Summary induction guidelines
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The document provides guidelines for postterm induction, including: 1) Using the Bishop score, cervical dilation, parity, and EGA to determine timing of induction between 41w 0d-41w 6d 2) Favorable cervix for induction is a Bishop score of 6 or more 3) Risk of cesarean section is increased for Bishop score <5 or multiparous with cervix <2cm dilated/nulliparous with cervix <3-4cm dilated
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Guidelines for induction
The document provides guidelines for cervical ripening and labor induction. Key points include:
- The modified Bishop score is the best tool for predicting successful induction outcomes. Cervical dilation carries the most weight.
- Early amniotomy and oxytocin ("pop and pit") results in faster labor onset, shorter delivery time, and lower C-section rates compared to delayed amniotomy or oxytocin alone.
- Outpatient cervical ripening with misoprostol (Cytotec) should allow assessment for admission or discharge by 8:30am following the induction attempt.
When to schedule posterm induction
The document provides guidelines for postterm induction, including:
1) Using the Bishop score, cervical dilation, parity, and EGA to determine when to schedule inductions between 41w 0d-41w 6d.
2) Scheduling outpatient Cytotec inductions in the evenings staggered to allow for assessment and additional dosing if needed.
3) Scheduling inpatient Pitocin inductions staggered in the mornings.
4) Favorable criteria for induction include Bishop score of 6 or more and cervical dilation of 3-4cm for nulliparous and 2cm for multiparous patients.
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This document discusses the history and efficacy of antenatal corticosteroids in managing preterm birth. It notes that while antenatal corticosteroids have been shown to significantly reduce neonatal mortality and morbidity rates, questions remain about their efficacy in specific patient populations and safety with repeat courses. The history demonstrates how clinical practices can be adopted before sufficient evidence is available and how arbitrary choices can become standardized. Further research is still needed to determine optimal dosing schedules and administration in special cases.
MANAGEMENT OF PRETERM PROM ON INDUCTION OF LABOUR
INCIDENCE OF PPROM
Preterm PROM-defined as PROM prior to 37 weeks of gestation complicates
2% to 4% of all singleton
7% to 20% of twin pregnancies.
It is the leading identifiable cause of premature birth ( 30%)
accounts for approximately 18% to 20% of perinatal deaths in the United States.
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Induction of Labour
This document discusses the definition, indications, timing, criteria, and contraindications of induced labor. It notes that induced labor is initiated before spontaneous labor to achieve delivery when the benefits outweigh the risks of continuing the pregnancy, such as in cases of post-dates pregnancy, preeclampsia, diabetes, or fetal compromise. The timing depends on the indication, and criteria include confirmed dates and no acute fetal distress. Contraindications include conditions that could increase risks during a vaginal delivery. District hospitals have limits on the number of prostaglandins that can be used to induce labor without specialist consultation.
Induction OF labor
This document provides information on induction and augmentation of labor. It discusses the definitions of labor, induction, and augmentation. It reviews trends showing rising rates of labor induction in the US. Common indications and contraindications for induction are outlined. Methods for evaluating maternal and fetal status prior to induction are described. Various pharmacologic and mechanical methods for cervical ripening are explained in detail. Finally, the document reviews protocols for labor induction and augmentation using oxytocin and associated risks and complications.
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The document discusses recommendations for antenatal corticosteroid therapy for fetal maturation. It recommends a single course of corticosteroids between 24-34 weeks gestation for women at risk of preterm birth within 7 days. It also recommends corticosteroids before 32 weeks for premature rupture of membranes to reduce risks. While a single rescue course may be considered if more than 2 weeks have passed, regularly scheduled repeat courses are not recommended due to limited data and potential risks. The document discusses different corticosteroid regimens and their efficacy based on available evidence.
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Guidelines for induction
The document provides guidelines for cervical ripening and labor induction. Key points include:
- The modified Bishop score is the best tool for predicting successful induction outcomes. Cervical dilation carries the most weight.
