INDICATIONS. Enstilar® (calcipotriene and betamethasone dipropionate) Foam is indicated for the topical treatment of plaque psoriasis in patients 18 years of age and. Plain language summary. Antenatal perineal massage for reducing perineal trauma. Antenatal perineal massage helps reduce both perineal trauma during birth and pain. Stress; Weight loss or gain; Exhaustion; Thyroid disorder; Irregular physical activity; Remember that c-section does not affect the start of your first period but it. Labour and Birth Guideline . The Cochrane Database of Systematic Reviews contains regularly updated reviews on a variety of health issues and is available electronically as part of the Cochrane Library. Consensus statement: A statement of the advised course of action in relation to a particular clinical topic, based on the collective views of a body of experts. ![]() ![]() ![]() ![]()
Evidence level: A code (e. Also called levels of evidence. Meta- analysis: A meta- analysis refers to methods employed to contrast and combine results from different studies, to identify patterns among study results, areas of agreement or disagreement among those results, or other relationships that may come to light. Systematic review: A review in which evidence from scientific studies has been identified, appraised, and synthesised in a methodical way according to predetermined criteria. It may ormay not include a meta- analysis. GUIDELINE DEVELOPMENT. ACKNOWLEDGEMENTS AND MEMBERSHIPThe labour and birth Guideline Development Group wish to give thanks for contributions made by all the midwifery and medical staff that have contributed to the formulation of these guidelines. MEMBERS OF THE GUIDELINE COMMITTEE: Tanya Farrell Co- chair, 3centres Collaboration. Euan Wallace Co- chair, 3centres Collaboration. Wendy Cutchie Project Manager, 3centres Collaboration. Robyn Aldridge Obstetric expert, 3centres Collaboration. GUIDELINE DEVELOPMENT GROUPAngela Muir Mercy Hospital for Women. Bernadette White Mercy Hospital for Women. Caprice Brown Royal Women’s Hospital. Christine East Monash Medical Centre. Christine Tippett Maternity & Newborn Clinical Network. Jacobus Du. Plessis Royal Women’s Hospital. Jenny Ryan Royal Women’s Hospital. Karen Moffat Royal Women’s Hospital. When Does Menstruation After Pregnancy Return and How Different Is It? Menstruation after pregnancy is usually delayed by 8-14 weeks in non-nursing mothers and up to. Kerrie Papacostas Monash Medical Centre. Lynne Stewart Monash Medical Centre. Megan Burgmann Mercy Hospital for Women. Michael Rasmussen Mercy Hospital for Women. AIMThis guideline aims to provide consistent, evidence- based advice on the care of women and their babies at term (3. Victoria. Namely; Mercy Hospital for Women, Monash Medical Centre, and The Royal Women’s Hospital. It is anticipated that this guideline will be used as a basis for the development of guidelines at other hospitals; which will take into account local service provision and the needs of the local population. SEARCH AND APPRAISALThe following methods of search and appraisal were used: An Ovid platform database search was undertaken using Medline, Embase, CINAHL and Cochrane databases for evidence published in English. ![]() ![]() ![]() ![]() Most of these publications were sourced from the year 2. Professional body websites were also used. These included the American College of Obstetricians and Gynecologists (ACOG), Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), Royal College of Obstetricians and Gynaecologists (RCOG), Society of Obstetricians and Gynaecologists of Canada (SOGC). Other websites accessed were: National Health and Medical Research Council (NHMRC), National Institute for Health and Clinical Excellence (NICE) World Health Organisation and BMJ Best practice. The 3centres Collaboration has predominately endorsed the NICE Intrapartum care of healthy women and their babies during childbirth 2. Evidence included systematic reviews, meta- analysis, or randomised controlled trials (RCT’s). Where reviews or RCT’s did not exist, other appropriate cohort studies, case series, or observational studies were included. Where no substantial evidence was available to answer the clinical question, formal consensus methods were used to identify best practice and recommendations were made accordingly. Published guidelines from each of the three level six (tertiary) maternity hospitals were gathered, compared, and contrasted against the international reviews and guidelines. Following an iterative consultation process among key stakeholders from the three level six hospitals, a consensus of opinion was gained in most instances. In cases of conflicting points of view, a variance process was initiated whereby the Co- Chairs of the 3centres Collaboration made the final decision. INTRODUCTIONThe World Health Organisation describes normal birth as “Spontaneous in onset, low- risk at the start of labour and remaining so throughout labour and delivery. The infant is born spontaneously in the vertex position between 3. After birth