Place of Birth

Olsen O, Jewell MD.
Home versus hospital birth (Cochrane Review)
In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software, Abstract

Only one randomised trial of 11 women was of sufficient quality to be included in this review. There is therefore insufficient RCT evidence to reach any conclusions. However the observational evidence is also reviewed.

Olsen O.
A meta-analysis of observational studies: Meta-analysis of the safety of home birth
Birth 1997; 24(1): 4-13

Showed no statistically significant difference in mortality between planned home and planned hospital births. (Abstract)

Hodnett ED.
Home-like versus conventional institutional settings for birth (Cochrane Review)
In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software, Abstract.

Compares birth in a home-like setting vs conventional hospital care. In this review home-like settings resulted in a reduction in intervention but a non statistically significant trend towards higher perinatal mortality.

RCOG Statement: Birth in Water
Evidenced based statements regarding labour and delivery in water.
http://www.rcog.org.uk/mainpages.asp?PageID=641

Induction of Labour

Membrane sweeping

Boulvain M, Stan C, Irion O.
Membrane sweeping for induction of labour (Cochrane Review).
In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software, Abstract

Reviews current trials examining the evidence for membrane sweeping

Induction of Labour
Department of Health Communication: Induction of Labour, 2001,
http://www.rcog.org.uk/resources/pdf/rcog_induction_of_labour.pdf

Describes indications, induction methods and required monitoring

Fetal Monitoring

Department of Health Communication: The Use of Electronic Fetal Monitoring 2001
http://www.rcog.org.uk/resources/pdf/efm_guideline_final_2may2001.pdf

Intrapartum management/care

Progress in labour
Perinatal Institute Reviews:Active Management of Labour

Reviews the evidence for Active Management

Position in Labour

Gupta JK , Nikodem VC.
Position for women during second stage of labour (Cochrane Review).
In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software, Abstract

Reviews the risks and benefits of different positions in the second stage

Gardosi J, Hutson N, Lynch CB.
Randomised, controlled trial of squatting in the second stage of labour.
Lancet 1989;2:74-7, Abstract

Epidural vs Non Epidural Analgesia

Howell CJ.
Epidural versus non-epidural analgesia for pain relief in labour (Cochrane Review).
In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software, Abstract

This concluded that epidural analgesia is effective in reducing pain in labour. The potentially adverse effects are reviewed

Instrumental Delivery/Caesarian Section

RCOG Green top Guidelines: Instrumental delivery No.26
http://www.rcog.org.uk/guidelines.asp?PageID=106&GuidelineID=12

This evidenced based review covers indications for delivery, choice of instrument (including information from the Cochrane reviews below), complications, training and documentation.

Johanson RB, Menon BKV.
Vacuum extraction vs forceps delivery. (Cochrane Review).
In: The Cochrane Library, Issue 4, 1999. Oxford: Update Software, Abstract

10 trials were of sufficient quality to be included. The vacuum extractor appears to cause less maternal trauma but the forceps results in less cephalohaematoma and retinal haemorrhages.

Johanson R, Menon V.
Soft versus rigid vacuum extractor cups for assisted vaginal delivery (Cochrane Review).
In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software, Abstract

Smaill F, Hofmeyr GJ.
Antibiotic prophylaxis for cesarean section (Cochrane Review).
In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software, Abstract.

Routine antibiotic prophylaxis significantly reduces postpartum fever, Endometritis, wound infection and urinary tract infections.

Third Stage

Prendiville WJ, Elbourne D, McDonald S.
Active versus expectant management in the third stage of labour (Cochrane Review)
In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software, Abstract

Active management results in less blood loss, postpartum haemorrhage and prolonged third stage than expectant management.

McDonald S, Prendiville WJ, Elbourne D.
Prophylactic syntometrine versus oxytocin for delivery of the placenta (Cochrane Review).
In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software, Abstract.

Syntometrine use resulted in less blood loss when the total loss was less than 1000ml. However there were more frequent episodes of vomiting and hypertension.

Perineal Care - (Episiotomy/tears)

Carroli G, Belizan J.
Episiotomy for vaginal birth (Cochrane Review).
In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software, Abstract

Compares restrictive vs routine episiotomy, midline and mediolateral. Restrictive use reduces posterior perineal trauma, suturing and complications with no difference in pain or severe trauma and an increase in anterior trauma.

RCOG Green Top Guideline: Perineal Repair No.23
http://www.rcog.org.uk/guidelines.asp?PageID=106&GuidelineID=15
Evidence based review which includes suture material, method of repair, operator experience and risk management.

Kettle C, Johanson RB.
Absorbable synthetic versus catgut suture material for perineal repair (Cochrane Review).
In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software, Abstract.

Absorbable synthetic suture material resulted in less short term pain, analgesia usage and dehiscence with no change in long term pain or dysparunia. However absorption time was longer and it needed removal more often than catgut.

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