Updates on Delivery Room

2705 WordsOct 14, 201311 Pages
Upright vs. Recumbent Maternal Position During First Stage of Labor Am Fam Physician. 2010 Feb 1;81(3):285-286. Clinical Question During the first stage of labor, what is the effect of maternal positioning on duration of the first stage of labor, type of delivery, maternal satisfaction, and neonatal and maternal outcomes? Evidence-Based Answer Upright positions include sitting, standing, walking, and kneeling. Based on heterogenous results, women who maintained upright positions had a first stage of labor that was about one hour less than women who were supine or reclined. There were no differences in type of delivery, and there were insufficient data on maternal satisfaction and maternal and neonatal outcomes. (Strength of Recommendation…show more content…
Clinical Question For assisted vaginal delivery, does the use of forceps or vacuum devices result in lower morbidity for the mother and newborn? Evidence-Based Answer Use of forceps is more likely to result in a vaginal delivery than use of vacuum devices (relative risk [RR] = 1.5; 95% confidence interval [CI], 1.1 to 2.2), but has a higher rate of perineal trauma, tears, pain, and incontinence, and a trend toward more cesarean deliveries. Use of metal-cup vacuum devices is more likely to result in a vaginal delivery than use of soft-cup devices, but is more likely to cause neonatal scalp injury and cephalohematoma. (Strength of Recommendation = A, based on consistent, good-quality patient-oriented evidence) Practice Pointers Assisted vaginal deliveries are recommended for fetal distress, failure to deliver after a prolonged second stage of labor, or maternal factors that would make pushing dangerous, such as exhaustion or medical problems. The choice of instrument depends on factors such as the training of the physician, fetal position, and the degree of anesthesia. Vacuum extraction does not require as much anesthesia for the mother as forceps.1 To determine the safest delivery method for the mother and newborn, the authors of this Cochrane review searched for randomized controlled trials comparing methods of assisted vaginal delivery at term. The authors found 32 studies including 6,597 women. Seventeen of the studies
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