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Word - The Cochrane Collaboration ...

    The Cochrane Library

    … the best single source of reliable evidence

    about the effects of health care

     thStrictly Embargoed until 00:01 hours (BST), 17 October 2007

This release focuses on two Cochrane Systematic Reviews on birthing publishing

    next week in The Cochrane Library, 2007, Issue 4, and their implications for practice.

To receive a full copy of the Reviews highlighted in this newsletter, or to arrange an

    interview with an author, contact Jennifer Beal +44 (0)1243 770633 or by email,

    jbeal@wiley.co.uk.

Reviews highlighted in this newsletter:

    ? Don‟t „break the waters‟ during labour without good clinical reason,

    concludes review

    A Cochrane Review concluded that amniotomy, also known as breaking the

    waters, should not be used routinely as part of standard labour management

    and care. It found that it doesn’t affect the woman’s satisfaction with her

    childbirth experience, and doesn’t result in the child being in better condition

    immediately after birth.

    ? Don‟t routinely use enemas during labour

    Giving women enemas during labour does not shorten labour or decrease the

    risk of infection to mother or baby. Consequently there is no evidence for any

    routine use of enemas in labour, a Cochrane Review has found.

Don‟t „break the waters‟ during labour without good clinical reason, concludes

    review

“We do not recommend that amniotomy, also known as breaking the waters, should

    be used routinely as part of standard labour management and care” says Cochrane

    Researcher Rebecca Smyth, after completing a systematic review of relevant

    research studies. “Women should be informed that it doesn’t shorten the first or

    second stage of labour, it doesn’t affect the woman’s satisfaction with her childbirth

    experience, and doesn’t result in the child being in better condition immediately after

    birth.”

This Cochrane Systematic Review found that breaking the waters may be associated

    with a slightly (non-significantly) higher rate of Caesarean section. Breaking the

    waters may cause changes in the baby’s heart rate.

The aim of breaking the waters is to speed up and strengthen contractions, with the

    intention of shortening labour. The membranes are punctured using a long handled

    hook, and it is thought that hormones in the amniotic fluid that flows out will stimulate

    contractions. In some centres, it is performed as a routine part of care for all women

    in labour in others it is used only for women with a clinical need to have their waters broken.

Ms Smyth came to these conclusions after she and colleagues had identified 14

    relevant studies that involved almost 5,000 women. The overall quality of the studies

    was variable, making it difficult for the group to give firm recommendations about the

    use of amniotomy. There is a need for further research in this area.

“Our evidence suggesting this lack of effect should be discussed with women in the

    antenatal period,” says Smyth.

Smyth RMD, Alldred SK, Markham C. Amniotomy for shortening spontaneous labour. Cochrane

    Database of Systematic Reviews 2007, Issue 4. DOI: 10.1002/14651858.CD006167.pub2.

Don‟t routinely use enemas during labour

Giving women enemas during labour does not shorten labour or decrease the risk of

    infection to mother or baby. Consequently there is no evidence for any routine use of

    enemas in labour, a Cochrane Review has found.

Enemas are frequently given to women early in labour so that they empty their back

    passage. The idea is that this will give more room for the baby as it passes through

    the pelvis. It is also hoped that it will reduce the chance of the woman leaking faecal

    material while she is giving birth, a situation that is both embarrassing to the woman

    and a potential source of infection to mother and child.

A team of Cochrane Researchers coordinated from Bogota, Colombia, searched for

    studies involving the use of enemas and found three relevant randomised controlled

    trials that included 1765 women. Analysing all the data showed no differences in the

    rates of any form of infection in the women or their babies for at least one month after

    the birth. There was a slight trend towards labours being shorter in women given

    enemas.

“This evidence does not support the routine use of enemas during labour, and

    consequently the practice of routinely giving them should be discouraged,” says lead

    researcher Dr Ludovic Reveiz, who works at the Research Institute of the Fundación

    Universitaria Sanitas in Bogota.

Reveiz L, Gaitán HG, Cuervo LG. Enemas during labour. Cochrane Database of Systematic Reviews

    2007, Issue 4. DOI: 10.1002/14651858.CD000330.pub2.

    *************************************************************************

Extracts from a selection of other Cochrane Systematic Reviews

This section contains extracts from 2 selected updated reviews also publishing in The

    Cochrane Library 2007, Issue 4 from the Cochrane Pregnancy and Childbirth Group

To receive a full copy of the results from this selection, or to arrange an interview with an

    author, contact Jennifer Beal on +44 (0)1243 770633 or by email, jbeal@wiley.co.uk.

“Continuous versus interrupted sutures for repair of episiotomy or second

    degree tears”

    (CD000947) by C Kettle, RK Hills, KMK Ismail

    Background

    Millions of women worldwide undergo perineal suturing after childbirth and the type of repair

    may have an impact on pain and healing. For more than 70 years, researchers have been

    suggesting that continuous non-locking suture techniques for repair of the vagina, perineal

    muscles and skin are associated with less perineal pain than traditional interrupted methods.

