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Prevention of Labor Dystocia

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41. 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

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

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 (...) 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

2014 eMedicine.com

43. Abnormal Labor (Overview)

. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol . 2010 Dec. 116(6):1281-7. . . Arulkumaran S, Koh CH, Ingemarsson I, Ratnam SS. Augmentation of labour--mode of delivery related to cervimetric progress. Aust N Z J Obstet Gynaecol . 1987 Nov. 27 (4):304-8. . American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol . 2014 Mar. 123 (3):693 (...) . 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

2014 eMedicine.com

44. 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

45. Abnormal Labor (Follow-up)

, Branch DW, et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol . 2010 Dec. 116(6):1281-7. . . Arulkumaran S, Koh CH, Ingemarsson I, Ratnam SS. Augmentation of labour--mode of delivery related to cervimetric progress. Aust N Z J Obstet Gynaecol . 1987 Nov. 27 (4):304-8. . American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol (...) 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

2014 eMedicine.com

46. Abnormal Labor (Diagnosis)

. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol . 2010 Dec. 116(6):1281-7. . . Arulkumaran S, Koh CH, Ingemarsson I, Ratnam SS. Augmentation of labour--mode of delivery related to cervimetric progress. Aust N Z J Obstet Gynaecol . 1987 Nov. 27 (4):304-8. . American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol . 2014 Mar. 123 (3):693 (...) . 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

2014 eMedicine.com

47. 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

48. Defining an Abnormal First Stage of Labor based on Maternal and Neonatal Outcomes. Full Text available with Trip Pro

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

2013 American Journal of Obstetrics and Gynecology

49. A re-evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour. (Abstract)

, singleton cephalic births between 2 November 2006 and 30 November 2010 with malposition of the fetal head during the second stage of labour leading to an attempt to deliver by KF, RV or pEMCS.Maternal and neonatal outcomes of all KF births were compared with other methods of operative birth for malposition in the second stage of labour (RV or pEMCS).Achieving a vaginal birth was the primary outcome and fetal (admission to special care baby unit, low cord pH, low Apgar, shoulder dystocia, Erb's palsy (...) hands, assisted vaginal birth by KF is likely to be the most effective and safe method to prevent the ever rising rate of caesarean sections when malposition complicates the second stage of labour.© 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG.

2013 BJOG

50. 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

51. 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)

52. New Prophylactic Maneuver: the &quot;Pushing&quot; 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

53. 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)

54. 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

55. 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

56. 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

57. Intrapartum care for women with existing medical conditions or obstetric complications and their babies

1.4 Asthma 20 1.5 Long-term systemic steroids 20 1.6 Bleeding disorders 21 1.7 Subarachnoid haemorrhage or arteriovenous malformation of the brain 25 1.8 Acute kidney injury or chronic kidney disease 27 1.9 Obesity 30 1.10 Information for women with obstetric complications or no antenatal care 32 1.11 Risk assessment for women with obstetric complications or no antenatal care 33 1.12 Pyrexia 36 1.13 Sepsis 36 1.14 Intrapartum haemorrhage 42 1.15 Breech presenting in labour 45 1.16 Small (...) -for-gestational-age baby 46 1.17 Large-for-gestational-age baby 46 1.18 No antenatal care 47 1.19 Previous caesarean section 50 1.20 Labour after 42 weeks of pregnancy 52 T erms used in this guideline 52 Recommendations for research 54 1 Subarachnoid haemorrhage or arteriovenous malformation of the brain 54 2 Needle siting in pregnant women who are obese 54 Intrapartum care for women with existing medical conditions or obstetric complications and their babies (NG121) © NICE 2019. All rights reserved. Subject

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

58. Diabetes in Pregnancy

clinical trials, and observational studies. There were no date limits but results were limited to English or French language materials. Values The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Summary Statements 1 The adverse outcomes associated with diabetes in pregnancy are substantially associated with hyperglycemia as well as the co-existing metabolic environment. Women with pre-existing diabetes should receive (...) compared with the general obstetrical population. Similarly, large recent cohort and simulation studies of women with gestational diabetes mellitus pregnancies also indicate a higher risk of stillbirth between 36-39 weeks gestation (II-2). 3 Women with gestational diabetes mellitus have a higher risk of pre-eclampsia, shoulder dystocia, Caesarean section and large for gestational age infants (II-2). 4 Treatment of women with gestational diabetes mellitus and optimization of glycemic control reduces

2020 Society of Obstetricians and Gynaecologists of Canada

59. Guidance for maternal medicine in the evolving coronavirus (COVID-19) pandemic

with those taken at the booking appointment. This will facilitate planning for one-stop booking clinics, preventing the need for the woman to reattend the hospital for additional tests when requested by her maternal medicine team. Routine obstetric checks (e.g. measurement of fundal height, urine dip, blood pressure) conducted at midwifery appointments need not be repeated in maternal medicine clinics. Maternal medicine clinics can therefore be run effectively using telephone or video consultations (...) . • The elements of care which could be modified to support national recommendations for social distancing of all pregnant women and the more stringent ‘shielding’. • Additional antenatal or labour and birth considerations for women with co-morbidities and co-existing COVID-19 infection. For many of these co-morbidities, there is no evidence to date to inform whether pregnant women are at higher risk of COVID-19 complications than those who are not pregnant. We have however identified the co-morbidities

2020 Royal College of Obstetricians and Gynaecologists

60. Assisted Vaginal Birth

in theatre have an indwelling catheter in situ after the birth to prevent covert urinary retention. This should be removed according to the local protocol. [New 2020] Grade of recommendation: ✓ Offer women physiotherapy‐directed strategies to reduce the risk of urinary incontinence at 3 months. Grade of recommendation: B How can psychological morbidity be reduced for the woman? Shared decision making, good communication, and positive continuous support during labour and birth have the potential to reduce (...) to assisted vaginal birth is recommended where uncertainty exists following clinical examination. [New 2020] Grade of recommendation: A There is insufficient evidence to recommend the routine use of abdominal or perineal ultrasound for assessment of the station, flexion and descent of the fetal head in the second stage of labour. [New 2020] Grade of recommendation: C What type of consent is required prior to attempting assisted vaginal birth? Women should be informed about assisted vaginal birth

2020 Royal College of Obstetricians and Gynaecologists

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