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Prevention of Labor Dystocia

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61. 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)

62. Are all brachial plexus injuries caused by shoulder dystocia? (PubMed)

with OBPP have no known risk factors. Shoulder dystocia increases the risk for OBPP 100-fold. The reported incidence of OBPP after shoulder dystocia varies widely from 4% to 40%. Other risk factors include birth weight >4 kg, maternal diabetes mellitus, obesity or excessive weight gain, prolonged pregnancy, prolonged second stage of labor, persistent fetal malposition, operative delivery, and breech extraction of a small baby. OBPP after caesarean section accounts for 1% to 4% of cases. Historically (...) are not associated with shoulder dystocia. Possible mechanisms of intrauterine injury include the endogenous propulsive forces of labor, intrauterine maladaptation, or failure of the shoulders to rotate, and impaction of the posterior shoulder behind the sacral promontory. Uterine anomalies, such as fibroids, an intrauterine septum, or a bicornuate uterus may also result in OBPP. It is not possible to reliably predict which fetuses will experience OBPP. Future research should be directed in prospective

2009 Obstetrical & Gynecological Survey

63. 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

64. 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

65. Birth after Previous Caesarean Birth

, the higher the success rate; the success rate of women with a VBAC score of more than 16 was greater than 85%, in contrast to those with a VBAC score of 10 who had a 49% success rate. The use of specific population-based models to predict VBAC success needs further data, 101,102 although initial results are promising. Induced labour, no previous vaginal delivery, BMI greater than 30 and previous caesarean for labour dystocia are associated with an increased risk of unsuccessful VBAC. If all (...) for either labour dystocia (64%) or fetal distress (73%) indications. 18,103 Younger women and those of white ethnicity experienced the highest success rate, in contrast to women of black ethnicity who experienced a lower success rate. Those who had an emergency caesarean delivery in their first birth also had a lower VBAC success rate, in particular those who experienced a failed induction of labour. 112 Despite a degree of data inconsistency, successful VBAC appears more likely among women

2015 Royal College of Obstetricians and Gynaecologists

66. Umbilical Cord Prolapse

. This practice is not recommended. To prevent vasospasm, there should be minimal handling of loops of cord lying outside the vagina. T o prevent cord compression, it is recommended that the presenting part be elevated either manually or by filling the urinary bladder. Cord compression can be further reduced by the mother adopting the knee–chest or left lateral (preferably with head down and pillow under the left hip) position. T ocolysis can be considered while preparing for caesarean section (...) if there are persistent fetal heart rate abnormalities after attempts to prevent compression mechanically, particularly when birth is likely to be delayed. Although the measures described above are potentially useful during preparation for birth, they must not result in unnecessary delay. What is the optimal mode of birth with cord prolapse? Caesarean section is the recommended mode of delivery in cases of cord prolapse when vaginal birth is not imminent in order to prevent hypoxic acidosis. A category 1 caesarean

2014 Royal College of Obstetricians and Gynaecologists

67. Otezla - apremilast

-a release. Apremilast significantly inhibited MEK cytotoxicity induced by UVB radiation by 20% and 23% at 0.1 and 10 µM, respectively. T and B Cell Adaptive Transfer Model MDCG5 14 days T/B cell 5 mg/kg IgHb Mice Apremilast did not have any significant effects upon the T cell activation markers CD69 and CD25, or alter CD86, CD40, or MHC II cells. Apremilast prevented the down regulation of CD62L on activated T cells amd CD80 expression on B cells. No effects on T cell proliferation or OVA-specific

2015 European Medicines Agency - EPARs

68. Polyhydramnios in singleton pregnancies

to search for evidence of a pathological condition in the fetus or pregnant woman. A control program is then initiated to see if the amnion volume increases, if the fetus is affected or if the pregnant woman gets symptoms. To avoid pregnancy and birth related complications such as preterm birth, PPROM, placental abruption, fetal distress, cord prolapse, dystocia, and postpartum hemorrhage, it is important to have a plan to control the pregnant woman with polyhydramnios during pregnancy and delivery (...) polyhydramnios, or those of moderate polyhydramnios and severe maternal symptoms (dyspnea, abdominal pain, movement limitations) in order to decrease the maternal symptoms. There is no convincing evidence that amnion drainage can prevent preterm birth. EVIDENCE B Polyhydramnios, guideline DSOG, January 21 st , 2016 page 3 10. The strategy for the treatment (therapeutic amnion drainage, indomethacin or controlled delivery) will depend on the gestational age, the severity of the polyhydramnios and the maternal

