate, refer suitable families. Competence in obstetric ultrasound is a prerequisite for advanced skills in prenatal diagnosis and fetal medicine. Trainees must complete the new Intermediate Ultrasound of Fetal Anatomy module prior to entry into the ATSM in Fetal Medicine. Attendance at a suitable Fetal Medicine theoretical course is a compulsory requirement of the module. This must be attended before completion of the ATSM and can have been done not more than three years previously. Specifically, once trained, individuals should: Work well as part of a multidisciplinary team Understand the organization of prenatal screening and diagnostic services at a local and regional level Be clinically competent in the prenatal diagnosis, counselling and management of common fetal abnormalities and markers of chromosomal abnormality. Be clinically competent and certified in first trimester screening for chromosomal abnormality by a combination of nuchal translucency assessment and biochemical marker assays. Be clinically competent at amniocentesis and have a sound knowledge of the principles and techniques of first trimester chorion villus biopsy. -
• Chapter 8 • Nursing Care of Women with Complications During Labor and Birth • Obstetric Procedures • Amnioinfusion –
• Chapter 8 • Nursing Care of Women with Complications During Labor and Birth • Obstetric Procedures • Amnioinfusion – Oligohydramnios – Umbilical cord compression – Reduction of recurrent variable decelerations – Dilution of meconium-stained amniotic fluid – Replaces the “cushion ” for the umbilical cord and relieves the variable decelerations • Obstetric Procedures (cont.) • Amniotomy – The artificial rupture of membranes – Done to stimulate or enhance contractions – Commits the woman to delivery – Stimulates prostaglandin secretion – Complications • Prolapse of the umbilical cord • Infection • Abruptio placentae • Obstetric Procedures (cont.) • Observe for complications post-amniotomy – Fetal heart rate outside normal range (110-160 beats/min) suggests umbilical cord prolapse – Observe color, odor, amount, and character of amniotic fluid – Woman ’s temperature 38 ° C (100.4 ° F) or higher is suggestive of infection – Green fluid may indicate that the fetus has passed a meconium stool • Nursing Tip • Observe for wet underpads and linens after the membranes rupture. Change them as often as needed to keep the woman relatively dry and to reduce the risk for infection or skin breakdown. • Induction or Augmentation of Labor • Induction is the initiation of labor before it begins naturally • Augmentation is the stimulation of contractions after they have begun naturally • Indications for Labor Induction • Gestational hypertension • Ruptured membranes without spontaneous onset of labor • Infection within the uterus • Medical problems in the -
Obstetrics Seventh Edition
PROLOGObstetrics seventh edition The American College of Obstetricians and Gynecologists WOMEN’S HEALTH CARE PHYSICIANS Obstetrics seventh edition Assessment Book The American College of Obstetricians and Gynecologists WOMEN’S HEALTH CARE PHYSICIANS ISBN 978-1-934984-22-2 Copyright 2013 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. 12345/76543 The American College of Obstetricians and Gynecologists 409 12th Street, SW PO Box 96920 Washington, DC 20090-6920 Contributors PROLOG Editorial and Advisory Committee CHAIR MEMBERS Ronald T. Burkman Jr, MD Bernard Gonik, MD Professor of Obstetrics and Professor and Fann Srere Chair of Gynecology Perinatal Medicine Tufts University School of Medicine Division of Maternal–Fetal Medicine Division of General Obstetrics and Department of Obstetrics and Gynecology Gynecology Department of Obstetrics and Wayne State University School of Gynecology Medicine Baystate Medical Center Detroit, Michigan Springfield, Massachusetts Louis Weinstein, MD Past Paul A. and Eloise B. Bowers Professor and Chair Department of Obstetrics and Gynecology Thomas Jefferson University Philadelphia, Pennsylvania Linda Van Le, MD Leonard Palumbo Distinguished Professor UNC Gynecologic Oncology University of North Carolina School of Medicine Chapel Hill, North Carolina PROLOG Task Force for Obstetrics, Seventh Edition COCHAIRS MEMBERS Vincenzo Berghella, MD Cynthia Chazotte, MD Director, Division of Maternal–Fetal Professor of Clinical Obstetrics and Medicine Gynecology and Women’s Health Professor, Department of Obstetrics Department of Obstetrics and Gynecology and Gynecology Weiler Hospital of the Albert Einstein Thomas Jefferson University College of Medicine Philadelphia, Pennsylvania Bronx, New York George A. -
Safety Profile of Misoprostol for Obstetrical Indications
