New in RHL

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

There is currently insufficient evidence on the methods of term labour induction for women with a previous caesarean section. More research is required.

The use of uterotonics for the prevention of postpartum haemorrhage

WHO recommends the use of uterotonics for the prevention of postpartum haemorrhage during the third stage of labour.

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

There is insufficient data to support or refute the use of fetal assessment methods for improving neonatal and maternal outcomes in women with preterm prelabour rupture of membranes (PPROM), a condition that can increase the risk of respiratory distress, infection or brain haemorrhage in newborns.

Strategies of testing for syphilis during pregnancy

On-site syphilis screening strategy seems to show benefits regarding syphilis detection and treatment in pregnancy, reduction in incidence of congenital syphilis, and reduction in treatment delay when compared to conventional syphilis infection tests.

Postpartum misoprostol for preventing maternal mortality and morbidity

The use of postpartum misoprostol for prevention or treatment of postpartum haemorrhage is not associated with increased or decreased maternal mortality and serious morbidity (excluding hyperpyrexia).

Fetal fibronectin testing for reducing the risk of preterm birth

Current evidence is not sufficient to support the use of fetal fibronectin tests (FFT) for reducing the risk of preterm birth.

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

Currently there is not enough evidence to support routine use of umbilical vein injection of oxytocin or other uterotonics in third stage of labour.

Fetal intrapartum pulse oximetry for fetal assessment in labour

Cardiotocography (CTG) for fetal monitoring during labour reduces short-term neonatal adverse outcomes, but is expensive and over-diagnoses fetal distress. Adding fetal pulse oxymetry (PO) to CTG did not help to reduce unnecessary caesarean sections (CS). Fetal assessment in low-resource settings depends mainly on a Pinard stethoscope or hand-held doptone ‘auscultation’, and simplified clinical fetal arousal tests.

Antibiotic prophylaxis versus no prophylaxis for preventing infection after caesarean section

Routine prophylactic antibiotics for caesarean section reduced the risk of wound infection, endometritis and severe infection by 60% or more, whether given before or after cord clamping. Single dose prophylactic antibiotics after cord clamping can be used for all caesarean sections.

Antibiotic prophylaxis for operative vaginal delivery

The evidence to support routine antibiotic prophylaxis for operative vaginal delivery is insufficient both in quantity and in quality.

Accuracy of urinary human papillomavirus testing for presence of cervical HPV

There is not yet sufficient evidence to support the adoption of urinary HPV testing for the presence of cervical HPV into routine clinical practice. It is a potentially accurate and non-invasive option, however this method requires further validation and standardization.

Resources


Guidelines

Health-care practice guidance from WHO and other institutions

Methodological resources

Methodological and education resources for improved understanding of the concepts and discussions related to generation of best evidence

Videos
 

A set of training videos to help clinicians master details of manual or surgical procedures

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WHO