2016 Nordic Federation of Societies of Obstetrics and Gynecology

69. Practice Guidelines for Obstetric Anesthesia

), and local institutional policies. Perianesthetic Recording of Fetal Heart Rate Patterns. Fetal heart rate patterns should be monitored by a qualified individual before and after administration of neuraxial analgesia for labor. Continuous electronic recording of fetal heart rate patterns may not be necessary in every clinical setting and may not be possible during placement of a neuraxial catheter. Aspiration Prevention Aspiration prevention includes (1) clear liquids, (2) solids, and (3) antacids, H 2 (...) aspects of cesarean anesthesia ( e.g. , when an anesthesiology consult is appropriate) and of labor analgesia ( e.g. , parenteral opioids) that an obstetrician would use to counsel their patients. These guidelines also include perianesthetic management of other obstetric procedures and emergencies. Methodology Definition of Perioperative Obstetric Anesthesia For the purposes of these updated guidelines, obstetric anesthesia refers to peripartum anesthetic and analgesic activities performed during

2016 American Society of Anesthesiologists

70. Gestational diabetes mellitus

system for women and their GP about the importance of post natal OGTT Queensland Clinical Guideline: Gestational diabetes mellitus Refer to online version, destroy printed copies after use Page 12 of 38 2 Risk assessment Abnormalities of glucose tolerance have immediate, short-term, and long-term implications for the health of the woman and her baby 6 which may be prevented by adequate treatment. 12-14 Discuss with all women the benefits of achieving or maintaining a healthy lifestyle (e.g. nutrition (...) • Development of cardiovascular disease 26 Newborn/Fetal short term • Respiratory distress syndrome 22 • Jaundice 18,27 • Hypoglycaemia 18,22 • Premature birth 18 • Hypocalcaemia 27 • Polycythaemia • Increased newborn weight 18 and adiposity 28 • Macrosomia 15,18 o Shoulder dystocia - risk increases as fetal weight increases o Bone fracture o Nerve palsy o Caesarean section birth o Hypoxic-ischaemic encephalopathy (HIE) o Death Newborn long term • Impaired glucose tolerance 29 • Development of type 2

2015 Queensland Health

71. SMFM State of Pregnancy Monograph

pregnancy loss 2. PTB prevention a. Asymptomatic (e.g. prior second trimester loss, possible cervical insufficiency; prior PTB; Mullerian abnormalities; short cervical length; issues related to cerclage, pessary, progesterone, or other interventions for prevention of PTB b. Symptomatic (PTL or PPROM) <34 weeks gestation 3. Meconium complications 4. Malpresentation and malposition 5. Shoulder dystocia 6. Abnormal third stage of labor 7. Placenta accreta, increta, percreta 8. Second- or third-trimester (...) and/or fetal condition and the local resources. The discipline of MFM involves several pregnancy- related aspects, including: preconception care for women with medical or genetic risk factors or prior adverse pregnancy outcomes; antepartum care for pregnancies with medical, surgical, obstetric or fetal complications; labor and delivery and associated complications; obstetric complications; maternal medical complications; fetal evaluation for anomalies; fetal testing; gynecologic issues related to pregnancy

2015 Society for Maternal-Fetal Medicine

72. Nonimmune hydrops fetalis

a risk for trauma to the infant during delivery. Depending on the degree of associated effusions and anasarca, consideration should be given to the potential for dystocia at delivery. If a decision has been made not to intervene for fetal indicationseto provide comfort care only, vaginal delivery is preferred unless otherwise contraindicated. Where should delivery occur? If the NIHF is considered to have an etiology that is potentially amenable to postnatal treatment, or if the etiology (...) -transient myeloproliferative disorder. J Perinat Med 2010;38:445-7 (Level III). 26. AcarA,BalciO,GezgincK,etal.Evaluation oftheresultsofcordocentesis.TaiwanJObstet Gynecol 2007;46:405-9 (Level II-2). 27. Malin GL, Kilby MD, Velangi M. Transient abnormal myelopoiesis associated with Down Quality of evidence The quality of evidence for each article was evaluated according to the method outlined by the US Preventative Services Task Force: I Properly powered and conducted randomized controlled trial (RCT

2015 Society for Maternal-Fetal Medicine

73. Core Competencies for Management of Labour

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 3. Assessment and Immediate Management of Preterm Labour . . . . . . . . . . . . . . . . . . . . 31 4. Evaluation of Progress of Labour/Dystocia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 5. Discomfort and Pain in Labour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 5A. Administration of Nitrous Oxide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 6. Birth in the Absence (...) of a Primary Care Provider. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 7 . Postpartum Hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 8A. Obstetrical Emergencies – Cord Prolapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 8B. Obstetrical Emergencies – Shoulder Dystocia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81Perinatal Services BC Copyright © 2011 - PSBC MANAGEMENT

2014 British Columbia Perinatal Health Program

74. WHO recommendations for augmentation of labour

WHO recommendations for augmentation of labour WHO recommendations for WHO recommendations for augmentation of labourWHO Library Cataloguing-in-Publication Data WHO recommendations for augmentation of labour. 1.Dystociaprevention and control. 2.Labor, Induced – methods. 3.Labor, Induced - standards. 4.Labor Presentation. 5.Perinatal Care – methods. 6.Guideline. I.World Health Organization. ISBN 978 92 4 150736 3 (NLM classification: WQ 440) © World Health Organization 2014 All rights (...) millilitre MPA Maternal and Perinatal Health & Preventing Unsafe Abortion (a team in WHO’s Department of Reproductive Health and Research) NICU neonatal intensive care unit PPH postpartum haemorrhage RCT randomized controlled trial RHR [WHO Department of] Reproductive Health and Research RR relative risk TENS transcutaneous electrical nerve stimulation WHO World Health OrganizationWHO recommendations for augmentation of labour 3 Executive summary Introduction Prolonged labour is an important cause

2014 World Health Organisation Guidelines

75. Induction of Labour at Term in Older Mothers

defined FGR as growth 12 hours) and surgical intervention because of dystocia approximately one third higher in spontaneously labouring nulliparous women aged = 35 years compared to younger women. 29 This group employed a strict ‘active management of labour’ policy which may have removed any bias resulting from obstetricians intervening earlier in older women. The need for oxytocin augmentation of labour also increased with age until 30–34 years. Others have found women = 35 years of age require (...) and woman to decide on a caesarean section, but a significant concern to them is prevention of neonatal harm. Planned caesarean sections result in increased neonatal intensive care admissions compared to vaginal deliveries (RR 2.20, 95% CI 1.4–3.18) 32 and those performed before 39 weeks of gestation risk an increase in neonatal adverse respiratory outcomes. 33 Emergency caesarean sections have higher risks of maternal and neonatal complications. However, vaginal birth remains more likely than

2013 Royal College of Obstetricians and Gynaecologists

76. High Dose Versus Low Dose Oxytocin for Augmentation of Delayed Labour in Obese Women

delivery, failed induction of labor and labor dystocia, and prolonged labor curves especially among women with class III obesity. Condition or disease Intervention/treatment Phase DELAYED LABOUR Drug: Oxytocin Phase 4 Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Estimated Enrollment : 280 participants Allocation: Randomized Intervention Model: Parallel Assignment Masking: Double (Participant, Care Provider) Primary Purpose: Prevention Official Title (...) research staff using the contacts provided below. For general information, Layout table for eligibility information Ages Eligible for Study: Child, Adult, Older Adult Sexes Eligible for Study: Female Accepts Healthy Volunteers: No Criteria Inclusion Criteria: Spontaneous onset of labor. Body mass index ≥ 30 kg/m2. Gestational age ≥ 37 weeks. Singleton pregnancy. Cephalic presentation. Reassuring fetal heart rate monitoring. Inefficient uterine contractions during active labor Women who will accept

