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delivery, for concern regarding fetal well-being or fetalmalpresentation. Whenever possible, periviable births for which maternal or neonatal intervention is planned should occur in centers that offer expertise in maternal and neonatal care and the needed infrastructure, including intensive care units, to support such services. This document describes newborn outcomes after periviable birth, provides current evidence and recommendations regarding interventions in this setting, and provides an outline (...) are faced with complex and ethically challenging decisions. Multiple factors have been found to be associated with short-term and long-term outcomes of periviable births in addition to gestational age at birth. These include, but are not limited to, nonmodifiable factors (eg, fetal sex, weight, plurality), potentially modifiable antepartum and intrapartum factors (eg, location of delivery, intent to intervene by cesarean delivery or induction for delivery, administration of antenatal corticosteroids
, for concern regarding fetal well-being or fetalmalpresentation. Whenever possible, periviable births for which maternal or neonatal intervention is planned should occur in centers that offer expertise in maternal and neonatal care and the needed infrastructure, including intensive care units, to support such services. This document describes newborn outcomes after periviable birth, provides current evidence and recommendations regarding interventions in this setting, and provides an outline for family (...) with complex and ethically challenging decisions. Multiple factors have been found to be associated with short-term and long-term outcomes of periviable births in addition to gestational age at birth. These include, but are not limited to, nonmodifiable factors (eg, fetal sex, weight, plurality), potentially modifiable antepartum and intrapartum factors (eg, location of delivery, intent to intervene by cesarean delivery or induction for delivery, administration of antenatal corticosteroids and magnesium
delivery, including those coded as elective or for fetalmalpresentation. Primary maternal outcomes included infection (composite of chorioamnionitis, endometritis, wound separation, and wound infection), blood transfusion, or transfer to the intensive care unit. Primary neonatal outcomes included neonatal asphyxia, mechanical ventilation, and composite neonatal morbidity, consisting of ≥1 of the following: birth injury, 5-minute Apgar <4, arterial pH <7.0 or base excess <-12.0, neonatal asphyxia (...) a multiinstitution obstetric cohort.We performed a retrospective cohort study using data from the Consortium on Safe Labor, identifying triplet pregnancies with delivery at a gestational age ≥28 weeks. Women with a history of cesarean delivery and pregnancies complicated by chromosomal or congenital anomalies, twin-twin transfusion syndrome, or a fetal demise were excluded. The attempted vaginal group included all women with spontaneous or induced labor and excluded all women delivering by prelabor cesarean
: Risk factor of trauma eg; macrosomia, congenital fetal malformations as (exophthalmous major, hydrocephalus, spinal cord teratoma….etc. Instrumental delivery. Primipara refuses to be in the study. Other techniques of episiotomy. Preterm onset of labour. Indication for CS eg; CPD, malposition and malpresentation, fetal distress….etc. Use of epidural analgesics. Factors affecting wound healing eg;DM, corticosteroid therapy, chronic debilitating diseases…etc. Contacts and Locations Go to Information
for pain control Anticipate malpresentations Complete cervical dilation may be less than 10 cm Elective ceserean <36 weeks offered in some settings Consider transport to tertiary center with NICU Strongly consider if <34 weeks gestation Contraindications Imminent delivery or maternal status unstable No safe transport to referral center III. Management: Corticosteroids Indications Intact membranes at 24-34 weeks without at 24 to 32 weeks Consider in women 23 weeks gestation who are likely to delivery (...) . Management: Tocolytic agents See Contraindications or lethal fetal anomaly or Maternal bleeding with hemodynamic instability Preferred s (also used for neuroprotective benefit, in addition to ) Load: 6 grams bolus IV over 20 min (Very high dose!) Maintenance: 2 grams/hour IV infusion Must follow protocols for patient safety and neuroprotective (with decreased risk of in deliveries before 32 weeks) Load: 50-100 mg orally or rectally Maintenance: 25-50 mg orally every 4-6 hours Avoid use >48 hours (risk
