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Prevention of Labor Dystocia

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181. Birth Trauma (Treatment)

of labor must be appropriate. Occasionally, injury may be sustained in utero. Previous Next: Bone Injury Fractures are most often observed following breech delivery, shoulder dystopia, or both in infants with excessive birth weights. Clavicular fracture The clavicle is the most frequently fractured bone in the neonate during birth; this is most often an unpredictable, unavoidable complication of normal birth. [ ] Some correlation with birth weight, midforceps delivery, and shoulder dystocia (...) damage, edema, hemorrhage, or fracture in the neonate. The use of obstetric instrumentation may further amplify the effects of such forces or may induce injury alone. Under certain conditions, cesarean delivery can be an acceptable alternative but does not guarantee an injury-free birth. Factors predisposing to injury include the following: Prima gravida Cephalopelvic disproportion, small maternal stature, maternal pelvic anomalies Prolonged or rapid labor Deep, transverse arrest of descent

2014 eMedicine Pediatrics

182. The Fetus as a Patient: Prenatal Diagnosis and Fetal Therapy (Treatment)

, assessment of fetal well-being in the third trimester, when preterm birth appears imminent, and in labor may include the following diagnostic tests: Amniocentesis Nonstress test (NST) Biophysical profile test: Combines the NST with an assessment of amniotic fluid volume (AFV), fetal breathing movements, fetal activity, and fetal muscle tone Contraction stress test Doppler study: Assesses fetal umbilical arterial blood flow velocity or resistance to flow Radiologic studies Diagnostic imaging modalities (...) fetal exposure, to monitor both patients, to prevent , and to prevent the leak of amniotic fluid Knowledge gaps - The maternal-placental-fetal physiology and metabolism presents distinct challenges that preclude mere extrapolation of common medical fundamentals Fetal treatment center The fetal treatment center has been established as a solution to these problems. These centers offer many advantages. One such advantage is that the fetal treatment center is staffed with fetal surgeons, either

2014 eMedicine Pediatrics

183. Birth Trauma (Follow-up)

of labor must be appropriate. Occasionally, injury may be sustained in utero. Previous Next: Bone Injury Fractures are most often observed following breech delivery, shoulder dystopia, or both in infants with excessive birth weights. Clavicular fracture The clavicle is the most frequently fractured bone in the neonate during birth; this is most often an unpredictable, unavoidable complication of normal birth. [ ] Some correlation with birth weight, midforceps delivery, and shoulder dystocia (...) damage, edema, hemorrhage, or fracture in the neonate. The use of obstetric instrumentation may further amplify the effects of such forces or may induce injury alone. Under certain conditions, cesarean delivery can be an acceptable alternative but does not guarantee an injury-free birth. Factors predisposing to injury include the following: Prima gravida Cephalopelvic disproportion, small maternal stature, maternal pelvic anomalies Prolonged or rapid labor Deep, transverse arrest of descent

2014 eMedicine Pediatrics

184. Birth Trauma (Diagnosis)

of labor must be appropriate. Occasionally, injury may be sustained in utero. Previous Next: Bone Injury Fractures are most often observed following breech delivery, shoulder dystopia, or both in infants with excessive birth weights. Clavicular fracture The clavicle is the most frequently fractured bone in the neonate during birth; this is most often an unpredictable, unavoidable complication of normal birth. [ ] Some correlation with birth weight, midforceps delivery, and shoulder dystocia (...) damage, edema, hemorrhage, or fracture in the neonate. The use of obstetric instrumentation may further amplify the effects of such forces or may induce injury alone. Under certain conditions, cesarean delivery can be an acceptable alternative but does not guarantee an injury-free birth. Factors predisposing to injury include the following: Prima gravida Cephalopelvic disproportion, small maternal stature, maternal pelvic anomalies Prolonged or rapid labor Deep, transverse arrest of descent

