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Pregnancy HELP
Based on 100,000 articles published since 2008
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These are the 100000 published articles about Pregnancy that originated from Worldwide during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
1 Guideline Screening for Elevated Blood Lead Levels in Children and Pregnant Women: US Preventive Services Task Force Recommendation Statement. 2019

Anonymous4641133 / Curry, Susan J / Krist, Alex H / Owens, Douglas K / Barry, Michael J / Cabana, Michael / Caughey, Aaron B / Doubeni, Chyke A / Epling, John W / Kemper, Alex R / Kubik, Martha / Landefeld, C Seth / Mangione, Carol M / Pbert, Lori / Silverstein, Michael / Simon, Melissa A / Tseng, Chien-Wen / Wong, John B. ·University of Iowa, Iowa City. · Fairfax Family Practice Residency, Fairfax, Virginia. · Virginia Commonwealth University, Richmond. · Veterans Affairs Palo Alto Health Care System, Palo Alto, California. · Stanford University, Stanford, California. · Harvard Medical School, Boston, Massachusetts. · University of California, San Francisco. · Oregon Health & Science University, Portland. · University of Pennsylvania, Philadelphia. · Virginia Tech Carilion School of Medicine, Roanoke. · Nationwide Children's Hospital, Columbus, Ohio. · Temple University, Philadelphia, Pennsylvania. · University of Alabama at Birmingham. · University of California, Los Angeles. · University of Massachusetts Medical School, Worcester. · Boston University, Boston, Massachusetts. · Northwestern University, Evanston, Illinois. · University of Hawaii, Honolulu. · Pacific Health Research and Education Institute, Honolulu, Hawaii. · Tufts University, Medford, Massachusetts. ·JAMA · Pubmed #30990556.

ABSTRACT: Importance: Elevated blood lead levels in children are associated with neurologic effects such as behavioral and learning problems, lower IQ, hyperactivity, hearing problems, and impaired growth. In pregnant women, lead exposure can impair organ systems such as the hematopoietic, hepatic, renal, and nervous systems, and increase the risk of preeclampsia and adverse perinatal outcomes. Many of the adverse health effects of lead exposure are irreversible. Objective: To update the 2006 US Preventive Services Task Force (USPSTF) recommendation on screening for elevated blood lead levels in children and pregnant women. Evidence Review: The USPSTF reviewed the evidence on the benefits and harms of screening for and treatment of elevated blood lead levels. In this update, an elevated blood lead level was defined according to the Centers for Disease Control and Prevention reference level of 5 μg/dL. Findings: The USPSTF found adequate evidence that questionnaires and other clinical prediction tools to identify asymptomatic children with elevated blood lead levels are inaccurate. The USPSTF found adequate evidence that capillary blood testing accurately identifies children with elevated blood lead levels. The USPSTF found inadequate evidence on the effectiveness of treatment of elevated blood lead levels in asymptomatic children 5 years and younger and in pregnant women. The USPSTF found inadequate evidence regarding the accuracy of questionnaires and other clinical prediction tools to identify asymptomatic pregnant women with elevated blood lead levels. The USPSTF found inadequate evidence on the harms of screening for or treatment of elevated blood lead levels in asymptomatic children and pregnant women. The USPSTF concluded that the current evidence is insufficient, and that the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic children 5 years and younger and in pregnant women cannot be determined. Conclusions and Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic children. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic pregnant persons. (I statement).

2 Guideline Interventions to Prevent Perinatal Depression: US Preventive Services Task Force Recommendation Statement. 2019

Anonymous3491079 / Curry, Susan J / Krist, Alex H / Owens, Douglas K / Barry, Michael J / Caughey, Aaron B / Davidson, Karina W / Doubeni, Chyke A / Epling, John W / Grossman, David C / Kemper, Alex R / Kubik, Martha / Landefeld, C Seth / Mangione, Carol M / Silverstein, Michael / Simon, Melissa A / Tseng, Chien-Wen / Wong, John B. ·University of Iowa, Iowa City. · Fairfax Family Practice Residency, Fairfax, Virginia. · Virginia Commonwealth University, Richmond. · Veterans Affairs Palo Alto Health Care System, Palo Alto, California. · Stanford University, Stanford, California. · Harvard Medical School, Boston, Massachusetts. · Oregon Health & Science University, Portland. · Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York. · University of Pennsylvania, Philadelphia. · Virginia Tech Carilion School of Medicine, Roanoke. · Kaiser Permanente Washington Health Research Institute, Seattle. · Nationwide Children's Hospital, Columbus, Ohio. · Temple University, Philadelphia, Pennsylvania. · University of Alabama at Birmingham. · University of California, Los Angeles. · Boston University, Boston, Massachusetts. · Northwestern University, Evanston, Illinois. · University of Hawaii, Honolulu. · Pacific Health Research and Education Institute, Honolulu, Hawaii. · Tufts University, Medford, Massachusetts. ·JAMA · Pubmed #30747971.

ABSTRACT: Importance: Perinatal depression, which is the occurrence of a depressive disorder during pregnancy or following childbirth, affects as many as 1 in 7 women and is one of the most common complications of pregnancy and the postpartum period. It is well established that perinatal depression can result in adverse short- and long-term effects on both the woman and child. Objective: To issue a new US Preventive Services Task Force (USPSTF) recommendation on interventions to prevent perinatal depression. Evidence Review: The USPSTF reviewed the evidence on the benefits and harms of preventive interventions for perinatal depression in pregnant or postpartum women or their children. The USPSTF reviewed contextual information on the accuracy of tools used to identify women at increased risk of perinatal depression and the most effective timing for preventive interventions. Interventions reviewed included counseling, health system interventions, physical activity, education, supportive interventions, and other behavioral interventions, such as infant sleep training and expressive writing. Pharmacological approaches included the use of nortriptyline, sertraline, and omega-3 fatty acids. Findings: The USPSTF found convincing evidence that counseling interventions, such as cognitive behavioral therapy and interpersonal therapy, are effective in preventing perinatal depression. Women with a history of depression, current depressive symptoms, or certain socioeconomic risk factors (eg, low income or young or single parenthood) would benefit from counseling interventions and could be considered at increased risk. The USPSTF found adequate evidence to bound the potential harms of counseling interventions as no greater than small, based on the nature of the intervention and the low likelihood of serious harms. The USPSTF found inadequate evidence to assess the benefits and harms of other noncounseling interventions. The USPSTF concludes with moderate certainty that providing or referring pregnant or postpartum women at increased risk to counseling interventions has a moderate net benefit in preventing perinatal depression. Conclusions and Recommendation: The USPSTF recommends that clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions. (B recommendation).

