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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. J Obstet Gynecol Neonatal Nurs 2024; 53:e10-e48. [PMID: 38363241 DOI: 10.1016/j.jogn.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. Nurs Womens Health 2024; 28:e1-e39. [PMID: 38363259 DOI: 10.1016/j.nwh.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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Nunes I, Nicholson W, Theron G. FIGO good practice recommendations on surgical techniques to improve safety and reduce complications during cesarean delivery. Int J Gynaecol Obstet 2023; 163 Suppl 2:21-33. [PMID: 37807585 DOI: 10.1002/ijgo.15117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
FIGO is actively contributing to the global effort to reduce maternal morbidity, mortality, and disability worldwide. Cesarean delivery rates are increasing globally, without signs of slowing down. Bleeding associated with cesarean delivery has become an important cause of hemorrhage-related maternal deaths in many low- and middle-income countries. Correct surgical techniques to improve safety and reduce complications of cesarean delivery is of the utmost importance. This article presents FIGO's good practice recommendations for effective surgical techniques to reduce cesarean complications. Evidence-based information is included where data are available. An expanded WHO Surgical Safety Checklist for maternity cases is suggested. Different incision techniques through the layers of the abdominal wall with appropriate indications are discussed. Hysterotomy through a transverse incision is described, as are indications for low vertical and classical incisions. Important precautions when extracting the fetus are explained. Uterine closure includes a safe method ensuring adequate reapproximation of the upper segment if a vertical incision is made. The paper concludes with the management of two common bleeding problems following delivery of the placenta.
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Affiliation(s)
- Inês Nunes
- Centro Hospitalar Vila Nova de Gaia/Espinho, Department of Obstetrics and Gynaecology, CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Wanda Nicholson
- George Washington University Milken School of Public Health, Washington, District of Columbia, USA
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Barnea ER, Muller M, Di Simone N, Inversetti A, Pacagnella R, Borovac-Pinheiro A, Nicholson W. Prep-for-Labor: Overview of FIGO's labor and delivery triage bundles of care to optimize maternal and newborn outcomes. Int J Gynaecol Obstet 2023; 163 Suppl 2:34-39. [PMID: 37807589 DOI: 10.1002/ijgo.15112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Childbirth is an intense event in which decisions may need to be made in seconds to guarantee the health of both mother and newborn. Despite health systems and care approaches varying widely according to real-life scenarios, availability of facilities, beliefs, resources, staff, and geography, among others, optimal outcomes should be ensured worldwide. Triaging low-risk pregnancies from high-risk pregnancies is the first step to ensure proper allocation of resources. From this need, we developed FIGO's Prep-For-Labor triage methods, a series of 2-minute labor and delivery bundles of care, with special regard given to low- and middle-income countries and rural settings. Around 80% of women, once properly triaged, can pursue vaginal delivery with minimal intervention, while those at risk can either be managed on site or transferred promptly to an advanced care site. FIGO's bundles of care and good practice recommendations for labor and delivery and immediate newborn triage cover four clinical scenarios: (1) preterm labor; (2) induced or spontaneous labor at term; (3) cesarean delivery; and (4) newborn care. From rapid triage of the mother (low vs high risk) to the list of required equipment, description of skilled staff, and coordination of resources, the recommendations for care are introduced across these four areas in this overview article. Implementing the proposed management steps described in each summary can improve maternal and neonatal outcomes.
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Affiliation(s)
- Eytan R Barnea
- Society for the Investigation of Early Pregnancy (SIEP), New York, New York, USA
- Department of Obstetrics Gynecology & Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Martin Muller
- Department of Obstetrics and Gynecology, Lindenhofgruppe, Bern, Switzerland
- Department of Pediatrics, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Annalisa Inversetti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Rodolfo Pacagnella
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Campinas, São Paulo, Brazil
| | | | - Wanda Nicholson
- The George Washington Milken Institute of Public Health, Washington, District of Columbia, USA
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5
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Pingray V, Widmer M, Ciapponi A, Hofmeyr GJ, Deneux C, Gülmezoglu M, Bloemenkamp K, Oladapo OT, Comandé D, Bardach A, Vázquez P, Cormick G, Althabe F. Effectiveness of uterine tamponade devices for refractory postpartum haemorrhage after vaginal birth: a systematic review. BJOG 2021; 128:1732-1743. [PMID: 34165867 PMCID: PMC9292664 DOI: 10.1111/1471-0528.16819] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate uterine tamponade devices' effectiveness for atonic refractory postpartum haemorrhage (PPH) after vaginal birth and the effect of including them in institutional protocols. SEARCH STRATEGY PubMed, EMBASE, CINAHL, LILACS, POPLINE, from inception to January 2021. STUDY SELECTION Randomised and non-randomised comparative studies. OUTCOMES Composite outcome including surgical interventions (artery ligations, compressive sutures or hysterectomy) or maternal death, and hysterectomy. RESULTS All included studies were at high risk of bias. The certainty of the evidence was rated as very low to low. One randomised study measured the effect of the condom-catheter balloon compared with standard care and found unclear results for the composite outcome (relative risk [RR] 2.33, 95% CI 0.76-7.14) and hysterectomy (RR 4.14, 95% CI 0.48-35.93). Three comparative studies assessed the effect of including uterine balloon tamponade in institutional protocols. A stepped wedge cluster randomised controlled trial suggested an increase in the composite outcome (RR 4.08, 95% CI 1.07-15.58) and unclear results for hysterectomy (RR 4.38, 95% CI 0.47-41.09) with the use of the condom-catheter or surgical glove balloon. One non-randomised study showed unclear effects on the composite outcome (RR 0.33, 95% CI 0.11-1.03) and hysterectomy (RR 0.49, 95% CI 0.04-5.38) after the inclusion of the Bakri balloon. The second non-randomised study found unclear effects on the composite outcome (RR 0.95, 95% CI 0.32-2.81) and hysterectomy (RR 1.84, 95% CI 0.44-7.69) after the inclusion of Ebb or Bakri balloon. CONCLUSIONS The effect of uterine tamponade devices for the management of atonic refractory PPH after vaginal delivery is unclear, as is the role of the type of device and the setting. TWEETABLE ABSTRACT Unclear effects of uterine tamponade devices and their inclusion in institutional protocols for atonic refractory PPH after vaginal delivery.
