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Prevention of Labor Dystocia

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121. 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

122. 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

123. 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

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

trial of labour induction for 200 women with diabetes treated with insulin (187 had gestational diabetes). The risk of macrosomia, de?ned as birthweight above 4000 g, was reduced in the active induction group, while two infants in the expectant group had a birthweight of more than 4500 g. Mean birthweight and proportion of large-for- gestational age infants (at or above 90th percentile) were higher in the expectant management group. Perinatal morbidity was rare. Three cases of mild shoulder dystocia (...) 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

2010 OHRI Knowledge to Action

125. 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

126. Management of Women with Obesity in Pregnancy

discussion antenatally about possible intrapartum complications associated with a high BMI, and management strategies considered. This should be documented in the notes. Observational studies have shown that there is a higher incidence of intrapartum complications among women with obesity compared to women with a healthy weight. There is an increased risk of slow labour progression, 12,46 shoulder dystocia 15,20 and emergency caesarean section. 10,20 There is also an increased risk of primary postpartum (...) is granted to reproduce for personal and educational use only. Page 1 of 29 March 2010 CMACE/RCOG JOINT GUIDELINE MANAGEMENT OF WOMEN WITH OBESITY IN PREGNANCY 1. Purpose and scope 2 2. Background and introduction 2 3. Methodology 2 4. Pre-pregnancy care 4 5. Provision of antenatal care 5 6. Measuring weight, height and BMI 6 7. Information-giving during pregnancy 6 8. Risk assessment during pregnancy 7 9. Thromboprophylaxis 7 10. Maternal surveillance and screening 9 11. Planning labour and delivery 10

2010 Royal College of Obstetricians and Gynaecologists

127. 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

128. 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

129. Incidence of Neonatal Birth Injuries and Related Factors in Kashan, Iran Full Text available with Trip Pro

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

2015 Archives of trauma research

130. Richard Lehman’s journal review—29 June 2015

and Teilhard de Chardin in biology. To induce or not to induce if the bébé looks insufficiently petit ? Induce, I’d say. “Induction of labour for suspected large for date fetuses is associated with a reduced risk of shoulder dystocia and associated morbidity compared with expectant management. Induction of labour does not increase the risk of caesarean delivery and improves the likelihood of spontaneous vaginal delivery. These benefits should be balanced with the effects of early term induction of labour (...) simply. This is a sort of “damn it, why are we doomed to dissatisfaction” piece: do read it if you have the patience, and do have a look at some of del Sarto’s work, which was admired by Michelangelo. Right, now where was I? Ah yes, . “In patients with atrial fibrillation who had warfarin treatment interrupted for an elective operation or other elective invasive procedure, forgoing bridging anticoagulation was noninferior to perioperative bridging with low molecular weight heparin for the prevention

2015 The BMJ Blog

131. 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

132. 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

133. Teratology and Drug Use During Pregnancy (Diagnosis)

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

134. 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

135. 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

136. 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

137. Prenatal Nutrition (Diagnosis)

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

138. Neonatal Brachial Plexus Palsies (Treatment)

mobility and strengthening initially are facilitated through age-appropriate developmental activities. As the child gets older, standard strengthening exercises are used and specific functional skills are introduced. Specific muscle groups can be targeted for strengthening through functional movement. Compensatory and substitute movements should be avoided, as they may perpetuate weak muscles and deformity. Static and dynamic splinting of the arm is useful to reduce contractures, prevent further (...) about whether EMG provides useful prognostic information to select appropriate surgical candidates (see Other Tests). [ ] Unfortunately, the lack of uniform outcome measures and of large, controlled studies has prevented this debate from being put to rest. Many authors do agree that early surgery should be considered in children who have injuries affecting the entire brachial plexus (ie, C5-T1). Two neurosurgical options (ie, neurolysis vs excision of the neuroma and nerve graft reconstruction

2014 eMedicine.com

140. Cesarean Delivery (Overview)

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

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