American Journal of Obstetrics & Gynecology
Volume 199, Issue 5 , Pages 445-454, November 2008

Evidence-based labor and delivery management

  • Vincenzo Berghella, MD

      Affiliations

    • Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA
  • ,
  • Jason K. Baxter, MD, MSCP

      Affiliations

    • Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA
  • ,
  • Suneet P. Chauhan, MD

      Affiliations

    • Aurora Health Care, Milwaukee, WI

Received 12 February 2008; received in revised form 21 April 2008; accepted 30 June 2008.

Our objective was to provide evidence-based guidance for managment decisions during labor and delivery. We performed MEDLINE, PubMed, and COCHRANE searches with the terms labor, delivery, pregnancy, randomized trials, plus each management aspect of labor and delivery (eg, early admission). Each management step of labor and delivery was reviewed separately. Evidence-based good quality data favor hospital births, delayed admission, support by doula, training birth assistants in developing countries, and upright position in the second stage. Home-like births, enema, shaving, routine vaginal irrigation, early amniotomy, “hands-on” method, fundal pressure, and episiotomy can be associated with complications without sufficient benefits and should probably be avoided. We conclude that labor and delivery interventions supported by good quality data as just described should be routinely performed. All aspects with lower data quality should be researched with adequately powered and designed trials.

Key words: delivery, evidence-based, labor

 

 Reprints not available from the authors.

PII: S0002-9378(08)00775-8

doi:10.1016/j.ajog.2008.06.093

Refers to article:

  • Cross-reference Synthesize evidence and they will change?

    John Thorp
    American Journal of Obstetrics & Gynecology November 2008 (Vol. 199, Issue 5, Pages 441-442)

American Journal of Obstetrics & Gynecology
Volume 199, Issue 5 , Pages 445-454, November 2008