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62. Placenta Praevia and Placenta Accreta: Diagnosis and Management

of gestation indicated that corticosteroids administration at 35 +5 weeks of gestation followed by planned delivery at 36 weeks of gestation optimises maternal and neonatal outcomes. 69 Evidence level 4 4.7 Is there a place for the use of tocolytics in women presenting with symptomatic low‐lying placenta or placenta praevia, who are in suspected preterm labour? Tocolysis for women presenting with symptomatic placenta praevia or a low‐lying placenta may be considered for 48 hours to facilitate (...) administration of antenatal corticosteroids. [ New 2018 ] Grade of recommendation: C If delivery is indicated based on maternal or fetal concerns, tocolysis should not be used in an attempt to prolong gestation. [ New 2018 ] Grade of recommendation: C A systematic review to determine if the prolonged (48 hours or more) use of tocolytics in women with symptomatic preterm placenta praevia improves perinatal outcome identified two retrospective studies (total, n = 217) and one RCT (n = 60). The results

2018 Royal College of Obstetricians and Gynaecologists

63. Magnesium sulfate: risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy

–7 days when used as a tocolytic (not an authorised indication in the UK). Such prolonged exposure may result in significantly higher cumulative doses than those encountered with use of magnesium sulfate in the UK for eclampsia or foetal neuroprotection (see ). The US FDA alert was based on 4 reports of fractures and 35 reports of osteopenia or radiographical bone abnormalities in neonates, some of which also describe hypocalcaemia and hypermagnesemia in the neonate. The long-term clinical

2019 MHRA Drug Safety Update

65. Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews. (PubMed)

of mild to moderate hypertension versus placebo (RR 0.33, 95% CI 0.01 to 8.01; one RCT; 110 children); magnesium sulphate for prevention of preterm birth versus other tocolytic agents (RR 0.13, 95% CI 0.01 to 2.51; one RCT; 106 children); and vitamin K and phenobarbital prior to preterm birth for prevention of neonatal periventricular haemorrhage versus placebo (RR 0.77, 95% CI 0.33 to 1.76; one RCT; 299 children).This overview summarises evidence from Cochrane reviews on the effects of antenatal

Full Text available with Trip Pro

2017 Cochrane

66. Home uterine monitoring for detecting preterm labour. (PubMed)

Home uterine monitoring for detecting preterm labour. To reduce the morbidity and mortality associated with preterm birth, home uterine activity monitoring aims for early detection of increased contraction frequency, and early intervention with tocolytic drugs to inhibit labour and prolong pregnancy. However, the effectiveness of such monitoring is disputed.To determine whether home uterine activity monitoring is effective in improving the outcomes for women and their infants considered (...) risk of bias (RR 0.86, 95% CI 0.74 to 1.01; one study, 1292 babies). Women using home uterine monitoring made more unscheduled antenatal visits (mean difference (MD) 0.48, 95% CI 0.31 to 0.64; two studies, 1994 women) (GRADE moderate). Women using home uterine monitoring were also more likely to have prophylactic tocolytic drug therapy (average RR 1.21, 95% CI 1.01 to 1.45; seven studies, 4316 women; random-effects, Tau2 = 0.03, I2 = 62%), but this difference was no longer evident when we

Full Text available with Trip Pro

2017 Cochrane

67. Low-Dose Aspirin Use During Pregnancy

growth retardation. Br J Obstet Gynaecol 1997;104:450–9. 47. Abramovici A, Cantu J, Jenkins SM. Tocolytic therapy for acute preterm labor. Obstet Gynecol Clin North Am 2012; 39:77–87. 48. van Vliet EO, Askie LA, Mol BW, Oudijk MA. Antiplatelet agents and the prevention of spontaneous preterm birth: a systematic review and meta-analysis. Obstet Gynecol 2017;129:327–36. 49. Silver RM, Ahrens K, Wong LF, Perkins NJ, Galai N, LesherLL,et al.Low-doseaspirin and pretermbirth: aran- domized controlled trial

