scholarly journals 2021 Update on obstetrics

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Jaimey M Pauli ◽  
Jaimie L. Maines
Keyword(s):  
Gestational Age ◽  
Management Strategies ◽  
Vte Prophylaxis ◽  
Delivery Term

Essential updated guidance on FGR workup and timing of delivery; term and preterm PROM management strategies based on gestational age; and approaches to VTE prophylaxis, including for patients with COVID-19 infection

Human milk mycobiota composition: relationship with gestational age, delivery mode, and birth weight

2020 ◽  
Vol 11 (2) ◽  
pp. 151-162 ◽  
Author(s):  
M. Dinleyici ◽  
V. Pérez-Brocal ◽  
S. Arslanoglu ◽  
O. Aydemir ◽  
S. Sevuk Ozumut ◽  
...  
Keyword(s):  
Human Milk ◽  
Gestational Age ◽  
Caesarean Delivery ◽  
Abundant Species ◽  
Large For Gestational Age ◽  
Delivery Mode ◽  
Mature Milk ◽  
Milk Samples ◽  
Delivery Term ◽  
Spontaneous Delivery

Intestinal and human milk microbiota studies during infancy have shown variations according to geographical location, delivery mode, gestational age, and mother-related factors during pregnancy. In this study, we performed metagenomic mycobiota analyses of 44 transient and mature human milk among five different groups: mothers of normal spontaneous delivery-term (NS-T), caesarean delivery-term (CS-T), premature (PT), small for gestational age (SGA), and large for gestational age (LGA) infants. Fungi were detected in 80 out of the 88 samples. Regarding the number of observed fungal species, the NS-T group was more homogeneous (less variable) comparing the other groups (P<0.05). In the transient human milk samples, the most abundant species were Saccharomyces cerevisiae (33.3%) and Aspergillus glaucus (27.4%). While A. glaucus (33.7%) was second most abundant species in mature milk, S. cerevisiae disappeared (P<0.01) and Penicillium rubens became the most abundant species (35.5%) (P<0.05). Among the NS-T group, the most abundant species was Malassezia globosa in both transient and mature milk. In contrast, S. cerevisiae was the most abundant species in transient human milk (45.0%) in the CS-T group, but it disappeared in mature milk (P<0.01). In transient milk, M. globosa was only represented 6.0-9.0% of taxa in the PT, SGA, and LGA groups (P<0.05). In transient and mature milk in the PT, SGA and LGA groups, the most abundant species were A. glaucus and P. rubens. In mature milk samples, P. rubens is more abundant in CS-T group, PT group and LGA group, than the NS-T groups (P<0.05 for all). Although fungi constitute only a very small part of the human milk microbiome, we observed some changes that the human milk mycobiota composition varies in caesarean delivery, premature, SGA and LGA groups, comparing the normal spontaneous delivery, as well as differences between transient and mature human milk.

scholarly journals Venous Thromboembolism in COVID-19: Are Women Different?

2020 ◽  
Vol 5 (03) ◽  
pp. 200-208
Author(s):  
Shibba Takkar Chhabra ◽  
Prerna Goyal
Keyword(s):  
Health Workers ◽  
Management Strategies ◽  
Epidemiological Data ◽  
Risk Profile ◽  
Baseline Risk ◽  
Critically Ill Patient ◽  
Vte Prophylaxis ◽  
Therapeutic Benefits ◽  
Pregnancy And Postpartum ◽  
Low Exposure