3 Guideline Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older - United States, 2019. 2019

Kim, David K / Hunter, Paul. · ·MMWR Morb Mortal Wkly Rep · Pubmed #30730868.

ABSTRACT: In October 2018, the Advisory Committee on Immunization Practices (ACIP)* voted to recommend approval of the Recommended Immunization Schedule for Adults, Aged 19 Years or Older, United States, 2019. The 2019 adult immunization schedule, available at https://www.cdc.gov/vaccines/schedules,

4 Guideline Care of Women with Obesity in Pregnancy: Green-top Guideline No. 72. 2019

Denison, F C / Aedla, N R / Keag, O / Hor, K / Reynolds, R M / Milne, A / Diamond, A / Anonymous1491094. · ·BJOG · Pubmed #30465332.

ABSTRACT: -- No abstract --

5 Guideline None 2019

Bouillet, Laurence / Defendi, Frederica / Hardy, Gaelle / Cesbron, Jean Yves / Boccon-Gibod, Isabelle / Deroux, Alban / Mansard, Catherine / Launay, David / Gompel, Anne / Floccard, Bernard / Jaussaud, Roland / Beaudouin, Etienne / Armengol, Guillaume / Olliver, Yann / Gayet, Stephane / Du Than, Aureli / Sailler, Laurent / Guez, Stephane / Sarrat, Anne / Sorin, Lucile / de Moreuil, Claire / Pelletier, Fabien / Javaud, Nicolas / Marmion, Nicolas / Fain, Olivier / Fauré, Julien / Dumestre-Pérard, Chantal. ·Université Grenoble Alpes (UGA), service de médecine interne, CHUGA, unité Inserm 1036, Grenoble, France; Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France. Electronic address: lbouillet@chu-grenoble.fr. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; Service d'immunologie, CHUGA, 38043 Grenoble, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; Laboratoire de biochimie génétique et moléculaire, CHUGA, 38043 Grenoble, France. · Université Grenoble Alpes (UGA), service de médecine interne, CHUGA, unité Inserm 1036, Grenoble, France; Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; CHU de Lille, université de Lille, département de médecine interne et immunologie clinique, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), 59000 Lille, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; Université Paris Descartes, hôpitaux universitaires Cochin, hôtel-dieu Broca, Inserm U 1007, 75014 Paris, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; Hôpital Edouard-Herriot, hospices civils de Lyon, département d'anesthésie-réanimation, 69000 Lyon, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; CHRU de Nancy et université de Lorraine, département de médecine interne immunologie clinique, 54035 Nancy, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; CH Emile Durkheim, service d'allergologie, 88021 Epinal, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; CHU de Rouen, service de médecine interne, 76000 Rouen, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; CHU de Caen, service d'allergologie, pôle médecine de spécialité, 14033 Caen, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; Hôpital de la Timone, service de médecine interne, Marseille, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; CHU de Montpellier, université Montpellier, service de dermatologie, 13005 Montpellier, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; CHU de Toulouse, service de médecine interne, Toulouse université, 34090 Toulouse, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; CHU de Bordeaux-GH Pellegrin, service de médecine interne et post-urgences, 31059 Bordeaux, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; CHU de Bordeaux, laboratoire d'immunologie et immunogénétique, 33000 Bordeaux, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; Centre hospitalier de Niort, service de médecine interne, 79000 Niort, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; CHU de Brest, service de médecine interne, GETBO - EA3878, 29200 Brest, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; Université de Franche-Comté, CHU de Besançon, unité de dermatologie-allergologie, Inserm 1098, 25030 Besançon, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; AP-HP, Urgences, université Paris 7, hôpital Louis-Mourier, 92700 Colombes, France. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; CHU de Saint Pierre, médecine polyvalente Saint Louis, 97448 Saint Pierre, Réunion. · Centre de référence national des angioedèmes (CREAK), 38043 Grenoble, France; AP-HP, Sorbonne Université, hôpital Saint-Antoine, hôpitaux universitaires de l'Est Parisien, service de médecine interne, 75012 Paris, France. ·Presse Med · Pubmed #30416009.

ABSTRACT: Bradykinin mediated angioedema (BK-AE) can be associated either with C1Inhibitor deficiency (hereditary and acquired forms), either with normal C1Inh (hereditary form and drug induced AE as angiotensin converting enzyme inhibitors…). In case of high clinical suspicion of BK-AE, C1Inh exploration must be done at first: C1Inh function and antigenemy as well as C4 concentration. C1Inh deficiency is significant if the tests are below 50 % of the normal values and controlled a second time. In case of C1Inh deficiency, you have to identify hereditary from acquired forms. C1q and anti-C1Inh antibody tests are useful for acquired BK-AE. SERPING1 gene screening must be done if a hereditary angioedema is suspected, even if there is no family context (de novo mutation 15 %). If a hereditary BK-AE with normal C1Inh is suspected, F12 and PLG gene screening is suitable.

6 Guideline ISUOG Practice Guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia. 2019

Sotiriadis, A / Hernandez-Andrade, E / da Silva Costa, F / Ghi, T / Glanc, P / Khalil, A / Martins, W P / Odibo, A O / Papageorghiou, A T / Salomon, L J / Thilaganathan, B / Anonymous3681028. ·Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece. · Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Hutzel Women Hospital, Wayne State University, Detroit, MI, USA. · Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; and Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia. · Obstetrics and Gynecology Unit, University of Parma, Parma, Italy. · Department of Radiology, University of Toronto, Toronto, Ontario, Canada. · Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK; and Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK. · SEMEAR Fertilidade, Reproductive Medicine and Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil. · Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA. · Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK; and Nuffield Department of Obstetrics and Gynecology, University of Oxford, Women's Center, John Radcliffe Hospital, Oxford, UK. · Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France. ·Ultrasound Obstet Gynecol · Pubmed #30320479.