- Early amniotomy and oxytocin ("pop and pit") results in faster labor onset, shorter delivery time, and lower C-section rates compared to delayed amniotomy or oxytocin alone.
- Outpatient cervical ripening with misoprostol (Cytotec) should allow assessment for admission or discharge by 8:30am following the induction attempt.
When to schedule posterm induction
The document provides guidelines for postterm induction, including:
1) Using the Bishop score, cervical dilation, parity, and EGA to determine when to schedule inductions between 41w 0d-41w 6d.
2) Scheduling outpatient Cytotec inductions in the evenings staggered to allow for assessment and additional dosing if needed.
3) Scheduling inpatient Pitocin inductions staggered in the mornings.
4) Favorable criteria for induction include Bishop score of 6 or more and cervical dilation of 3-4cm for nulliparous and 2cm for multiparous patients.
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The document summarizes key points from the Neonatal Resuscitation Program (NRP) 8th edition. It discusses improvements to teamwork and communication during resuscitation. It provides clinical guidance on ventilation, temperature management, medications and other aspects of resuscitation. The document emphasizes preparation, effective communication, and ongoing quality improvement to optimize neonatal outcomes.
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This document discusses the history and efficacy of antenatal corticosteroids in managing preterm birth. It notes that while antenatal corticosteroids have been shown to significantly reduce neonatal mortality and morbidity rates, questions remain about their efficacy in specific patient populations and safety with repeat courses. The history demonstrates how clinical practices can be adopted before sufficient evidence is available and how arbitrary choices can become standardized. Further research is still needed to determine optimal dosing schedules and administration in special cases.
MANAGEMENT OF PRETERM PROM ON INDUCTION OF LABOUR
INCIDENCE OF PPROM
Preterm PROM-defined as PROM prior to 37 weeks of gestation complicates
2% to 4% of all singleton
7% to 20% of twin pregnancies.
It is the leading identifiable cause of premature birth ( 30%)
accounts for approximately 18% to 20% of perinatal deaths in the United States.
Dr. Sharda Jain
Dr. jyoti Bhasker
Induction of Labour
This document discusses the definition, indications, timing, criteria, and contraindications of induced labor. It notes that induced labor is initiated before spontaneous labor to achieve delivery when the benefits outweigh the risks of continuing the pregnancy, such as in cases of post-dates pregnancy, preeclampsia, diabetes, or fetal compromise. The timing depends on the indication, and criteria include confirmed dates and no acute fetal distress. Contraindications include conditions that could increase risks during a vaginal delivery. District hospitals have limits on the number of prostaglandins that can be used to induce labor without specialist consultation.
Induction OF labor
This document provides information on induction and augmentation of labor. It discusses the definitions of labor, induction, and augmentation. It reviews trends showing rising rates of labor induction in the US. Common indications and contraindications for induction are outlined. Methods for evaluating maternal and fetal status prior to induction are described. Various pharmacologic and mechanical methods for cervical ripening are explained in detail. Finally, the document reviews protocols for labor induction and augmentation using oxytocin and associated risks and complications.
Acog 2011 acs for flm
The document discusses recommendations for antenatal corticosteroid therapy for fetal maturation. It recommends a single course of corticosteroids between 24-34 weeks gestation for women at risk of preterm birth within 7 days. It also recommends corticosteroids before 32 weeks for premature rupture of membranes to reduce risks. While a single rescue course may be considered if more than 2 weeks have passed, regularly scheduled repeat courses are not recommended due to limited data and potential risks. The document discusses different corticosteroid regimens and their efficacy based on available evidence.
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This document discusses the use of antenatal steroids to accelerate fetal lung maturation and reduce complications of prematurity. It finds that a single course of antenatal corticosteroids between 24-34 weeks gestation significantly reduces rates of respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and mortality in preterm infants. While betamethasone and dexamethasone are commonly used, betamethasone is preferred due to fewer required doses. The benefits last up to 7 days, so treatment should be considered if delivery is anticipated within the next week.
