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196 results for

Prevention of Labor Dystocia

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101. 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

102. 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

103. Breech Presentation (Overview)

is imminent, even in multiparas, as it may help prevent soft tissue dystocia for the aftercoming head (see the images below). Assisted vaginal breech delivery. Thick meconium passage is common as the breech is squeezed through the birth canal. This is usually not associated with meconium aspiration because the meconium passes out of the vagina and does not mix with the amniotic fluid. Assisted vaginal breech delivery. The Ritgen maneuver is applied to take pressure off the perineum during vaginal delivery (...) . Episiotomies are often performed for assisted vaginal breech deliveries, even in multiparous women, to prevent soft tissue dystocia. The Pinard maneuver may be needed with a frank breech to facilitate delivery of the legs but only after the fetal umbilicus has been reached. Pressure is exerted in the popliteal space of the knee. Flexion of the knee follows, and the lower leg is swept medially and out of the vagina. No traction should be exerted on the infant until the fetal umbilicus is past the perineum

2014 eMedicine.com

104. Diabetes Mellitus and Pregnancy (Diagnosis)

pregnant women, the incidence is 2- to 4-fold higher in women with diabetes. Common birth injuries associated with diabetes are brachial plexus injury, facial nerve injury, and cephalohematoma. With strict glycemic control, the birth injury rate has been shown to be only slightly higher than controls (3.2 vs 2.5%). Currently, clinical ability to predict shoulder dystocia is poor. Warning signs during labor (labor protraction, suspected fetal macrosomia, need for operative vaginal delivery) successfully (...) Preventive Services Task Force (USPSTF) recommends screening for gestational diabetes mellitus after 24 weeks of pregnancy. The recommendation applies to asymptomatic women with no previous diagnosis of type 1 or type 2 diabetes mellitus. [ , ] The recommendation does not specify whether the 1-step or 2-step screening approach would be preferable. Type 1 diabetes The disease is typically diagnosed during an episode of hyperglycemia, ketosis, and dehydration It is most commonly diagnosed in childhood

2014 eMedicine.com

105. Breech Presentation (Diagnosis)

is imminent, even in multiparas, as it may help prevent soft tissue dystocia for the aftercoming head (see the images below). Assisted vaginal breech delivery. Thick meconium passage is common as the breech is squeezed through the birth canal. This is usually not associated with meconium aspiration because the meconium passes out of the vagina and does not mix with the amniotic fluid. Assisted vaginal breech delivery. The Ritgen maneuver is applied to take pressure off the perineum during vaginal delivery (...) . Episiotomies are often performed for assisted vaginal breech deliveries, even in multiparous women, to prevent soft tissue dystocia. The Pinard maneuver may be needed with a frank breech to facilitate delivery of the legs but only after the fetal umbilicus has been reached. Pressure is exerted in the popliteal space of the knee. Flexion of the knee follows, and the lower leg is swept medially and out of the vagina. No traction should be exerted on the infant until the fetal umbilicus is past the perineum

2014 eMedicine.com

106. Breech Presentation (Follow-up)

is imminent, even in multiparas, as it may help prevent soft tissue dystocia for the aftercoming head (see the images below). Assisted vaginal breech delivery. Thick meconium passage is common as the breech is squeezed through the birth canal. This is usually not associated with meconium aspiration because the meconium passes out of the vagina and does not mix with the amniotic fluid. Assisted vaginal breech delivery. The Ritgen maneuver is applied to take pressure off the perineum during vaginal delivery (...) . Episiotomies are often performed for assisted vaginal breech deliveries, even in multiparous women, to prevent soft tissue dystocia. The Pinard maneuver may be needed with a frank breech to facilitate delivery of the legs but only after the fetal umbilicus has been reached. Pressure is exerted in the popliteal space of the knee. Flexion of the knee follows, and the lower leg is swept medially and out of the vagina. No traction should be exerted on the infant until the fetal umbilicus is past the perineum

2014 eMedicine.com

107. Vanishing Twin Syndrome (Diagnosis)

the first trimester is limited. The mother is most likely to develop mild vaginal bleeding and cramping. If the event occurs later in the first trimester, morbidity may be similar to that of the second and third trimesters. Maternal morbidity in the second and third trimesters Maternal complications include premature labor, infection from a retained fetus, severe puerperal hemorrhage, consumptive coagulopathy, and obstruction of labor by a low-lying fetus papyraceus causing dystocia and leading (...) , or amorphous material. [ ] The timing of this event significantly affects the outcome of the viable twin and the maternal complications. For example, if the event occurs during the second half of pregnancy, the fetus could develop cerebral palsy or cutis aplasia, and the mother could develop preterm labor, infection, puerperal hemorrhage, consumptive coagulopathy, or obstruction of labor. [ , ] Next: Pathophysiology Abnormalities that result in the disappearance of a fetus usually appear to be present from

