Cord Prolapse Prolapse in Inlate Late Pregnancypregnancypublished in July 2015
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Induction of Labor
36 O B .GYN. NEWS • January 1, 2007 M ASTER C LASS Induction of Labor he timing of parturi- nancies that require induction because of medical com- of labor induction, the timing of labor induction, and the tion remains a conun- plications in the mother. advisability of the various conditions under which in- Tdrum in obstetric Increasingly, however, patients are apt to have labor in- duction can and does occur. medicine in that the majority duced for their own convenience, for personal reasons, This month’s guest professor is Dr. William F. Rayburn, of pregnancies will go to for the convenience of the physician, and sometimes for professor and chairman of the department of ob.gyn. at term and enter labor sponta- all of these reasons. the University of New Mexico, Albuquerque. Dr. Ray- neously, whereas another This increasingly utilized social option ushers in a burn is a maternal and fetal medicine specialist with a na- portion will go post term and whole new perspective on the issue of induction, and the tional reputation in this area. E. ALBERT REECE, often require induction, and question is raised about whether or not the elective in- M.D., PH.D., M.B.A. still others will enter labor duction of labor brings with it added risk and more com- DR. REECE, who specializes in maternal-fetal medicine, is prematurely. plications. Vice President for Medical Affairs, University of Maryland, The concept of labor induction, therefore, has become It is for this reason that we decided to develop a Mas- and the John Z. -
ABCDE Acronym Blood Transfusion 231 Major Trauma 234 Maternal
Cambridge University Press 978-0-521-26827-1 - Obstetric and Intrapartum Emergencies: A Practical Guide to Management Edwin Chandraharan and Sir Sabaratnam Arulkumaran Index More information Index ABCDE acronym albumin, blood plasma levels 7 arterial blood gas (ABG) 188 blood transfusion 231 allergic anaphylaxis 229 arterio-venous occlusions 166–167 major trauma 234 maternal collapse 12, 130–131 amiadarone, overdose 178 aspiration 10, 246 newborn infant 241 amniocentesis 234 aspirin 26, 180–181 resuscitation 127–131 amniotic fluid embolism 48–51 assisted reproduction 93 abdomen caesarean section 257 asthma 4, 150, 151, 152, 185 examination after trauma 234 massive haemorrhage 33 pain in pregnancy 154–160, 161 maternal collapse 10, 13, 128 atracurium, drug reactions 231 accreta, placenta 250, 252, 255 anaemia, physiological 1, 7 atrial fibrillation 205 ACE inhibitors, overdose 178 anaerobic metabolism 242 automated external defibrillator (AED) 12 acid–base analysis 104 anaesthesia. See general anaesthesia awareness under anaesthesia 215, 217 acidosis 94, 180–181, 186, 242 anal incontinence 138–139 ACTH levels 210 analgesia 11, 100, 218 barbiturates, overdose 178 activated charcoal 177, 180–181 anaphylaxis 11, 227–228, 229–231 behaviour/beliefs, psychiatric activated partial thromboplastin time antacid prophylaxis 217 emergencies 172 (APTT) 19, 21 antenatal screening, DVT 16 benign intracranial hypertension 166 activated protein C 46 antepartum haemorrhage 33, 93–94. benzodiazepines, overdose 178 Addison’s disease 208–209 See also massive -
Umbilical Cord Prolapse Guideline
Umbilical Cord Prolapse Guideline Document Control Title Umbilical Cord Prolapse Guideline Author Author’s job title Specialty Trainee in Obstetrics and Gynaecology Directorate Department Women’s and Children’s Obstetrics and Gynaecology Date Version Status Comment / Changes / Approval Issued 1.0 Mar Final Approved by the Maternity Services Guideline Group in 2011 April 2011. 1.1 Aug Revision Minor amendments by Corporate Governance to 2012 document control report, headers and footers, new table of contents, formatting for document map navigation. 2.0 Feb Final Approved by the Maternity Services Guideline Group in 2016 February 2016. 2.1 Apr Revision Harmonised with Royal Devon & Exeter guideline 2019 3.0 May Final Approved by Maternity Specialist Governance Forum 2019 meeting on 01.05.2019 Main Contact ST1 O&G Tel: Direct Dial– 01271 311806 North Devon District Hospital Raleigh Park Barnstaple Devon EX31 4JB Lead Director Medical Director Superseded Documents Nil Issue Date Review Date Review Cycle May 2019 May 2022 Three years Consulted with the following stakeholders: (list all) Senior obstetricians Senior midwives Senior management team Filename Umbilical Cord Prolapse Guideline v3. 01May 19.doc Policy categories for Trust’s internal Tags for Trust’s internal website (Bob) website (Bob) Cord, accidents, prolapse Maternity Services Maternity Page 1 of 11 Umbilical Cord Prolapse Guideline CONTENTS Document Control .................................................................................................... 1 1. Introduction -
L&D – Amnioinfusion Guideline and Procedure for Amnioinfusion
