Abstract
Objective
The purpose of this guideline is to provide guidance for the intrapartum management
of spontaneous labour, whether normal or abnormal, in term, healthy women, and to
provide guidance in the management of first and second stage dystocia to increase
the likelihood of a vaginal birth and optimize birth outcomes.
Evidence
Published literature was retrieved through searches of PubMed and the Cochrane Library
in October 2011 using appropriate, controlled vocabulary (e.g., labour pain; labour,
obstetric; dystocia) and key words (e.g., obstetric labor, perineal care, dysfunctional
labor). When appropriate, results were restricted to systematic reviews, randomized
control trials/controlled clinical trials, and observational studies. Results were
limited to the last 10 years. Searches were updated on a regular basis and incorporated
in the guideline up to June 15, 2015.
Values
The quality of evidence in this document was rated using the criteria described in
the Report of the Canadian Task Force on Preventive Health Care (Table 1).
Summary Statements
- 1.The duration of the first stage of labour increases with maternal age and body mass index. (II-2)
- 2.In low-risk nulliparous women in the active phase of labour (i.e., equal to or greater than 4 cm dilatation), progress of cervical dilatation greater than or equal to 0.5 cm/hour is considered normal. (II-2)
- 3.Each labour unit should have a guideline for opioid use during labour that includes the method of action, average and maximum doses, route of administration, possible maternal and fetal side effects, precautions, and opioid antagonists and resuscitative measures for each drug. (III)
- 4.Epidural analgesia provides the most effective pain relief for women in labour. The timing of initiation of labour epidural is dependent on the woman’s choice once the diagnosis of labour has been established. (I)
Recommendations
- 1.Health care providers should delay term labour admission to the birthing unit until active labour (i.e., equal to or greater than 4 cm dilatation) is established. (II-2A)
- 2.Documentation and communication of labour progress are important aspects of labour management. Labour and delivery units should establish local policy regarding labour documentation, including partogram use and its application in labour management. (III-A)
- 3.Women should be informed of the benefits of upright positioning in labour and encouraged and assisted to assume whatever positions they find most comfortable. (I-B)
- 4.Women who are at low risk of requiring general anesthesia should have the choice to eat or drink as desired or tolerated in labour. (I-A)
- 5.Continuous labour support is recommended for all women in active labour. Each labour unit should aim to provide the opportunity for each woman to receive continuous 1-to-1 labour support. (I-A)
- 6.Amniotomy and oxytocin, in addition to other measures, should be considered once a diagnosis of dystocia has been made in either the first or second stage of labour. (I-B)
- 7.Women and health care providers should have information about coping strategies for early labour and mechanisms for accessing support from caregivers. (III-A)
- 8.When appropriate, health care providers should support women in their choice of analgesic options in labour. These may include pharmacological and non-pharmacological measures. (III-A)
- 9.Each woman should be provided with evidence-based information about labour analgesia options prior to the onset of labour and offered ample opportunity to discuss the risks and benefits of each option available at her planned site of delivery. (III-A)
- 10.The use of meperidine as labour analgesia should be avoided due to its long-acting active metabolites and negative effects on neonatal behaviours. (II-2B)
- 11.Low-dose epidural, when available, is preferred over high-dose epidural for labour analgesia and in promoting mobility in labour. (I-A)
- 12.Women who receive an epidural should be encouraged to maintain mobility and flexibility in positions of comfort throughout labour. (I-B)
- 13.Once an epidural has been established, the infusion should be continued until completion of the third stage of labour. (I-A)
