National clinical guideline concerning primiparous women with dystocia (lack of progress)

Main Editor Danish Health Authority, 2015
Language en
Last Update Jun 17, 2019
Published Date Jun 17, 2019
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Disclaimer

This is a digital version of the guideline, published by The Danish Health Authority 19 of Maj 2015. The original version can be found on the homepage of The Danish Health Authority . The DHMA's national clinical guidelines are systematically prepared statements based on relevant expert knowledge. National clinical guidelines are aimed at facilitating decision-making for professionals concerning appropriate and good clinical healthcare services in specific situations. The national clinical guidelines are publicly available, and patients are also welcome to read the guidelines. National clinical guidelines are classified as professional counselling, which implies that the DHMA recommends that the guidelines be followed by relevant professionals. The national clinical guidelines are not legally binding, and the professional judgment in the specific clinical situation will always take priority when deciding about appropriate and correct clinical healthcare services. A successful treatment outcome cannot be guaranteed, even if healthcare professionals follow the recommendations. In certain situations, a treatment method with a lower strength of evidence may be preferable, because it is considered a better choice for the patient and by the patient. Generally, healthcare professionals should involve the patient when choosing a particular treatment option. All the binding rules and guidelines from the DHMA in this field must be complied with.

Sponsors Danish Health Authority
Abstract

PICOS
PICO 3.0
P: Primiparous women in the dilatation phase of spontaneous and induced labour, with dystocia, on term (gestational age 37+0) and with a fetus in cephalic presentation.
I: Oxytocin augmentation delayed for some hours after diagnosing dystocia.
C: Oxytocin augmentation immediately after diagnosing dystocia.
O:

PICO 4.0
P: Primiparous women in the descending phase of spontaneous and induced labour, on term (gestational age 37+0) and with a fetus in cephalic presentation.
I: Oxytocin augmentation delayed for some time after diagnosing dystocia.
C: Oxytocin augmentation immediately after diagnosing dystocia.
O:

PICO 5.0
P: Primiparous women in the dilatation phase of spontaneous and induced labour, on term (gestational age 37+0) and with a fetus in cephalic presentation.
I: Oxytocin dosage regimen 1. (Randomised studies)
C: Oxytocin dosage regimen 2. (Randomised studies)
O:

PICO 6.0
P: Population: Primiparous women in the descending phase of spontaneous and induced labour, with an epidural, on term (gestational age 37+0) and with a fetus in cephalic presentation.
I: Intervention after the same time period with slow progress as in parturients without an epidural.
C: Intervention after a longer time period with slow progress than in parturients without an epidural.
O:

PICO 7.0
P: Primiparous women in spontaneous and induced active labour, on term (gestational age 37+0) and with a fetus in cephalic presentation.
I: Intravenous fluid and free oral intake
C: Free oral intake alone
O:

PICO 8.0
P: primiparous women in spontaneous and induced active labour, with dystocia, on term (gestational age 37+0) and with a fetus in cephalic presentation.
I: Acupunctur
C: No acupuncture
O:

PICO 9.0
P: Primiparous women in spontaneous and induced active labour, on term (gestational age 37+0) and with a fetus in cephalic presentation.
I: Rebozo
C: No rebozo
O:

PICO 10.0
P: Singleton pregnant women in spontaneous labour, both primiparous and multiparous women
I: Amniotomy
C: Preservation on membranes
O:

PICO 11.0
P: Primiparous women in the active phase of the first stage (the dilatation phase) of spontaneous and induced labour receiving treatment with oxytocin, on term (gestational age 37+0) and with a fetus in cephalic presentation.
I: Oxytocin augmentation for X hours (long-time treatment) prior to caesarean section.
C: Comparison: Oxytocin augmentation for Y hours (short-time treatment) prior to caesarean section.
O:

PICO 4.0
P: Primiparous women in the expulsive phase of spontaneous and induced labour, on term (gestational age 37+0) and with a fetus in cephalic presentation.
I: Oxytocin augmentation delayed for some time after diagnosing dystocia.
C: Oxytocin augmentation immediately after diagnosing dystocia.
O:

PICO 5.0
P: Primiparous women in the dilatation phase of spontaneous and induced labour, on term (gestational age 37+0) and with a fetus in cephalic presentation.
I: Oxytocin dosage regimen 1. (Observational study)
C: Oxytocin dosage regimen 2. (Observational study)
O:

PICO 10.0
P: Singleton pregnant women in spontaneous, active labour (cervical dilatation of 3 cm) on term, with dystocia (no progress for 2 hours or <1 cm / 3 hours), both primiparous and multiparous women.
I: Amniotomy
C: Preservation of membranes
O:

PICO 10.0
P: Women in spontaneous labour, gestational age 36 completed weeks, singleton fetus in cephalic presentation, cervical dilatation of at least 4 cm, intact membranes and dystocia defined as a dilatation of 1 cm assessed over 2 hours.
I: Oxytocin augmentation without previous amniotomy (oxytocin first).
C: Oxytocin augmentation preceded by amniotomy (amniotomy first).
O: