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Prevention of Labor Dystocia


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81. Cervical Cerclage

the risk of puerperal pyrexia. The use of tocolytics increases with cerclage, as does the rate of hospital admissions, and one study found a higher rate of Caesarean sections. However, the risk and nature of complications is influenced by whether the cerclage is inserted electively or as an emergency with membranes bulging through the cervix. The complications reported with cerclage include sepsis, premature rupture of membranes, premature labour, cervical dystocia, cervical laceration at delivery (11 (...) % to 14%), and hemorrhage. However, meta-analysis of a number of studies has not confirmed higher rates of chorioamnionitis or preterm pre-labour membrane rupture in women managed with cerclage than in those managed by other means. Although cervical dystocia is frequently cited as a complication of cerclage due to cervical scarring, data do not support its being truly attributable to cerclage; the increased risk of cervical laceration, however, although it appears to be unrelated to the timing

2017 National Guideline Clearinghouse (partial archive)

82. Normal birth

, Brisbane Qld 4001, email, phone (07) 3234 1479. Queensland Clinical Guideline: Normal birth Refer to online version, destroy printed copies after use Page 3 of 42 Flow Chart: Initial assessment Queensland Clinical Guidelines: Normal birth. Flowchart version: F17.25-1-V2-R22 Initial contact · Reason for presentation/contact · Preferences for labour and birth · Emotional and psychological needs Review history · Verbal · Pregnancy Health Record · Obstetric, gynaecological (...) wellbeing · Ask about fetal movements · Auscultate FHR towards the end of contraction and continue for at least 30?60 seconds after contraction finished · Differentiate fetal heart beat from maternal pulse Vaginal loss · Nil, discharge, liquor, blood · Note colour, odour, amount, and consistency Vaginal examination · If stage of labour uncertain, may assist decision making · Consider speculum examination if SROM Discomfort and pain · Reassure, promote, reinforce coping strategies · Assess response

2017 Queensland Health

83. Intrapartum care for healthy women and babies

of birth 5 1.2 Care throughout labour 17 1.3 Latent first stage of labour 18 1.4 Initial assessment 20 1.5 Ongoing assessment 24 1.6 General principles for transfer of care 26 1.7 Care in established labour 27 1.8 Pain relief in labour: non-regional 28 1.9 Pain relief in labour: regional analgesia 30 1.10 Monitoring during labour 32 1.11 Prelabour rupture of membranes at term 53 1.12 First stage of labour 54 1.13 Second stage of labour 57 1.14 Third stage of labour 63 1.15 Care of the newborn baby 70 (...) 1.16 Care of the woman after birth 74 Putting this guideline into practice 80 Context 82 More information 83 Recommendations for research 84 1 Models of midwifery-led care 84 2 Effect of information giving on place of birth 84 3 Long-term consequences of planning birth in different settings 85 4 Education about the latent first stage of labour 85 5 Postpartum haemorrhage 86 Appendix A: Adverse outcomes 87 Intrapartum care for healthy women and babies (CG190) © NICE 2019. All rights reserved

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

84. Diabetes in Pregnancy

the criteria described in the Report of the Canadian Task Force on Preventive Health Care ( Table 1 ). Summary Statements 1. The adverse outcomes associated with diabetes in pregnancy are substantially associated with hyperglycemia and the coexisting metabolic environment. Women with preexisting diabetes should receive preconception care to optimize blood sugar control and other comorbidities. Outcomes for the fetus/neonate and the mother in both pre-gestational diabetes mellitus and gestational diabetes (...) of stillbirth between 36 to 39 weeks' gestation. (II-2) 3. Women with gestational diabetes mellitus have a higher risk of preeclampsia, 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 reduce the risk of preeclampsia, shoulder dystocia, and large for gestational age infants. (I) 5. The occurrence of gestational diabetes mellitus increases the risk of developing type 2 diabetes

2016 Society of Obstetricians and Gynaecologists of Canada

85. 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

86. 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

87. NHMRC Statement on Homeopathy and NHMRC Information Paper - Evidence on the effectiveness of homeopathy for treating health conditions

spondylitis • boils and pyoderma (types of skin infections) • Broca’s aphasia in people who have had a stroke • bronchitis • cholera • cough • chronic polyarthritis • dystocia (difficult labour) • eczema • heroin addiction • knee joint haematoma (bruising) • lower back pain • nausea and vomiting associated with chemotherapy • oral lichen planus • osteoarthritis • proctocolitis • postoperative pain-agitation syndrome • radiodermatitis (skin damage caused by radiotherapy) in women with breast cancer (...) offered to patients, or proposed as preventive means by the health system and its policy and decision makers. NHMRC is a strong advocate for the development and use of evidence to inform policy and practice and in recent years, NHMRC and other health research funding bodies have increased funding for such research. NHMRC is of the view that when offering treatments for illness, all registered health practitioners must give consideration to the evidence for the effectiveness of such treatments

