acog guidelines for induction of labour 2021 pdf

Oxytocin: A hormone made in the body that can cause contractions of the uterus and release of milk from the breast. Laminaria are thin rods inserted into the cervix to dilate it. (Endorsed October 2015). Labor & Delivery. Management of suboptimally dated pregnancies. The following ACOG documents have been revised: ACOG Committee Opinion No. Although most cesarean births are safe, there may be additional risks for you, including. ACOG Committee Opinion No. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Misoprostol, a medication for peptic ulcers, is a commonly used off-label drug that both ripens the cervix and induces labor. Green-top Guidelines. 360 Other risks of labor induction may include, chorioamnionitis, an infection of the amniotic fluid, placenta, or membranes. BJOG. There is a lack of consensus regarding terminology, etiology, and diagnostic criteria for fetal growth restriction, with uncertainty surrounding the optimal management and timing of delivery for the growth-restricted fetus. Timing of indicated late-preterm and early- term birth Contractions usually start in about 30 minutes after oxytocin is given. to maintaining your privacy and will not share your personal information without To know more, see our. This may cause the uterus to contract too often. HHS Vulnerability Disclosure, Help Amniotomy can be done to start labor when the cervix is dilated and the baby's head has moved down into the pelvis. When the health of a woman or her fetus is at risk, induction before 39 weeks may be recommended. Induction rates were at least twice as high in 2010 as in Disclaimer. However, there are a number of maternal, fetal, and placental complications in which either a late-preterm or early-term delivery is warranted. Bookshelf 107: Induction of labor Obstet Gynecol. ACOG Practice Bulletin No. and transmitted securely. PMC or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 . Frye DK With some induction methods, the uterus can be overstimulated, causing it to contract too often. Any potential conflicts have been considered and managed in accordance with ACOGs Conflict of Interest Disclosure Policy. The reasons for this are multiple and interrelated. SEARCH. Too many contractions may lead to changes in the fetal heart rate. Although rare, there are potential complications with some methods of labor induction. Chorioamnionitis: A condition during pregnancy that can cause unexplained fever with uterine tenderness, a high white blood cell count, rapid heart rate in the fetus, rapid heart rate in the woman, and/or foul-smelling vaginal discharge. Responsibilities of the Most Responsible Health Practitioner for Induction by Cervical Ripening 5.1 Provide an order to initiate cervical ripening. Low Weak 3. FOGSI. Please enable scripts and reload this page. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement A health care provider might recommend inducing labor for various reasons, primarily when there's concern for the mother's or baby's health. : . Table 2. To rupture the amniotic sac, an ob-gyn makes a hole in the sac with a special device. National Society of Genetic Counselors (NSGC) and Perinatal Quality Foundation (PQF). These situations include (but are not limited to) transverse fetal position, umbilical cord prolapse, active genital herpes infection, placenta previa, and women who have had a previous myomectomy (fibroid removal) from the inside of the uterus, according to ACOG. Bczek G, Rzoca E, Rzoca P, Rychlewicz S, Budner M, Bie A. Int J Environ Res Public Health. Gestational Diabetes: Diabetes that starts during pregnancy. Term Prelabor Rupture of Membranes. ET), Clinical Considerations and Recommendations, Summary of Recommendations and Conclusions, Alliance for Innovation on Women's Health, Postpartum Contraceptive Access Initiative, Easy, advanced search function to find the most relevant guidance. Induction of labour is recommended for women who are known with certainty to have reached 41 weeks (>40 weeks + 7 days) of gestation. This site needs JavaScript to work properly. Miller DD This procedure, called an amniotomy, may be done after a woman has been given oxytocin. Induction of labour is not recommended in women with an uncomplicated pregnancy at gestational age less than 41 weeks. Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury. Wapner RJ If you and your pregnancy are doing well and the amniotic sac has not ruptured, you may be given the option to go home. In the case of an anticipated late-preterm delivery, a single course of antenatal betamethasone is recommended within 7 days of the delivery in select women who have not received a previous course of antenatal corticosteroids 7. The variation in the clinical indications and methods of IOL highlights the need to adopt an international consensus, which may help to optimize the quality of obstetric care and further promote evidence-based medicine. 