Labour and delivery
Table of contents
- Signs of impending labour
- Stages of labour
- Types of delivery evd
- Induction of labour
- Foetal monitoring during hospital birth evd
- Vacuum extraction evd
- Caesarean section evd
- Breech delivery evd
- Shoulder dystocia
- Twin delivery
- Management of delivery when the mother has a blood-borne infection
- Pain management during labour and delivery evd
- Early postpartum discharge evd
- Out-of-hospital delivery
- Preterm labour and delivery
- Umbilical cord blood sampling
- Vitamin K
- References
Extract
- Labour may be preceded by transient contractions lasting for several hours; they do not always signify the start of true labour.
- The cervical mucus plug, sometimes tinged with blood, is usually released from the cervix 1–7 days before the actual start of labour.
- When labour begins, contractions become more frequent and stronger; contractions lasting for 45–60 seconds occur every 10 minutes or more often. Labour begins when the contractions are at regular intervals and the cervix starts to dilate.
- Labour may begin with uterine contractions or with rupture of the foetal membranes before the start of contractions.
- Full-term delivery occurs after ≥ 37+0 gestational weeks.
Linked evidence summaries
- Intracutaneous or subcutaneous sterile water injections might possibly have some effect for relief of low back pain during labour compared to isotonic saline injections.D
- Inhaled analgesia is effective for reducing pain during labour compared with placebo.A
- Local anaesthetic nerve block appears to be effective for pain management in labour.B
- Epidural and combined spinal epidural analgesia are effective for reducing pain during labour. However, they increase the risk of instrumental vaginal birth.A
- Restrictive episiotomy policies is effective for reducing severe perineal trauma compared to routine episiotomy policies.A
- Upright posture during the second stage of labour may 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.C
- Labour induction after 41 completed weeks compared to awaiting spontaneous labour reduces perinatal mortality, although the absolute risk difference is very small.A
- Oral misoprostol is effective for induction of labour compared with placebo.A
- Vaginal PGE2 is effective for induction of labour at term compared with placebo.A
- Oxytocin is effective for induction of labour compared with placebo.A
- Amniotomy with i.v. oxytocin is effective for induction of labour compared with placebo.A
- A Foley catheter is effective for induction of labour compared with placebo and as effective as prostaglandin E2.A
- Amniotomy plus intravenous oxytocin is effective fo induction of labour, and may be the most effective method.A
- Continuous cardiotocography (CTG) during labour is effective in reducing neonatal seizures compared with intermittent auscultation. However, CTG or continuous CTG may not reduce infant mortality or cerebral palsy. Continuos CTG appears to increase caesarean sections and instrumental vaginal births.A
- The use of adjunctive ST waveform analysis (STAN) during continuous electronic fetal heart rate monitoring in labour may result in fewer operative vaginal deliveries compared to continuous electronic fetal heart rate monitoring alone, but there is insufficient evidence for patient-important outcomes.C
- Intrapartum foetal scalp lactate sampling appears to be effective, and as effective as pH estimation for foetal assessment in the presence of a non-reassuring foetal heart rate trace. Lactate sampling appears to be more often successfully undertaken than pH estimation.B
- Caesarean delivery appears to increase the risk of severe maternal and neonatal morbidity and mortality in cephalic presentations.B
- External cephalic version (ECV) at term in breech presentation appears to reduce the chance of non-cephalic births and caesarean section and to be safe. Parenteral beta stimulants appear to to be effective for facilitating successful ECV.B
- There appears to be no clear benefit from planned caesarean section for term twin pregnancies with leading cephalic presentation compared with planned vaginal birth.B
- Water immersion during the first stage of labour compared to no water immersion appears to reduce the use of analgesia and reported maternal pain.B
- Massage may be effective for pain management in first stage of labour compared with usual care.C
- A single dose (1.0 mg) of intramuscular vitamin K after birth appears to be effective in the prevention hemorrhagic disease of the newborn.B
Search terms
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