of fluid from vagina Fluid leakage increases with movement change V. Signs See evaluation below VI. Differential diagnosis Water from recent bathing VII. Complications Premature Birth (PPROM) Cord compression Respiratory distress syndrome e Malpresentation VIII. Course prior to delivery Term: Labor starts within 24 hours in 95% of cases Weeks 28 to 34 Labor starts within 24 hours in 50% of cases Labor starts within 1 week in 80% of cases Weeks 24 to 26 Labor starts within 1 week in >50% Labor delayed 4 (...) Estimates fetal weight Evaluate Method to confirm ROM in uncertain cases Uses Indigo carmine dye 1 ml in 9 ml sterile NS Instilled into via Vaginal tampon turns blue within 30 min in ROM XI. Precautions: Avoid digital cervical exam in PPROM Digital exam raises infection risk, other morbidities Digital exam reduces time to labor by 9 days Speculum visualization offers similar dilation estimate XII. Precautions: Indications for imminent delivery Fetal Compromise XIII. Management: Term Premature Rupture
as above Maternal conditions (or other maternal serious chronic comorbidity) Maternal Other Maternal factors Maternal age <17 years old or over age 38 years old Limited or absent Maternal Fetal Status Oligohydramnios or polyhydramnios (especially if < 1500 g or immature ) Decreased fetal activity VI. Risk Factors: Intrapartum Maternal factors (or other serious infection) Maternal medications ( s, sedation) ( , ) Prolonged or Premature Labor Precipitous Delivery Meconium stained amniotic fluid Fetal (...) Status Malpresentation (e.g. ) VII. References (2016) Manual, 14th ed, p. I-198 Claudius, Behar, Nichols in Herbert (2015) EM:Rap 15(1): 3-4 Spangler, Claudius, Behar and Nicholas in Herbert (2016) EM:Rap 16(9): 11-3 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Neonatal Distress Causes." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Related Topics
injury) IV. Indications Suspicion of fetal compromise (e.g. nonreassuring ) Maternal exhaustion Prolonged second stage of labor Nulliparous: Failed preogression over 3 hours with anesthesia and 2 hours without Multiparous: Failed preogression over 2 hour with anesthesia and 1 hours without V. Contraindications Fetal head not engaged earlier than 34 weeks Known fetal disorders predisposing to complication Bone mineralization disorders s Malpresentation Noncephalic presentation Occipitoposterior (...) presentation is not a contraindication to Vacuum Assisted Delivery However, anal sphincter approaches 33% VI. Complications See VII. Precautions Vacuum can do as much or more damage as forceps Criteria to discontinue (prevent ) No progress after 3 pulls No baby extraction in 30 minutes after initiation Cup disengages 3 times Significant fetal scalp or maternal VIII. Preparation See IX. Technique Apply Suction cup during contraction Decrease cup pressure to 100 mmHg between contractions No traction until
Posterior , Occipitoposterior Malpresentation , OP Presentation From Related Chapters II. Definition Abnormal with occiput at maternal Fetal face towards maternal symphysis pubis III. Epidemiology Represents 10% of s IV. Physiology Less favorable fetal head diameter for delivery Deflexion of fetal head Posterior presentation Usually corrects spontaneously Rotates to position in 90% of cases V. Symptoms Back labor Prolonged labor Nulliparous: Additional two hours Multiparous: Additional one hour VI (...) . Signs: Digital cervical exam Asymmetric cervical dilation Persistant anterior lip Palpation of fetal head Fetal anterior most palpable Follow sagittal to posterior Posterior , lambdoid with be posterior VII. Complications Extended episiotomy or perineal VIII. Management Spontaneous Delivery (anticipate in 45% of cases) Maternal position changes (unclear efficacy) Any position in which mother curls forward from hips Hands and knees Squatting Manual rotation during vaginal exam See Vacuum Delivery
window. Related Studies (from Trip Database) Ontology: Breech Presentation (C0006157) Definition (NCI) A fetal presentation in which the baby descends into the birth canal with hips, buttocks or its foot first during delivery.(NICHD) Definition (MSH) A malpresentation of the FETUS at near term or during OBSTETRIC LABOR with the fetal cephalic pole in the fundus of the UTERUS. There are three types of breech: the complete breech with flexed hips and knees; the incomplete breech with one or both hips (...) or Incomplete Breech (35-45%) One or both hips and knees extended One or both feet presenting IV. Risk Factors Prematurity Multiple prior pregnancies Polyhydramnios or oligohydramnios Uterine abnormalities Fetal abnromalities (e.g. , ) Macrosomia Breech Presentation in prior pregnancy Absolute V. Signs Longitudinal Firm lower pole Limbs to one side Hard head at uterine fundus Head may be obscured by maternal ribs Fetal heart tone auscultation Breech Fetal heart best heard above Cervical examination No hard
to safe and timely transport to nearby hospitals. The Committee on Obstetric Practice considers fetalmalpresentation, multiple gestation, or prior cesarean delivery to be an absolute contraindication to planned home birth.
and timely transport to nearby hospitals. The Committee on Obstetric Practice considers fetalmalpresentation, multiple gestation, or prior cesarean delivery to be an absolute contraindication to planned home birth.