ABSTRACT: -- No abstract --

7 Guideline Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green-top Guideline No. 27a. 2019

Jauniaux, Erm / Alfirevic, Z / Bhide, A G / Belfort, M A / Burton, G J / Collins, S L / Dornan, S / Jurkovic, D / Kayem, G / Kingdom, J / Silver, R / Sentilhes, L / Anonymous2181086. · ·BJOG · Pubmed #30260097.

ABSTRACT: -- No abstract --

8 Guideline Vasa Praevia: Diagnosis and Management: Green-top Guideline No. 27b. 2019

Jauniaux, Erm / Alfirevic, Z / Bhide, A G / Burton, G J / Collins, S L / Silver, R / Anonymous2171086. · ·BJOG · Pubmed #30260094.

ABSTRACT: -- No abstract --

9 Guideline Recommendations of the Polish Society of Gynecologists and Obstetricians regarding caesarean sections. 2018

Wielgos, Miroslaw / Bomba-Opoń, Dorota / Breborowicz, Grzegorz H / Czajkowski, Krzysztof / Debski, Romuald / Leszczynska-Gorzelak, Bozena / Oszukowski, Przemyslaw / Radowicki, Stanislaw / Zimmer, Mariusz. ·1st Chair and Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland. dbomba@wum.edu.pl. ·Ginekol Pol · Pubmed #30508218.

ABSTRACT: -- No abstract --

10 Guideline Blastocyst culture and transfer in clinically assisted reproduction: a committee opinion. 2018

Anonymous2361126 / Anonymous2371126. ·American Society for Reproductive Medicine, Birmingham, Alabama. ·Fertil Steril · Pubmed #30503113.

ABSTRACT: The purposes of this Practice Committee Opinion, which replaces the 2013 ASRM Practice Committee Opinion of the same name (Fertil Steril 2013; 99:667-72), are to review the literature regarding the clinical application of blastocyst transfer and identify the potential risks and laboratory issues related to the use of this technology. This document does not apply to patients undergoing blastocyst culture and transfer for preimplantation genetic testing.

11 Guideline Fetal Heart Rate Auscultation, 3rd edition. 2018

Wisner, Kirsten / Holschuh, Carrie. · ·Nurs Womens Health · Pubmed #30501909.

ABSTRACT: The use of intermittent auscultation (IA) for fetal surveillance during labor decreased with the introduction of electronic fetal monitoring (EFM). The increased use of EFM is associated with an increase in cesarean births. IA is an evidence-based method of fetal surveillance during labor for women with low risk pregnancies and considered one component of comprehensive efforts to reduce the primary cesarean rate and promote vaginal birth. Many clinicians are not familiar with IA practice. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues, and strategies to promote implementation of IA into practice.

12 Guideline [Intrauterine contraception: CNGOF Contraception Guidelines]. 2018

Vidal, F / Paret, L / Linet, T / Tanguy le Gac, Y / Guerby, P. ·Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France. Electronic address: vidal.fabien@chu-toulouse.fr. · Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France. · Service de gynécologie-obstétrique, centre hospitalier Loire-Vendée-Océan, 85300 Challans, France. · Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France. ·Gynecol Obstet Fertil Senol · Pubmed #30429071.

ABSTRACT: OBJECTIVE: To provide national clinical guidelines focusing on intrauterine contraception. METHODS: A systematic review of available literature was performed using Pubmed and Cochrane libraries. American, British and Canadian guidelines were considered as well. RESULTS: Intrauterine contraception (IUC) displays a wide panel of indications, including adolescents, nulliparous, patients living with HIV before AIDS (Grade B) and women with history of ectopic pregnancy (Grade C). Cervical cancer screening should not be modified in women with IUC (Grade B). Bimanual examination and cervix inspection are mandatory before device insertion (Grade B). Patients should not systematically undergo screening for sexually transmitted infections (STI) before device insertion (Grade B). Screening for STI should be preferably done before insertion but it can be performed at the time of device insertion in asymptomatic women (Grade B). Routine antibiotic prophylaxis and premedication are not recommended before insertion (Grade A). A follow-up visit may be offered several weeks after insertion (Professional consensus). Routine pelvic ultrasound examination in not recommended after device insertion (Grade B). In patients with IUC, unscheduled bleeding, when persistent or associated with pelvic pain, requires further investigation to rule out complication (Professional agreement). Suspected uterine perforation warrants radiological workup to locate the device (Professional consensus). Laparoscopic approach should be preferred for elective removal of intrauterine device from abdominal cavity (Professional consensus). In case of accidental pregnancy with intrauterine device in situ, ectopic pregnancy should be excluded (Grade B). In case of viable and desired intrauterine pregnancy, intrauterine device removal is recommended if the strings are reachable (Grade C). Detection of Actinomyces-like organisms on pap smear in asymptomatic patients with intrauterine contraception does not require further intervention (Grade B). Immediate removal of intrauterine device is not recommended in case of STI or pelvic inflammatory disease (Grade B). Device removal should be considered in the absence of clinical improvement after 48 to 72 hours of appropriate treatment (Grade B). CONCLUSION: Intrauterine contraception is a long-acting and reversible contraception method displaying great efficacy and high continuation rate. In contrast, complication rate is low. It should thus be offered to both nulliparous and multiparous women.

13 Guideline [Contraception for women after 40: CNGOF Contraception Guidelines]. 2018

Lambert, M / Begon, E / Hocké, C. ·Service de gynécologie et de médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux cedex, France. Electronic address: marie.lambert@chu-bordeaux.fr. · Service de gynécologie et de médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux cedex, France. ·Gynecol Obstet Fertil Senol · Pubmed #30424983.

