Management of Labor and Delivery E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1205

Veröffentlichungsjahr: 2016

Beschreibung

The process of labor and delivery has been one of the most perilous activities in human life. The awkward evolutionary compromises giving rise to humans makes birthing potentially life threatening for both mother and child. Despite the development of modern care, labor and delivery continues to be a dangerous process even though the levels of fatality have decreased over the past several decades.

This clinically focused guide to modern labor and delivery care covers low and high-risk situations, the approach of the team in achieving a successful outcome and what to consider when quick decisions have to be made. Aimed at both trainee and practicing obstetrician-gynecologists, this new edition includes practical guidance such as algorithms, protocols, and quick-reference summaries. It is squarely focused on the process of birth and concentrates on modern clinical concerns, blending science with clinical applications.

Leseprobe

CONTENTS

Cover

Title Page

Contributor List

CHAPTER 1: Antenatal preparation for labor

1.1 Introduction

1.2 Goals of antenatal childbirth education

1.3 Theoretical approaches to antenatal childbirth education

1.4 Effectiveness of childbirth preparation: educational goals and pregnancy outcomes

1.5 Future direction for advancing antenatal childbirth education

1.6 Who teaches childbirth education classes and where?

1.7 Prenatal education class content

1.8 Group prenatal care

1.9 Self-prepared birth plans

References

CHAPTER 2: Normal labor and delivery

2.1 Introduction

2.2 Labor onset

2.3 First stage of labor

2.4 Second stage of labor

2.5 Third stage of labor

2.6 Intrapartum care during normal labor and delivery

2.7 Conclusion

References

CHAPTER 3: Management of labor and delivery in low-risk subjects

3.1 Introduction

3.2 First stage

3.3 Amniotomy

3.4 Second stage

3.5 Perineal massage

3.6 Episiotomy

3.7 Cord clamping

3.8 Third stage

3.9 Conclusion

References

CHAPTER 4: Induction and augmentation of labor

4.1 Introduction

4.2 Indications and contraindications for induction or augmentation of labor

4.3 Risks associated with labor induction

4.4 Predicting success of labor

4.5 Mechanical cervical ripening

4.6 Biochemical agents for cervical ripening

4.7 Oxytocin

4.8 Active management of labor

4.9 Failed induction

4.10 Safety and quality protocols

4.11 Conclusion

References

CHAPTER 5: Fetal monitoring and assessment

5.1 Introduction

5.2 Historical perspectives

5.3 Intrapartum electronic fetal monitoring

5.4 Fetal scalp sampling

5.5 Fetal pulse oximetry

5.6 Fetal ST segment analysis

5.7 Research and the future

References

CHAPTER 6: Operative vaginal delivery

6.1 Introduction

6.2 Indications, contraindications, and prerequisites for operative vaginal delivery

6.3 Classification system for operative vaginal delivery

6.4 Technical aspects of operative vaginal delivery

6.5 Effectiveness of operative vaginal delivery

6.6 Maternal morbidity

6.7 Pelvic floor dysfunction after operative vaginal delivery

6.8 Neonatal morbidity

6.9 Long-term neonatal outcomes

6.10 Mode of delivery: sequential instruments versus cesarean section

6.11 Subsequent pregnancy outcomes following operative vaginal delivery

6.12 The future of operative vaginal delivery

6.13 Conclusion

References

CHAPTER 7: Cesarean delivery

7.1 Introduction

7.2 Cesarean technique

7.3 Postcesarean delivery care

7.4 Considerations for cesarean under special scenarios

References

CHAPTER 8: Trial of labor after cesarean

8.1 Background

8.2 Risks of trial of labor after cesarean

8.3 Predictors of vaginal birth after cesarean

8.4 Uterine rupture

8.5 Pregnancy management

References

CHAPTER 9: Malpresentation and malposition

9.1 Introduction

9.2 Malpresentation

9.3 Malposition

9.4 Conclusions

References

CHAPTER 10: Multiple gestations

10.1 Introduction

10.2 Perinatal and maternal complications

10.3 Intrapartum preparation

10.4 Timing of delivery

10.5 Delivery

10.6 Vertex/vertex

10.7 Vertex/nonvertex

10.8 Nonvertex first twin

10.9 Cesarean delivery

10.10 Special cases

10.11 Special procedures

10.12 Conclusion

