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Umbilical Cord Prolapse

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101. Intrapartum fetal surveillance

cardiotocography 13 3.6.1 Special Considerations 14 4 Cardiotocograph 15 Features in labour 15 Normal CTG 16 Fetal compromise 17 Management of reversible causes of abnormal CTG 18 5 Intrapartum fetal blood sampling 19 Interpretation of fetal blood sampling results 20 5.1.1 *Special considerations for fetal scalp lactate measurements 20 6 Paired umbilical cord blood gas or lactate analysis 21 Normal cord blood values 22 7 Other methods of fetal monitoring 22 References 23 Appendix A: Interpretation of CTG 25 (...) . Description of normal FHR 16 Table 12. Compromised fetus 17 Table 13. Reversible causes of abnormal CTG 18 Table 14. Intrapartum fetal blood sampling 19 Table 15. Intrapartum fetal blood sampling results 20 Table 16. Paired umbilical cord sampling 21 Table 17 Cord blood sampling outcome 22 Table 18 Normal cord blood gas and lactate (at birth) 22 Queensland Clinical Guideline: Intrapartum fetal surveillance Refer to online version, destroy printed copies after use Page 7 of 30 1 Introduction The principal

2010 Clinical Practice Guidelines Portal

102. Comparing 30mL Single Versus 80mL Double Balloon Catheters for Pre-induction Cervical Ripening

Unexplained vaginal bleeding Active herpes simplex virus infection Non-English speaking Previous attempt at an induction of labor in the current pregnancy Prolapsed umbilical cord More than one prior cesarean delivery or history of classical cesarean delivery Patients receiving or planning to undergo exogenous prostaglandin administration as the primary induction agent Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may

2014 Clinical Trials

103. Obstetric Antecedents to Body Cooling Treatment of the Newborn Infant. Full Text available with Trip Pro

or younger, low parity, maternal body habitus (body mass index of ≥40 kg/m(2)), diabetes, preeclampsia, induction, epidural analgesia, chorioamnionitis, length of labor, and mode of delivery were associated with significantly increased risk of infant cooling during a univariable analysis. Catastrophic events to include umbilical cord prolapse (odds ratio [OR], 14; 95% confidence interval [CI], 3-72), placental abruption (OR, 17; 95% CI, 7-44), uterine rupture (OR, 130; 95% CI, 11-1477) were the strongest (...) factors associated with infant cooling after staged-stepwise logistic analysis.A variety of intrapartum characteristics were associated with infant cooling for neonatal encephalopathy, with the most powerful antecedents being umbilical cord prolapse, placental abruption, and uterine rupture.Copyright © 2014 Mosby, Inc. All rights reserved.

2014 American Journal of Obstetrics and Gynecology

104. Vacuum Extraction (Diagnosis)

relationship, operator skill, and a judgment of the severity of risk dictate the mode of delivery. In most cases, cord prolapse, , or persistent bradycardia at a high station, even with full dilation with an engaged head are best managed by a cesarean delivery. Evaluation must be undertaken to assess if vaginal delivery can be safely and readily achieved before proceeding. Maternal medical disorders Certain maternal disorders preclude the ability of the mother to safely Valsalva. Typically, cardiac (...) , Guzman ER, Knuppel RA. Effect of vacuum extraction on umbilical cord blood acid-base measurements. J Matern Fetal Med . 1996 Jan-Feb. 5(1):11-7. . Nilsen ST. Boys born by forceps and vacuum extraction examined at 18 years of age. Acta Obstet Gynecol Scand . 1984. 63:548-54. Johanson RB, Heycock E, Carter J. Maternal and child health after assisted vaginal delivery: five-year follow up of a randomised controlled study comparing forceps and ventouse. Br J Obstet Gynaecol . 1999 Jun. 106(6):544-9

2014 eMedicine.com

105. Malposition of the Uterus (Diagnosis)

or advanced diastasis recti associated with advanced multiparity. Presentation The clinical presentation is striking. A history of prior abdominal surgery or cesarean delivery via a midline incision or a prior, unrepaired umbilical hernia is noted. Beginning in the midtrimester when the uterus is sufficiently large so as to become an abdominal organ, it progressively prolapses anteriorly into the hernia sac. [ ] Varying degrees of this condition are observed. In the most extreme cases, the fundus (...) ) or in the immediate postpartum state, are simply normal variants. Uncommonly, obstetric complications result from acute or chronic changes in uterine shape or position prior to labor (retroversion or incarceration, prolapse, torsion, herniation or sacculation), during labor (pathologic retractions rings), or postpartum (acute or chronic inversion). [ ] The most common uterine malpositioning seen during pregnancy, retroversion with incarceration, is depicted below. Uterine retroversion and incarceration

