4.1.1.-Shaving of the perineum
evidence available (see details in Annex I).
analyzed a Cochrane Database systematic review and recommendations of the WHO
. We included two clinical trials that evaluated the effects of perineal shaving routine
maternal infection. The available evidence is insufficient to recommend the implementation
perineal shaving for women in labor to prevent perineal infections
. His practice is considered unreasonable because of the inconvenience caused
Recommendations:
• Avoid routine practice perineal shaving of women in labor.
• Optionally, and if necessary at the time of suture, you can do a shaved
part of the pubic hair, or as preference of the mother.
4.1.2.-Enema
evidence available (see details in Annex I).
We included randomized clinical investigation (ICA), a systematic review of Cochrane Database
and recommendations of WHO, which evaluated the effects of
routine administration of enema in the first stage of labor and its relationship to infection rates
maternal and neonatal length of labor and episiotomy dehiscence.
Recommendations:
• Discourage the routine administration of enema during pregnancy. • Optional
advance notification, if the mother desired for some reason.
4.1.3.-Accompaniment during
evidence available (see details in Annex I).
It included a systematic review of Cochrane Database,
Recommendations of the WHO and a review of the literature that evaluated the effects of continuous intrapartum support custom
in mothers and their newborn babies
compared with usual care. The institutionalization and medicalization of childbirth was the determining factor
to separate the family at the time of birth.
physical structure of the institutions and hospital routines were designed to respond more to
needs of health professionals to postpartum women and their families.
there a contradiction between what the evidence shows and how they are organized
care practices.
accompaniment during delivery is an integral part of the strategy of humanization.
Women receiving continuous support were less likely to:
- Receive regional analgesia / anesthesia (RR: 0.90, 95% CI 0.81 to 0.99)
- To receive any analgesia / anesthesia (RR: 0.87, 95% CI 0.79 - 0.96)
- have vaginal deliveries (RR 0.89, 95% CI: 0.83 to 0.96)
- have cesarean deliveries (RR: 0.90, 95% CI 0.82 - 0.99)
- Expressing dissatisfaction with their childbirth experiences (RR 0.73, 95% CI: 0.65 -
0.83)
In a subgroup analysis, continuous intrapartum support was associated with greater benefits
if the accompanying person was not part of hospital staff and if you started early
. There were no adverse effects.
Recommendations:
• Allow and encourage all women, if they wish, to have people
support throughout the process without interruption, providing the accompaniment
start from the earliest stages of it.
• Promote a corporate policy to allow pregnant women to freely choose the person to accompany
continuously throughout the delivery process.
4.1.4.-expansion Period
Available evidence (see details in Annex I).
were included Cochrane systematic reviews Database,
Reproductive Health Library (RHL / WHO), ICAs and WHO recommendations.
Recommendations:
• Educate the pregnant woman in recognizing the signs of a true work of
labor to reduce the number of hits on guard for false labor.
• Facilitate the pregnant woman can wander and choose to adopt the position
according to their needs and preferences. • Allow
food intake, particularly fluids, according to the needs of pregnant women
.
• Promote friendly environments (natural, architectural and psycho-social) that help
attitude and experience in the best conditions. Partogram
• Use as a method of evaluating the progress of labor.
• Conduct monitoring and control of fetal well-suited to the WHO recommendations
.
• Do not perform routine amniotomy.
• Do not place peripheral intravenous prophylactic routine.
• The use of oxytocin is limited to cases of necessity.
is not considered necessary if the progress of labor is adequate.
• Limit the number of vaginal examinations to the minimum essential.
4.1.5.-management of pain during labor
Available evidence (see details in Annex I).
epidural analgesia is the method of pain relief most studied and disseminated. In some countries
being used as an alternative administration
inhaled nitrous oxide 50%. We also report other non-pharmacological methods such as accompanying
, water immersion, acupuncture, massage and rubber bullets.
evaluated randomized controlled trials (ICA) and systematic reviews of Cochrane Database
assessing the effects of different methods of analgesia during labor
and childbirth in women and newborns.
analgesia epidural seems to be the most effective method of pain relief during childbirth
. However, women using this method have a higher risk of having a
failed instrumental delivery and breastfeeding.
nitrous oxide is a potent analgesic during labor, but
appears to be safe for women and newborns. It should be noted that women who receive
nitrous oxide should have pulse oximetry, and
additional administration of local anesthetics in case you need to perform episiotomy.
Recommendations:
• Inform women about the different methods of pain relief
, its benefits and potential risks.
• Inform women of the brain's ability to produce
analgesic substances (endorphins) in a physiological birth in terms of privacy.
• Report on the risks and consequences of epidural analgesia for the mother and child
.
• Consider the application of epidural anesthesia without motor blockade.
• Do not perform routine analgesia.
• Providing women with a choice of one or more methods, if desired.
