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Prevention of Labor Dystocia

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61. 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

62. 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

63. 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

64. 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

65. 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

66. Macrosomia

, the likelihood of labor abnormalities, shoulder dystocia, birth trauma, and permanent injury to the newborn increases. The purpose of this document is to quantify those risks, address the accuracy and limitations of methods for estimating fetal weight, and suggest clinical management for a pregnancy with suspected macrosomia. This document has been revised to include recent literature and updated information on the prevention of macrosomia. Background Definition Two terms are applied to excessive fetal (...) of newborn macrosomia (birth weight more than 4,500 g) during that time (60). The risks of postpartum hemorrhage, chorioamnio- nitis,andsignificantvaginallacerations areelevatedwith macrosomia (54). In a multivariate analysis of nearly 9,000 deliveries, after adjustment for age, parity, diabe- tes, and labor induction, birth weight more than 4,500 g was associated with significantly increased risks of cho- rioamnionitis (OR 2.4), shoulder dystocia (OR 7.1), third-degree or fourth-degree lacerations

2020 American College of Obstetricians and Gynecologists

67. Prenatal Care

carry an increased risk of causing foodborne illness and should be avoided in pregnancy. See www.foodsafety.gov for current recommendations. Weight gain in pregnancy. Excessive weight gain during pregnancy increases the risk for complications of delivery from fetal macrosomia, such as labor dystocia, shoulder dystocia, and need for operative delivery. It also increases the risks of maternal gestational diabetes and postpartum obesity. Inadequate weight gain is associated with preterm delivery (...) ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. N Engl J Med. 2018 Aug 9;379(6):513- 523. doi: 10.1056/NEJMoa1800566. 18 UMHS Prenatal Care Guideline, September 2018 Hollier LM, Wendel GD. Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection. Cochrane Database of Systematic

2020 University of Michigan Health System

68. Erb's palsy

primitive reflexes, abnormal muscle tone, or abnormal body posture large fetal size (>4000 g) shoulder dystocia maternal diabetes (especially type 1) or gestational diabetes mellitus maternal obesity breech presentation abnormal second phase of labour assisted delivery Diagnostic investigations x-ray of chest and affected upper extremity (upper extremity 'babygram') ultrasound scan of the shoulder MRI of the shoulder CT scan of the shoulder EMG/nerve conduction studies three-dimensional proton-density (...) in order to maintain motion and prevent contracture as the nerves reinnervate muscles affected by the initial injury. Nerve reconstruction or muscle transfer surgery may be needed to improve function in children with incomplete recovery. Definition A type of brachial plexus birth palsy (a paralysis of the upper extremity due to an injury to the nerves that control movement and sensation to the upper extremity occurring at the time of birth). Often encountered as a consequence of a delivery complicated

2018 BMJ Best Practice

69. 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

70. Care of Women with Obesity in Pregnancy

, Reese C, Edwards RK. Mode of delivery in women with class III obesity: planned cesarean compared with induction of labor. Am J Obstet Gynecol 2014;211: 700.e1–700.e9. 139. Boulvain M, Senat MV, Perrotin F, Winer N, Beucher G, Subtil D, et al. Groupe de Recherche en Obst etrique et Gyn ecologie (GROG). Induction of labour versus expectant management for large-for-date fetuses: a randomised controlled trial. Lancet 2015;385:2600–5. 140. Magro-MalossoER,SacconeG,ChenM,NavatheR,DiTommasoM (...) or greater. The list should include details of safe working loads, product dimensions, as well as where speci?c equipment is located and how to access it. P Women with a booking BMI 40 kg/m 2 for whom moving and handling are likely to prove unusually dif?cult should have a moving and handling risk assessment carried out in the third trimester of pregnancy to determine any requirements for labour and birth. Clear communication of manual handling requirements should occur between the labour and theatre

