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Prevention of Labor Dystocia

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41. 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

42. Prevention, management, and outcomes of macrosomia: a systematic review of literature and meta-analysis. (PubMed)

Prevention, management, and outcomes of macrosomia: a systematic review of literature and meta-analysis. Macrosomia represents an obstetric challenge, and when suspected, there is no general consensus as to whether expectant management, induction of labor, or elective cesarean delivery are the best option. This review article was aimed to discuss literature published in the last decade about the identification, management, and outcomes of macrosomia. The identification of macrosomia remains (...) or greater, and 5000 g or greater, respectively. The odds ratios of shoulder dystocia are 7.18 (2.06-25.00), 7.33 (5.13-10.48), and 16.16 (7.62-34.26) for macrosomia 4000 g or greater, 4500 g or greater, and 5000 g or greater, respectively. Three birth traumas were reported after cesarean delivery. Perinatal mortality is similar between macrosomic and neonates with normal birth weight at each cutoff of macrosomia. Nonetheless, limitations of current literature, which are also discussed in this review, do

2013 Obstetrical & Gynecological Survey

43. Management of Normal Labor

and 2 to 4 h in multiparas. Traditionally, the cervix was expected to dilate about 1.2 cm/h in nulliparas and 1.5 cm/h in multiparas. However, recent data suggest that slower progression of cervical dilation from 4 to 6 cm may be normal ( ). Pelvic examinations are done every 2 to 3 h to evaluate labor progress. Lack of progress in dilation and descent of the presenting part may indicate dystocia (fetopelvic disproportion). If the membranes have not spontaneously ruptured, some clinicians use (...) anterior [OLA] for cephalic, sacrum right posterior [SRP] for breech). Presentation describes the part of the fetus at the cervical opening (eg, breech, vertex, shoulder). Preparation for delivery Women are admitted to the labor suite for frequent observation until delivery. If labor is active, they should receive little or nothing by mouth to prevent possible vomiting and aspiration during delivery or in case emergency delivery with general anesthesia is necessary. Shaving or clipping of vulvar

2013 Merck Manual (19th Edition)

44. Comparison of Two Doses of Carbetocin for Prevention of Uterine Atony, During Elective Cesarean Section

Postpartum Hemorrhage Uterine Inertia Pathologic Processes Obstetric Labor Complications Pregnancy Complications Puerperal Disorders Uterine Hemorrhage Dystocia Carbetocin Oxytocin Oxytocics Reproductive Control Agents Physiological Effects of Drugs (...) Comparison of Two Doses of Carbetocin for Prevention of Uterine Atony, During Elective Cesarean Section Comparison of Two Doses of Carbetocin for Prevention of Uterine Atony, During Elective Cesarean Section - 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

2012 Clinical Trials

45. ED90 Determination of Carbetocin for the Prevention of Uterine Atony in Women Undergoing an Elective Cesarean Delivery

Uterine Atony Obstetric Anesthesia Cesarean Section Carbetocin Additional relevant MeSH terms: Layout table for MeSH terms Hemorrhage Postpartum Hemorrhage Uterine Inertia Pathologic Processes Obstetric Labor Complications Pregnancy Complications Puerperal Disorders Uterine Hemorrhage Dystocia Carbetocin Oxytocin Oxytocics Reproductive Control Agents Physiological Effects of Drugs (...) ED90 Determination of Carbetocin for the Prevention of Uterine Atony in Women Undergoing an Elective Cesarean Delivery ED90 Determination of Carbetocin for the Prevention of Uterine Atony in Women Undergoing an Elective Cesarean Delivery - 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

2012 Clinical Trials

46. 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

47. Care of Women with Obesity in Pregnancy

College of Obstetricians and GynaecologistsWhat speci?c risk assessments are required for prevention of pressure sores? Women with a booking BMI 40 kg/m 2 or greater should have a documented risk assessment in the third trimester of pregnancy by an appropriately quali?ed professional to consider tissue viability issues. This should involve the use of a validated scale to support clinical judgement. D Special considerations for screening, diagnosis and management of maternal disease in women (...) pregnancy) may bene?t from taking 150 mg aspirin daily from 12 weeks of gestation until birth of the baby. B Women who develop hypertensive complications should be managed according to the NICE CG107. P What special considerations are recommended for prevention, screening, diagnosis and management of venous thromboembolism in women with obesity? Clinicians should be aware that women with a BMI 30 kg/m 2 or greater, prepregnancy or at booking, have a pre-existing risk factor for developing venous

