DOCSLIB.ORG

Maternal and Neonatal Outcomes of Elective Induction of Labor

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Maternal and Neonatal Outcomes of Elective Induction of Labor Evidence Report/Technology Assessment Number 176 Maternal and Neonatal Outcomes of Elective Induction of Labor Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-02-0017 Prepared by: Stanford University–UCSF Evidence-based Practice Center, Stanford, CA Investigators Aaron B. Caughey, M.D., M.P.P., M.P.H., Ph.D. Vandana Sundaram, M.P.H. Anjali J. Kaimal, M.D. Yvonne W. Cheng, M.D., M.P.H. Allison Gienger, B.A. Sarah E. Little, M.D. Jason F. Lee, M.P.H. Luchin Wong, MD, M.P.H. Brian L. Shaffer, M.D. Susan H. Tran, M.D. Amy Padula, M.P.H. Kathryn M. McDonald, M.M. Elisa F. Long, Ph.D. Douglas K. Owens, M.D., M.S. Dena M. Bravata, M.D., M.S. AHRQ Publication No. 09-E005 March 2009 This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders. Suggested Citation: Caughey AB, Sundaram V, Kaimal AJ, Cheng YW, Gienger A, Little SE, Lee JF, Wong L, Shaffer BL, Tran SH, Padula A, McDonald KM, Long EF, Owens DK, Bravata DM. Maternal and Neonatal Outcomes of Elective Induction of Labor. Evidence Report/Technology Assessment No. 176. (Prepared by the Stanford University-UCSF Evidenced-based Practice Center under contract No. 290-02-0017.) AHRQ Publication No. 09-E005. Rockville, MD.: Agency for Healthcare Research and Quality. March 2009. The investigators do no have any affiliations or financial involves that conflict with the material presented in this report. ii Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-Based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. The reports and assessments provide organizations with comprehensive, science-based information on common, costly medical conditions and new health care technologies. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments. To bring the broadest range of experts into the development of evidence reports and health technology assessments, AHRQ encourages the EPCs to form partnerships and enter into collaborations with other medical and research organizations. The EPCs work with these partner organizations to ensure that the evidence reports and technology assessments they produce will become building blocks for health care quality improvement projects throughout the Nation. The reports undergo peer review prior to their release. AHRQ expects that the EPC evidence reports and technology assessments will inform individual health plans, providers, and purchasers as well as the health care system as a whole by providing important information to help improve health care quality. We welcome comments on this evidence report. They may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by e-mail to [email protected]. Carolyn M. Clancy, M.D. Jean Slutsky, P.A., M.S.P.H. Director Director, Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Beth A. Collins Sharp, Ph.D., R.N. Margaret Coopey, R.N., M.G.A., M.P.S. Director, EPC Program EPC Program Task Order Officer Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality iii Acknowledgments We thank Marilyn Tinsley at the Stanford University Lane Library for her help with the literature searches. We also acknowledge with much gratitude our expert advisors and peer reviewers who are listed in Appendix E. iv Structured Abstract Background. Induction of labor is on the rise in the U.S., increasing from 9.5 percent in 1990 to 22.1 percent in 2004. Although, it is not entirely clear what proportion of these inductions are elective (i.e. without a medical indication), the overall rate of induction of labor is rising faster than the rate of pregnancy complications that would lead to a medically indicated induction. However, the maternal and neonatal effects of induction of labor are unclear. Many studies compare women with induction of labor to those in spontaneous labor. This is problematic, because at any point in the management of the woman with a term gestation, the clinician has the choice between induction of labor and expectant management, not spontaneous labor. Expectant management of the pregnancy involves nonintervention at any particular point in time and allowing the pregnancy to progress to a future gestational age. Thus, women undergoing expectant management may go into spontaneous labor or may require indicated induction of labor at a future gestational age. Objectives. The Stanford-UCSF Evidence-Based Practice Center examined the evidence regarding four Key Questions: 1) What evidence describes the maternal risks of elective induction versus expectant management? 2) What evidence describes the fetal/neonatal risks of elective induction versus expectant management? 