AbstractThe epidemiological data suggests predominant male prevalence, morbidity and mortality with SARS COVID-2. Similarly, venous thromboembolic (VTE) events have a male sex predilection with variant mechanisms involving angiotensin-converting enzyme 2 (ACE-2) expression and pathways in women. COVID-19 could directly affect or it could be an indirect action of the disease via critical ailment hypoxemia, or hemostatic abnormalities might be the underlying mechanisms of VTE in a COVID-19 patient with baseline risk factor profile. VTE diagnosis in a COVID scenario has issues of a prone positioned patient, exposure of health workers and minimal therapeutic benefits in a critically ill patient with acute respiratory distress syndrome (ARDS). Anticoagulation with low-molecular weight heparin (LMWH) can be chosen over unfractionated heparin (UFH) with less monitoring requirements and thereby low exposure to healthcare workers. Variant guidelines for thromboprophylaxis (in hospital/extended postdischarge) have come up, stating anticoagulant administration, according to baseline risk profile and hemostatic biomarkers. Catheter-directed interventions should be reserved only for life-threatening situations. In women, hormonal milieu (for e.g., 17 β-estradiol) might influence occurrence of favorable ACE 2 polymorphisms with less VTE events. The management strategies in a female patient with VTE would be more or less similar to males. Combined oral contraceptives (COC) and estrogen replacement therapies (ERT) may be curtailed in COVID-19 positive patients, given their thrombogenic potential. Pregnancy and postpartum state in COVID-19 positive patient need VTE prophylaxis all the more in the presence of risk profile favoring VTE. Also, VTE prophylaxis when indicated should be continued in women in a normal menstrual cycle. Bleeding risks specific to women (menorrhagia secondary to dysfunctional uterine bleeding [DUB], fibroids, adnexal malignancies and masses, hypothyroidism, etc.) need to be weighed while taking a decision for indicated anticoagulation regimen.

scholarly journals Caucasian and Asian difference in role of type 1 diabetes on large-for-gestational-age neonates

2020 ◽  
Vol 8 (2) ◽  
pp. e001746
Author(s):  
Yanfang Guo ◽  
Rong Luo ◽  
Daniel J Corsi ◽  
Ravi Retnakaran ◽  
Mark C Walker ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Racial Differences ◽  
Gestational Age ◽  
Management Strategies ◽  
Final Analysis ◽  
Population Based ◽  
Large For Gestational Age ◽  
Asian Women ◽  
Multivariable Logistic Regression Model

IntroductionRacial differences in the association between type 1 diabetes mellitus (T1DM) and large-for-gestational-age (LGA) neonates remain unclear. The objective of this study was to compare the effect of T1DM on LGA neonates between Caucasian and Asian women.Research design and methodsA population-based retrospective cohort study was conducted among Caucasian and Asian women who had prenatal screening and gave a singleton live birth in an Ontario hospital between April 2015 and March 2018. Multivariable log-binomial regression models were used to estimate the adjusted relative risks (aRRs) and 95% CIs of T1DM on LGA for Caucasian and Asian women. Relative contribution of T1DM to LGA was examined by multivariable logistic regression model, stratified by Caucasian and Asian women.ResultsA total of 232 503 women (69.4% Caucasians and 30.6% Asians) were included in the final analysis. The rate of T1DM was higher in Caucasians (0.5%) than in Asians (0.2%), and the rate of LGA neonates was also higher in Caucasians (11.0%) than in Asians (5.0%). The association between T1DM and LGA in Caucasians (aRR 4.18, 95% CI (3.84 to 4.55)) was more robust than that in Asians (aRR 2.11, 95% CI (1.24 to 3.59)). T1DM was the fourth strongest contributor to LGA in Caucasians, while T1DM was the seventh contributor to LGA in Asians.ConclusionsT1DM plays a more substantial role in LGA among Caucasians than Asians. Clinicians should be aware of the Caucasian–Asian differences of effects of T1DM on LGA when developing pregnancy management strategies.

scholarly journals Study On Diagnosis And Management Strategies On Heterotopic Pregnancy

2021 ◽  
Author(s):  
Yan Zhang ◽  
Xiujuan Chen ◽  
Yuan Lin ◽  
Chengying Lian ◽  
Xiumei Xiong
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Management Strategies ◽  
Cardiac Activity ◽  
Expectant Management ◽  
Heterotopic Pregnancy ◽  
Miscarriage Rate

