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Prevention of Labor Dystocia


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101. 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

102. 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

103. 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.

104. Pre-conception - advice and management

or in combination with vitamins and minerals, prevents NTDs but does not have a clear effect on other birth defects' [ ]. Dose of folate supplementation depending on the risk of NTD The recommendation to prescribe folic acid 5 mg daily to people at higher risk of an NTD and 400 micrograms to people at normal risk of NTD is based on the recommendations of an expert advisory group in 1992 [ ], and reiterated by NICE in the guideline: Antenatal care for uncomplicated pregnancies [ ]; and reports from the National (...) acid supplements throughout pregnancy in women with haemoglobinopathies. This recommendation is based on expert opinion in the Royal College of Obstetricians and Gynaecologists (RCOG) guideline Management of sickle cell disease in pregnancy that recommends that, to prevent neural tube defects, women with sickle cell disease should receive folic acid 5 mg once daily pre-conceptually and during pregnancy because of the increased demand for folate in pregnancy [ ]. This is supported by advice

2017 NICE Clinical Knowledge Summaries

105. Selective Use of Episiotomy: the Impact on Perineal Trauma.

Accepts Healthy Volunteers: No Sampling Method: Non-Probability Sample Study Population Unassisted vaginal delivery of the study period. Criteria Inclusion Criteria: Vaginal delivery Exclusion Criteria: All situations in which episiotomy was recommended according to our Labour Ward's procedures (such as shoulder dystocia, breech presentation and operative delivery with vacuum) have been excluded. Contacts and Locations Go to Information from the National Library of Medicine To learn more about (...) is an intentional perineal incision performed by midwifes or obstetricians to enlarge vaginal opening during the second stage of childbirth and has become the most common surgical procedure worldwide. A routine use of episiotomy was proposed to prevent severe spontaneous lacerations, although it failed to to demonstrate a clear protective role with no benefits both for mother and baby. Therefore the guidelines changed in a selective use of episiotomy, and we have introduced it in our routine obstetrics care

2018 Clinical Trials

106. IRELAnD: Investigating the Role of Early Low-dose Aspirin in Diabetes

the 10th centile or perinatal mortality). Condition or disease Intervention/treatment Phase Pre-Gestational Diabetes Drug: Aspirin Drug: Placebos Phase 3 Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Estimated Enrollment : 300 participants Allocation: Randomized Intervention Model: Parallel Assignment Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) Primary Purpose: Prevention Official Title: Investigating the Role (...) ) And/ or clinical seizures or moderate to severe encephalopathy using the Sarnat grading system Shoulder dystocia [ Time Frame: birth ] Shoulder dystocia is defined as a vaginal cephalic delivery that requires additional obstetric manoeuvres to deliver the fetus after the head has delivered and gentle traction has failed Composite measure of Maternal outcomes not directly related to primary outcome [ Time Frame: Delivery ] Mode of delivery: Recorded on day of delivery, as follows: Spontaneous vaginal birth

2018 Clinical Trials

107. 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)

108. 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)

109. Fetal ST Segment and T Wave Analysis in Labor

with the existing electronic fetal monitor used to measure the baby's heart rate and the mother's contractions during birth. The specific purpose of this research study is to see if this new instrument (fetal STAN monitor) will have an impact on newborn health. Condition or disease Intervention/treatment Phase Pregnancy Obstetric Labor Parturition Device: fetal STAN monitor Not Applicable Detailed Description: A Randomized Trial of Fetal ECG ST Segment and T Wave Analysis as an Adjunct to Electronic Fetal Heart (...) 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

2010 Clinical Trials

110. Intravenous Versus Intramuscular Administration of Methylergonovine for Uterine Contraction in Cesarean Sections

Studies a U.S. FDA-regulated Drug Product: Yes Studies a U.S. FDA-regulated Device Product: No Product Manufactured in and Exported from the U.S.: Yes Keywords provided by Johns Hopkins University: methylergonovine 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 Methylergonovine Oxytocics Reproductive Control Agents (...) of administration. Investigators hypothesize that intravenous methylergonovine reduces the time to adequate uterine tone (the tone at which the uterus is adequately contracted to prevent atony after delivery of neonate), decreases the total dose of methylergonovine to contract the uterus, and therefore produces fewer side effects of hypertension, nausea, and vomiting. Reducing the time to achieve adequate uterine tone is likely to decrease postpartum hemorrhage. Condition or disease Intervention/treatment Phase

2017 Clinical Trials

111. 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

112. Exploration and Determination of Genomic Markers Predictive of Uterine Atony

17, 2018 Last Verified: July 2018 Individual Participant Data (IPD) Sharing Statement: Plan to Share IPD: No Layout table for additional information Studies a U.S. FDA-regulated Drug Product: No Studies a U.S. FDA-regulated Device Product: No Keywords provided by Baylor Research Institute: genomic markers Additional relevant MeSH terms: Layout table for MeSH terms Uterine Inertia Dystocia Obstetric Labor Complications Pregnancy Complications (...) , 2018 See Sponsor: Baylor Research Institute Information provided by (Responsible Party): Baylor Research Institute Study Details Study Description Go to Brief Summary: The primary objective of this study is to determine whether there are markers in the tissue of atonic uteri, and in the patients' plasma that would help identify patients likely to suffer postpartum hemorrhage due to uterine atony. We also will attempt to identify the cause(s) of uterine atony that might suggest mechanisms to prevent

2017 Clinical Trials

113. Early Term Delivery Versus Expectant Management of the Large for Gestational Age Fetus

Intervention Model: Parallel Assignment Masking: None (Open Label) Primary Purpose: Prevention Official Title: Early Term Delivery Versus Expectant Management of the Large for Gestational Age Fetus (TEAM LGA Trial) Actual Study Start Date : July 12, 2017 Estimated Primary Completion Date : July 1, 2019 Estimated Study Completion Date : August 1, 2019 Resource links provided by the National Library of Medicine resources: Arms and Interventions Go to Arm Intervention/treatment Experimental: Labor induction (...) >4500 grams among uncomplicated large for gestational age (LGA) fetal growth at delivered 37 weeks versus expectant management. Condition or disease Intervention/treatment Phase Macrosomia, Fetal Labor Induction Procedure: Labor induction at 37.0 weeks to 37.6 weeks of gestation Procedure: Expectant monitoring and delivery Not Applicable Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Actual Enrollment : 0 participants Allocation: Randomized

2017 Clinical Trials

114. Intravenous fluid rate for reduction of cesarean delivery rate in nulliparous women: a systematic review and meta-analysis. Full Text available with Trip Pro

%; 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

115. Weight management before, during and after pregnancy

Overview erview This guideline covers how to assess and monitor body weight and how to prevent someone from becoming overweight or obese before, during and after pregnancy. The aim is help all women who have a baby to achieve and maintain a healthy weight by adopting a balanced diet and being physically active. This guideline does not cover women who are underweight (that is, those who have a body mass index [BMI] less than 18.5 kg/m²) or food safety advice. NICE has also produced guidelines (...) : assessing and monitoring body weight preventing someone from becoming overweight (body mass index [BMI] 25–29.9 kg/m²) or obese (BMI greater than or equal to 30 kg/m²) helping someone to achieve and maintain a healthy weight before, during and after pregnancy by eating healthily and being physically active and gradually losing weight after pregnancy. The recommendations are based on strategies and weight-loss programmes that are proven to be effective for the whole population. The criteria for effective

