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Piracetam is thought to support the metabolism of brain cells when they have an insufficient oxygen supply (hypoxia). It may, therefore, prevent any adverse effects for an infant with persistent fetal distress during labour.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 13, 2012

We reviewed the evidence about the effect of giving extra oxygen to pregnant women during planned caesarean section under epidural or spinal anaesthesia. (Epidural anaesthesia is when a drug is injected into the epidural space of the spinal cord; spinal anaesthesia is when a local anaesthetic is injected into the subarachnoid space).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 16, 2016

Spinal anaesthesia is a commonly used technique for caesarean birth as the mother is able to be awake for the birth and usually remains comfortable afterwards. In addition, the technique avoids the risks of general anaesthesia. The most common adverse effect of spinal anaesthesia is a fall in blood pressure (hypotension).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: August 4, 2017

Topical steroids are the most commonly used medicines for skin conditions. Pregnant women may need topical steroids to treat skin conditions, but it is unclear if they are safe or harmful during pregnancy. We aimed to examine the safety of topical steroids in pregnancy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 26, 2015

Dopamine to improve outcomes in newborn infants with a suspected lack of oxygen during birth. A lack of oxygen around the time of birth (perinatal asphyxia) can cause death and long‐term illness in newborn infants. It is indicated by a low Apgar score five minutes after birth and acidic umbilical cord blood (acidosis). An infant experiencing asphyxia may need urgent resuscitation, oxygen and supported breathing (assisted ventilation). Often they have low blood pressure and poor heart function. The drug dopamine stimulates the heart and is used to improve blood flow to the brain and other organs to reduce brain and other organ damage. Possible adverse events from giving such an agent include damage with the umbilical venous catheter and heart irregularities (arrhythmias). The review authors searched the medical literature and were able to find only one small randomised controlled trial. The 14 infants included in the trial had a birthweight over 2000 g and were enrolled at a mean age of 10 hours. They had received ventilatory support and fluid expansion after birth. Infants treated with low dose dopamine (2.5 microg/kg/min) did not differ from the infants receiving placebo (dextrose water) in the number who died before discharge from hospital. Neurodevelopmental disability was similar in both groups, in all infants randomised and in survivors. The timing of assessments was variable. These findings are limited with only one small study in which three of 12 survivors were lost to follow up.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 22, 2002

Betamimetic tocolytics are drugs that reduce contractions and delay labour, which can improve placental blood flow and fetal oxygenation. They may be suggested to a woman during labour if the baby is showing signs of stress, such as an unusual heartbeat. Tocolysis may also be used to prevent fetal distress (prophylactically) during the second stage of labour, the time from when the cervix is fully dilated by the baby’s head to actual childbirth.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 22, 1996

One method of monitoring a baby's well‐being is to listen to the fetal heart rate and its pattern intermittently during labour (intermittent auscultation). There are several ways that the baby's heart rate can be measured. Some tools for listening to the baby's heart are made from wood, plastic or aluminium (Pinard, Laennec and fetoscope), and there are also electronic tools of varying sophistication, including hand‐held (battery or wind‐up operated) Doppler ultrasound (Doppler) and cardiotocogram (CTG), which is sometimes referred to as electronic fetal monitoring (EFM).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: February 13, 2017

Abdominal decompression was first used to increase blood flow and the forward movement of the uterus during labour contractions as a way of relieving pain. A rigid covered dome is placed about the abdomen and the space around the abdomen is decompressed to ‐50 to ‐100 mm Hg for 15 to 30 seconds out of each minute for 30 minutes once to thrice daily, or continuously during labour. Observations that fetal wellbeing appeared to be improved led to its investigation for complications of pregnancy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 13, 2012

Preterm premature rupture of membranes (PPROM) accounts for one‐third of preterm births. Infants who are born before 37 weeks may suffer from problems related to prematurity, including death. Medications that aim to stop labor are often given in an attempt to prevent preterm birth. It is unclear whether these medications should be used in women with PPROM. This review of eight studies (involving 408 women) found that these medications do not effect perinatal death, but do increase latency and may increase maternal (e.g., chorioamnionitis) and neonatal morbidity (e.g., five‐minute Apgar of less than seven and increased need for ventilation of the neonate).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: February 27, 2014

This review could not provide evidence from randomised controlled trials that routine supplementation with vitamin B6 during pregnancy is of any benefit, other than one trial suggesting protection against dental decay. It may cause harm if too much is taken, as amounts well above the recommended daily allowance are associated with numbness and difficulty in walking.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 3, 2015

Evidence does not support routinely breaking the waters for women in normally progressing spontaneous labour or where labours have become prolonged.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 18, 2013

Abdominal decompression is a procedure during which a negative pressure is applied intermittently to a pregnant woman's abdomen, enclosed within an airtight frame. It is thought to improve the mother's blood flow to the placenta, and during labour to relieve pain. The review of three studies of abdominal decompression used for healthy pregnant women found no benefits with respect to high blood pressure in the mother nor the newborn baby's condition and subsequent intellectual development. Avenues for further research remain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 13, 2012

