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Evidence for Maternity Care stages of pregnancy

Evidence for Maternity Care: new evidence and resources – Quarter 3 2021

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The latest evidence and resources for midwives and clinical support staff. You can either scroll through this page or click on any of the links below to jump to the relevant section.

COVID-19

This year, Cochrane is continuing to produce new and updated reviews in response to the pandemic. We have blogged about many of them and this blog COVID-19 evidence: a Cochrane round-up brings together a large collection of evidence and resources, starting from when this evidence was first being produced in spring 2020. Like the reviews themselves, all our blogs are updated to reflect new evidence.

Cochrane has also signed on to the World Health Organization’s call for action about managing infodemics and WHO’s Vaccine Equity Declaration.

External to Cochrane, you might be interested to read about this work being done on the Impact of COVID-19 and other conditions requiring isolation on the provision of fundamental nursing care in hospital.

Cochrane Special Collections

Cochrane Special Collections assemble Cochrane Reviews on important topics for the prevention and treatment of COVID-19. They are developed with experts from our global Cochrane network. They are based on World Health Organization interim guidance, and continuously updated. You can find Coronavirus (COVID-19) Special Collections here.

Cochrane Podcasts

Cochrane COVID-19 Podcasts offer short summaries of Cochrane COVID-19 reviews from the authors themselves. A good way to hear the latest Cochrane evidence in under 5 minutes each.

Cochrane Clinical Answers

Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically-focused entry point to rigorous research from Cochrane Reviews. They are designed to be actionable and to inform point-of-care decision-making.

Each CCA contains a clinical question, a short answer, and data for the outcomes from the Cochrane Review deemed most relevant to practising healthcare professionals. The evidence is displayed in a user-friendly tabulated format that includes narratives, data, and links to graphics.

You can find Cochrane Clinical Answers related to COVID-19 here.

Antenatal care

Antenatal screening

Cochrane Clinical Answer: For pregnant women, what are the effects of antenatal screening on fetal growth and well‐being?

Gestational diabetes

Cochrane Review: Probiotics for preventing gestational diabetes (April 2021)

Compared with placebo, probiotics increase the risk of pre‐eclampsia (high‐certainty evidence), but make little to no difference to the risk of needing a caesarean section (high‐certainty evidence), and probably make little to no difference to weight gain during pregnancy or to the risk of giving birth to a big baby (moderate‐certainty evidence). It is uncertain how probiotics affect the risk of developing gestational diabetes (low‐certainty evidence). Effects of probiotics on infants are uncertain; including body fat, the risk of the infant having low blood sugar, having medical problems after birth, or dying (either before birth or as a newborn; all low‐certainty evidence). None of the studies reported on the risk of perineal trauma, postnatal depression, maternal and infant development of diabetes, or long‐term conditions that affect brain development.Cochrane Review (published April 2021); seven studies with 1647 pregnant women, comparing probiotics with placebo for preventing gestational diabetes.

Midwife-led care

Cochrane Clinical Answer: For pregnant women, what are the effects of midwife‐led and trained traditional birth attendant–led care?

Pregnancy in women with long-term conditions

In her blog Balancing diabetes and pregnancy: the keys are shared decision-making and technology Emma Doble, who lives with Type 1 Diabetes and gave birth for the first time in 2020, reflects on her pregnancy journey and afterwards.

Take-home points: Regular contact with health professionals is very reassuring for people who are living with diabetes and are pregnant. Being able to make changes to insulin regimes quickly reduces worry and risk, to both the baby and mum. The use of technology and online contact (e.g. uploading pump results and discussing over email) can support this hugely Birth options should be discussed with women with pre-existing conditions throughout their pregnancy, with every effort made to follow their preferences Postnatal care is hugely important for people navigating significant changes to their diabetes management once they have given birth

In their blog Contemplating pregnancy with long-term health conditions, Rachel Plachcinski and Ngawai Moss discuss the lack of evidence for planning pregnancy and maternity care for women with two or more long-term health conditions.

