TEST statement and guideline

Summary

Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua. Ut enim ad minim. Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua.

Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua. Ut enim ad minim. Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua.


4.8 Complications of instrumental birth original

Here I’ve converted bulleted list (with indented letters) to plain, and pasted (no further formatting). As you can see, this isn’t a good visual outcome.

The adverse effects of instrumental birth must be weighed against the consequences of awaiting vaginal birth or alternatively of performing a caesarean section with the head deep in the pelvis. The more serious complications are very uncommon but include:

•          Fetal complications

a.         Shoulder dystocia and its consequences.

The need to perform an instrumental birth for lack of progress in the presence of anticipated macrosomia  should alert the clinician to the increased likelihood of shoulder dystocia as would instrumental birth in a multigravida with a delay in second stage42

b.         Subaponeurotic/subgaleal haemorrhage.

A potentially life threatening complication, occurring in approximately 1 in 300 cases of  vacuum delivery.43, 44  Refer to College Statement Prevention Detection and Management of Subgaleal Haemorrhage in the Newborn (C-Obs 28)

c.         Facial nerve palsy, corneal abrasion, retinal haemorrhage.

Facial nerve palsy and corneal abrasion are more common with forceps and retinal haemorrhage with vacuum birth.6

d.         Skull fracture and/or intracranial haemorrhage.

A review of 583,340 live-born singleton babies of nulliparous women where the birth weight was between 2500 and 4000gm reported rates of intracranial haemorrhage with differing modes of birth: one in 664 (forceps); one in 860 (vacuum extraction); one in 907 (intrapartum caesarean section); one in 1900 (spontaneous vaginal birth); and, one in 2750 (pre-labour caesarean section).45

e.         Cervical spine injury.

Injury to the fetal cervical spinal cord is rare but the absolute rate is difficult to define. In a series from Canada it was estimated the risk may be 0.7/1000 rotation forceps births.46 This injury may occur less frequently with vacuum delivery. The risk may be minimised by ensuring uterine relaxation prior to attempting rotation.

These complications may require admission to a neonatal unit and may be associated with feeding and bonding difficulties.

•          Maternal complications

Maternal complications which may occur  include vaginal trauma, postpartum haemorrhage, urinary tract injury, and damage to pelvic floor and anal sphincter (details below).6


4.8 Re-bulleted

Here I’ve copied the above plain text, then re-applied bulleting – doesn’t have a solution for intents, and the text wraps back to the far left margin (doesn’t indent in line with bullet’s first line)

The adverse effects of instrumental birth must be weighed against the consequences of awaiting vaginal birth or alternatively of performing a caesarean section with the head deep in the pelvis. The more serious complications are very uncommon but include:

  1. Fetal complications
  2. a.         Shoulder dystocia and its consequences: The need to perform an instrumental birth for lack of progress in the presence of anticipated macrosomia  should alert the clinician to the increased likelihood of shoulder dystocia as would instrumental birth in a multigravida with a delay in second stage42
  3. b.         Subaponeurotic/subgaleal haemorrhage: A potentially life threatening complication, occurring in approximately 1 in 300 cases of  vacuum delivery.43, 44  Refer to College Statement Prevention Detection and Management of Subgaleal Haemorrhage in the Newborn (C-Obs 28)
  4. c.         Facial nerve palsy, corneal abrasion, retinal haemorrhage: Facial nerve palsy and corneal abrasion are more common with forceps and retinal haemorrhage with vacuum birth.6
  5. d.         Skull fracture and/or intracranial haemorrhage: A review of 583,340 live-born singleton babies of nulliparous women where the birth weight was between 2500 and 4000gm reported rates of intracranial haemorrhage with differing modes of birth: one in 664 (forceps); one in 860 (vacuum extraction); one in 907 (intrapartum caesarean section); one in 1900 (spontaneous vaginal birth); and, one in 2750 (pre-labour caesarean section).45
  6. e.         Cervical spine injury: Injury to the fetal cervical spinal cord is rare but the absolute rate is difficult to define. In a series from Canada it was estimated the risk may be 0.7/1000 rotation forceps births.46 This injury may occur less frequently with vacuum delivery. The risk may be minimised by ensuring uterine relaxation prior to attempting rotation.

These complications may require admission to a neonatal unit and may be associated with feeding and bonding difficulties.

•          Maternal complications

Maternal complications which may occur  include vaginal trauma, postpartum haemorrhage, urinary tract injury, and damage to pelvic floor and anal sphincter (details below).6


4.8 Partially formatted

Here I used one bulleted list item, then copy/pasted the plain text into a section, and applied bulleting. It’s so-so; still the problem of the text wrapping back to the far left margin, not indenting to the bullet.

