Table 4: Forms of Care of Unknown Effectiveness

The full text of A Guide to Effective Care in Pregnancy and Childbirth (Oxford University Press, 2000) is freely available on this website courtesy of the authors: Murray Enkin, Marc J.N.C. Keirse, James Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett and Justus Hofmeyr. (A separate page provides information about this Guide.)

Table 4 from the final chapter is reproduced below. The final chapter, a synopsis of the entire book (and field), includes 6 tables classifying hundreds of maternity practices according to effectiveness and safety. The fourth of these tables — Forms of care of unknown effectiveness — is reproduced in full below. The links in the table lead to the chapters that discuss the specific maternity practices.

Chapter 50. Effective care in pregnancy and childbirth: a synopsis

Table 4. Forms of care of unknown effectiveness


There are insufficient or inadequate quality data upon which to base a recommendation for practice		Chapter

Basic care
Formal preconceptional care for all women		5
Fish oil supplementation to improve pregnancy outcome		6 , 15
Prostaglandin precursors to improve pregnancy outcome		6 , 15
Calcium supplementation to improve pregnancy outcome		6 , 15 , 24
Magnesium supplementation to improve pregnancy outcome		6 , 15 , 24
Zinc supplementation to improve pregnancy outcome		6
Antigen-avoidance diets to reduce risk of an atopic child		6
Screening and diagnosis
Placental grading by ultrasound to improve perinatal outcome		8 , 12
Measuring placental proteins for pre-eclampsia		10
Doppler ultrasound of uterine artery for pre-eclampsia		10
Measuring hematocrit and platelets for following the course of pre-eclampsia		10
Fetal biophysical profile for fetal surveillance		12
Pregnancy Problems
Accupressure for nausea and vomiting of pregnancy if simple measures are ineffective		13
Vitamin B6 for nausea and vomiting of pregnancy if simple measures are ineffective		13
Ginger for nausea and vomiting of pregnancy		13
Acid suppressing drugs for heartburn		13
Rutosides for hemorrhoids		13
Rutosides for varicose veins		13
Exercise and education programs for backache		13
Increased salt intake for leg cramps		13
Oral magnesium for leg cramps		13
Progestogens for threatened miscarriage with a live fetus		14
Human chorionic gonadotrophin (HCG) for threatened miscarriage with a live fetus		14
Steroids for women with auto-antibodies and recurrent miscarriage		14
Evacuation versus 'wait and see' following spontaneous miscarriage		14
Medical versus surgical evacuation following spontaneous miscarriage		14
Hospitalization for women with pregnancy-induced hypertension		15
Bed rest for women with pre-eclampsia		15
Antihypertensive drugs for mild to moderate hypertension		15
Antioxidant vitamins C and E to prevent pre-eclampsia		15
Magnesium sulphate for pre-eclampsia		15
Interventionist versus expectant management for severe early onset pre-eclampsia		15
Plasma volume expansion for pre-eclampsia		15
Hospitalization and bed-rest for impaired fetal growth		16
Abdominal decompression for impaired fetal growth		16
Betamimetics for impaired fetal growth		16
Oxygen treatment for impaired fetal growth		16
Hormone treatment for impaired fetal growth		16
Calcium channel blockers for impaired fetal growth		16
Plasma volume expanders for impaired fetal growth		16
Hospitalization and bed-rest for triplet and higher order pregnancy		17
Antiviral agents for women with a history of recurrent genital herpes		19
Prophylactic antibiotics for prelabor rupture of membranes at term or preterm		23
Postpartum prophylactic antibiotics after prelabor rupture of membranes		23
Bed-rest to prevent preterm birth		24
Progestogens to prevent preterm birth		24
Calcium antagonists to stop preterm labor		24
Antibiotic treatment in preterm labor		24
Oxytocin antagonists to stop preterm labor		24
Sweeping of the membranes to prevent post-term pregnancy		26, 40
Nipple stimulation to prevent post-term pregnancy		26
Childbirth
Pre-admission assessment to determine if labor is in the active phase		29
Routine amnioscopy to detect meconium-stained amniotic fluid in labor		30
Routine artificial rupture of the membranes to detect meconiumstained amniotic fluid in labor		30
Short periods of electronic fetal monitoring as a screening test on admission in labor		30
Fetal stimulation tests for fetal assessment in labor		30
Maternal oxygen administration for fetal distress in labor		30
Institutional routines for repeating blood pressure measurements in labor		31
Nipple stimulation to prevent postpartum hemorrhage		33
Misoprostol in the third stage of labor to prevent postpartum hemorrhage		33
Early versus late clamping of the umbilical cord at birth		33
Methods for delivery of the placenta in the third stage of labor		33
Injecting oxytocin in the umbilical vein in the third stage of labor		33
Injecting oxytocin in the umbilical vein for retained placenta		33
Problems during childbirth
Abdominal decompression to relieve pain in labor		34
Immersion in water to relieve pain in labor		34
Acupuncture to relieve pain in labor		34
Acupressure to relieve pain in labor		34
Transcutaneous electrical nerve stimulation to relieve pain in labor		34
Intradermal injection of sterile water to relieve pain in labor		34
Aromatherapy to relieve pain in labor		34
Hypnosis to relieve pain in labor		34
Continuous infusion versus intermittent top-ups for epidural analgesia		34
Free mobility during labor to augment slow labor		35
Early use of oxytocin to augment slow or prolonged labor		35
'Active management' of labor		35
Cervical vibration for slow or prolonged labor		35
Histoacryl tissue adhesive for perineal skin repair		36
Cesarean section for very preterm delivery		37
Cesarean section for preterm breech delivery		37
Immediate versus delayed clamping of the umbilical cord of preterm infants		37
Techniques of induction and operative delivery
Oxytocin by automatic-infusion systems versus 'standard regimens' for induction of labor		40
Misoprostol orally or vaginally for induction of labor		40
Use of hemostatic stapler for the uterine incision at cesarean section		42
Single- versus two-layer closure of the uterine incision at cesarean section		42
Systemic versus intraperitoneal prophylactic antibiotics at cesarean section		43
Care after childbirth
Tracheal suctioning for meconium in babies without respiratory depression		44
Routine use of antiseptics on the umbilical cord stump		45
Oral proteolytic enzymes for breast engorgement in breastfeeding mothers		46
Cabbage leaves for breast engorgement in breastfeeding mothers		46
Dopamine agonists to improve milk supply in breastfeeding mothers		46
Oxytocin nasal spray to improve milk supply in breastfeeding mothers		46
Oral proteolytic enzymes for perineal pain postpartum		47
Ultrasound and pulsed electromagnetic energy for perineal pain		47
Rubber rings and similar devices to prevent pressure for perineal pain		47
Cabergoline versus physical methods of suppressing lactation		48

[Continue to Table 5. Forms of care unlikely to be beneficial from the synopsis chapter.]

Most recent page update: 3/8/2006

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