References

CHAPTER 11: Obstetrical emergencies

11.1 Background

11.2 Postpartum hemorrhage

11.3 Shoulder dystocia

11.4 Umbilical cord prolapse

11.5 Head entrapment

11.6 Seizure

11.7 Cardiopulmonary arrest and perimortem cesarean delivery

11.8 Summary

References

CHAPTER 12: Surgical management of obstetrical emergencies

12.1 Introduction

12.2 Uterine tamponade and packing

12.3 Uterine compression sutures

12.4 Uterine compression suture technique

12.5 Uterine artery ligation

12.6 Combination procedures for uterine preservation

12.7 Hypogastric artery ligation

12.8 Peripartum hysterectomy

12.9 Retained placenta

12.10 Obstetric laceration

12.11 Acute postpartum hematoma

12.12 Emergency cesarean

12.13 Perimortem cesarean

12.14 Conclusion

References

CHAPTER 13: Maternal disorders affecting labor and delivery

13.1 Hypertensive disorders of pregnancy

13.2 Gestational hypertension

13.3 Chronic hypertension/superimposed preeclampsia

13.4 Preeclampsia

13.5 Management of preeclampsia in labor

13.6 Eclampsia

13.7 Cardiac disease

13.8 Pulmonary disease

13.9 Renal disease

13.10 Diabetes

13.11 Neurologic disorders

13.12 Infections

References

CHAPTER 14: Fetal disorders affecting labor and delivery

14.1 Growth disturbances

14.2 Hemophilia

14.3 Skeletal dysplasias

14.4 Genetic abnormalities

14.5 Cardiac defects

14.6 Abdominal wall defects

14.7 Myelomeningocele

References

CHAPTER 15: Labor and delivery management of the obese gravida

15.1 Intrapartum management

15.2 Cesarean section

References

CHAPTER 16: Intrapartum and postpartum infections

16.1 Introduction

16.2 Group B

Streptoccocus

16.3 Varicella

16.4 Urinary tract infections / pyelonephritis

16.5 Parvovirus

16.6 Listeriosis

16.7 Human immunodeficiency virus / acquired immunodeficiency syndrome

16.8 Chorioamnionitis

16.9 Rubella

16.10 Toxoplasmosis

16.11 Hepatitis B

16.12 Hepatitis C

16.13 Cytomegalovirus

16.14 Herpes

16.15 Wound infections

16.16 Endometritis

16.17 Septic pelvic thrombophlebitis

16.18 Mastitis

References

CHAPTER 17: Obstetric anesthesia

17.1 A brief history of obstetric anesthesia

17.2 Anesthetic implications of the physiology of labor and delivery

17.3 Pain sensation in pregnancy, labor, and delivery

17.4 Management of pain in labor and delivery

17.5 Neuraxial techniques

17.6 Surgical anesthesia for the parturient

17.7 Non-delivery surgical anesthesia for the parturient

17.8 Hypertensive diseases of pregnancy

17.9 Management of obstetric hemorrhage

17.10 Anesthetic implications of specific maternal co-morbidities

References

CHAPTER 18: Postpartum care

18.1 Goals of care

18.2 Postpartum physiologic changes

18.3 The fourth stage of labor

18.4 Complications

Acknowledgments

References

CHAPTER 19: Development of an obstetrical patient safety program

19.1 Introduction

19.2 Background and fundamentals of patient safety

19.3 Building blocks of an obstetric patient safety program

19.4 Measuring patient safety

19.5 The evidence on quality improvement in obstetrics

19.6 Conclusion

References

Index

End User License Agreement

List of Tables

Chapter 01

Table 1.1 Goals of antenatal childbirth classes.

Table 1.2 Potential effects of childbirth classes identified in research.

Table 1.3 Prevalent models of antepartum education.

Table 1.4 Common methods of non-pharmacologic and pharmacologic pain control for labor and delivery.

Table 1.5 Possible benefits of group prenatal care.

Chapter 02

Table 2.1 Comparison of study populations between Friedman's study and the current study.

Table 2.2 Characteristics of the parturients by parity (weighted), Consortium on Safe Labor, 2002–2008.

Table 2.3 Duration of labor in hours by parity in spontaneous onset of labor.

Table 2.4 Comparison between CPP and CSL in nulliparous women.

Table 2.5 Duration of labor (in hours) in nulliparas based on cervical dilation at admission, National Collaborative Perinatal Project (CPP), 1959–1966.

Table 2.6 Maternal and labor characteristics of nulliparous women stratified by length of the first stage of labor.

*

Table 2.7 Adjusted odds ratios of perinatal outcomes in multivariate logistic regression analyses stratified by length of the first stage of labor.

