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Elective repeat cesarean delivery (ERCD) and trial of labor after previous cesarean delivery (TOLAC) both carry maternal risks. ERCD has slightly higher risks of endometritis and blood transfusion compared to TOLAC. TOLAC has a higher risk of uterine rupture compared to ERCD, but both procedures carry low risks of operative injury, hysterectomy, and death.
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Hcahps score trends in the past 4 years
This document shows trends in patient experience scores over 4 years from 2008-2012 at KP Riverside Medical Center based on the HCAHPS survey. The line graphs depict scores for various measures related to nurse and doctor communication, responsiveness of staff, pain management, medication communication, discharge processes, cleanliness and quietness. Scores fluctuate over time but generally remain between 60-90% for most measures.
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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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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.
Hyperemesis6 12
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Gbs 2010
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.
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Vbac tables
- 1. Table 1. Composite Maternal Risks from Elective Repeat Cesarean Delivery and Trial of Labor After Previous Cesarean Delivery Maternal Risks ERCD (%) TOLAC (%) Two or One CD more CDs Endometritis 1.5–2.1 2.9 3.1 Operative injury 0.4–0.6 0.4 0.4 Blood transfusion 1–1.4 0.7–1.7 3.2 Hysterectomy 0–0.4 0.2–0.5 0.6 Uterine rupture 0.4–0.5 0.7–0.9 0.9–1.8 Maternal Death NIH 13 / 100K 4 / 100K