2014 eMedicine.com

106. Management of the Third Stage of Labor (Diagnosis)

women; therefore, caregivers and institutions must have management strategies in place to deal with these problems promptly when they arise. Signs of placental separation Traditionally, 4 signs of placental separation are taught. [ , ] The most reliable sign is the lengthening of the umbilical cord as the placenta separates and is pushed into the lower uterine segment by progressive uterine retraction. Placing a clamp on the cord near the perineum makes it easier to appreciate this lengthening (...) . Never place traction on the cord without countertraction on the uterus above the symphysis; otherwise, one may mistake cord lengthening due to impending prolapse or inversion for that of uncomplicated placental separation. The uterus takes on a more globular shape and becomes firmer. This occurs as the placenta descends into the lower segment and the body of the uterus continues to retract. This change may be clinically difficult to appreciate. The uterus rises in the abdomen. The descent

2014 eMedicine.com

107. Management of the Third Stage of Labor (Overview)

women; therefore, caregivers and institutions must have management strategies in place to deal with these problems promptly when they arise. Signs of placental separation Traditionally, 4 signs of placental separation are taught. [ , ] The most reliable sign is the lengthening of the umbilical cord as the placenta separates and is pushed into the lower uterine segment by progressive uterine retraction. Placing a clamp on the cord near the perineum makes it easier to appreciate this lengthening (...) . Never place traction on the cord without countertraction on the uterus above the symphysis; otherwise, one may mistake cord lengthening due to impending prolapse or inversion for that of uncomplicated placental separation. The uterus takes on a more globular shape and becomes firmer. This occurs as the placenta descends into the lower segment and the body of the uterus continues to retract. This change may be clinically difficult to appreciate. The uterus rises in the abdomen. The descent

2014 eMedicine.com

108. Virtual Reality Biofeedback in Chronic Pain and Psychiatry (Overview)

of chronic pain in patients with multiple problems is complex, usually requiring specific treatment, simultaneous psychological treatment, and physical therapy (PT). [ , ] PT techniques include hot or cold applications, positioning, stretching exercises, traction, massage, ultrasonographic therapy, transcutaneous electrical nerve stimulation (TENS), and manipulations. Other treatments include nerve blocks, spinal cord stimulation, and intrathecal morphine pumps. Next: Etiology The pathophysiology (...) Faulty or poor posture [ , , , , ] Polymyalgia rheumatica Mechanical low back pain Muscular strains and sprains Pelvic floor myalgia (levator ani spasm) Piriformis syndrome (see the image below) Nerve irritation in the herniated disk occurs at the root (sciatic radiculitis). In piriformis syndrome, the irritation extends to the full thickness of the nerve (sciatic neuritis). Rectus tendon strain Hernias (eg, obturator, sciatic, inguinal, femoral, spigelian, perineal, umbilical) Abdominal wall

2014 eMedicine.com

109. Subcutaneous Fat Necrosis of the Newborn (Overview)

, [ ] placenta previa, umbilical cord prolapse, anoxia, seizures, [ ] preeclampsia, maternal cocaine abuse, [ ] gestational diabetes, [ ] maternal use of calcium antagonists during pregnancy, [ ] familial dyslipidemia, and a family history of thrombophilia. [ ] Some evidence implicates a maternal hypercoagulable state such as protein C deficiency and antiphospholipid syndrome. [ ] Local pressure trauma during delivery from forceps, from prolonged labor, and from being large for gestational age (macrosomia

2014 eMedicine.com

110. Chronic Pain Syndrome (Overview)

with multiple problems is complex, usually requiring specific treatment, simultaneous psychological treatment, and physical therapy (PT). [ , ] PT techniques include hot or cold applications, positioning, stretching exercises, traction, massage, ultrasonographic therapy, transcutaneous electrical nerve stimulation (TENS), and manipulations. Other treatments include nerve blocks, spinal cord stimulation, and intrathecal morphine pumps. Next: Etiology The pathophysiology of chronic pain syndrome (CPS (...) [ , , , , ] Polymyalgia rheumatica Mechanical low back pain Muscular strains and sprains Pelvic floor myalgia (levator ani spasm) Piriformis syndrome (see the image below) Nerve irritation in the herniated disk occurs at the root (sciatic radiculitis). In piriformis syndrome, the irritation extends to the full thickness of the nerve (sciatic neuritis). Rectus tendon strain Hernias (eg, obturator, sciatic, inguinal, femoral, spigelian, perineal, umbilical) Abdominal wall myofascial pain (trigger points) Chronic