It is not clear whether altering maternal posture or applying external pressure to the mother's pelvis before birth helps the baby's shoulders pass through the birth canal.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 18, 2006

Epidural analgesia involves the injection of medication just outside the spinal column. It is an effective form of pain relief during labour. The intensity of the pain increases as labour progresses. Epidural analgesia is an invasive procedure with side effects and more rarely complications. Reported side effects include muscle weakness, nausea, shivering, itching and headache. Epidural analgesia with low concentration infusions of bupivacaine has been shown to not increase the incidence of caesarean section but may increase the incidence of instrumental vaginal delivery and the duration of second stage of labour (Sia 2004). This Cochrane systematic review summarised the best available evidence (published before 12 February 2014) regarding the effectiveness and safety of early initiation versus late initiation of epidural analgesia for both spontaneous and augmented labour. Our meta‐analysis involved nine randomised controlled studies with a total of 15,752 women giving birth to their first baby and found no differences in the risk of caesarean section and instrumental birth with early initiation versus late initiation of epidural analgesia for pain relief during labour. Although the effects of early or late initiation of epidural analgesia on the duration of the second stage of labour are similar, we are unable to rule out early initiation leading to an appreciably shorter duration of labour. There was a lot of variation (heterogeneity) between the results of the studies for the duration of the first stage of labour. For the baby, Apgar scores and cord pH were not different. We conclude that it would appear to be advantageous to initiate epidural analgesia for labour early, when requested by the woman.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 9, 2014

About 5 to 10% of infants need resuscitation at birth. Many experts recommend that these babies be resuscitated with 100% oxygen, but other experts think that normal room air is as good as or better than 100% oxygen. Too much oxygen can make breathing difficult for babies and can cause other problems such as problems with brain development, an eye condition (retinopathy of prematurity), and a lung condition (bronchopulmonary dysplasia). The authors of this Cochrane review questioned whether resuscitation with room air resulted in fewer deaths or disabilities than 100% oxygen. After searching the literature, they found five studies. There were a total of 1302 infants in these studies; 24% of them were premature. In the studies, fewer babies died when resuscitated with room air than with 100% oxygen. Many of the babies resuscitated with room air also got some oxygen as a supplement, making it difficult to compare the two groups. There were also other problems with the way the studies were carried out. The authors of the Cochrane review concluded that there is not enough evidence to recommend room air over 100% oxygen, or vice versa.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 20, 2005

The rate of operative births (caesarean sections, forceps and vacuum extraction) continues to rise throughout the world. All three types of delivery are associated with significant complications for both the mother and her baby such as traumatic birth injuries, increased blood loss and placental complications in future pregnancies. One of the most common reasons for a woman to require an operative birth is because the labour does not progress adequately. Increasingly, epidurals are used to manage the pain during labour, however, epidurals may also slow the progression of labour. Oxytocin is a hormone that stimulates uterine contractions in labour and is given to women who are slow to progress in labour. By giving oxytocin to all women with epidurals during labour, the rate of operative deliveries, and the associated complications, could be reduced.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 11, 2013

During the second stage of labour a common technique is to encourage women to take a deep breath at the beginning of a contraction then hold it and bear down throughout the contraction (this is known as directed pushing). In spontaneous pushing, women are free to follow their own instincts and generally push three to five times per contraction. Delayed pushing involves instructing women to avoid pushing until there is an irresistible urge to push or when the presenting part of the baby has descended to the perineum.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 26, 2017

Background: The transition from fetus to newborn involves the clearing of lung fluid and expansion of the lungs with air. Traditionally, oro/nasopharyngeal suctioning at birth has been used routinely to remove fluids in vigorous infants at birth. While airway oro/nasopharyngeal suctioning can be successful in clearing the airway immediately after birth, the procedure can have serious consequences that may outweigh the potential benefits of oro/nasopharyngeal suctioning. This review examined the effect of oro/nasopharyngeal suctioning versus no suctioning.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 18, 2017

Induction of labour is offered to pregnant women when it is thought the outcome will be better for the mother or her baby if the pregnancy does not continue and the baby is born. Common reasons for induction include the pregnancy going beyond the due date, pre‐term or pre‐labour rupture of the membranes, and concerns about the health of the mother or baby such as pre‐eclampsia or poor growth of the baby. Some women look to using complementary therapies alongside conventional medical practice for induction. Acupuncture involves the insertion of fine needles into specific points of the body while acupressure involves using the thumbs or fingers to apply pressure to specific points. Both have been used to help soften and dilate the cervix with onset of labour contractions. They may provide a way of reducing labour pain and avoiding a medical induction with other methods such as prostaglandins.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 17, 2017

The accurate assessment of amniotic fluid volume by ultrasonography can be influenced by an inexperienced operator, fetal position, the probability of a transient change, and the different ultrasound diagnostic criteria of an abnormal volume.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 15, 2008

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