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Prevention of Labor Dystocia

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81. Motivational Interviewing With Focus on Diet and Weight Gain in Pregnant Women With Type 2 Diabetes

of intervention (example Misoprostol, Cervical Ripening Balloon, amniotomy) to delivery. Duration of active labor [ Time Frame: 2 years and 9 months ] Regular labor with contractions ≤ 5 minutes interval and orificium is ≥ 4 cm dilated without persistant collum. The appraisal will be made by local midwives. Shoulder dystocia [ Time Frame: 2 years and 9 months ] Shoulder dystocia is a situation when the fetus's shoulders cannot pass below the mother's pubic symphysis after delivery of the head and specific (...) : March 6, 2019 Sponsor: Rigshospitalet, Denmark Collaborator: Odense University Hospital Information provided by (Responsible Party): Björg Ásbjörnsdóttir, Rigshospitalet, Denmark Study Details Study Description Go to Brief Summary: The primary goal of this case control study is to investigate the effect of implementation of motivational interviewing with focus on diet and weight gain in addition to the routine treatment on prevention of excessive gestational weight gain and fetal growth in pregnant

2016 Clinical Trials

82. Postoperative Cesarean Delivery Pain Relief; Diclofenac Versus Bupivacaine

conditions: CPD, fail induction of labor, antepartum hemorrhage without hypovolemic shock, dystocia, previous cesarean section and active labor, malpresentation in labor, macrosomic presentation in labor Pregnant women more than 20 years of age Gestational age more than 37 week Cesarean section under regional or general anesthesia Ability to communicating, writing and reading Thai language Exclusion Criteria: Inability to communicating or writing or reading Thai language Contraindicated to bupivacaine (...) Intervention Model: Parallel Assignment Masking: Triple (Participant, Investigator, Outcomes Assessor) Primary Purpose: Prevention Official Title: A Randomized Comparison of Bupivacaine Peritoneal and Subcutaneous Infiltration Versus Diclofenac Intramuscular Injection for Postoperative Pain Relief in Patient Undergoing Cesarean Delivery Actual Study Start Date : January 1, 2017 Actual Primary Completion Date : June 30, 2017 Estimated Study Completion Date : December 2017 Resource links provided

2016 Clinical Trials

83. Role of Tranexamic Acid Versus Uterine Cooling at Caesarean Section

rate rose from 4.5-32.9%, and declined to 32.8% of all deliveries at 2010. In spite of the various measures to prevent blood loss during and after CS, post-partum hemorrhage (PPH) continues to be the most common complication seen in almost 20% of the cases, and causes approximately 25% of maternal deaths worldwide, leading to increased maternal morbidity and mortality. Women who undergo a CS are much more likely to be delivered by a repeat operation in subsequent pregnancies. For women undergoing (...) subsequent CS, the maternal risks are even greater like massive obstetric hemorrhage, hysterectomy, admission to an intensive care unit, or maternal death. Medications, such as oxytocin, misoprostol and prostaglandin F2α, have been used to control bleeding postoperatively. TXA is a synthetic analog of the amino acid lysine, as an antifibrinolytic agent. Its intravenous administration has been routinely used for many years to reduce or prevent excessive hemorrhage in various medical conditions

2016 Clinical Trials

84. Failure to Progress

: Failure to Progress , Labor Dystocia , Cephalopelvic Disproportion , CPD From Related Chapters II. Epidemiology Labor Dystocia is responsible for 50% of Cesereans Primary Ceserean rate: 20% in U.S. III. Criteria: Active phase delay or arrest Background Based on Assumes dilated to 6 cm and (prior criteria was 4 cm) Frequent contractions Protracted labor (slow rate of dilation and descent) Nulliparous women : <1 cm/hour Cervical Dilation: <1 cm/hour Multiparous women Cervical Dilation: <1.5 cm/hour : <2 (...) ) Ontology: Dystocia (C0013418) Definition (NCI) Uterine contractions (less than 3 in 10 minutes or inadequate strength) that do not result in progressive cervical dilation.(NICHD) Definition (MSH) Slow or difficult OBSTETRIC LABOR or CHILDBIRTH. Concepts Finding ( T033 ) MSH ICD9 661.9 ICD10 SnomedCT 45757002 , 199746004 , 111448009 , 237323007 , 289255001 , 199816006 , 289261003 English Dystocias , Unspecified abnormality of labor , dysfunctional labor (physical finding) , dysfunctional labor

2018 FP Notebook

85. The hospital with a high episiotomy rate

, will decrease the amount of time for delivery of the fetal head. The increased space also allows more room to perform maneuvers to relieve a shoulder dystocia. Episiotomy is, in general, not frequently performed. It was done in (compared to ). Although the ideal episiotomy rate is undefined, restrictive use of episiotomy is preferred over routine use. Since 2006 the American Congress of Obstetricians and Gynecologists has routine episiotomy use. It is troublesome to see any physicians with high episiotomy (...) rates, as the procedure is not necessary for the majority of vaginal births. Purported benefits of episiotomy include less severe perineal lacerations, easier laceration repair, better wound healing, and preservation of the pelvic floor support by preventing a spontaneous, irregular laceration. Data, however, does not support this. A found that pain, severity of perineal laceration, and pain medication use were not better with routine episiotomy use. There was also no demonstrated benefit from

2016 KevinMD blog

86. Management of diabetes

Crescent Edinburgh EH12 9EB www.sign.ac.ukContents 1 Introduction 1 1.1 The need for a guideline 1 1.2 Remit of the guideline 1 1.3 Definitions 2 1.4 Statement of intent 3 2 Key recommendations 5 2.1 Lifestyle management 5 2.2 Psychosocial factors 5 2.3 Management of type 1 diabetes 6 2.4 Management of diabetes in pregnancy 7 2.5 Management of diabetic cardiovascular disease 7 2.6 Management of kidney disease in diabetes 7 2.7 Prevention of visual impairment 8 2.8 Management of diabetic foot disease 8 (...) 8.1 Epidemiology 70 8.2 Cardiovascular risk factors 70 8.3 Primary prevention of coronary heart disease 71 8.4 Management of patients with diabetes and acute coronary syndromes 73 8.5 Management of patients with diabetes and heart failure 76 8.6 Management of patients with diabetes and stable angina 79 8.7 Management of acute stroke 81 8.8 Peripheral arterial disease 81 8.9 Checklist for provision of information 81 9 Management of kidney disease in diabetes 83 9.1 Definitions 83 9.2 Prevalence

2010 SIGN

87. Maternity Care Pathway

by The Canadian Task Force on Preventive Health Care (Table 1). 4 Table 1 Levels of recommendations* Recommendation A: There is good evidence to recommend the clinical preventive action Recommendation B: There is fair evidence to recommend the clinical preventive action Recommendation C: The existing evidence is conflicting and does not allow to make a recommendation for or against use of the clinical preventive action; however, other factors may influence decision-making Recommendation D: There is fair (...) evidence to recommend against the clinical preventive action Recommendation I: There is insufficient evidence (in quantity or quality) to make a recommendation; however other factors may influence decision making *Recommendations included in these guidelines have been adapted from the Levels and Quality of Evidence for Treatment Recommendations described in The Canadian Task Force on Preventive Health Care 5 Waiver Any procedure or clinical practice described in the guideline should be applied

2010 British Columbia Perinatal Health Program

88. Management of Women with Obesity in Pregnancy

acid supplementation reduces the risk of the first occurrence, as well as the recurrence, of NTDs (relative risk (RR) 0.28, 95% confidence interval (CI) 0.13–0.58). 29 In women at high risk of fetal NTD (due to previous pregnancy with NTD), a randomised double-blind prevention trial has shown that a higher dose of folic acid supplementation (4mg/day) reduces the risk of a subsequent NTD-affected pregnancy by 72% (RR 0.28, 95% CI 0.12–0.71). 30 † Evidence level 1++ Women with a raised BMI (...) with a number of large cohort studies reporting a three-fold increased risk compared to women with a healthy weight. 10,23,45,46,49 Evidence level 2++ A randomised controlled trial of 1000 women with GDM found that treatment, comprising dietary advice, blood glucose monitoring and insulin therapy as needed, significantly reduced the risk of a composite measure of serious adverse perinatal outcome (death, shoulder dystocia, bone fracture, and/or nerve palsy) compared to routine care, where women

2010 Royal College of Obstetricians and Gynaecologists

89. What is known about options and approaches to intrapartum management of women with gestational diabetes mellitus (GDM)?

the 90th percentile was significantly greater in the expectant- management group (23% compared with 10% with active induction). There were no significant differences in rates of cesarean delivery, shoulder dystocia, neonatal hypoglycemia, or perinatal deaths. Four observational studies suggested a potential reduction in macrosomia and shoulder dystocia with labor induction and cesarean delivery for estimated fetal weight indications. 50 In a 2008 AHRQ Evidence Report on therapeutic management, delivery (...) , and postpartum risk assessment and screening in GDM, two low-quality observational studies suggested a potential reduction in macrosomia and shoulder dystocia with elective labor induction and elective cesarean delivery for macrosomia or LGA infants. 49 KTA Evidence Summary: Intrapartum Management of Patients with Gestational Diabetes Mellitus (GDM) Page 13 of 19 May 2010 B A 1996 study of 96 women with GDM from Israel was conducted to test the hypothesis that the incidence of shoulder dystocia could