2018 Clinical Trials

77. Screening and Diagnosis of Gestational Diabetes Mellitus*

pregnancy, there will be a high rate of false-positive results and that women with positive testing may have anxiety and will suffer the burden of additional testing. Nevertheless, the Task Force recommended universal testing because it places the highest value on preventing fetal complications. USPSTF (2014) Potential harms of screening for gestational diabetes include psychological harms and intensive medical interventions (induction of labor, cesarean delivery, or admission to the neonatal intensive (...) clinical practice guideline. 2013 Nov 01 U.S. Preventive Services Task Force (USPSTF) Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. 2014 Mar 18 Citation: Internet citation: National Guideline Clearinghouse (NGC). Guideline synthesis: Screening and diagnosis of gestational diabetes. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2014 May (revised 2017 July). [cited YYYY

2014 National Guideline Clearinghouse (partial archive)

78. Screening and Diagnosing Gestational Diabetes Mellitus

dystocia with treatment for GDM. Low evidence showed no difference for neonatal hypoglycemia between treated and untreated GDM. Moderate evidence showed benefits of treatment for reduction of macrosomia (>4,000 g). There was insufficient evidence for long-term metabolic outcomes among offspring. Five studies provided data on harms of treating GDM. No difference was found for cesarean delivery, induction of labor, small for gestational age, or admission to a neonatal intensive care unit. There were (...) , the U.S. Preventive Services Task Force concluded that there was insufficient evidence upon which to make a recommendation regarding routine screening of all pregnant women. Objectives (1) Identify properties of screening tests for GDM, (2) evaluate benefits and harms of screening for GDM, (3) assess the effects of different screening and diagnostic thresholds on outcomes for mothers and their offspring, and (4) determine the benefits and harms of treatment for a diagnosis of GDM. Data Sources We

2012 Effective Health Care Program (AHRQ)

79. Intravenous fluid rate for reduction of cesarean delivery rate in nulliparous women: a systematic review and meta-analysis. (PubMed)

%; RR 0.70, 95% CI 0.53-0.92; seven studies, 1215 participants; I2 = 0%) and for dystocia (4.9 vs. 7.7%; RR 0.60, 95% CI 0.38-0.97; five studies, 1093 participants; I2 = 18%), a significantly shorter mean duration of labor of about one hour (mean difference -64.38 min, 95% CI -121.88 to -6.88; six studies, 1155 participants; I2 = 83%) and a significantly shorter mean length of second stage of labor (mean difference -2.80 min, 95% CI -4.49 to -1.10; 899 participants; I2 = 22%) compared with those who (...) that the duration of labor in low-risk nulliparous women may be shortened by a policy of intravenous fluids at a rate of 250 mL/h rather than 125 mL/h. A rate of 250 mL/h seems to be associated with a reduction in the incidence of cesarean delivery compared to 125 mL/h. The number needed to treat to prevent one cesarean delivery is 18 women. Our data support increased hydration among nulliparous women in labor when oral intake is restricted. Further study is needed regarding risks and benefits of increased

2017 Acta Obstetricia et Gynecologica Scandinavica

80. Oxytocin Dosing at Planned Cesarean Section and Anemia

a U.S. FDA-regulated Drug Product: No Studies a U.S. FDA-regulated Device Product: No Product Manufactured in and Exported from the U.S.: No Additional relevant MeSH terms: Layout table for MeSH terms Anemia Hemorrhage Uterine Inertia Hematologic Diseases Pathologic Processes Dystocia Obstetric Labor Complications Pregnancy Complications Oxytocin Oxytocics Reproductive Control Agents Physiological Effects of Drugs (...) Masking: Double (Participant, Investigator) Masking Description: Covering of labels on IV fluids Primary Purpose: Prevention Official Title: Oxytocin Dosing at Planned Cesarean Section and Postpartum Anemia: A Comparison of Two Protocols Estimated Study Start Date : March 1, 2019 Estimated Primary Completion Date : March 1, 2020 Estimated Study Completion Date : March 1, 2020 Resource links provided by the National Library of Medicine related topics: available for: Arms and Interventions Go to Arm

2017 Clinical Trials

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