), nonreassuring fetal testing, excluding transient bradycardia, after external cephalic version (6.9% vs 7.4%; relative risk, 0.93, 95% confidence interval, 0.53-1.64), and abruption placentae (0.4% vs 0.4%; relative risk, 1.01, 95% confidence interval, 0.06-16.1) were similar.Administration of neuraxial analgesia significantly increases the success rate of external cephalic version among women with malpresentation at term or late preterm, which then significantly increases the incidence of vaginal (...) the effectiveness of neuraxial analgesia as an intervention to increase the success rate of external cephalic version.Searches were performed in electronic databases with the use of a combination of text words related to external cephalic version and neuraxial analgesia from the inception of each database to January 2016.We included all randomized clinical trials of women, with a gestational age ≥36 weeks and breech or transverse fetal presentation, undergoing external cephalic version who were randomized
). Participants: A non-DHHS, nonadvocate 15-member panel representing the fields of obstetrics and gynecology, urogynecology, maternal and fetal medicine, pediatrics, midwifery, clinical pharmacology, medical ethics, internal medicine, family medicine, perinatal and reproductive psychiatry, anesthesiology, nursing, biostatistics, epidemiology, health care regulation, risk management, and a public representative. In addition, 21 experts from pertinent fields presented data to the panel and conference audience (...) – especially studies that would help to characterize more precisely the short-term and long-term maternal, fetal, and neonatal outcomes of trial of labor and elective repeat cesarean delivery. Introduction Vaginal birth after cesarean (VBAC) describes vaginal delivery by a woman who has had a previous cesarean delivery. For most of the twentieth century, once a woman had undergone a cesarean delivery, clinicians believed that her future pregnancies required cesarean delivery. Studies from the 1960s
) to Foley bulb plus vaginal misoprostol (n=56) or vaginal misoprostol alone (n=61). Women with fetalmalpresentation, multifetal gestation, spontaneous labor, contraindication to prostaglandins, nonreassuring fetal heart rate tracing, intrauterine growth restriction, anomalous fetus, fetal demise, or previous cesarean delivery or other significant uterine surgery were excluded. The primary outcome measure was induction-to-delivery time. Secondary outcomes were mode of delivery, tachysystole with fetal
to 60 Years (Adult) Sexes Eligible for Study: Female Accepts Healthy Volunteers: Yes Criteria Inclusion Criteria Term 37 weeks or more, singleton in cephalic presentation Age 18 years and older Patient admitted for induction of labor Exclusion Criteria: Malpresentation Preterm labor less than 37 weeks of gestation Patients with fetal anomalies Premature rupture of membranes If the cervix is closed and unable to place the foley bulb Multiple gestation Non-reassuring fetal heart tracing
/Failure to progress = Cord prolapse = Non-reassuring fetal tracing = Malpresentation = Placental abruption = Other Induction-to-delivery interval in hours [ Time Frame: Induction to delivery ] Number of participants with a need for oxytocin augmentation [ Time Frame: Induction to delivery ] Number of participants exhibiting tachysystole requiring terbutaline or Pitocin cessation [ Time Frame: Induction to delivery ] Tachysystole is indicated ≥ 5 contractions in a 10 minute period averaged over a 30 (...) that obese women experience increased labor duration and oxytocin needs when compared to normal-weight women. This in turn results in increased rates for unplanned cesarean delivery (CD) as a result of failed induction of labor (IOL), arrest disorders and non-reassuring fetal heart rate tracing, that is dose-dependent with increasing class of obesity. The investigators hypothesize that obese pregnant women and unfavorable cervix (Bishop score ≤ 6), IOL ≥ 24 weeks gestation using the Foley balloon plus
to 40 weeks (confirmed by a reliable date for the last menstrual period and 1st trimester ultrasound scan), vertex presentation of the fetus & intact membranes Exclusion Criteria: Women who had chronic or pregnancy induced diseases or any contraindication to vaginal delivery (e.g. malpresentation, contracted pelvis & placenta previa) were excluded. Additional exclusion criteria included rhesus (Rh) negative or (O) blood group mothers, prolonged labour (> 12h), fetal distress, instrumental delivery (...) A that included 109 women in whom labour was augmented by IV infusion of oxytocin using isotonic saline 0.9%, Drug: Oxytocin different oxytocin diluents and effect on fetal bilirubin&sodium levels. Other Name: syntocinon Active Comparator: 2 group B that included 109 women in whom labour was augmented by IV infusion of oxytocin using glucose 5% . Drug: Oxytocin different oxytocin diluents and effect on fetal bilirubin&sodium levels. Other Name: syntocinon Placebo Comparator: 3 Group C in which 109 women