2018 American College of Obstetricians and Gynecologists

68. Low-Dose Aspirin Use During Pregnancy

growth retardation. Br J Obstet Gynaecol 1997;104:450–9. 47. Abramovici A, Cantu J, Jenkins SM. Tocolytic therapy for acute preterm labor. Obstet Gynecol Clin North Am 2012; 39:77–87. 48. van Vliet EO, Askie LA, Mol BW, Oudijk MA. Antiplatelet agents and the prevention of spontaneous preterm birth: a systematic review and meta-analysis. Obstet Gynecol 2017;129:327–36. 49. Silver RM, Ahrens K, Wong LF, Perkins NJ, Galai N, LesherLL,et al.Low-doseaspirin and pretermbirth: aran- domized controlled trial

2018 American College of Obstetricians and Gynecologists

70. CRACKCast E178 – Co-Morbird Medical Emergencies During Pregnancy

affect labor? Beta agonists are tocolytics and often halt labour. [2] Which types of valvular heart disease cause the most problems during pregnancy? Mitral stenosis > class 1 fcor Advanced aortic stenosis Aortic or mitral lesions associated with pulmonary hypertension or ventricular dysfunction Mechanical prosthetic valves requiring anticoagulation See Table 179.5 in Rosen’s 9 th Edition Ddx of chest pain in pregnancy: Pulmonary embolus, reflux esophagitis, biliary colic, and aortic dissection

2018 CandiEM

71. CRACKCast E177 – Acute Complications of Pregnancy

oral tocolytic therapy with beta adrenergic agonists 8) How are BV, vaginal yeast infections and trichomonas infections managed during pregnancy? BV: BV associated with morbidity – so treat! 7-day course of metronidazole or 7-day course of clindamycin. Intravaginal treatment is not recommended in pregnant patients. Vaginal yeast infections: There is no association of Candida colonization with adverse pregnancy outcomes, and treatment is for relief of symptoms only. Oral azoles are contraindicated

2018 CandiEM

72. CRACKCast E180 – Labor & Delivery

. At this point, reduce the infusion rate to 1 to 2 mL/min. 7) List 8 factors linked to pre-term labor. Describe the management of premature labor in the ED. List 3 tocolytics. Preterm labor is defined as uterine contractions with cervical changes before 37 weeks of gestation. Early maternal signs and symptoms include an increase or change in vaginal discharge, pain resulting from uterine contractions (sometimes perceived as back pain), pelvic pressure, vaginal bleeding, and fluid leak. Box 181.2 – Factors (...) should mention the above because it is standard of care. Copied from Uptodate: Given the limited ability of tocolytic therapy to delay delivery for a prolonged period of time, the major goals of treatment of acute preterm labor are to: Delay delivery by at least 48 hours when it is safe to do so in order that antenatal corticosteroids (primary or rescue) given to the mother have time to achieve their maximum fetal/neonatal effects. Pre-delivery administration of reduces the risk of neonatal death

2018 CandiEM

73. Induction of labour

intravenous (IV) fluids via new administration set · VE to assess cervical dilation and exclude cord prolapse · If persists, consider use of tocolytic 1 : o Terbutaline: 250 micrograms subcutaneously or o Terbutaline: 250 micrograms in 5 mL IV over 5 minutes 3 o Salbutamol: 100 micrograms by slow IV injection 3 o *Sublingual Glyceryl Trinitrate (GTN) spray 400 micrograms 3 o Excessive uterine activity in the absence of evidence of fetal compromise is not in itself an indication for tocolysis 3