Chapter 04

Table 4.1 Bishop scoring system.

Table 4.2 Examples of oxytocin regimens.

Table 4.3 Example of midtrimester oxytocin regimen.

Table 4.4 Examples of prostaglandin regimens for cervical ripening at term.

Chapter 05

Table 5.1 Standard nomenclature – the EFM category system.

Chapter 06

Table 6.1 ACOG classification of types of forceps delivery.

Table 6.2 Forceps delivery versus vacuum delivery: risk of maternal perineal trauma.

Table 6.3 Forceps delivery versus vacuum delivery: neonatal trauma.

Table 6.4 Rate of intracranial hemorrhage by mode of delivery.

Table 6.5 Maternal outcomes and preferences regarding subsequent pregnancy following delivery during the second stage of labor by operative vaginal delivery compared to cesarean delivery.

Chapter 08

Table 8.1 Maternal risks by route of delivery in women with a prior cesarean.

Table 8.2 Neonatal risks by route of delivery in women with a prior cesarean.

Chapter 09

Table 9.1 Proportion of singleton live births that were delivered in breech presentation in the US in 2008, with stratification by gestational age.

Table 9.2 Factors associated with success/failure of external cephalic version.

Chapter 10

Table 10.1 Maternal-fetal risks of multiple gestations.

Table 10.2 Intrapartum preparation in multiple gestations.

Table 10.3 Nonvertex second twin-similar outcomes for cesarean and vaginal delivery.

Table 10.4 Studies favoring cesarean for delivery of nonvertex second twin.

Table 10.5 Trial of labor after cesarean (TOLAC) in twins.

Chapter 11

Table 11.1 Etiology and risk factors for postpartum hemorrhage.

Table 11.2 Medical and surgical management of postpartum hemorrhage.

Table 11.3 Blood product components.

Table 11.4 “HELPERR” Mnemonic for management of shoulder dystocia.

Chapter 13

Table 13.1 Systolic and diastolic blood pressure criteria for diagnosis of mild and severe chronic hypertension.

Table 13.2 Recommended gestational age for delivery for women with chronic hypertensive disease in pregnancy.

Table 13.3 Diagnostic criteria for preeclampsia and preeclampsia with severe features.

Table 13.4 Maternal and fetal indications for delivery in patients with severe preeclampsia.

Table 13.5 The content, volume, and indications for blood product replacement in the case of severe hemorrhage or coagulopathy.

Table 13.6 Subsets of oliguria (I–III), the associated hemodynamic findings, and recommended treatments.

Table 13.7 Indications for invasive monitoring of maternal status in preeclampsia.

Table 13.8 New York Heart Association classification of heart failure by patient symptoms.

Table 13.9 Maternal cardiac disease and risk stratification during pregnancy.

Table 13.10 Indications for endocarditis prophylaxis in the pregnant patient during labor and delivery.

Table 13.11 Recommended antibiotic prophylaxis regimens for prevention of bacterial endocarditis for women during labor and delivery.

Table 13.12 White’s classification of diabetes.

Table 13.13 Carpenter–Coustan blood glucose cutoffs for the 100-gram glucose test in pregnancy. Two or more values elevated above the cutoffs are used to diagnose the patient with gestational diabetes.

Table 13.14 Duration and onset of action for various types of insulin used in pregnancy.

Table 13.15 Management of fluid and metabolic derangements associated with diabetic ketoacidosis in pregnancy.

Table 13.16 Clinical presentation and diagnostic work-up for various neurologic conditions commonly seen in pregnancy.

Table 13.17 Dosages of commonly used antiepileptic drugs in pregnancy.

Table 13.18 Recommended treatments for opportunistic infections in AIDs patients.

Table 13.19 Recommend doses of antiviral medications for herpes in pregnancy.

Chapter 14

Table 14.1 Various maternal, fetal, and placental factors leading to intrauterine growth restriction of the fetus.

Table 14.2 Features of osteogenesis imperfecta by type.

Table 14.3 Considerations and recommended mode of delivery for fetal congenital heart defects.

Chapter 16

Table 16.1 GBS indications for treatment.

Chapter 17

Table 17.1 Systemic opioids commonly used for labor pain relief.

Table 17.2 New York Heart Association functional capacity.

Table 17.3 Central hemodynamic assessment of normal term pregnancy.

Table 17.4 Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy.

Table 17.5 Prevention of bacterial endocarditis.

