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Fetal Malpresentation

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181. Labor and Delivery, Normal Delivery of the Newborn

delivery is not imminent, placenta previa, suspected or confirmed cephalopelvic disproportion, fetal malpresentation, maternal instability, a history of multiple prior abdominal deliveries or of a vertical uterine scar, or active genital herpes. Controlled maternal pushing helps prevent deep perineal tearing. Prophylactic episiotomy is not recommended for routine births. The incidence of shoulder dystocia is increasing. A higher incidence is associated with macrosomia, although most cases occur (...) of the head after delivery to facilitate shoulder delivery Several clinical parameters are followed. The fetal presentation is determined by the first fetal body part that passes through the birth canal. Most commonly, this is the occiput or the vertex of the head. The fetal station is the relation of the fetal head to the maternal ischial spines. The station is defined as -5 cm to +5 cm; 0 station is at the level of the ischial spines. The fetal position is the orientation of the fetal vertex (the top

2014 eMedicine.com

182. 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

183. 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

184. 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

185. 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

186. Surgical Management of Mullerian Duct Anomalies (Diagnosis)

outcomes are generally poor in this group. Unicornuate uterus is associated with the poorest fetal survival among all müllerian anomalies. [ ] Cesarean delivery rates are high. Common obstetrical complications include malpresentation, intrauterine growth retardation, and preterm birth. [ , ] A review of compiled data from several studies of uterine anomalies and pregnancy outcomes revealed that the unicornuate uterus had the poorest overall reproductive outcomes of all the uterine anomalies. Problems

2014 eMedicine.com

187. Premature Rupture of Membranes (Diagnosis)

hours, expectant management and waiting for spontaneous labor may be considered in selected patients for the first 12-24 hours if a patient desires expectant management. The use of expectant management after the first 24 hours is questionable. Digital vaginal examinations should be avoided until labor is initiated; however, fetal presentation should be documented to avoid discovering malpresentation of the fetus long after admission for ROM. All patients with ROM should be asked to come (...) to the hospital to ensure fetal well being. The neonatal risks of expectant management of PROM include infection, placental abruption, fetal distress, fetal restriction deformities and pulmonary hypoplasia, and fetal/neonatal death. Fetal death does occur in approximately 1% of patients with PROM after viability who have been expectantly managed [ ] and in about 1:1000 term PROM. [ ] The primary determinant of neonatal morbidity and mortality is gestational age at delivery, again stressing the importance

2014 eMedicine.com

188. Pregnancy, Eclampsia (Treatment)

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

189. Premature Rupture of Membranes (Treatment)

hours, expectant management and waiting for spontaneous labor may be considered in selected patients for the first 12-24 hours if a patient desires expectant management. The use of expectant management after the first 24 hours is questionable. Digital vaginal examinations should be avoided until labor is initiated; however, fetal presentation should be documented to avoid discovering malpresentation of the fetus long after admission for ROM. All patients with ROM should be asked to come (...) to the hospital to ensure fetal well being. The neonatal risks of expectant management of PROM include infection, placental abruption, fetal distress, fetal restriction deformities and pulmonary hypoplasia, and fetal/neonatal death. Fetal death does occur in approximately 1% of patients with PROM after viability who have been expectantly managed [ ] and in about 1:1000 term PROM. [ ] The primary determinant of neonatal morbidity and mortality is gestational age at delivery, again stressing the importance

2014 eMedicine.com

190. Assisted Reproduction Technology (Treatment)

, 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 (...) and the physician. This goal is also less vulnerable to misinterpretation than the pregnancy rate (single positive hCG vs serial increases) or the clinical pregnancy rate (gestational sac vs fetal pole vs fetal pole with heartbeat). IVF outcomes 2005 data for IVF outcomes are summarized and results can be viewed on the and Society for Web sites. Outcomes are stratified based on cycle type (fresh IVF, frozen embryo IVF, donor IVF, and maternal age). Overall, 134,260 ART cycles were performed in the United States

2014 eMedicine.com

191. Maintenance agonist treatments for opiate dependent pregnant women. (PubMed)

Maintenance agonist treatments for opiate dependent pregnant women. The prevalence of opiate use among pregnant women ranges from 1% to 2% to as much as 21%. Heroin crosses the placenta and pregnant opiate dependent women experience a six fold increase in maternal obstetric complications such as low birth weight, toxaemia, 3rd trimester bleeding, malpresentation, puerperal morbidity, fetal distress and meconium aspiration. Neonatal complications include narcotic withdrawal, postnatal growth

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2008 Cochrane

192. Management of Pregnancy

Weeks) 51 I- 22. Establishing the Gestational Age: Weeks 10-12 51 I- 23. Auscultation Fetal Heart Tones: Weeks 10-12, All following visits 53 I- 24. Screening Fundal Height: Weeks 10-12; All following visits 54 I- 25. Assessing (Inappropriate) Weight Gain: Weeks 10-12; All following visits 55 I- 26. Nutritional Supplements: Weeks 10-12 56 I- 27. Obesity: Weeks 10-12 58 I- 28. History of Gastric Bypass/Bariatric Surgery: Weeks 10-12 59 I- 29. Screening for Gonorrhea: Weeks 10-12 60 I- 30. Screening (...) for Chlamydia: Weeks 10-12 61 I- 31. Screening for and Prevention of Cervical Cancer: Weeks 10-12 62 I- 32. Screening for HSV: Weeks 10-12 or onset of symptoms 63 I- 33. Counseling for Cystic Fibrosis Screening: Weeks 10-12 64 I- 34. Management of Depression during Pregnancy: When diagnosed 65 I- 35. Periodontal Disease and Dental Care: Weeks 10-12 67 I- 36. Prenatal Screening for Fetal Chromosomal Abnormalities: W e e ks 1 0- 12; 16-20 68 Visits During Weeks: 16-27 76 I- 37. Obstetric Ultrasound: Week 16

2009 VA/DoD Clinical Practice Guidelines

193. 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

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. Trending elective preterm deliveries using administrative data. (PubMed)

%) 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

196. Factors influencing stillbirth in bangladesh: a case-control study. (PubMed)

(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

197. Oral Paracetamol as Preemptive Analgesia for Labor Pain

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 (...) 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

2013 Clinical Trials

198. 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

199. In vitro fertilization and multiple pregnancies: an evidence-based analysis. (PubMed)

-eclampsia, polyhydramnios, gestational diabetes, fetal malpresentation requiring Caesarean section, postpartum haemorrhage, and postpartum depression. Babies from multiple pregnancies are at a significantly higher risk of early death, prematurity, and low birth weight, as well as mental and physical disabilities related to prematurity. Increased maternal and fetal morbidity leads to higher perinatal and neonatal costs of multiple pregnancies, as well as subsequent lifelong costs due to disabilities

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2012 Ontario health technology assessment series

200. Quality of caesarean delivery services and documentation in first-line referral facilities in Afghanistan: a chart review. (PubMed)

early neonatal deaths were documented. In cases of maternal and fetal death, the most common indications for CS delivery were placenta praevia or abruption and malpresentation. In 62% of maternal deaths, the fetus was stillborn or died shortly after birth. In 48% of stillbirths, the fetus had a normal heart rate at the last check. Information on partograph use was missing in 38% of cases, information on parity missing in 23% of cases and indications for cesareans missing in 9%.Timely referral within

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2012 BMC Pregnancy and Childbirth

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