2018 Royal College of Obstetricians and Gynaecologists

48. Gestational Diabetes

to allow weighing the potential benefits and harms of routine induction of labor in women with GDM. • There is moderate-quality evidence from RCTs with limitations and from observational studies suggesting that elective induction of labor in low-risk pregnant women with GDM or women with impending macrosomia may reduce the risk of shoulder dystocia without increasing the rate of cesarean section. o The GINEXMAL RCT (Alberico 2017), which compared induction of labor (at 38 weeks 0 days and 39 weeks 0 (...) and pregnancies with large-for-date fetuses (impending macrosomia) may decrease the rate of shoulder dystocia and does not increase the rate of cesarean delivery. o The Melamed observational study (2016) suggests that induction of labor at 38 or 39 weeks gestation in women with low-risk GDM is associated with a lower risk of caesarean section compared to expectant management. Induction of labor at 38 weeks was, however, associated with an increased risk of neonatal intensive care unit admission. 11 References

2018 Kaiser Permanente Clinical Guidelines

49. Intrapartum fever

of >38.0ºC 30 minutes apart or 1 rectal temperature measurement of = 39°C B Temperature should be measured during labor in the following circumstances: • Suspicion of fever • PROM • ROM = 18 hours • Dystocia • Foul-smelling vaginal discharge/amniotic fluid • FHR > 150 beats per minute or rising baseline • Maternal tachycardia =100 beats per minute • Placement of epidural analgesia (before and after placement) • Threatening preterm labor/PPROM B-C Temperature measurement during labor is recommended every (...) Intrapartum fever Intrapartum fever These guidelines were approved by DSOG (Danish Society of Obstetrics and Gynecology) in January 2019. 1. Recommendations in English (3 pages) 2. Recommendations in Danish (60 pages) Clinical Recommendations Summary of the clinical recommendations regarding handling of intrapartum fever Clinical recommendations Strength A-D Temperature should be a rectal measurement B (A) Intrapartum fever/ fever during labor is defined as: 2 rectal temperature measurements

2019 Nordic Federation of Societies of Obstetrics and Gynecology

50. Child Abuse, Elder Abuse, and Intimate Partner Violence

for Intimate Partner Violence or Sex Trafficking 122 Appendix C-2 Trauma Coder’s Guide to Abuse Injury Coding 123 Expert Panel 127 3INTRODUCTION Child abuse, elder abuse, and intimate partner violence are serious, preventable public health problems that affect millions of people. This guideline seeks to help the trauma practitioner identify victims of abuse that present with physical injury and to initiate treatment and reporting. While this Best Practices Guideline (BPG) is not intended to focus (...) is to provide health care professionals with evidence-based recommendations regarding care of the trauma patient. The Best Practices Guidelines do not include all potential options for prevention, diagnosis, and treatment and are not intended as a substitute for the provider’s clinical judgment and experience. The responsible provider must make all treatment decisions based upon their independent judgment and the patient’s individual clinical presentation. The ACS and any entities endorsing the Guidelines

2019 American College of Surgeons

51. Primary postpartum haemorrhage

management 12 2.3.1 Third stage management 13 2.3.2 Fourth stage monitoring 14 2.4 Postnatal risk management 14 2.5 Secondary prevention with misoprostol 15 3 Treatment 16 3.1 Estimation of blood loss 16 3.2 Point of care blood clotting analysers 16 3.3 Resuscitation 17 3.3.1 Tranexamic acid 18 3.3.2 Support during PPH 18 3.4 Tone 19 3.4.1 First line pharmacological therapy for uterine atony 19 3.4.2 Second line pharmacological therapy for uterine atonia 20 3.4.3 Intractable bleeding 21 3.5 Trauma 22 (...) in Queensland 7 Table 3. Aetiology of PPH 8 Table 4. Clinical standards 8 Table 5. Risk factors for PPH 9 Table 6. Antenatal risk 10 Table 7. Blood products declined 11 Table 8. Intrapartum risk 12 Table 9. Third stage management 13 Table 10. Monitoring 14 Table 11. Postnatal risk management 14 Table 12. Secondary prevention with misoprostol 15 Table 13. Clinical findings in PPH 16 Table 14. Point of care blood clotting analysers 16 Table 15. Resuscitation 17 Table 16. Tranexamic acid 18 Table 17. Support