Table 17.6 Prevention of bacterial endocarditis.

Table 17.7 Anesthetic implications of systemic lupus erythematosus.

Table 17.8 Anesthetic implications of rheumatoid arthritis.

Table 17.9 Clinical classification of myasthenia gravis.

Chapter 18

Table 18.1 Trajectory of normal recovery in the inpatient period.

Table 18.2 Contraindications to breastfeeding.

Table 18.3 CDC categories for classifying hormonal contraceptives and intrauterine devices.

Table 18.4 Recommendations for postpartum hormonal, intrauterine, and barrier contraceptive use.

Table 18.5 Etiology and risk factors for postpartum hemorrhage.

Table 18.6 Key issues in hemorrhage management, by stage of hemorrhage.

Table 18.7 Uterotonics.

Table 18.8 Baseline risk of postpartum VTE of > 3%.

Table 18.9 VTE recommendations for antepartum and postpartum management: comparison.

Table 18.10 Differential diagnosis of postpartum hypertension.

Table 18.11 Differential diagnosis of postpartum headache.

Table 18.12 Risk factors for anal sphincter injury and perineal wound breakdown.

Table 18.13 Helpful and unhelpful responses for grieving parents.

Chapter 19

Table 19.1 Obstetric Adverse Outcome Index (AOI) indicators [44].

List of Illustrations

Chapter 01

Figure 1.1 The Pain Management Model.

Figure 1.2 Mastery as the key to childbirth satisfaction.

Chapter 02

Figure 2.1 Comparison between the Friedman curve and the pattern of cervical dilation based on the current data.

Figure 2.2 Patterns of cervical dilation (left) and fetal descent (right) in nulliparous women.

Figure 2.3 Average labor curves by parity in singleton term pregnancies with spontaneous onset of labor, vaginal delivery, and normal neonatal outcomes. P0, nulliparous women; P1, women of parity 1; P2, women of parity 2 or higher. The Consortium on Safe Labor, 2002–2008.

Figure 2.4 The average labor curves for nulliparas in the CPP and CSL cohorts. Average labor curves for women by study with singleton term pregnancies presenting in spontaneous labor with vaginal delivery for nulliparas. Curves were evaluated at the average values of the combined population for maternal age, maternal race, body mass index at delivery, spontaneous rupture of membranes, gestational age, and birthweight. Collaborative Perinatal Project (CPP) was conducted from 1959 to 1966; Consortium on Safe Labor (CSL) was conducted from 2002 to 2008.

Figure 2.5 The average labor curves for multiparas in the CPP and CSL cohorts. Average labor curves for women by study with singleton term pregnancies presenting in spontaneous labor with vaginal delivery for nulliparas. Curves were evaluated at the average values of the combined population for maternal age, maternal race, body mass index at delivery, spontaneous rupture of membranes, gestational age, and birthweight. Collaborative Perinatal Project (CPP) was conducted from 1959 to 1966; Consortium on Safe Labor (CSL) was conducted from 2002 to 2008.

Figure 2.6 The average labor curves by parity in women with singleton term pregnancies with spontaneous onset of labor and vertex presentation who completed the first stage of labor and whose newborns had 5-minute Apgar scores of at least 7. The National Collaborative Perinatal Project, 1959–966. P0, nulliparas; P1, parity 1; P2_, parity 2 or higher.

Chapter 04

Figure 4.1 Illustration of Dilapan

®

. (a) Dilapan prior to insertion; (b) Dilapan after fluid absorption and expansion.

Figure 4.2 Image of balloon catheters. Top: Foley catheter inflated with 30 mL sterile saline. Bottom: Cook

®

Balloon catheter with 60 mL inflated in the cervical balloon and 40 mL inflated in the vaginal balloon.

Figure 4.3 Example of guidelines for scheduling induction of labor.

Chapter 05

Figure 5.1 Fetal scalp electrode (FSE). (a) FSE in the plastic introducer; (b) FSE electrode to be applied to the fetal scalp.

Figure 5.2 Sample of bedside monitoring of EFM and contractions; uterine contractions are found in the lower band.

Figure 5.3 An intrauterine pressure catheter (IUPC) inside its plastic guide, ready for insertion.

Figure 5.4 A prolonged deceleration; note the fetal heart rate baseline in the 150s.

Figure 5.5 Repetitive variable decelerations.

Figure 5.6 Amnioinfusion: intrauterine pressure catheter connected with intravenous tubing to a saline infusion required to start an amnioinfusion.