2015 National Health and Medical Research Council

88. Management of Third- and Fourth-degree Perineal Tears

–2.36) l shoulder dystocia 1 (OR 1.90, 95% CI 1.72–2.08) l occipito-posterior position 15 (RR 2.44, 95% CI 2.07–2.89) l prolonged second stage of labour: 15 m duration of second stage between 2 and 3 hours (RR 1.47, 95% CI 1.20–1.79) m duration of second stage between 3 and 4 hours (RR 1.79, 95% CI 1.43–2.22) m duration of second stage more than 4 hours (RR 2.02, 95% CI 1.62–2.51) l instrumental delivery: 1 m ventouse delivery without episiotomy (OR 1.89, 95% CI 1.74–2.05) m ventouse delivery (...) of labour for reducing perineal trauma. Cochrane Database Syst Rev 2011;(12):CD006672. 33. Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev 2013;(4):CD005123. 34. Stamp G, Kruzins G, Crowther C. Perineal massage in labour and prevention of perineal trauma: randomised controlled trial. BMJ 2001;322:1277–80. 35. Groom KM, Paterson-Brown S. Can we improve on the diagnosis of third degree tears? Eur J Obstet Gynecol Reprod Biol 2002;101:19–21. 36

2015 Royal College of Obstetricians and Gynaecologists

89. WHO guidelines on the management of health complications from female genital mutilation

Postpartum blood loss of 500 ml or more Episiotomy Prolonged labour Obstetric tears/lacerations Instrumental delivery Difficult labour/dystocia Extended maternal hospital stay Stillbirth and early neonatal death Infant resuscitation at delivery SEXUAL FUNCTIONING RISKS (6, 11) Dyspareunia (pain during sexual intercourse) There is a higher risk of dyspareunia with type III FGM relative to types I and II (6). Decreased sexual satisfaction Reduced sexual desire and arousal Decreased lubrication during (...) practice statements on the management of health complications from FGM are summarized in the table below. They will be reviewed and updated following identification of new evidence. Guiding principles I Girls and women living with female genital mutilation (FGM) have experienced a harmful practice and should be provided quality health care. II All stakeholders – at the community, national, regional and international level – should initiate or continue actions directed towards primary prevention of FGM

2016 World Health Organisation Guidelines

90. 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

91. Practice Guidelines for Obstetric Anesthesia Full Text available with Trip Pro

), 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

92. Guidelines for Weight Gain During Pregnancy: A Focused Practice Question

of delivery, vaginal birth after caesarean, vaginal lacerations, shoulder dystocia, cephalopelvic disproportion, complications of labour and delivery. Postpartum period: lactation, weight retention, premenopausal breast cancer, postpartum depression and maternal mortality. Birth outcomes: preterm birth, birthweight, low birthweight, macrosomia, large for gestational age, small for gestational age, apgar scores. Infant outcomes: perinatal mortality, birth defects, breastfeeding initiation and maintenance (...) be gained during pregnancy. The search included: Turning Research into Practice (TRIP) database, National Guideline Clearinghouse, National Institute for Health Care Excellence (NICE), Society of Obstetricians and Gynaecologists of Canada (SOGC), Health Canada, Public Health Agency of Canada, Public Health Ontario, Centers for Disease Control and Prevention (CDC), Institute of Medicine, and the World Health Organization. The search was completed in November 2015 and is outlined in Appendix A. 4

2016 Peel Health Library

93. WHO recommendations on antenatal care for a positive pregnancy experience

pregnancy for mother and baby (including preventing or treating risks, illness and death), having an effective transition to positive labour and birth, and achieving positive motherhood (including maternal self-esteem, competence and autonomy). Recognizing that a woman’s experience of care is key to transforming ANC and creating thriving families and communities, this guideline addresses the following questions: n n What are the evidence-based practices during ANC that improve outcomes and lead (...) health conditions for both mother and baby during pregnancy. The components of ANC include: risk identification; prevention and management of pregnancy-related or concurrent diseases; and health education and health promotion. ANC reduces maternal and perinatal morbidity and mortality both directly, through detection and treatment of pregnancy-related complications, and indirectly, through the identification of women and girls at increased risk of developing complications during labour and delivery