2014 eMedicine.com

111. Cesarean Delivery (Overview)

. [ ] The emerging consensus is that a randomized prospective study is required to address this issue. [ ] Fetal indications Fetal indications for cesarean delivery include the following: Situations in which neonatal morbidity and mortality could be decreased by the prevention of trauma Malpresentations Certain congenital malformations or skeletal disorders Infection Prolonged acidemia A fetus in a nonvertex presentation is at increased risk for trauma, cord prolapse, and head entrapment. Malpresentation (...) of antibiotic prophylaxis for cesarean delivery administered up to 60 minutes before skin incision rather than after umbilical cord clamping. [ , ] There is no benefit from oral antibiotics for eradication of MRSA colonization among patients in the health care setting, and oral antibiotics are not currently routinely recommended for the purpose of MRSA decolonization. Routine screening of obstetric patients for MRSA colonization is not recommended. For obstetric patients known to be MRSA colonized, a single

2014 eMedicine.com

112. Evaluation of Fetal Death (Overview)

of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory (...) influence estimates of recurrence and future preconceptional counseling, pregnancy management, prenatal diagnostic procedures, and neonatal management. Many institutions use a selective workup based on clinical findings. For example, when clinical findings strongly suggest a cause for the fetal demise at Santa Clara Valley Medical Center, either no further testing or limited testing is performed. Causes deemed fairly obvious include cord accident (ie, prolapse, entanglement, true knot, tight nuchal cord

2014 eMedicine.com

113. Breech Presentation (Overview)

and no physical evidence of a prolapsed cord is evident, management may be expectant while awaiting full cervical dilation. Technique and tips for assisted vaginal breech delivery The fetal membranes should be left intact as long as possible to act as a dilating wedge and to prevent overt . Oxytocin induction and augmentation are controversial. In many previous studies, oxytocin was used for induction and augmentation, especially for hypotonic uterine dysfunction. However, others are concerned (...) , "star gazing"). Risks Lower Apgar scores, especially at 1 minute, are more common with vaginal breech deliveries. Many advocate obtaining an umbilical cord artery and venous pH for all vaginal breech deliveries to document that neonatal depression is not due to perinatal acidosis. Fetal head entrapment may result from an incompletely dilated cervix and a head that lacks time to mold to the maternal pelvis. This occurs in 0-8.5% of vaginal breech deliveries. [ ] This percentage is higher with preterm

2014 eMedicine.com

114. Breech Presentation (Treatment)

and no physical evidence of a prolapsed cord is evident, management may be expectant while awaiting full cervical dilation. Technique and tips for assisted vaginal breech delivery The fetal membranes should be left intact as long as possible to act as a dilating wedge and to prevent overt . Oxytocin induction and augmentation are controversial. In many previous studies, oxytocin was used for induction and augmentation, especially for hypotonic uterine dysfunction. However, others are concerned (...) , "star gazing"). Risks Lower Apgar scores, especially at 1 minute, are more common with vaginal breech deliveries. Many advocate obtaining an umbilical cord artery and venous pH for all vaginal breech deliveries to document that neonatal depression is not due to perinatal acidosis. Fetal head entrapment may result from an incompletely dilated cervix and a head that lacks time to mold to the maternal pelvis. This occurs in 0-8.5% of vaginal breech deliveries. [ ] This percentage is higher with preterm

2014 eMedicine.com

115. Cesarean Delivery (Treatment)

. [ ] The emerging consensus is that a randomized prospective study is required to address this issue. [ ] Fetal indications Fetal indications for cesarean delivery include the following: Situations in which neonatal morbidity and mortality could be decreased by the prevention of trauma Malpresentations Certain congenital malformations or skeletal disorders Infection Prolonged acidemia A fetus in a nonvertex presentation is at increased risk for trauma, cord prolapse, and head entrapment. Malpresentation (...) of antibiotic prophylaxis for cesarean delivery administered up to 60 minutes before skin incision rather than after umbilical cord clamping. [ , ] There is no benefit from oral antibiotics for eradication of MRSA colonization among patients in the health care setting, and oral antibiotics are not currently routinely recommended for the purpose of MRSA decolonization. Routine screening of obstetric patients for MRSA colonization is not recommended. For obstetric patients known to be MRSA colonized, a single

