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Preconception, pregnancy, childbirth and postpartum care

This section includes RHL summaries of published systematic reviews on various aspects of pregnancy and childbirth, including preconception care.

Postpartum care

WHO recommendation on uterine tonus assessment for early identification of uterine atony

Postpartum abdominal uterine tonus assessment for early identification of uterine atony is recommended for all women.

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WHO recommendation on the use of uterotonics for the treatment of postpartum haemorrhage (PPH)

The use of uterotonics (oxytocin alone as the first choice) plays a central role in the treatment of postpartum haemorrhage.

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WHO recommendation on routine antibiotic prophylaxis for episiotomy

Routine antibiotic prophylaxis is not recommended for women with episiotomy.

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WHO recommendation on skin-to-skin contact during the first hour after birth

Newborns without complications should be kept in skin-to-skin contact (SSC) with their mothers during the first hour after birth to prevent hypothermia and promote breastfeeding.

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Interventions for promoting the initiation of breastfeeding

In under-resourced settings, breastfeeding education during the antenatal period delivered by multipurpose health-care workers chosen from the community can help with the early initiation of breastfeeding. Simple interventions after delivery – such as early rooming-in, skin-to-skin contact and support to the mother – are likely to have the greatest impact.

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Prophylactic interventions after delivery of placenta for reducing bleeding during the postnatal period

Citation: Yaju Y, Kataoka Y, Eto H, Horiuchi S, Mori R. Prophylactic interventions after delivery of placenta for reducing bleeding during the postnatal period. CochraneDatabase of Systematic Reviews 2013, Issue 11. Art. No.: CD009328. DOI:10.1002/14651858.CD009328.pub2.

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Postpartum misoprostol for preventing maternal mortality and morbidity

Citation: Hofmeyr G Justus, Gülmezoglu A Metin, Novikova Natalia, Lawrie Theresa A. Postpartum misoprostol for preventing maternal mortality and morbidity. Cochrane Database of Systematic Review Issue 11, Art. No. CD008982. DOI: 10.1002/14651858.CD008982.pub2.

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WHO recommendation on the use of uterine packing for the treatment of postpartum haemorrhage

There is no evidence of benefit of uterine packing for the treatment of postpartum haemorrhage and placed a high value on concerns regarding its potential harm.

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WHO recommendation on breastfeeding as soon as possible after birth

All newborns, including low-birth-weight (LBW) babies who are able to breastfeed, should be put to the breast as soon as possible after birth when they are clinically stable, and the mother and baby are ready.

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WHO recommendation on routine postpartum maternal assessment

All postpartum women should have regular assessment of vaginal bleeding, uterine contraction, fundal height, temperature and heart rate (pulse) routinely during the first 24 hours starting from the first hour after birth. Blood pressure should be measured shortly after birth. If normal, the second...

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Treatments for breast abscess in breastfeeding women

Citation: Irusen H, Rohwer AC, Steyn DW, Young T. Treatments for breast abscesses in breastfeeding women. Cochrane Database of Systematic Review 2015, Issue 8. Art. No.: CD010490. DOI: 10.1002/14651858.CD010490.pub2.

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Antidepressant treatment for postnatal depression

Citation: Molyneaux E, Howard LM, McGeown HR, Karia AM, Trevillion K. Antidepressant treatment for postnatal depression. Cochrane Database of Systematic Review 2014, Issue 9. Art. No.: CD002018. DOI: 10.1002/14651858.CD002018.pub2.

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Anti-D administration after childbirth for preventing Rhesus alloimmunisation

Citation: Crowther CA, Middleton P. Anti-D administration after childbirth for preventing Rhesus alloimmunisation CochraneDatabase of Systematic Reviews 1997, Issue 2. Art. No.: CD000021. DOI: 10.1002/14651858.CD000021

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Methods of milk expression for lactating women

Citation:Becker GE, Cooney F, Smith HA. Methods of milk expression for lactating women. CochraneDatabase of Systematic Reviews 2011, Issue 12. Art. No.: CD006170. DOI: 10.1002/14651858.CD006170.pub3.

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WHO recommendation on tranexamic acid for the treatment of postpartum haemorrhage

Early use of intravenous tranexamic acid (within 3 hours of birth) in addition to standard care is recommended for women with clinically diagnosed postpartum haemorrhage.

