Using a computerised decision-support system to interpret the outputs of continuous electronic fetal monitoring during labour does not show any advantages over clinicians interpreting the outputs themselves. This is the first trial to assess decision support of this kind.
In this large NIHR-funded trial, rates of poor neonatal outcomes, caesarean sections and assisted deliveries were not affected by whether clinicians were alerted to potential problems by the decision-support system or by their own interpretation of the data. Developmental outcomes at two years of age were not affected either.
The system used in the trial only looked at fetal heart rate patterns, and didn’t use other data about the labour (which may affect how a clinician manages the labour). This suggests that maternity units should focus on other ways of improving recognition of problems and decision making when they are detected rather than investing in such decision-support systems at this time.
Induction of labour does not increase the risk of caesarean delivery in pregnant women with a larger than average baby.
This is based on a review of four trials of 1190 women with a suspected large baby who were allocated either to have labour induced from 38 weeks or to watchful waiting.
Induction did not increase the risk of most negative outcomes for the baby, such as bleeding in the brain, or mother, such as major tearing. However, these outcomes are rare, so a larger number of women would need to be studied to be confident in these findings. When mothers were not induced babies were larger and born about a week later than if they were induced. They did suffer from more fractures, which can be a complication of delivering a larger baby.
Current guidance recommends only offering induction at 41 or 42 weeks in otherwise healthy women who have a larger than average baby.
This analysis suggests that earlier induction is likely to be safe and may be an option for women to consider.
Inducing labour may halve the risk of infection in the womb when waters break from 37 weeks. The procedure was started within 24 hours and was compared to waiting for labour to start on its own.
Waters breaking at full term without the onset of labour is called pre-labour rupture of membranes. This can increase risks of maternal and neonatal infection and the need for caesarean section. As most women deliver spontaneously within a day, NICE recommend that women are offered an informed choice of either induction 24 hours after premature rupture of membranes or to watch and wait.
This updated Cochrane review included new evidence and suggests that induction before 24 hours may reduce infections without increasing caesarean sections, but there remains some uncertainty. This is due to low study quality, lack of longer term outcomes, and too few participants in trials to compare the numbers of any rare serious events.
These findings may help inform shared decisions about induction by providing more information to help women understand the risks.
This guideline provides up-to-date information on methods of delivery for women with breech presentation, this is the fourth edition of this guideline, first published in 1999 and revised in 2001 and 2006 under the same title.
The aim of this guideline is to aid decision making regarding the route of delivery and choice of various techniques used during delivery. It does not include antenatal or postnatal care. Information regarding external cephalic version is the topic of the separate Royal College of Obstetricians and Gynaecologists Green-top Guideline No. 20a External Cephalic Version and Reducing the Incidence of Term Breech Presentation.
This guideline summarises the evidence regarding the routine use of external cephalic version (ECV) for breech presentation, and is the second edition of this guideline, first published in 2006 under the title External Cephalic Version (ECV) and Reducing the Incidence of Breech Presentation.
It presents the best evidence concerning methods to prevent noncephalic presentation at delivery and therefore caesarean section and its sequalae. The mode and technique of delivering a breech presentation is summarised in the Royal College of Obstetricians and Gynaecologists Green-top Guideline No. 20b Management of Breech Presentation.
The National Federation of Women’s Institutes (NFWI) and National Childbirth Trust have published Support overdue: women’s experiences of maternity services 2017. This report presents the findings of the NFWI’s and NCT’s second survey of women’s experiences of maternity care, providing insights into key aspects of the experiences of 2,500 women. Women are generally positive about the maternity care they receive and many praised the professionalism of the staff who cared for them but some findings gave cause for concern.
The Royal College of Obstetrics and Gynaecologists has updated their guideline Postpartum haemorrhage, prevention and management (Green-top Guideline No. 52). This provides information about the prevention and management of postpartum haemorrhage, primarily for clinicians working in obstetric-led units in the UK.