The adverse effects of instrumental birth must be weighed against the consequences of awaiting vaginal birth or alternatively of performing a caesarean section with the head deep in the pelvis. The more serious complications are very uncommon but include:

Fetal complications

  • Shoulder dystocia and its consequences: The need to perform an instrumental birth for lack of progress in the presence of anticipated macrosomia  should alert the clinician to the increased likelihood of shoulder dystocia as would instrumental birth in a multigravida with a delay in second stage42
  • Subaponeurotic/subgaleal haemorrhage: A potentially life threatening complication, occurring in approximately 1 in 300 cases of  vacuum delivery.43, 44  Refer to College Statement Prevention Detection and Management of Subgaleal Haemorrhage in the Newborn (C-Obs 28)
  • Facial nerve palsy, corneal abrasion, retinal haemorrhage: Facial nerve palsy and corneal abrasion are more common with forceps and retinal haemorrhage with vacuum birth.6
  • Skull fracture and/or intracranial haemorrhage: A review of 583,340 live-born singleton babies of nulliparous women where the birth weight was between 2500 and 4000gm reported rates of intracranial haemorrhage with differing modes of birth: one in 664 (forceps); one in 860 (vacuum extraction); one in 907 (intrapartum caesarean section); one in 1900 (spontaneous vaginal birth); and, one in 2750 (pre-labour caesarean section).45
  • Cervical spine injury: Injury to the fetal cervical spinal cord is rare but the absolute rate is difficult to define. In a series from Canada it was estimated the risk may be 0.7/1000 rotation forceps births.46 This injury may occur less frequently with vacuum delivery. The risk may be minimised by ensuring uterine relaxation prior to attempting rotation.

These complications may require admission to a neonatal unit and may be associated with feeding and bonding difficulties.


4.8 Fully formatted

This is fully formatted in list groups, but wasn’t quick at all… circling back to our original problem :/

The adverse effects of instrumental birth must be weighed against the consequences of awaiting vaginal birth or alternatively of performing a caesarean section with the head deep in the pelvis. The more serious complications are very uncommon but include:

Fetal complications

a)

Shoulder dystocia and its consequences: The need to perform an instrumental birth for lack of progress in the presence of anticipated macrosomia  should alert the clinician to the increased likelihood of shoulder dystocia as would instrumental birth in a multigravida with a delay in second stage42

b)

Subaponeurotic/subgaleal haemorrhage: A potentially life threatening complication, occurring in approximately 1 in 300 cases of  vacuum delivery.43, 44  Refer to College Statement Prevention Detection and Management of Subgaleal Haemorrhage in the Newborn (C-Obs 28)

c)

Facial nerve palsy, corneal abrasion, retinal haemorrhage: Facial nerve palsy and corneal abrasion are more common with forceps and retinal haemorrhage with vacuum birth.6

Maternal complications

Shoulder dystocia and its consequences: The need to perform an instrumental birth for lack of progress in the presence of anticipated macrosomia  should alert the clinician to the increased likelihood of shoulder dystocia as would instrumental birth in a multigravida with a delay in second stage42

Subaponeurotic/subgaleal haemorrhage: A potentially life threatening complication, occurring in approximately 1 in 300 cases of  vacuum delivery.43, 44  Refer to College Statement Prevention Detection and Management of Subgaleal Haemorrhage in the Newborn (C-Obs 28)

Facial nerve palsy, corneal abrasion, retinal haemorrhage: Facial nerve palsy and corneal abrasion are more common with forceps and retinal haemorrhage with vacuum birth.6

Test waypoint

If you have any vaginal bleeding, severe abdominal pain, high fever or unusual fluid loss from the vagina, you should go to your emergency department. In general, if you have been well for the first week or two after the amniocentesis, it is unlikely that any complications will happen after this.

1.0

Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua. Ut enim ad minim. Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua. Ut enim ad minim. Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua. Ut enim ad minim.

Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua.

Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua.

1.1

Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua. Ut enim ad minim. Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua. Ut enim ad minim. Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua. Ut enim ad minim.

a)

Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua.

b)

Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua.

1.2

Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua. Ut enim ad minim. Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua. Ut enim ad minim. Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua. Ut enim ad minim.

1.3

Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua. Ut enim ad minim. Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua. Ut enim ad minim. Lorem ipsum dolor sit amet, consec tetur adipi scing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliq ua. Ut enim ad minim.


Test waypoint

If you have any vaginal bleeding, severe abdominal pain, high fever or unusual fluid loss from the vagina, you should go to your emergency department. In general, if you have been well for the first week or two after the amniocentesis, it is unlikely that any complications will happen after this.


Disclaimer

This document is intended to be used as a guide of general nature, having regard to general circumstances. The information presented should not be relied on as a substitute for medical advice, independent judgement or proper assessment by a doctor, with consideration of the particular circumstances of each case and individual needs. This document reflects information available at the time of its preparation, but its currency should be determined having regard to other available information. RANZCOG disclaims all liability to users of the information provided.

© RANZCOG 28/07/2016


RESOURCES FOR THE PUBLIC

Find an O&G doctor

Patient information resources


RESOURCES FOR MEDICAL PROFESSIONALS

Statements and guidelines

Order pamphlets