Obstetrical Management of Zuni-Ramah Population
| Condition | Management |
|---|---|
| ACOG indicates American College of Obstetricians and Gynecologists; GDM A1, gestational diabetes controlled with diet; GDM A2, gestational diabetes requiring insulin; and CDC, Centers for Disease Control and Prevention. | |
| Previous cesarean section | Trial of labor strongly encouraged for women meeting ACOG criteria (at a hospital with cesarean delivery capability) |
| Breech | All offered external cephalic version at 37 to 38 weeks; selective availability of vaginal breech birth at Gallup Indian Medical Center |
| Postdates | Nonstress test and amniotic fluid index biweekly starting at 41 weeks; if reassuring, induction deferred until ≥ 42 weeks |
| Mild preeclampsia | Induction at 37 to 39 weeks based on Bishop score |
| GDM A1 | Nonstress test and amniotic fluid index biweekly starting at 40 weeks; if reassuring, induction deferred until 42 weeks |
| Chronic hypertension, pregestational diabetes, and GDM A2 | Induction at 38 to 39 weeks depending on Bishop score and antepartum surveillance |
| Elective/social induction | Not done |
| Induction for macrosomia | Not done in women without diabetes |
| Premature rupture of membranes at term | Option of expectant management for up to 72 hours; most women were induced at 24 to 48 hours if not in labor. |
| Group B streptococcus prophylaxis | The CDC risk-factor-based protocol was used rather than a screening-based protocol. |