2016 World Health Organisation Guidelines

94. 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

95. 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

96. Choices about episiotomy: A decision aid for women having a vaginal birth

to increase the size of the opening of the vagina. The cut is usually between 2cm and 4cm long [4]. An episiotomy is about the same in size as having a 2 nd degree tear. There are different reasons that a care provider might offer to do an episiotomy. Some common reasons for offering to do an episiotomy are explained below. To try to prevent a severe tear Your care provider might offer to do an episiotomy if he or she thinks you might have a severe tear (a 3 rd or 4 th degree tear). It used to be thought (...) that episiotomies prevented severe tears. Studies now show that severe tears are more common when episiotomies are done routinely (all the time) than when episiotomies are done selectively (only in certain circumstances) [5]. More information about this is provided later in this decision aid. Because you have had a severe tear in a previous birth Your care provider might offer to do an episiotomy if you have had a severe tear in a previous birth. Women who have had a severe tear in a previous birth have

2015 EUnetHTA

97. Gestational diabetes mellitus

when labour established Insulin • Cease when labour established • If morning IOL (and labour not established) o Eat breakfast and give usual rapid acting Insulin o Omit morning long or intermediate acting Insulin • If afternoon IOL (and labour not established) o Give usual mealtime and bedtime Insulin GDM Insulin or Metformin Mode of birth? Day before procedure • Cease Metformin 24 hours prior to procedure • Give usual Insulin the night before procedure Day of morning procedure • Fast from 2400 (...) weight gain IOL Induction of labour IOM Institute of Medicine LGA Large for gestational age MNT Medical nutrition therapy NDSS National Diabetes services scheme OGTT Oral glucose tolerance test – 75 gram glucose load USS Ultrasound scan Definition of terms Antenatal contact In this guideline the term antenatal contact includes all forms of interaction between the pregnant woman and her care providers for the purpose of providing antenatal care. For example, telephone consults or SMS messaging, email

2015 Queensland Health

98. Umbilical Cord Prolapse

, 11,21 particularly in the presence of an unengaged presenting part, are the interventions that most frequently precede cord prolapse. In general, these factors predispose to cord prolapse by preventing close application of the presenting part to the lower part of the uterus and/or pelvic brim. One study of induction of labour using transcervical balloon catheters showed a significant increase in the rate of cord presentation after inflation with saline above 180 ml. 20 Amnioinfusion is used (...) first be diagnosed at routine vaginal examination in labour. 1 4.5 What is the optimal initial management of cord prolapse in a fully equipped hospital setting? When cord prolapse is diagnosed before full dilatation, assistance should be immediately called and preparations made for immediate birth in theatre. There are insufficient data to evaluate manual replacement of the prolapsed cord above the presenting part to allow continuation of labour. This practice is not recommended. To prevent

2014 Royal College of Obstetricians and Gynaecologists

99. Adasuve (loxapine)

), M 1 (117). In a separate Adasuve Assessment report Page 15/91 study using guinea pig cerebral cortex receptors, loxapine also exhibited a K i value of 14.9 nM for the histamine H 1 receptor. Loxapine has shown to prevent the stimulation of adenylate cyclase by dopamine in rat striatal homogenates by 60% of inhibition. IC 50 values for rat striatal [ 3 H]-spiroperidol binding were 101, 196 and 5870 nM for loxapine, amoxapine and imipramine, respectively. Loxapine, amoxapine and their 8 (...) (likely due to its antagonistic action at 5-HT 7 receptors) as its administration prevented 5-HT induced contractions of isolated rat jejunum. In rats, loxapine (1 - 20 mg/kg) did not increase the number of animals that developed stress-induced gastric ulcers suggesting its lack of ulcerogenic effects. Loxapine was also shown to produce mild diuretic effects when administered alone. Pharmacodynamic drug interactions Based on literature data, interactions of loxapine succinate with diuretic

2013 European Medicines Agency - EPARs

100. Screening for gestational diabetes mellitus: are the criteria proposed by the International Association of the Diabetes and Pregnancy Study Groups cost-effective? Full Text available with Trip Pro

complications (pre-term labour admissions, pre-eclampsia, shoulder dystocia, brachial plexus injury, and intensive care admissions). The unit costs and quantities of resources were from published literature or the authors’ institution; some data were from Medicaid reimbursement tariffs. All costs were in US $ and the price year was 2011. A 3% annual discount rate was applied. Analysis of uncertainty: One-way sensitivity analyses were carried out by varying the model inputs over plausible ranges of values (...) by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG), compared with usual screening. The authors concluded that the IADPSG strategy was cost-effective, as long as the gestational diabetes diagnosis was followed by intensive intervention to prevent diabetes. The cost-effectiveness framework was valid, the sources were robust, and key areas of uncertainty were addressed. The authors’ conclusions are robust. Type of economic evaluation Cost-utility analysis Study objective This study

2013 NHS Economic Evaluation Database.

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