EDITOR'S NOTE:
This article is the text and six tables from the
final chapter (Chapter 50) of the new third edition of A Guide to Effective Care
in Pregnancy and Childbirth. It summarizes the authors' conclusions and
recommendations, based on the information they have compiled in the book about
the beneficial or harmful effects of the various elements of care used during
pregnancy, and childbirth.
The underlying thesis of this book is that evidence
from well-controlled comparisons provides the best basis, for choosing
among alternative forms of care in pregnancy and childbirth. This evidence
should encourage the adoption of useful measures and the abandonment of those
that are useless or harmful.
Research based
on the study of groups may riot always apply to
individuals, although it should
be relevant to guide broad policies of care. Forms of care listed in Tables, 5
and 6 may still be useful in particular circumstances, although, once again,
they should be discouraged as a matter of policy. Practices listed in Table 3
will require careful consideration by the individuals concerned, while those in Table
4 should usually be avoided except in the context of trials to better evaluate
their effects.
Table 4. Forms of
Care of Unknown
Effectiveness
There are insufficient or
inadequate quality data upon which
to base a recommendation for practice "Table
4 should usually be avoided except in the context of trials to better evaluate
their effects."
Basic
care
Formal preconceptional care for all women
Fish oil supplementation to improve pregnancy outcome
Prostaglandin precursors to improve pregnancy outcome
Calcium supplementation to improve pregnancy outcome
Magnesium supplementation to improve pregnancy outcome
Zinc supplementation to improve pregnancy outcome
Antigen-avoidance diets to reduce risk of an atopic child
Screening
and diagnosis
Placental grading by ultrasound to improve perinatal
outcome
Measuring placental proteins for pre-eclampsia
Doppler ultrasound of' uterine artery for pre-eclampsia
Measuring hematocrit and platelets for following the
course of pre-eclampsia
Fetal biophysical profile for fetal surveillance
Pregnancy
problems
Acupressure for nausea and vomiting of pregnancy if
simple measures are ineffective
Vitamin 136 for nausea and vomiting of pregnancy if
simple measures are ineffective
Ginger for nausea and vomiting of' pregnancy
Acid-suppressing drugs for heartburn
Ritiosides for hemorrhoids
Rutosides for varicose veins
Exercise and education programs for backache
Increased salt intake for leg cramps
Oral magnesium for leg cramps
Progestogens for threatened miscarriage with a live
fetus
Human chorionic gonadotrophin (HCG) for threatened
miscarriage with a live fetus
Steroids for women with auto‑antibodies and
recurrent miscarriage
Evacuation (of uterine contents) versus “wait and
see” following spontaneous miscarriage
Medical versus surgical evacuation following
spontaneous miscarriage
Hospitalization for women with pregnancy-induced
hypertension
Bed-rest for women with pre-eclampsia
Antihypertensive drugs for mild to moderate
hypertension
Antioxidant vitamins C and E to prevent pre-eclampsia
Magnesium sulphate for pre-eclampsia
Interventionist versus expectant management for severe
early onset pre‑eclampsia
Plasma volume expansion for pre-eclampsia
Hospitalization and bed‑rest for impaired fetal
growth
Abdominal decompression for impaired fetal growth
Betamimetics for impaired fetal growth
Oxygen treatment for impaired fetal growth
Hormone treatment for impaired fetal growth
Calcium channel blockers for impaired fetal growth
Plasma volume expanders for impaired fetal growth
Hospitalization and bed-rest for triplet and
higher order pregnancy
Antiviral agents for women with a history of recurrent
genital herpes
Prophylactic antibiotics for prelabor rupture of
membranes at term or preterm
Postpartum prophylactic antibiotics after prelabor
rupture of membranes
Bed‑rest to prevent preterm birth
Progestogens to prevent preterm birth
Calcium antagonists to stop preterm labor
Antibiotic treatment in preterm labor
Oxytocin antagonists to stop preterm labor
Sweeping of the membranes to prevent post‑term
pregnancy
Nipple stimulation to prevent post‑term pregnancy
Childbirth
Pre-admission assessment to determine if labor is
in the active phase
Routine amnioscopy to
detect meconium‑stained amniotic fluid in labor
Routine artificial rupture of membranes to detect
meconium-stained amniotic fluid in labor
Short periods of electronic fetal monitoring as a
screening test on admission in labor
Fetal stimulation tests for fetal assessment in labor
Maternal oxygen administration for fetal distress in
labor
Institutional routines for repeating blood pressure
measurements in labor
Nipple stimulation to prevent postpartum haemorrhage
Misoprostol in the third stage of labor to prevent
postparturm hermorrhage
Early versus, late clamping of the umbilical cord at
birth
Method for delivery of the placenta in the third stage
of labor
Injecting oxytocin in the umbilical vein in the third
stage of labor
Injecting oxytocin in the umbilical vein for retained
placenta
Problems
during childbirth
Abdominal decompression to relieve pain in labor
Immersion in water to relieve pain in labor
Acupuncture to relieve pain in labor
Acupuncture to relieve pain in labor
Transcutancous electrical nerve stimulation to relieve
pain in labor
Intradermal injection of sterile water to relieve pain
in labor
Aromatherapy to relieve pain in labor
Hypnosis to relieve pain in labor
Continuous infusion versus intermittent top-ups
for epidural analgesia
Free mobility during labor to augment slow labor
Early use of oxytocin to augment slow or prolonged
labor
"Active management" of labor
Cervical vibration for slow or prolonged labor
Histoacryl tissue adhesive for perineal skin repair
Cesarean section for very preterm delivery
Cesarean section for preterm breech delivery
Immediate versus delayed clamping of' the umbilical
cord of preterm infants
Techniques
of induction and operative delivery
Oxytocin by automatic-infusion systems versus
"standard regimens" for induction of' labor
Misoprostol orally or vaginally for induction of labor
Use of hemostatic stapler for the uterine incision at
cesarean section
Single versus two layer closure of the uterine
incision at cesarean section
Systemic versus intraperitoneal prophylactic
antibiotics at cesarean section
Care
after childbirth
Tracheal suctioning for meconium in babies without
respiratory depression
Routine use of antiseptics on the umbilical cord stump
Oral protcolytic enzymes, for breast engorgement in
breastfeeding mothers
Cabbage leaves for breast engorgement in breastfeeding
mothers
Dopamine agonists to improve milk supply in
breastfeeding mothers
Oxytocin nasal spray to improve milk supply in
breastfeeding mothers
Oral protcolytic enzymes for perineal pain postpartum
Ultrasound and pulsed electromagnetic energy for
perineal pain
Rubber rings and similar devices to prevent pressure
for perineal pain
Cabergoline versus physical methods of suppressing
lactation
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