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This document provides an overview of induction of labor presented by Dr. Mansi Gupta. It defines induction and augmentation of labor and discusses gestational age classifications. The document outlines absolute and relative indications for induction as well as absolute and relative contraindications. It discusses elective induction of labor and recommendations from WHO on inducing labor in various situations. Evaluation before induction includes assessing maternal and fetal status and assigning a cervical scoring system. Methods for stabilizing induction and inducing labor in specific high-risk situations like IUGR, hypertension in pregnancy, and IUFD are presented.
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This document discusses induction and augmentation of labor. It begins by defining induction of labor as artificially stimulating uterine contractions before the onset of labor, while augmentation refers to stimulating inadequate spontaneous contractions. The document then covers the structures and physiology of the cervix as it relates to ripening. It discusses various methods of assessing cervical status including Bishop's score and indications, contraindications, risks and prerequisites for labor induction. The document provides an overview of common methods used for cervical ripening and labor induction.
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This document discusses labor induction, including its definition, reasons it may be done, risks, preparation, methods, duration, and outcomes. Labor induction is a procedure used to stimulate uterine contractions before spontaneous labor begins. It carries some risks but may be recommended if the mother or baby's health is at risk late in pregnancy. Common induction methods include stripping the membranes, dilating the cervix, intravenous oxytocin, or rupturing the amniotic sac. The duration of induction can vary from a few hours to a few days depending on the individual case. Outcomes include successful vaginal birth in most cases but may require a C-section in some situations.
Medical induction of labour
This document discusses induction of labor, including definitions, purposes, indications, contraindications, and methods. The key methods of medical induction discussed are prostaglandins like dinoprostone and misoprostol, oxytocin, and mifepristone. Prostaglandins work to ripen the cervix and stimulate contractions through local effects on cervical collagen and myometrium. Oxytocin stimulates contractions through receptor-mediated pathways. Mifepristone is a progesterone antagonist that blocks progesterone receptors to ripen the cervix. The document compares these methods and provides dosing and administration details.
Novel Formulation of Prostaglandins for Induction of Labour Dinoprostone V...
The document discusses a novel formulation of prostaglandins called dinoprostone vaginal pessary for induction of labour. It provides several key advantages over existing prostaglandin formulations like misoprostol and dinoprostone gel. The sustained release pessary allows for precise control of cervical ripening over 24 hours with one application and is easy to administer and remove. Clinical studies show the pessary increases rates of vaginal delivery within 24 hours and reduces need for oxytocin or C-section compared to other induction methods.
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This document discusses induction of labor, including its definition, indications, contraindications, methods, and risks. It defines induction of labor as planned initiation of uterine contractions before spontaneous onset. Common indications include prolonged pregnancy and fetal growth restriction. Contraindications include placenta previa and severe fetal compromise. Methods discussed include membrane stripping, amniotomy, prostaglandins like misoprostol and dinoprostone, and oxytocin. Risks of induction include greater pain, uterine hyperstimulation, cord prolapse, and potential need for C-section if induction fails. The document provides three scenarios involving induction and asks for opinions on indications and complications.
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This document discusses induction of labor and provides definitions, objectives, indications, contraindications, risks, prerequisites, and methods of induction. It defines grades of evidence and levels of recommendations. The main methods discussed are natural/non-medical, mechanical (laminaria, balloons), surgical (stripping membranes, amniotomy), and pharmacological (misoprostol, mifepristone, oxytocin, prostaglandin E2). It provides details on administration and risks for each method. The goal is to create awareness of appropriate induction techniques and select the best method for each individual patient.
Cervical ripening
1) Cervical ripening is used to induce labor when the cervix is unfavorable (Bishop score <6) and involves using agents like prostaglandins, misoprostol, or mechanical methods to soften and dilate the cervix.
2) Oxytocin is commonly used for labor induction when the cervix is favorable but careful monitoring is needed due to risks of uterine tachysystole and changes in the fetal heart rate.
3) While prostaglandins are more effective cervical ripening agents compared to oxytocin alone, all methods have risks and more research is still needed to evaluate some traditional induction methods.
