Obstetrics Book

Delivery

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Active Management of Labor

Aka: Active Management of Labor, Labor Dystocia Management
  1. See Also
    1. Labor Dystocia
    2. Labor Dystocia Prevention
  2. Indications
    1. Failure to Progress
  3. Management: Stage 1
    1. See Labor Coaching
    2. Consider Active Management of Labor
      1. See Oxytocin Augmentation
    3. Consider amniotomy
    4. Indications for cesarean delivery (arrested labor)
      1. Cervical dilation 6 cm AND
      2. No cervical change
        1. At 4 hours if adequate contractions (>200 Montevideo Units) or
        2. At 6 hours if inadequate contractions
  4. Management: Stage 2
    1. Consider Oxytocin Augmentation
    2. Avoid exhausting mother early
      1. Consider not pushing until involuntary urge to push
      2. Consider waiting until vertex approaches introitus
    3. Consider Assisted Delivery
      1. Vacuum Assisted Delivery
      2. Forceps Assisted Delivery
    4. Perineal Laceration prevention
      1. Avoid routine episiotomy (associated with worse perineal Lacerations and greater healing complications)
      2. Warm perineal compresses may reduce risk of third and fourth degree perineal Lacerations
        1. Aasheim (2011) Cochrane Database Syst Rev (5):CD002006 [PubMed]
      3. Shorter pushes as the head is crowning may reduce perineal Lacerations
    5. Consider correction of malposition: Occiput Posterior
      1. See Manual Rotation in Occipitoposterior Presentation
      2. Maternal position change
        1. Position mother curling forward from hips
  5. Management: Dystocia refractory to above management
    1. See Arrest of the Second Stage of Labor
    2. Consider Cesarean Section
  6. Preventive Measures
    1. See Labor Dystocia Prevention
  7. References
    1. Shields (2000) ALSO, F:1-14
    2. Dresang (2015) Am Fam Physician 92(3): 202-8 [PubMed]
    3. Peaceman (1996) Am J Obstet Gynecol 175(2):363-8 [PubMed]
    4. Shields (2007) Am Fam Physician 75(11):1671-8 [PubMed]

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