ITEMS IN AFP WITH KEYWORD:
Labor, Delivery, Postpartum
Neonatal abstinence syndrome (NAS) is a constellation of symptoms observed in newborns exposed to opioids during pregnancy. The incidence of NAS has steadily increased during the past decade as more infants have been born to mothers with opioid use disorder (OUD). Pregnancy and the postpartum period...
Obstetric lacerations are a common complication of vaginal delivery and can lead to chronic pain and urinary and fecal incontinence. Perineal lacerations are defined by the depth of musculature involved. Late third-trimester perineal massage can reduce perineal lacerations in primiparous women. Lacerations involving the anal sphincter complex require additional expertise, exposure, and lighting. Postdelivery care should focus on pain control, preventing constipation, and monitoring for urinary retention. Acetaminophen and nonsteroidal anti-inflammatory drugs should be administered for pain as needed. Osmotic laxative use leads to earlier bowel movements and less pain during the first bowel movement.
Most out-of-hospital births occur at home and are assisted by midwives. U.S. studies have shown that home births increase perinatal mortality and neonatal morbidity compared with hospital births. However, planned community births also have lower odds of obstetric interventions, including cesarean delivery. Maternal and newborn health professionals who attend planned community births should be licensed and integrated into a maternity health care system. Family physicians are uniquely poised to counsel patients and their families on the risks and benefits of choosing community birth.
Jun 1, 2021 Issue
Oxytocin as First-line Uterotonic Therapy for Postpartum Hemorrhage [Medicine by the Numbers]
Oxytocin decreases the chances of a blood transfusion and has fewer adverse effects compared with misoprostol.
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.
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.
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.
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.