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Extra fluids for breastfeeding mothers for increasing milk production

Citation: Ndikom CM, Fawole B, Ilesanmi RE. Extra fluids for breastfeeding mothers for increasing milk production. CochraneDatabase of Systematic Reviews 2014, Issue 6. Art. No.: CD008758. DOI: 10.1002/14651858.CD008758.pub2

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Early postnatal discharge from hospital for healthy mothers and term infants

The current evidence is insufficient to support the policy of early postnatal discharge from hospital as routine practice. Early discharge after childbirth has already been implemented in many resource-poor countries for economic reasons. Health administrators need to be aware that the risks and benefits of this policy have not been adequately assessed, particularly in developing countries

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Care during childbirth

WHO recommendation on interventions targeted at women for the reduction of unnecessary caesarean sections

Health education for women is an essential component of antenatal care

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Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth

Citation: Dodd JM, Crowther CA, Huertas E, Guise JM, Horey D. Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth Cochrane Database of Systematic Review 2013, Issue 12. Art. No.: CD004224. DOI: 10.1002/14651858.CD004224.pub3.

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WHO recommendation on opioid analgesia for pain relief during labour

Recommendation Parenteral opioids, such as fentanyl, diamorphine and pethidine, are recommended options for healthy pregnant women requesting pain relief during labour, depending on a woman’s preferences. (Recommended) Publication history First published: February 2018 Updated: No update planned...

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WHO recommendation on respectful maternity care during labour and childbirth

Respectful maternity care – which refers to care organized for and provided to all women in a manner that maintains their dignity, privacy and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth – is...

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WHO recommendation on the optimal mode of birth for women in refractory preterm labour

Recommendation Routine delivery by caesarean section for the purpose of improving preterm newborn outcomes is not recommended, regardless of cephalic or breech presentation. (Conditional recommendation based very low-quality evidence) Publication history First published: November 2015 Updated: No...

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WHO recommendation on epidural analgesia for pain relief during labour

Recommendation Epidural analgesia is recommended for healthy pregnant women requesting pain relief during labour, depending on a woman’s preferences. (Recommended) Publication history First published: February 2018 Updated: No update planned Assessed as up-to-date: February 2018 Remarks The GDG...

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Different classes of antibiotics given to women routinely for preventing infection at caesarean section

This updated review found: Penicillins and cephalosporines have similar positive effect on the prevention of infection at cesarean section. Benefits seem not to improve with the use of extended-spectrum antibiotics. There is a lack of information on regard to post-discharge infections, infant...

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Parenteral opioids for maternal pain management in labour

Citation: Ullman R, Smith LA, Burns E, Mori R, Dowswell T. Parenteral opioids for maternal pain management in labour. Cochrane Database of Systematic Review 2010, Issue 9. Art. No.: CD007396. DOI: 10.1002/14651858.CD007396.pub2.

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Fundal pressure during the second stage of labour

Citation: Verheijen EC, Raven JH, Hofmeyr GJ. Fundal pressure during the second stage of labour. Cochrane Database of Systematic Review 2009, Issue 4. Art. No.: CD006067. DOI: 10.1002/14651858.CD006067.pub2.

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WHO recommendation on routine antibiotic prophylaxis for episiotomy

Routine antibiotic prophylaxis is not recommended for women with episiotomy.

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Absorbable suture materials for primary repair of episiotomy and second degree tears

Repair of perineal trauma with synthetic absorbable sutures is associated with less short-term pain, reduction in the use of analgesia, less wound breakdown and reduced need for perineal re-suturing compared with catgut. However, the use of standard synthetic sutures was associated with greater frequency of removal of unabsorbed sutures compared with catgut. There was no significant difference between standard synthetic sutures and rapidly absorbed synthetic sutures, although with the latter fewer women required removal of unabsorbed suture up to 3 months post delivery, there was less analgesic use and more gaping wound edges.

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Umbilical vein injection for the routine management of third stage of labour

This article should be cited as: WHO Reproductive Health Library: Umbilical vein injection for the routine management of third stage of labour (last revised March 2016). The WHO Reproductive Health Library; Geneva: World Health Organization.

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Intrapartum interventions for preventing shoulder dystocia

Data are too limited to support or refute the use of prophylactic manoeuvres for the prevention of shoulder dystocia.

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WHO recommendation on relaxation techniques for pain management during labour

Recommendation Relaxation techniques, including progressive muscle relaxation, breathing, music, mindfulness and other techniques, are recommended for healthy pregnant women requesting pain relief during labour, depending on a woman’s preferences (Recommended) Publication history First published:...

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WHO recommendation on antibiotics for uncomplicated vaginal birth

Routine antibiotic prophylaxis is not recommended for women with uncomplicated vaginal birth

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WHO recommendation on techniques for preventing perineal trauma during labour

For women in the second stage of labour, techniques to reduce perineal trauma and facilitate spontaneous birth (including perineal massage, warm compresses and a “hands on” guarding of the perineum) are recommended, based on a woman’s preferences and available options. (Recommended)

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WHO recommendation on method of pushing

Women in the expulsive phase of the second stage of labour should be encouraged and supported to follow their own urge to push.

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Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection

Citation: Ohlsson A, Shah VS, Stade BC. Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection (Review). Cochrane Database of Systematic Review 2014, Issue 12. Art. No.: CD003520. DOI: 10.1002/14651858.CD003520.pub3.

