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Prevention of Labor Dystocia

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21. Randomized Control Trial of Second Stage of Labor

risk for postpartum hemorrhage, bowel and bladder injury, abnormal placentation, febrile morbidity and death. The most common reason for a cesarean delivery is a repeat cesarean delivery. One way to reduce this number is to prevent the first cesarean delivery. The aim of this study is evaluate if extending the second stage of labor affects the cesarean delivery rate and subsequent perinatal morbidity. Condition or disease Intervention/treatment Phase Labor Complications Other: Length of Second (...) Randomized Control Trial of Second Stage of Labor Randomized Control Trial of Second Stage of Labor - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Randomized Control Trial of Second Stage of Labor

2014 Clinical Trials

22. New Prophylactic Maneuver: the "Pushing" Maneuver, Aiming to Reduce the Risk for Shoulder Dystocia

between pushes), aiming to facilitate the anterior shoulder to slip off behind the symphysis pubis, reducing thus the risk of shoulder dystocia. This preventive maneuver may reduce the power (energy/time unit) exerted on the perineal tissues and give the shoulders time to enter the pelvic cavity. The "pushing" maneuver will be evaluated in comparison with either an expectative attitude or a suctioning of fetal nose and mouth. Condition or disease Intervention/treatment Phase Shoulder Dystocia (...) Purpose: Prevention Official Title: CONTRADYS : A Randomized Controlled Trial of a New Prophylactic Maneuver, the "Pushing" Maneuver, Aiming to Reduce the Risk for Shoulder Dystocia Study Start Date : March 2011 Actual Primary Completion Date : November 2013 Actual Study Completion Date : March 2014 Arms and Interventions Go to Arm Intervention/treatment group M Normal delivery without "pushing" maneuver suctioning of fetal nose and mouth during delivery Procedure: suctioning of fetal nose and mouth

2011 Clinical Trials

23. Accelerated Titration of Oxytocin for Nulliparous Patients With Labour Dystocia: ACTION Pilot Study

protocols are also frequently associated with a higher maximum concentration of oxytocin. While, most Canadian birthing centres currently follow a 'gradual titration' or 'low dose' protocol, there is evidence that 'accelerated titration' or 'high dose' protocols may be more effective in correcting dystocia and in preventing caesarean section. It is postulated that by more rapidly progressing to the required therapeutic dose, cervical dilatation is achieved more rapidly, the likelihood of a spontaneous (...) Hospital Research Institute ClinicalTrials.gov Identifier: Other Study ID Numbers: 2010-521 First Posted: July 19, 2011 Last Update Posted: June 25, 2015 Last Verified: June 2015 Additional relevant MeSH terms: Layout table for MeSH terms Dystocia Obstetric Labor Complications Pregnancy Complications Oxytocin Oxytocics Reproductive Control Agents Physiological Effects of Drugs

2011 Clinical Trials

24. Normal Labor and Delivery (Overview)

cesarean delivery rate of 5-6% in nulliparas. [ ] Data from randomized controlled trials confirmed that active management of labor shortens the first stage of labor and reduces the likelihood of maternal febrile morbidity, but it does not consistently decrease the probability of cesarean delivery. [ , , ] Although the active management protocol likely leads to early diagnosis and interventions for labor dystocia, a number of risk factors are associated with a failure of labor to progress during (...) the first stage. These risk factors include premature rupture of the membranes (PROM), nulliparity, induction of labor, increasing maternal age, and or other complications (eg, previous perinatal death, pregestational or gestational diabetes mellitus, hypertension, infertility treatment). [ , ] While the ACOG defines labor dystocia as that results form abnormalities of the power (uterine contractions or maternal expulsive forces), the passenger (position, size, or presentation of the fetus

2014 eMedicine.com

25. Abnormal Labor (Follow-up)

for a recurrence of abnormal labor is high. In an attempt to determine whether increasing maternal age is more commonly associated with dystocia, a study by Treacy et al demonstrated that the incidences of oxytocin augmentation, prolonged labor, instrument delivery, and intrapartum cesarean delivery (including cesarean for dystocia) all increased significantly and progressively with increasing maternal age. [ ] This study used an established active management protocol, and oxytocin augmentation proved (...) a generally effective intervention in all age categories. These findings have implications for the analysis of intervention rates by health care providers, particularly in developed countries where the proportion of older nulliparas is increasing. A study by Zhu et al revealed that, with increasing interpregnancy intervals, the risk for labor dystocia increases. [ ] Both functional and mechanical dystocia were more prevalent in first births than in subsequent births. In singleton births to multiparous