2018 Royal College of Obstetricians and Gynaecologists

71. 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 (...) )) AND ((((((((criteria) OR diagnosed) OR diagnose) OR diagnosis) OR diagnostic) OR define) OR defined) OR definition) 2) 22-10-2017: ((((((("Delivery, Obstetric"[Mesh]) OR "Parturition"[Mesh]) OR "Labor, Obstetric"[Mesh]) OR labor) OR intrapartum)) AND ((maternal) OR mother)) AND temperature 3) 25-10-2017: ((((rectal) AND tympanic) AND "Body Temperature"[Mesh])) AND "Review" [Publication Type] 4) 25-10-2017: ((((rectal) AND oral) AND "Body Temperature"[Mesh])) AND "Review" [Publication Type] UpToDate; 1) 25-08-2017

2019 Nordic Federation of Societies of Obstetrics and Gynecology

72. ShortGUIDE: Instrumental vaginal birth

with a live fetus with cephalic presentation in second stage labour where 2 : o There is inadequate progress in active second stage in the presence of adequate uterine activity [refer to Queensland Clinical Guideline: Normal birth 3 ] o Maternal effort is contraindicated (e.g. cardiac conditions, hypertensive crisis 4 ) o Fetal compromise is suspected 4,5 Contraindications · Head is above the ischial spines or 2/5th or more palpable abdominally above the symphysis pubis 1 · Known or suspected fetal bone (...) · If difficulty is anticipated, perform in operating theatre to facilitate access to immediate CS 1 Sequential instrumentation · Associated with increased rates of maternal 15,16 and neonatal 16 morbidity · Balance risks of sequential instrumentation with the risks of CS in second stage of labour · Maintain low threshold for CS after unsuccessful forceps 17 Discontinuation Aspect Consideration Context · No high-level evidence on the maximum number of attempts, detachments 18 or pulls 1,4,19

2019 Queensland Health

73. 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

74. 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

75. Primary postpartum haemorrhage

postpartum haemorrhage 2.3.1 Third stage management The care provided during the third and fourth stages of labour may assist in the prevention or earlier detection and treatment of PPH. Refer to Queensland Clinical Guidelines: Normal birth 43 for routine management of third stage. Table 9. Third stage management Aspects Risk reduction measures Oxytocin · Recommend prophylactic uterotonics to all women giving birth as they reduce the risk of PPH 4,12,44,45 (oxytocin is the uterotonic of choice) o (...) haemorrhage 3.5.3 Uterine rupture Uterine rupture can occur spontaneously or be associated with previous obstetric surgery. The severity of the haemorrhage depends upon the extent of the rupture. Table 25. Uterine rupture Aspect Considerations Risk factors 68,69 · Previous uterine surgery or CS · Oxytocin administration · Malpresentation or undiagnosed cephalopelvic disproportion · Dystocia during second stage of labour · Grand multiparity · Macrosomic fetus · Placenta percreta · Uterine abnormalities

2019 Queensland Health

76. 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

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

with mandatory second opinion for caesarean indication Recommendation 2.1 36 3.3. Implementation of evidence-based clinical practice guidelines combined with audit and feedback Recommendation 2.2 41 C. INTERVENTIONS T ARGETED A T HEAL TH ORGANIZA TIONS, F ACILITIES OR SYSTEMS 45 3.4. Collaborative midwifery-obstetrician model of care in which the obstetrician provides in-house labour and delivery coverage, 24 hours a day, without competing clinical duties. Recommendation 3.1 45 3.5. Financial strategies (...) 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

2018 World Health Organisation Guidelines

78. 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

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

, 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 (...) and food intake during labour is recommended. b Recommended Maternal mobility and position 25. Encouraging the adoption of mobility and an upright position during labour in women at low risk is recommended. b Recommended Vaginal cleansing 26. Routine vaginal cleansing with chlorhexidine during labour for the purpose of preventing infectious morbidities is not recommended. a Not recommended Active management of labour 27. A package of care for active management of labour for prevention of delay

2018 World Health Organisation Guidelines

80. Perineal care

with and/or refer to obstetrician if history of 35 : o FGM o OASIS · If fetal macrosomia is identified, refer to Queensland Clinical Guideline: Induction of Labour 36 o Despite reduced incidence of shoulder dystocia, and lower birth weights, induction of labour may be associated with increased incidence of third and fourth degree tears (RR 3.70, 95% CI 1.04 to 13.17) 37,38 Recommendations · Offer women information about protective strategies that may reduce or mitigate: o Perineal injury (incidence or severity (...) 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

2018 Queensland Health

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