2019 Queensland Health

52. Intrapartum fetal surveillance

aim of intrapartum fetal surveillance is to prevent adverse perinatal outcomes arising from fetal metabolic acidosis related to labour. 2 As the fetal brain modulates the fetal heart rate (FHR) through an interplay of sympathetic and parasympathetic forces, fetal heart rate monitoring can be used as an indicator of whether or not a fetus is well oxygenated. 3 In the absence of risk factors FHR surveillance by continuous electronic fetal monitoring (CEFM) does not provide proven benefit and may (...) increase the intervention rate in a normal spontaneous labour lasting less than 12 hours in the active phase. 2,4,5 This guideline is congruent with and builds on the Intrapartum Fetal Surveillance Clinical Guideline published by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). 2 1.1 Definition The primary purpose of fetal surveillance is to attempt to prevent adverse fetal outcomes. 6 Fetal surveillance includes intermittent auscultation IA) of fetal heart

2019 Queensland Health

53. Stillbirth care

1.2.1 Maternal risk factors 9 1.3 Clinical standards 10 1.4 Prevention 11 1.5 Communication 12 2 Reporting requirements 13 2.1 Legal definitions 13 2.2 Reporting and documentation 14 3 Model of care of woman and family 15 3.1 Care at time of diagnosis of fetal death 15 3.2 Labour and birth 16 3.3 Post birth care of woman and family 17 3.4 Care of baby 18 4 Clinical management 19 4.1 Diagnosis of intrauterine death 19 4.2 Management of labour 19 4.2.1 Induction of labour 20 4.2.2 Regimen (...) . Clinical standards 10 Table 4. Prevention 11 Table 5. Communication with parents 12 Table 6. Legal definitions 13 Table 7. Reporting and documentation 14 Table 8. Time of diagnosis care 15 Table 9. Labour and birth 16 Table 10. Post birth care 17 Table 11. Care after birth 18 Table 12. Management of labour 19 Table 13. IOL medications 20 Table 14. Induction of labour regimen 21 Table 15. Labour, birth and post birth care 22 Table 16. Core maternal investigations 23 Table 17. Selective maternal tests 24

2019 Queensland Health

54. Perineal care

of anal sphincter defect (e.g. defect > 30 degrees) o Low anorectal manometric pressures (e.g. incremental squeeze pressure 4 kg · OP position · Instrumental birth · Shoulder dystocia · Prolonged second stage · Midline episiotomy · Previous OASIS Woman elects vaginal birth? Elective CS Yes Yes No No Yes *Experienced clinician: The clinician best able to provide the required clinical care in the context of the clinical circumstances and local and HHS resources and structure. May include clinicians (...) is not used routinely during spontaneous vaginal birth but only for specific conditions (e.g. selective use in instrumental deliveries or if fetal compromise). Sitz bath Warm bath to which salt has been added. Slow birth of fetal head Refers to measures taken to prevent rapid head expulsion at the time of crowning (e.g. counter pressure to the head (as needed) and minimising active pushing; it does not include measures such as fetal head flexion or the Ritgen manoeuvre). Queensland Clinical Guideline

2018 Queensland Health

55. Management of Pregnancy

and well-being by guiding health care providers who are taking care of pregnant women along the management pathways that are supported by evidence. The expected outcome of successful implementation of this guideline is to: • Assess the condition of the mother and baby and determine the best management method in collaboration with the mother and, when possible and desired, other family and caregivers • Optimize the mother and baby’s health outcomes and improve quality of life • Minimize preventable (...) complications and morbidity • Emphasize the use of patient-centered care (PCC) II. Background A. Description of Pregnancy Pregnancy is the reproductive time during which a developing fetus grows inside of the uterus. It is a time of dramatic change for a developing fetus and a woman’s body. Most pregnancies are uncomplicated and labor results in a normal vaginal birth with a healthy mother and baby. Rarely, complications arise, which have the potential to lead to lifelong implications. As the fetus