2010 OHRI Knowledge to Action

90. What is known about 3rd and 4th degree lacerations during vaginal birth?

for improvement. Risk factors commonly found to be associated with 3 rd /4 th degree lacerations from prospective data include nulliparity, higher birth weight, and forceps delivery. In addition, risks identified by retrospective data are persistent occipitoposterior position, induction of labour, epidural analgesia, second stage labour longer than 1 hour, shoulder dystocia, and midline episiotomy. Data from RCTs indicate that while the preventative practice of antenatal perineal massage does not improve (...) occipitoposterior position (up to 3%) Nulliparity (up to 4%) Induction of labour (up to 2%) Epidural analgesia (up to 2%) Second stage longer than 1 hour (up to 4%) Shoulder dystocia (up to 4%) Midline episiotomy (up to 3%) Forceps delivery (up to 7%)”KTA Evidence Summary: 3 rd and 4 th degree lacerations Page 7 of 13 December 2010 c. Best practices for prevention Multiple practices 4/10 A 2000 systematic review conducted by Eason and colleagues at The Ottawa Hospital, assessed the evidence of practices

2010 OHRI Knowledge to Action

91. 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

92. 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

2010 Clinical Practice Guidelines Portal

93. Clinical Practice Guideline on Care in Normal Childbirth

of Labour 57 5.2. Duration and Progress of the First Stage of Labour 59 5.3. Maternity Admission 62 5.4. Care on Admission 64 5.5. Possible Routine Interventions during the First Stage of Labour 68 6. Second Stage of Labour 101 6.1. Definition 101 6.2. Duration and Progress 103 6.3. Asepsis Measures 110 6.4. Position during the Second Stage of Labour 115 6.5. Maternal Pushing and Directed Pushing 120 6.6 Preventing Perineal Trauma 127 6.7. Episiotomy 133 6.8. Suturing Method and Materials for Perineal (...) IN NORMAL CHILDBIRTH 11 Authorship and Collaboration Working Group of the CPG on Care In Normal Childbirth Luis Fernández-Llebrez del Rey, obstetrician/gynaecologist, Hospital de Cruces, Barakaldo, Bizkaia Charo Quintana Pantaleón, obstetrician/gynaecologist, Marqués de Valdecilla University Hospital, Santander Itziar Etxeandia Ikobaltzeta, pharmacist, Health Technology Assessment Service Osteba, Vitoria-Gasteiz Rosa Rico Iturrioz, specialist in preventive medicine and public health, Health Technology

2010 GuiaSalud

94. Lateral Episiotomy or Not in Vacuum Assisted Delivery in Non-parous Women

: Layout table for MeSH terms Hypoxia Fecal Incontinence Pelvic Floor Disorders Dystocia Fetal Hypoxia Signs and Symptoms, Respiratory Signs and Symptoms Rectal Diseases Intestinal Diseases Gastrointestinal Diseases Digestive System Diseases Pregnancy Complications Obstetric Labor Complications Fetal Diseases (...) anal sphincter injury (OASIS) of any degree. Condition or disease Intervention/treatment Phase Pelvic Floor Disorders Fecal Incontinence Dystocia Fetal Hypoxia Procedure: Lateral episiotomy Not Applicable Detailed Description: The study has started at Danderyd Hospital. Danderyd Hospital is a large teaching hospital affiliated to the Karolinska Institute in Stockholm, Sweden. South General Hospital in Stockholm, Uppsala University Hospital, Falun Hospital, and Helsingborg Hospital have joined

2015 Clinical Trials

95. Incidence of Neonatal Birth Injuries and Related Factors in Kashan, Iran (PubMed)

study, all live-born neonates in the hospitals of Kashan City were assessed prospectively by a checklist included demographic variables (maternal age, weight, and nationality), reproductive and labor variables (prenatal care, parity, gestational age, premature rupture of membrane (PROM), fetal heart rate (FHR) pattern, duration of PROM, induction of labor, fundal pressure, shoulder dystocia, fetal presentation, duration of second stage, type of delivery, and delivery attendance), and neonatal (...) and 1.2% in cesarean sections (P < 0.0001). The most common trauma was cephalohematoma (57.2%) and then asphyxia (16.8%). In multiple logistic regression analyses, decreased fetal heart rate (FHR), fundal pressure, shoulder dystocia, vaginal delivery, male sex, neonatal weight, delivery by resident, induction of labor, and delivery in a teaching hospital were predictors of birth trauma.Overall, incidence of birth trauma in Kashan City was lower in comparison with most studies. Considering existing

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2015 Archives of trauma research