    Extract from the Implications for Practice findings

    The continuous suturing techniques for perineal closure, compared to interrupted methods,

    are associated with less short-term pain. Moreover, if the continuous technique is used for all

    layers (vagina, perineal muscles and skin) compared to perineal skin only, the reduction in

    pain is even greater. The evidence produced by this review shows that continuous suturing

    techniques for perineal closure is associated with less short-term pain. However, if the

    continuous technique is used for all layers (vagina, perineal muscles and skin), the benefit in

    terms of reducing pain is even greater. For every five women who were sutured using the

    continuous suturing technique (for all layers), there will be one less complaining of pain up to

    day 10 postpartum compared to the interrupted method groups. The continuous technique is

    easily performed by the novice or inexperienced operator. In addition, it has economical

    advantages in that the continuous technique requires one packet of suture material per

    perineal repair compared to two or more packets for the interrupted method (Kettle 2002).

    Therefore, the non-locking continuous suturing technique is recommended for repair of vagina

    and perineal muscles with a continuous subcutaneous stitch to close the perineal skin.

“Hands and knees posture in late pregnancy or labour for fetal malposition

    (lateral or posterior)” (CD001063) by S Hunter, GJ Hofmeyr, R Kulier

    Background

    Lateral and posterior position of the baby's head (the back of the baby's head facing to the

    mother's side or back) may be associated with more painful, prolonged or obstructed labour

    and difficult delivery. It is possible that certain positions adopted by the mother may influence

    the baby's position.

    Extract from the Implications for Practice findings

    Use of hands and knees position for 10 minutes twice daily to correct occipito-posterior

    position of the fetus in late pregnancy cannot be recommended as an intervention. This is not

    to suggest that women should not adopt this position if they find it comfortable. The use of

    position in labour was associated with reduced backache. Further trials are needed to assess

    the effects on other labour outcomes. Use of hands and knees posture for 10 minutes twice

    daily to correct occipito-posterior position of the fetus in late pregnancy cannot be

    recommended as an intervention. This is not to suggest that women should not adopt this

    position if they find it comfortable. The use of this position during labour was associated with a

    significant reduction in persistent back pain. Women may therefore be encouraged to use this

    position for comfort in labour.

    - Ends -

Notes for editors

1. The Cochrane Library contains high quality health care information, including Systematic Reviews

    from The Cochrane Collaboration. These Reviews bring together research on the effects of health

    care and are considered the gold standard for determining the relative effectiveness of different

    interventions. The Cochrane Collaboration (http://www.cochrane.org) is a UK registered

    international charity and the world's leading producer of systematic Reviews. It has been

    demonstrated that Cochrane Systematic Reviews are of comparable or better quality and are ªupdated more often than the Reviews published in print journals.

    2. The Cochrane Library can be accessed at http://www.thecochranelibrary.com. Guest users may

    access abstracts for all Reviews in the database, and members of the media may request full

    access to the contents of the Library. For further information, see contact details below.

    A number of countries have national provisions by which some or all of their residents are able to

    access The Cochrane Library for free. These include:

    Australia http://www.nicsl.com.au/Cochrane

    England http://www.library.nhs.uk

    Finland http://www.terveysportti.fi

    India http://www.icmr.nic.in/

    Ireland http://www.thecochranelibrary.com

    Latin and Central America and Caribbean http://cochrane.bireme.br

    New Zealand http://www.moh.govt.nz/cochranelibrary or http://www.nzgg.org.nz/ or

    http://www.cochrane.org.nz/

    Norway http://www.cochrane.no

    Poland http://www.aotm.gov.pl

    Scotland http://www.nes.scot.nhs.uk

    Spain http://www.update-software.com/Clibplus/ClibPlus.asp

    South Africa http://www.sahealthinfo.org/evidence/databases.htm

    Sweden http://www.sbu.se

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    The Canadian Province of New Brunswick http://www.gnb.ca/0003

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    The Canadian Province of Nova Scotia http://www.library.dal.ca/kellogg/ahkp/cochrane.htm

    The US State of Wyoming http://wyld.state.wy.us/dbloginform.html

3. There are also several programmes, such as the Health InterNetwork Access to Research Initiative

    (HINARI) and the International Network for the Availability of Scientific Publications (INASP) that

    provide access in developing countries. To find out whether your country is included in any of these

    programmes/provisions, or to learn how to get access if you don’t already have it, please visit:

    http://www.thecochranelibrary.com.

     rdth4. The XV Cochrane Colloquium 2007 will be held in Sao Paulo, Brazil, 23 - 27 October 2007. All

    plenary sessions will be recorded and available for free online at www.cochrane.org.

If you would like to see a full list of Reviews published in the new issue of The Cochrane Library, or

    would like to request full access to the contents of The Library, please contact:

Contact: Jennifer Beal

    Tel: +44 (0)1243 770633

    Email: jbeal@wiley.co.uk

ª Jadad AR, Cook DJ, Jones A, Klassen TP, Tugwell P, Moher M, et al. Methodology and reports of

    systematic Reviews and meta-analysies: a comparison of Cochrane Reviews with articles published in

    paper-based journal.

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