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Fetal Malpresentation

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181. Cesarean Delivery (Diagnosis)

. [ ] The emerging consensus is that a randomized prospective study is required to address this issue. [ ] Fetal indications Fetal indications for cesarean delivery include the following: Situations in which neonatal morbidity and mortality could be decreased by the prevention of trauma Malpresentations Certain congenital malformations or skeletal disorders Infection Prolonged acidemia A fetus in a nonvertex presentation is at increased risk for trauma, cord prolapse, and head entrapment. Malpresentation (...) state maternal care collaborative agencies are even implementing tools to decrease the likelihoond of cesarean section in the instance of a breech presentation, with guidelines recommending the formation of a team in the hospital that is trained and confortable with breach and operative deliveries. [ ] If a patient is diagnosed with a fetal malpresentation (ie, breech or transverse lie) after 36 weeks, the option for an external cephalic version is offered to try to convert the fetus to a vertex lie

2014 eMedicine.com

182. Cervical Ripening (Diagnosis)

of . [ ] The major risk of the above prostaglandin preparations is uterine hyperstimulation. The woman and fetus must be monitored for contractions, fetal well-being, and changes in the cervical Bishop score. Finally, Christensen et al demonstrate that the combination of oxytocin induction, preceded by a dinoprostone insert is safe, and this significantly shortens induction-to-delivery times. [ ] The exception to this appears to be women with prior cesarean deliveries. The ACOG Committee on Obstetric Practice (...) with an "unfavorable" or unripened cervix. Previous Next: Contraindications to Cervical Ripening Contraindications to cervical ripening include, but are not limited to, the following: Active herpes Fetal malpresentation Nonreassuring fetal surveillance History of prior traumatic delivery Regular contractions Unexplained vaginal bleeding Placenta previa Vasa previa Prior uterine myomectomy involving the endometrial cavity or classical cesarean delivery Previously, a history of a prior low transverse cesarean

2014 eMedicine.com

183. Assisted Reproduction Technology (Diagnosis)

decreases as the number of oocytes decreases. Cycle fecundity also decreases, largely due to an increase in miscarriages. See the image below. Female age and fertility. The number and quality of a woman’s oocytes declines with age. The decline in the number of oocytes begins at 20 weeks' gestation when the female fetus has approximately 6-7 million oogonia (largest lifetime endowment). The number of oocytes decreases to approximately 2-3 million at birth and decreases again to 300,000 by the time (...) , retained products of conception, or postpartum curettage should alert the clinician to a possible uterine factor. A history of abnormal bleeding, such as heavy menses, midcycle spotting, or irregular bleeding, may represent an intrauterine fibroid, polyp, or synechiae. Malpresentation during pregnancy or often suggests a uterine anomaly, such as a septum or bicornuate uterus. A screening transvaginal ultrasonography performed immediately following the cessation of menses may demonstrate a uterine

2014 eMedicine.com

184. Abnormal Labor (Diagnosis)

dilatation or lack of descent), and cephalopelvic disproportion (CPD). Friedman's original research in 1955 defined the following three stages of labor [ ] : The first stage starts with uterine contractions leading to complete cervical dilation and is divided into latent and active phases. In the latent phase, irregular uterine contractions occur with slow and gradual cervical effacement and dilation. The active phase is demonstrated by an increased rate of cervical dilation and fetal descent. The active (...) for multiparous women . [ ] ACOG has also stated that extending the time from 2 to 4 hours with oxytocin augmentation appears effective. Irrespective of the duration, maternal and fetal well-being status must be confirmed. In another study it was found that extending oxytocin augmentation for an additional 4 hours, up to 8 hours total, in patients who were dilated at least 3cm and had unsatisfactory progress resulted in a greater number of vaginal deliveries (38% delivered vaginally) without any evidence

2014 eMedicine.com

185. Face Presentation (Diagnosis)

along the longitudinal axis of the uterus. Nonvertex presentations (including breech, transverse lie, face, brow, and compound presentations) occur in less than 4% of fetuses at term. Malpresentation of the vertex presentation occurs if there is deflexion or extension of the fetal head leading to brow or face presentation, respectively. In a face presentation, the fetal head and neck are hyperextended, causing the occiput to come in contact with the upper back of the fetus while lying (...) in a longitudinal axis. The presenting portion of the fetus is the fetal face between the orbital ridges and the chin. The fetal chin (mentum) is the point designated for reference during an internal examination through the cervix. The occiput of a vertex is usually hard and has a smooth contour, while the face and brow tend to be more irregular and soft. Like the occiput, the mentum can present in any position relative to the maternal pelvis. For example, if the mentum presents in the left anterior quadrant

