Velamentous Cord Insertion
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Placental Abruption
Placental Abruption Definition: Placental separation, either partial or complete prior to the birth of the fetus Incidence 0.5 – 1% (4). Risk factors include hypertension, smoking, preterm premature rupture of membranes, cocaine abuse, uterine myomas, and previous abruption (5). Diagnosis: Symptoms (may present with any or all of these) o Vaginal bleeding (usually dark and non-clotting). o Abdominal pain and/or back pain varying from intermittent to severe. o Uterine contractions are usually present and may vary from low amplitude/high frequency to hypertonus. o Fetal distress or fetal death. Ultrasound o Adherent retroplacental clot OR may just appear to be a thick placenta o Resolving hematomas become hypoechoic within one week and sonolucent within 2 weeks May be a diagnosis of exclusion if vaginal bleeding and no other identified etiology Consider in differential with uterine irritability on toco and cat II-III tracing, as small proportion present without bleeding Classification: Grade I: Slight vaginal bleeding and some uterine irritability are usually present. Maternal blood pressure, and fibrinogen levels are unaffected. FHR remains normal. Grade II: Mild to moderate vaginal bleeding seen; tetanic contractions may be present. Blood pressure usually normal, but tachycardia may be present. May be postural hypotension. Decreased fibrinogen; with levels below 250 mg percent; may be evidence of fetal distress. Reviewed 01/16/2020 1 Updated 01/16/2020 Grade III: Bleeding is moderate to severe, but may be concealed. Uterus tetanic and painful. Maternal hypotension usually present. Fetal death has occurred. Fibrinogen levels are less then 150 mg percent with thrombocytopenia and coagulation abnormalities. -
Placenta Praevia/Low-Lying Placenta
LOCAL OPERATING PROCEDURE – CLINICAL Approved Quality & Patient Safety Committee 18/6/20 Review June 2022 PLACENTA PRAEVIA/LOW-LYING PLACENTA This LOP is developed to guide clinical practice at the Royal Hospital for Women. Individual patient circumstances may mean that practice diverges from this LOP. 1. AIM • Diagnosis and clinical management of woman with low-lying placenta (LLP) or placenta praevia (PP) 2. PATIENT • Pregnant woman with a LLP/PP after 20 weeks gestation 3. STAFF • Medical and midwifery staff 4. EQUIPMENT • Ultrasound • 16-gauge intravenous (IV) cannula • Blood tubes 5. CLINICAL PRACTICE Screening: • Recommend a morphology ultrasound at 18-20 weeks gestation to ascertain placental location • Include, on the ultrasound request form, any history of uterine surgery e.g. previous caesarean section (CS), myomectomy, to ensure that features of placenta accreta are examined • Identify woman with a: o LLP i.e. within 2cm of, but not covering the internal cervical os o PP i.e. covering the internal cervical os Antenatal care: • Reassure woman that 9 out of 10 LLP found at 18-20 week morphology ultrasound are no longer low-lying by term1 • Reassure woman with LLP that if she remains asymptomatic, there is no increased risk of adverse outcomes in the mid-trimester and she can continue normal activities e.g. travel, intercourse, exercise2 • Advise woman with LLP from 36 weeks that it is not a contraindication for trial of labour, chance of vaginal birth approximately9: o 43% if placenta is 0-10mm from cervical os o 85% if placenta -
Cohort Study of High Maternal Body Mass Index and the Risk of Adverse Pregnancy and Delivery Outcomes in Scotland
Open access Original research BMJ Open: first published as 10.1136/bmjopen-2018-026168 on 20 February 2020. Downloaded from Cohort study of high maternal body mass index and the risk of adverse pregnancy and delivery outcomes in Scotland Lawrence Doi ,1 Andrew James Williams ,2 Louise Marryat ,3,4 John Frank3,5 To cite: Doi L, Williams AJ, ABSTRACT Strengths and limitations of this study Marryat L, et al. Cohort Objective To examine the association between high study of high maternal maternal weight status and complications during pregnancy ► This study used a large, retrospectively accessed body mass index and the and delivery. risk of adverse pregnancy but cohort- structured, national database covering Setting Scotland. and delivery outcomes some of the major maternal and neonatal outcomes Participants Data from 132 899 first- time singleton in Scotland. BMJ Open in Scotland over eight recent years. deliveries in Scotland between 2008 and 2015 were used. 2020;10:e026168. doi:10.1136/ ► Analyses were adjusted for some of the key potential Women with overweight and obesity were compared with bmjopen-2018-026168 confounders to estimate impact of high maternal- women with normal weight. Associations between maternal ► Prepublication history and weight status on each outcome. body mass index and complications during pregnancy and 2 additional material for this ► All women with body mass index (BMI) of 30 kg/m delivery were evaluated. paper are available online. To or more were considered as having obesity; it is like- Outcome measures Gestational diabetes, gestational view these files, please visit ly that differentiating morbid obesity or obesity class hypertension, pre- eclampsia, placenta praevia, placental the journal online (http:// dx. -