3) What is the evidence that certain physical conditions/patient characteristics are predictive of a successful induction of labor? and 4) How is a failed induction defined? Methods. We performed a systematic review to answer the Key Questions. We searched MEDLINE® (1966-2007) and bibliographies of prior systematic reviews and the included studies for English language studies of maternal and fetal outcomes after elective induction of labor. We evaluated the quality of included studies. When possible, we synthesized study data using random effects models. We also evaluated the potential clinical outcomes and cost-effectiveness of elective induction of labor versus expectant management of pregnancy labor at 41, 40, and 39 weeks’ gestation using decision- analytic models. Results. Our searches identified 3,722 potentially relevant articles, of which 76 articles met inclusion criteria. Nine RCTs compared expectant management with elective induction of labor. We found that overall, expectant management of pregnancy was associated with an approximately 22 percent higher odds of cesarean delivery than elective induction of labor (OR 1.22, 95 percent CI 1.07-1.39; absolute risk difference 1.9, 95 percent CI: 0.2-3.7 percent). The majority of these studies were in women at or beyond 41 weeks of gestation (OR 1.21, 95 percent CI 1.01-1.46). In studies of women at or beyond 41 weeks of gestation, the evidence was rated as moderate because of the size and number of studies and consistency of the findings. Among women less than 41 weeks of gestation, there were three trials which reported no difference in risk of cesarean delivery among women who were induced as compared to expectant management (OR 1.73; 95 percent CI: 0.67-4.5, P=0.26), but all of these trials were small, non-U.S., older, and of poor quality. When we stratified the analysis by country, we found that the odds of cesarean delivery were higher in women who were expectantly managed compared to v elective induction of labor in studies conducted outside the U.S. (OR 1.22; 95 percent CI 1.05-1.40) but were not statistically different in studies conducted in the U.S. (OR 1.28; 95 percent CI 0.65-2.49). Women who were expectantly managed were also more likely to have meconium-stained amniotic fluid than those who were electively induced (OR 2.04; 95 percent CI: 1.34-3.09). Observational studies reported a consistently lower risk of cesarean delivery among women who underwent spontaneous labor (6 percent) compared with women who had an elective induction of labor (8 percent) with a statistically significant decrease when combined (OR 0.63; 95 percent CI: 0.49-0.79), but again utilized the wrong control group and did not appropriately adjust for gestational age. We found moderate to high quality evidence that increased parity, a more favorable cervical status as assessed by a higher Bishop score, and decreased gestational age were associated with successful labor induction (58 percent of the included studies defined success as achieving a vaginal delivery anytime after the onset of the induction of labor; in these instances, induction was considered a failure when it led to a cesarean delivery). In the decision analytic model, we utilized a baseline assumption of no difference in cesarean delivery between the two arms as there was no statistically significant difference in the U.S. studies or in women prior to 41 0/7 weeks of gestation. In each of the models, women who were electively induced had better overall outcomes among both mothers and neonates as estimated by total quality-adjusted life years (QALYs) as well as by reduction in specific perinatal outcomes such as shoulder dystocia, meconium aspiration syndrome, and preeclampsia. Additionally, induction of labor was cost-effective at $10,789 per QALY with elective induction of labor at 41 weeks of gestation, $9,932 per QALY at 40 weeks of gestation, and $20,222 per QALY at 39 weeks of gestation utilizing a cost-effectiveness threshold of $50,000 per QALY. At 41 weeks of gestation, these results were generally robust to variations in the assumed ranges in univariate and multi-way sensitivity analyses. However, the findings of cost-effectiveness at 40 and 39 weeks of gestation were not robust to the ranges of the assumptions. In addition, the strength of evidence for some model inputs was low, therefore our analyses are exploratory rather than definitive. Conclusions. Randomized controlled trials suggest that elective induction of labor at 41 weeks of gestation and beyond may be associated with a decrease in both the risk of cesarean delivery and of meconium-stained amniotic fluid.
