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A Practical Guide To First Trimester Of Pregnancy

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A Practical Guide To First Trimester Of Pregnancy

In addition to updating recommendations on the basis of new evidence regarding management of chronic pain, this clinical practice guideline is intended to assist clinicians in weighing benefits and risks of prescribing opioid pain medication for painful acute conditions (e.g., low back pain, neck pain, other musculoskeletal pain, neuropathic pain, dental pain, kidney stone pain, and acute episodic migraine) and pain related to procedures (e.g., postoperative pain and pain from oral surgery). In 2020, several of these indications were prioritized by an ad hoc committee of the National Academies of Sciences, Engineering, and Medicine (86) as those for which evidence-based clinical practice guidelines would help inform prescribing practices, with the greatest potential effect on public health. This update includes content on management of subacute painful conditions, when duration falls between that typically considered acute (defined as lasting 3 months). The durations used to define acute, subacute, and chronic pain might imply more specificity than is found in real-life patient experience, when pain often gradually transitions from acute to chronic. These time-bound definitions are not meant to be absolute but rather to be approximate guides to facilitate the consideration and practical use of the recommendations by clinicians and patients.

CDC identified peer reviewers on the basis of multiple factors, including scientific and subject matter expertise, racial and ethnic diversity, gender diversity, diversity of experiences and perspectives, independence from the clinical practice guideline development process, and consideration of conflicts of interest. Specific effort was made to identify subject matter experts with knowledge and experience in topics such as chronic and acute pain management, clinical practice, health equity, mental health and well-being, opioids and opioid therapies, opioid tapering, opioid use disorder treatment, pharmacologic and nonpharmacologic pain management, and surgical pain management. CDC assessed potential conflicts of interest before finalizing selection of peer reviewers. The NCIPC Associate Director for Science reviewed conflict of interest disclosure forms and determined no conflicts of interest were present. After the peer reviews were completed, CDC posted the names of peer reviewers on the NCIPC and CDC/ATSDR Peer Review Agenda websites, which provide information about the peer review of influential government scientific documents (114,115). Peer reviewers independently reviewed the draft clinical practice guideline and evaluated its scientific merit and practical implementation considerations, with the goal of maintaining high-quality science and providing evidence-based recommendations to guide clinical practice and decision-making to help prevent opioid-related harms. CDC reviewed and considered peer review comments when revising the clinical practice guideline.

So, during the first trimester, the fertilised egg will burrow into the womb lining. By the fourth or fifth week, the initial egg cell forms into three layers. These layers are the breathing and digestive system, the heart and blood vessels, and the brain and the nervous systems (NHS Choices, 2017a).

In addition to strong evidence linking dysglycaemia in pregnancy with adverse outcomes, studies have shown the benefits of treating GDM. However, there are key questions yet to be answered. The first relates to the diagnosis of GDM. The association between adverse pregnancy outcomes and maternal glycaemia is a continuum, so current diagnostic criteria are based on consensus rather than definitive demarcation of risk. Second, the optimal timing and type of testing of women at high risk of GDM is uncertain, and the effects of early treatment unclear. Third, treatment targets for GDM remain the subject of ongoing debate. Finally, while there is agreement about the need for long-term follow-up after a GDM pregnancy, there are no consistent recommendations for its implementation.

To find out if you're pregnant, you can do a pregnancy test from the first day you miss your period. Home pregnancy tests are very reliable, but see your GP to be sure and also to start your antenatal care.

If you do start having cravings, it'll probably be in your first trimester (it could be as early as 5 weeks into pregnancy). They'll get stronger in your second trimester, and then eventually stop in your third trimester.

If you sleep on your back, it's safe to continue during the first trimester, but as your bump gets bigger and heavier you'll need to sleep on your side, so it's best to get into the habit as soon as you can.

By the third trimester (after 28 weeks of pregnancy), sleeping on your side is the safest position for your baby as it helps prevent the risk of stillbirth. Don't worry, if your pregnancy is uncomplicated your risk of stillbirth is low (1 in 200 babies are stillborn) and going to sleep on your side will make it even lower.

Treatment of hyperthyroidism, unless it is related to human chorionic gonadotrophin, involves propylthiouracil in the first trimester. Carbimazole may be used in the second trimester. Thyroid function tests are checked every month and every two weeks following a change in dose.

The rising concentration of beta-human chorionic gonadotrophin (HCG) in the first trimester can directly stimulate the thyroid stimulating hormone (TSH) receptor as HCG has structural similarities to TSH. This in turn leads to increased free triidothyronine (fT3) and free thyroxine (fT4), suppressing TSH secretion. A serum TSH below 0.1 mIU/L may be present in 5% of women by the 11th week of pregnancy.

For women with overt hypothyroidism who are planning pregnancy, guidelines recommend optimisation of TSH before conception. Thyroid dysfunction in pregnancy is clinically important as insufficient thyroxine is associated with an increased risk of premature birth, low birth weight and miscarriage.2,4,5

Thyroxine is used for treating overt hypothyroidism and is recommended in antibody positive subclinical hypothyroidism. For hyperthyroidism, propylthiouracil is the preferred antithyroid drug in the preconception and first trimester to reduce the risk of teratogenicity.1 Carbimazole may be used in the second trimester.

Pregnancies are rare in women with pituitary adenomas, which may relate to hormone excess from secretory subtypes such as prolactinomas or corticotroph adenomas. Decreased fertility may also result from pituitary hormone deficiencies due to compression of the gland by large tumours and/or surgical or radiation treatment of the lesion. Counselling premenopausal women with pituitary adenomas about their chance of conceiving spontaneously or with assisted reproductive technology, and the optimal pre-conception treatment, should start at the time of initial diagnosis. The normal physiological changes during pregnancy need to be considered when interpreting endocrine tests in women with pituitary adenomas. Dose adjustments in hormone substitution therapies may be needed across the trimesters. When medical therapy is used for pituitary hormone excess, consideration should be given to the known efficacy and safety data specific to pregnant women for each therapeutic option. In healthy women, pituitary gland size increases during pregnancy. Since some pituitary adenomas also enlarge during pregnancy, there is a risk of visual impairment, especially in women with macroadenomas or tumours near the optic chiasm. Pituitary apoplexy represents a rare acute complication of adenomas requiring surveillance, with surgical intervention needed in some cases. This guideline describes the choice and timing of diagnostic tests and treatments from the pre-conception stage until after delivery, taking into account adenoma size, location and endocrine activity. In most cases, pregnant women with pituitary adenomas should be managed by a multidisciplinary team in a centre specialised in the treatment of such tumours.

Pregnancy changes the morphology and function of the pituitary gland. The gland size increases and reaches its maximal volume in late pregnancy and the first days post-partum with a height of up to 12 mm followed by a gradual decline to normal size within 6 months after delivery (1, 2, 3). This growth is related to lactotroph hyperplasia starting in the first month of pregnancy and due to the increased concentrations of oestradiol (E2) (4). 59ce067264


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