L&D – Amnioinfusion Guideline and Procedure for Amnioinfusion. Purpose: Replacing the amniotic fluid with normal saline has been found to be a safe, simple, and very effective way to reduce the occurrence of repetitive variable decelerations. Procedure: Initiation of Amnioinfusion will be ordered and performed by a Certified Nurse Midwife (CNM) or physician (MD). 1. Prepare NS or LR 1000ml with IV tubing in the same fashion as for intravenous infusion. Flush the tubing to clear air. 2. An intrauterine pressure catheter (IUPC) will be placed by the MD/CNM. 3. Elevate the IV bag 3-4 feet above the IUPC tip for rapid infusion. Infuse 250-500ml of solution over a 20-30 minute time frame followed by a 60-180ml/hour maintenance infusion. The total volume infused should not exceed 1000ml unless one has access to ultrasound and can titrate to an amniotic fluid index (AFI) of 8-12 cm to prevent polyhydramnios and hypertonus. 4. If variable decelerations recur or other new non-reassuring FHR patterns develop, notify the MD/CNM. The procedure may be repeated as ordered. 5. Resting tone of the uterus will be increased during infusion but should not increase > 15mmHg from previous baseline. If this occurs, infusion should stop until there is a return to the previous baseline then it can be restarted. An elevated baseline prior to infusion is a contraindication. 6. Monitor for an outflow of infusion. If there is a sudden cessation of outflow fetal head engagement may have occurred increasing the risk of polyhydramnios. Complications are rare but can include iatrogenic polyhydramnios, uterine hypertonus, chorioamnionitis, uterine rupture, placental abruption, and maternal pulmonary embolus. -
Messages from the Placentae Across Multiple Species a 50 Years
Placenta 84 (2019) 14–27 Contents lists available at ScienceDirect Placenta journal homepage: www.elsevier.com/locate/placenta Messages from the placentae across multiple species: A 50 years exploration T Hiroaki Soma Saitama Medical University, Japan ARTICLE INFO ABSTRACT Keywords: This review explores eight aspects of placentation in multiple mammalian. Gestational trophoblastic disease 1) Specialities of gestational trophoblastic disease. SUA(Single umbilical artery) 2) Clinical significance of single umbilical artery (SUA) syndrome. DIC(Disseminated intravascular coagulation) in 3) Pulmonary trophoblast embolism in pregnant chinchillas and DIC in pregnant giant panda. giant panda 4) Genetics status and placental behaviors during Japanese serow and related antelopes. Placentation in Japanese serow 5) Specific living style and placentation of the Sloth and Proboscis monkey. Hydatidiform mole in chimpanzee Placentation in different living elephant 6) Similarities of placental structures between human and great apes. Manatee and hyrax 7) Similarities of placental forms in elephants, manatees and rock hyrax with different living styles. Specific placental findings of Himalayan people 8) Specialities of placental pathology in Himalayan mountain people. Conclusions: It was taught that every mammalian species held on placental forms applied to different environ- mental life for their infants, even though their gestational lengths were different. 1. Introduction of effective chemotherapeutic agents. In 1959, I was fortunate tore- ceive an invitation from Prof. Kurt Benirschke at the Boston Lying-in Last October, Scientific American published a special issue about a Hospital. Before that, I had written to Prof. Arthur T. Hertig, Chairman baby's first organ, the placenta [1]. It is full of surprises and amazing of Pathology, Harvard Medical School, asking to study human tropho- science. -
FASD Effects of Alcohol on a Fetus
EFFECTS OF ALCOHOL ON A FETUS “Of all the substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.” —Institute of Medicine Report to Congress, 19961 Prenatal exposure to alcohol can damage a fetus at any time, causing problems that persist throughout the individual’s life. There is no known safe level of alcohol use in pregnancy. WHAT IS THE SCOPE OF THE PROBLEM? identified in virtually every part of the body, including the brain, face, eyes, ears, heart, kidneys, and bones. No Alcohol is one of the most dangerous teratogens, which single mechanism can account for all the problems that are substances that can damage a developing fetus.1 Every alcohol causes. Rather, alcohol sets in motion many time a pregnant woman has a drink, her unborn child processes at different sites in the developing fetus: has one, too. Alcohol, like carbon monoxide from cigarettes, passes easily through the placenta from the • Alcohol can trigger cell death in a number of ways, mother's bloodstream into her baby's blood (See Figure causing different parts of the fetus to develop abnormally. 1)—and puts her fetus at risk of having a fetal alcohol • Alcohol can disrupt the way nerve cells develop, travel spectrum disorder (FASD). The blood alcohol level to form different parts of the brain, and function. (BAC) of the fetus becomes equal to or greater than the blood alcohol level of the mother. Because the fetus • By constricting the blood vessels, alcohol interferes with cannot break down alcohol the way an adult can, its BAC blood flow in the placenta, which hinders the delivery 2 remains high for a longer period of time. -
Management of Prolonged Decelerations ▲
