List of Articles
- Maternal Obesity and Impact on Fetal Brain Development
Obesity is preventable. Body mass index (BMI) calculated at the first prenatal visit should be used to provide diet and exercise counseling. Because even small weight reduction before pregnancy in women with obesity may be associated with improved pregnancy outcomes, weight loss before pregnancy should be encouraged. Optimal control of obesity begins before pregnancy. The problems go beyond fetal metabolic programming. Maternal obesity has effects on fetal neurodevelopment. Impaired dopaminergic signaling has been implicated in the development of certain psychiatric disorders in humans. The effect of maternal obesity, high fat diet, and gestational weight gain on fetal neurodevelopment and offspring behavior is also the focus of this review. For patients with prepregnancy BMI of 35.0 – 39.9, weekly antenatal fetal surveillance may be considered beginning by 37 0/7 weeks of gestation. For patients with pre-pregnancy BMI 40 or greater, weekly antenatal fetal surveillance may be considered beginning at 34 0/7 weeks of gestation. Weight-based dosage for venous thromboembolism thromboprophylaxis may be considered rather than BMI-stratified dosage strategies in class III obese women after cesarean delivery. Consultation with anesthesia service should be considered for obese pregnant woman with obstructive sleep apnea, because they are at an increased risk of hypoxemia, hypercapnia, and sudden death. - Newborn Exposed to HIV: Prevention, Evaluation & Management
This review offers guidance on the evaluation and management of infants born to women with Human Immunodeficiency Virus (HIV) infection. In addition to standard clinical care for the newborn infant, it is important that appropriate steps are taken for early detection of HIV infection, appropriate vaccines are administered, and adequate counseling is provided to families living with HIV infection. Prevention of mother-to-child transmission of HIV is the best treatment. Early detection and proper management saves lives and long-term effects. Intrapartum administration of IV Zidovudine (ZDV) provides antiretroviral pre-exposure prophylaxis at a time when infants are at increased risk of exposure to maternal blood and body fluids. IV ZDV also is recommended for those with an initial diagnosis of HIV during labor and pregnant people with HIV whose HIV RNA level is unknown. For infants who are at high risk of perinatal HIV infection, virologic diagnostic testing in recommended at birth and at 2 to 6 weeks after antiretroviral (ARV) drugs are discontinued. Definitive exclusion of HIV infection in non-breastfed infants is based on two or more negative virologic tests conducted after infants have completed ARV prophylaxis or presumptive HIV therapy, with one negative test obtained at age >1 month and one at age >4 months, or two negative HIV antibody tests form separate specimens that were obtained at age > 6 months. - Rare Clotting Factor Deficiencies
The purpose of this document is to identify rare clotting factor deficiencies and management. By definition, rare factor deficiencies have a prevalence of less than 200,000 in the US population, or an incidence of less than 1 in 2,000 in Europe. The very small numbers of patients with rare clotting factor disorders present challenges in diagnosis, evaluation of bleeding risk and treatment. Use of new assays, full genome sequencing, and global clotting assays will significantly improve diagnosis of patients with rare bleeding disorders. Rare clotting factor deficiencies are bleeding disorders in which one of the other factors (i.e. factor I, II, V, V + VIII, VII, X, XI, or XIII) is missing or not working properly. Less is known about these disorders because they are diagnosed so rarely. In fact, many have only been discovered in the last 40 years. Understanding the pathophysiology, presentation, and treatment options for rare bleeding disorders is critical to facilitate genetic counseling, optimal patient management, and improved long-term outcomes. Ongoing efforts continue to promote international data harmonization. In the United States, the American Thrombosis and Hemostasis Network is expanding its data collection system to assure inclusion of individuals with rare bleeding disorders followed through the US federal Hemophilia Treatment Center Network. - Hemophilia: A Comprehensive Review
The review identifies the etiology of hemophilia, literature review the evaluation of hemophilia, outlines the treatment and management options available for hemophilia and describes interprofessional team strategies for improving care coordination and communication to advance hemophilia and improve outcomes. The principal aim of care should be to avoid and treat bleeding. The patient should receive treatment in a comprehensive treatment center where interprofessional services are offered at all times to the patients and their families. Hemophilia should be considered in the neonatal period in the case of unusual bleeding or in case of positive family history. The outlook for most hemophilia A is guarded. Repeated transfusions of blood products and related factors is not being event. Additionally, these patients are prone to bleeding, which can be life-threatening. Adeno-associated virus (AAV)- mediated gene transfer has successfully raised, and in some cases transiently normalized, FVIII or FIX activity levels in adults with severe hemophilia. Hemophilia dose not predispose to any mental illness, but the person with hemophilia and his environment may greatly benefit from having professionals help them manage to adapt to the disease.
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Women's Health & Education Center
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Dedicated to Women's and Children's Well-being and Health Care Worldwide
www.womenshealthsection.com