- 14.Pushing, as a component of second stage progress, may commence when the cervix is fully dilated, the presenting part is confirmed to be engaged, and the woman feels an urge to push. (III-A)
- 15.Delayed pushing is preferred when the woman has no urge to push, particularly if the presenting part is above station +2 and/or in a non-occiput anterior position, assuming the fetus does not display abnormal monitoring and the pregnant woman’s status is satisfactory. (I-A)
- 16.Delay of pushing according to parity and the presence or absence of an epidural should follow the time limits described in the text unless there are extenuating circumstances. (II-2B)
- 17.The method of pushing, spontaneous or directed with Valsalva manoeuvre, should be chosen using the woman’s own preference. Directed pushing may assist with the final expulsion of the head. (II-2B)
- 18.Avoid the use of routine episiotomy in spontaneous vaginal births. (I-A)
- 19.Prophylactic oxytocics should be given after the delivery of the baby. (I-A)
- 20.In term and preterm infants who do not require neonatal resuscitation, delayed umbilical cord clamping for 60 seconds is recommended irrespective of the mode of delivery. (I-B)
- 21.Dystocia should not be diagnosed prior to the onset of the active phase of the first stage of labour or before the cervix is at least 4 cm dilated. (II-2D)
- 22.Oxytocin augmentation should be titrated to avoid tachysystole or excessive uterine activity and to produce a uterine contraction pattern of 4 to 5 contractions in 10 minutes (200 Montevideo units). A minimum of 4 to 6 hours of adequate uterine activity may be required to achieve the desired response. (I-A) It is recommended that every obstetrical unit have an identified and accessible protocol that includes a starting dose, increment interval, and maximum dose. Consistent use of 1 standard approach to oxytocin administration in any 1 obstetrical unit should be considered. (III-A)
- 23.Operative delivery less than 2 hours after commencing pushing is not recommended, provided maternal status and fetal surveillance are normal. (III-D)
- 24.When the second stage exceeds the recommended time limits (see text), consideration should be given to expediting delivery. Extending these time limits may be appropriate in the presence of continued descent of the head, satisfactory maternal and fetal status, and imminent vaginal birth. (II-2B)
- 25.High-dose oxytocin regimens have been shown to decrease labour duration compared with low-dose regimens. The lowest dose needed to produce normal progress is recommended to reduce the risk of tachysystole or excessive uterine activity and to create a uterine contraction pattern of 3 to 5 contractions or 200 or more Montevideo units every 10 minutes. (I-A)
Key Words
Abbreviations:
AMTSL (active management of the third stage of labour), BMI (body mass index), CCT (controlled cord traction), CLS (continuous labour support), CS (Caesarean section), IUPC (intrauterine pressure catheter), IV (intravenous), OASIS (obstetrical anal sphincter injuries), PCEA (patient-controlled epidural analgesia), PPH (postpartum hemorrhage), RCT (randomized controlled trial), SOGC (Society of Obstetricians and Gynaecologists of Canada), TENS (transcutaneous electrical nerve stimulation)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Obstetrics and Gynaecology CanadaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- ACOG Technical Bulletin Number 157—July 1991.Int J Gynaecol Obstet. 1992; 39: 139-142
Fraser WB, Krauss I, Boulvain M, Oppenheimer L, Milne KJ, Liston RM, Dystocia. SOGC Clinical Practice Guidelines, No. 40, October 1995. Available at: http://sogc.org/wp-content/uploads/2013/11/gui40EPS9510.pdf. Accessed May 5, 2016.
- Active management of labour: the Dublin experience.ed 4. Mosby, London2003
- Induction of labour. SOGC Clinical Practice Guidelines, No. 296, September 2013.J Obstet Gynaecol Can. 2013; 35: 840-860
- Labor: clinical evaluation and management.ed 2. Appleton Century Crofts, New York1978
- Epidural analgesia lengthens the Friedman active phase of labor.Obstet Gynecol. 2002; 100: 46-50
- Reassessing the labor curve in nulliparous women.Am J Obstet Gyecol. 2002; 187: 824-828
- “Active labor” duration and dilation rates among low-risk, nulliparous women with spontaneous labor onset: a systematic review.J Midwifery Women’s Health. 2010; 55: 208-318