OBG_1106_Dildy.finalREV 10/24/06 10:05 AM Page 30 OBGMANAGEMENT Gary A. Dildy III, MD OBSTETRIC EMERGENCIES Clinical Professor, Department of Obstetrics and Gynecology, Management of Louisiana State University Health Sciences Center New Orleans prolonged decelerations Director of Site Analysis HCA Perinatal Quality Assurance Some are benign, some are pathologic but reversible, Nashville, Tenn and others are the most feared complications in obstetrics Staff Perinatologist Maternal-Fetal Medicine St. Mark’s Hospital prolonged deceleration may signal ed prolonged decelerations is based on bed- Salt Lake City, Utah danger—or reflect a perfectly nor- side clinical judgment, which inevitably will A mal fetal response to maternal sometimes be imperfect given the unpre- pelvic examination.® BecauseDowden of the Healthwide dictability Media of these decelerations.” range of possibilities, this fetal heart rate pattern justifies close attention. For exam- “Fetal bradycardia” and “prolonged ple,Copyright repetitive Forprolonged personal decelerations use may onlydeceleration” are distinct entities indicate cord compression from oligohy- In general parlance, we often use the terms dramnios. Even more troubling, a pro- “fetal bradycardia” and “prolonged decel- longed deceleration may occur for the first eration” loosely. In practice, we must dif- IN THIS ARTICLE time during the evolution of a profound ferentiate these entities because underlying catastrophe, such as amniotic fluid pathophysiologic mechanisms and clinical 3 FHR patterns: embolism or uterine rupture during vagi- management may differ substantially. What would nal birth after cesarean delivery (VBAC). The problem: Since the introduction In some circumstances, a prolonged decel- of electronic fetal monitoring (EFM) in you do? eration may be the terminus of a progres- the 1960s, numerous descriptions of FHR ❙ Complete heart sion of nonreassuring fetal heart rate patterns have been published, each slight- block (FHR) changes, and becomes the immedi- ly different from the others. -
Complicating Conditions Associated with Childbirth, by Delivery Method and Payer, 2011
HEALTHCARE COST AND Agency for Healthcare UTILIZATION PROJECT Research and Quality STATISTICAL BRIEF #173 May 2014 Highlights Complicating Conditions Associated With ■ Among the 3.6 million hospital Childbirth, by Delivery Method and Payer, stays involving childbirth in 2011 2011, cesarean section deliveries were 11 percent more Jennifer E. Moore, Ph.D., R.N., Whitney P. Witt, Ph.D., M.P.H., and likely among women who were Anne Elixhauser, Ph.D. covered by private insurance than among women covered by Introduction Medicaid. Mean length of stay and mean hospital costs were Childbirth is the most prevalent reason for hospitalization in the similar by payer type. United States.1,2 Of the 4.1 million hospital stays in 2009 involving childbirth, 91.3 percent of vaginal and 99.9 percent of ■ Among women who delivered cesarean section deliveries had at least one complicating by cesarean section and were condition.3 These conditions range in severity and may include covered by Medicaid, 94.6 those that are preexisting, such as mental health disorders; those percent of discharges included a that create risk factors, such as multiple gestation; and those that complicating condition. may lead to complications of care, such as an abnormality of fetal heart rate or rhythm. ■ Overall, for discharges among women with vaginal deliveries In the United States, childbirth accounts for about 10 percent of all covered by private insurance, maternal hospital stays and $12.4 billion in hospitalization costs the rate of cases with for live births; it represents, in the aggregate, one of the most complications increased with costly conditions for inpatient hospital care.4,5 The average cost age (75.5 per 100 for of a vaginal birth in 2008 was $2,900 without complications and adolescents younger than 15 $3,800 with complications.2 The average cost of a cesarean years versus 83.3 per 100 for section was $4,700 without complications and $6,500 with women aged 40–44 years). -
Turning Your Breech Baby to a Head-Down Position (External Cephalic Version)
Turning your breech baby to a head-down position (External Cephalic Version) This leaflet explains more about External Cephalic Version (ECV), including the benefits and risks. It will also describe any alternatives and what you can expect when you come to hospital. If you have any further questions, please speak to a doctor or midwife caring for you. What is a breech position? A breech position means that your baby is lying with its feet or bottom in your pelvis rather than in a head first position. This is common throughout most of pregnancy, but we expect that most babies will turn to lie head first by the end of pregnancy. If your baby is breech at 36 weeks of pregnancy it is unlikely that it will turn into a head down position on its own. Three in every 100 babies will still be in a breech position by 36 weeks. A breech baby may be lying in one of the following positions: Extended or frank Flexed breech – the Footling breech – the breech – the baby is baby is bottom first, with baby’s foot or feet are bottom first, with the thighs the thighs against the below the bottom. against the chest and feet chest and the knees bent. up by the ears. Most breech babies are in this position. Pictures reproduced with permission from ‘A breech baby at the end of pregnancy’ published by The Royal College of Obstetricians and Gynaecologists, 2008. 1 of 5 What causes breech? Breech is more common in women who are expecting twins, or in women who have a differently-shaped womb (uterus). -
Fetal Cardiac Interventions—Are They Safe for the Mothers?
Journal of Clinical Medicine Article Fetal Cardiac Interventions—Are They Safe for the Mothers? Beata Rebizant 1,* , Adam Kole´snik 2,3,4, Agnieszka Grzyb 2,5 , Katarzyna Chaberek 1, Agnieszka S˛ekowska 1,6, Jacek Witwicki 7, Joanna Szymkiewicz-Dangel 2 and Marzena D˛ebska 1,8,* 1 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; [email protected] (K.C.); [email protected] (A.S.) 2 Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, US Clinic Agatowa, 03-680 Warsaw, Poland; [email protected] (A.K.); [email protected] (A.G.); [email protected] (J.S.-D.) 3 Cardiovascular Interventions Laboratory, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland 4 Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, 02-004 Warsaw, Poland 5 Department of Cardiology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland 6 Pain Clinic, Department of Anesthesiology and Intensive Care, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland 7 Department of Neonatology, Centre of Postgraduate Medical Education, 01-809 Warsaw, Poland; [email protected] 8 Department of Gynecologic Oncology and Obstetrics, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland * Correspondence: Correspondence: [email protected] (B.R.); [email protected] (M.D.); Tel.: +48-508130737 (B.R.); +48-607449302 (M.D.) Abstract: The aim of fetal cardiac interventions (FCI), as other prenatal therapeutic procedures, is to bring benefit to the fetus. However, the safety of the mother is of utmost importance. -
Glossary of Common MCH Terms and Acronyms
Glossary of Common MCH Terms and Acronyms General Terms and Definitions Term/Acronym Definition Accountable Care Organizations that coordinate and provide the full range of health care services for Organization individuals. The ACA provides incentives for providers who join together to form such ACO organizations and who agree to be accountable for the quality, cost, and overall care of their patients. Adolescence Stage of physical and psychological development that occurs between puberty and adulthood. The age range associated with adolescence includes the teen age years but sometimes includes ages younger than 13 or older than 19 years of age. Antepartum fetal Fetal death occurring before the initiation of labor. death Authorization An act of a legislative body that establishes government programs, defines the scope of programs, and sets a ceiling for how much can be spent on them. Birth defect A structural abnormality present at birth, irrespective of whether the defect is caused by a genetic factor or by prenatal events that are not genetic. Cost Sharing The amount an individual pays for health services above and beyond the cost of the insurance coverage premium. This includes co-pays, co-insurance, and deductibles. Crude birth rate Number of live births per 1000 population in a given year. Birth spacing The time interval from one child’s birth until the next child’s birth. It is generally recommended that at least a two-year interval between births is important for maternal and child health and survival. BMI Body mass index (BMI) is a measure of body weight that takes into account height. -
Cord Prolapse
CLINICAL PRACTICE GUIDELINE CORD PROLAPSE CLINICAL PRACTICE GUIDELINE CORD PROLAPSE Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland and the Clinical Strategy and Programmes Division, Health Service Executive Version: 1.0 Publication date: March 2015 Guideline No: 35 Revision date: March 2017 1 CLINICAL PRACTICE GUIDELINE CORD PROLAPSE Table of Contents 1. Revision History ................................................................................ 3 2. Key Recommendations ....................................................................... 3 3. Purpose and Scope ............................................................................ 3 4. Background and Introduction .............................................................. 4 5. Methodology ..................................................................................... 4 6. Clinical Guidelines on Cord Prolapse…… ................................................ 5 7. Hospital Equipment and Facilities ....................................................... 11 8. References ...................................................................................... 11 9. Implementation Strategy .................................................................. 14 10. Qualifying Statement ....................................................................... 14 11. Appendices ..................................................................................... 15 2 CLINICAL PRACTICE GUIDELINE CORD PROLAPSE 1. Revision History Version No.