Peripartum Clause Samples
The Peripartum clause defines the period surrounding childbirth, typically encompassing the time shortly before, during, and after delivery. In practice, this clause may specify the rights, responsibilities, or coverage related to medical care, leave, or insurance benefits for individuals during this critical timeframe. Its core function is to ensure that the unique needs and circumstances associated with childbirth are clearly addressed and protected within the agreement, reducing ambiguity and safeguarding the interests of those affected.
Peripartum. The period shortly before, during, and immediately after giving birth The plan of care for anticoagulation in the pregnant patient will be initiated by the referring provider. The plan will include the duration of anticoagulation during pregnancy, puerperium, and post-partum. UFH and LMWH do not cross the placenta and are safe for the fetus
1. LMWH is the preferred anticoagulation option in pregnant patients
a. Prophylactic dose:
i. Enoxaparin 40mg SC every 24hours
ii. Dalteparin 5000units SC every 24hours Note: prophylactic dosing may require modification for extremes of bodyweight
b. Intermediate dose:
i. Enoxaparin 40mg SC every 12hours or 1mg/kg SC every 24hours
ii. Dalteparin 5000units SC every 12hours or 100units/kg SC every 24hours
c. Therapeutic Dose
i. Enoxaparin 1mg/kg SC every 12hours ii. Dalteparin 100units/kg SC every 12 hours
2. Heparin is preferred if CrCl<30ml/min, when rapid reversal is needed and in patients with cost concerns
a. Prophylactic dose:
i. Heparin 5,000units SC every 12hours b. Intermediate dose:
i. First trimester: 5,000-7,500 units SC every 12hours ii. Second trimester: 7,500-10,000 units SC every 12hours iii. Third trimester: 10,000 units SC every 12hours
Peripartum. Peripartum cardiomyopathy (PPCM) is a form of DCM with systolic dysfunction that presents in late pregnancy or early post-partum period in women without pre-existing heart disease. Specifically, it refers to the interval of one month before delivery to five months post-partum to differentiate from an underlying idiopathic DCM unmasked as a result of the haemodynamic and hormonal change induced by pregnancy (125). The incidence may be well underestimated due to the presence of symptoms akin to heart failure that can occur as part of normal pregnancy, such as ankle oedema, shortness of breath or lethargy. Although the pathophysiology is not well understood, the risk of PPCM appears increased in the presence of advanced maternal age, African ancestry, pre- eclampsia, autoimmune disease and multi-gestational pregnancies (126). Alongside some of the shared clinical features with idiopathic DCM, there is some genetic overlap also, and a similar burden of genetic variants identified across the two cohorts with TTNtv being the most prevalent genetic predisposition (66). No specific biomarkers or parameters have been identified that differentiate this subgroup from other non-ischaemic causes of cardiomyopathy, however, it is a DCM associated with a high chance of LV functional recovery (127). Hence, initial LVEF is relatively poor for predicting events in this cohort, particularly, in light of the high-risk early post- partum period when the risk of dying can affect up to 30% of women (128–130). Whilst risk stratification is unclear in this setting, management requires a multidisciplinary focus that takes into account both mother and foetal wellbeing, in addition to the altered physiological parameters that may affect the hierarchy of heart failure medication options (127).