• For those women who do not want to use drugs during labor, should
report on the evidence alternative methods available.
• Allow women to be accompanied by a continuous basis throughout the
process.
4.1.7.-Episiotomy
evidence available (see details in Annex I).
was evaluated two Cochrane Database of Systematic Reviews,
Agency for Healthcare Research and Quality (AHRQ) and Recommendations
Organization (WHO) who studied the effects of restricted use of episiotomy compared
routine practice during vaginal delivery, and their influence on the results
maternal postpartum. Its routine use or systematic practice has been questioned.
Recommendations:
• Promote a policy of selective and non-systematic episiotomy.
• Do not suture minor lacerations or minor cuts.
• If necessary, you should carry with mediolateral episiotomy suture of absorbable material
.
• Improve training on the protection of the perineum.
4.1.8.-Delivery Available evidence (see details in Annex I).
four systematic reviews were included Cochrane Database, ICAs, comments
Reproductive Health Library WHO (BSR-WHO) and WHO Recommendations
comparing the effects of active versus expectant
regarding blood loss, PPH and other
maternal and perinatal complications during delivery. Interventions in these studies used different combinations
component of active management, including different types, doses and routes of administration
uterotonic, different times and
cord clamping non-standardized use of cord traction.
Recommendations:
• Do not clamp the cord to beat as usual practice.
• In the absence of uniformity regarding the birth expectant or active as
practice in the NHS, it is recommended that an investigation into the
risk of bleeding in the third stage of labor, in straight games in
physiological conditions not audited and in those with active management, to provide useful knowledge
to develop appropriate recommendations.
4.1.9.-Births
instrumental evidence available (see details in Annex I).
assessed a Cochrane Database systematic review, reviews of the
WHO RHL and RCTs that evaluated the effects of vacuum extraction compared to extraction
forceps assisted vaginal delivery. The Cochrane review included ten
randomized controlled trials of good methodological quality.
Recommendations:
• Avoid performing instrumental deliveries unless otherwise indicated by pathology and respect the times
duration of delivery.
• Given the fact that there is a reduction in the likelihood of maternal morbidity
vacuum extraction compared with forceps, and in the presence of
staff with good experience in the use of vacuum, this method is recommended
as a first option when indicated an assisted delivery.
should develop training programs in the use of vacuum extraction in those locations where there is no adequate experience
. The adoption of vacuum as a first choice in assisted delivery
be promoted only after reaching a minimum standard of training
personnel attending deliveries.
4.1.11. Early Mother-Newborn Contact tenacity @
evidence available (see details in Annex I)
In the first two hours after birth, the newborn baby born (RN) is
quiet alert for longer, is called the sensitive period, caused by the discharge of noradrenaline
during delivery, which facilitates the early recognition of maternal odor
very important to establish the link and adaptation to environment
postnatal. Positioning
newborn child prone skin to skin contact, little by little it
crawling out of the breasts of his mother by flexion-extension movements of the lower extremities
and reaching the nipple starts reflections Search and sucks
correctly. This process should not be forced, should be spontaneous. It lasts
about 70 minutes in 90% of cases. M-RN separation
alter this process and reduce the frequency of successful shots.
skin to skin contact also has other beneficial effects
newly born baby (you recover faster from stress, normalize your blood sugar before, the acid-base balance
and temperature) and mother (uterine size reduction
secretion of oxytocin). Also for the link M-RN, increasing duration of breastfeeding and avoiding
negative emotional experiences.
Recommendations:
• The healthy newborn child and its mother should stay together after delivery and
not separated at any time if the health of the mother allows it.
• Immediately after birth, the newborn child is placed on the mother's abdomen
, it is dry and covered with a dry towel. This will grab the chest of
form spontaneously in most cases, staying at least 70 minutes
close skin contact with their mother.
• The procedures to be performed only to the newborn child during this time
skin contact with their mother, are identification and award
the Apgar score.
• Inform mothers the benefits of skin contact.
• Postpone ocular prophylaxis practices, weight, vitamin K, etc.., At the end
early contact, trying to complete all procedures in the presence of
mothers and fathers, and after their consent.
• not performed routinely suctioning, lavage,
the passage of the orogastric tube, the passage of a probe to confirm the patency of the nostrils
and passage of rectal probe. Are not necessary and are not without risk.
• It is also recommended in cases of caesarean section. Whenever possible, prepare the field for
early contact M-RN.
• If the health of the mother does not permit, be offered to the father
possible to do skin to skin contact with their child.
• Establish a methodology of development centered care, encouraging
kangaroo mother method, the skin contact for mothers and fathers and their collaboration
in their care, especially in cases of newborn babies more
vulnerable.
• Encourage the elimination of the pull-out rooms in hospitals.
• Work with support groups that facilitate good practice.
(From the protocol of the same title prepared by the Ministry of Health)
0 comments:
Post a Comment