Conduct of preterm delivery

Rates of neonatal morbidity and mortality are higher in babies transferred ex utero to neonatal intensive care units when compared to those born in the tertiary referral centre. Every effort should therefore be made to transfer a woman to an obstetric unit linked to a neonatal intensive care unit prior to a preterm delivery. The introduction of fetal fibronectin testing may reduce the numbers of unnecessary in utero transfers which currently take place. Except at the extremes of prematurity there should be continuous electronic fetal heart rate monitoring once preterm labour is clearly established. There is no evidence for a benefit of routine delivery by Caesarean section where the presentation is cephalic. However, hypoxia is a major risk factor for the development of periventricular leukomalacia and there should therefore be a relatively low threshold for delivery by Caesarean section in the presence of abnormal fetal heart rate patterns. The preterm delivery of a breech continues to be an obstetric dilemma. Although it is now established that elective Caesarean section is preferable for the term breech, it has proved impossible to undertake randomized trials of Caesarean section for the preterm breech. One potential disadvantage of planning to deliver the preterm breech (or indeed the cephalic presentation preterm) by 'elective' Caesarean section is the high incidence of 'threatened' preterm labour which does not lead to preterm delivery. An aggressive policy of delivering preterm babies by Caesarean section has the potential to lead to iatrogenic preterm deliveries. At the other end of the spectrum, Caesarean section preterm where the breech is already in the vagina, may be more traumatic than a vaginal delivery. At the present time, until further evidence becomes available, the mode of delivery of the preterm breech will need to be made on a case by case basis by the obstetrician at the time. There is no evidence for the old practice of elective forceps delivery to protect the fetal head during preterm delivery and episiotomy is rarely required.

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Getting Back Into Shape After The Pregnancy

Getting Back Into Shape After The Pregnancy

Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.

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