2014 eMedicine.com

108. Uterine Rupture in Pregnancy (Diagnosis)

, shoulder dystocia, manual extraction of placenta) Fundal pressure Uterine trauma includes the following: Direct uterine trauma (eg, motor vehicle accident, fall) Violence (eg, gunshot wound, blunt blow to abdomen) Next: Rupture of the Unscarred Uterus The normal, unscarred uterus is least susceptible to rupture. Grand multiparity, neglected labor, malpresentation, breech extraction, and uterine instrumentation are all predisposing factors for uterine rupture. A 10-year Irish study by Gardeil et al (...) after cesarean, VBAC, trial of labor (TOL), trial of labor after cesarean (TOLAC), uterine scar dehiscence, and pregnancy and myomectomy. Standard reference tracing was also used. Articles published from 1976 through May, 2012 that described the incidence of uterine rupture and that included sufficient information regarding the authors' definitions of uterine rupture and of uterine scar dehiscence were incorporated for review. All studies were observational or reviews. A total of 133 published

2014 eMedicine.com

109. Malposition of the Uterus (Diagnosis)

retroversion, aneurysmal dilatation of the superior uterine wall (sacculation) may permit the uterus to expand abdominally. [ , , ] If this occurs, the pregnancy may progress even into the third trimester. In such instances, the correct diagnosis is established only when dystocia in labor ensues or when abdominal and/or pelvic examination reveals markedly unusual findings that lead to an MRI study. In the rare case that reaches the third trimester, the uterine malpositioning is fixed, cesarean delivery (...) [ ] Uterine Torsion, degrees (n = 212) Signs and Symptoms* Intestinal Urinary Pain Shock (Hemorrhage) Labor Dystocia Other† None ≤90 (n = 66) 10 5 43 4 (6) 7 13 9 >90 to 180 (n = 122) 17 91 22 (13) 19 19 14 >180 to 360 (n = 14) 7 10 14 6 (1) 3 3 0 >360 (n = 6) 0 0 6 6 (1) 6 6 0 Unknown (n = 4) 0 0 4 2 (0) 0 0 0 *Some cases include more than 1 sign or symptom. † Hypertonic uterus, PROM, pre-eclampsia, uterine rupture, etc Pathophysiology In a uterine torsion, the uterus twists more than 45° around its long

2014 eMedicine.com

110. Cesarean Delivery (Diagnosis)

of maternal trauma and fetal trauma (eg, Erb-Duchenne or Klumpke palsy and metabolic acidosis) from a shoulder dystocia. [ , ] Among women who have a uterine scar (prior transmural myomectomy or cesarean delivery by high vertical incision), a cesarean delivery should be performed prior to the onset of labor to prevent the risk of , which is approximately 4-10%. [ ] Contraindications There are few contraindications to performing a cesarean delivery. If the fetus is alive and of viable gestational age (...) clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. The most common indications for primary cesarean delivery include labor dystocia, abnormal or indeterminate fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia. Safe reduction of the primary cesarean delivery rate will require different approaches for these indications, as well as others. Increasing

2014 eMedicine.com

111. Prenatal Nutrition (Treatment)

weight is defined as a BMI of 18.5-24.9 kg/m 2 . Overweight is defined as a BMI of 25-29.9 kg/m 2 . Obesity is defined as a BMI that exceeds 30 kg/m 2 . [ ] Birth weight is affected by pre-pregnancy BMI, independent of actual weight gain during pregnancy. Women who are underweight are at increased risk for low birth weight babies; women who are overweight or obese are at increased risk for macrosomic infants. Macrosomic infants are at increased risk for shoulder dystocia and brachial plexus injuries (...) women. Folate supplements should be administered 3 months prior to conception and throughout the first trimester. If the mother had a prior child affected by a neural tube defect, supplementation in the subsequent pregnancy should be increased to 4 mg/d. [ ] The US Preventative Services Task Force recommends a daily supplement of folic acid (0.4 to 0.8 mg) for all women who are planning or capable of pregnancy. [ ] Niacin Niacin is a water-soluble vitamin involved in the release of energy from cells

2014 eMedicine.com

112. Teratology and Drug Use During Pregnancy (Treatment)

of these medications. [ ] Thus, the 5-letter system is being phased out over the next 3 years in favor of a more comprehensive system with a narrative summary of the risks posed by drugs. The FDA, the government agency that oversees the safety of drugs, provides the most widely used system to grade the teratogenic effects of medications. Each drug summary will have three sections: pregnancy, lactation, and females and males of reproductive potential. “Pregnancy” merges previous categories of “pregnancy” and “labor (...) . If there is more than one risk based on human data, the information should be placed in order of clinical importance. Clinical Considerations See the list below: Relevant information is presented under the following five headings, to the extent information is available: - Disease-associated maternal and/or embryo/fetal risk - Dose adjustments during pregnancy and the postpartum period - Maternal adverse reactions - Fetal/Neonatal adverse reactions - Labor or Delivery Data --Under the subheading Data, labeling