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Amnioinfusion for meconium-stained liquor in labour

In settings with limited intrapartum perinatal surveillance facilities, amnioinfusion in women with moderate or thick meconium staining of the amniotic fluid could improve perinatal outcomes. However, available data are not enough to detect serious obstetric adverse effects of amnioinfusion.

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Interventions for helping to turn term breech babies to head first presentation when using external cephalic version

This updated review found: Parenteral beta sympathomimetics significantly increase successful external cephalic version (ECV), cephalic presentation in labour and cephalic vaginal birth, and significantly decrease rate of caesarean section, helping to prevent risk of complications at birth for...

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Antibiotic prophylaxis for third- and fourth-degree perineal tear during vaginal birth

In one small trial, antibiotic prophylaxis with a single dose second-generation cephalosporin significantly reduced the risk of perineal wound complications at two-weeks postpartum. However, the statistical significance was borderline and there was a high loss to follow up rate.

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Symphysiotomy for feto-pelvic disproportion

Currently there are no experimental data on the relative advantages or disadvantages of symphysiotomy compared with alternative interventions. Clinical decisions on symphysiotomy should therefore continue to be made on a case-by-case basis.

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WHO recommendation on postnatal discharge following uncomplicated vaginal birth

After an uncomplicated vaginal birth in a health care facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth.

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WHO recommendation on episiotomy policy

Routine or liberal use of episiotomy is not recommended for women undergoing spontaneous vaginal birth.

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WHO recommendation on delayed umbilical cord clamping

Delayed umbilical cord clamping (not earlier than 1 minute after birth) is recommended for improved maternal and infant health and nutrition outcomes.

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WHO recommendation on controlled cord traction

In settings where skilled birth attendants are available, controlled cord traction (CCT) is recommended for vaginal births if the care provider and the parturient woman regard a small reduction in blood loss and a small reduction in the duration of the third stage of labour as important.

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WHO recommendation on routine postpartum maternal assessment

All postpartum women should have regular assessment of vaginal bleeding, uterine contraction, fundal height, temperature and heart rate (pulse) routinely during the first 24 hours starting from the first hour after birth. Blood pressure should be measured shortly after birth. If normal, the second...

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Antibiotics for meconium-stained amniotic fluid in labour for preventing maternal and neonatal infections

An updated version of this systematic review has been published and can be found online at www.cochrane.org . We will soon update the below RHL summary to reflect the updated findings of the systematic review. Available evidence is insufficient to draw any conclusions regarding the efficacy or side...

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Closure versus non-closure of the peritoneum at caesarean section

Citation: Bamigboye AA, Hofmeyr GJ. Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes. Cochrane Database of Systematic Review 2014, Issue 8. Art. No.: CD000163. DOI: 10.1002/14651858.CD000163.pub2.

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Fetal intrapartum pulse oximetry for fetal assessment in labour

Citation: East CE, Begg L, Colditz PB, Lau R. Fetal pulse oximetry for fetal assessment in labour. Cochrane Database of Systematic Review 2014, Issue 10. Art. No.: CD004075. DOI: 10.1002/14651858.CD004075.pub4.

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Methods of repair for obstetric anal sphincter injury

Key findings: No statistically significant difference in the occurrence of perineal pain and dyspareunia at 12 months and of flatus incontinence and fecal incontinence at 36 months when comparing the repair of OASIS using primary overlap or end-to-end (approximation) repair techniques. Primary...

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WHO recommendation on prophylactic uterotonics for the prevention of postpartum haemorrhage

The use of uterotonics for the prevention of postpartum haemorrhage (PPH) during the third stage of labour is recommended for all births. Oxytocin is the recommended uterotonic drug for the prevention of postpartum haemorrhage (PPH). In settings where oxytocin is unavailable, the use of other...

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WHO recommendation on antibiotics for uncomplicated vaginal birth

Routine antibiotic prophylaxis is not recommended for women with uncomplicated vaginal birth

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WHO recommendation on birth position (for women with epidural analgesia)

For women with epidural analgesia, encouraging the adoption of a birth position of the individual woman’s choice, including upright birth positions, is recommended.

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WHO recommendation on method of pushing (for women with epidural analgesia)

For women with epidural analgesia in the second stage of labour, delaying pushing for one to two hours after full dilatation or until the woman regains the sensory urge to bear down is recommended in the context where resources are available for longer stay in second stage and perinatal hypoxia can...

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Skin preparation for preventing infection following caesarean section

Citation: Hadiati DR, HakimiM, Nurdiati DS, Ota E. Skin preparation for preventing infection following caesarean section. Cochrane Database of Systematic Review 2014, Issue 9. Art. No.: CD007462. DOI: 10.1002/14651858.CD007462.pub3.