Load more

Recommended publications
  • Preventing the First Cesarean Delivery
    Current Commentary Preventing the First Cesarean Delivery Summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal- Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop Catherine Y. Spong, MD, Vincenzo Berghella, MD, Katharine D. Wenstrom, MD, Brian M. Mercer, MD, and George R. Saade, MD points were identified to assist with reduction in cesar- With more than one third of pregnancies in the United ean delivery rates including that labor induction should States being delivered by cesarean and the growing be performed primarily for medical indication; if done knowledge of morbidities associated with repeat cesar- for nonmedical indications, the gestational age should be ean deliveries, the Eunice Kennedy Shriver National Insti- at least 39 weeks or more and the cervix should be favor- tute of Child Health and Human Development, the able, especially in the nulliparous patient. Review of the Society for Maternal-Fetal Medicine, and the American current literature demonstrates the importance of adher- College of Obstetricians and Gynecologists convened ing to appropriate definitions for failed induction and a workshop to address the concept of preventing the first arrest of labor progress. The diagnosis of “failed induc- cesarean delivery. The available information on maternal tion” should only be made after an adequate attempt. and fetal factors, labor management and induction, and Adequate time for normal latent and active phases of nonmedical factors leading to the first cesarean delivery the first stage, and for the second stage, should be was reviewed as well as the implications of the first allowed as long as the maternal and fetal conditions per- cesarean delivery on future reproductive health.
    [Show full text]
  • Labor and Vaginal Delivery
    VI LABOR, DELIVERY, AND POSTPARTUM LABOR AND VAGINAL DELIVERY Kelly A. Best, MD CHAPTER 61 1. What is the definition of labor? Labor begins when uterine contractions of sufficient frequency, intensity, and duration are attained to bring about effacement and progressive dilation of the cervix. 2. What two steps are theorized to be crucial to the initiation of labor in human pregnancy? 1. Retreat from pregnancy maintenance 2. Uterotonic induction Despite extensive investigation into the associated physiologic and biochemical changes, the physiologic processes in human pregnancy that result in the onset of labor are still not defined. 3. In which patients is induction of labor considered? Awaiting the onset of normal labor may not be an option in certain circumstances. At preterm gestations, indications for labor induction include severe preeclampsia, fetal growth restriction with abnormal antepartum surveillance or other evidence of fetal compromise, and deterioration of maternal disease to the point that continuation of pregnancy is believed to be detrimental. In cases of rupture of membranes without labor (i.e., premature rupture of membranes) at term (37 to 42 weeks) or postterm (≥42 weeks), induction of labor is often performed. 4. What is a Bishop score, and how is it used? A Bishop score is a quantifiable method to assess the likelihood of a successful induction. Elements include dilation, effacement, station, consistency, and position of the cervix (Table 61-1). A score of 6 or less trans- lates into a need to ripen the cervix and is associated with less successful inductions. A score 8 or greater generally means the cervix does not need ripening and induction is more likely to be successful.
    [Show full text]
  • A Guide to Obstetrical Coding Production of This Document Is Made Possible by Financial Contributions from Health Canada and Provincial and Territorial Governments
    ICD-10-CA | CCI A Guide to Obstetrical Coding Production of this document is made possible by financial contributions from Health Canada and provincial and territorial governments. The views expressed herein do not necessarily represent the views of Health Canada or any provincial or territorial government. Unless otherwise indicated, this product uses data provided by Canada’s provinces and territories. All rights reserved. The contents of this publication may be reproduced unaltered, in whole or in part and by any means, solely for non-commercial purposes, provided that the Canadian Institute for Health Information is properly and fully acknowledged as the copyright owner. Any reproduction or use of this publication or its contents for any commercial purpose requires the prior written authorization of the Canadian Institute for Health Information. Reproduction or use that suggests endorsement by, or affiliation with, the Canadian Institute for Health Information is prohibited. For permission or information, please contact CIHI: Canadian Institute for Health Information 495 Richmond Road, Suite 600 Ottawa, Ontario K2A 4H6 Phone: 613-241-7860 Fax: 613-241-8120 www.cihi.ca [email protected] © 2018 Canadian Institute for Health Information Cette publication est aussi disponible en français sous le titre Guide de codification des données en obstétrique. Table of contents About CIHI ................................................................................................................................. 6 Chapter 1: Introduction ..............................................................................................................
