Effective Care In Pregnancy and Childbirth: Table #1 Beneficial Forms of Care

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
{Contains some evidence-based recommendations that are not outdated}

Table 1. Beneficial Forms of Care ~ Demonstrated by Clear evidence from controlled trials

Basic care

  • Women carrying their pregnancy record to enhance their feeling of being in control
  • Pre and peri-conceptional folic acid supplementation to prevent recurrent neural tube defects
  • Folic acid supplementation (or high folate diet) for all women envisaging pregnancy
  • Assistance (especially behavioural strategies) to stop smoking during pregnancy
  • Balanced energy and protein supplementation when dietary supplementation is required
  • Vitamin D supplementation for women with inadequate exposure to sunlight iodine supplementation in populations with a high incidence of endemic cretinism

Screening and Diagnosis

  • Doppler ultrasound in pregnancies at high risk of fetal compromise

Pregnancy problems

  • Antihistamines for nausea and vomiting of pregnancy that is resistant to simple measures
  • Local imidazoles for vaginal candida infection (thrush) Local imidaxoles instead of nystatin for vagina] candida infection (thrush)
  • Magnesium Sulphate rather than other anticonvulsants for treatment of eclampsia
  • Administration of anti-D immunoglobulin to Rh-negative women whose newborn baby is not Rh-negative
  • Administration of anti-D immunoglobulin to Rh-negative women at 28 weeks of pregnancy
  • Antirotroviral treatment of HIV-inflected pregnant women to prevent transmission to fetus
  • Antibiotic treatment of asymptomatic bacteriuria Antibiotics during labor for women known to be colonized with group B streptococcus
  • Tight as opposed to too strict or loose control of blood sugar levels in pregnant diabetic women
  • External cephalic version at term to avoid breech birth
  • Corticosteroids to promote fetal maturity before preterm birth
  • Offering induction of labor after 41 completed weeks of gestation

Childbirth

  • Physical, emotional, and psychological support during labor and birth
  • Continuous Support for women during labor and childbirth
  • Agents to reduce acidity of’ stomach contents before general anaesthesia
  • Complementing fetal heart rate monitoring in labor with fetal acid-base assessment
  • Oxytocics to treat postpartum hemorrhage
  • Prophylactic oxytocics in the third stage of labor
  • Active versus expectant management of’ third stage of labor

Problems during childbirth

  • Absorbable instead of non-absorbable sutures for skin repair of’ perineal trauma
  • Polylycolic acid Sutures instead of chromic catgut for repair of’ perineal trauma

Techniques of induction and operative delivery

  • Prostaglandins to increase cervical readiness for induction of labor
  • Aniniotomy plus, oxytocin for induction of labor instead of either amniotomy alone or oxytocin alone
  • Vacuum extraction instead of forceps when operative vaginal delivery is required
  • Antibiotic prophylaxis (short course or intraperitoncal lavage with cesarean section

Care after childbirth

  • Use of surfactant for very preterm infants, to prevent respiratory distress syndrome
  • Support for socially disadvantaged mothers to improve parenting
  • Consistent support for breastfeeding mothers
  • Personal support from a knowledgeable individual for breastfeeding mothers
  • Unrestricted breastfeeding
  • Local anesthetic sprays for relief of perineal pain postpartum
  • Cabergoline instead of’ bromocriptine for relief of breast symptoms in non-breastfeeding mothers

Continue to Table #2