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This document provides information about premature labor including its definition, incidence, etiology, risk factors, signs and symptoms, investigations, management, nursing management, prevention, and complications. Premature labor is defined as regular uterine contractions before 37 weeks of gestation. It affects about 5-18% of pregnancies in India. The causes are often unknown but can be due to infections, multiple pregnancies, pre-eclampsia, and other medical conditions. Management involves bed rest, tocolytic drugs, corticosteroids, and in some cases surgical cervical cerclage. Complications for the fetus include respiratory distress, brain injuries, and death. Nursing care focuses on monitoring contractions and status of the cervix and membranes
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This document discusses various methods of antepartum fetal surveillance including fetal movement counting, non-stress tests, contraction stress tests, biophysical profiles, and Doppler ultrasounds. It provides details on how each test is performed and interpreted, and what outcomes they can predict regarding fetal wellbeing and risk of complications. The goal of antepartum fetal surveillance is to monitor the fetus, identify any risks, and prevent fetal death or neonatal complications through timely medical intervention when needed.
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Contraception in the postpartum period differs due to breastfeeding, increased risk of blood clots, and unpredictable ovulation. Counseling should occur during antenatal and postnatal periods. Options include breastfeeding, progestin-only pills, implants, IUDs, sterilization, condoms. Timing of use depends on breastfeeding status and bleeding risk. Recommendations balance effectiveness, safety, and ease of use while supporting breastfeeding.
Induction summary
This document provides guidelines for induction of labor, including:
1. Recommending inpatient and outpatient Cytotec inductions arrive at 7:00 PM to facilitate admission/discharge decisions and additional Cytotec doses if needed.
2. Inpatient Pitocin-only inductions should arrive at 6:00 AM to start Pitocin before 7:00 AM.
3. Favorable criteria for induction include a modified Bishop score of 6 or more and cervical dilation of 3-4 cm for nulliparous patients.
Induction summary
This document provides guidelines for induction of labor, including:
1. Recommending inpatient and outpatient Cytotec inductions arrive at 7:00 PM to facilitate admission/discharge decisions and additional Cytotec doses if needed.
2. Inpatient Pitocin-only inductions should arrive at 6:00 AM to start Pitocin before 7:00 AM.
3. Favorable criteria for induction include a modified Bishop score of 6 or more and cervical dilation of 3-4 cm for nulliparous patients.
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This document provides an overview of induction of labor presented by Dr. Mansi Gupta. It defines induction and augmentation of labor and discusses gestational age classifications. The document outlines absolute and relative indications for induction as well as absolute and relative contraindications. It discusses elective induction of labor and recommendations from WHO on inducing labor in various situations. Evaluation before induction includes assessing maternal and fetal status and assigning a cervical scoring system. Methods for stabilizing induction and inducing labor in specific high-risk situations like IUGR, hypertension in pregnancy, and IUFD are presented.
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This document discusses induction and augmentation of labor. It begins by defining induction of labor as artificially stimulating uterine contractions before the onset of labor, while augmentation refers to stimulating inadequate spontaneous contractions. The document then covers the structures and physiology of the cervix as it relates to ripening. It discusses various methods of assessing cervical status including Bishop's score and indications, contraindications, risks and prerequisites for labor induction. The document provides an overview of common methods used for cervical ripening and labor induction.
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Dr Ramya Pathiraja
Senior Lecturer
Faculty of Medical Sciences
University of Sri Jayewrdenepura
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Medical induction of labour
This document discusses induction of labor, including definitions, purposes, indications, contraindications, and methods. The key methods of medical induction discussed are prostaglandins like dinoprostone and misoprostol, oxytocin, and mifepristone. Prostaglandins work to ripen the cervix and stimulate contractions through local effects on cervical collagen and myometrium. Oxytocin stimulates contractions through receptor-mediated pathways. Mifepristone is a progesterone antagonist that blocks progesterone receptors to ripen the cervix. The document compares these methods and provides dosing and administration details.