Maternal and Foetal Mortality in Placenta Praevia"
J Obs Gyn Brit Emp 1962 V-69 MATERNAL AND FOETAL MORTALITY IN PLACENTA PRAEVIA" BY C. H. G. MACAFEE,C.B.E., D.Sc., F.R.C.S., F.R.C.O.G. Professor of Obstetrics and Gynaecology, The Queen's Universiiy of Belfast W. GORDONMILLAR, F.R.F.P.S., F.R.C.S., M.R.C.O.G. Consultant Obstetrician and Gynaecologist, Royal Injirmary, Perth; formerly Lecturer in Department qf Obstetrics and Gynaecology, The Queen's University of Belfast AND GRAHAMHARLEY, M.D., M.R.C.O.G. Lecturer, Department of Obstetrics and Gynaecology, The Queen's University of Belfast IN the 95 years between 1844-1939 the foetal During the first eight-year period 206 patients mortality from placenta praevia remained at were dealt with and in the second period the between 54 per cent and 60 per cent, while the number was 219. These two figures correspond maternal mortality fell from 30 per cent to 5 so closely that they permit a good statistical per cent. comparison to be made between the two eight- year periods. TABLE I Maternal Foetal Expectant Treatment Author Date Mortality Mortality In recent years the value of this treatment has been recognized and is becoming more 01,'O % SimDson . .. 1844 30 60 widely accepted even though it entails the Berkeley . 1936 7 59 occupation of antenatal beds sometimes for Browne . 1939 5 54 weeks. It is obvious that the nearer the preg- Belfast series . 1945-52 nil 14.9 nancy can be carried to full term the more 1953-60 0.9 11.1 favourable the outlook for the baby. -
Incidence of Eclampsia with HELLP Syndrome and Associated Mortality in Latin America
International Journal of Gynecology and Obstetrics 129 (2015) 219–222 Contents lists available at ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo CLINICAL ARTICLE Incidence of eclampsia with HELLP syndrome and associated mortality in Latin America Paulino Vigil-De Gracia a,⁎, José Rojas-Suarez b, Edwin Ramos c, Osvaldo Reyes d, Jorge Collantes e, Arelys Quintero f,ErasmoHuertasg, Andrés Calle h, Eduardo Turcios i,VicenteY.Chonj a Critical Care Unit, Department of Obstetrics and Gynecology, Complejo Hospitalario de la Caja de Seguro Social, Panama City, Panama b Critical Care Unit, Clínica de Maternidad Rafael Calvo, Cartagena, Colombia c Department of Gynecology and Obstetrics, Hospital Universitario Dr Luis Razetti, Barcelona, Venezuela d Unit of Research, Department of Gynecology and Obstetrics, Hospital Santo Tomás, Panama City, Panama e Department of Gynecology and Obstetrics, Hospital Regional de Cojamarca, Cajamarca, Peru f Department of Gynecology and Obstetrics, Hospital José Domingo de Obaldía, David, Panama g Unit of Perinatology, Department of Gynecology and Obstetrics, Instituto Nacional Materno Perinatal, Lima, Peru h Department of Gynecology and Obstetrics, Hospital Carlos Andrade Marín, Quito, Ecuador i Unit of Research, Department of Gynecology and Obstetrics, Hospital Primero de Mayo de Seguridad Social, San Salvador, El Salvador j Department of Gynecology and Obstetrics, Hospital Teodoro Maldonado Carbo, Guayaquil, Ecuador article info abstract Article history: Objective: To describe the maternal outcome among women with eclampsia with and without HELLP syndrome Received 7 July 2014 (hemolysis, elevated liver enzymes, and low platelet count). Methods: A cross-sectional study of women with Received in revised form 14 November 2014 eclampsia was undertaken in 14 maternity units in Latin America between January 1 and December 31, 2012. -
Vitamin D, Pre-Eclampsia, and Preterm Birth Among Pregnancies at High Risk for Pre-Eclampsia: an Analysis of Data from a Low-Dos
HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author BJOG. Author Manuscript Author manuscript; Manuscript Author available in PMC 2021 January 29. Published in final edited form as: BJOG. 2017 November ; 124(12): 1874–1882. doi:10.1111/1471-0528.14372. Vitamin D, pre-eclampsia, and preterm birth among pregnancies at high risk for pre-eclampsia: an analysis of data from a low- dose aspirin trial AD Gernanda, HN Simhanb, KM Bacac, S Caritisd, LM Bodnare aDepartment of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA bDivision of Maternal-Fetal Medicine, Magee-Women’s Hospital and Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA cDepartment of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA dDepartment of Obstetrics, Gynecology and Reproductive Sciences and Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA eDepartments of Epidemiology and Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Graduate School of Public Health and School of Medicine, Pittsburgh, PA, USA Abstract Objective—To examine the relation between maternal vitamin D status and risk of pre-eclampsia and preterm birth in women at high risk for pre-eclampsia. Design—Analysis of prospectively collected data and blood samples from a trial of prenatal low- dose aspirin. Setting—Thirteen sites across the USA. Population—Women at high risk for pre-eclampsia. Methods—We measured 25-hydroxyvitamin D [25(OH)D] concentrations in stored maternal serum samples drawn at 12–26 weeks’ gestation (n = 822). We used mixed effects models to Correspondence: LM Bodnar, University of Pittsburgh Graduate School of Public Health, A742 Crabtree Hall, 130 DeSoto St, Pittsburgh, PA 15261, USA. -