ABSTRACT: INTRODUCTION: Choosing contraception for women over 40 can be sometimes difficult but it is crucial since fertility and pregnancy's risks still exist. It requires a thorough evaluation of the situation, in order to identify any vascular and metabolic risk factors, along with the uterine and mammary benign pathologies already diagnosed. OBJECTIVE: The objective of this review was to elaborate some guidelines for clinical practice regarding contraception's prescription for women over 40. METHODS: A systematic review of the French and English existing literature was conducted. Pubmed and the Cochrane library were used to identify studies about contraception for perimenopausal women. International guidelines published by scientific societies were also reviewed (RCOG, FSRH, ESHRE, ACOG, WHO, HAS). RESULTS: No contraceptive methods are contraindicated on the sole basis of age alone. However, because age is a risk factor for vascular and metabolic diseases, combined hormonal contraception and DMPA should not be prescribed at first intention. Copper IUD and progestin-only contraceptives (pill, implant, intrauterine device) should primarily be considered, since they offer good efficacy with lower risks. CONCLUSIONS: Contraception for women over 40 should not be put aside. Long acting reversible contraception and progestin-only pill have to be prescribed as first-ine. Contraception is no longer needed for women over 50 who use non-hormonal contraception, after a 12 month-amenorrhea. Patients treated with combined hormonal contraception must stop using it over 50. Measuring hormonal levels while using hormonal contraception is not recommended. An hormonal-contraception-free interval must be considered, while using barrier contraception method. If an ovarian activity persists, a non-hormonal contraception or progestin-only contraception (except for DMPA) should be (re-)established.

14 Guideline [A Process-Oriented Approach at Current Recommendations for Obstetric Anesthesia and Postoperative Monitoring After C-Section]. 2018

Gude, Philipp / Weber, Thomas. · ·Anasthesiol Intensivmed Notfallmed Schmerzther · Pubmed #30423599.

ABSTRACT: The known guidelines before a planned operation on aspiration, fasting and preoperative risk evaluation also apply in obstetrics. Extended measures are only justified under concrete anamnestic or specific symptoms. Neuraxial anesthesia techniques should be offered to the mother as early as possible, as waiting for a certain opening of the cervix is not justified. Catheter procedures offer numerous advantages and are useful for possible emergency situations. Low-dose local anesthetic concentrations in combination with an opioid are still recommended. The benefit of pencil-point spinal needles in minimizing the risk of post-puncture headache has been demonstrated. Predictable emergencies are airway emergencies, hemorrhagic emergencies and cardiopulmonary resuscitation with emergency cesarean if appropriate (> 20 SSW).

15 Guideline [Technical guidelines for seasonal influenza vaccination in China (2018-2019)]. 2018

Feng, L Z / Peng, Z B / Wang, D Y / Yang, P / Yang, J / Zhang, Y Y / Chen, J / Jiang, S Q / Xu, L L / Kang, M / Chen, T / Zheng, Y M / Zheng, J D / Qin, Y / Zhao, M J / Tan, Y Y / Li, Z J / Feng, Z J. ·Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China. ·Zhonghua Yu Fang Yi Xue Za Zhi · Pubmed #30419692.

ABSTRACT: Seasonal influenza vaccination is the most effective way to prevent influenza virus infection and complications from infection. Currently, China has licensed trivalent inactivated influenza vaccine (IIV3) and quadrivalent inactivated influenza vaccine (IIV4), including split-virus influenza vaccine and subunit vaccine. Except for a few major cities, influenza vaccine is a category Ⅱ vaccine, which means influenza vaccination is voluntary, and recipients must pay for it. To strengthen the technical guidance for prevention and control of influenza and operational research on influenza vaccination in China, the National Immunization Advisory Committee (NIAC) Influenza Vaccine Technical Working Group (TWG), updated the 2014 technical guidelines and compiled the "Technical guidelines for seasonal influenza vaccination in China (2018-2019)" . The main updates in this version include: epidemiology, disease burden, types of influenza vaccines, northern hemisphere influenza vaccination composition for the 2018-2019 season, IIV3 and IIV4 immune response, durability of immunity, immunogenicity, vaccine efficacy, effectiveness, safety, cost-effectiveness and cost-benefit. The influenza vaccine TWG provided the recommendations for influenza vaccination for the 2018-2019 influenza season based on existing scientific evidence. The recommendations described in this report include the following: Points of Vaccination clinics (PoVs) should provide influenza vaccination to all persons aged 6 months and above who are willing to be vaccinated and do not have contraindications. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended, and appropriate product is available. To decrease the risk of severe infections and complications due to influenza virus infection among high risk groups, the recommendations prioritize seasonal influenza vaccination for children aged 6-59 months, adults ≥60 years of age, persons with specific chronic diseases, healthcare workers, the family members and caregivers of infants <6 months of age, and pregnant women or women who plan to become pregnant during the influenza season. Children aged 6 months through 8 years require 2 doses of influenza vaccine administered a minimum of 4 weeks apart during their first season of vaccination for optimal protection. If they were vaccinated in 2017-2018 influenza season or a prior season, 1 dose is recommended. People more than 8 years old require 1 dose of influenza vaccine. It is recommended that people receive their influenza vaccination by the end of October. Influenza vaccination should be offered as soon as the vaccination is available. For the people unable to be vaccinated before the end of October, influenza vaccination will continue to be offered for the whole season. Influenza vaccine is also recommended for use in pregnant women during any trimester. These guidelines are intended for use by staff members of the Centers for Disease Control and Prevention at all levels who work on influenza control and prevention, PoVs staff members, healthcare workers from the departments of pediatrics, internal medicine, and infectious diseases, and staff members of maternity and child care institutions at all levels.