2005 Jul;25(5):451-4. doi: 10.1080/01443610500160121. 142: Cerclage for the Management of Cervical Insufficiency (Obstet Gynecol 2014;123:3729), ACOG Practice Bulletin No. Prelabor Rupture of Membranes (PROM): Rupture of the amniotic membranes that happens before labor begins. Don't have an ob-gyn? "There are certain situations where labor induction is contraindicated," says Dr. Ramin. e102 All rights reserved. external cephalic version is unsuccessful, declined or contraindicated, and. Babies born at or after 39 weeks have the best chance at healthy outcomes compared with babies born before 39 weeks. Inducing labour [CG70] Guidance from the National Institute for Health and Care Excellence (NICE). An official website of the United States government. Too many contractions may lead to changes in the fetal heart rate. The fetus develops in this sac. If the cervix is not sufficiently dilated, then drugs or mechanical cervical dilators should be used to ripen the cervix before labor is induced. Low Weak 2. By reading this page you agree to ACOG's Terms and Conditions. This paper discusses the induction of labour in women of advanced maternal age (40+ years) and the possible benefits of inducing at an earlier stage of gestation (39-40 weeks). National Library of Medicine Some of these conditions include the following: Placenta previa (the placenta covers the opening of the uterus), The fetus is lying sideways in the uterus or is in a breech presentation, Prolapsed umbilical cord (the cord has dropped down in the vagina ahead of the fetus), Some types of previous uterine surgery, such as certain types of cesarean birth or surgery to remove fibroids. Bulk pricing was not found for item. 2023 Feb 14;23(1):114. doi: 10.1186/s12884-023-05426-7. 151: Cytomegalovirus, Parvovirus B19, Varicella Zoster, and Toxoplasmosis in Pregnancy (Obstet Gynecol 2015;125:151025), ACOG Practice Bulletin No. Published online on June 24, 2021.Copyright 2021 by the American College of Obstetricians and Gynecologists. Please try after some time. Read common questions on the coronavirus and ACOGs evidence-based answers. Use of this site is subject to our terms of use, privacy policy, advertisement policy. This information is designed as an educational aid for the public. Table 1 It can be used to start labor or to speed up labor that began on its own. Results: Before , acog.org (Monday through Friday, 8:30 a.m. to 5 p.m. PMC The purpose of this document is to review the findings of a recent randomized trial of induction of labor versus expectant management in low-risk nulliparous women at 39 weeks of gestation, and to provide guidance for implementation of the study findings into practice. Kilpatrick S Get new journal Tables of Contents sent right to your email inbox, https://www.acog.org/clinical/clinical-guidance/acog-endorsed, https://www.asccp.org/Assets/b2263c88-ec67-4ab0-9f07-6f112e76f8d7/637269576182030000/2019-asccp-risk-based-management-consensus-3-5-pdf, https://onlinelibrary.wiley.com/doi/full/10.1002/jum.14677, https://www.perinatalquality.org/Vendors/NSGC/NIPT/, https://www.nsgc.org/page/abnormal-non-invasive-prenatal-testing-results, https://www.acog.org/clinical/journals-and-publications/clinical-updates, Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222, ACOG Practice Bulletin No. Read ACOGs complete disclaimer. These drugs can be inserted into the vagina or taken by mouth. 2022. Last reviewed: August 2022. The Bishop score may be used to rate the readiness of the cervix for labor. , These signs include an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, or a severe headache or changes in vision. Before inducing labor, your ob-gyn or other health care professional may check to see if your cervix is ready using the Bishop score. ; Read copyright and permissions information. BY SPECIALTY. Evid Based Complement Alternat Med. Placenta: An organ that provides nutrients to and takes waste away from the fetus. This bimonthly monograph series is available online to ACOG members at https://www.acog.org/clinical/journals-and-publications/clinical-updates. These are recommendations only and will need to be individualized and reevaluated as new evidence becomes available. Oxytocin is given through an intravenous (IV) line in the arm. Obstet Gynecol ; . 