2014 eMedicine.com

116. Evaluation of Fetal Death (Treatment)

of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory (...) influence estimates of recurrence and future preconceptional counseling, pregnancy management, prenatal diagnostic procedures, and neonatal management. Many institutions use a selective workup based on clinical findings. For example, when clinical findings strongly suggest a cause for the fetal demise at Santa Clara Valley Medical Center, either no further testing or limited testing is performed. Causes deemed fairly obvious include cord accident (ie, prolapse, entanglement, true knot, tight nuchal cord

2014 eMedicine.com

117. Vacuum Extraction (Treatment)

relationship, operator skill, and a judgment of the severity of risk dictate the mode of delivery. In most cases, cord prolapse, , or persistent bradycardia at a high station, even with full dilation with an engaged head are best managed by a cesarean delivery. Evaluation must be undertaken to assess if vaginal delivery can be safely and readily achieved before proceeding. Maternal medical disorders Certain maternal disorders preclude the ability of the mother to safely Valsalva. Typically, cardiac (...) , Guzman ER, Knuppel RA. Effect of vacuum extraction on umbilical cord blood acid-base measurements. J Matern Fetal Med . 1996 Jan-Feb. 5(1):11-7. . Nilsen ST. Boys born by forceps and vacuum extraction examined at 18 years of age. Acta Obstet Gynecol Scand . 1984. 63:548-54. Johanson RB, Heycock E, Carter J. Maternal and child health after assisted vaginal delivery: five-year follow up of a randomised controlled study comparing forceps and ventouse. Br J Obstet Gynaecol . 1999 Jun. 106(6):544-9

2014 eMedicine.com

118. Management of the Third Stage of Labor (Treatment)

women; therefore, caregivers and institutions must have management strategies in place to deal with these problems promptly when they arise. Signs of placental separation Traditionally, 4 signs of placental separation are taught. [ , ] The most reliable sign is the lengthening of the umbilical cord as the placenta separates and is pushed into the lower uterine segment by progressive uterine retraction. Placing a clamp on the cord near the perineum makes it easier to appreciate this lengthening (...) . Never place traction on the cord without countertraction on the uterus above the symphysis; otherwise, one may mistake cord lengthening due to impending prolapse or inversion for that of uncomplicated placental separation. The uterus takes on a more globular shape and becomes firmer. This occurs as the placenta descends into the lower segment and the body of the uterus continues to retract. This change may be clinically difficult to appreciate. The uterus rises in the abdomen. The descent

2014 eMedicine.com

119. Malposition of the Uterus (Treatment)

or advanced diastasis recti associated with advanced multiparity. Presentation The clinical presentation is striking. A history of prior abdominal surgery or cesarean delivery via a midline incision or a prior, unrepaired umbilical hernia is noted. Beginning in the midtrimester when the uterus is sufficiently large so as to become an abdominal organ, it progressively prolapses anteriorly into the hernia sac. [ ] Varying degrees of this condition are observed. In the most extreme cases, the fundus (...) ) or in the immediate postpartum state, are simply normal variants. Uncommonly, obstetric complications result from acute or chronic changes in uterine shape or position prior to labor (retroversion or incarceration, prolapse, torsion, herniation or sacculation), during labor (pathologic retractions rings), or postpartum (acute or chronic inversion). [ ] The most common uterine malpositioning seen during pregnancy, retroversion with incarceration, is depicted below. Uterine retroversion and incarceration

2014 eMedicine.com

120. Malposition of the Uterus (Overview)

or advanced diastasis recti associated with advanced multiparity. Presentation The clinical presentation is striking. A history of prior abdominal surgery or cesarean delivery via a midline incision or a prior, unrepaired umbilical hernia is noted. Beginning in the midtrimester when the uterus is sufficiently large so as to become an abdominal organ, it progressively prolapses anteriorly into the hernia sac. [ ] Varying degrees of this condition are observed. In the most extreme cases, the fundus (...) ) or in the immediate postpartum state, are simply normal variants. Uncommonly, obstetric complications result from acute or chronic changes in uterine shape or position prior to labor (retroversion or incarceration, prolapse, torsion, herniation or sacculation), during labor (pathologic retractions rings), or postpartum (acute or chronic inversion). [ ] The most common uterine malpositioning seen during pregnancy, retroversion with incarceration, is depicted below. Uterine retroversion and incarceration

2014 eMedicine.com

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