Labor, Delivery, Postpartum

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.

Jun 1, 2020 Issue
Potential of Fetal Fibronectin Testing to Prevent Preterm Birth [Cochrane for Clinicians]

Fetal fibronectin testing may reduce preterm birth, although the evidence is not strong enough to recommend regular testing.

May 1, 2020 Issue
Tranexamic Acid for Postpartum Hemorrhage [Medicine by the Numbers]

Postpartum hemorrhage is the most common cause of maternal death worldwide. Tranexamic acid is an antifibrinolytic agent that has shown to decrease bleeding in surgical patients and all-cause death in trauma patients. Does early administration of tranexamic acid reduce the rate of death and hysterec...

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