Take-home points: Having two or more long-term health conditions is increasingly common among pregnant women There is little research evidence to inform maternity care for these women or to guide them in navigating the additional challenges they face A UK-wide research project, MuMPreDiCT, is working to better understand the experiences and needs of women managing two or more long-term conditions in pregnancy and improve maternity care for such women

These blogs are among several in Living with long-term conditions: a Cochrane UK special series.  

Preventing miscarriage

Cochrane Review: Progestogens for preventing miscarriage: a network meta‐analysis (April 2021)

Cochrane Clinical Answers:

 For women with a threatened miscarriage, how do progesterone and dydrogesterone compare with placebo and with each other?

For women with recurrent miscarriage, how do progesterone and dydrogesterone compare with placebo and each other?

Preventing stillbirth

Podcast: What are the most effective interventions during pregnancy for preventing stillbirth?

Preventing venous thromboembolism

Cochrane Review: Venous thromboembolism prophylaxis for women at risk during pregnancy and the early postnatal period (March 2021)

The evidence is very uncertain about the possible benefits and harms of treatments used to prevent deep vein clots in high-risk women, during pregnancy and around the time of childbirth (either important outcomes were not reported in the studies or the evidence is very low-certainty). Evidence gap.Cochrane Review (published March 2021); 29 studies with 3839 women at increased risk of deep vein clots during pregnancy, in childbirth, and after the birth. Treatments assessed included different types and doses of heparin (of low molecular weight heparin and unfractionated heparin), and compression stockings or devices, compared with either placebo, no treatment, or with different types and doses of heparin.

Smoking cessation in pregnancy

Cochrane Clinical Answer: For pregnant women, what are the effects of smoking cessation interventions?

Vitamin and mineral supplementation

Cochrane Clinical Answers: 

For pregnant women, what are the effects of vitamin supplements for prevention of stillbirth, fetal loss, and perinatal death?

How does zinc supplementation improve pregnancy and infant outcomes?

Labour and birth

Induction of labour 

Featured review: Low-dose misoprostol given by mouth for induction of labour

Reducing nausea and vomiting

Featured Review: Reducing nausea and vomiting in women having a caesarean birth with regional anaesthesia (May 2021)

Cochrane Clinical Answer: For women undergoing regional anesthesia for cesarean section, which medications prevent nausea and vomiting?

Postnatal care and care of the newborn, including preterm infants 

Antibiotics for early-onset neonatal sepsis

Cochrane Review: Antibiotic regimens for early‐onset neonatal sepsis (May 2021)

Bed sharing

Cochrane Review: Bed sharing versus no bed sharing for healthy term neonates (April 2021)

Early postnatal discharge from hospital

Cochrane Review: Early postnatal discharge from hospital for healthy mothers and term infants (June 2021)

Feeding preterm infants

Cochrane Review: Continuous nasogastric milk feeding versus intermittent bolus milk feeding for preterm infants less than 1500 grams (June 2021)

Ibuprofen for preventing patent ductus arteriosus

Cochrane Clinical Answer: What are the benefits and harms of ibuprofen for preventing patent ductus arteriosus (PDA) in preterm and/or low birth weight infants?

Management of transient tachypnoea of the newborn

 For this recent Cochrane Review: Fluid restriction in the management of transient tachypnea of the newborn (February 2021) there is now a Cochrane Clinical Answer: How does restricted fluid management compare with standard fluid management for preventing transient tachypnea in neonates?

Opioids for ventilated newborns

Podcast: Opioids for newborns receiving mechanical ventilation

Perineal pain

Cochrane Clinical Answer: How does acetaminophen (paracetamol) compare with placebo for women with early postpartum perineal pain following episiotomy during childbirth?

A single dose of paracetamol may provide greater perineal pain relief following vaginal birth, and may reduce the need for additional pain relief, compared with placebo (low-certainty evidence).There may be little to no difference between paracetamol and placebo in the risk of mothers experiencing nausea or sleepiness, but only one study reported information about this (low-certainty evidence). No other maternal adverse events were reported. None of the studies measured potential adverse effects in babies.Cochrane Review (published January 2021); 10 studies with 1301 women with perineal pain in the early postpartum period. The studies compared paracetamol with placebo; five of the studies assessed 500 mg to 650 mg and six studies assessed 1000 mg of paracetamol.