Novel Formulation of Prostaglandins for Induction of Labour Dinoprostone V...
The document discusses a novel formulation of prostaglandins called dinoprostone vaginal pessary for induction of labour. It provides several key advantages over existing prostaglandin formulations like misoprostol and dinoprostone gel. The sustained release pessary allows for precise control of cervical ripening over 24 hours with one application and is easy to administer and remove. Clinical studies show the pessary increases rates of vaginal delivery within 24 hours and reduces need for oxytocin or C-section compared to other induction methods.
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This document discusses induction of labor, including its definition, indications, contraindications, methods, and risks. It defines induction of labor as planned initiation of uterine contractions before spontaneous onset. Common indications include prolonged pregnancy and fetal growth restriction. Contraindications include placenta previa and severe fetal compromise. Methods discussed include membrane stripping, amniotomy, prostaglandins like misoprostol and dinoprostone, and oxytocin. Risks of induction include greater pain, uterine hyperstimulation, cord prolapse, and potential need for C-section if induction fails. The document provides three scenarios involving induction and asks for opinions on indications and complications.
Ind madina
This document discusses induction of labor and provides definitions, objectives, indications, contraindications, risks, prerequisites, and methods of induction. It defines grades of evidence and levels of recommendations. The main methods discussed are natural/non-medical, mechanical (laminaria, balloons), surgical (stripping membranes, amniotomy), and pharmacological (misoprostol, mifepristone, oxytocin, prostaglandin E2). It provides details on administration and risks for each method. The goal is to create awareness of appropriate induction techniques and select the best method for each individual patient.
Cervical ripening
1) Cervical ripening is used to induce labor when the cervix is unfavorable (Bishop score <6) and involves using agents like prostaglandins, misoprostol, or mechanical methods to soften and dilate the cervix.
2) Oxytocin is commonly used for labor induction when the cervix is favorable but careful monitoring is needed due to risks of uterine tachysystole and changes in the fetal heart rate.
3) While prostaglandins are more effective cervical ripening agents compared to oxytocin alone, all methods have risks and more research is still needed to evaluate some traditional induction methods.
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This document discusses evidence-based approaches to antenatal Doppler fetal surveillance. It begins by outlining the objectives and aims of fetal surveillance, including identifying fetuses at risk of hypoxia and improving perinatal outcomes. It then describes various methods of fetal surveillance, including daily fetal movement counts, non-stress tests, biophysical profiles, and Doppler velocimetry. The document discusses the indications and measurements of Doppler indices for the uterine, umbilical, and middle cerebral arteries. It reviews recent evidence showing that Doppler ultrasound in high-risk pregnancies can reduce perinatal deaths and interventions without increasing them in low-risk pregnancies. The document concludes by emphasizing that not all pregnancies require surveillance and that monitoring
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This document provides information about premature labor including its definition, incidence, etiology, risk factors, signs and symptoms, investigations, management, nursing management, prevention, and complications. Premature labor is defined as regular uterine contractions before 37 weeks of gestation. It affects about 5-18% of pregnancies in India. The causes are often unknown but can be due to infections, multiple pregnancies, pre-eclampsia, and other medical conditions. Management involves bed rest, tocolytic drugs, corticosteroids, and in some cases surgical cervical cerclage. Complications for the fetus include respiratory distress, brain injuries, and death. Nursing care focuses on monitoring contractions and status of the cervix and membranes
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Similar to Summary induction guidelines
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This document provides guidelines for induction of labor, including:
1. Recommending inpatient and outpatient Cytotec inductions arrive at 7:00 PM to facilitate admission/discharge decisions and additional Cytotec doses if needed.
2. Inpatient Pitocin-only inductions should arrive at 6:00 AM to start Pitocin before 7:00 AM.
3. Favorable criteria for induction include a modified Bishop score of 6 or more and cervical dilation of 3-4 cm for nulliparous patients.
