Evidence for Maternity Care: new evidence and resources – January 2022

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.

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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 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.

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

Antenatal care

Fear of pregnancy and childbirth

A Cochrane Review on Interventions for fear of childbirth including tocophobia looked at the evidence for non-pharmacological interventions, such as CBT, and found that the effects on fear are uncertain but that they probably reduce the number of women having a caesarean section.

Cochrane Clinical Answer: What are the effects of non‐pharmacological interventions for women with fear of pregnancy and childbirth?

Stillbirth prevention and respectful bereavement care

A Cochrane Special Collection Stillbirth prevention and respectful bereavement care highlights evidence-based interventions to reduce stillbirth and improve care for families after stillbirth and in a subsequent pregnancy, identify women at increased risk of stillbirth, and improve knowledge of causes of and contributors to stillbirth.

There is an accompanying Evidently Cochrane blog: Preventing stillbirth: what’s the latest evidence?.

A Cochrane overview of systematic reviews found eight clearly, probably, or possibly effective ways to prevent stillbirth, depending on the specific context and populations in which they are used. But large gaps in research remain. Reducing fatalism (the belief that stillbirth is inevitable) and stigma, and raising awareness of stillbirth at all levels of society, should help to increase research funding and focus prevention efforts on the highest-priority areas Communicating the evolving research evidence around stillbirth prevention to the public should be done with sensitivity and care, being mindful of the many families already bereaved by stillbirth

The authors of this blog also wrote another – Pregnancy after stillbirth: experience and evidence gaps, in which they discuss the research gap and Susannah shares her personal experience of stillbirth, followed by many women sharing their own stories in the comments.

Ultrasound-estimated fetal weight for identifying placental dysfunction

Cochrane Clinical Answer: Can ultrasound‐estimated fetal weight (EFW) after 24 weeks of pregnancy identify placental dysfunction that could result in a small‐for‐gestational‐age (SGA) infant?

Labour and birth

Induction of labour versus expectant management

Cochrane Clinical Answer: For women at or beyond term, how does induction of labor compare with expectant management for maternal outcomes?

Instruments for assisted vaginal birth

The updated Cochrane Review Instruments for assisted vaginal birth (September 2021) finds that:

  • forceps may be more likely to achieve vaginal birth and have lower rates of fetal trauma, but at a greater risk of perineal trauma and higher pain relief requirements compared with vacuum cups
  • rigid vacuum cups may be more likely to achieve a vaginal birth than soft cups but with more fetal trauma, whilst handheld vacuum cups had similar success rates compared to other cups
  • There was no evidence of a difference in the rates of third‐ or fourth‐degree tears or postpartum haemorrhages between types of cups, but wide confidence intervals around the estimates indicate further research is needed in this area.

Postnatal care and care of the newborn, including preterm infants 

Avoidance of bottles in establishing breastfeeds in preterm infants

The authors of the Cochrane Review Avoidance of bottles during the establishment of breastfeeds in preterm infants (October 2021) have concluded:

“Avoiding the use of bottles when preterm infants need supplementary feeds probably increases the extent of any breastfeeding at discharge, and may improve any and full breastfeeding (exclusive) up to six months postdischarge. Most of the evidence demonstrating benefit was for cup feeding. Only one study used a tube feeding strategy. We are uncertain whether a tube alone approach to supplementing breastfeeds improves breastfeeding outcomes.”

Preterm infants who are given supplementary feeds using a cup, rather than being bottle fed, are probably more likely to be either partially or exclusively breastfed at discharge (moderate-certainty evidence). They may also be more likely to be breastfed up to 6 months after discharge (low-certainty evidence). Avoiding bottles may have little or no impact on length of hospital stay or infant infection rates (low-certainty evidence). It is uncertain whether a tube-alone approach to supplementing breastfeeds improves breastfeeding outcomes. There may be little or no difference between bottle feeding and feeding with a novel teat (low-certainty evidence). Cochrane Review (published October 2021); seven studies with 1152 preterm infants in neonatal units. The studies compared supplementary bottle feeding versus either: cup feeds (five studies), tube feeds (one study), or feeds with a novel, specially-designed teat (one study).

