Management of Labor

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Conclusion Grading Worksheet B – Annotation #66 Management of Labor (Management of Protracted Labor) Third Edition/May 2009 Authors' Conclusions/ Work Group's Comments (italicized) Class Qual- Population Studied/Sample Size Primary Outcome Measure(s)/Results (e.g., p-value, ity confidence interval, relative risk, odds ratio, likeli- +,–,ø hood ratio, number needed to treat) C – -1000 consecutive nulliparous -Mode of Delivery: women in labor after 32 wks Spontaneous Labor Induced Labor Total gestation with a cephalic pres- (n=614) (n=386) (n=1000) entation and a single, live fetus; Normal 81% 71% 77% labor confirmed Low Cavity Forc. 13% 18% 15% -Progress of labor monitored by Rotational Forc. 3% 3% 3% vaginal assessment every 2 hrs; Caesarean 3% 9% 6% progress in 1st stage measured -2.5% had CS for dystocia; 3% for fetal distress; by cervical dilatation; progress 0.3% for cephalopelvic disproportion; 0.2% for cord in 2nd stage measured by de- prolapse scent of head; failure to progress -There were no CS for dystocia after spontaneous treated with oxytocin onset of labor; 13 after induced labor -Labor induced if necessary -Oxytocin used during 1st stage for 31% and during -Electronic fetal heart rate 2nd stage for 13% monitoring used routinely -4% were in labor for >12 hrs -Duration of labor was from -No intrapartum fetal deaths; 1 neonatal death due to time of admission to delivery congenital heart lesion; 1 death 11 days postpartum suite in labor due to perinatal asphyxia (related to use of oxytocin despite fetal distress); no neonatal seizures -Compared to data from previous 4 years: fewer CS (p
I CSI I NSTITUTE FOR CLINICAL S YSTEMS IMPROVEMENT Support for Implementation: Management of Labor This section provides resources, strategies and measurement specifications for use in closing the gap between current clinical practice and the recommendations set forth in the guideline. The subdivisions of this section are: • Priority Aims and Suggested Measures - Measurement Specifications • Key Implementation Recommendations • Knowledge Resources • Resources Available Copyright © 2009 by Institute for Clinical Systems Improvement 52
Page 1 and 2: I CSI I NSTITUTE FOR CLINICAL S YST
Page 3 and 4: Management of Signs/Symptoms of Pre
Page 5 and 6: Vaginal Birth After Caesarean (VBAC
Page 7 and 8: Intrapartum Fetal Heart Rate (FHR)
Page 9 and 10: Foreword Scope and Target Populatio
Page 11 and 12: Management of Labor Foreword Third
Page 13 and 14: Management of Labor Algorithm Annot
Page 29 and 30: Appendix A - Patient Education Hand
Page 31 and 32: I CSI I NSTITUTE FOR CLINICAL S YST
Page 33 and 34: References Agency for HealthCare Re
Page 35 and 36: Management of Labor References Thir
Page 41 and 42: Conclusion Grading Worksheet A - An
Page 43 and 44: Conclusion Grading Worksheet A - Ma
Page 45 and 46: Conclusion Grading Worksheet B - An
Page 51: Conclusion Grading Worksheet B - An
Page 55 and 56: Management of Labor Priority Aims a
Page 61: Resources Available * Author/Organi

Management of Labor

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