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WHO recommendation on effective communication between maternity care providers and women in labour

Effective communication between maternity care providers and women in labour, using simple and culturally acceptable methods, is recommended.

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WHO recommendation on intermittent fetal heart rate auscultation during labour

Recommendation Intermittent auscultation of the fetal heart rate with either a Doppler ultrasound device or a Pinard fetal stethoscope is recommended for healthy pregnant women in labour. (Recommended) Publication history First published: February 2018 Updated: No update planned Assessed as up-to-...

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Induction of labour

WHO recommendation on induction of labour at gestational age less than 41 weeks.

Induction of labour is not recommended for women with an uncomplicated pregnancy at gestational age less than 41 weeks. ( low-certainty evidence, conditional recommendation )

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Induction of labour in women with gestational diabetes

Induction of labour (artificially initiated labour) is becoming more common worldwide. Up to 25% of women in developed countries undergo induction, while in developing countries these are generally rates are generally lower, but increasing. Induction of labour is not risk-free and many women find...

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Induction of labour in women at or beyond term

Induction of labour (artificially initiated labour) is becoming more common worldwide. Up to 25% of women in developed countries undergo induction, while in developing countries these are generally rates are generally lower, but increasing. Induction of labour is not risk-free and many women find...

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Outpatient versus inpatient induction of labour for improving birth outcomes

Citation: Kelly AJ, Alfirevic Z, Ghosh A. Outpatient versus inpatient induction of labour for improving birth outcomes. Cochrane Database of Systematic Review 2013, Issue 11. Art. No.: CD007372. DOI: 10.1002/14651858.CD007372.pub3.

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High-dose versus low-dose oxytocin infusion regimens for induction of labour at term

Citation: Budden A, Chen LJY, Henry A. High-dose versus low-dose oxytocin infusion regimens for induction of labour at term. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD009701. DOI: 10.1002/14651858.CD009701.pub2.

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Oral misoprostol for induction of labour

This review compared oral misoprostol to other induction agents, including: IV oxytocin, vaginal dinoprostone, sublingual misoprostol, intracervical prostaglandins and placebo/no treatment.

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Misoprostol for induction of labour to terminate pregnancy in the second or third trimester for women with a fetal anomaly or after intrauterine fetal death

For the termination of second- or third-trimester pregnancy involving fetal anomaly or intrauterine fetal death, vaginal misoprostol is more effective than oral misoprostol. It is also as effective as the traditionally-used and more expensive prostaglandins such as PGF2α and gemeprost, which are more difficult to store than misoprostol and are associated with more side-effects.

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Methods of term labour induction for women with a previous cesarean section

Key Findings: Included trials were underpowered to detect differences in relevant maternal and infant outcomes When comparing prostaglandin E2 versus oxytocin, trials found no statistically significant differences for rates of caesarean section, serious neonatal morbidity or perinatal death, nor...

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Elective birth at 37 weeks’ gestation for women with an uncomplicated twin pregnancy

Citation: Dodd JM, Deussen AR, Grivell RM, Crowther CA. Elective birth at 37 weeks’ gestation for women with an uncomplicated twin pregnancy.Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD003582. DOI:10.1002/14651858.CD003582.pub2.

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WHO recommendation on induction of labour for women beyond 41 weeks of gestation

Induction of labour is recommended for women who are known with certainty to have reached 41 weeks (>40 weeks + 7 days) of gestation (Conditional recommendation, low-certainty evidence)

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Pregnancy complications

WHO recommendation on the method for diagnosing asymptomatic bacteriuria in pregnancy

Midstream urine culture is the recommended method for diagnosing asymptomatic bacteriuria (ASB) in pregnancy. In settings where urine culture is not available, on-site midstream urine Gram staining is recommended over the use of dipstick tests as the method for diagnosing ASB in pregnancy.

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Fetal fibronectin testing for reducing the risk of preterm birth

Citation: Berghella Vincenzo, Hayes Edward, Visintine John, Baxter Jason K. Fetal fibronectin testing for reducing the risk of preterm birth. Cochrane Database of Systematic Reviews2008, Issue 4. Art. No.: CD006843. DOI: 10.1002/14651858.CD006843.pub2.

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WHO recommendation on duration of bladder catheterization after surgical repair of simple obstetric urinary fistula

For women in the postoperative period after the surgical repair of a simple obstetric urinary fistula, short duration bladder catheterization (7 to 10 days) is recommended as an alternative to longer duration of catheterization

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Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term

Citation: Sotiriadis Alexandros, Makrydimas George, Papatheodorou Stefania, Ioannidis John PA. Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database of Systematic Reviews2009, Issue 4. Art. No.: CD006614. DOI:10.1002/14651858.CD006614.pub2.

