Neuroprotection
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The document discusses guidelines for using magnesium sulfate to reduce the risk of cerebral palsy in preterm infants. It describes protocols for magnesium sulfate administration before imminent preterm birth between 23-33 weeks gestation. Magnesium sulfate is thought to exert neuroprotective effects through vasodilation, anti-inflammatory actions, and modulation of NMDA receptors. Larger clinical trials and meta-analyses support the efficacy and safety of magnesium sulfate for reducing cerebral palsy.
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Magnesium Sulfate for Neuroprotection .pptx
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thanks.
1471 2393-13-91
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01
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This document discusses the use of magnesium sulfate in treating neonatal seizures. It provides dosing and administration guidelines for magnesium sulfate via intravenous infusion to treat seizures refractory to other anticonvulsants, hypomagnesaemia, and severe persistent pulmonary hypertension. Possible adverse effects and special considerations are also outlined. The document also examines the use of magnesium sulfate in reducing mortality and neurological morbidity in neonates with moderate to severe perinatal asphyxia.
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This document discusses the use of steroids in neonatology, including both antenatal and postnatal applications. It begins by introducing the current recommendations for antenatal steroid therapy to reduce neonatal morbidity and mortality. It then covers the classification, mechanisms of action, benefits and considerations for administration of antenatal corticosteroids. It also discusses the use of postnatal steroids in the NICU to treat conditions like chronic lung disease. While noting both the benefits and risks, it concludes that postnatal steroids should be reserved for high-risk preterm infants who remain ventilator-dependent beyond 2-3 weeks of age.
CƠ CHẾ PHÒNG NGỪA BẠO NÃO MgSO4
Magnesium sulfate is being studied for its potential neuroprotective effects in preventing cerebral palsy. Several studies have investigated administering magnesium sulfate either postnatally to newborns with hypoxic-ischemic encephalopathy or antenatally to mothers at risk of preterm birth. While some individual studies found magnesium sulfate improved short-term outcomes like reducing brain lesions or improving outcomes at hospital discharge, the larger trials found no clear statistically significant benefits. Overall the evidence remains unclear whether magnesium sulfate administration prevents long-term disabilities like cerebral palsy, though some studies found signals of potential benefit worth further investigation. Larger multicenter trials are still needed to provide more definitive evidence.
C059553
This document provides guidelines for managing preterm labor, including recommendations on diagnosing preterm labor, treating it with tocolytic drugs and antibiotics, administering antenatal corticosteroids, and special clinical situations. It recommends using ultrasonography and fetal fibronectin testing to determine risk of preterm delivery. For treatment, it finds limited benefit from tocolytic drugs and no clear preferred drug. Antibiotics are not recommended solely to prevent preterm delivery. Antenatal corticosteroids significantly reduce neonatal respiratory issues and mortality.
Antenatal corticosteroids
This document discusses the use of antenatal corticosteroids (ACS) to improve outcomes for preterm infants. It finds that ACS reduces rates of respiratory distress syndrome, mortality, intraventricular hemorrhage and necrotizing enterocolitis in preterm neonates when administered to mothers between 24-34 weeks of gestation who are at risk of preterm birth within 7 days. The mechanisms of action include accelerating lung development. Either betamethasone or dexamethasone can be used, though dexamethasone is preferred in India due to drug availability. Guidelines recommend ACS use in specified high-risk populations, but not as routine care before elective c-sections or beyond 34 weeks
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Neural tube defects occur when the neural tube fails to close properly during early embryonic development. This document discusses several types of neural tube defects including anencephaly, myelomeningocele (spina bifida), and meningocele. It covers the pathophysiology, clinical presentation, diagnostic evaluation, management including surgical repair, and long term prognosis of those affected. Prevention through adequate folic acid intake before and during early pregnancy is also discussed.
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This document provides protocols for various neonatal conditions presented by Dr. Nishant Prabhakar and moderated by Dr. M. Lazarus on 6/12/2016. It includes guidelines on hyperbilirubinemia, neonatal seizures, hypoglycemia, and neonatal sepsis. For hyperbilirubinemia and sepsis, it outlines risk factors, diagnostic criteria, treatment guidelines including phototherapy and antibiotic protocols. For other conditions, it summarizes evaluation and management recommendations from sources such as the American Academy of Pediatrics and AIIMS.
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Kpsc diabetes in pregnancy pathway 8.6.2012
The document outlines guidelines for managing diabetes in pregnancy across medical centers. It discusses:
1. Individual centers being graded on compliance with performing HbA1c tests on all prenatal patients and FBS tests for GDM patients at 6 weeks postpartum. Bonuses may be tied to these performance measures.
2. Risk stratification of patients into low, medium, and high risk groups based on diabetes history and control. This determines interventions like medication management and fetal monitoring.
3. Screening all prenatal patients for GDM risk and providing diabetes education. High risk patients receive early glucose testing while low risk patients are tested at 24-28 weeks.