16 Guideline [Contraception: CNGOF Guidelines for Clinical Practice (Short Version)]. 2018

Chabbert-Buffet, N / Marret, H / Agostini, A / Cardinale, C / Hamdaoui, N / Hassoun, D / Jonville-Bera, A P / Lambert, M / Linet, T / Pienkowski, C / Plu-Bureau, G / Pragout, D / Robin, G / Rousset-Jablonski, C / Scheffler, M / Vidal, F / Vigoureux, S / Hédon, B. ·Service de gynécologie-obstétrique et médecine de la reproduction, hôpitaux universitaires Est parisien, hôpital Tenon, Assistance publique des hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; UMRS_938, Inserm Sorbonne université, 75012 Paris, France. Electronic address: nathalie.chabbert-buffet@aphp.fr. · Service de chirurgie pelvienne gynécologique et oncologique, centre hospitalier universitaire de Bretonneau, pôle de gynécologie-obstétrique, 2, boulevard Tonnellé, 37044 Tours cedex 1, France. · Service de gynécologie-obstétrique, hôpital de la Conception, boulevard Baille, 13005 Marseille, France. · 38, rue Turenne, 75003 Paris, France. · Centre régional de pharmacovigilance, centre Val-de-Loire, CHRU de Tours, 37044 Tours cedex, France. · Service de gynécologie et de médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux cedex, France. · Service de gynécologie-obstétrique, centre hospitalier de Loire-Vendée-Océan, 85302 Challans, France. · Unité d'endocrinologie et de gynécologie médicale, TSA 70034, centre de référence de pathologies gynécologiques rares (PGR Toulouse), hôpital des Enfants, CHU de Toulouse, 31000 Toulouse, France. · Unité de gynécologie endocrinienne, hôpital Port-Royal, 53, avenue de l'Observatoire, 75679 Paris, France; Université Paris Descartes, 75005 Paris, France; Inserm UMR 1153, Obstetrical, perinatal and paediatric epidemiology research team (Épopé), Centre for epidemiology and statistics Sorbonne Paris Cité (CRESS), 75005 Paris, France. · Unité d'orthogénie, service de gynécologie-obstétrique, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France. · Centre d'assistance médicale à la procréation et de préservation de la fertilité, centre hospitalier universitaire de Lille, hôpital Jeanne de Flandre, 59000 Lille, France; EA 4308, gamétogenèse et qualité du gamète, centre hospitalier universitaire de Lille, 59000 Lille, France. · Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France; Centre hospitalier de Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France. · Service de gynécologie, CHU, 10, rue du Dr-Heydenreich, 54000 Nancy, France. · CHU de Purpan, hôpital Paule-de-Viguier, pôle femme-mère-couple, 330, avenue Grande-Bretagne, 31059 Toulouse, France. · Service de gynécologie-obstétrique, hôpital Bicêtre, Assistance publique des Hôpitaux de Paris (AP-HP), 94276 Le Kremlin-Bicêtre, France; Faculté de médecine Paris-Sud, université Paris-Sud, 94276 Le Kremlin-Bicêtre, France; U1018, Inserm, reproduction and child development, Centre for research in epidemiology and population health (CESP), 94805 Villejuif, France. · Département de gynécologie-obstétrique, faculté de médecine université de Montpellier (France), centre hospitalier universitaire Arnaud-de-Villeneuve, 34000 Montpellier, France. ·Gynecol Obstet Fertil Senol · Pubmed #30416023.

ABSTRACT: The French College of Obstetrics and Gynecology (CNGOF) releases its first global recommendations for clinical practice in contraception, to provide physicians with an updated synthesis of available data as a basis for their practice. The French Health Authority (HAS) methodology was used. Twelve practical issues were selected by the organizing committee and the task force members. The available literature was screened until December 2017, and allowed the release of evidence-based, graded recommendations. This synthesis is issued from 12 developed texts, previously reviewed by experts and physicians from public and private practices, with an experience in the contraceptive field. Male and female sterilization, as well as the use of hormonal treatments without contraceptive label were excluded from the field of this analysis. Specific practical recommendations on the management of contraception prescription, patient information including efficacy, risks, and benefits of the different contraception methods, follow up, intrauterine contraception, emergency contraception, local and natural methods, contraception in teenagers and after 40, contraception in vascular high-risk situations, and in case of cancer risk are provided. The short/mid-term future of contraception mostly relies on improving the use of currently available methods. This includes reinforced information for users and increased access to contraception for women, whatever the social and clinical context. That is the goal of these recommendations.

17 Guideline [Current knowledge on contraceptive knowledge in France: CNGOF Contraception Guidelines]. 2018

Vigoureux, S / Le Guen, M. ·Service de gynécologie obstétrique, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94000 Le Kremlin-Bicêtre, France; Faculté de médecine Paris-Sud, université Paris-Sud, 94276 Le Kremlin-Bicêtre, France; Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Équipe « Genre, sexualité, santé », hôpital Paul-Brousse, 94807 Villejuif, France. Electronic address: solene.vigoureux@aphp.fr. · Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Équipe « Genre, sexualité, santé », hôpital Paul-Brousse, 94807 Villejuif, France; Institut National d'Etudes Démographiques, 75020 Paris, France. ·Gynecol Obstet Fertil Senol · Pubmed #30416022.

ABSTRACT: OBJECTIVE: To summarize current knowledge on contraceptive coverage in France and worldwide, describe the effectiveness of different types of contraceptives, describe the characteristics of women using contraception, contraceptive failure situations and describe the different medical risks associated with contraceptive methods. METHODS: Consultation of the Medline database and of national or international reports on contraception. RESULTS: Contraceptive coverage in France is high: 97% of women in 2013 use a contraceptive method (among fertile, sexually active women without a desire for pregnancy), with a majority using medical methods (72% using pills and other hormonal contraceptives, intrauterine devices and 25% using natural and traditional barrier methods). The 2013 pill scare called into question the use of estrogen-progestogenic contraception and the information provided by doctors, but the pill remains the first contraceptive method followed by the intrauterine device, condoms and the traditional and natural methods. Lifetime contraceptive coverage changes according to a defined standard in France: condoms for the teen-agers, pills before pregnancy and then intrauterine devices after childbirth. Sterilization is very rarely chosen and offered. Contraception in France remains a predominantly female domain. Women and couples should be informed about all contraceptive methods, allowing them to choose the method that best suits their health, living conditions and sexuality.

18 Guideline [Additional non-contraceptive effects of contraception: CNGOF Contraception Guidelines]. 2018

Amat, L / Bulach, A / Leclercq, M / Mesrine, S / Scheffler, F / Sperandeo, D / Scheffler, M. ·Service de gynécologie-obstétrique, CHRU de Nancy, 10, avenue du Dr-Heydenreich, 54035 Nancy, France. · Service de gynécologie-obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59000 Lille, France. · Service de gynécologie-obstétrique, CHIC d'Amboise, rue des Ursulines, 37403 Amboise cedex, France. · Service de gynécologie-obstétrique, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens, France. · Clinique de Bonneveine, 89, boulevard du Sablier, 13008 Marseille, France. · Service de gynécologie-obstétrique, CHRU de Nancy, 10, avenue du Dr-Heydenreich, 54035 Nancy, France. Electronic address: michele@cglre.org. ·Gynecol Obstet Fertil Senol · Pubmed #30414725.