96. The Effect of Episiotomy on Maternal and Fetal Outcomes (EPITRIAL)

: Randomized Intervention Model: Parallel Assignment Masking: None (Open Label) Primary Purpose: Prevention Official Title: The Effect of Episiotomy on Advanced Perineal Tears and Other Maternal and Fetal Outcomes - Randomized Controlled Multicentric Trial (EPITRIAL) Study Start Date : June 2015 Estimated Primary Completion Date : February 2019 Estimated Study Completion Date : February 2019 Arms and Interventions Go to Arm Intervention/treatment Experimental: No episiotomy Episiotomy will not be performed (...) . Of note, episiotomy will be considered as a 2nd degree tear. Duration of the second stage of labor [ Time Frame: From beginning of full dilatation to the delivery of the baby ] Time in minutes from full dilatation stage of labor until the delivery of the baby Postpartum hemorrhage [ Time Frame: From delivery to one hour postpartum ] Excessive vaginal bleeding (above 500 ml according to the subjective evaluation of the attending accoucher, or associated with hemodynamic instability), from the moment

2015 Clinical Trials

97. Once a Cesarean ... now, a vaginal delivery

in the U.S., with the most common indications being elective repeat Cesarean delivery (30%) and dystocia or failure to progress (30%). A in the "Narrative Matters" section of Health Affairs by physician and health policy researcher Carla Keirns highlighted the challenges that even a highly educated, well-informed patient faces in achieving the desired outcome of a vaginal childbirth, especially if her pregnancy is classified as high risk. Dr. Keirns, whose pregnancy was complicated by "advanced maternal (...) forty-eight hours into my labor induction, I might have agreed. If they had told me that my baby’s life or health was in jeopardy, I would have consented to anything . The vision of the empowered consumer, or even the autonomous patient, is laughable under these circumstances. Once a woman has had one Cesarean delivery, she faces considerable pressure from the medical system to choose repeat Cesarean deliveries in subsequent pregnancies. A in The Atlantic explained why the dictum "once a Cesarean

2015 The AFP Community Blog

98. Can Cooling the Uterus During Cesarean Section Decrease Blood Loss, Decrease Uterotonic Drug Use, and Decrease the Number of Emergency Hysterectomies?

uterine cooling 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 (...) uterotonic medications, and fewer hysterectomies following cesarean section. The investigators suspect that it may. Condition or disease Intervention/treatment Phase Postpartum Hemorrhage Uterine Atony Procedure: Uterine Cooling Not Applicable Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Actual Enrollment : 200 participants Allocation: Randomized Intervention Model: Parallel Assignment Masking: None (Open Label) Primary Purpose: Prevention Official

2014 Clinical Trials

99. Postpartum Hemorrhage (Overview)

usually has a single cause, but more than one cause is also possible, most likely following a prolonged labor that ultimately ends in an operative vaginal birth. Previous Next: Prevention High-quality evidence suggests that active management of the third stage of labor reduces the incidence and severity of PPH. [ ] Active management is the combination of (1) uterotonic administration (preferably oxytocin) immediately upon delivery of the baby, (2) early cord clamping and cutting, and (3) gentle cord (...) . . Vaid A, Dadhwal V, Mittal S, Deka D, Misra R, Sharma JB. A randomized controlled trial of prophylactic sublingual misoprostol versus intramuscular methyl-ergometrine versus intramuscular 15-methyl PGF2alpha in active management of third stage of labor. Arch Gynecol Obstet . 2009 Mar 11. . Tunçalp Ö, Hofmeyr GJ, Gülmezoglu AM. Prostaglandins for preventing postpartum haemorrhage. Cochrane Database Syst Rev . 2012 Aug 15. 18;(3):CD000494. . Winikoff B, Dabash R, Durocher J, Darwish E, Nguyen TN, León

2014 eMedicine.com

100. Postterm Pregnancy (Overview)

weeks gestation including meconium and meconium aspiration, neonatal acidemia, low Apgar scores, macrosomia, and, in turn, birth injury. For example, since postterm infants are larger than term infants, with a higher incidence of fetal macrosomia (defined as estimated fetal weight ≥ 4,500 g) [ ] , they are, in turn, at greater risk for other complications. [ , ] Such complications associated with fetal macrosomia include prolonged labor, cephalopelvic disproportion, and shoulder dystocia (...) elective induction of labor to expectant management of pregnancy. [ ] However, elective induction of labor is increasingly being used as a management strategy. [ , ] While this management may be reasonable in a practice that allows 48 hours or more for the management of the latent phase and the first stage of labor overall, in a setting where induction of labor is called a failure after 18-24 hours, it will likely further increase the cesarean delivery rate. Previous Next: Prevention of Postterm

2014 eMedicine.com

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