mother and infant are in good condition”. Therefore, it is imperative that all health care disciplines work harmoniously and collaboratively in order to achieve the optimum outcome for the woman and her baby. CORE ASSUMPTIONSThis guideline has been developed around a set of core assumptions that underpin the philosophy that care remains woman- centred, is informed by international standards, and is evidence based best practice. These assumptions are: labour and birth are considered to be a natural physiological process until established otherwisethere should be a valid medical reason before intervening with the process of normal labour and birththe woman will be kept informed of her progress throughout labourthe clinician, in partnership with the woman, is responsible for informed decision makingcollaboration and cooperation between the professional groups underpins optimal care for all womenthere will be appropriate and timely escalation processes to expedite decision- making and action. CENTRES COLLABORATION RECOMMENDATIONSSECTIONPAGETelephone triage and advice Listen to the woman’s story with sympathy and concern. All advice is individualised according to the woman’s circumstances. Each maternity unit should have clear, easily accessible pathways for appropriate telephone triage questions to ask and advice that should be given. Telephone advice imparted should be clearly documented with the date, time, printed name and signature of the clinician taking the call. Telephone advice forms should be centrally located and easily accessible for subsequent calls. Clinicians should be adequately trained and experienced when telephone triaging. Qualified interpreters are the preferred option, as culture and custom can be a barrier to effective communication when family members are used as interpreters. The woman could be invited to attend the hospital for assessment at any time and should be encouraged to attend after three telephone calls or should the clinician deem it necessary. Latent phase of labour 1. The latent phase can be defined as: contractions that may be painful and regular or could vary in strength and frequency. The process of cervical effacement has begun, which may also include some cervical dilatation. The average length of a latent phase for a spontaneous labour at term, with a fetal vertex position, in a well woman and fetus is an estimated 1. Place of care is ideally at home unless preference or circumstance dictate otherwise. Women should maintain normal levels of activity, continue with a light diet, ensure good hydration, take a warm bath, take simple over the counter analgesia such as paracetamol and advised against mixing stronger analgesia such as Panadeine Forte. Multiparous women up to 1. Delay diagnosis is not based on duration alone. Strength and frequency of contractions, fetal descent and rotation, cervical dilatation, plus maternal and fetal well- being must all be considered. Research is divided as to whether amniotomy shortens labour or confers any benefits in cases of delay. Experienced clinicians should be consulted and the evidence discussed with the woman. Maternal & fetal observations on admission and during the first stage of labour 1. Clinicians are encouraged to listen to a woman’s story and promote free communication. Good practice includes gathering history, performing observations and examining a woman at her first presentation. Clinical information may be gathered from the woman or clinical notes, which ever is the most appropriate. Collection of blood for a group and save should be reserved for high- risk women and reflect local resources. The use of routine maternal observations need to be critically reviewed, reflect local resources and would affect care given to the women, if an abnormality was found. Fetal wellbeing should be assessed according to the RANZCOG Intrapartum Fetal Surveillance Clinical Guidelines. Further evidence is required about the use of partograms and the effect on maternal or neonatal outcomes. Until that evidence is available it would not be justifiable to abandon the routine use of the partogram. Bladder care and urinalysis 2. Encourage the woman to void every 3- 4 hours during labour. Encourage clear oral fluids during labour and Isotonic drinks in the presence of ketonuria. Services are encouraged to develop post partum bladder care guidelines. Eating and drinking during the first stage of labour 2. A woman in labour can eat a light diet and drink water or isotonic drinks, as she desires. In the presence of ketonuria isotonic drinks to combat ketosis, are preferable to water. Hygiene during the first stage of labour 2. The use of tap water for vulval cleansing if required, prior to vaginal examination. Good hand hygiene and adherence to local infection control policies. During vaginal examinations and birth, the research into the use of sterile- vs- non- sterile gloves is equivocal. The use of double gloving for vaginal birth is not recommended unless circumstances dictate.
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