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This document provides guidelines for induction of labor, including:
1. Recommending inpatient and outpatient Cytotec inductions arrive at 7:00 PM to facilitate admission/discharge decisions and additional Cytotec doses if needed.
2. Inpatient Pitocin-only inductions should arrive at 6:00 AM to start Pitocin before 7:00 AM.
3. Favorable criteria for induction include a modified Bishop score of 6 or more and cervical dilation of 3-4 cm for nulliparous patients.
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Induction of labour is performed in over 20% of pregnancies and involves initiating contractions before spontaneous labour begins. It is indicated when delivery is considered safer for the mother or baby than continuing the pregnancy. Common indications include prolonged pregnancy beyond 41 weeks, maternal or fetal medical conditions like diabetes or growth restriction, and prelabour rupture of membranes. The decision requires weighing the potential benefits against risks of a vaginal delivery within 24-48 hours of induction versus continuing the pregnancy. Guidelines make recommendations on the gestational age for induction depending on the indication.
Management of monochorionic pregnancy
1. This document provides definitions and information on the management of monochorionic twin pregnancies. It discusses the types of twin pregnancies, screening and diagnosis of conditions like twin-twin transfusion syndrome (TTTS), selective growth restriction (sGR), and optimal treatment plans.
2. Monitoring of uncomplicated monochorionic twins involves ultrasounds every 2 weeks from 16 weeks to check amniotic fluids and growth. TTTS is diagnosed based on fluid discordance and treated with fetoscopic laser ablation before 26 weeks.
3. sGR is diagnosed when growth discordance is over 20% and referred for specialist care, with delivery planned between 32-36 weeks depending on severity. Out
Induction of labour
Induction of labour is defined as inducing labour after 28 weeks of gestation but before spontaneous onset of labour, with the aim of vaginal delivery. Common indications for induction include post-term pregnancy, hypertensive disorders, diabetes, and premature rupture of membranes. Methods for induction include mechanical methods like laminaria tents, surgical methods like artificial rupture of membranes, and medical methods using prostaglandins or oxytocin drips.
Vijayalakshmi Pillai Labor Room Protocols
The document discusses practices related to labor and delivery at Vijayalakshmi Medical Centre in Ernakulam, Kerala. It covers topics such as the benefits of pain relief during delivery, encouraging natural childbirth when possible, protocols for inducing and monitoring labor, options for pain management like epidurals and gas analgesia, policies around cesarean sections and VBAC, and techniques for instrumental deliveries.
induction of labour prtocol in palestine.pptx
This document outlines protocols for induction of labor in Palestine, including:
1. Definitions, processes, and methods of induction including vaginal prostaglandins and oxytocin infusion.
2. Precautions for each method and guidelines for amniotomy and cervical balloon placement.
3. Special considerations for induction in abnormal pregnancies like IUGR, IUFD, and previous c-section. Close monitoring and consultant discretion is advised in complex cases.
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This document discusses post-term pregnancy, defined as a pregnancy extending beyond 42 weeks from the last menstrual period. It notes that the incidence of post-term pregnancy ranges from 4-14% and can be caused by inaccurate dating, biological variability, or placental aging. Diagnosis involves assessing the patient history, weight, abdominal girth, and fetal size and position. Potential complications for both mother and baby include fetal distress, meconium aspiration, shoulder dystocia, and increased risk of operative delivery. Management of uncomplicated post-term pregnancy involves fetal surveillance and selective induction at 41 weeks, while complicated cases may require cesarean section.
Post dates and induction
This document discusses induction of labor for post-term pregnancies beyond 40 weeks gestation. It notes that while post-term births do not harm the mother, the fetus is at increased risk of complications due to placental deterioration. Specifically, the risks of meconium aspiration, low Apgar scores, and birth injury are greater. The causes of post-term births are often unknown, though inaccurate dating increases the likelihood. Methods of monitoring the fetus to determine the need for induction include kick counts, CTG, biophysical profiles and Doppler flow studies. Natural, mechanical and pharmacological methods can be used to induce labor, though risks include uterine hyperstimulation and failed induction requiring C-section.