    [Show full text]
  • THE PRACTICE of EPISIOTOMY: a QUALITATIVE DESCRIPTIVE STUDY on PERCEPTIONS of a GROUP of WOMEN Online Brazilian Journal of Nursing, Vol
    Online Brazilian Journal of Nursing E-ISSN: 1676-4285 [email protected] Universidade Federal Fluminense Brasil Yi Wey, Chang; Rejane Salim, Natália; Pires de Oliveira Santos Junior, Hudson; Gualda, Dulce Maria Rosa THE PRACTICE OF EPISIOTOMY: A QUALITATIVE DESCRIPTIVE STUDY ON PERCEPTIONS OF A GROUP OF WOMEN Online Brazilian Journal of Nursing, vol. 10, núm. 2, abril-agosto, 2011, pp. 1-11 Universidade Federal Fluminense Rio de Janeiro, Brasil Available in: http://www.redalyc.org/articulo.oa?id=361441674008 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative THE PRACTICE OF EPISIOTOMY: A QUALITATIVE DESCRIPTIVE STUDY ON PERCEPTIONS OF A GROUP OF WOMEN Chang Yi Wey1, Natália Rejane Salim2, Hudson Pires de Oliveira Santos Junior3, Dulce Maria Rosa Gualda4 1. Hospital Universitário, Universidade de São Paulo 2,3,4. Escola de Enfermagem, Universidade de São Paulo ABSTRACT: This study set out to understand the experiences and perceptions of women from the practices of episiotomy during labor. This is a qualitative descriptive approach, performed in a school hospital in São Paulo, which data were collected through interviews with the participation of 35 women, who experienced and not episiotomy in labor. The thematic analysis shows these categories: Depends the size of the baby facilitates the childbirth; Depends each woman; The woman is not open; and Episiotomy is not necessary. The results allowed that there is lack of clarification and knowledge regarding this practice, which makes the role of decision ends up in the professionals’ hands.
    [Show full text]
  • Mid-Trimester Preterm Premature Rupture of Membranes (PPROM): Etiology, Diagnosis, Classification, International Recommendations of Treatment Options and Outcome
    J. Perinat. Med. 2018; 46(5): 465–488 Review article Open Access Michael Tchirikov*, Natalia Schlabritz-Loutsevitch, James Maher, Jörg Buchmann, Yuri Naberezhnev, Andreas S. Winarno and Gregor Seliger Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome DOI 10.1515/jpm-2017-0027 neonates delivered without antecedent PPROM. The “high Received January 23, 2017. Accepted May 19, 2017. Previously pub- PPROM” syndrome is defined as a defect of the chorio- lished online July 15, 2017. amniotic membranes, which is not located over the inter- nal cervical os. It may be associated with either a normal Abstract: Mid-trimester preterm premature rupture of mem- or reduced amount of amniotic fluid. It may explain why branes (PPROM), defined as rupture of fetal membranes sensitive biochemical tests such as the Amniosure (PAMG-1) prior to 28 weeks of gestation, complicates approximately or IGFBP-1/alpha fetoprotein test can have a positive result 0.4%–0.7% of all pregnancies. This condition is associ- without other signs of overt ROM such as fluid leakage with ated with a very high neonatal mortality rate as well as an Valsalva. The membrane defect following fetoscopy also increased risk of long- and short-term severe neonatal mor- fulfils the criteria for “high PPROM” syndrome. In some bidity. The causes of the mid-trimester PPROM are multi- cases, the rupture of only one membrane – either the cho- factorial. Altered membrane morphology including marked rionic or amniotic membrane, resulting in “pre-PPROM” swelling and disruption of the collagen network which is could precede “classic PPROM” or “high PPROM”.