2014 eMedicine.com

26. Management of the Third Stage of Labor (Diagnosis)

to front over the baby's head or by delivering the baby through the loop of cord. While these maneuvers are preferable and usually successful, clamps must be ready in case the maneuver fails or the cord is inadvertently torn. Clamping and dividing a nuchal cord is most problematic when it is followed by a shoulder dystocia. The divided cord prevents what little placental support that would have been present from reaching the baby. Additionally, no intrauterine resuscitation can occur if the clinician (...) of Obstetrical Emergencies . 3rd ed. Bristol, UK: Clinical Press; 1999. 196-201. Sleep J. Physiology and management of the third stage of labour. Bennett VR, Brown LK, eds. Myles' Textbook for Midwives . 12th ed. London, UK: Churchill Livingstone; 1993. 216-29. Dupont C, Ducloy-Bouthors AS, Huissoud C. [Clinical and pharmacological procedures for the prevention of postpartum haemorrhage in the third stage of labor.]. J Gynecol Obstet Biol Reprod (Paris) . 2014 Nov 6. 43(10):966-997. . Prendiville WJ

2014 eMedicine.com

27. Abnormal Labor (Treatment)

& Management Updated: May 08, 2017 Author: Nina S Olsen, MD; Chief Editor: Ronald M Ramus, MD Share Email Print Feedback Close Sections Sections Abnormal Labor Treatment Medical Care A prolonged latent phase (see Table in Background) is not indicative of dystocia in itself because this diagnosis cannot be made in the latent phase. Gabbe and colleagues state the following: [ ] For those in the latent phase, the treatment of choice is rest for several hours. During this interval, uterine activity, fetal (...) in the Medication section. Limited studies have shown improvement in dysfunctional labor with use of a beta-blocker. In cases of dysfunctional labor resulting from functional dystocia or an abnormal uterine contractility pattern and in which oxytocin implementation has not improved the outcome, a beta-blocker may be considered. Low-dose administration of intravenous propranolol in abnormal labor augmented with oxytocin reduced the need for cesarean delivery, particularly among patients with inadequate uterine

2014 eMedicine.com

28. Normal Labor and Delivery (Treatment)

cesarean delivery rate of 5-6% in nulliparas. [ ] Data from randomized controlled trials confirmed that active management of labor shortens the first stage of labor and reduces the likelihood of maternal febrile morbidity, but it does not consistently decrease the probability of cesarean delivery. [ , , ] Although the active management protocol likely leads to early diagnosis and interventions for labor dystocia, a number of risk factors are associated with a failure of labor to progress during (...) the first stage. These risk factors include premature rupture of the membranes (PROM), nulliparity, induction of labor, increasing maternal age, and or other complications (eg, previous perinatal death, pregestational or gestational diabetes mellitus, hypertension, infertility treatment). [ , ] While the ACOG defines labor dystocia as that results form abnormalities of the power (uterine contractions or maternal expulsive forces), the passenger (position, size, or presentation of the fetus

2014 eMedicine.com

29. Management of the Third Stage of Labor (Overview)

to front over the baby's head or by delivering the baby through the loop of cord. While these maneuvers are preferable and usually successful, clamps must be ready in case the maneuver fails or the cord is inadvertently torn. Clamping and dividing a nuchal cord is most problematic when it is followed by a shoulder dystocia. The divided cord prevents what little placental support that would have been present from reaching the baby. Additionally, no intrauterine resuscitation can occur if the clinician (...) of Obstetrical Emergencies . 3rd ed. Bristol, UK: Clinical Press; 1999. 196-201. Sleep J. Physiology and management of the third stage of labour. Bennett VR, Brown LK, eds. Myles' Textbook for Midwives . 12th ed. London, UK: Churchill Livingstone; 1993. 216-29. Dupont C, Ducloy-Bouthors AS, Huissoud C. [Clinical and pharmacological procedures for the prevention of postpartum haemorrhage in the third stage of labor.]. J Gynecol Obstet Biol Reprod (Paris) . 2014 Nov 6. 43(10):966-997. . Prendiville WJ

2014 eMedicine.com

30. Management of the Third Stage of Labor (Treatment)

to front over the baby's head or by delivering the baby through the loop of cord. While these maneuvers are preferable and usually successful, clamps must be ready in case the maneuver fails or the cord is inadvertently torn. Clamping and dividing a nuchal cord is most problematic when it is followed by a shoulder dystocia. The divided cord prevents what little placental support that would have been present from reaching the baby. Additionally, no intrauterine resuscitation can occur if the clinician (...) of Obstetrical Emergencies . 3rd ed. Bristol, UK: Clinical Press; 1999. 196-201. Sleep J. Physiology and management of the third stage of labour. Bennett VR, Brown LK, eds. Myles' Textbook for Midwives . 12th ed. London, UK: Churchill Livingstone; 1993. 216-29. Dupont C, Ducloy-Bouthors AS, Huissoud C. [Clinical and pharmacological procedures for the prevention of postpartum haemorrhage in the third stage of labor.]. J Gynecol Obstet Biol Reprod (Paris) . 2014 Nov 6. 43(10):966-997. . Prendiville WJ