ABSTRACT: Hormonal and intrauterine contraceptive methods provide women with highly efficient protection against undesired pregnancy. Additional non-contraceptive effects are now well documented. Combined hormonal contraceptives use, either through the oral transdermal and vaginal route, allow a reduction in menorrhagia, dysmenorrhea, functional ovarian cysts, benign breast and uterine disease, endometriosis-related pain and recurrence. A reduction in ovarian cancer risks, including in women with BRCA syndrome, endometrial and colon cancer is documented. This effect is prolonged for years after contraception discontinuation. Non-contraceptive benefits of progestin-only contraceptives are less documented. Use of the levonorgestrel IUD is associated with a reduction in menorrhagia, dysmenorrhea including in case of endometriosis. Copper IUD use is associated with a decrease in cervix and endometrial cancer risk.

19 Guideline [Childbirth pelvic floor trauma: Anatomy, physiology, pathophysiology and special situations - CNGOF perineal prevention and protection in obstetrics guidelines]. 2018

de Tayrac, R / Schantz, C. ·Service de gynécologie-obstétrique, CHU Carémeau, place du Pr-Debré, 30900 Nîmes, France. Electronic address: renaud.detayrac@chu-nimes.fr. · Commission Scientifique du Collège National des Sages-Femmes (CNSF), Centre population et développement (Ceped), institut de la recherche et du développement (IRD), université Paris Descartes, Inserm, 75006, Paris, France. ·Gynecol Obstet Fertil Senol · Pubmed #30396762.

ABSTRACT: OBJECTIVES: To assess whether pelvic size and shape, spinal curvature, perineal body length and genital hiatus size are associated with the incidence of childbirth pelvic floor trauma. Special situations, such as obesity, ethnicity and hyperlaxity, will also be studied. METHODS: A bibliographic research using Pubmed and Cochrane Library databases was conducted until May 2018. Publications in English and French were selected by initial reading of the abstracts. Randomized trials, meta-analyzes, case-control studies and large cohorts were studied in a privileged way. RESULTS: A pubic arch angle<90° (measured clinically) does not appear to increase the risk of OASIS (Level 3), but appears to be a risk factor for postnatal anal incontinence at short-term, but not at long-term (Level 3). Measurement of pelvic dimensions and the subpubic angle is not recommended to predict OASIS or to choose the mode of delivery for the purpose of protecting the perineum (GradeC). Prenatal measurement of both perineal body (Level 3) and genital hiatus (Level 2) does not predict the incidence of 2nd or 3rd degree OASIS. Therefore, the routine prenatal measurement of the length of the perineal body or the genital hiatus is not recommended for any objective related to perineal protection (Grade C). Levator avulsion, resulting in a widening of the genital hiatus, is potentially a source of long-term pelvic floor dysfunction. Biomechanical models suggest that performing a mediolateral episiotomy and applying the fingers to the posterior perineum at the time of expulsive phase may reduce pelvic floor trauma. Obese women have a longer perineal body (Level 3), and obesity does not seem to increase the risk of OASIS (Level 2). There is no difference between Asian and non-Asian women perineal body (Level 3). No studies have validated that the liberal practice of episiotomy in Asian women reduced the risk of OASIS. It is therefore not recommended to practice an episiotomy for simple ethnic reasons in Asian women (GradeC). Compared to white women, black women do not appear to have an increased risk of OASIS and even appear to have a decreased risk of perineal tears of all stages (Level 2). Ligament hyperlaxity seems to be associated with an increased risk of OASIS (Level 2). CONCLUSIONS: Prenatal assessment of pelvis bone, spine curvature, perineal body and genital hiatus do not allow to predict the incidence of childbirth pelvic floor trauma. Obesity and ethnicity are not risk factors for OASIS.

20 Guideline [Perineal tears and episiotomy: Surgical procedure - CNGOF perineal prevention and protection in obstetrics guidelines]. 2018

Marty, N / Verspyck, E. ·Service de gynécologie-obstétrique, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France. · Service de gynécologie-obstétrique, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France. Electronic address: eric.verspyck@chu-rouen.fr. ·Gynecol Obstet Fertil Senol · Pubmed #30392991.

ABSTRACT: OBJECTIVES: To recommend the episiotomy procedure, repair of perineal or vaginal tears and episiotomy. METHODS: Published Literature was retrieved using PubMed and Cochrane Library computer databases up to May 2018 and recommendations issued from international societies. RESULTS: A midline episiotomy increases the risk of OASIS compared with a mediolateral procedure (LE2). OASIS rates are similar for mediolateral and lateral episiotomies (LE1). A scar angle of at least 45° (measured in relation to the midline after suturing) is associated with a lower risk of OASIS (LE3). To obtain this final angle, the episiotomy must be performed at a 60° angle (LE1). Current data are insufficient to recommend the length, the timing, and the modalities procedure during instrumental delivery for mediolateral episiotomy. Suturing the superficial plane of a perineal tear provides no benefits when the edges touch and do not bleed (LE2). The techniques for suturing perineal lacerations by continuous sutures are associated with a reduction in immediate pain, reduced use of analgesics, and less frequent removal of stitches, compared with interrupted stitches (LE1). Synthetic suture materials with either standard or rapid absorption provide similar results for perineal pain and women's satisfaction: rapid absorption polyglactin has the advantage of a reduced need for later stitch removal, but it increases the risk of scar dehiscence (LE1). There are not enough published studies to recommend the use of biological glues in the repair of first-degree perineal tears or skin in second-degree tears. Delaying repair of OASIS for several hours does not aggravate the subsequent prognosis for anal continence (LE1). Internal sphincter injury lead to significant further anal incontinence (LE3). There is no study comparing methods for internal sphincter repair. To repair the external sphincter, overlap and end-to-end suture techniques yield similar results for anal continence (LE2). Use of polydioxanone 3/0 or polyglactin 2/0 to repair the EAS produces similar results for perineal pain and anal incontinence scores (LE2) CONCLUSIONS: A mediolateral incision is recommended for an episiotomy (Grade B). The angle of incision recommended for a mediolateral episiotomy is 60° (GradeC). It is recommended that continuous running sutures be preferred for the repair of episiotomies and second-degree tears (Grade A). It is recommended that obstetrics professionals optimise surgical conditions to the extent possible for repair of OASIS (professional consensus); a detailed report of the extent of the injuries, the techniques of repair, and the material used is recommended (GradeC). The external anal sphincter can be repaired with either overlap or end-to-end suture techniques (Grade B).