2018 Queensland Health

74. Chinese herbal medicines for unexplained recurrent miscarriage. (PubMed)

tocolytic drugs such as salbutamol and magnesium sulphate; hormonal supplementation with human chorionic gonadotrophin (HCG), progesterone or dydrogesterone; and supportive supplements such as vitamin E, vitamin K and folic acid.Overall, the methodological quality of the included studies was poor with unclear risk of bias for nearly all the 'Risk of bias' domains assessed.Chinese herbal medicines alone versus other pharmaceuticals alone - the live birth rate was no different between the two groups (risk

2016 Cochrane

75. Techniques for assisting difficult delivery at caesarean section. (PubMed)

Techniques for assisting difficult delivery at caesarean section. Caesarean section involves making an incision in the woman's abdomen and cutting through the uterine muscle. The baby is then delivered through that incision. Difficult caesarean birth may result in injury for the infant or complications for the mother. Methods to assist with delivery include vacuum or forceps extraction or manual delivery utilising fundal pressure. Medication that relaxes the uterus (tocolytic medication) may (...) , maternal complications (particularly postpartum haemorrhage requiring blood transfusion), and long-term measures of infant and childhood morbidity.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2015) and reference lists of retrieved studies.All published, unpublished, and ongoing randomised controlled trials comparing the use of tocolytic agents (routine or selective) at caesarean section versus no use of tocolytic or placebo at caesarean section to facilitate

2016 Cochrane

77. Cervical Cerclage

developers also address the placement of a second suture in addition to the primary cerclage, with both agreeing that no benefit of this approach has been demonstrated. With regard to the use of perioperative antibiotics and/or tocolytics, there is consensus among the guideline developers that there is no evidence to support their routine use. Cerclage Removal The guideline developers agree that a transvaginal cerclage is removed electively before labor, typically between 36 and 38 weeks gestation (ACOG (...) insufficiency and their use is discouraged. The standard transvaginal cerclage methods currently used include modifications of the McDonald and Shirodkar techniques. The superiority of one suture type or surgical technique over another has not been established. Cerclage may increase the risk of preterm birth in women with a twin pregnancy and an ultrasonographically detected cervical length less than 25 mm and is not recommended. Neither antibiotics nor prophylactic tocolytics have been shown to improve

2017 National Guideline Clearinghouse (partial archive)

79. Guidelines for the Use of Laparoscopy during Pregnancy

abnormalities have been reported in the literature [90, 127] . Preoperative and postoperative monitoring of the fetal heart rate for a fetus considered viable is the current standard, with no increased fetal morbidity having been reported [91, 93, 219] .The current lower limit of viability is between 22 weeks and 24 weeks [220, 221] . Tocolytics Guideline 22: Tocolytics should not be used prophylactically in pregnant women undergoing surgery but should be considered perioperatively when signs of preterm (...) labor are present (++++; Strong). Threatened preterm labor can be successfully managed with tocolytic therapy. The specific agent and indications for the use of tocolytics should be individualized and based on the recommendation of an obstetrician [222-225] . No literature supports the use of prophylactic tocolytics [226, 227] . Limitations of available literature More data have accumulated recently as laparoscopy has become common during pregnancy. Most of the data are found in case series

2017 Society of American Gastrointestinal and Endoscopic Surgeons

80. Periviable Birth

), potentially modifiable antepartum and intrapartum factors (eg, location of delivery, intent to intervene by cesarean delivery or induction for delivery, administration of antenatal corticosteroids and magnesium sulfate), and postnatal management (eg, starting or withholding and continuing or withdrawing intensive care after birth). Antepartum and intrapartum management options vary depending upon the specific circumstances but may include short-term tocolytic therapy for preterm labor to allow time (...) . Protocols with guidelines for the initial management and safe transport of the periviable gestation should include recommendations for such treatments as antenatal corticosteroids, magnesium sulfate for neuroprotection, tocolytic therapy, antibiotics for latency after preterm PROM, and group B streptococci prophylaxis. In some cases, circumstances may preclude antenatal maternal transport because of a rapidly evolving clinical situation or because of maternal instability due to severe illness

2017 American College of Obstetricians and Gynecologists

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