501: MaternalFetal Intervention and Fetal Care Centers (Obstet Gynecol 2011;118:40510), ACOG Committee Opinion No. You can schedule another appointment to try induction again. MeSH Read common questions on the coronavirus and ACOGs evidence-based answers. Any content/information on this website does not replace the advice of medical and/or health professionals and should not be construed as medical/diagnostic advice/endorsement or prescription. HHS Vulnerability Disclosure, Help 1.2.21 Induction of labour is not generally recommended if a woman's baby is in the breech position. ACOG Practice Bulletin No. There is a lack of consensus regarding terminology, etiology, and diagnostic criteria for fetal growth restriction, with uncertainty surrounding the optimal management and timing of delivery for the . Some examples of these conditions include uterine dehiscence or chronic placental abruption. Read terms, Number 831 , Cesarean Birth: Birth of a fetus from the uterus through an incision (cut) made in the woman's abdomen. . Laminaria: Slender rods made of natural or synthetic material that expand when they absorb water. 2022 Apr 13;22(1):316. doi: 10.1186/s12884-022-04663-6. Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is high blood pressure and other signs of organ injury. Sometimes labor induction may be needed even if it means that the fetus will be born early. may email you for journal alerts and information, but is committed 2003 Jul;82(1):71-2. doi: 10.1016/s0020-7292(03)00129-2. The 2008 guidance stated that, "Women with uncomplicated pregnancies should usually be offered induction of labour between 41+0 and 42+0 weeks" (NICE 2008). To strip the membranes, your ob-gyn or other health care professional sweeps a gloved finger over the thin membranes that connect the amniotic sac to the wall of your uterus. Unable to load your collection due to an error, Unable to load your delegates due to an error. With this scoring system, a number ranging from 0 to13 is given to rate the condition of the cervix. , Fetus: The stage of human development beyond 8 completed weeks after fertilization. Stripping the membranes, also called sweeping the membranes, is a common way to induce labor. If there are problems with the fetal heart rate, oxytocin may be reduced or stopped. You have gestational diabetes or had diabetes mellitus before pregnancy. 133 The World Health Organization seems to be the most evidence-based guideline with recommendations based mainly on Cochrane reviews. . FOIA According to NHS Maternity Statistics [3] the proportion of labours in England that are induced has increased from 21% in the year to March 2010 to 34% in the year to March 2021. The purpose of this document is to review current methods for cervical ripening and induction of labor and to summarize the effectiveness of these approaches based on appropriately conducted outcomes-based research. Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high. When you choose labor induction and you and your fetus are healthy, it is called elective induction. ition A descriptive review was conducted of major published guidelines on IOL: the American College of Obstetricians and Gynecologists' "Induction of Labor" and "Management of Late-Term and Postterm Pregnancies," the guidelines of the Society of Obstetricians and Gynaecologists of Canada (SOGC) on "Induction of Labour," those of the National Institute for Health and Care Excellence . The Committee on Practice Bulletins-Obstetrics of the American College of Obstetricians and Gynecologists (ACOG) has developed clinical management . Buy. Coronavirus . This procedure, called an amniotomy, may be done before or after you have been given oxytocin. The site is secure. Currently, induction of labor is one of the most . The following ACOG documents have been withdrawn: ACOG Committee Opinion No. It is not intended as a statement of the standard of care. It also may be recommended when labor has not started on its own. Blackwell S Oxytocin is a hormone that causes contractions of the uterus. Accessibility Deferring delivery to the 39th week is not recommended if there is a medical or obstetric indication for earlier delivery. 2017 Amniotic Fluid: Fluid in the sac that holds the fetus. Copyright 2023 by the American College of Obstetricians and Gynecologists. You and your obstetriciangynecologist (ob-gyn) or other health care professional may talk about induction at 39 weeks if: When a woman and her fetus are healthy, induction should not be done before 39 weeks. The ways to start labor may include the following: If your labor does not progress, and if you and your fetus are doing well after attempting induction, you may be sent home. https://www.acog.org/membership/member-benefits/acog-app However, these data were from 2010; robust . ET), This Committee Opinion integrates the findings in this report, as well as more recent evidence, to provide recommendations regarding timing of delivery for frequent obstetric, maternal, fetal, and placental or uterine conditions that would necessitate delivery before 39 weeks of gestation. Laurie Barclay, MD. 4 These guidelines were compared in terms of their recommendations on clinical indications and methods. Anesthesia: Relief of pain by loss of sensation. 