21 Guideline [Contraception for adolescent : CNGOF Contraception guidelines]. 2018

Pienkowski, C / Cartault, A. ·Unité d'endocrinologie et de gynécologie médicale, hôpital des Enfants, TSA 70034, Centre de référence de pathologies gynécologiques rares (PGR Toulouse), CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France. Electronic address: pienkowski.c@chu-toulouse.fr. · Unité d'endocrinologie et de gynécologie médicale, hôpital des Enfants, TSA 70034, Centre de référence de pathologies gynécologiques rares (PGR Toulouse), CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France. ·Gynecol Obstet Fertil Senol · Pubmed #30392989.

ABSTRACT: OBJECTIVE: The goal is to establish dialogue and determine the needs and skill levels of adolescence. This concerns sexuality, the prevention of STIs, the informed choice of contraception to avoid an unplanned pregnancy. MéTHODES: A systematic review based on literature about contraception AND teenagers was performed using Pubmed, Cochrane, national and international recommendations. RESULTS: The surveillance of the teenager contraception must integrate more specifically: global health with a stability of weight and corpulence, a sufficient calcium intake, the prevention of the sexually transmitted infections (STIs) and the vaccination against HPV. The 1st consultations with adolescent girls are an essential moment for dialogue in order to develop sexuality education. Main themes are: prevention of STIs with the use of condoms, detection of situations of precariousness or sexual abuse, and finally adherence to treatment to avoid unplanned pregnancy. Use of condoms associated with regular contraception is essential to assure a barrier against sexually transmitted infections (STIs) (NP1). To preserve the patient confidentiality, the patient is received alone (Grade B). She must be reassured about respect of anonymity and availability of free treatment. Clinical examination collects weight, height, BMI and blood pressure (Grade C). It is important to give them the choice of contraceptive method and provide objective information on the different contraceptive methods (NP2). If there are any contraindications, when the first prescription is a pill, it must be a 1st or 2nd generation pill with levonorgestrel. For some experts, it would be important to prescribe a pill at 30μg EE for better efficacy in case of forgetfulness in very young patients and for the good maintenance of bone mineralization (NP4). Information on long-acting reversible contraceptives, or LARCs, is essential. These contraceptive methods have proved their efficacy and their place in the first intention. (NP1). CONCLUSION: Prescribing contraception to a teenage girl requires the adaptation of the best treatment to her needs to prevent an unwanted pregnancy. This requires good information on prevention of STIs and on different methods of contraception in a confidence climate.

22 Guideline [Methods of preventing perineal injury and dysfunction during pregnancy: CNGOF Perineal prevention and protection in obstetrics]. 2018

Schantz, C. ·Commission scientifique du Collège National des sages-femmes (CNSF), Centre population et développement (Ceped), institut de la recherche et du développement (IRD), université Paris Descartes, Inserm, 45, rue des Saints-Pères, 75006 Paris, France. Electronic address: clemschantz@hotmail.com. ·Gynecol Obstet Fertil Senol · Pubmed #30392987.

ABSTRACT: OBJECTIVE: Several interventions during pregnancy have been described that might prevent the risk of postnatal perineal injury or dysfunction; these include prenatal perineal massage, use of the Epi-No device, and pelvic floor muscle training exercises. Our objective was to evaluate the effectiveness of these different interventions during pregnancy. METHODS: A systematic review of the literature was conducted on PubMed, including articles in French and English published before May 2018, to evaluate the effectiveness of these different interventions on perineal protection in the post-partum period. RESULTS: Perineal massage during pregnancy diminishes the episiotomy rate (LE1) as well as post-partum perineal pain and flatus (LE2). It does not reduce the rate of either OASIS (LE1) or post-partum urinary incontinence (LE2). The Epi-No device does not provide benefits for perineal protection (LE1). Prenatal pelvic floor muscle training exercises do not reduce the risk of perineal lacerations (LE2); they reduce the prevalence of post-partum urinary incontinence at 3 to 6 months but not at 12 months post-partum (LE2). CONCLUSION: Perineal massage during pregnancy must be encouraged among women who want it (Grade B). The use of the Epi-No device during pregnancy is not recommended for the prevention of OASIS (grade B). Pelvic floor muscle training during pregnancy is not recommended for the prevention of OASIS (grade B); moreover, its absence of effect in the medium term does not allow us to recommend it for urinary incontinence (professional consensus).

23 Guideline Coronary computed tomographic imaging in women: An expert consensus statement from the Society of Cardiovascular Computed Tomography. 2018

Truong, Quynh A / Rinehart, Sarah / Abbara, Suhny / Achenbach, Stephan / Berman, Daniel S / Bullock-Palmer, Renee / Carrascosa, Patricia / Chinnaiyan, Kavitha M / Dey, Damini / Ferencik, Maros / Fuechtner, Gudrun / Hecht, Harvey / Jacobs, Jill E / Lee, Sang-Eun / Leipsic, Jonathan / Lin, Fay / Meave, Aloha / Pugliese, Francesca / Sierra-Galán, Lilia M / Williams, Michelle C / Villines, Todd C / Shaw, Leslee J / Anonymous3891033. ·Weill Cornell Medicine, USA. Electronic address: qat9001@med.cornell.edu. · Piedmont Healthcare, USA. · UT Southwestern Medical Center, USA. · University of Erlangan, Germany. · Cedars-Sinai Medical Center, USA. · Deborah Heart and Lung Center, USA. · Maipu Diagnosis, Argentina. · William Beaumont Hospital, USA. · Oregon Health & Science University, USA. · Medical University of Innsbruck, Austria. · Mount Sinai Health System, USA. · NYU Langone Medical Center, USA. · Severance Hospital, South Korea. · Providence Healthcare, Canada. · Weill Cornell Medicine, USA. · Ignacio Chavez National Institute for Cardiology, Mexico. · William Harvey Research Institute, UK. · American British Cowdray Medical Center, Mexico. · British Heart Foundation, UK. · Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, USA. ·J Cardiovasc Comput Tomogr · Pubmed #30392926.