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WHO recommendation on antenatal corticosteroid therapy for women at risk of preterm birth from 24 weeks to 34 weeks of gestation

Antenatal corticosteroid therapy is recommended for women at risk of preterm birth from 24 weeks to 34 weeks of gestation when certain treatment conditions are met

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Induction of labour for improving birth outcomes for women at or beyond term

Compared with waiting indefinitely or waiting at least one week for labour to occur spontaneously, labour induction after 41 weeks of gestation is associated with fewer perinatal deaths. Labour induction can help reduce the need for additional monitoring of women and reduce the duration of...

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WHO recommendation on effectiveness of plastic bags/wraps in providing thermal care for preterm newborns immediately after birth

There is insufficient evidence on the effectiveness of plastic bags/wraps in providing thermal care for preterm newborns immediately after birth. However, during stabilization and transfer of preterm newborns to specialized neonatal care wards, wrapping in plastic bags/wraps may be considered as an...

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WHO recommendation on human deficiency virus and syphilis testing in pregnancy

In high-prevalence settings, a provider-initiated testing and counselling (PITC) for HIV should be considered a routine component of the package of care for pregnancy women in all antenatal care settings. In low-prevalence settings, PITC can be considered for pregnant women in antenatal care...

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Drugs for preventing malaria in pregnant women in endemic areas

Citation: Radeva-Petrova D, Kayentao K, ter Kuile FO, Sinclair D, Garner P. Drugs for preventing malaria in pregnant women in endemic areas: any drug regimen versus placebo or no treatment. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD000169. DOI: 10.1002/14651858.CD000169.pub3.

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Antibiotics for preterm rupture of membranes

Administration of antibiotics to women with PROM is associated with short-term delay in delivery and reduction in maternal and neonatal morbidity. However, in the longer-term antibiotic use for PROM has little effect.

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Tocolytics for preterm premature rupture of membranes

Citation:Mackeen AD, Seibel-Seamon J, Muhammad J, Baxter JK, BerghellaV. Tocolytics for preterm premature rupture of membranes.Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD007062. DOI: 10.1002/14651858.CD007062.pub3.

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Amnioinfusion for third trimester preterm premature rupture of membranes

The effects of amnioinfusion for preterm premature rupture of membranes (PPROM) are limited by the small sample sizes of the included studies

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WHO recommendation on antibiotic administration for women with preterm prelabour rupture of membranes

Recommendation Antibiotic administration is recommended for women with preterm prelabour rupture of membranes. (Strong recommendation based on moderate-quality evidence). Publication history First published: November 2015 Updated: No update planned Assessed as up-to-date: November 2015 Remarks In...

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WHO recommendation on birth preparedness and complication readiness

Birth preparedness and complication readiness interventions are recommended to increase the use of skilled care at birth and to increase the timely use of facility care for obstetric and newborn complications.

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WHO recommendation on the optimal mode of birth for women in refractory preterm labour

Recommendation Routine delivery by caesarean section for the purpose of improving preterm newborn outcomes is not recommended, regardless of cephalic or breech presentation. (Conditional recommendation based very low-quality evidence) Publication history First published: November 2015 Updated: No...

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WHO recommendation on the prophylactic administration of surfactant in preterm newborns

Administration of surfactant before the onset of respiratory distress syndrome (prophylactic administration) in preterm newborns is not recommended.

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WHO recommendation on continuous positive airway pressure therapy for the treatment of preterm newborns with respiratory distress syndrome

Continuous positive airway pressure therapy is recommended for the treatment of preterm newborns with respiratory distress syndrome.

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Interventions for suspected placenta praevia

The limited available data suggest that both home care and cerclage are associated with reduced length of stay in hospital during the antenatal period, but there is little evidence of any clear advantage or disadvantage of the policy of home versus hospital care. Hence, no change is recommend in...

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Prophylactic antibiotics for manual removal of retained placenta in vaginal birth

Citation: Chongsomchai C, Lumbiganon P, Laopaiboon M. Prophylactic antibiotics for manual removal of retained placenta in vaginal birth. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD004904. DOI: 10.1002/14651858.CD004904.pub3.

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Strategies of testing for syphilis during pregnancy

Citation: Shahrook S, Mori R, Ochirbat T, Gomi H. Strategies of testing for syphilis during pregnancy. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD010385. DOI: 10.1002/14651858.CD010385.pub2.

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WHO recommendation on use of a single repeat course of antenatal corticosteroid

A single repeat course of antenatal corticosteroid is recommended if preterm birth does not occur within 7 days after the initial dose, and a subsequent clinical assessment demonstrates that there is a high risk of preterm birth in the next 7 days.

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WHO recommendation on the use of magnesium sulfate for fetal protection from neurological complications

The use of magnesium sulfate is recommended for women at risk of imminent preterm birth before 32 weeks of gestation for prevention of cerebral palsy in the infant and child.

