Labor, Delivery, Postpartum

Apr 1, 2021 Issue
Active vs. Expectant Management in the Third Stage of Labor [Cochrane for Clinicians]

Very low-quality evidence suggests that active management of the third stage of labor reduces the risk of severe primary postpartum hemorrhage greater than 1,000 mL.

Mar 15, 2021 Issue
Pain Management in Labor [Article]

Individual patient priorities for labor pain management should be explored as a part of routine prenatal care. Continuous labor support, water immersion, and upright positioning in the first stage of labor are associated with decreased use of pharmacologic analgesia. If the patient chooses to use pain medications, effective options include parenteral opioids and regional blocks.

Jan 15, 2021 Issue
Labor Dystocia in Nulliparous Women [Article]

Avoiding admission to labor and delivery during the latent phase, assuming maternal/fetal status is reassuring, is recommended. Managing a protracted active stage includes oxytocin augmentation with or without amniotomy. Primary interventions for a protracted second stage include use of oxytocin and manual rotation from the occiput posterior fetal position. When contractions or pushing is inadequate, vacuum or forceps delivery may be needed. Effective measures for preventing dystocia and subsequent cesarean delivery include providing cervical ripening agents for induction in patients with an unfavorable cervix and walking or upright positioning during the first stage.

Jan 15, 2021 Issue
Antepartum Perineal Massage for Intrapartum Lacerations [FPIN's Help Desk Answers]

Digital antepartum and intrapartum perineal massage did not decrease perineal lacerations compared with a control group.

Nov 1, 2020 Issue
Mechanical Methods of Induction of Labor [Cochrane for Clinicians]

Mechanical induction of labor with single or double balloon catheters is similar to induction with vaginal prostaglandin E2 in rates of vaginal delivery achieved within 24 hours, and it has a more favorable safety profile.

Oct 1, 2020 Issue
Antibiotic Prophylaxis for Operative Vaginal Delivery [Medicine by the Numbers]

Current guidelines from the World Health Organization do not recommend routine antibiotic prophylaxis for operative vaginal birth because of insufficient evidence of effectiveness.

Sep 1, 2020 Issue
Placental Alpha Macroglobulin-1 (PartoSure) Immunoassay to Assess the Risk of Spontaneous Preterm Birth [Diagnostic Tests: What Physicians Need to Know]

Placental alpha macroglobulin-1 (PartoSure) is an immunoassay that measures the presence of placental alpha macroglobulin-1 (PAMG-1). PartoSure is used to assess the risk of spontaneous preterm birth and may be a useful adjunct to determine which patients with threatened preterm labor might benefit ...

Aug 1, 2020 Issue
Fetal Fibronectin Testing in Threatened Preterm Labor [Medicine by the Numbers]

Fetal fibronectin testing is a common clinical test, performed via cervicovaginal secretion swab after 22 weeks of pregnancy, and is used to identify women at increased risk for preterm delivery. Learn more about the benefits and harms of fetal fibronectin testing in threatened preterm labor.

Aug 1, 2020 Issue
Intrapartum Fetal Monitoring [Article]

Continuous electronic fetal monitoring was developed to screen for signs of hypoxic-ischemic encephalopathy, cerebral palsy, and impending fetal death during labor; it is appropriately used in high-risk labor. Structured intermittent auscultation can be used in low-risk labor and can lower operative vaginal and cesarean deliveries; however, structured intermittent auscultation remains difficult to implement because of perceived barriers in nurse staffing and physician oversight.

Jul 15, 2020 Issue
Shoulder Dystocia: Managing an Obstetric Emergency [Article]

Shoulder dystocia is an obstetric emergency. It can lead to neonatal brachial plexus injuries, hypoxia, and maternal trauma. Most cases occur without warning, but prior shoulder dystocia and preexisting or gestational diabetes mellitus increase risk. Each institution should consider the length of time it will take to prepare the operating room for general inhalational anesthesia and abdominal rescue and practice this during simulation exercises.

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