2018 VA/DoD Clinical Practice Guidelines

56. WHO recommendations: non-clinical interventions to reduce unnecessary caesarean sections

is a surgical procedure that can effectively prevent maternal and newborn mortality when used for medically indicated reasons. Caesarean section rates have increased steadily worldwide over the last decades. This trend has not been accompanied by significant maternal or perinatal benefits. On the contrary, there is evidence that, beyond a certain threshold, increasing caesarean section rates may be associated with increased maternal and perinatal morbidity. Caesarean birth is associated with short- and long (...) relaxation training programme (content includes group discussion of anxiety and stress-related issues in pregnancy and purpose of applied relaxation, deep breathing techniques, among other relaxation techniques). ? ? Psychosocial couple-based prevention programme (content includes emotional self-management, conflict management, problem solving, communication and mutual support strategies that foster positive joint parenting of an infant). “Couple” in this recommendation includes couples, people

2018 World Health Organisation Guidelines

57. WHO recommendations: intrapartum care for a positive childbirth experience

ages. One of the WHO strategic priorities over the next five years for achieving Sustainable Development Goal (SDG) targets is to support countries to strengthen their health systems to fast-track progress towards achieving universal health coverage (UHC). WHO is supporting countries to ensure that all people and communities have access to and can use the promotive, preventive and curative health services that are appropriate to their needs, and that are effective and of sufficient quality, while (...) , depending on a woman’s preferences. Recommended Manual techniques for pain management 22. Manual techniques, such as massage or application of warm packs, are recommended for healthy pregnant women requesting pain relief during labour, depending on a woman’s preferences. Recommended Pain relief for preventing labour delay 23. Pain relief for preventing delay and reducing the use of augmentation in labour is not recommended. b Not recommended Oral fluid and food 24. For women at low risk, oral fluid

2018 World Health Organisation Guidelines

58. Management of glycaemic control in pregnant women with diabetes on obstetric wards and delivery units

with type 1 diabetes should be screened for post-partum thyroiditis with a TSH at 3 and 6 months postpartum. 2324 8 Diabetic Ketoacidosis (DKA) This is a new protocol based on national guidance (ref: www.diabetologists-abcd.org.uk/JBDS/JBDS_ IP_DKA_Adults_Revised.pdf) which uses a fixed rate of insulin infusion (FRIII) and a variable amount of intravenous glucose to prevent hypoglycaemia. This guidance is only for use in DKA, a “traditional” intravenous insulin sliding scale (now called VRIII) should (...) hypoglycaemia 2.2 mmol/L, admission to NICU, shoulder dystocia, neonatal jaundice, hypocalcaemia, hypomagnesaemia, RDS, birth defects) Not defined Institutional accountability and integrity: Percentage of women with diabetes during pregnancy identified as such on the hospital patient administration system 100% Percentage of women with diabetes during pregnancy coded correctly in the coding system 100% Patient and staff satisfaction: Percentage of obstetric staff who feel they have appropriate, timely

2017 Association of British Clinical Diabetologists

60. Cervical Cerclage

developers also address the placement of a second suture in addition to the primary cerclage, with both agreeing that no benefit of this approach has been demonstrated. With regard to the use of perioperative antibiotics and/or tocolytics, there is consensus among the guideline developers that there is no evidence to support their routine use. Cerclage Removal The guideline developers agree that a transvaginal cerclage is removed electively before labor, typically between 36 and 38 weeks gestation (ACOG (...) specifies 36–37 weeks; SOGC 36–38 weeks). For women undergoing elective cesarean section at or beyond 39 weeks of gestation, ACOG states that removal can be delayed until this time. The developer cautions, however, that the possibility of spontaneous labor between 37 and 39 weeks of gestation must be considered. ACOG also notes that if there is cervical change, painful contractions or progression of vaginal bleeding in women presenting with symptoms of preterm labor, cerclage removal is recommended

2017 National Guideline Clearinghouse (partial archive)

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