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Prevention of Labor Dystocia

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41. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. (PubMed)

Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. Outcomes of treating gestational diabetes mellitus (GDM) are not well-established.To summarize evidence about the maternal and neonatal benefits and harms of treating GDM.15 electronic databases from 1995 to May 2012, gray literature, Web sites of relevant organizations (...) as needed with no treatment. Women who were treated had more prenatal visits than those in control groups. Moderate evidence showed fewer cases of preeclampsia, shoulder dystocia, and macrosomia in the treated group. Evidence was insufficient for maternal weight gain and birth injury. Low evidence showed no difference between groups for neonatal hypoglycemia. Evidence was insufficient for long-term metabolic outcomes among offspring. No difference was found for cesarean delivery (low evidence

2013 Annals of Internal Medicine

42. 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)

43. 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

44. 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

45. 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

46. Fetal ST Segment and T Wave Analysis in Labor

With an Indication for Forceps or Vacuum Delivery [ Time Frame: During labor through delivery ] Indication for delivery by forceps or vacuum Median Duration of Labor Post-randomization [ Time Frame: Onset of Labor through delivery ] Duration of labor in hours after randomization through delivery Number of Neonates With Shoulder Dystocia During Delivery [ Time Frame: Delivery ] Presence of shoulder dystocia during delivery Number of Participants With Chorioamnionitis [ Time Frame: Any time from Randomization (...) Fetal ST Segment and T Wave Analysis in Labor Fetal ST Segment and T Wave Analysis 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 studies before adding more. Fetal ST Segment and T Wave Analysis in Labor (STAN) The safety

2010 Clinical Trials

47. 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

48. 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

49. 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

50. 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

51. 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

52. 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

53. 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

54. 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

55. 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

56. 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

57. Management of Spontaneous Labour at Term in Healthy Women

dystocia to increase the likelihood of a vaginal birth and optimize birth outcomes. Evidence Published literature was retrieved through searches of PubMed and the Cochrane Library in October 2011 using appropriate, controlled vocabulary (e.g., labour pain; labour, obstetric; dystocia) and key words (e.g., obstetric labor, perineal care, dysfunctional labor). When appropriate, results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies (...) . Results were limited to the last 10 years. Searches were updated on a regular basis and incorporated in the guideline up to June 15, 2015. Values The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care ( Table 1 ). Summary Statements 1. The duration of the first stage of labour increases with maternal age and body mass index. (II-2) 2. In low-risk nulliparous women in the active phase of labour (i.e., equal

2016 Society of Obstetricians and Gynaecologists of Canada

58. 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)

60. Management of Spontaneous Labour at Term in Healthy Women

or abnormal, in term, healthy women, and to provide guidance in the management of first and second stage dystocia to increase the likelihood of a vaginal birth and optimize birth outcomes. Evidence Published literature was retrieved through searches of PubMed and the Cochrane Library in October 2011 using appropriate, controlled vocabulary (e.g., labour pain; labour, obstetric; dystocia) and key words (e.g., obstetric labor, perineal care, dysfunctional labor). When appropriate, results were restricted (...) to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Results were limited to the last 10 years. Searches were updated on a regular basis and incorporated in the guideline up to June 15, 2015. Values The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care ( Table 1 ). Summary Statements 1. The duration of the first stage of labour increases with maternal age and body

2016 Society of Obstetricians and Gynaecologists of Canada

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