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WHO recommendation on antenatal corticosteroid therapy in women undergoing planned caesarean section at late preterm gestations (34–36+6 weeks)

Recommendation Antenatal corticosteroid therapy is not recommended in women undergoing planned caesarean section at late preterm gestations (34–36+6 weeks). (Conditional recommendation based on very low-quality evidence) Publication history First published: November 2015 Updated: No update planned...

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Disorders affecting the unborn baby

WHO recommendation on human deficiency virus and syphilis testing in pregnancy

In high-prevalence settings, a provider-initiated testing and counselling (PITC) for HIV should be considered a routine component of the package of care for pregnancy women in all antenatal care settings. In low-prevalence settings, PITC can be considered for pregnant women in antenatal care...

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Ultrasound for fetal assessment in early pregnancy

Key Findings: This updated review found that routine early ultrasound (before 24 weeks ‘gestation) was associated with: Statistically significant increased detection rates for multiple pregnancies and fetal abnormalities; Statistically significant reduction in induction of labour by improving...

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Symphysial fundal height (SFH) measurement in pregnancy for detecting abnormal fetal growth

Key Findings: No trials comparing SFH measurement to serial ultrasound measurement of fetal growth. No differences in the incidence of small for gestational age(SGA) or perinatal deaths when comparing SFH measurement to abdominal palpation

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Screening for gestational diabetes mellitus based on different risk profiles and settings for improving maternal and infant health

There is not enough evidence on effects of screening for GDM based on different risk profiles or settings on outcomes for women and their babies. Further large, well-designed, randomised controlled trials are required to assess important short- and long-term outcomes for mothers and their babies.

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Amniocentesis and chorionic villus sampling for prenatal diagnosis

On safety grounds, second-trimester amniocentesis is better than transcervical CVS and early amniocentesis. For prenatal diagnosis in the first trimester, transabdominal CVS and transcervical CVS should be considered, in that order of preference. The effectiveness of amniocentesis and CVS depends...

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Routine ultrasound in late pregnancy (after 24 weeks’ gestation)

This updated review found that routine late pregnancy ultrasound was associated with: No significant effect on induction of labour and caesarean section. No differences to the occurrence of preterm birth less than 37 weeks and perinatal mortality. No statistically significant differences on...

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Fetal assessment methods for improving neonatal and maternal outcomes in preterm prelabour rupture of membranes

Key Findings: Overall, trials showed few statistically significant improvements in maternal, fetal or neonatal outcomes. There was a non-statistically significant increase in the risk of neonatal death in the intervention groups of endovaginal ultrasound and amniocentesis for fetal lung surfactant...

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Medical problems during pregnancy

Treatments for iron-deficiency anaemia in pregnancy

Even though the limited number of trials included in this review found oral, intramuscular and intravenous iron to increase maternal haemoglobin values, the data were not sufficient to ascertain the clinical significance of these findings. Hence, this review does not recommend any treatment for iron-deficiency anaemia in pregnant women.

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WHO recommendation regarding Vitamin D supplementation during pregnancy

Vitamin D supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes.

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WHO recommendation on magnesium sulfate regimen to prevent and treat eclampsia

The full intravenous or intramuscular magnesium sulfate regimens are recommended for the prevention and treatment of eclampsia.

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WHO recommendation on the method for diagnosing anaemia in pregnancy

Full blood count testing is the recommended method for diagnosing anaemia during pregnancy. In settings where full blood count testing is not available, onsite haemoglobin testing with a haemoglobinometer is recommended over the use of the haemoglobin colour scale as the method for diagnosing...

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WHO recommendation against vitamin C or vitamin E supplementation during pregnancy for the prevention of pre-eclampsia

Vitamin E and C supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes.

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WHO recommendation on daily oral iron and folic acid supplementation

Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental iron and 400 g (0.4 mg) of folic acid is recommended for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth.

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WHO recommendation on the diagnosis of gestational diabetes in pregnancy

Hyperglycaemia first detected at any time during pregnancy should be classified as either gestational diabetes mellitus (GDM) or diabetes mellitus in pregnancy, according to WHO criteria.

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Micronutrient supplementation in pregnant women with HIV infection

Citation: Horvath T, Madi BC, Iuppa IM, Kennedy GE, Rutherford G, Read JS. Micronutrient supplementation in pregnant women with HIV infection. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD009755. DOI: 10.1002/14651858.CD009755.

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Antioxidants for preventing pre-eclampsia

Current evidence does not support routine prescription of antioxidants during pregnancy to reduce the risk of pre-eclampsia.

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WHO recommendation on antibiotics for asymptomatic bacteriuria

A seven-day antibiotic regimen is recommended for all pregnant women with asymptomatic bacteriuria (ASB) to prevent persistent bacteriuria, preterm birth and low birth weight.