    [Show full text]
  • Amnioinfusion in the Etiological Diagnosis and Therapeutics Of
    14th World Congress in Fetal Medicine Amnioinfusion in the etiological diagnosis and therapeutics of oligohydramnios: 17 years of experience Borges-Costa S, Bernardo A, Santos A Prenatal Diagnosis Center, Hospital Garcia de Orta, Almada, Portugal Objective To review the maternal and fetal outcomes of all amnioinfusions performed for the diagnosis and treatment of oligohydramnios during pregnancy (excluding labor). Methods This is a retrospective study of 31 singleton pregnancies with oligohydramnios in the second and third trimesters which underwent transabdominal amnioinfusion between December/1997 and December/2014 in the Prenatal Diagnosis Center at the Hospital Garcia de Orta. The gestational age ranged from 15 weeks and 5 days to 32 weeks and 2 days (average 22 weeks). The initial amniotic fluid index ranged from 0 to 6, 5 cm. The procedure was done only by trained professionals. Under ultrasound guidance, isotonic fluid, such as normal saline or Ringer's lactate, is infused into the amniotic cavity via a 20 G needle inserted through the uterine wall. The volume infused ranged from 100 to 800cc (average 380cc). A genetic study was conducted in 29 cases (93, 5%), performed after amniocentesis (26 cases) or cordocentesis (3 cases). In all cases, there was an exhaustive study of the fetal anatomy after the amnioinfusion. In this study the following parameters were evaluated: maternal characteristics (age, personal and obstetrical history), evolution of pregnancy, perinatal mortality and maternal complications. Histopathological examinations
    [Show full text]
  • 2020 CDA Paper Abstraction Forms
    2020 OBI DATA ABSTRACTION FORMS DEMOGRAPHICS Hospital Name: Patient Last Name: Patient First Name: Medical Record Number (MRN): Maternal Birthdate (MM/DD/YY): Postal Zip Hispanic Ethnicity: Code: Hispanic or Latino Not Hispanic or Latino Race (select all that apply): Unknown American Indian or Alaskan Native Asian Patient's Insurance Type: Black or African American Medicaid Self Pay/None Native Hawaiian or Other Pacific Islander Private Other: __________ White Unknown LABOR MANAGEMENT: Admission L&D Admission Date: L&D Admission Time: Provider admitting patient to Labor & Delivery (Last Name, First Name): Service/Practice patient admitted to: Admitting Nurse (Last name, First name): Certified Nurse Midwife Family Practice / Family Medicine Gravidity on admission: Parity on admission: Maternal Fetal Medicine Obstetrics Physician Maternal Height at admission: Maternal Weight at admission: Pre-pregnancy Weight: IN LBS LBS CM K G KG Did the patient receive prenatal care? If yes, date prenatal care Transfer of care from an intended home birth? started: Yes No Unable to determine Yes No LABOR MANAGEMENT: Maternal Comorbidities Present On Admission Pre-pregnancy diabetes (Type I or Type II Yes Was the patient using opioids during this Yes diabetes diagnosed prior to this pregnancy) No pregnancy? No Gestational diabetes (diagnosis in this pregnancy Yes What was the status of the patient's opioid use during this with or without medication tx) No pregnancy? (select all that apply): In treatment for opioid use disorder during pregnancy Pre-pregnancy
    [Show full text]
  • Hospital Maternity Care Report Card, 2018
    New Jersey Hospital Maternity Care Report Card, 2018 Revised on 06/16/2020 1 | P a g e HEALTHCARE QUALITY AND INFORMATICS Prepared by: Erin Mayo, DVM, MPH Genevieve Lalanne-Raymond, RN, MPH Mehnaz Mustafa, MPH, MSc Yannai Kranzler, PhD Technical Support Andreea A. Creanga, MD, PhD Debra Bingham, DrPH, RN, FAAN Jennifer Fearon, MPH Marcela Maziarz, MPA Hospital Partners Diana Contreras, MD-Atlantic Health System Lisa Gittens-Williams, MD Obstetrics & Gynecology– University Hospital Thomas Westover, MD, FACOG- Cooper University Health Care Perry L. Robin, MD, MSEd, FACOG- Cooper University Health Care Hewlett Guy, MD, FACOG- Cooper University Health Care Suzanne Spernal, DNP, APN-BC, RNC-OB, CBC- RWJBarnabas Health 2 | P a g e Table of Contents Statute ........................................................................................................................................................... 5 Summary of the Statute ............................................................................................................................. 5 Summary of Findings ................................................................................................................................ 6 Variation in Delivery Outcomes by Hospital .................................................................................... 6 Complication Rates by Race/Ethnicity: ............................................................................................ 6 General Observations ........................................................................................................................