2014 eMedicine Pediatrics

185. The Fetus as a Patient: Prenatal Diagnosis and Fetal Therapy (Follow-up)

, assessment of fetal well-being in the third trimester, when preterm birth appears imminent, and in labor may include the following diagnostic tests: Amniocentesis Nonstress test (NST) Biophysical profile test: Combines the NST with an assessment of amniotic fluid volume (AFV), fetal breathing movements, fetal activity, and fetal muscle tone Contraction stress test Doppler study: Assesses fetal umbilical arterial blood flow velocity or resistance to flow Radiologic studies Diagnostic imaging modalities (...) fetal exposure, to monitor both patients, to prevent , and to prevent the leak of amniotic fluid Knowledge gaps - The maternal-placental-fetal physiology and metabolism presents distinct challenges that preclude mere extrapolation of common medical fundamentals Fetal treatment center The fetal treatment center has been established as a solution to these problems. These centers offer many advantages. One such advantage is that the fetal treatment center is staffed with fetal surgeons, either

2014 eMedicine Pediatrics

186. The Fetus as a Patient: Prenatal Diagnosis and Fetal Therapy (Diagnosis)

, assessment of fetal well-being in the third trimester, when preterm birth appears imminent, and in labor may include the following diagnostic tests: Amniocentesis Nonstress test (NST) Biophysical profile test: Combines the NST with an assessment of amniotic fluid volume (AFV), fetal breathing movements, fetal activity, and fetal muscle tone Contraction stress test Doppler study: Assesses fetal umbilical arterial blood flow velocity or resistance to flow Radiologic studies Diagnostic imaging modalities (...) fetal exposure, to monitor both patients, to prevent , and to prevent the leak of amniotic fluid Knowledge gaps - The maternal-placental-fetal physiology and metabolism presents distinct challenges that preclude mere extrapolation of common medical fundamentals Fetal treatment center The fetal treatment center has been established as a solution to these problems. These centers offer many advantages. One such advantage is that the fetal treatment center is staffed with fetal surgeons, either

2014 eMedicine Pediatrics

187. The Fetus as a Patient: Prenatal Diagnosis and Fetal Therapy (Overview)

, assessment of fetal well-being in the third trimester, when preterm birth appears imminent, and in labor may include the following diagnostic tests: Amniocentesis Nonstress test (NST) Biophysical profile test: Combines the NST with an assessment of amniotic fluid volume (AFV), fetal breathing movements, fetal activity, and fetal muscle tone Contraction stress test Doppler study: Assesses fetal umbilical arterial blood flow velocity or resistance to flow Radiologic studies Diagnostic imaging modalities (...) fetal exposure, to monitor both patients, to prevent , and to prevent the leak of amniotic fluid Knowledge gaps - The maternal-placental-fetal physiology and metabolism presents distinct challenges that preclude mere extrapolation of common medical fundamentals Fetal treatment center The fetal treatment center has been established as a solution to these problems. These centers offer many advantages. One such advantage is that the fetal treatment center is staffed with fetal surgeons, either

2014 eMedicine Pediatrics

188. Birth Trauma (Overview)

of labor must be appropriate. Occasionally, injury may be sustained in utero. Previous Next: Bone Injury Fractures are most often observed following breech delivery, shoulder dystopia, or both in infants with excessive birth weights. Clavicular fracture The clavicle is the most frequently fractured bone in the neonate during birth; this is most often an unpredictable, unavoidable complication of normal birth. [ ] Some correlation with birth weight, midforceps delivery, and shoulder dystocia (...) damage, edema, hemorrhage, or fracture in the neonate. The use of obstetric instrumentation may further amplify the effects of such forces or may induce injury alone. Under certain conditions, cesarean delivery can be an acceptable alternative but does not guarantee an injury-free birth. Factors predisposing to injury include the following: Prima gravida Cephalopelvic disproportion, small maternal stature, maternal pelvic anomalies Prolonged or rapid labor Deep, transverse arrest of descent