Postnatal depression

Podcast: Antidepressant treatment for postnatal depression

Postpartum haemorrhage

Cochrane Clinical Answer: How do uterotonic agents compare for first‐line treatment of postpartum hemorrhage?

Preventing hypoglycaemia

Cochrane Review: Oral dextrose gel to prevent hypoglycaemia in at‐risk neonates (May 2021)

Cochrane Clinical Answer: What are the effects of oral dextrose for preventing hypoglycemia in at‐risk neonates?

Sedatives for opioid withdrawal in newborns

Cochrane Review: Sedatives for opioid withdrawal in newborn infants (May 2021)

Cochrane Clinical Answer: For newborn infants with opiate withdrawal, how do different sedatives compare?

Surfactant therapy

Cochrane Review: Surfactant therapy via thin catheter in preterm infants with or at risk of respiratory distress syndrome (May 2021)

Topical emollient for preventing infection

Cochrane Review: Topical emollient for preventing infection in preterm infants (May 2021)

Cochrane Clinical Answer: How do topical emollients compare with routine skin care for preventing infection in preterm infants?

Healthcare worker education and training

Cochrane Reviews:

 Education and training for preventing sharps injuries and splash exposures in healthcare workers (April 2021)

Cochrane Clinical Answer: Can multi‐professional simulation‐based team training improve patient outcomes and trainee performance in obstetric emergencies?

Pelvic health

Myra Robson, a pelvic health physiotherapist, has written an Evidently Cochrane blog Pessaries for pelvic organ prolapse – looking at the Cochrane evidence.

50% of women over 50 have a prolapse A Cochrane Review has found gaps in the evidence on pessaries to treat pelvic organ prolapse Combining pessaries with pelvic floor muscle training probably improves symptoms but may make abnormal bleeding more likely Prolapse can often be very well-managed with physiotherapy

 

NICE seek comments on draft guidance on pelvic floor dysfunction

NICE has recently published draft guidance on pelvic floor dysfunction and the importance of exercises and has opened a period of consultation from stakeholders, until 9 August 2021.

Opportunities to get involved with Cochrane 

On this page, Important Cochrane Links, you can find opportunities to get involved, including how to join Cochrane, find volunteer tasks, or jump into the Cochrane Library.

Find out more about Cochrane’s Early Career Professionals Group and their upcoming activities.

Please note that this page includes a round-up of materials mainly published within the last three months, and is not updated after it’s posted.

References (pdf)

Join in the conversation on Twitter with @SarahChapman30 and @CochraneUK or leave a comment on the blog.

Please note, we cannot give medical advice and do not publish comments that link to individual pages requesting donations or to commercial sites, or appear to endorse commercial products. We welcome diverse views and encourage discussion but we ask that comments are respectful and reserve the right to not publish any we consider offensive. Cochrane UK does not fact check – or endorse – readers’ comments, including any treatments mentioned.

Sarah and Selena have nothing to disclose.

 

 


Sarah Chapman and Selena Ryan-Vig

About Sarah Chapman and Selena Ryan-Vig

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Sarah and Selena are Cochrane UK’s Knowledge Brokers. Their role involves sharing evidence in accessible ways with those who could find it helpful for their health decision-making, and encouraging engagement with it through social media. Sarah trained and worked as a nurse, has degrees in History from the Universities of Oxford and Reading, and worked in health services research before joining Cochrane UK in 2007. She is a recent cochlear implant recipient (2021) and is a Patient Ambassador for the COACH Trial, a randomised controlled trial of cochlear implantation versus hearing aids in adults with severe hearing loss. Sarah tweets @SarahChapman30. Selena has a psychology degree from the University of Bath and has previously worked for a national charity that provides support for young women. With a colleague, Selena delivers interactive sessions to students from Years 10 to 13 to teach about evidence-based practice and to encourage critical thinking, particularly around healthcare claims made in the media.

Evidence for Maternity Care: new evidence and resources – Quarter 3 2021 by Sarah Chapman and Selena Ryan-Vig

is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International

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