Effective Care in Pregnancy & Childbirth: Table #3 ~ Trade-off btw Beneficial and Adverse Effects
Murray Enkin, MD, FRCS(C), L L D, Marc J. N. C Keirse, MD, DPhil, DPH, FRA NWOG, FRCOG
James Neilson, BSc, MD, FRCOG, Caroline Crowther, MD, DCH, DDU, FRCOG, FRANWOG,
Lelia Duley, MD, MSc(Epid), MRCOG, Ellen Hodnett, RN, PhD,
and G. Justus Hofmneyr, MBBCH, MRCOG
Third Edition ~ 2000
Table 3. Forms of care with a trade-off between beneficial & adverse effects
Women and caregivers should weigh these effects according to circumstances, priorities, and preferences
Basic care
- Continuity of caregiver for childbearing women
- Legislation restricting type of employment for pregnant women
Screening and diagnosis
- Formal systems of risk scoring
- Routine ultrasound in early pregnancy
- Chorionic villus sampling versus amniocentesis for diagnosis of chromosomal abnormalities
- Scrum alpha‑fetoprotein screening for neural tube defects
- Triple‑test screening for Down syndrome and neural tube defects
Pregnancy problems
- Corticosteroids, to promote fetal maturity before preterm birth in diabetic pregnancy
- Routine elective cesarean for breech presentation
- Induction of labor for prelabor rupture of the membranes at term
- Oral betamimetics to maintain uterine quiescence after arrest of preterm labor
- Cervical cerclage for women at risk of preterm birth
- Betamimetic drugs to stop preterm labor
- Induction instead of surveillance for pregnancy after 41 weeks gestation
- Expectant care versus induction of labor after fetal death
Childbirth
- Continuous electronic monitoring (with scalp sampling) versus intermittent auscultation during labor
- Milling versus mediolateral episiotomy, when episiotomy is necessary
- Prophylactic ergometrine /oxytocin (syntometrine) versus oxytocin alone in the third stage of labor
Problems during childbirth
- Routine preloading with intravenous fluids before epidural analgesia
- Narcotics to relieve pain in labor
- Inhalation analgesia to relieve pain in labor
- Epidural analgesia to relieve pain in labor
- Epidural administration of opiates to relieve pain in labor
- Early amniotomy in spontaneous labor
Techniques of induction and operative delivery
- Mechanical methods for cervical ripening or induction of labor
- Endocervical versus vaginal prostaglandin for cervical ripening before induction of labor
- Oral prostaglandin L, for induction of labor with a ripe cervix
- Natural prostaglandins versus oxytocin for induction of labor
- Soft versus rigid vacuum extractor cups
- Regional Versus general anaesthesia for cesarean section
- Epidural versus spinal anesthesia for cesarean section
- Ampicillin versus broader spectrum antibiotics for cesarean section
Care after childbirth
- Prophylactic antibiotic eye ointments to prevent eye infection in the newborn
- Prophylactic versus “rescue” surfactant for very preterm infants