- Safe prevention of the primary Cesarean delivery.Obstet Gynecol. 2014; 123: 603-711
- Transition from latent to active labor.Obstet Gynecol. 1986; 68: 448-451
- Outcomes after internal versus external tocodynamometry for monitoring labor.N Engl J Med. 2010; 362: 306-313
- Pelvimetry for fetal cephalic presentations at or near term.Cochrane Database Syst Rev. 1997; : CD000161
- Predicting delivery date by ultrasound and last menstrual period in early gestation.Obstet Gynecol. 2001; 97: 189-194
- Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior).Cochrane Database Syst Rev. 2007; : CD001063
- Individual or group antenatal education for childbirth or parenthood, or both.Cochrane Database Syst Rev. 2007; : CD002869
- In due time: why maternal age matters. Canadian Institute for Health Information.2011 (Available at:) (Accessed on April 10, 2015)
- Society of Obstetricians and Gynaecologists of Canada. Delayed child-bearing.J Obstet Gynaecol Can. 2012; 34: 80-93
- The effect of delaying childbirth on primary cesarean rates.PLoS Med. 2008; 5: e144
- Maternal prepregnancy overweight and obesity and the pattern of labor progression in term nulliparous women.Obstet Gynecol. 2004; 104: 943-951
- Poor uterine contractility in obese women.BJOG. 2007; 114: 343-348
- Effects of maternal obesity on duration and outcomes of prostaglandin cervical ripening and labor induction.Obstet Gynecol. 2009; 114: 1315-1321
- Non-elective caesarean delivery due to ineffective uterine contractility or due to obstructed labour in relation to maternal body mass index.Eur J Obstet Gynecol Reprod Biol. 2009; 145: 163-166
- Risk indicators for dystocia in low-risk nulliparous women: a study on lifestyle and anthropometrical factors.J Obstet Gynaecol. 2010; 30: 25-29
- The effects of obesity on the first stage of labor.Obstet Gynecol. 2012; 120: 130-135
- Effects of obesity on length of labor in nulliparous women.Am J Perinatol. 2012; 29: 127-132
- Contemporary labor patterns: the impact of maternal body mass index.Am J Obstet Gynecol. 2011; 205: 244.e1-244.e8
- Proposed biological linkages between obesity, stress, and inefficient uterine contractiliy during labor in humans.Med Hypotheses. 2011; 76: 755-760
- BC Perinatal Health Program. Perinatal health report 2008. BC Perinatal Health Program, Vancouver2008
- Canadian perinatal health report.ed 2008. Public Health Agency of Canada, Ottawa2008
- Outcomes of women presenting in active versus latent phase of spontaneous labor.Obstet Gynecol. 2005; 105: 77-79
- The relationship between cervical dilatation at initial presentation in labour and subsequent intervention.BJOG. 2001; 108: 1120-1124
- Impact of early admission in labor on method of delivery.Int J Gynaecol Obstet. 2006; 92: 217-220
- An early labor assessment program: a randomized, controlled trial.Birth. 1998; 25: 5-10
- Early labor assessment and support at home versus telephone triage: a randomized controlled trial.Obstet Gynecol. 2006; 108: 1463-1469
- Effect of partogram use on outcomes for women in spontaneous labour at term.Cochrane Database Syst Rev. 2013; : CD005461
- Maternal positions and mobility during first stage labor.Cochrane Database Syst Rev. 2013; : CD003934
- Restricting oral fluid and food intake during labour.Cochrane Database Syst Rev. 2013; : CD003930
- Mothers’ experiences of labor support: exploration of qualitative research.J Obstet Gynecol Neonatal Nurs. 2002; 31: 742-752
- Continuous support for women during childbirth.Cochrane Database Syst Rev. 2013; : CD003766
- What can a meta-analysis tell us about traditional birth attendant training and pregnancy outcomes?.Midwifery. 2004; 20: 51-60
- Early amniotomy increases the frequency of fetal heart rate abnormalities. Amniotomy Study Group.Br J Obstet Gynaecol. 1997; 104: 548-553
- Amniotomy for shortening spontaneous labour.Cochrane Database Syst Rev. 2013; : CD006167
- Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care.Cochrane Database Syst Rev. 2013; : CD006794
- Active management of labor as an alternative to cesarean section for dystocia.Obstet Gyencol. 1984; 63: 485-490
- Factors that influence route of delivery—active versus traditional labor management.Am J Obstet Gynecol. 1993; 169: 940-944