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The document outlines guidelines for managing diabetes in pregnancy across medical centers. It discusses:
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2. Risk stratification of patients into low, medium, and high risk groups based on diabetes history and control. This determines interventions like medication management and fetal monitoring.
3. Screening all prenatal patients for GDM risk and providing diabetes education. High risk patients receive early glucose testing while low risk patients are tested at 24-28 weeks.
4. Postpartum follow-up
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The document discusses issues with the current scheduling system including too many changes and vague requests. It proposes implementing scheduled cesarean sections on call days to improve efficiency by ensuring the primary surgeon performs the surgery and eliminating wasted time. This could add 30 hours of clinic access per month. Some providers argue they are too busy, but deliveries have decreased so scheduling cesareans this way could help protect staffing levels. No more than 2 cesareans would be scheduled per provider per call day.
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This document provides guidelines for managing twin pregnancies, including determining chorionicity and amnioticity. It recommends that all twins undergo an NT ultrasound before 14 weeks to validate chorionicity/amnionicity and detect early complications. Management of monochorionic twins requires more intensive surveillance due to increased risks of complications affecting fetal growth and well-being. Dichorionic twins generally require less frequent monitoring while monochorionic twins should be monitored more closely, with delivery planned before 37 weeks.
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This document summarizes recommendations for using progesterone to prevent preterm birth based on a woman's history and cervical length. It recommends 17-hydroxyprogesterone caproate injections weekly from 16-20 weeks until 36 weeks for women with a prior spontaneous preterm birth. For women without a prior preterm birth but an incidental short cervical length of 10-20mm before 24 weeks, it recommends daily vaginal progesterone until 36 weeks. Safety follow-up of children exposed to 17-hydroxyprogesterone caproate in clinical trials found no differences compared to placebo.
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The document discusses improving patient satisfaction scores related to communication about medications at Riverside Medical Center's maternity service. The goal is to increase the HCAHPS medication communication score from 66% to 75% by December 2012 and 85% by June 2013. This will be achieved through education of providers, patients, and staff. Providers will be educated on medications through meetings and flashcards. Patients will receive verbal and written information about new medications. Staff will track medication discussions on patient care boards. Progress will be measured through education documentation and eventual HCAHPS scores.
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Pph share drive
This document discusses the management of postpartum hemorrhage (PPH). It defines PPH and risk factors. It outlines the roles and responsibilities of the nursing team in responding to a PPH. It also details the differential diagnosis, initial resuscitation steps, and therapeutic escalation based on the severity of bleeding and patient's response to treatment. The goal is to recognize and treat PPH early through decisive clinical response and prevent complications like shock.
Late preterm delivery
Late preterm infants born between 34 0/7 and 36 6/7 weeks have higher rates of morbidity than full term infants. During the initial birth hospitalization, late preterm infants are more likely to experience conditions like temperature instability, hypoglycemia, respiratory distress, and jaundice. The risks are even higher for late preterm infants whose mothers have complications like hypertension, diabetes, bleeding, or infections. Readmission rates within the first year are also higher, around 15%, for late preterm infants compared to full term infants. Late preterm infants also have higher mortality rates within the first year of life and are at greater risk for long-term neurodevelopmental issues.
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The document summarizes key findings from a review of literature on polycystic ovary syndrome (PCOS). It finds that the most consistent predictors of PCOS are hyperandrogenemia (high levels of "male" hormones) in 60-80% of cases, hirsutism (excess hair growth) in 60% of cases, and polycystic ovaries in 75% of cases. It also discusses debates around definitions of PCOS and relationships with insulin resistance.
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The document summarizes changes to CDC guidelines for prevention of early-onset group B streptococcal (GBS) disease. Key changes include: expanded laboratory detection options for GBS; revised thresholds for reporting GBS in urine cultures; clarified definitions of adequate antibiotic prophylaxis and high risk for anaphylaxis; and adjustments to neonatal management algorithms to reduce unnecessary evaluations. Guidelines emphasize using cefazolin over clindamycin or vancomycin when possible for penicillin-allergic women.