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Affiliation(s)
- V Pingray
- Instituto de Efectividad Clínica y Sanitaria (IECS‐CONICET)Buenos AiresArgentina
| | - M Widmer
- UNDP‐UNFPA‐UNICEF‐WHO‐World Bank Special Program of Research, Development, and Research Training in Human Reproduction (HRP)Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - A Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS‐CONICET)Buenos AiresArgentina
| | - GJ Hofmeyr
- University of BotswanaGaboroneBotswana
- Effective Care Research UnitUniversity of the Witwatersrand/Walter Sisulu UniversityMthathaSouth Africa
| | - C Deneux
- Obstetrical Perinatal and Pediatric Epidemiology Research TeamEPOPéINSERMINRAU1153 Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS)Université de ParisParisFrance
| | - M Gülmezoglu
- UNDP‐UNFPA‐UNICEF‐WHO‐World Bank Special Program of Research, Development, and Research Training in Human Reproduction (HRP)Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
- Concept FoundationGenevaSwitzerland
| | - K Bloemenkamp
- Department of ObstetricsBirth Centre Wilhelmina's Children Hospital, Division Woman and BabyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - OT Oladapo
- UNDP‐UNFPA‐UNICEF‐WHO‐World Bank Special Program of Research, Development, and Research Training in Human Reproduction (HRP)Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - D Comandé
- Instituto de Efectividad Clínica y Sanitaria (IECS‐CONICET)Buenos AiresArgentina
| | - A Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS‐CONICET)Buenos AiresArgentina
| | - P Vázquez
- Instituto de Efectividad Clínica y Sanitaria (IECS‐CONICET)Buenos AiresArgentina
| | - G Cormick
- Instituto de Efectividad Clínica y Sanitaria (IECS‐CONICET)Buenos AiresArgentina
| | - F Althabe
- UNDP‐UNFPA‐UNICEF‐WHO‐World Bank Special Program of Research, Development, and Research Training in Human Reproduction (HRP)Department of Sexual and Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
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Di Pasquo E, Volpe N, Labadini C, Morganelli G, Di Tonto A, Schera GBL, Rizzo G, Frusca T, Ghi T. Antepartum evaluation of the obstetric conjugate at transabdominal 2D ultrasound: A feasibility study. Acta Obstet Gynecol Scand 2021; 100:1917-1923. [PMID: 34240404 DOI: 10.1111/aogs.14226] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The obstetric conjugate represents the shortest anteroposterior diameter of the birth canal and it reflects the capacity of the pelvic inlet to allow the passage and the engagement of the fetal head. The antepartum evaluation of this parameter may be attempted at digital examination to predict the risk of cephalopelvic disproportion, but the accuracy of clinical pelvimetry is notoriously poor. The aim of our study was to describe the sonographic measurement of the obstetric conjugate at transabdominal 2D-ultrasound and to assess its reproducibility. MATERIAL AND METHODS This is a prospective cohort study conducted at a tertiary University hospital. A non-consecutive series of pregnant women with uncomplicated singleton pregnancies attending the antenatal clinic for routine booking from 34 weeks of gestation onward were included. The ultrasound probe was longitudinally placed above the level of the symphysis and the interpubic fibrocartilaginous disk was visualized. Then the promontory was identified as the most prominent segment of the sacral vertebral column. The obstetric conjugate was measured as the distance between the inner edge of the interpubic disk and the promontory. The inter- and intraobserver repeatability of this measurement was calculated using the intraclass correlation coefficient (ICC) and the Bland-Altman method. RESULTS In all, 119 women were considered eligible for the study; of these, 111/119 (93.3%) women were included in the analysis with a median gestational age of 36.0 (35.0-37.0) weeks. The mean obstetric conjugate measurement was 11.4 ± 0.93 mm for the first operator and 11.4 ± 0.91 mm for the second operator. The overall interobserver ICC was 0.95 (95% [confidence interval] CI 0.92-0.96) and the overall intraobserver ICC was 0.97 (95% CI 0.96-0.98). Limits of agreement ranged from -0.84 to 0.80 for interobserver measures and from -0.64 to 0.62 for intraobserver measures. The degree of reliability was also analyzed for women with a body mass index ≥30 and for women with a gestational age ≥37 weeks. The inter- and intraobserver ICCs were respectively 0.97 (95% CI 0.90-0.98) and 0.98 (0.95-0.99) in the former group and 0.96 (95% CI 0.93-0.98) and 0.97 (95% CI 0.95-0.98) in the latter group. CONCLUSIONS Our study demonstrated that among pregnant women at term gestation, sonographic measurement of the obstetric conjugate is feasible and reproducible.