    [Show full text]
  • OBGYN-Study-Guide-1.Pdf
    OBSTETRICS PREGNANCY Physiology of Pregnancy: • CO input increases 30-50% (max 20-24 weeks) (mostly due to increase in stroke volume) • SVR anD arterial bp Decreases (likely due to increase in progesterone) o decrease in systolic blood pressure of 5 to 10 mm Hg and in diastolic blood pressure of 10 to 15 mm Hg that nadirs at week 24. • Increase tiDal volume 30-40% and total lung capacity decrease by 5% due to diaphragm • IncreaseD reD blooD cell mass • GI: nausea – due to elevations in estrogen, progesterone, hCG (resolve by 14-16 weeks) • Stomach – prolonged gastric emptying times and decreased GE sphincter tone à reflux • Kidneys increase in size anD ureters dilate during pregnancy à increaseD pyelonephritis • GFR increases by 50% in early pregnancy anD is maintaineD, RAAS increases = increase alDosterone, but no increaseD soDium bc GFR is also increaseD • RBC volume increases by 20-30%, plasma volume increases by 50% à decreased crit (dilutional anemia) • Labor can cause WBC to rise over 20 million • Pregnancy = hypercoagulable state (increase in fibrinogen anD factors VII-X); clotting and bleeding times do not change • Pregnancy = hyperestrogenic state • hCG double 48 hours during early pregnancy and reach peak at 10-12 weeks, decline to reach stead stage after week 15 • placenta produces hCG which maintains corpus luteum in early pregnancy • corpus luteum produces progesterone which maintains enDometrium • increaseD prolactin during pregnancy • elevation in T3 and T4, slight Decrease in TSH early on, but overall euthyroiD state • linea nigra, perineum, anD face skin (melasma) changes • increase carpal tunnel (median nerve compression) • increased caloric need 300cal/day during pregnancy and 500 during breastfeeding • shoulD gain 20-30 lb • increaseD caloric requirements: protein, iron, folate, calcium, other vitamins anD minerals Testing: In a patient with irregular menstrual cycles or unknown date of last menstruation, the last Date of intercourse shoulD be useD as the marker for repeating a urine pregnancy test.
    [Show full text]
  • Therapeutic Amnioinfusion in Oligohydramnios During Pregnancy (Excluding Labor)
    International Journal of Reproduction, Contraception, Obstetrics and Gynecology Qazi M et al. Int J Reprod Contracept Obstet Gynecol. 2017 Oct;6(10):4577-4582 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20174445 Original Research Article Therapeutic amnioinfusion in oligohydramnios during pregnancy (excluding labor) Mahvish Qazi1, Najmus Saqib2*, Abida Ahmed1, Imran Wagay3 1Department of Obstetrics and Gynecology, SKIMS Soura Srinagar Kashmir, India 2Department of Paediatrics and Neonatology, Government Medical College Jammu, Jammu and Kashmir, India 3Department of Radiodiagnosis, Govt. Medical College Srinagar, Jammu and Kashmir, India Received: 05 August 2017 Accepted: 04 September 2017 *Correspondence: Dr. Najmus Saqib, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Oligohydramnios is a serious complication of pregnancy that is associated with a poor perinatal outcome and complicates 1-5% of pregnancies. The purpose of this study was to evaluate the role of antepartum transabdominal amnioinfusion on amniotic fluid volume/latency period in pregnancies with oligohydramnios. Methods: This study was conducted in the Department of Obstetrics and Gynaecology at Sher-i-Kashmir Institute of Medical Sciences Soura Srinagar. In this study, a total of 54 pregnant women with ultrasonographically diagnosed oligohydramnios i.e. AFI < 5 cm and gestational age of >24 weeks were taken for therapeutic amnioinfusion and its effects on amniotic fluid volume were studied.