4. Postpartum follow-up
Economy
The document discusses issues with the current scheduling system including too many changes and vague requests. It proposes implementing scheduled cesarean sections on call days to improve efficiency by ensuring the primary surgeon performs the surgery and eliminating wasted time. This could add 30 hours of clinic access per month. Some providers argue they are too busy, but deliveries have decreased so scheduling cesareans this way could help protect staffing levels. No more than 2 cesareans would be scheduled per provider per call day.
Twins clinical management 2012
This document provides guidelines for managing twin pregnancies, including determining chorionicity and amnioticity. It recommends that all twins undergo an NT ultrasound before 14 weeks to validate chorionicity/amnionicity and detect early complications. Management of monochorionic twins requires more intensive surveillance due to increased risks of complications affecting fetal growth and well-being. Dichorionic twins generally require less frequent monitoring while monochorionic twins should be monitored more closely, with delivery planned before 37 weeks.
New Progesterone Guideline for Preterm labor and incidental shortened cervix
This document summarizes recommendations for using progesterone to prevent preterm birth based on a woman's history and cervical length. It recommends 17-hydroxyprogesterone caproate injections weekly from 16-20 weeks until 36 weeks for women with a prior spontaneous preterm birth. For women without a prior preterm birth but an incidental short cervical length of 10-20mm before 24 weeks, it recommends daily vaginal progesterone until 36 weeks. Safety follow-up of children exposed to 17-hydroxyprogesterone caproate in clinical trials found no differences compared to placebo.
Medication 53333-phpapp02
The document discusses improving patient satisfaction scores related to communication about medications at Riverside Medical Center's maternity service. The goal is to increase the HCAHPS medication communication score from 66% to 75% by December 2012 and 85% by June 2013. This will be achieved through education of providers, patients, and staff. Providers will be educated on medications through meetings and flashcards. Patients will receive verbal and written information about new medications. Staff will track medication discussions on patient care boards. Progress will be measured through education documentation and eventual HCAHPS scores.
Hcahps score trends in the past 4 years
This document shows trends in patient experience scores over 4 years from 2008-2012 at KP Riverside Medical Center based on the HCAHPS survey. The line graphs depict scores for various measures related to nurse and doctor communication, responsiveness of staff, pain management, medication communication, discharge processes, cleanliness and quietness. Scores fluctuate over time but generally remain between 60-90% for most measures.
Coccidioidomycosis in pregnancy
This document discusses coccidioidomycosis (Valley fever) during pregnancy. It notes that the infection is more severe when acquired during pregnancy, especially in the third trimester, and that the use of azole antifungals during pregnancy can be teratogenic. It reviews literature on cases of coccidioidomycosis in pregnancy and the effect of sex hormones on fungal growth. It also discusses the risk of birth defects from azole exposure during pregnancy, specifically the Antley-Bixler syndrome. The document provides recommendations for managing coccidioidomycosis in pregnant women based on their infection status and trimester.
Von willebrands disease
Von Willebrand disease is the most common inherited bleeding disorder caused by mutations that decrease or impair von Willebrand factor, which promotes platelet adhesion and clotting. It ranges from mild to severe. Type I is the most common form with a quantitative deficiency, while type II has qualitative defects affecting function. Treatment involves desmopressin, which releases stored VWF, or VWF replacement for refractory or severe cases. Careful management is needed around procedures and delivery to maintain adequate VWF and factor VIII levels through replacement to prevent bleeding.
Hini2012 update
The document provides guidelines for evaluating and managing patients with influenza-like illness (ILI) during pregnancy. It describes the symptoms of ILI and H1N1 flu. Patients with mild ILI symptoms and no risk factors can be treated as outpatients, while those with concerning signs, comorbidities, or symptom progression warrant further evaluation and treatment including Tamiflu and possible hospitalization.
Pph share drive
This document discusses the management of postpartum hemorrhage (PPH). It defines PPH and risk factors. It outlines the roles and responsibilities of the nursing team in responding to a PPH. It also details the differential diagnosis, initial resuscitation steps, and therapeutic escalation based on the severity of bleeding and patient's response to treatment. The goal is to recognize and treat PPH early through decisive clinical response and prevent complications like shock.
Late preterm delivery
Late preterm infants born between 34 0/7 and 36 6/7 weeks have higher rates of morbidity than full term infants. During the initial birth hospitalization, late preterm infants are more likely to experience conditions like temperature instability, hypoglycemia, respiratory distress, and jaundice. The risks are even higher for late preterm infants whose mothers have complications like hypertension, diabetes, bleeding, or infections. Readmission rates within the first year are also higher, around 15%, for late preterm infants compared to full term infants. Late preterm infants also have higher mortality rates within the first year of life and are at greater risk for long-term neurodevelopmental issues.