2019 The guidelines for induction of labour in 2021 require that if a woman is in a position of low risk to childbearing, she should be allowed to have an induction of labour. Amniocentesis for the determination of fetal lung maturity should not be used to guide the timing of delivery, even in suboptimally dated pregnancies 5. 563: Ethical Issues in Pandemic Influenza Planning Concerning Pregnant Women (Obstet Gynecol 2013;121:113843), ACOG Committee Opinion No. The tube is inserted into the cervix and then expanded. Terms and Conditions of Use, Get the latest on COVID-19, pregnancy, and breastfeeding, Special Procedures for Labor and Delivery. Varner MW Fibroids: Growths that form in the muscle of the uterus. Bookshelf ACOG concludes that "Induction of labor between 41 0/7 and 42 0/7 weeks can be considered" and "Induction of labor after 42 0/7 weeks and by 42 6/7 weeks of gestation is recommended, given evidence of an increase in perinatal morbidity and mortality." Available at: https://www.perinatalquality.org/Vendors/NSGC/NIPT/. It aims to improve advice and care for pregnant women who are thinking about or having induction of labour. Explore ACOG's library of patient education pamphlets. 5. Leveno KJ According to the ACOG committee, there is a significant cost difference between misoprostol and dinoprostone for induction of labor. , eCollection 2022. Guidance consultation documents. Int J Gynaecol Obstet. 702: Female Athlete Triad (Obstet Gynecol 2017;129:e1607). The guidelines provide physicians with guidance regarding which induction methods may be most appropriate under particular circumstances, as well as the safety requirements, and risks and benefits of the different methods. Individual subscriptions include print and online access. The reason for this longstanding principle is that the neonatal risks of late-preterm (34 0/736 6/7 weeks of gestation) and early-term (37 0/738 6/7 weeks of gestation) births are well established, and the potential neonatal complications associated with elective delivery at less than 39 0/7 weeks of gestation are well described 1 2. Tita AT This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. All rights reserved. A pump hooked up to the IV tube controls the amount given. Doctors and campaigners have raised concerns over proposed NICE guidance that recommends that inducing labour should be considered at 39 weeks in women from an ethnic minority family background, even if their pregnancies are considered uncomplicated.1 The draft guidance, under consultation until 6 July, has advised healthcare professionals to consider induction of labour from 39 weeks in . 8600 Rockville Pike BY ORGANIZATION. In addition, the number of cesarean births you have had is a major factor in how you will give birth to any future babies. 719: Multifetal Pregnancy Reduction (Obstet Gynecol 2017;130:15863), ACOG Practice Bulletin No. They also should be given oxytocin at least 12-18 hours after stripping of the membranes. A score of 6 or less means that your cervix is not yet ready for labor. Please try again soon. For these reasons, and because the recommendations for timing of delivery are based on limited data, decisions regarding timing of delivery always should be individualized to the needs of the patient. sharing sensitive information, make sure youre on a federal This method provides women who desire a vaginal delivery the possibility of achieving that goal-a vaginal birth after cesare Healthy women whose labor is induced at 39 weeks may have lower rates of preeclampsia and gestational hypertension than women who do not have induction at 39 weeks. Tita AT Amniotomy: Artificial rupture (bursting) of the amniotic sac. to address and adjudicate competing delivery indications. Read copyright and permissions information. 