Effective Care in Pregnancy & Childbirth: Table #4 ~ Forms of Care of Unknown Effectiveness
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 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