Insulin resistance and pcos
The document summarizes key findings from a review of literature on polycystic ovary syndrome (PCOS). It finds that the most consistent predictors of PCOS are hyperandrogenemia (high levels of "male" hormones) in 60-80% of cases, hirsutism (excess hair growth) in 60% of cases, and polycystic ovaries in 75% of cases. It also discusses debates around definitions of PCOS and relationships with insulin resistance.
Induction summary
This document provides guidelines for induction of labor, including:
1. Recommending inpatient and outpatient Cytotec inductions arrive at 7:00 PM to facilitate admission/discharge decisions and additional Cytotec doses if needed.
2. Inpatient Pitocin-only inductions should arrive at 6:00 AM to start Pitocin before 7:00 AM.
3. Favorable criteria for induction include a modified Bishop score of 6 or more and cervical dilation of 3-4 cm for nulliparous patients.
Hyperemesis6 12
Hyperemesis Gravidarum is a condition characterized by persistent and severe nausea and vomiting during pregnancy. It can lead to weight loss of 5% or more of the woman's pre-pregnancy weight and the presence of ketones in the urine. Potential causes include multiple gestation, trophoblastic disease, or genetic conditions like trisomy 21. Treatment focuses on managing symptoms, avoiding triggers, dietary changes, medications like antihistamines, phenothiazines, and serotonin antagonists. Intravenous fluids and supplementation of vitamins and minerals may be needed to address nutritional deficiencies and prevent complications like Wernicke's encephalopathy. Enteral nutrition through nasojejunal feeding tubes is preferable to parent
Gbs 2010
The document summarizes changes to CDC guidelines for prevention of early-onset group B streptococcal (GBS) disease. Key changes include: expanded laboratory detection options for GBS; revised thresholds for reporting GBS in urine cultures; clarified definitions of adequate antibiotic prophylaxis and high risk for anaphylaxis; and adjustments to neonatal management algorithms to reduce unnecessary evaluations. Guidelines emphasize using cefazolin over clindamycin or vancomycin when possible for penicillin-allergic women.
Foley bulb
The document discusses the use of Foley bulbs for cervical ripening and labor induction. It finds that:
1) A Foley bulb induction is as effective as common prostaglandin methods like misoprostol for cervical ripening and inducing labor, with fewer risks of complications.
2) Inflating the Foley bulb to 60-80ml is more effective for cervical dilation and shorter delivery times than only inflating to 30ml.
3) Using a Foley bulb alone without additional prostaglandins or oxytocin is equally effective while avoiding increased need for pain management.
Fht interpretation & management
This document provides guidelines for the management and interpretation of intrapartum fetal heart rate tracings. It discusses important factors to consider when interpreting tracings such as gestational age, maternal conditions, and fetal conditions. It describes the physiology underlying different fetal heart rate patterns. It also presents the NICHD nomenclature for standardized description of tracings, including definitions for baseline rate, variability, accelerations, and decelerations. Tracings are categorized as Category I, II, or III based on patterns that reflect fetal acid-base status. Category I tracings are normal while Category III tracings indicate abnormal fetal status and need for prompt evaluation and treatment.
Asymptomatic short cervix and vaginanal, progesterone
1. Vaginal progesterone reduces preterm birth in women with an asymptomatic sonographic short cervix in the midtrimester. The meta-analysis found vaginal progesterone once daily from identification of a short cervix <25mm until 37 weeks decreases preterm birth <33 weeks by 45% and decreases neonatal morbidity and mortality.
2. Treatment with vaginal progesterone was associated with significant reductions in preterm birth before 28 weeks, 33 weeks, and 35 weeks as well as composite neonatal morbidity and mortality.
3. There were no significant differences in adverse maternal events or congenital anomalies between the vaginal progesterone and placebo groups.
Prevention of pertussis
The document discusses pertussis (whooping cough) prevention, treatment, and epidemiology. It provides guidelines for vaccinating pregnant women and new mothers with Tdap to prevent transmission to infants. It describes the symptoms and phases of pertussis, recommends antibiotic treatment and prophylaxis, and defines close contacts for evaluation and post-exposure prophylaxis. Pertussis cases are increasing significantly in California and infants are most at risk for severe disease.
Labor down
1) Studies on delayed pushing, also called "laboring down", have shown mixed results, with the main consistent benefit being a reduced need for operative vaginal deliveries in nulliparous women with epidurals.
2) Delaying pushing can prolong the second stage of labor by about an hour and may increase risks like chorioamnionitis with delays over 1 hour.
3) Delayed pushing may be considered for nulliparous women with epidurals who do not have an urge to push and the fetal head is not yet at station +2, as long as the fetal heart rate is reassuring and no other risk factors exist. The delay should not exceed 90 minutes.
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- 1. Magnesium Sulfate Neuroprotection GUIDELINES FOR REDUCTION OF Cerebral Palsy NOVEMBER 2010 CP results in Motor & Postural Dysfunction Commonly associated with Mental disability, and Abnormalities of Vision , Hearing , and Speech