2014 eMedicine Pediatrics

189. Pregnancy, Breech Delivery (Diagnosis)

. Episiotomies are often performed for assisted vaginal breech deliveries, even in multiparous women, to prevent soft tissue dystocia. Assisted vaginal breech delivery. No downward or outward traction is applied to the fetus until the umbilicus has been reached. Assisted vaginal breech delivery. With a towel wrapped around the fetal hips, gentle downward and outward traction is applied in conjunction with maternal expulsive efforts until the scapula is reached. An assistant should be applying gentle fundal (...) the Table below). However, the overall frequency is 3-4% at delivery. [ ] Table. Gestational age and frequency of breech birth Gestational Age, Weeks Breech, % 21-24 33 25-28 28 29-32 14 33-36 9 37-40 3-4 International The international incidence has been reported at 3-4%. [ ] Mortality/Morbidity See the list below: Many complications are associated with a breech presentation in labor. This may be due to the underlying etiology of the breech presentation, such as fetal anomalies or polyhydramnios

2014 eMedicine Emergency Medicine

190. Pregnancy, Delivery (Follow-up)

Pregnancy, Delivery (Follow-up) Labor and Delivery in the Emergency Department Treatment & Management: Prehospital Care, Emergency Department Care, Consultations Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNzk2Mzc5LXRyZWF0bWVudA== processing > Labor and Delivery in the Emergency Department Treatment & Management Updated: Jul 26, 2017 Author: Thomas E Benzoni, DO, MT(ASCP); Chief Editor: Mark A Clark, MD Share Email Print Feedback Close Sections Sections Labor and Delivery in the Emergency Department Treatment Prehospital Care Provide oxygen. Obtain intravenous access. Generally, transport the patient in the left lateral recumbent position; use this position especially if the expectant mother's blood pressure decreases

2014 eMedicine Emergency Medicine

191. Pregnancy, Breech Delivery (Follow-up)

as the breech is squeezed through the birth canal. This is usually not associated with meconium aspiration because the meconium passes out of the vagina and does not mix with the amniotic fluid. Assisted vaginal breech delivery. The Ritgen maneuver is applied to take pressure off the perineum during vaginal delivery. Episiotomies are often performed for assisted vaginal breech deliveries, even in multiparous women, to prevent soft tissue dystocia. Assisted vaginal breech delivery. No downward or outward (...) , aspiration, anesthesia risk), especially with emergency delivery. Fetus and infant mortality increases to 9%, compared with 3% in cephalic presentations. Average Apgar score, especially at 1 minute, is lower. Congenital abnormalities increase to 6%, compared with 2.4% in infants with cephalic presentations. Factors for increased adverse fetal outcome include the following: [ ] Older mothers Footling presentation Hyperextended fetal head Birth weight less than 2500 g or greater than 4000 g Prolonged labor

2014 eMedicine Emergency Medicine

192. Pregnancy, Breech Delivery (Overview)

. Episiotomies are often performed for assisted vaginal breech deliveries, even in multiparous women, to prevent soft tissue dystocia. Assisted vaginal breech delivery. No downward or outward traction is applied to the fetus until the umbilicus has been reached. Assisted vaginal breech delivery. With a towel wrapped around the fetal hips, gentle downward and outward traction is applied in conjunction with maternal expulsive efforts until the scapula is reached. An assistant should be applying gentle fundal (...) the Table below). However, the overall frequency is 3-4% at delivery. [ ] Table. Gestational age and frequency of breech birth Gestational Age, Weeks Breech, % 21-24 33 25-28 28 29-32 14 33-36 9 37-40 3-4 International The international incidence has been reported at 3-4%. [ ] Mortality/Morbidity See the list below: Many complications are associated with a breech presentation in labor. This may be due to the underlying etiology of the breech presentation, such as fetal anomalies or polyhydramnios

2014 eMedicine Emergency Medicine

193. Comparison of IV Ergonovine With IM Carboprost, With Oxytocin IV, During Cesarean Section for Failure to Progress

is given as an injection in the muscle. Although they are not routinely given in every case, these are very frequently given as rescue medications to patients who fail to respond appropriately to oxytocin. This study is designed to determine if ergonovine or carboprost given in association with oxytocin, in a preventive way, after delivery of the baby and placenta, can reduce the amount of blood loss during Cesarean sections following a trial of labour. Condition or disease Intervention/treatment Phase (...) Additional relevant MeSH terms: Layout table for MeSH terms Hemorrhage Postpartum Hemorrhage Dystocia Pathologic Processes Obstetric Labor Complications Pregnancy Complications Puerperal Disorders Uterine Hemorrhage Oxytocin Ergonovine Carboprost Carboprost tromethamine Oxytocics Reproductive Control Agents Physiological Effects of Drugs Abortifacient Agents, Nonsteroidal Abortifacient Agents

2013 Clinical Trials

194. A Randomized Trial of Induction Versus Expectant Management

requiring antibiotics Pneumonia Pyelonephritis Bacteremia - unknown source Septic pelvic thrombosis Number of Participants With Venous Thromboembolism [ Time Frame: delivery through discharge ] Maternal deep venous thrombosis or pulmonary embolism Number of Participants With Indications for Cesarean Delivery [ Time Frame: Labor and delivery ] Number of participants with indications for cesarean delivery including dystocia, non-reassuring fetal status or other indication Duration of Respiratory Support (...) Postpartum Length of Hospital Stay [ Time Frame: delivery through hospital discharge ] Neonatal Length of Hospital Stay [ Time Frame: delivery through hospital discharge ] Number of Participants With Indications for Operative Vaginal Delivery [ Time Frame: Labor and delivery ] Number of participants with indications for operative vaginal delivery including dystocia, non-reassuring fetal status and other indications Number of Participants and Breastfeeding Status at 4-8 Weeks After Delivery [ Time Frame

2013 Clinical Trials

195. The hospital with a high episiotomy rate

, will decrease the amount of time for delivery of the fetal head. The increased space also allows more room to perform maneuvers to relieve a shoulder dystocia. Episiotomy is, in general, not frequently performed. It was done in (compared to ). Although the ideal episiotomy rate is undefined, restrictive use of episiotomy is preferred over routine use. Since 2006 the American Congress of Obstetricians and Gynecologists has routine episiotomy use. It is troublesome to see any physicians with high episiotomy (...) rates, as the procedure is not necessary for the majority of vaginal births. Purported benefits of episiotomy include less severe perineal lacerations, easier laceration repair, better wound healing, and preservation of the pelvic floor support by preventing a spontaneous, irregular laceration. Data, however, does not support this. A found that pain, severity of perineal laceration, and pain medication use were not better with routine episiotomy use. There was also no demonstrated benefit from

2016 KevinMD blog

196. Failure to Progress

, dysfunctional labor was observed , Abnormal labor , Labor abnormal , Abnormal labour , Unspecified abnormality of labour , Dystocia NOS , Dystocia [Disease/Finding] , delivery problems , difficult labor , delivery problem , abnormal labor , labour problems , dystocias , Dystocia (disorder) , Dystocia NOS (finding) , Labour abnormal , Labour problem (disorder) , Arrest of Dilatation , Failure to Progress , Labor Dystocia , Dysfunctional Labor , Difficult labor , Dysfunctional labor , Dysfunctional labour (...) , Difficult labour , Delivery problem , Labor problem , Labour problem , Delivery problem (finding) , Labor problem (finding) , Dystocia , dystocia , abnormal; labor , Abnormal labor, NOS , Dystocia, NOS , Dystocia (disorder) [Ambiguous] Italian Travaglio anormale , Anomalia del travaglio non specificata , Distocia Dutch niet-gespecificeerde abnormale bevallling , abnormale bevalling , niet-gespecificeerde abnormale bevalling , abnormaal; weeën , abnormale ontsluitingsfase , Dystocie French Anomalie non

2015 FP Notebook

197. Assessing Childbirth-related Complications at the Community Level in Kenya

: Other Study ID Numbers: P141/03/2012 First Posted: August 15, 2012 Last Update Posted: April 28, 2014 Last Verified: April 2014 Keywords provided by Wilson Liambila, Kenyatta National Hospital: complications Additional relevant MeSH terms: Layout table for MeSH terms Hemorrhage Pre-Eclampsia Postpartum Hemorrhage Eclampsia Breech Presentation Placenta, Retained Dystocia Pathologic Processes Hypertension, Pregnancy-Induced Pregnancy Complications Obstetric Labor Complications Puerperal Disorders (...) . Information provided by (Responsible Party): Wilson Liambila, Kenyatta National Hospital Study Details Study Description Go to Brief Summary: Kenya is one of the countries in sub-Saharan Africa that still experience high maternal mortality. For instance, in 2008/09 maternal mortality ratio was estimated to be 488/100,000 live births. Direct obstetric complications such as puerperal sepsis, postpartum hemorrhage, pre-eclampsia and eclampsia, obstructed labor and indirect causes including HIV, malaria

2012 Clinical Trials

198. Management of Pregnancy

labor include: home uterine activity monitoring, salivary estriol, screening for periodontal disease, and bacterial vaginosis (I-60) testing. However, the efficacy of these modalities has not been clearly demonstrated and their use remains controversial. Historically, the lack of an effective treatment to prevent preterm birth has rendered any prediction scheme impotent. The ability of cervical cerclage to prevent preterm birth or lengthen gestation likewise remains questionable with conflicting (...) reports of efficacy in the obstetric literature. Antimicrobial therapy, including treatment of bacterial vaginosis, does not appear to meaningfully reduce the preterm birth rate. Tocolysis of preterm labor with various agents remains unproven in the prevention of preterm delivery but is often used to prolong latency to allow the administration of antenatal corticosteroids. In contrast to these controversial or minimally effective treatments, recent data suggest that the administration of progesterone

2009 VA/DoD Clinical Practice Guidelines

199. Once a Cesarean ... now, a vaginal delivery

in the U.S., with the most common indications being elective repeat Cesarean delivery (30%) and dystocia or failure to progress (30%). A in the "Narrative Matters" section of Health Affairs by physician and health policy researcher Carla Keirns highlighted the challenges that even a highly educated, well-informed patient faces in achieving the desired outcome of a vaginal childbirth, especially if her pregnancy is classified as high risk. Dr. Keirns, whose pregnancy was complicated by "advanced maternal (...) forty-eight hours into my labor induction, I might have agreed. If they had told me that my baby’s life or health was in jeopardy, I would have consented to anything . The vision of the empowered consumer, or even the autonomous patient, is laughable under these circumstances. Once a woman has had one Cesarean delivery, she faces considerable pressure from the medical system to choose repeat Cesarean deliveries in subsequent pregnancies. A in The Atlantic explained why the dictum "once a Cesarean

2015 The AFP Community Blog

200. Early amniotomy and early oxytocin reduce caesarean section rate

group also received oxytocin but often later than in the intervention group. The severity of delay which was sufficient to justify interventions remains to be defined. Context Caesarean section rates are over 20% in many developed countries. The main diagnosis contributing to the high rate in nulliparous women is dystocia or prolonged labour. The present review assesses the effects of a policy of early amniotomy with early oxytocin administration for the prevention or therapy for delay in labour (...) Early amniotomy and early oxytocin reduce caesarean section rate PEARLS Practical Evidence About Real Life Situations PEARLS are succinct summaries of Cochrane Systematic Reviews for primary care practitioners. They Early amniotomy and early oxytocin reduce caesarean section rate Clinical question How effective are early amniotomy and early oxytocin for prevention or therapy for delay in labour progress, with respect to the caesarean birth rate and indicators of maternal and neonatal morbidity

2009 Cochrane PEARLS

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