2014 eMedicine.com

186. Eclampsia (Diagnosis)

delivery until the acute phase of the seizure or coma has passed. The mode of delivery should be based on obstetric indications but should be chosen with an awareness that vaginal delivery is preferable from a maternal standpoint. Adequate maternal pain relief for labor and delivery is vital and may be provided with either systemic opioids or epidural anesthesia. In the absence of fetal malpresentation or fetal distress, oxytocin or prostaglandins may be initiated to induce labor. Cesarean delivery may (...) in the absence of hypertension with proteinuria has been demonstrated to occur in 38% of cases reported in the United Kingdom. [ ] Similarly, hypertension was absent in 16% of cases reviewed in the United States. [ ] The clinical manifestations of maternal preeclampsia are hypertension and proteinuria with or without coexisting systemic abnormalities involving the kidneys, liver, or blood. There is also a fetal manifestation of preeclampsia involving fetal growth restriction, reduced amniotic fluid

2014 eMedicine.com

187. Gynecologic Myomectomy (Diagnosis)

. Pedunculated myomas can undergo torsion, causing the same severe pain as torsion of the ovary. Large myomas can outgrow their blood supply, leading to infarction and necrosis (degenerating myoma), which can be extremely painful. Lastly, prolapse of a myoma can be acutely painful. Although general agreement is lacking on the mechanism, myomas are also thought to be related to infertility, fetal malpresentations, and preterm labor. Possible mechanisms for infertility include distortion of the endometrial

2014 eMedicine.com

188. Labor and Delivery, Normal Delivery of the Newborn

. In 2008, the following consensus guidelines were developed to unify the interpretation of fetal heart tracings. Category One: Normal fetal heart tracings. Continue expectant management. Category Two: Indeterminate fetal heart tracings. These tracings require close observation or interventions to determine whether the fetus has acidemia. Category Three: Abnormal fetal heart tracings. These tracings require immediate intervention. They are not reassuring and are indicative of fetal acidemia (...) the risk of harm to the fetus and mother. Fetal complications from vacuum delivery include hematomas of the scalp, retina, and intracranium. Maternal complications are less than those with forceps but also include vaginal and perineal lacerations. The decision to use forceps or a vacuum assistance is guided by the particular indication for an instrumented delivery and the clinician’s experience with each technique. In cases of a nonreassuring fetal tracing, the decision to perform an assisted vaginal

2014 eMedicine.com

189. Polyhydramnios and Oligohydramnios (Overview)

> Polyhydramnios and Oligohydramnios Updated: Sep 20, 2017 Author: Brian S Carter, MD, FAAP; Chief Editor: Dharmendra J Nimavat, MD, FAAP Share Email Print Feedback Close Sections Sections Polyhydramnios and Oligohydramnios Overview Background The amniotic fluid that bathes the fetus is necessary for its proper growth and development. It cushions the fetus from physical trauma, permits fetal lung growth, and provides a barrier against infection. Normal amniotic fluid volume varies. The average volume increases (...) , approximately 20% of neonates are born with a congenital anomaly of some type; therefore, the delivery of these newborns in a tertiary care setting is preferred. This article presents the causes, outcomes, and treatments of polyhydramnios and oligohydramnios, as well as their effects on the developing fetus and neonate. Next: Pathophysiology Rupture of the membranes is the most common cause of oligohydramnios. However, because the amniotic fluid is primarily fetal urine in the latter half of the pregnancy

2014 eMedicine Pediatrics

190. Polyhydramnios and Oligohydramnios (Diagnosis)

> Polyhydramnios and Oligohydramnios Updated: Sep 20, 2017 Author: Brian S Carter, MD, FAAP; Chief Editor: Dharmendra J Nimavat, MD, FAAP Share Email Print Feedback Close Sections Sections Polyhydramnios and Oligohydramnios Overview Background The amniotic fluid that bathes the fetus is necessary for its proper growth and development. It cushions the fetus from physical trauma, permits fetal lung growth, and provides a barrier against infection. Normal amniotic fluid volume varies. The average volume increases (...) , approximately 20% of neonates are born with a congenital anomaly of some type; therefore, the delivery of these newborns in a tertiary care setting is preferred. This article presents the causes, outcomes, and treatments of polyhydramnios and oligohydramnios, as well as their effects on the developing fetus and neonate. Next: Pathophysiology Rupture of the membranes is the most common cause of oligohydramnios. However, because the amniotic fluid is primarily fetal urine in the latter half of the pregnancy