2014 eMedicine.com

114. Cesarean Delivery (Treatment)

of maternal trauma and fetal trauma (eg, Erb-Duchenne or Klumpke palsy and metabolic acidosis) from a shoulder dystocia. [ , ] Among women who have a uterine scar (prior transmural myomectomy or cesarean delivery by high vertical incision), a cesarean delivery should be performed prior to the onset of labor to prevent the risk of , which is approximately 4-10%. [ ] Contraindications There are few contraindications to performing a cesarean delivery. If the fetus is alive and of viable gestational age (...) clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. The most common indications for primary cesarean delivery include labor dystocia, abnormal or indeterminate fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia. Safe reduction of the primary cesarean delivery rate will require different approaches for these indications, as well as others. Increasing

2014 eMedicine.com

115. Breech Presentation (Treatment)

is imminent, even in multiparas, as it may help prevent soft tissue dystocia for the aftercoming head (see the images below). Assisted vaginal breech delivery. Thick meconium passage is common as the breech is squeezed through the birth canal. This is usually not associated with meconium aspiration because the meconium passes out of the vagina and does not mix with the amniotic fluid. Assisted vaginal breech delivery. The Ritgen maneuver is applied to take pressure off the perineum during vaginal delivery (...) . Episiotomies are often performed for assisted vaginal breech deliveries, even in multiparous women, to prevent soft tissue dystocia. The Pinard maneuver may be needed with a frank breech to facilitate delivery of the legs but only after the fetal umbilicus has been reached. Pressure is exerted in the popliteal space of the knee. Flexion of the knee follows, and the lower leg is swept medially and out of the vagina. No traction should be exerted on the infant until the fetal umbilicus is past the perineum

2014 eMedicine.com

116. Uterine Rupture in Pregnancy (Treatment)

, shoulder dystocia, manual extraction of placenta) Fundal pressure Uterine trauma includes the following: Direct uterine trauma (eg, motor vehicle accident, fall) Violence (eg, gunshot wound, blunt blow to abdomen) Next: Rupture of the Unscarred Uterus The normal, unscarred uterus is least susceptible to rupture. Grand multiparity, neglected labor, malpresentation, breech extraction, and uterine instrumentation are all predisposing factors for uterine rupture. A 10-year Irish study by Gardeil et al (...) after cesarean, VBAC, trial of labor (TOL), trial of labor after cesarean (TOLAC), uterine scar dehiscence, and pregnancy and myomectomy. Standard reference tracing was also used. Articles published from 1976 through May, 2012 that described the incidence of uterine rupture and that included sufficient information regarding the authors' definitions of uterine rupture and of uterine scar dehiscence were incorporated for review. All studies were observational or reviews. A total of 133 published

2014 eMedicine.com

117. Postterm Pregnancy (Treatment)

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

119. Teratology and Drug Use During Pregnancy (Overview)

of these medications. [ ] Thus, the 5-letter system is being phased out over the next 3 years in favor of a more comprehensive system with a narrative summary of the risks posed by drugs. The FDA, the government agency that oversees the safety of drugs, provides the most widely used system to grade the teratogenic effects of medications. Each drug summary will have three sections: pregnancy, lactation, and females and males of reproductive potential. “Pregnancy” merges previous categories of “pregnancy” and “labor (...) . If there is more than one risk based on human data, the information should be placed in order of clinical importance. Clinical Considerations See the list below: Relevant information is presented under the following five headings, to the extent information is available: - Disease-associated maternal and/or embryo/fetal risk - Dose adjustments during pregnancy and the postpartum period - Maternal adverse reactions - Fetal/Neonatal adverse reactions - Labor or Delivery Data --Under the subheading Data, labeling

2014 eMedicine.com

120. Uterine Rupture in Pregnancy (Overview)

, shoulder dystocia, manual extraction of placenta) Fundal pressure Uterine trauma includes the following: Direct uterine trauma (eg, motor vehicle accident, fall) Violence (eg, gunshot wound, blunt blow to abdomen) Next: Rupture of the Unscarred Uterus The normal, unscarred uterus is least susceptible to rupture. Grand multiparity, neglected labor, malpresentation, breech extraction, and uterine instrumentation are all predisposing factors for uterine rupture. A 10-year Irish study by Gardeil et al (...) after cesarean, VBAC, trial of labor (TOL), trial of labor after cesarean (TOLAC), uterine scar dehiscence, and pregnancy and myomectomy. Standard reference tracing was also used. Articles published from 1976 through May, 2012 that described the incidence of uterine rupture and that included sufficient information regarding the authors' definitions of uterine rupture and of uterine scar dehiscence were incorporated for review. All studies were observational or reviews. A total of 133 published

2014 eMedicine.com

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