Abstract Objective The aims of this study were to analysis the clinical characteristics of women with heterotopic pregnancy (HP) following embryo transfer (ET) and explore the early predictors for pregnancy outcomes.Methods This retrospective study reviewed patients with HP following assisted reproductive technology (ART) in our institution between January 2013 and December 2020. The relationships between pregnancy outcomes and general features, ultrasonic characteristics and different treatment modality were analyzed by logistic regression analysis.Results Fourty patients were identified, including 27 with tubal HP, 7 interstitial HP and 6 cornual HP. The most frequent manifestations before diagnosis was vaginal bleeding (30.0%), while 7 patients (17.5%) had no symptoms before diagnosis. The mean gestational age at symptom onset was 44.8 ± 8.6 days (range 27–68). Gestational age at diagnosis was 49.4 ± 7.6 days (range 29–68). Among these cases, twenty-nine patients of HP were accurately diagnosed by transvaginal ultrasonography (TVS). Hence, the sensitivity of TVS for detecting HP was 72.5% (29/40). Eleven patients received expectant management, while 29 patients underwent laparotomy (13/29) or laparoscopy (16/29) surgery. Gestational age at surgery day was 51.0±8.6 days (range 33–67). Live births occurred for 18 patients in the surgery group, 3 of whom delivered preterm. Additionally, the miscarriage rate was lower for patients with IUP cardiac activity (16.7% vs. 90.0%) than patients without IUP cardiac activity at HP diagnosis (P < 0.001). Further by logistic regression analysis, an IUP with cardiac activity at HP diagnosis was identified as an independent factors of pregnancy outcome (P<0.001).Conclusions Symptoms combined with routine TVS scans could reduce misdiagnosis and facilitate the diagnosis of HP. An IUP with cardiac activity at HP diagnosis as predictors for a favorable prognosis of HP. Prompt surgical intervention after diagnosis may minimize the incidence of abortion of IUP.

Resuscitation Decisions for Extremely Premature Infants: A UK NICU Experience

2021 ◽  
pp. 097321792110597
Author(s):  
Jennifer Peterson ◽  
Mia Kahvo ◽  
Ramiyya Tharumakunarajah ◽  
Nabiah Malik ◽  
Ranganath Ranganna
Keyword(s):  
Premature Infants ◽  
Gestational Age ◽  
Perinatal Care ◽  
Management Strategies ◽  
Age Groups ◽  
P Value ◽  
Chest Compressions ◽  
Infant Outcomes ◽  
Antenatal Steroids ◽  
Extremely Preterm

Background: Improvements in extreme preterm infant outcomes have led to an increasing recognition of the importance of antenatal optimization and delivery room (DR) management strategies for these infants. Methods: Retrospective cohort evaluation of every infant born at 22+0 to 25+6 weeks gestation in St Mary’s tertiary NICU between 2008 and 2018. Aiming to evaluate utilization of chest compressions and resuscitation medications during DR-resuscitation of extremely premature infants. Results: This study found that 90% of infants 22+0 to 22+6 weeks did not receive antenatal steroids. Whereas, for infants born between 23+0 and 23+6 weeks gestation, 75% did receive antenatal steroids. This difference is significant ( P value = .00006). This study shows there is a predisposition to not provide DR-chest compressions (DR-CC) and/or adrenaline (DR-CC+/−A) to extremely preterm For infants. Infants that received DR-CC, there was no statistically significant increase in death and no clear association with poorer long-term outcomes in survivors. Conclusions: Marked differences in provision of perinatal care were found dependent on gestational age. If infants are inadequately prepared for delivery and resuscitative measures are not fully utilized, it cannot be clear whether subsequently increased rates of death in the lower gestational age groups are solely due to gestational age or are influenced by the lack of preparative management.

Improving Speech and Language Services through Effective Time Management

1983 ◽  
Vol 14 (2) ◽  
pp. 86-91 ◽  
Author(s):  
Barbara W. Travers
Keyword(s):  
Time Management ◽  
Management Strategies ◽  
Federal State ◽  
Speech Language Pathologist ◽  
School Based ◽  
Work Area ◽  
Paper Work ◽  
Areas Of Concern ◽  
State And Local ◽  
Therapeutic Services

This paper presents strategies for increasing the effectiveness and efficiency of the school-based speech-language pathologist. Various time management strategies are adapted and outlined for three major areas of concern: using time, organizing the work area, and managing paper work. It is suggested that the use of such methods will aid the speech-language pathologist in coping with federal, state, and local regulations while continuing to provide quality therapeutic services.

