Balance of long-term benefits and risks of caesarean delivery explained
Caesarean delivery has immediate known benefits and risks for those women who need help in childbirth. This review measures the long-term outcomes for the mothers’ health, the links to a higher risk of childhood illness and the chance of problems with future pregnancies.
The large review of 80 studies from high-income countries used data from nearly 30 million women and compared caesarean section with vaginal delivery. Caesarean delivery was associated with a lower risk of urinary inconti...
Plastic wraps or bags keep pre-term infants warm immediately after birth
Cheap and simple plastic wrapping used in the first 10 minutes after birth helps pre-term and low birth weight infants avoid hypothermia. Infants treated in this way are likely to be warmer when admitted to neonatal intensive care than those treated according to standard care. Pre-term infants are most likely to benefit.
Routine infant care usually involves ensuring the delivery room is warm, drying the infant immediately after birth, wrapping the infant in pre-warmed dry blankets and pre-warmi...
Domperidone increases breast milk production in mothers of premature babies
The drug domperidone increases the amount of breast milk women produce. This review looked at its use for up to two weeks in women with premature babies being fed with expressed milk. Women had a moderate increase in breast milk of about 88ml a day, a clinically important increase for these small babies.
Domperidone is an anti-sickness medication. It has not been widely used to increase breast milk because of unknown effectiveness and concerns that it can cause an irregular heart rhythm with lo...
Imaging is the only way to diagnose blood clots in pregnancy
No blood test can accurately tell if a pregnant or recently pregnant woman has a blood clot. All pregnant women with a suspected clot should continue to have imaging investigations as per current UK guidelines.
This NIHR-funded study recruited 328 pregnant or postpartum women with a suspected blood clot in the lung (pulmonary embolism) or leg (deep vein thrombosis). They had a blood test to measure the levels of 13 biomarkers, such as the D-dimer, to see if they could rule a blood clot in or ou...
Delayed umbilical cord clamping reduces hospital mortality for preterm infants
Delays to clamping the umbilical cord of about a minute can reduce hospital mortality for preterm infants by around 32%. Delayed clamping also reduced the proportion of infants needing a blood transfusion by 10%.
This review adds more precise data on survival from new trials including a large Australian trial (over 1,600 babies) to a previous Cochrane 2012 review of trails including 738 infants and provides new more precise data on the survival benefit.
These findings are consistent with curre...
Single urine samples are just as good as 24-hour collections for diagnosing pre-eclampsia
The urine spot albumin-creatinine ratio (which is done on a single, on-the-spot sample) reliably identified 99% of pregnant women with high blood pressure who went on to develop severe pre-eclampsia. The spot protein-creatinine ratio, as currently recommended by NICE, was slightly less sensitive identifying over 90% of women. Both spot tests were good value for money.
Nearly 1,000 women, suspected of having pre-eclampsia, took part in this NIHR-funded study, in 36 UK obstetric units. They had h...
Lying on one’s side in labour with an epidural is safe and leads to more spontaneous births
Women who lie on their side in the second stage of labour after a low-dose epidural are more likely to give birth spontaneously than those who remain upright when actively contracting. Lying down on either side doesn’t appear to be harmful to mothers or babies. This means that 17 of these women would need to lie on their side instead of maintaining an upright position for one more of them to have an unassisted or “spontaneous” birth.
This UK trial looked at how position in lab...
Aspirin reduces a woman’s chance of developing pre-eclampsia in pregnancy
Giving low dose aspirin to high-risk women reduced their risk of pre-eclampsia before 37 weeks of pregnancy. Preterm pre-eclampsia developed in 1.6% of women given 150mg aspirin daily compared with 4.3% who took a placebo.
Pre-eclampsia is a condition which can harm mother and baby. In the mother, it causes high blood pressure and protein in the urine, which can show in pregnancy after 20 weeks. Women with risk factors, such as previous pre-eclampsia, diabetes or high blood pressure, are often ...
Drug reduces deaths from bleeding after childbirth
Tranexamic acid, given to women who bleed heavily after giving birth, reduced the risk of death by 31% when given within three hours.
This trial included 20,060 women with postpartum haemorrhage who were randomly assigned to receive tranexamic acid or placebo. This is the first large study to indicate that it is safe and implies it should be considered as an early drug option for postpartum haemorrhage. In keeping with other recent research, there was no increase in the risk of blood clots.
Induction of labour may be considered in pregnant women with a large baby
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...