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WHO recommendation on tuberculosis testing in pregnancy

In settings where the tuberculosis (TB) prevalence in the general population is 100/100 000 population or higher, systematic screening for active TB should be considered for pregnant women as part of antenatal care.

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WHO recommendation on human deficiency virus and syphilis testing in pregnancy

In high-prevalence settings, a provider-initiated testing and counselling (PITC) for HIV should be considered a routine component of the package of care for pregnancy women in all antenatal care settings. In low-prevalence settings, PITC can be considered for pregnant women in antenatal care...

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Antihypertensive drug therapy for mild to moderate hypertension during pregnancy

Citation: Abalos, E., Duley, L., & Steyn, D. W. (2014). Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD002252. DOI: 10.1002/14651858.CD002252.pub3.

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Anticonvulsant therapy for eclampsia

Magnesium sulfate is the drug of choice for the treatment of women with eclampsia. The duration of treatment should normally not exceed 24 hours beyond delivery or the last convulsion, whichever occurs last. Either intravenous or intramuscular route can be used for maintenance therapy. Clinical monitoring of respiration, urine output and tendon reflexes is essential, while serum monitoring is unnecessary and should not be used.

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WHO recommendation on the method for diagnosing asymptomatic bacteriuria in pregnancy

Midstream urine culture is the recommended method for diagnosing asymptomatic bacteriuria (ASB) in pregnancy. In settings where urine culture is not available, on-site midstream urine Gram staining is recommended over the use of dipstick tests as the method for diagnosing ASB in pregnancy.

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WHO recommendation on antibiotic prophylaxis to prevent recurrent urinary tract infections

Antibiotic prophylaxis is only recommended to prevent recurrent urinary tract infections in pregnant women in the context of rigorous research.

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WHO recommendation on intermittent oral iron and folic acid supplementation

Intermittent oral iron and folic acid supplementation with 120 mg of elemental irone and 2800 µg (2.8 mg) of folic acid once weekly is recommended for pregnant women to improve maternal and neonatal outcomes if daily iron is not acceptable due to side-effects, and in populations with anaemia...

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Antenatal care

Specialized antenatal care clinics for women with a pregnancy at high risk of preterm birth (excluding multiple pregnancy) to improve maternal and infant outcomes

Citation: Whitworth M, Quenby S, Cockerill RO, Dowswell T. Specialised antenatal clinics for women with a pregnancy at high riskof preterm birth (excluding multiple pregnancy) to improve maternal and infant outcomes. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD006760. DOI: 10.1002/14651858.CD006760.pub2.

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Group versus conventional antenatal care for women

Citation: Catling CJ, Medley N, Foureur M, Ryan C, Leap N, Teate A, Homer CSE. Group versus conventional antenatal care for women. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD007622. DOI: 10.1002/14651858.CD007622.pub3.

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WHO recommendation on interventions targeted at women for the reduction of unnecessary caesarean sections

Health education for women is an essential component of antenatal care

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WHO recommendation on task shifting components of antenatal care delivery

Task shifting the promotion of health-related behaviours for maternal and newborn health ad to a broad range of cadres, including lay health workers, auxiliary nurses, nurses, midwives and doctors is recommended. Task shifting the distribution of recommended nutritional supplements and intermittent...

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Hospitalisation and bed rest for multiple pregnancy

Citation: Crowther CA, Han S. Hospitalisation and bed rest for multiple pregnancy.Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD000110. DOI: 10.1002/14651858.CD000110. pub2.10.pub2

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Vibroacoustic stimulation for fetal assessment in labour in the presence of a nonreassuring fetal heart rate trace

Citation: East CE, Smyth RMD, Leader LR, Henshall NE, Colditz PB, Lau R,Tan KH. Vibroacoustic stimulation for fetal assessmentin labour in the presence of a nonreassuring fetal heart rate trace.Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD004664. DOI: 10.1002/14651858.CD004664.pub3

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WHO recommendation on antenatal care contact schedules

Antenatal care models with a minimum of eight contacts are recommended to reduce perinatal mortality and improve women’s experience of care

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Traditional birth attendant (TBA) training for improving health behaviours and pregnancy outcome

Citation: Sibley LM, Sipe TA, Barry D. Traditional birth attendant training for improving health behaviours and pregnancy outcomes. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD005460. DOI: 10.1002/14651858.CD005460.pub3.

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Vitamin E supplementation for prevention of morbidity and mortality in preterm infants

Vitamin E supplementation, particularly in doses that exceed the recommended daily intake, reduces the risk of intraventricular haemorrhage, but increases the incidence of sepsis in preterm neonates. Hence, the present evidence does not support the practice of high-dose vitamin E supplementation, especially intravenously, in preterm and low-birth-weight infants.