Chapter 06

Figure 6.1a Simpson forceps demonstrating fenestrated blades and parallel shanks.

Figure 6.1b Simpson forceps with a Luikart modification defined by the addition of pseudo-fenestrated blades.

Figure 6.2 Kiwi® OmniCup vacuum extractor: Soft cup with handheld pump designed for single operator use.

Chapter 07

Figure 7.1 Vertical midline and transverse skin incision at cesarean delivery.

Figure 7.2 Low-transverse, low-vertical, and classical uterine incisions

.

Figure 7.3 Closure of low-transverse uterine after delivery of the fetus and placenta with continuous suture.

Chapter 10

Figure 10.1 Fetal death rate and prospective risk of fetal death (stillbirth) for singleton and twin gestations.

Figure 10.2 Three presentation alternatives encountered in twin gestations and their relative frequencies.

Figure 10.3 Interlocking chins of a breech/vertex twin gestation resulting in an impacted delivery.

Figure 10.4 Deflexion of the head of breech twin A due to the influence of the vertex of twin B.

Figure 10.5 During the delivery of twin A, an assistant uses the ultrasound transducer to identify the lie of twin B and initiates efforts to induce the fetal version to a cephalic presentation.

Figure 10.6 Following delivery of twin A, the operator uses both hands to perform a forward roll into a cephalic presentation.

Chapter 11

Figure 11.1 Sample form for documentation of shoulder dystocia events.

Figure 11.2 American Heart Association Maternal Cardiac Arrest algorithm.

Chapter 12

Figure 12.1 Bakri Balloon for uterine tamponade.

Figure 12.2 Glenveigh Belfort-Dildy Obstetric Tamponade System (ebb

TM

).

Figure 12.3 Drawing of the B-Lynch uterine compression suture.

Chapter 13

Figure 13.1 Recommendations from the American College of Obstetricians and Gynecologists for the use of intravenous labetalol and hydralazine in the management of severe range blood pressure.

Figure 13.2 Recommendations for anticoagulation prophylaxis or treatment during the antepartum and postpartum period for women with a history of VTE or inherited thrombophilia from the American College of Obstetricians and Gynecologists. Low-risk thrombophilias include factor V Leiden heterozygous, prothrombin mutation heterozygous, and protein C or S deficiency. High risk thrombophilias include antithrombin deficiency, double heterozygous prothrombin mutation and factor V Leiden, factor V Leiden homozygous, and prothrombin mutation heterozygous.

Figure 13.3 Prophylactic and therapeutic anticoagulation doses for the antepartum and postpartum periods from the American College of Obstetricians and Gynecologists.

Figure 13.4 Flowchart for management of status epilepticus in a pregnant patient.

Chapter 16

Figure 16.1 GBS treatment regimens.

Figure 16.2 Ascending pyelonephritis.

Figure 16.3 Parvo virus treatment flow diagram.

Figure 16.4 Chorioamnionitis.

Figure 16.5 Necrotizing fasciitis.

Figure 16.6 Mastitis.

Chapter 18

Figure 18.1 Anatomy of a proper latch.

Figure 18.2 The uterine fundus can be replaced by steady upward pressure from the provider’s upturned hand.

Figure 18.3 After replacement, the provider’s hand should remain in place while contractions are stimulated.

Figure 18.4 Management algorithm for persistent postpartum hypertension.

Figure 18.5 Evaluation of severe postpartum headache.

Figure 18.6 Sensitive photography assists families with creating mementos after perinatal loss.

Chapter 19

Figure 19.1 Example of a chain of command.

Figure 19.2 and Figure 19.3 Examples of a laminated reference card outlining the key principles of team training.

Figure 19.4 and Figure 19.5 Examples of a laminated reference card outlining the key principles of electronic fetal monitoring interpretation.

Figure 19.6 The Yale-New Haven Hospital obstetric Adverse Outcomes Index from September 2004 to August 2007.

Guide

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Table of Contents

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Management of Labor and Delivery

EDITED BY

George A. Macones MD

Mitchell and Elaine Yanow Professor and ChairDepartment of Obstetrics and GynecologyWashington University School of MedicineSt Louis, MO, USA

SECOND EDITION

This edition first published 2016 © 2016, 1997 by John Wiley & Sons, Ltd

Registered OfficeJohn Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

Editorial Offices9600 Garsington Road, Oxford, OX4 2DQ, UKThe Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK111 River Street, Hoboken, NJ 07030-5774, USA