- Active management of labour: current knowledge and research issues.BMJ. 1994; 309 ([published erratum appears in BMJ 1994;309(6956):704]): 366-369
- Package of care for active management in labour for reducing caesarean section rates in low-risk women.Cochrane Database Syst Rev. 2013; : CD004907
- Update on nonpharmacologic approaches to relieve labor pain and prevent suffering.J Midwifery Womens Health. 2004; 49: 489-504
- Fear, pain and stress hormones during childbirth.J Psychosom Obstet Gynaecol. 2005; 26: 153-165
- Labor experience, maternal mood and cortisol and catecholamine levels in low-risk primiparous women.J Psychosom Obstet Gynaecol. 1995; 16: 181-186
- Complementary and alternative therapies for pain management in labour.Cochrane Database Syst Rev. 2006; : CD003521
- Transcutaneous electrical nerve stimulation (TENS) for pain management in labour.Cochrane Database Syst Rev. 2009; : CD007214
- Acupuncture as pain relief during delivery: a randomized controlled trial.Birth. 2009; 36: 5-12
- Immersion in water in labour and birth.Cochrane Database Syst Rev. 2009; : CD000111
- Sterile water injection for labour pain: a systematic review and meta-analysis of randomised controlled trials.Br J Obstet Gynaecol. 2009; 116: 1158-1166
- Intracutaneous or subcutaneous sterile water injection compared with blinded controls for pain management in labour.Cochrane Database Syst Rev. 2012; : CD009107
- Is nitrous oxide an effective analgesic for labor?.in: Halpern S.H. Douglas M.J. Evidence-based obstetric anesthesia. Blackwell Publishing, Malden, MA2005: 38-55
- Parenteral opioids for maternal pain management in labour.Cochrane Database Syst Rev. 2010; : CD007396
- Effects of low doses of meperidine on neonatal behavior.Anesth Analg. 1985; 64: 335-342
- Postcesarean analgesia with both epidural morphine and intravenous patient-controlled analgesia: neurobehavioral outcomes among nursing neonates.Anesth Analg. 1997; 85: 600-606
- Effects of routinely given pethidine during labour on infants’ developing breastfeeding behaviour. Effects of dose-delivery time interval and various concentrations of pethidine/norpethidine in cord plasma.Acta Paediatr. 1997; 86: 201-208
- Pharmacology and physiology in anesthetic practice.ed 4. Lippincott Williams and Wilkins, Philadelphia, PA2006
- Obstetrical anesthesia.in: Cunningham F.G. Hauth J.C. Leveno K.J. Gilstrap III, L. Bloom S.L. Wenstrom K.D. Williams obstetrics. ed 22. McGraw-Hill Medical Publishing Division, New York2005
- Epidural versus non-epidural or no analgesia in labour.Cochrane Database Syst Rev. 2011; : CD000331
- Labour epidural analgesia and anti-infectious management of the neonate: a meta-analysis.J Perinat Med. 2012; 40: 625-630
- Delayed pushing with lumbar epidural in labour-does it increase the incidence of spontaneous delivery?.J Obstet Gynaecol. 1988; 8: 258-261
- The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis.Can J Anaesth. 2013; 60: 840-854
- Ambulation in labour and delivery mode: a randomised controlled trial of high-dose vs mobile epidural analgesia.Anaesthesia. 2009; 64: 266-272
- Walking reduces the post-void residual volume in parturients with epidural analgesia for labor: a randomized-controlled study.Acta Anaesthesiol Scand. 2009; 53: 665-672
- Patient-controlled epidural analgesia for labour.Anesth Analg. 2009; 108: 921-928
- Patient-controlled epidural analgesia versus continuous infusion for labour analgesia: a meta-analysis.Br J Anaesth. 2002; 89: 459-465
- Programmed intermittent epidural bolus versus continuous epidural infusion for labor analgesia: the effects on maternal motor function and labor outcome. A randomized double-blind study in nulliparous women.Anesth Analg. 2011; 113: 826-831
- Epidural analgesia in the latent phase of labor and the risk of cesarean delivery: a five-year randomized controlled trial.Anesthesiology. 2009; 111: 871-880
- Early versus late initiation of epidural analgesia.Cochrane Database Syst Rev. 2014; : CD007238
- A meta-analysis of upright positions in the second stage to reduce instrumental deliveries in women with epidural analgesia.Acta Obstet Gynecol Scand. 2005; 84: 794-798
- Position in the second stage of labour for women without epidural anaesthesia.Cochrane Database Syst Rev. 2012; : CD002006