    [Show full text]
  • • Chapter 8 • Nursing Care of Women with Complications During Labor and Birth • Obstetric Procedures • Amnioinfusion –
    • Chapter 8 • Nursing Care of Women with Complications During Labor and Birth • Obstetric Procedures • Amnioinfusion – Oligohydramnios – Umbilical cord compression – Reduction of recurrent variable decelerations – Dilution of meconium-stained amniotic fluid – Replaces the “cushion ” for the umbilical cord and relieves the variable decelerations • Obstetric Procedures (cont.) • Amniotomy – The artificial rupture of membranes – Done to stimulate or enhance contractions – Commits the woman to delivery – Stimulates prostaglandin secretion – Complications • Prolapse of the umbilical cord • Infection • Abruptio placentae • Obstetric Procedures (cont.) • Observe for complications post-amniotomy – Fetal heart rate outside normal range (110-160 beats/min) suggests umbilical cord prolapse – Observe color, odor, amount, and character of amniotic fluid – Woman ’s temperature 38 ° C (100.4 ° F) or higher is suggestive of infection – Green fluid may indicate that the fetus has passed a meconium stool • Nursing Tip • Observe for wet underpads and linens after the membranes rupture. Change them as often as needed to keep the woman relatively dry and to reduce the risk for infection or skin breakdown. • Induction or Augmentation of Labor • Induction is the initiation of labor before it begins naturally • Augmentation is the stimulation of contractions after they have begun naturally • Indications for Labor Induction • Gestational hypertension • Ruptured membranes without spontaneous onset of labor • Infection within the uterus • Medical problems in the
    [Show full text]
  • Management of Spontaneous Rupture of the Amnion with an Intact Chorion Jenny A
    Jacob et al. Obstet Gynecol cases Rev 2015, 2:5 ISSN: 2377-9004 Obstetrics and Gynaecology Cases - Reviews Case Report: Open Access Management of Spontaneous Rupture of the Amnion with an Intact Chorion Jenny A. Jacob1, Norman A. Ginsberg2, Lee P. Shulman2* and Leeber Cohen2 1Albert-Ludwigs-University School of Medicine, Germany 2Northwestern Feinberg School of Medicine, USA *Corresponding author: Prof. Lee P. Shulman MD, 250 E. Superior Street, Prentice Women’s Hospital, Room 05- 2174, Chicago, IL, USA 60611, Tel: 1.312.730.8694, Email: [email protected] weeks‘gestation with an AFI of 1cm. The patient reported no history Abstract of vaginal amniotic fluid leakage. Speculum examination showed Idiopathic severe preterm oligohydamnios as a result of spontaneous no evidence of vaginal pooling. The fetal kidneys were visualized at rupture of the amnion with an intact chorion is a rare event with a the time of the ultrasound and were considered functioning since scarcity of reports found in the literature. We evaluated the impact the fetal bladder was visualized at the time of ultrasound. Chorionic of serial amnioinfusions on this unusual occurrence. This is a follow- villus sampling (CVS) was performed after the 18-week scan and up of a 37-year-old woman with idiopathic severe oligohydramnios diagnosed at 18 weeks of gestation. We performed five serial showed a normal 46,XX complement. amnioinfusions with the purpose of improving fetal lung maturity The patient was informed of the complications accompanied and to prevent Potter anomalad. At 31 weeks‘gestation the patient with oligohydramnios and was offered pregnancy termination.
    [Show full text]