2014 eMedicine Pediatrics

191. Pregnancy, Eclampsia (Follow-up)

delivery until the acute phase of the seizure or coma has passed. The mode of delivery should be based on obstetric indications but should be chosen with an awareness that vaginal delivery is preferable from a maternal standpoint. Adequate maternal pain relief for labor and delivery is vital and may be provided with either systemic opioids or epidural anesthesia. In the absence of fetal malpresentation or fetal distress, oxytocin or prostaglandins may be initiated to induce labor. Cesarean delivery may (...) in the absence of hypertension with proteinuria has been demonstrated to occur in 38% of cases reported in the United Kingdom. [ ] Similarly, hypertension was absent in 16% of cases reviewed in the United States. [ ] The clinical manifestations of maternal preeclampsia are hypertension and proteinuria with or without coexisting systemic abnormalities involving the kidneys, liver, or blood. There is also a fetal manifestation of preeclampsia involving fetal growth restriction, reduced amniotic fluid

2014 eMedicine Emergency Medicine

192. Pregnancy, Eclampsia (Diagnosis)

delivery until the acute phase of the seizure or coma has passed. The mode of delivery should be based on obstetric indications but should be chosen with an awareness that vaginal delivery is preferable from a maternal standpoint. Adequate maternal pain relief for labor and delivery is vital and may be provided with either systemic opioids or epidural anesthesia. In the absence of fetal malpresentation or fetal distress, oxytocin or prostaglandins may be initiated to induce labor. Cesarean delivery may (...) in the absence of hypertension with proteinuria has been demonstrated to occur in 38% of cases reported in the United Kingdom. [ ] Similarly, hypertension was absent in 16% of cases reviewed in the United States. [ ] The clinical manifestations of maternal preeclampsia are hypertension and proteinuria with or without coexisting systemic abnormalities involving the kidneys, liver, or blood. There is also a fetal manifestation of preeclampsia involving fetal growth restriction, reduced amniotic fluid

2014 eMedicine Emergency Medicine

193. Pregnancy, Eclampsia (Overview)

delivery until the acute phase of the seizure or coma has passed. The mode of delivery should be based on obstetric indications but should be chosen with an awareness that vaginal delivery is preferable from a maternal standpoint. Adequate maternal pain relief for labor and delivery is vital and may be provided with either systemic opioids or epidural anesthesia. In the absence of fetal malpresentation or fetal distress, oxytocin or prostaglandins may be initiated to induce labor. Cesarean delivery may (...) in the absence of hypertension with proteinuria has been demonstrated to occur in 38% of cases reported in the United Kingdom. [ ] Similarly, hypertension was absent in 16% of cases reviewed in the United States. [ ] The clinical manifestations of maternal preeclampsia are hypertension and proteinuria with or without coexisting systemic abnormalities involving the kidneys, liver, or blood. There is also a fetal manifestation of preeclampsia involving fetal growth restriction, reduced amniotic fluid

2014 eMedicine Emergency Medicine

194. A Trial Comparing Combined Spinal- Epidural Dosing Strategies for External Cephalic Version

significance:Increasing the success and comfort of ECV for fetal malpresentation may help decrease the cesarean section rate. Condition or disease Intervention/treatment Phase Pregnancy Pain Drug: Group 2.5 Drug: Group 5 Drug: Group 7.5 Drug: Group 10 Phase 4 Detailed Description: At term 2 to 3% of singleton pregnancies are in breech presentation. Many of these deliveries are managed by cesarean delivery due to higher neonatal morbidity associated with vaginal breech delivery. However, cesarean delivery, the safer (...) was: Recruiting First Posted : November 25, 2013 Last Update Posted : February 1, 2017 Sponsor: Northwestern University Information provided by (Responsible Party): Laurie Chalifoux, Northwestern University Study Details Study Description Go to Brief Summary: We plan to conduct a prospective, single blinded, randomized clinical trial to assess the impact of combined spinal-epidural dosing on the success rate of, and patient satisfaction during, external version for breech fetal position and the incidence

2013 Clinical Trials

195. The Obstetric Cook Double Balloon Catheter in Combination With Oral Misoprostol for Induction of Labor

Inclusion Criteria: Single, live fetus Cephalic (head-first) presentation Reassuring fetal health assessment Gestational age between 23 and 42 weeks Maternal age 18 and above Bishop score less than 8 in primigravidae Bishop score less than 6 in multigravidae Exclusion Criteria: 1. Fetal demise 2. Fetal malpresentation 3. Estimated fetal weight less than 500 grams or more than 4000 grams 4. Placenta previa 5. Non-reassuring fetal health assessment 6. Active maternal asthma exacerbation requiring (...) Investigators Layout table for investigator information Principal Investigator: Meg Hill, MBBS University of Arizona More Information Go to Layout table for additonal information Responsible Party: Meg Hill, Fellow, Maternal Fetal Medicine, University of Arizona ClinicalTrials.gov Identifier: Other Study ID Numbers: 12-1027-01 First Posted: May 31, 2013 Last Update Posted: August 30, 2016 Last Verified: August 2016 Keywords provided by Meg Hill, University of Arizona: Labor induction Misoprostol Cytotec