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Vaccines for women for preventing neonatal tetanus

Citation: Demicheli V, Barale A, Rivetti A. Vaccines for women for preventing neonatal tetanus. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD002959. DOI: 10.1002/14651858.CD002959.pub4.

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Interventions for preventing or reducing domestic violence against pregnant women

Citation: Jahanfar S, Howard LM, Medley N. Interventions for preventing or reducing domestic violence against pregnant women. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD009414. DOI: 10.1002/14651858.CD009414.pub3.

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WHO recommendation on intermittent oral iron and folic acid supplementation

Intermittent oral iron and folic acid supplementation with 120 mg of elemental irone and 2800 µg (2.8 mg) of folic acid once weekly is recommended for pregnant women to improve maternal and neonatal outcomes if daily iron is not acceptable due to side-effects, and in populations with anaemia...

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WHO recommendation on multiple micronutrient supplementation during pregnancy

Antenatal multiple micronutrient supplements that include iron and folic acid are recommended in the context of rigorous research

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Interventions for managing asthma in pregnancy

Citation: Bain E, Pierides KL, Clifton VL, Hodyl NA, Stark MJ, Crowther CA, Middleton P. Interventions for managing asthma in pregnancy. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD010660. DOI: 10.1002/14651858.CD010660.pub2.

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WHO recommendation on interventions for the relief of leg cramps during pregnancy

Magnesium, calcium or non-pharmacological treatment options can be used for the relief of leg cramps in pregnancy, based on a woman’s preferences and available options.

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WHO recommendation on high-protein supplements during pregnancy

In undernourished populations, high-protein supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes

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WHO recommendation on daily oral iron and folic acid supplementation

Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental iron and 400 g (0.4 mg) of folic acid is recommended for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth.

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Antibiotic prophylaxis during the second and third trimester to reduce adverse pregnancy outcomes and morbidity

Citation: Thinkhamrop J,HofmeyrGJ, AdetoroO, Lumbiganon P,Ota E. Antibiotic prophylaxis during the second and third trimester to reduce adverse pregnancy outcomes and morbidity.Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD002250.DOI: 10.1002/14651858.CD002250.pub3.

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Multiple-micronutrient supplementation for women during pregnancy

This review found no added benefit of multiple-micronutrient supplementation compared with supplementation with iron and folic acid alone. Until more information becomes available, it is advisable to follow the WHO recommendation of providing iron and folate supplementation to all women during pregnancy.

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Intrapartum antibiotics for known maternal Group B streptococcal colonization

Citation: Ohlsson A, Shah VS. Intrapartum antibiotics for known maternal Group B streptococcal colonization.Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD007467. DOI: 10.1002/14651858. CD007467.pub4.

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Micronutrient supplementation in pregnant women with HIV infection

Citation: Horvath T, Madi BC, Iuppa IM, Kennedy GE, Rutherford G, Read JS. Micronutrient supplementation in pregnant women with HIV infection. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD009755. DOI: 10.1002/14651858.CD009755.

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Energy and protein intake in pregnancy

Dietary advice is unlikely to yield any major benefits for either the infant or the mother. The best way of improving the dietary status of pregnant women may be to supplement their diets with energy-rich foods through community-based sustainable programmes. The best long-term solution is to raise the social and economic status of women.

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WHO recommendation on caffeine intake during pregnancy

For pregnant women with high daily caffeine intake (more than 300 mg per day), lowering daily caffeine intake during pregnancy is recommended to reduce the risk of pregnancy loss and low-birth-weight neonates.

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Miscarriage

Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant

Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant

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Immunotherapy for recurrent miscarriage

Hopes that outcomes could be improved with immunotherapy have not been supported by randomized trial evidence. For these couples, the mainstay of management remains supportive counseling.

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Medical treatment for early fetal death (less than 24 weeks)

Vaginal misoprostol is an effective treatment for the termination of non-viable pregnancies before 24 weeks. It is likely to be more beneficial in under-resourced settings because miscarriages due to maternal infection are likely to respond better to medical therapy than miscarriages resulting from...

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Antibiotics for incomplete abortion

There is a lack of research evidence on the effectiveness of routine antibiotic prophylaxis for women with incomplete abortion and more research is needed.

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Expectant care versus surgical treatment for miscarriage

With expectant management, women require a surgical intervention more often than with surgical management (repeat surgery), but expectant management carries a significantly lower risk of infection. Where prevalence of unsafe abortion is low, expectant management of miscarriage would be safe and...

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Follow-up for improving psychological well-being for women after a miscarriage

There is insufficient evidence to demonstrate the superiority of psychological support over no intervention following miscarriage. Most of studies included in this review were not adequately powered and there was marked heterogeneity in their methods.

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Preconception care

WHO recommendation on interventions to promote awareness of human, sexual and reproductive rights and the right to access quality skilled care

Because of the paucity of evidence available, additional research is recommended.

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