- Position in the second stage of labour for women with epidural anaesthesia.Cochrane Database Syst Rev. 2013; : CD008070
- Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia.Cochrane Database Syst Rev. 2004; : CD004457
- A retrospective case-controlled study of the association between request to discontinue second stage labor epidural analgesia and risk of instrumental vaginal delivery.Int J Obstet Anesth. 2008; 17: 304-308
- Impact of pain level on second-stage delivery outcomes among women with epidural analgesia: results from the PEOPLE study.Am J Obstet Gynecol. 2008; 199: 500.e1-500.e6
- Cost-effectiveness of a delayed pushing policy for patients with epidural anesthesia. The PEOPLE (Pushing Early or Pushing Late with Epidural) Study Group.Am J Obstet Gynecol. 2000; 182: 1158-1164
- Multicenter, randomized, controlled trial of delayed pushing for nulliparous women in the second stage of labor with continuous epidural analgesia.Am J Obstet Gynecol. 2000; 182: 1165-1172
- The Ottawa Hospital’s clinical practice guideline for the second stage of labour.J Obstet Gynaecol Can. 2006; 28: 769-779
- How long is too long: does a prolonged second stage of labor in nulliparous women affect maternal and neonatal outcomes?.Am J Obstet Gynecol. 2004; 191: 933-938
- The characteristics of the second stage of labour in 25 069 singleton deliveries in the North West Thames Health Region, 1988.Br J Obstet Gynaecol. 1992; 99: 377-380
- Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes.Am J Obstet Gynecol. 2009; 201: 357.e1-357.e7
- When to stop pushing: effects of duration of second-stage expulsion efforts on maternal and neonatal outcomes in nulliparous women with epidural analgesia.Am J Obstet Gynecol. 2009; 201: 361-367
- Active pushing versus passive fetal descent in the second stage of labor: a randomized controlled trial.Obstet Gynecol. 2002; 99: 29-34
Perinatal Services BC. Core competencies for management of labour: evaulation of progress of labor/dystocia. Perinatal Services BC; 2011. Available at: http://www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Standards/Competencies/4CoreCompDSTEvalofLabourDystocia.pdf. Accessed January 23, 2013.
- Perinatal outcome in relation to second-stage duration.Am J Obstet Gynaecol. 1995; 173: 906-912
- Increasing maternal body mass index and characteristics of the second stage of labor.Obstet Gynecol. 2001; 118: 1309-1313
- The effect of maternal obesity on the course of labor.J Perinat Med. 2009; 37: 651-655
- Intrauterine pressure during the second stage of labor in obese women.Obstet Gynecol. 2004; 103: 225-230
- The effect of maternal obesity on labour and labour pain.Anaesthesia. 1995; 50: 322-326
- Maternal obesity and labour complications following induction of labour in prolonged pregnancy.BJOG. 2001; 118: 578-588
- Effect of spontaneous pushing versus Valsalva pushing in the second stage of labour on mother and fetus: a systematic review of randomised trials.BJOG. 2011; 118: 662-670
- Episiotomy for vaginal birth.Cochrane Database Syst Rev. 2009; : CD000081
- A randomised controlled trial of routine versus restrictive use of episiotomy at operative vaginal delivery: a multicentre pilot study.Br J Obstet Gynaecol. 2008; 115: 1695-1702
- Mediolateral episiotomy reduces the risk for anal shphincter injury during operative vaginal delivery: a multicentre pilot study.Br J Obstet Gynaecol. 2008; 115: 104-108
- The effect of a mediolateral episiotomy during operative vaginal delivery on the risk of developing obstetrical anal sphincter injuries.Am J Obstet Gynecol. 2012; 206: 404.e1-404.e5
- The impact of an intervention programme employing a hands-on technique to reduce the incidence of anal sphincter tears: interrupted time-series reanalysis.BMJ Open. 2013; 10: e003355
- The incision angle of mediolaterial episiotomy before delivery and after repair.Int J Gynaecol Obstet. 2008; 103: 5-8
- Incidence of obstetric anal sphincter injuries after training to protect the perineum: cohort study.BMJ Open. 2012; 2: e001649
- Perineal techniques during the second stage of labour for reducing perineal trauma.Cochrane Database Syst Rev. 2011; : CD006672