2014 eMedicine.com

31. Abnormal Labor (Overview)

. Failure to meet these milestones defines abnormal labor, which suggests an increased risk of an unfavorable outcome. Thus, abnormal labor alerts the obstetrician to consider alternative methods for a successful delivery that minimize risks to both the mother and the infant. Dystocia of labor is defined as difficult labor or abnormally slow progress of labor. Other terms that are often used interchangeably with dystocia are dysfunctional labor, failure to progress (lack of progressive cervical (...) ) and chorioamnionitis (aOR: 1.58). The neonatal risk is associated with a higher incidence of neonatal ICU admissions in the absence of any other of the major morbidities (aOR: 1.53). [ ] These results were again confirmed by another study, which established that prolonged first stage of labor lead to increased risks of a prolonged second stage, maternal fever, shoulder dystocia, and admission to a level 2-3 nursery [ ] Second stage of labor The Consortium on Safe Labor also addressed the 95th percentile

2014 eMedicine.com

32. Normal Labor and Delivery (Follow-up)

cesarean delivery rate of 5-6% in nulliparas. [ ] Data from randomized controlled trials confirmed that active management of labor shortens the first stage of labor and reduces the likelihood of maternal febrile morbidity, but it does not consistently decrease the probability of cesarean delivery. [ , , ] Although the active management protocol likely leads to early diagnosis and interventions for labor dystocia, a number of risk factors are associated with a failure of labor to progress during (...) the first stage. These risk factors include premature rupture of the membranes (PROM), nulliparity, induction of labor, increasing maternal age, and or other complications (eg, previous perinatal death, pregestational or gestational diabetes mellitus, hypertension, infertility treatment). [ , ] While the ACOG defines labor dystocia as that results form abnormalities of the power (uterine contractions or maternal expulsive forces), the passenger (position, size, or presentation of the fetus

2014 eMedicine.com

33. Management of the Third Stage of Labor (Follow-up)

to front over the baby's head or by delivering the baby through the loop of cord. While these maneuvers are preferable and usually successful, clamps must be ready in case the maneuver fails or the cord is inadvertently torn. Clamping and dividing a nuchal cord is most problematic when it is followed by a shoulder dystocia. The divided cord prevents what little placental support that would have been present from reaching the baby. Additionally, no intrauterine resuscitation can occur if the clinician (...) of Obstetrical Emergencies . 3rd ed. Bristol, UK: Clinical Press; 1999. 196-201. Sleep J. Physiology and management of the third stage of labour. Bennett VR, Brown LK, eds. Myles' Textbook for Midwives . 12th ed. London, UK: Churchill Livingstone; 1993. 216-29. Dupont C, Ducloy-Bouthors AS, Huissoud C. [Clinical and pharmacological procedures for the prevention of postpartum haemorrhage in the third stage of labor.]. J Gynecol Obstet Biol Reprod (Paris) . 2014 Nov 6. 43(10):966-997. . Prendiville WJ

2014 eMedicine.com

34. Abnormal Labor (Diagnosis)

. Failure to meet these milestones defines abnormal labor, which suggests an increased risk of an unfavorable outcome. Thus, abnormal labor alerts the obstetrician to consider alternative methods for a successful delivery that minimize risks to both the mother and the infant. Dystocia of labor is defined as difficult labor or abnormally slow progress of labor. Other terms that are often used interchangeably with dystocia are dysfunctional labor, failure to progress (lack of progressive cervical (...) ) and chorioamnionitis (aOR: 1.58). The neonatal risk is associated with a higher incidence of neonatal ICU admissions in the absence of any other of the major morbidities (aOR: 1.53). [ ] These results were again confirmed by another study, which established that prolonged first stage of labor lead to increased risks of a prolonged second stage, maternal fever, shoulder dystocia, and admission to a level 2-3 nursery [ ] Second stage of labor The Consortium on Safe Labor also addressed the 95th percentile