A Case Study: Unique Challenges of an Adolescent Female With Autism Spectrum Disorder

2020 ◽  
Vol 5 (1) ◽  
pp. 314-325
Author(s):  
Kimberly F. Frazier ◽  
Jessica Collier ◽  
Rachel Glade
Keyword(s):  
Autism Spectrum Disorder ◽  
Cognitive Abilities ◽  
Social Cognitive ◽  
Social Performance ◽  
Management Strategies ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Self Management ◽  
Adolescent Female ◽  
Social Thinking

Background The aim of this study was to determine the clinical efficacy of combining self-management strategies and a social thinking approach to address the social performance and executive function of an adolescent female with autism spectrum disorder. Method This research examined the effects of a social knowledge training program, “Think Social,” as well as strategies to improve higher order cognitive abilities. Results and Conclusion Although quantitative improvement was not found, several qualitative gains in behavior were noted for the participants of this study, suggesting a benefit from using structured environmental cues of self-management strategies, as well as improved social understanding through social cognitive training.

Prevalence of Speech Problems and the Use of Augmentative and Alternative Communication in Children With Cerebral Palsy: A Registry-Based Study in Norway

2010 ◽  
Vol 19 (1) ◽  
pp. 12-20 ◽  
Author(s):  
Guro Andersen ◽  
Tone R. Mjøen ◽  
Torstein Vik
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Gestational Age ◽  
Augmentative And Alternative Communication ◽  
Alternative Communication ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Children With Cerebral Palsy ◽  
Communicative Abilities ◽  
Normal Speech

Abstract This study describes the prevalence of speech problems and the use of augmentative and alternative communication (AAC) in children with cerebral palsy (CP) in Norway. Information on the communicative abilities of 564 children with CP born 1996–2003, recorded in the Norwegian CP Registry, was collected. A total of 270 children (48%) had normal speech, 90 (16%) had slightly indistinct speech, 52 (9%) had indistinct speech, 35 (6%) had very indistinct speech, 110 children (19%) had no speech, and 7 (1%) were unknown. Speech problems were most common in children with dyskinetic CP (92 %), in children with the most severe gross motor function impairments and among children being totally dependent on assistance in feeding or tube-fed children. A higher proportion of children born at term had speech problems when compared with children born before 32 weeks of gestational age 32 (p > 0.001). Among the 197 children with speech problems only, 106 (54%) used AAC in some form. Approximately 20% of children had no verbal speech, whereas ~15% had significant speech problems. Among children with either significant speech problems or no speech, only 54% used AAC in any form.

Understanding Limited Use of Amplification in Infants and Children Who Are Hard of Hearing

2015 ◽  
Vol 25 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Ryan W. McCreery ◽  
Elizabeth A. Walker ◽  
Meredith Spratford
Keyword(s):  
Hard Of Hearing ◽  
Hearing Aid ◽  
Management Strategies ◽  
Infants And Children ◽  
Future Research ◽  
Research Needs ◽  
Case Examples ◽  
Hearing Aid Use ◽  
Wide Range ◽  
In Infants And Children

The effectiveness of amplification for infants and children can be mediated by how much the child uses the device. Existing research suggests that establishing hearing aid use can be challenging. A wide range of factors can influence hearing aid use in children, including the child's age, degree of hearing loss, and socioeconomic status. Audiological interventions, including using validated prescriptive approaches and verification, performing on-going training and orientation, and communicating with caregivers about hearing aid use can also increase hearing aid use by infants and children. Case examples are used to highlight the factors that influence hearing aid use. Potential management strategies and future research needs are also discussed.

Modulation of birthweight through gestational age and fetal growth

1996 ◽  
Vol 22 (1) ◽  
pp. 37-53 ◽  
Author(s):  
E Petridou ◽  
D Trichopoulos ◽  
K Revinthi ◽  
D Tong ◽  
E Papathoma
Keyword(s):  
Fetal Growth ◽  
Gestational Age
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