Management of delivery (outside hospital) – Related resources
26.02.2016 • Sonuncu dəyişiklik 08.11.2010
This article is created and updated by the EBMG Editorial Team
Cochrane reviews
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Vaginal misoprostol is effective for induction of labour compared to placebo, but may cause more uterine hyperstimulation than conventional methods .
The combination of gentamicin and clindamycin is appropriate for the treatment of endometritis after delivery. Regimens with activity against penicillin- resistant anaerobic bacteria are better than those without .
Upright posture during the second stage of labour appears to provide several possible benefits; however, there may be an increased risk of blood loss greater than 500 ml. Women should be encouraged to give birth in the position they find most comfortable .
- Vaginal chlorhexidine during labour appears to be no effective in preventing maternal and neonatal infections .
Routine use of intramuscular penicillin to prevent early-onset group B streptococcal disease in newborn infants is probably not effective .
Discontinuation of epidural analgesia late in labour appears not to reduce the rate of instrumental delivery or other unwanted delivery outcomes .
There is no clear evidence of one practice over another concerning early vs. late umbilical cord clamping in term infants .
Delaying umbilical cord clamping by up to two minutes may reduce the need for transfusion and the occurrence of intraventricular haemorrhage in preterm infants .
Vaginal chlorhexidine during labour is probably not effective in preventing maternal and neonatal infections .
Closure of the subcutaneous fat in caesarean section may reduce wound complications but whether this affects the well-being and recovery of the patients is unclear .
Plastic wraps or bags, plastic caps, skin-to-skin care and transwarmer mattresses all keep preterm infants warmer, leading to higher temperatures on admission to neonatal units and less hypothermia .
- Early discharge of healthy mothers and term infants may be safe after uncomplicated delivery for well-informed mothers when accompanied by a policy of offering women at least one nurse-midwife home visit post discharge .
Other evidence summaries
The benefits of routine amniotomy may include a reduction in labour duration and possible reduction in abnormal 5-minute Apgar scores. An association between early amniotomy and caesarean delivery for foetal distress was noted in one large trial, suggesting that amniotomy should be reserved for patients with abnormal labour process .
Trial of labour appears to be at least as safe for most outcomes as repeat caesarean section .