Policy of Interventionist Versus Expectant Management of Severe
WHO recommendations Policy of interventionist versus expectant management of severe pre-eclampsia before term WHO recommendations Policy of interventionist versus expectant management of severe pre-eclampsia before term WHO recommendations: policy of interventionist versus expectant management of severe pre-eclampsia before term ISBN 978-92-4-155044-4 © World Health Organization 2018 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. WHO recommendations: policy of interventionist versus expectant management of severe pre-eclampsia before term. Geneva: World Health Organization; 2018. -
Umbilical Cord Prolapse Guideline
Umbilical Cord Prolapse Guideline Document Control Title Umbilical Cord Prolapse Guideline Author Author’s job title Specialty Trainee in Obstetrics and Gynaecology Directorate Department Women’s and Children’s Obstetrics and Gynaecology Date Version Status Comment / Changes / Approval Issued 1.0 Mar Final Approved by the Maternity Services Guideline Group in 2011 April 2011. 1.1 Aug Revision Minor amendments by Corporate Governance to 2012 document control report, headers and footers, new table of contents, formatting for document map navigation. 2.0 Feb Final Approved by the Maternity Services Guideline Group in 2016 February 2016. 2.1 Apr Revision Harmonised with Royal Devon & Exeter guideline 2019 3.0 May Final Approved by Maternity Specialist Governance Forum 2019 meeting on 01.05.2019 Main Contact ST1 O&G Tel: Direct Dial– 01271 311806 North Devon District Hospital Raleigh Park Barnstaple Devon EX31 4JB Lead Director Medical Director Superseded Documents Nil Issue Date Review Date Review Cycle May 2019 May 2022 Three years Consulted with the following stakeholders: (list all) Senior obstetricians Senior midwives Senior management team Filename Umbilical Cord Prolapse Guideline v3. 01May 19.doc Policy categories for Trust’s internal Tags for Trust’s internal website (Bob) website (Bob) Cord, accidents, prolapse Maternity Services Maternity Page 1 of 11 Umbilical Cord Prolapse Guideline CONTENTS Document Control .................................................................................................... 1 1. Introduction -
Low-Lying Placenta
LOW- LYING PLACENTA LOW-LYING PLACENTA WHAT IS PLACENTA PRAEVIA? The placenta develops along with the baby in the uterus (womb) during pregnancy. It connects the baby with the mother’s blood system and provides the baby with its source of oxygen and nourishment. The placenta is delivered after the baby and is also called the afterbirth. In some women the placenta attaches low in the uterus and may be near, or cover a part, or lie over the cervix (entrance to the womb). If it is shown in early ultrasound scans, it is called a low-lying placenta. In most cases, the placenta moves upwards as the uterus enlarges. For some women the placenta continues to lie in the lower part of the uterus in the last months of pregnancy. This condition is known as placenta praevia. If the placenta covers the cervix, this is known as major placenta praevia. Normal Placenta Placenta Praevia Major Placenta Praevia WHAT ARE THE RISKS TO MY BABY AND ME? When the placenta is in the lower part of the womb, there is a risk that you may bleed in the second half of pregnancy. Bleeding from placenta praevia can be heavy, and so put the life of the mother and baby at risk. However, deaths from placenta praevia are rare. You are more likely to need a caesarean section because the placenta is in the way of your baby being born. HOW IS PLACENTA PRAEVIA DIAGNOSED? A low-lying placenta may be suspected during the routine 20-week ultrasound scan. Most women who have a low-lying placenta at the routine 20-week scan will not go on to have a low-lying placenta later in the pregnancy – only 1 in 10 go on to have a placenta praevia. -
Caesarean Section for Placenta Praevia (Consent Advice No
