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Postpartum women who lose weight return to their pre-pregnancy weight at varying rates because of a number of factors including their pre-pregnancy weight, type of delivery, gestational weight gain, breastfeeding status, and age. Excessive postpartum weight retention is a concern, and evidence suggests it is associated with longer-term overweight and obesity (Endres et al. There is no specifc guideline for how soon after birth to monitor postpartum weight loss and the exact timing of when a woman should return to her pre-pregnancy weight. Bilateral pitting edema can be a clinical sign of a specifc form of severe malnutrition known as nutritional edema, edematous malnutrition, severe malnutrition with edema, or kwashiorkor. However, edema is quite common during pregnancy, especially in the third trimester due to the additional blood and body fuid needed to support the fetus, and typically does not indicate malnutrition. Therefore, edema during pregnancy can be normal or it can indicate other medical conditions, such as pre-eclampsia (particularly if the edema is sudden and in the hands and face) (Swamy and Heine n. It is recommended that pregnant women and girls with edema be assessed further to determine the cause and provided with appropriate treatment as needed. Summary Tables: Classifying Nutritional Status of Pregnant and Postpartum Women and Girls the summary tables in this section indicate cutofs for various nutrition conditions and are organized according to the measurement or index used. For adolescent girls, height-for-age is the appropriate measure to identify stunting (see Table 4. Z-scores girls up to Moderate stunting that fall outside of the normal range indicate a age 19 3 and < 2 z-score (height-for-age) nutritional issue (undernutrition or overweight). Condition: Short stature Condition: Stunting Who Needs to Understand Z-Scores and Why Z-score cutofs are used to defne malnutrition according to anthropometric indices. Therefore, health care workers and nutrition program staf need to understand what z-scores are, how to interpret them, and what they mean at individual and population levels to make informed decisions. Z-scores can be estimated using growth charts/ tables and/or calculated using computer software. The guidelines may apply to similar populations outside the United States and have been adopted by some industrialized countries, such as Canada and New Zealand (Health Canada 2014; New Zealand Ministry of Health 2014).

Syndromes

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In a dissenting study, the usual criteria for assessment of sperm 23 morphology provided better prognostic information than did assessment by strict criteria. Technicians well trained in using strict criteria can provide highly reproducible results, but the standardization may not be possible on a more widespread scale. Interobserver differences in assessing sperm morphology could be 24 decreased with the utilization of computer-assisted morphometric evaluations. A volume of less than 1 mL may be too small to make contact with the cervix, and a volume greater than 7 mL may dilute the sperm concentration so that insufficient numbers are in close proximity to the cervix. Round cells in the specimen can be either white cells or immature cells, and these look similar in wet preparations. In laboratories where these tests are not performed, all round cells are lumped together and reported as white blood cells. It is reasonable to obtain a culture, perhaps by prostatic massage, when the report states that there are 5 or more white cells per high power field, even though some of these may be immature cells, and the presence of white cells does not always correlate with infection. Repetitive agglutination of sperm (except when it is on pieces of debris) is suggestive of an immunologic effect or an infection. Although it is common practice to evaluate the pH of semen because abnormalities may provide a clue to disorders of the accessory glands, in practice this measurement is of little value. Tests of Sperm Function Although all of the major elements of the semen analysis (numbers, motility, and morphology) have some bearing on fertility, especially when markedly deficient, the lack of precise correlations has led to a search for tests of the functional capacity of sperm. Despite enthusiasms generated by a variety of assays over the past 4 decades, no test has emerged as a reliable standard for the fertilizing ability of sperm. One problem is that the functional tests individually measure only one aspect of the many functions performed by sperm, whether it is attachment to the zona, penetration of the egg membrane, or the release of enzymes. If the functional tests were better prognosticators and less cumbersome to perform, they still could play a role in clinical practice. For example, a couple with unexplained infertility and an abnormal result might consider donor insemination as a therapeutic option. However, foreign sperm can fuse with and penetrate an egg if the zona is removed by gentle enzyme digestion. Presence of a swollen sperm head in the egg cytoplasm is evidence of successful penetration. Most laboratories report the percentage of eggs penetrated and compare this figure to the percent penetrated by a known fertile sperm specimen (some laboratories use the criterion of number of sperm penetrations per egg with 2 or more considered normal). For example, the source of the albumin used as the protein supplement in the media can influence the result as can use of resuspended compared to swim-up sperm. In addition, different laboratories utilize different cutoff points for the lower limit of normal penetration with the most common points being 0, 10, 14, and 20%.

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Associated anomalies are frequently found, including congenital heart disease, polycystic kidneys, and intestinal atresia. In about 50% of cases, there are simple transverse reduction deficiencies of one forearm or hand without associated anomalies. The atypical variety (found in 1 per 150 000 births) is characterized by a much wider cleft formed by a defect of the metacarpals and the middle fingers; the cleft is U-shaped and wide, with only the thumb and small finger remaining. Ulnar clubhand, which is less common, ranges from mild deviations of the hand on the ulnar side of the forearm to complete absence of the ulna. Neurological, muscular, connective tissue, and skeletal abnormalities result in multiple joint contractures, including bilateral talipes and fixed flexion or extension deformities of the hips, knees, elbows and wrists. In the first trimester, a common feature of many chromosomal defects is increased nuchal translucency thickness. Triploidy Triploidy, where the extra set of chromosomes is paternally derived, is associated with a molar placenta and the pregnancy rarely persists beyond 20 weeks. If the defects are either lethal or they are associated with severe handicap, fetal karyotyping constitutes one of a series of investigations to determine the possible cause and therefore the risk of recurrence. Examples of these defects include hydrocephalus, holoprosencephaly, multicystic renal dysplasia and severe hydrops. It is therefore uncertain whether, in such cases, karyotyping should be undertaken, especially for those abnormalities that have a high prevalence in the general population and for which the prognosis in the absence of a chromosomal defect is good. Turner syndrome is usually due to loss of the paternal X chromosome and, consequently, the frequency of conception of 45, X embryos, unlike that of trisomies, is unrelated to maternal age. The prevalence is about 1 per 1500 at 12 weeks, 1 per 3000 at 20 weeks and 1 per 4000 at 40 weeks. Polyploidy affects about 2% of recognized conceptions but it is highly lethal and it is very rarely observed in live births; the prevalence at 12 and 20 weeks is about 1 per 2000 and 1 per 250 000, respectively. However, it is sometimes associated with chromosomal defects, cardiac anomalies, infection or genetic syndromes. However, there is some evidence that isolated short femur may not be more common in trisomic than normal fetuses. For isolated hyperechogenic foci, the risk for trisomy 21 may be three-times the background risk. When any of this developmentally abnormal tissue is present at birth, it is inferred that the cells failed to mature, migrate or differentiate properly during intrauterine life. Prognosis Apart from intracranial tumors (where the prognosis is generally poor), the prognosis for tumors in other locations is variable and depends on the size of the tumor (with resultant compression of adjacent organs), degree of vascularization (with the risk of causing heart failure and hydrops), and associated polyhydramnios (with the risk of preterm delivery). Etiology Embryonic tumors are thought to derive from embryologically displaced cells. In some cases, the lesion appears as a low echogenic structure, and it may be difficult to recognize.

Diseases