2010 National Institute for Health and Clinical Excellence - Clinical Guidelines

116. Failure to Progress

, dysfunctional labor was observed , Abnormal labor , Labor abnormal , Abnormal labour , Unspecified abnormality of labour , Dystocia NOS , Dystocia [Disease/Finding] , delivery problems , difficult labor , delivery problem , abnormal labor , labour problems , dystocias , Dystocia (disorder) , Dystocia NOS (finding) , Labour abnormal , Labour problem (disorder) , Arrest of Dilatation , Failure to Progress , Labor Dystocia , Dysfunctional Labor , Difficult labor , Dysfunctional labor , Dysfunctional labour (...) , Difficult labour , Delivery problem , Labor problem , Labour problem , Delivery problem (finding) , Labor problem (finding) , Dystocia , dystocia , abnormal; labor , Abnormal labor, NOS , Dystocia, NOS , Dystocia (disorder) [Ambiguous] Italian Travaglio anormale , Anomalia del travaglio non specificata , Distocia Dutch niet-gespecificeerde abnormale bevallling , abnormale bevalling , niet-gespecificeerde abnormale bevalling , abnormaal; weeën , abnormale ontsluitingsfase , Dystocie French Anomalie non

2018 FP Notebook

117. What are the maternal and newborn outcomes associated with episiotomy during spontaneous vaginal delivery?

perinatal asphyxia, less fetal distress, better Apgar scores, less fetal acidosis, and reduced complications from shoulder dystocia), there is little data to support any of these claims. Even the claim of shortening the second stage of labour, the guideline argues, “has not been conclusively shown”. Ultimately the guideline differs to clinical judgment stating that “current data and clinical opinion suggest that there are insufficient objective evidence-based criteria to recommend episiotomy (...) performed prophylactically to prevent severe vaginal tears and to facilitate an easier/faster birth of the baby (Carroli and Mignini 2009, ACOG 2006). Other suggested maternal benefits include the preservation of muscle relaxation of the pelvic floor leading to improved sexual function, reduced risk of faecal and/or urinary incontinence, and improved surgical healing (i.e., subsequent to a clean surgical incision and repair, rather than a potential 3 rd or 4 th degree laceration). For the neonate

2011 OHRI Knowledge to Action

118. Operative Vaginal Delivery

’ and ‘parturition’. 4. Preparation for operative vaginal delivery 4.1 Can operative vaginal delivery be avoided? All women should be encouraged to have continuous support during labour as this can reduce the need for operative vaginal delivery. A© Royal College of Obstetricians and Gynaecologists 3of 19 RCOG Green-top Guideline No. 26 Use of upright or lateral positions and avoiding epidural analgesia can reduce the need for operative vaginal delivery. Delayed pushing in primiparous women with an epidural can (...) to prevent asymptomatic bladder overfilling. Women should be offered physiotherapy-directed strategies to prevent urinary incontinence. Urine retention with bladder overdistension should be avoided, particularly in women who have had spinal or dense epidural blocks. Operative delivery, prolonged labour and epidural analgesia may predispose to postpartum urinary retention, which can be associated with long-term bladder dysfunction. 82–84 There is considerable variation in practice in postpartum bladder

2011 Royal College of Obstetricians and Gynaecologists

119. Maternal Collapse in Pregnancy and the Puerperium

attempt Tamponade (cardiac) Following trauma/suicide attempt Eclampsia and pre-eclampsia Includes intracranial haemorrhage5of 24 RCOG Green-top Guideline No. 56 © Royal College of Obstetricians and Gynaecologists rate in cases of AFE is 135/1000 total births. 25 AFE presents as collapse during labour or delivery or within 30 minutes of delivery in the form of acute hypotension, respiratory distress and acute hypoxia. 29 Seizures and cardiac arrest may occur. There are different phases to disease (...) cricoid pressure and the use of H 2 antagonists and antacids prophylactically in all women considered to be at high risk of obstetric intervention during labour is advised. 4.3.5 Circulation The increased cardiac output and hyperdynamic circulation of pregnancy mean that large volumes of blood can be lost rapidly, especially from the uterus, which receives 10% of the cardiac output at term. Otherwise healthy women tolerate blood loss remarkably well, and can lose up to 35% of their circulation before

2011 Royal College of Obstetricians and Gynaecologists

120. Management of diabetes

Crescent Edinburgh EH12 9EB 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

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