Noninvasive prenatal screening has significantly changed the practice of prenatal screening. However, while increasing the detection of Down syndrome, the concomitant decrease in DP and lack of aCGH results in missing many more abnormalities than the increase in Down syndrome and complications of DP combined. From a public health perspective, such represents a missed opportunity for overall health care delivery.
ICD-10-CM O720 Third-stage hemorrhage O721 Other immediate postpartum hemorrhage O722 Delayed and secondary postpartum hemorrhage ICD-9-CM 66600 Third-stage postpartum hemorrhage, unspecified as to episode of care or not applicable 66602 Third-stage postpartum hemorrhage, delivered, with mention of postpartum complication 66604 Third-stage postpartum hemorrhage, postpartum condition or complication 66610 Other immediate postpartum hemorrhage, unspecified as to episode of care or not applicable 66612 Other immediate postpartum hemorrhage, delivered, with mention of postpartum complication 66614 Other immediate postpartum hemorrhage, postpartum condition or complication 66620 Delayed and secondary postpartum hemorrhage, unspecified as to episode of care or not applicable 66622 Delayed and secondary postpartum hemorrhage, delivered, with mention of postpartum complication 66624 Delayed and secondary postpartum hemorrhage, postpartum condition or complication Bakri balloon (PPH level 3) EMR notes n/a Any EMR note that contains the term 'Bakri' Goffman D, Friedman AM, Sheen JJ, Kessler A, Vawdrey D, Green R, et al. A framework for improving characterization of obstetric hemorrhage using informatics data. Obstet Gynecol 2019;134.The authors provided this information as a supplement to their article.
Several isolated reports of fetal goiter treatment have shown limited generalizability of approaches and provide no real guidance for optimal timing, dosages, and treatment strategies. Graves' disease accounts for >60% of these cases. Maternal treatments of hyperthyroidism include antithyroid medications such as methimazole and more commonly propylthiouracil (PTU). Here, our management of a patient with a fetal thyroid goiter from maternal exposure to PTU diagnosed at 23.6 weeks' gestation and the management of other cases allow us propose a general strategy for treatment. Intrauterine therapy with 200 and then 400 μg of levothyroxine (3 weeks apart) showed an 85% reduction in fetal thyroid goiter volume. We collected amniotic fluid samples at the time of treatments and assayed thyroid hormones and associated antibodies which closely reflected the changes in thyroid goiter mass volume. Our observations suggest a weekly or biweekly therapeutic intervention schedule. Utilizing both goiter size as well as a novel approach in using amniotic fluid hormone levels to monitor therapy efficacy might improve the quality of treatments. Only with a standardized approach and collection of amniotic fluid thyroid panels do we have the opportunity to develop the database required to determine the number and timing of treatments needed.
There are multiple causes for hematuria in infants and children. When hematuria is accompanied by dysuria, however, one should focus attention on the lower urinary tract. Although ultrasound (US) is a well-established method for assessing the kidneys and bladder, little attention has been focused on its use for evaluating urethral abnormalities, since voiding cystourethrography or retrograde urethrography usually is used. In the cases of two young boys, sonography aided in the identification of clinically unsuspected urethral stones. US evaluation of the urethra is now included as an integral part of urinary tract sonography in male patients with hematuria accompanied by dysuria.
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