Foley bulb
The document discusses the use of Foley bulbs for cervical ripening and labor induction. It finds that:
1) A Foley bulb induction is as effective as common prostaglandin methods like misoprostol for cervical ripening and inducing labor, with fewer risks of complications.
2) Inflating the Foley bulb to 60-80ml is more effective for cervical dilation and shorter delivery times than only inflating to 30ml.
3) Using a Foley bulb alone without additional prostaglandins or oxytocin is equally effective while avoiding increased need for pain management.
Fht interpretation & management
This document provides guidelines for the management and interpretation of intrapartum fetal heart rate tracings. It discusses important factors to consider when interpreting tracings such as gestational age, maternal conditions, and fetal conditions. It describes the physiology underlying different fetal heart rate patterns. It also presents the NICHD nomenclature for standardized description of tracings, including definitions for baseline rate, variability, accelerations, and decelerations. Tracings are categorized as Category I, II, or III based on patterns that reflect fetal acid-base status. Category I tracings are normal while Category III tracings indicate abnormal fetal status and need for prompt evaluation and treatment.
Asymptomatic short cervix and vaginanal, progesterone
1. Vaginal progesterone reduces preterm birth in women with an asymptomatic sonographic short cervix in the midtrimester. The meta-analysis found vaginal progesterone once daily from identification of a short cervix <25mm until 37 weeks decreases preterm birth <33 weeks by 45% and decreases neonatal morbidity and mortality.
2. Treatment with vaginal progesterone was associated with significant reductions in preterm birth before 28 weeks, 33 weeks, and 35 weeks as well as composite neonatal morbidity and mortality.
3. There were no significant differences in adverse maternal events or congenital anomalies between the vaginal progesterone and placebo groups.
Prevention of pertussis
The document discusses pertussis (whooping cough) prevention, treatment, and epidemiology. It provides guidelines for vaccinating pregnant women and new mothers with Tdap to prevent transmission to infants. It describes the symptoms and phases of pertussis, recommends antibiotic treatment and prophylaxis, and defines close contacts for evaluation and post-exposure prophylaxis. Pertussis cases are increasing significantly in California and infants are most at risk for severe disease.
Magnesium sulfate
The document discusses evidence that magnesium sulfate administered to mothers at risk of preterm birth reduces the risk of cerebral palsy in infants. Several large randomized controlled trials and meta-analyses involving over 15,000 women found magnesium sulfate decreased the risk of cerebral palsy without increasing mortality. The number needed to treat to prevent one case of cerebral palsy is estimated at 63 women. The document also describes a modified magnesium sulfate neuroprotection protocol used at Riverside Hospital for imminent preterm deliveries between 23 and 33 weeks.
Labor down
1) Studies on delayed pushing, also called "laboring down", have shown mixed results, with the main consistent benefit being a reduced need for operative vaginal deliveries in nulliparous women with epidurals.
2) Delaying pushing can prolong the second stage of labor by about an hour and may increase risks like chorioamnionitis with delays over 1 hour.
3) Delayed pushing may be considered for nulliparous women with epidurals who do not have an urge to push and the fetal head is not yet at station +2, as long as the fetal heart rate is reassuring and no other risk factors exist. The delay should not exceed 90 minutes.
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Summary induction guidelines
- 1. Postterm Induction Guidelines USE 1) THE BISHOP SCORE 2) CERVICAL DILATION 3) PARITY 4) EGA TO MAKE DECSISONS WHEN TO SCHEDULE THER IS A RANGE FROM 41W 0d – 41 6d TO CONSIDER
- 2. DILATION SCORE 0 0 cm 2 1-2 cm 4 3-4 cm 6 >4 cm CERVICAL LENGTH SCORE By digital PALPATION 0 3 cm 1 2 cm 2 1 cm 3 0 cm STATION SCORE In relation to spines 0 -3 1 -2 2 -1/O 3 + 1/+2