- Continuous and interrupted suturing techniques for repair of episiotomy or second-degree tears.Cochrane Database Syst Rev. 2012; : CD000947
- Absorbable suture materials for primary repair of episiotomy and second degree tears.Cochrane Database Syst Rev. 2010; : CD000006
- Antibiotic prophylaxis for prevention of postpartum perineal wound complications: a randomized controlled trial.Obstet Gyncol. 2008; 111: 1268-1273
- Active management of third stage of labour: prevention and treatment of postpartum hemorrhage.Br J Obstet Gynaecol. 2009; 31: 980-993
- Active versus expectant management for women in the third stage.Cochrane Database Syst Rev. 2015; : CD007412
- Prophylactic oxytocin for the third stage of labour to prevent postpartum hemorrhage.Cochrane Database Syst Rev. 2013; : CD001808
- Timing of prophylactic uterotonics for the third stage of labour after vaginal birth.Cochrane Database Syst Rev. 2010; : CD006173
- Controlled cord traction for the third stage of labour.Cochrane Database Syst Rev. 2015; : CD008020
- Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes.Cochrane Database Syst Rev. 2012; : CD003248
- Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes.Cochrane Database Syst Rev. 2013; : CD001808
- Contemporary patterns of spontaneous labour with normal neonatal outcomes. Consortium on Safe Labour.Obstet Gynecol. 2010; 116: 1281-1287
- The effect of early oxytocin augmentation in labor: a meta-analysis.Obstet Gynecol. 2009; 114: 641-649
- A randomized controlled trial of the effect of increased intravenous hydration on the course of labor in nulliparous women.Am J Obstet Gynecol. 2000; 183: 1544-1548
- Metea-analysis of low-dose versus high-dose oxytocin for labour induction.JOGC. 1998; 20: 1215-1223
- High-dose vs low-dose oxytocin for labor augmentation: a systematic review.Am J Obstet Gynecol. 2010; 203: 296-304
- Oxytocin as a high-alert medication: implications for perinatal patient safety.MCN Am J Matern Child Nurs. 2009; 34: 8-15
- Oxytocin: new perspectives on an old drug.Am J Obstet Gynecol. 2009; 200: 35.e1-35.e6
- Oxytocin regimen for labor augmentation, labor progression, and perinatal outcomes.Obstet Gynecol. 2011; 118: 249-256
- A randomized control study of oxytocin augmentation of labour. 1. Obstetric outcome.Br J Obstet Gynaecol. 1987; 94: 512-517
- A controlled trial of a program for the active management of labor.N Engl J Med. 1992; 326: 450-454
- Randomized, double-masked comparison of oxytocin dosage in induction and augmentation of labor.Obstet Gynecol. 1999; 94: 455-463
- Low-dose versus high-dose oxytocin augmentation of labor—a randomized trial.Am J Obstet Gynecol. 1995; 173: 1874-1878
- Epidural analgesia associated with low-dose oxytocin augmentation increases cesarean births: a critical look at the external validity of randomized trials.Am J Obstet Gynecol. 2006; 194: 809-814
- Augmentation of labour—mode of delivery related to cervimetric progress.Aust NZ J Obstet Gynaecol. 1987; 27: 304-308
- Active-phase labor arrest: oxytocin augmentation for at least 4 hours.Obstet Gynecol. 1999; 93: 323-328
- Active phase labor arrest: revisiting the 2-hour minimum.Obstet Gynecol. 2001; 98: 550-554
- Maternal and perinatal outcomes with increasing duration of the second stage of labor.Obstet Gynecol. 2009; 113: 1248-1258
Article info
Publication history
Published online: June 25, 2016
No. 336, September 2016Footnotes
This Clinical Practice Guideline has been prepared by the Clinical Practice Obstetrics Committee, reviewed by the Family Physician Advisory, Maternal Fetal Medicine, Medico-Legal and Obstetrical Content Review Committees, and approved by the Board of the Society of Obstetricians and Gynaecologists of Canada.
Identification
Copyright
Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Prise en charge du travail spontané chez les femmes en santé, à termeJournal of Obstetrics and Gynaecology Canada Vol. 38Issue 9
- PreviewLa présente directive vise à fournir des conseils concernant la prise en charge du travail spontané intrapartum, normal ou anormal, à terme, chez les femmes en santé, ainsi que des conseils relatifs à la prise en charge de la dystocie lors du premier et du deuxième stade du travail, pour favoriser l’accouchement vaginal et optimiser les issues de la grossesse.
- Full-Text
- Preview