2014 eMedicine.com

35. Labor and Delivery, Normal Delivery of the Newborn

anesthesia options with the patient early so that appropriate plans can be made. Record medications given. Consider the use of oxytocin in cases of prolonged labor. Encourage frequent spontaneous bladder voiding or provide catheter drainage. This prevents bladder distension, especially in patients with an epidural, and allows for better abdominal palpation and external maneuvers in cases of dystocia. Discuss positioning options for the upcoming second stage of labor. Mothers may ambulate and reposition (...) with an increase in uterine firmness The clinician can facilitate placental delivery. Apply gentle traction on the umbilical cord with one hand. Apply vertical pressure just superior to the pubic symphysis with the other hand to prevent inversion of the uterus. Administer intravenous oxytocin to expedite the third stage of labor. Oxytocin should be started at delivery of the anterior shoulder. Inspect the placenta after delivery. Manually explore the uterus if the placenta is not intact. Retained placenta

2014 eMedicine.com

36. Normal Labor and Delivery (Diagnosis)

cesarean delivery rate of 5-6% in nulliparas. [ ] Data from randomized controlled trials confirmed that active management of labor shortens the first stage of labor and reduces the likelihood of maternal febrile morbidity, but it does not consistently decrease the probability of cesarean delivery. [ , , ] Although the active management protocol likely leads to early diagnosis and interventions for labor dystocia, a number of risk factors are associated with a failure of labor to progress during (...) the first stage. These risk factors include premature rupture of the membranes (PROM), nulliparity, induction of labor, increasing maternal age, and or other complications (eg, previous perinatal death, pregestational or gestational diabetes mellitus, hypertension, infertility treatment). [ , ] While the ACOG defines labor dystocia as that results form abnormalities of the power (uterine contractions or maternal expulsive forces), the passenger (position, size, or presentation of the fetus

2014 eMedicine.com

37. Defining an Abnormal First Stage of Labor based on Maternal and Neonatal Outcomes. (PubMed)

first stage of less than the 90th percentile, 251 between the 90th and 94th percentiles, 102 between the 95th and 96th percentiles, and 143 at the 97th percentile or greater. Longer labors were associated with an increased risk of a prolonged second stage, maternal fever, the composite neonatal outcome, shoulder dystocia, and admission to a level 2 or 3 nursery (P < .01). Depending on the cutoff used, 29-30 cesarean deliveries would need to be performed to prevent 1 shoulder dystocia.Although women (...) determined specific for parity and labor onset. Women with a first stage above and below each centile were compared. Maternal outcomes were cesarean delivery in the second stage, operative delivery, prolonged second stage, postpartum hemorrhage, and maternal fever. Neonatal outcomes were a composite of the following: admission to level 2 or 3 nursery, 5 minute Apgar less than 3, shoulder dystocia, arterial cord pH of less than 7.0, and a cord base excess of -12 or less.Of the 5030 women, 4534 experienced

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2013 American Journal of Obstetrics and Gynecology

38. Fetal Dystocia

Presentation SOCIAL MEDIA Add to Any Platform Loading , MD, The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Fetal dystocia is abnormal fetal size or position resulting in difficult delivery. Diagnosis is by examination, ultrasonography, or response to augmentation of labor. Treatment is with physical maneuvers to reposition the fetus, , or . Fetal dystocia may occur when (...) head can compress the umbilical cord if the fetal umbilicus is visible at the introitus, particularly in primiparas whose pelvic tissues have not been dilated by previous deliveries. Predisposing factors for breech presentation include Uterine abnormalities Fetal anomalies If delivery is vaginal, breech presentation may increase risk of Dystocia Perinatal death Preventing complications is more effective and easier than treating them, so abnormal presentation must be identified before delivery

2013 Merck Manual (19th Edition)

39. Active Management of Labor

Active Management of Labor Active Management of Labor Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Active Management of Labor (...) Active Management of Labor Aka: Active Management of Labor , Labor Dystocia Management From Related Chapters II. Indications III. Management: Stage 1 See Consider Active Management of Labor See Augmentation Consider amniotomy Indications for cesarean delivery (arrested labor) Cervical dilation 6 cm AND No cervical change At 4 hours if adequate contractions (>200 Montevideo Units) or At 6 hours if inadequate contractions IV. Management: Stage 2 Consider Augmentation Avoid exhausting mother early

2015 FP Notebook

40. The Maternal and Perinatal Outcomes Associated With the Use of Non-pharmacological in Labor

was: Recruiting First Posted : May 18, 2012 Last Update Posted : June 5, 2013 Sponsor: University of Sao Paulo Information provided by (Responsible Party): Alessandra Cristina Marcolin, University of Sao Paulo Study Details Study Description Go to Brief Summary: Although there are studies that investigated the use of non-pharmacological pain relief and correction of dystocia during labor, there are few randomized controlled trials, especially related to combined protocols that use such resources. The use (...) The Maternal and Perinatal Outcomes Associated With the Use of Non-pharmacological in Labor The Maternal and Perinatal Outcomes Associated With the Use of Non-pharmacological in Labor - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more

2011 Clinical Trials

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