ABSTRACT: This expert consensus statement from the Society of Cardiovascular Computed Tomography (SCCT) provides an evidence synthesis on the use of computed tomography (CT) imaging for diagnosis and risk stratification of coronary artery disease in women. From large patient and population cohorts of asymptomatic women, detection of any coronary artery calcium that identifies females with a 10-year atherosclerotic cardiovascular disease risk of >7.5% may more effectively triage women who may benefit from pharmacologic therapy. In addition to accurate detection of obstructive coronary artery disease (CAD), CT angiography (CTA) identifies nonobstructive atherosclerotic plaque extent and composition which is otherwise not detected by alternative stress testing modalities. Moreover, CTA has superior risk stratification when compared to stress testing in symptomatic women with stable chest pain (or equivalent) symptoms. For the evaluation of symptomatic women both in the emergency department and the outpatient setting, there is abundant evidence from large observational registries and multi-center randomized trials, that CT imaging is an effective procedure. Although radiation doses are far less for CT when compared to nuclear imaging, radiation dose reduction strategies should be applied in all women undergoing CT imaging. Effective and appropriate use of CT imaging can provide the means for improved detection of at-risk women and thereby focus preventive management resulting in long-term risk reduction and improved clinical outcomes.

24 Guideline ACR Appropriateness Criteria 2018

Anonymous2681124 / diFlorio-Alexander, Roberta M / Slanetz, Priscilla J / Moy, Linda / Baron, Paul / Didwania, Aarati D / Heller, Samantha L / Holbrook, Anna I / Lewin, Alana A / Lourenco, Ana P / Mehta, Tejas S / Niell, Bethany L / Stuckey, Ashley R / Tuscano, Daymen S / Vincoff, Nina S / Weinstein, Susan P / Newell, Mary S. ·Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Electronic address: rmda@hitchcock.org. · Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Panel Vice-Chair, NYU Clinical Cancer Center, New York, New York. · Roper St Francis Physician Partners Breast Surgery, Charleston, South Carolina; American College of Surgeons. · Northwestern University Feinberg School of Medicine, Chicago, Illinois; American College of Physicians. · New York University School of Medicine, New York, New York. · Emory University Hospital, Atlanta, Georgia. · Alpert Medical School of Brown University, Providence, Rhode Island. · H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. · Women and Infants Hospital, Providence, Rhode Island; American Congress of Obstetricians and Gynecologists. · Mecklenburg Radiology Associates, Charlotte, North Carolina. · Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York. · Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania. · Panel Chair, Emory University Hospital, Atlanta, Georgia. ·J Am Coll Radiol · Pubmed #30392595.

ABSTRACT: Breast imaging during pregnancy and lactation is challenging due to unique physiologic and structural breast changes that increase the difficulty of clinical and radiological evaluation. Pregnancy-associated breast cancer (PABC) is increasing as more women delay child bearing into the fourth decade of life, and imaging of clinical symptoms should not be delayed. PABC may present as a palpable lump, nipple discharge, diffuse breast enlargement, focal pain, or milk rejection. Breast imaging during lactation is very similar to breast imaging in women who are not breast feeding. However, breast imaging during pregnancy is modified to balance both maternal and fetal well-being; and there is a limited role for advanced breast imaging techniques in pregnant women. Mammography is safe during pregnancy and breast cancer screening should be tailored to patient age and breast cancer risk. Diagnostic breast imaging during pregnancy should be obtained to evaluate clinical symptoms and for loco-regional staging of newly diagnosed PABC. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

25 Guideline [Perineal prevention and protection in obstetrics: CNGOF Clinical Practice Guidelines (short version)]. 2018

Ducarme, G / Pizzoferrato, A C / de Tayrac, R / Schantz, C / Thubert, T / Le Ray, C / Riethmuller, D / Verspyck, E / Gachon, B / Pierre, F / Artzner, F / Jacquetin, B / Fritel, X. ·Service de gynécologie-obstétrique, centre hospitalier départemental Vendée, boulevard Stéphane-Moreau, 85000 La Roche-sur-Yon, France. Electronic address: g.ducarme@gmail.com. · Service de gynécologie-obstétrique, CHU Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France. · Service de gynécologie-obstétrique, CHU Carémeau, place du Pr-Debré, 30900 Nîmes, France. · Centre population et développement (Ceped), institut de la recherche et du développement (IRD), université Paris Descartes, Inserm, Commission scientifique du Collège national des sages-femmes (CNSF), 75000 Paris, France. · Service de gynécologie-obstétrique, CHU Hôtel-Dieu, hôpitaux de Nantes, université de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; GMC-UPMC 01, GREEN (Groupe de recherche clinique en neurourologie), 4, rue de la Chine, 75020 Paris, France. · Maternité Port-Royal, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 123, boulevard de Port-Royal, 75014 Paris, France; Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France. · Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France. · Service de gynécologie-obstétrique, CHU Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France. · Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France. · Collectif inter-associatif autour de la naissance (CIANE), 40, rue de Chanzy, 75011 Paris, France. · Pôle Femme-Enfant, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France. ·Gynecol Obstet Fertil Senol · Pubmed #30391283.

ABSTRACT: INTRODUCTION: The objective of these clinical practice guidelines was to analyse all of the interventions during pregnancy and childbirth that might prevent obstetric anal sphincter injuries (OASIS) and postnatal pelvic floor symptoms. MATERIAL AND METHODS: These guidelines were developed in accordance with the methods prescribed by the French Health Authority (HAS). RESULTS: A prenatal clinical examination of the perineum is recommended for women with a history of Crohn's disease, OASIS, genital mutilation, or perianal lesions (professional consensus). Just after delivery, a perineal examination is recommended to check for OASIS (Grade B); if there is doubt about the diagnosis, a second opinion should be requested (GradeC). In case of OASIS, the injuries (including their severity) and the technique for their repair should be described in detail (GradeC). Perineal massage during pregnancy must be encouraged among women who want it (Grade B). No intervention conducted before the start of the active phase of the second stage of labour has been shown to be effective in reducing the risk of perineal injury. The crowning of the baby's head should be manually controlled and the posterior perineum manually supported to reduce the risk of OASIS (GradeC). The performance of an episiotomy during normal deliveries is not recommended to reduce the risk of OASIS (Grade A). In instrumental deliveries, episiotomy may be indicated to avoid OASIS (GradeC). When an episiotomy is performed, a mediolateral incision is recommended (Grade B). The indication for episiotomy should be explained to the woman, and she should consent before its performance. Advising women to have a caesarean delivery for primary prevention of postnatal urinary or anal incontinence is not recommended (Grade B). During pregnancy and again in the labour room, obstetrics professionals should focus on the woman's expectations and inform her about the modes of delivery.

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