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Affiliation(s)
- Elvira Di Pasquo
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | - Nicola Volpe
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | - Corinne Labadini
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Surgical Sciences, University of Parma, Parma, Italy
| | - Giovanni Morganelli
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Surgical Sciences, University of Parma, Parma, Italy
| | - Andrea Di Tonto
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Surgical Sciences, University of Parma, Parma, Italy
| | - Giovanni B L Schera
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Surgical Sciences, University of Parma, Parma, Italy
| | - Giuseppe Rizzo
- Department of Maternal and Fetal Medicine, "Cristo Re" Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Tiziana Frusca
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Surgical Sciences, University of Parma, Parma, Italy
| | - Tullio Ghi
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Surgical Sciences, University of Parma, Parma, Italy
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Bartlett L, Avery L, Ponnappan P, Chelangat J, Cheruiyot J, Matthews R, Rocheleau M, Tikkanen M, Allen M, Amendola P, Labrique A. Insights into the design, development and implementation of a novel digital health tool for skilled birth attendants to support quality maternity care in Kenya. Fam Med Community Health 2021; 9:fmch-2020-000845. [PMID: 34344764 PMCID: PMC8336131 DOI: 10.1136/fmch-2020-000845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Linda Bartlett
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lisa Avery
- Centre for Global Public Health, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | | | | | | | | | | | | | - Mark Allen
- Strategic Partnerships, Merck for Mothers, Kenilworth, New Jersey, USA
| | | | - Alain Labrique
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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8
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Antepartum evaluation of the obstetric conjugate at transabdominal 2D ultrasound: A feasibility study. Acta Obstet Gynecol Scand 2021. [DOI: org/10.1111/aogs.14226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Theron GB, Mpumlwana V. A case series of post-partum haemorrhage managed using Ellavi uterine balloon tamponade in a rural regional hospital. S Afr Fam Pract (2004) 2021; 63:e1-e4. [PMID: 34082561 PMCID: PMC8377784 DOI: 10.4102/safp.v63i1.5266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 11/17/2022] Open
Abstract
Uterine balloon tamponade (UBT) should be attempted once emergency measures have been applied and medical treatment for post-partum haemorrhage (PPH) resulting from an atonic uterus has failed. Sinapi Biomedical (Pty) Ltd developed the Ellavi UBT, a free-flow pressure-controlled UBT unit. The device is affordable for use in lesser-resourced countries. A case series of Ellavi UBT used by medical officers in a rural regional hospital without specialist supervision was conducted. This case series was conducted in St Elizabeth’s Hospital in Lusikisiki, South Africa. The hospital serves as the regional hospital for the Ingquza Hill Subdistrict in the Eastern Cape Province. The Nelson Mandela Academic Hospital (NMAH) in Mthatha is the tertiary referral hospital. Workshops were conducted on the use of Ellavi UBT, and devices were made freely available to the hospital. The case series included 10 patients. Six patients delivered by caesarean section, and four had normal vertex deliveries. All patients had additional oxytocin infusions, and eight patients received misoprostol. Following the insertion and inflation of the Ellavi UBT, the PPH stopped in seven patients, was much reduced in one patient and reduced in one patient. In one case, the Ellavi UBT had no effect on the bleeding. All 10 patients were referred to the NMAH. All patients in the case series had good outcomes. The insertion of the Ellavi UBT and subsequent referral proved to be feasible in a rural regional hospital. All patients included in the case series arrived at the referral hospital and had a good outcome.
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Affiliation(s)
- Gerhard B Theron
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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Visser GH, Stones W, Nassar A, Ayres‐de‐Campos D, Barnea ER, Bernis L, Di Renzo GC, Escobar Vidarte MF, Lloyd I, Nicholson W, Shah P, Sun L, Theron GB, Walani S. Framework for safe delivery: A call to action. Int J Gynaecol Obstet 2019; 146:1-2. [DOI: 10.1002/ijgo.12840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gerard H.A. Visser
- Department of Obstetrics University Medical Center Utrecht Utrecht The Netherlands
| | - William Stones
- Departments of Public Health and Obstetrics & Gynaecology Malawi College of Medicine Blantyre Malawi
| | - Anwar Nassar
- Department of Obstetrics and Gynecology American University of Beirut Medical Center Beirut Lebanon
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