145: Antepartum Fetal Surveillance (Obstet Gynecol 2014;124:18292), ACOG Practice Bulletin No. Yes. 817: Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment (Obstet Gynecol 2021;137:e715), ACOG Committee Opinion No. . your express consent. eCollection 2022. Trial of labor after cesarean delivery (TOLAC) refers to a planned attempt to deliver vaginally by a woman who has had a previous cesarean delivery, regardless of the outcome. The selected Green Journal articles are free through the end of the calendar year. f preterm labor are not well understood, the burden of preterm births is clearpreterm births account for approximately 70% of neonatal deaths and 36% of infant deaths as well as 25-50% of cases of long-term neurologic impairment in children (7-9). | , 2003 May 15;67(10):2123-8. eCollection 2022. Looking for ABOG articles? Mercer BM The frequency of labor induction in the United States was 31.4 percent in 2020, more than tripling since 1990 when it was 9.5 percent . Bethesda, MD 20894, Web Policies This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. Search for doctors near you. , Cervical ripening is the first component to labor induction. Bulk pricing was not found for item. Sometimes labor induction does not work. Ripening the cervix is a procedure that helps the cervix soften and thin out so that it will dilate (open) during labor. You might consider induction at 39 weeks to reduce the risk of certain health problems. ABSTRACT: The neonatal risks of late-preterm and early-term births are well established, and the potential neonatal complications associated with elective delivery at less than 39 0/7 weeks of gestation are well described. Importance: 831. Summary. In some cultures, food and drinks are consumed during labour for nourishment and comfort to help meet the demands of labour. Deferring delivery to the 39th week of gestation is not recommended if there is a medical or obstetric indication for earlier delivery. 8 However, a medically indicated late-preterm delivery should not be delayed for the administration of antenatal corticosteroids. Available at: https://www.nsgc.org/d/do/4584. 2018 [ 1] Regardless of whether labor is induced or spontaneously occurs, the goal is vaginal birth. Publication types Practice Guideline Review MeSH terms Table 1. Herpes causes painful, highly infectious sores on or around the vulva and penis. They also should be given oxytocin at least 1218 hours after stripping of the membranes. There are several important principles to consider in the timing of delivery. FOGSI. There are problems with the fetus, such as poor growth. Objective: You have health problems, such as problems with your . Induction of labour: information for the public; Induction of labour: information for the public. Epub 2015 Jul 6. Spong CY 2, March 2021. For additional quantities, please contact [emailprotected] If a womans labor does not progress, it may be considered a failed attempt at induction. Ripening of the cervix can be done with medications or with special devices. In the 2021 guideline, the "between" has changed to "from," and the conversation is about offering induction and discussing risks that occur "from 41 weeks" (NICE 2021).. Health care providers should weigh the risks and benefits of each strategy in a given clinical scenario and . All ACOG committee members and authors have submitted a conflict of interest disclosure statement related to this published product. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine have long discouraged nonindicated delivery before 39 weeks of gestation. 2020 Minerva Medical Treatment Pvt Ltd, Email: info@medicaldialogues.in Phone: 011 - 4372 0751. Careers. In some cases, health care providers will need to weigh competing risks and benefits for the woman and her fetus. Society for Maternal-Fetal Medicine (SMFM). "These guidelines will help physicians utilize the most appropriate method depending on the unique characteristics of the pregnant woman and her fetus. Any updates to this document can be found on (Endorsed December 2015), Abnormal Prenatal Cell-free DNA Screening Results: What do they mean? For additional quantities, please contact [emailprotected] Available at: https://onlinelibrary.wiley.com/doi/full/10.1002/jum.14677. Unable to load your collection due to an error, Unable to load your delegates due to an error. (III . N Engl J Med evidence regarding timing of indicated delivery for most conditions is limited, with recommendations based largely on expert consensus and relevant observational studies. A Bishop score of less than 6 means that your cervix may not be ready for labor. American College of Obstetricians and Gynecologists 409 12th Street SW, Washington, DC 20024-2188. indication for induction of labour unless concurrent medical co-morbidities exist or there are other indications that induction of labour is required. The tube is inserted through the vagina and into the opening of the cervix. 