As obstetricians and obstetric providers such as midwives and others, many of us chose this field for the magic and challenges in labor and delivery. The birth of a new life remains for me at the same time the most emotional, happy, and challenging time in pregnancy. For the pregnant woman, labor and delivery is also the most potentially stressful and anxiously awaited time of her gestation.
When I trained as a resident in the early 1990s, there were few randomized controlled trials (RCTs) guiding the management of possible interventions in labor and delivery; now in 2020, there are thousands of RCTs and dozens of metaanalyses of RCTs that can help guide our intrapartum care. Although professional organizations have several documents on labor and delivery (eg, 119 by the American College of Obstetricians and Gynecologists as of November 18, 2019),
1there are few resources available that comprehensively cover all the possible interventions in labor and delivery and the technical aspects of cesarean delivery.
The American College of Obstetricians and Gynecologists website.
Date accessed: November 18, 2019
2For example, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics Guidelines for Perinatal Care, now in their 8th edition, do not cover several possible interventions in labor and do not cover how to perform a cesarean delivery, of which approximately >30 million occur in the world annually.
Vincenzo Berghella Obstetric evidence based guidelines. Third edition. Taylor and Francis, New York2017
- Kilpatrick S.J.
- Papile L.
- Macones G.A.
- Watterberg K.L.
Guidelines for perinatal care, 8th ed. Elk Grove Village (IL): American Academy of Pediatrics.
American College of Obstetricians and Gynecologists, Washington, DC2017
This AJOG MFM L&D series plans to cover the topics that are listed in the Table. They will focus on the healthy woman, carrying a singleton healthy gestation at term, usually in vertex presentation. Recommendations for clinical care will be synthesized in a table format, with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment of the quality of the evidence and strength of recommendation.
4Some topics, such as intrapartum fetal monitoring (and related interventions), group B streptococcus prophylaxis, meconium, anesthesia, operative delivery, multiple gestations, and neonatal care are not covered because each of these topics would require an extensive review behind the scope of this series. We plan to publish at least 1 of the topics that are listed in the Table per issue, hoping to complete publications of all topics in a timely manner. We look forward to feedback, comments, and hot debate!
- Guyatt G.H.
- Oxman A.D.
- Vist G.E.
- et al.
GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.
BMJ. 2008; 336: 924-926
TableThe 10 reviews on evidence based labor and delivery management and cesarean delivery
|1||Labor management: before labor|
|2||Induction of labor|
|3||Labor management: first stage|
|4||Labor management: second stage|
|5||Labor management: third stage|
|6||Vaginal delivery: postpartum care|
|7||Cesarean delivery: before cesarean|
|8||Cesarean delivery: technique, from skin incision to baby|
|9||Cesarean delivery: technique, from after baby to skin closure|
|10||Cesarean delivery: postpartum care|
Berghella. New series of reviews on evidence-based L&D management and cesarean delivery! AJOG MFM 2020.
- The American College of Obstetricians and Gynecologists website.(Available at:)https://www.acog.org/Search?Keyword=labor&Topics=16779859-83fb-4663-ae3a-6d1651db79f2Date accessed: November 18, 2019
- Vincenzo Berghella Obstetric evidence based guidelines. Third edition. Taylor and Francis, New York2017
- Guidelines for perinatal care, 8th ed. Elk Grove Village (IL): American Academy of Pediatrics.American College of Obstetricians and Gynecologists, Washington, DC2017
- GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.BMJ. 2008; 336: 924-926
Accepted: December 16, 2019
Received: December 16, 2019
The author reports no conflict of interest.
© 2019 Elsevier Inc. All rights reserved.
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- Evidence-based labor management: before labor (Part 1)American Journal of Obstetrics & Gynecology MFMVol. 2Issue 1
- PreviewIn preparation for labor and delivery, there is high-quality evidence for providers to recommend perineal massage with oil for 5–10 minutes daily starting at 34 weeks until labor; ≥1 daily sets of repeated voluntary contractions of the pelvic floor muscles, performed at least several days of the week starting at approximately 30–32 weeks gestation; no x-ray pelvimetry; sweeping of membranes weekly starting at 37–38 weeks gestation; for women with a risk factor for abnormal outcome plans should be made to deliver in a hospital setting; for low-risk women, alongside birth center birth is associated with maternal benefits and higher satisfaction, compared with hospital birth; midwife-led care for low-risk women; continuous support by a professional such as doula, midwife, or nurse during labor; and training of birth attendants in low- and middle-income countries.