Royal College of Obstetricians and Gynaecologists Consent Advice No. 12 December 2010 CAESAREAN SECTION FOR PLACENTA PRAEVIA This is the first edition of this guidance. This paper provides additional advice for clinicians in obtaining consent of a woman to undergo caesarean section in the specific circumstance of current pregnancy with placenta praevia with or without previous caesarean section. It is designed to be used in conjunction with Consent Advice No. 7: Caesarean section.1 The aim of this paper is to highlight the additional and specific consequences of caesarean section performed in the presence of placenta praevia. The information should, where possible, be provided during the antenatal period in the form of an information sheet to allow the woman to understand the situation and to provide ample opportunities for her to ask any questions she may have and to antenatally meet providers of additional services that may become necessary, such as interventional radiologists. Depending on local clinical governance arrangements, an additional consent form may be used with the addition- al risks highlighted, or the additional risks may be incorporated in a specific consent form for the whole procedure. CONSENT FORM 1. Name of proposed procedure or course of treatment Caesarean section for placenta praevia. 2. The proposed procedure Describe the nature of caesarean section and emphasise how a procedure in the presence of placenta praevia varies in comparison with one performed in the presence of a normally sited placenta. Explain the procedure as described in the patient information. 3. Intended benefits The aim of the procedure is to secure the safest route of delivery to avoid the anticipated risks to the mother and/or baby of the heavy bleeding that would occur during labour and attempted vaginal delivery owing to the position of the placenta. -
Management of Subsequent Pregnancy After an Unexplained Stillbirth
Journal of Perinatology (2010) 30, 305–310 r 2010 Nature Publishing Group All rights reserved. 0743-8346/10 $32 www.nature.com/jp STATE-OF-THE-ART Management of subsequent pregnancy after an unexplained stillbirth SJ Robson1 and LR Leader2 1Department of Obstetrics and Gynaecology, Australian National University, Canberra, Australia and 2School of Women’s and Children’s Health, University of New South Wales, Royal Hospital for Women, Randwick, Australia they face in a subsequent pregnancy, as well as potential Purpose: To review the management of pregnancy after an unexplained management strategies to optimize future pregnancy outcomes.2–4 stillbirth. Unfortunately, as many as one-third of such cases remain Epidemiology: Approximately 1 in 200 pregnancies will end in ‘unexplained’ and unexplained stillbirth is now the commonest stillbirth, of which about one-third will remain unexplained. Unexplained single contributor to perinatal mortality. stillbirth is the largest single contributor to perinatal mortality. There is no evidence that extensive research efforts over the last Subsequent pregnancies do not appear to have an increased risk of two decades have yielded a reduction in the incidence of this 2,5 stillbirth, but are characterized by increased rates of intervention distressing outcome. Virtually all of the published literature is (induction of labor, elective cesarean section) and iatrogenic adverse concerned with population-based strategies for primary prevention outcomes (low birth weight, prematurity, emergency cesarean section and of unexplained stillbirth. However, the commonest situation in post-partum hemorrhage). which clinicians will find themselves is management of women in their next pregnancy after an unexpected unexplained stillbirth. Conclusions: There is no level-one evidence to guide management in Effective care of women in their next pregnancy after an this situation. -
Ophthalmic Associations in Pregnancy
CLINICAL Ophthalmic associations in pregnancy Queena Qin, Celia Chen, Sudha Cugati PREGNANCY RESULTS in various physiological variation in pregnancy.2 It normally changes in the female body, including in fades slowly after pregnancy and does the eyes. A typical pregnancy results in not need active intervention. Background A range of ocular pathology exists cardiovascular, pulmonary, metabolic, • Cornea – corneal thickness, curvature during pregnancy. Some pre-existing eye hormonal and immunological changes. and sensitivity may be altered during conditions, such as diabetic retinopathy, Hormonal changes occur, with a rise of pregnancy. Corneal thickness and can be exacerbated during pregnancy. oestrogen and progesterone levels to curvature can increase in pregnancy, Other conditions manifest for the first suppress the menstrual cycle.1 especially in the second and third time during pregnancy as a result of The eye, an end organ, undergoes trimesters, and return to normal in complications such as pre-eclampsia changes during pregnancy. Some of the postpartum period.3 Patients who and eclampsia. Early recognition and understanding of the management of these changes exacerbate pre-existing wear contact lenses may experience ophthalmic conditions is crucial. eye conditions, while other conditions intolerance to the use of contact lenses. manifest for the first time during Pregnant women should be advised Objective pregnancy. Early recognition and to delay obtaining a new prescription The aim of this article is to discuss the understanding of management of for glasses or undergoing a contact physiological and pathological changes in the eyes of pregnant women. ophthalmic conditions during pregnancy lens fitting until after delivery. Laser Pathological changes are sub-divided is crucial for the primary care physician.