162: Prenatal Diagnostic Testing for Genetic Disorders (Obstet Gynecol 2016;127:e10822), ACOG Practice Bulletin No. The goal of induction of labor is to achieve vaginal delivery by stimulating uterine con- Contractions usually start about 30 minutes after oxytocin is given. "And, there are some nonmedical situations in which induction also may be prudent, for instance, in rural areas where the distance to the hospital is just too great to risk waiting for spontaneous labor to happen at home." Importance: Induction of labor (IOL) is a common obstetric intervention that stimulates the onset of labor using artificial methods. ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer . Please try reloading page. Saade G their hospital stay may be longer than with a spontaneous labour. . Incidental Findings at the Time of Cystoscopy, Volume XX, No. If you or your fetus are not doing well after attempting induction, a cesarean delivery may be needed. 20 Acog guidelines for vbac induction acog 2019 vbac guidelines. 2021 : 106: O: Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles (Obstet Gynecol 2009;114:192-202) (Practice Advisory) Jul-09 : 2021 : 107: O: Induction of Labor (Obstet Gynecol 2009;114:386-97) Aug-09 : 2020 : 114: G: Management of Endometriosis (Obstet Gynecol 2010;116:223-36) July 2010 . The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine have long discouraged nonindicated delivery before 39 weeks of gestation. The ACOG guidelines indicate that inducing labor with misoprostol should be avoided in women who have had even one prior cesarean delivery due to the possibility of uterine rupture (which can be catastrophic). Diagnosis and Management of Gestational Diabetes Mellitus: An Overview of National and International Guidelines. The health content on Medical Dialogues and its subdomains is created and/or edited by our, Website Last Updated On : 12 Oct 2022 7:06 AM GMT, We use cookies for analytics, advertising and to improve our site. Use of induction of labour and emergency caesarean section and perinatal outcomes in English maternity services: a national hospital-level study. J Obstet Gynaecol. For trusted, in-depth advice from ob-gyns, turn to Your Pregnancy and Childbirth: Month to Month. Maternal and Neonatal Outcomes of Elective Induction of Labor at 39 or More Weeks: A Prospective, Observational Study. The purpose of this document is to review the topic of fetal growth restriction with a focus on terminology, etiology, diagnostic and surveillance tools, and guidance for management and timing of delivery. Am Fam Physician. : , Am J Obstet Gynecol 2017; DOI: 10.1016/j.ajog.2017.07.039. FOGSI-ICOG GCPR (Good Clinical Practice Recommendation) development group was constituted. The timing of IOL in postterm pregnancies also differs among the guidelines. Eclampsia: Seizures occurring in pregnancy or after pregnancy that are linked to high blood pressure. This is a subtle but significant change, not . Gurol-Urganci I, Jardine J, Carroll F, Frmeaux A, Muller P, Relph S, Waite L, Webster K, Oddie S, Hawdon J, Harris T, Khalil A, van der Meulen J; National Maternity and Perinatal Audit Project Team. First, if there is a clear indication for a late-preterm or early-term delivery for either maternal or newborn benefit, then delivery should occur regardless of the results of lung maturity testing. 2022 Dec 23;13(1):38. doi: 10.3390/diagnostics13010038. guideline is to develop clinical practice recommendations for the appropriate setting, monitoring, and methods of induction in order to improve maternal and neonatal health outcomes . Some conditions may make a vaginal delivery unsafe for you or your fetus. : e29 Also, there remain several conditions for which data to guide delivery timing are not available. Cesarean Birth: Birth of a fetus from the uterus through an incision made in the womans abdomen. Dildy GA It involves the clinician inserting one or two fingers into the lower part of the uterus (the cervix) and using a continuous circular sweeping motion to free the . You agree to our use of cookies by continuing to use our site. Labor Induction with Intravaginal Misoprostol versus Spontaneous Labor: Maternal and Neonatal Outcomes. : , Medications or devices may be used to soften the cervix so it will stretch (dilate) for labor. Elective induction should not be done before 39 weeks of pregnancy. Eunice Kennedy Shriver Levels of evidence. All the guidelines also make similar recommendations regarding the management of uterine tachysystole in cases of IOL. Based on these and other data, timing of elective delivery at 39 weeks of gestation or later is recommended 3. The point in pregnancy at which it is suggested will depend on the reason for suggesting it.

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