SAFETY PROFILE OF MISOPROSTOL FOR OBSTETRICAL INDICATIONS Lenita Wannmacher INTRODUCTION Cervical ripening, full‐term labour induction, and postpartum haemorrhage (PPH) are obstetric conditions that require proper and early interventions in order to save maternal and fetal lives. These interventions include pharmacological (uterotonic agents, mainly) and non‐pharmacological methods that have been tested and compared throughout the past decade. Regarding injectable uterotonic medicines (such as oxytocin, ergometrine, syntometrine, prostaglandins, and, more recently, carbetocin), factors limiting their use in low‐resource settings have been their cost, instability at high ambient temperatures, and difficult requirements of administration. In poor and rural settings, birth attendant skills are limited, transport facilities are inadequate, and injectable uterotonics and blood are hardly available. In contrast, misoprostol, a synthetic prostaglandin E1 analogue, presents low cost, storage at room temperature, and widespread availability. Misoprostol could also be easily administered by unskilled attendants or the women themselves, thus making them available for women giving birth at home or in isolated areas. These are benefits that make it particularly appealing for developing poor countries.1 Despite the built evidence of efficacy, induction of full‐term labour in women with a live fetus, as well as prevention and treatment of PPH, remains as a major challenge in modern obstetrics. Safety profile of misoprostol is still a matter of concern, especially relating to doses and routes used for the mentioned purposes.2 Misoprostol can be effectively administered vaginally, rectally, bucally, orally and sublingually. Pharmacokinetic studies have demonstrated the properties of misoprostol after various routes of administration. The rate of absorption varies considerably between routes, and care must be taken to use the correct dose and frequency for the specified route. -
Chapter III: Case Definition
NBDPN Guidelines for Conducting Birth Defects Surveillance rev. 06/04 Appendix 3.5 Case Inclusion Guidance for Potentially Zika-related Birth Defects Appendix 3.5 A3.5-1 Case Definition NBDPN Guidelines for Conducting Birth Defects Surveillance rev. 06/04 Appendix 3.5 Case Inclusion Guidance for Potentially Zika-related Birth Defects Contents Background ................................................................................................................................................. 1 Brain Abnormalities with and without Microcephaly ............................................................................. 2 Microcephaly ............................................................................................................................................................ 2 Intracranial Calcifications ......................................................................................................................................... 5 Cerebral / Cortical Atrophy ....................................................................................................................................... 7 Abnormal Cortical Gyral Patterns ............................................................................................................................. 9 Corpus Callosum Abnormalities ............................................................................................................................. 11 Cerebellar abnormalities ........................................................................................................................................ -
Prenatal Prediction of Outcome by Fetal Gastroschisis in a Tertiary Referral Center
diagnostics Article Prenatal Prediction of Outcome by Fetal Gastroschisis in a Tertiary Referral Center Katharina Nitzsche 1, Guido Fitze 2, Mario Rüdiger 3 and Cahit Birdir 1,* 1 Department of Obstetrics and Gynecology, University Clinic of Carl Gustav Carus Dresden, Technische Universität Dresden, 01307 Dresden, Germany; [email protected] 2 Department of Pediatric Surgery, University Clinic of Carl Gustav Carus Dresden, Technische Universität Dresden, 01307 Dresden, Germany; guido.fi[email protected] 3 Department of Pediatrics, University Clinic of Carl Gustav Carus Dresden, Technische Universität Dresden, 01307 Dresden, Germany; [email protected] * Correspondence: [email protected] Received: 4 June 2020; Accepted: 30 July 2020; Published: 30 July 2020 Abstract: The aim of this study was to find a prenatal parameter to be able to predict possible prenatal complications or postnatal surgical options, thus allowing the fetal medicine specialist, together with pediatric surgeons and neonatologists, to improve the counseling of the parents and to determine the timing of delivery and therapy. This was a retrospective analysis of prenatal diagnosis and outcome of fetuses with 34 cases of gastroschisis between the years 2007 and 2017. A total of 34 fetuses with gastroschisis were examined and 33 outcomes registered: 22 cases of simple gastroschisis (66.7%) and 11 cases of complex gastroschisis (33.3%). A cut-off value of 18 mm for intraabdominal bowel dilatation (IABD) showed a positive predictive value (PPV) of 100% for predicting simple gastroschisis. IABD gives the best prediction for simple versus complex gastroschisis (cut-off of 18 mm). Extra-abdominal bowel dilatation (EABD) cut-off values of 10 mm and 18 mm showed low sensitivity and specificity to predict complex gastroschisis.