2013 Clinical Trials

196. Oral Paracetamol as Preemptive Analgesia for Labor Pain

hours postpartum ] To document safety and evaluate adverse events recorded during the study either maternal or fetal. Duration of labor [ Time Frame: Start of medication till delivery of fetus. ] To assess the effect of the duration of labor. Eligibility Criteria Go to Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study (...) of age (below18-above 40) Multiparous Multiple gestation Malpresentation Congenital or acquired pelvic abnormalities(eg. Poliomyelitis) Any medical disorder with pregnancy Induction of labour Advanced 1st stage > 5 cm Use of any other kind of analgesia before recruitment in the study Scared uterus Fetal distress Contacts and Locations Go to No Contacts or Locations Provided More Information Go to Layout table for additonal information Responsible Party: Ahmed Elsayed Hassan Elbohoty, Dr, Ain Shams

2013 Clinical Trials

197. FOLCROM Trial: Foley Catheter in Rupture of Membranes

labor - defined as contractions more frequent than every 5 minutes (or ≥ 12 contractions in 1 hour) associated with ≥ 1 cm cervical change. In the absence of ≥ 1 cm cervical change after 2 hours, patients with contractions can be included in the study. Suspicion of chorioamnionitis Any contraindications to vaginal delivery, including malpresentation, active herpes, complete placenta previa, greater than two prior cesarean deliveries, etc. HIV positive status or AIDS Intrauterine fetal demise (...) . If the fetal status is reassuring, this can be increased by 2 milliunits/milliliter every 30 minutes to achieve an adequate contraction pattern as per the institution's definition to a maximum of 30 milliunits/milliliter. This infusion may be continued until delivery. Drug: Oxytocin Each arm will receive oxytocin at a rate of 2 milliunits/milliliter. If the fetal status is reassuring, this can be increased by 2 milliunits/milliliter every 30 minutes to achieve an adequate contraction pattern as per

2013 Clinical Trials

198. Trending elective preterm deliveries using administrative data. (Abstract)

%) were preterm. Elective PTBs increased 27.7% over the 6-year study period, with nearly all cases confined to the late PTB stratum; elective late PTB rates rose from 10.5% to 13.5% of all late PTBs (P < 0.0001). Indications for delivery in this Elective Group ('soft indications') included prior pelvic floor repair, mental health conditions, fetal anomalies, malpresentation and oligohydramnios. Six per cent of patients with a late PTB had a medical intervention with no hard or soft indication

2013 Paediatric and perinatal epidemiology

199. Factors influencing stillbirth in bangladesh: a case-control study. (Abstract)

(OR 2.9 [95% CI 1.5, 25.5]), preterm delivery (OR 5.2 [95% CI, 3.2, 8.5]), prolonged labour (OR 2.8 [95% CI 1.6, 4.6]) and failure of labour progress (OR 2.4 [95% CI 1.1, 5.5]) were significant maternal risk factors, while decreased fetal movement, fetal malpresentation and fetal distress were the fetal risk factors associated with stillbirth.Risk factors associated with stillbirths are amenable to intervention. There is an urgent need to educate pregnant women about risk factors for stillbirths

2013 Paediatric and perinatal epidemiology

200. Spontaneous Vaginal Delivery

Spontaneous Vaginal Delivery Aka: Spontaneous Vaginal Delivery , Vaginal Delivery , Vaginal Birth , Normal Spontaneous Vaginal Delivery , NSVD From Related Chapters II. Epidemiology Vaginal Birth accounts for 70% of deliveries in the United States Of the 4 million births in the U.S. in 2013, three million were vaginal deliveries III. Contraindications Complete Active genital (or prodromal symptoms) at time of labor Malpresentation Non- with mentum anterior Prior uterine surgery that raises risk of labor (...) click) to open the source website in a new browser window. Related Studies (from Trip Database) Ontology: Normal delivery (C1384485) Definition (NCI) Birth of the fetus through the vagina without the application of vacuum or forceps or any other instrument. (adapted from reVITALize)(NICHD) Concepts Finding ( T033 ) ICD9 650 SnomedCT 48782003 , 267325009 , 267353009 , 281686002 , 200477006 , 199313007 English FTND - Full term norm delivery , SVD - Spont vaginal delivery , Spontaneous vaginal delivery

2015 FP Notebook

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