This review has been added to two existing Evidently Cochrane blogs:

Cochrane Clinical Answer: For preterm infants, does avoidance of bottles during establishment of breast‐feeding help to increase the extent and duration of breast‐feeding?

Corticosteroids for prevention of bronchopulmonary dysplasia

A Cochrane Review Early (< 7 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants (October 2021) has been updated. From high-certainty evidence, the review authors have found that systemic postnatal corticosteroids, in the regimens used, have had “significant short‐term and long‐term effects ‐ both beneficial and harmful”. They conclude that “Early systemic postnatal corticosteroid treatment (started during the first six days after birth) prevents BPD [bronchopulmonary dysplasia] and the combined outcome of mortality or BPD. However, it increases risks of gastrointestinal perforation, cerebral palsy, and the combined outcome of mortality or cerebral palsy. Most beneficial and harmful effects are related to early treatment with dexamethasone, rather than to early treatment with hydrocortisone, but early hydrocortisone may prevent mortality, whereas early dexamethasone does not.”

Cochrane Clinical Answer: For preterm infants with evolving or established bronchopulmonary dysplasia, what are the effects of systemic corticosteroids administered within eight days after birth?

The Cochrane Review Late (≥ 7 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants (November 2021) has also been updated. There is high-certainty evidence that “late systemic postnatal corticosteroid treatment (started at seven days or more after birth) reduces the risks of mortality and BPD, and the combined outcome of mortality or BPD, without evidence of increased cerebral palsy. ” But the authors note that there is limited evidence on long-term outcomes, including possible neurodevelopment harms.

Cochrane Clinical Answer: For preterm infants with evolving or established bronchopulmonary dysplasia (BPD), what are the effects of late (≥ 7 days) systemic corticosteroids (CSs)?

CPAP for preterm infants

The authors of a Cochrane Review Nasal continuous positive airway pressure levels for the prevention of morbidity and mortality in preterm infants (November 2021) conclude: “There are insufficient data from randomized trials to guide nasal CPAP level selection in preterm infants, whether provided as initial respiratory support or following extubation from invasive mechanical ventilation. We are uncertain as to whether low or moderate‐high nasal CPAP levels improve morbidity and mortality in preterm infants.”

There is also a Cochrane Clinical Answer Can prophylactic nasal continuous positive airway pressure help to prevent morbidity and mortality in very preterm infants? for the review Prophylactic or very early initiation of continuous positive airway pressure (CPAP) for preterm infants (October 2021).

Enteral zinc supplementation

The Cochrane Review Enteral zinc supplementation for prevention of morbidity and mortality in preterm neonates (February 2021) found that “Enteral supplementation of zinc in preterm infants compared to no supplementation or placebo may moderately decrease mortality and probably improve short‐term weight gain and linear growth, but may have little or no effect on common morbidities of prematurity. There are no data to assess the effect of zinc supplementation on long‐term neurodevelopment.”

Cochrane Clinical Answer: What are the benefits and harms of enteral zinc supplementation for preterm neonates?

Home visits in the early postpartum period

A Cochrane Review on Schedules for home visits in the early postpartum period was updated in July 2021. The review authors found that:

  • The evidence is very uncertain about the effect of home visits on maternal and neonatal mortality.
  • Individualised care as part of a package of home visits probably improves depression scores at four months.
  • Increasing the frequency of home visits may improve exclusive breastfeeding rates and infant healthcare utilisation.
  • Maternal satisfaction may also be better with home visits compared to hospital check‐ups.

Cochrane Clinical Answers:

Opioid withdrawal in newborn infants

The Cochrane Review Opioid treatment for opioid withdrawal in newborn infants was updated in July 2021 with new trials added and conclusions changed.

Cochrane Clinical Answer: For newborn infants with opioid withdrawal, how does morphine compare with methadone, buprenorphine, phenobarbital, and chlorpromazine?

Postnatal depression

The Cochrane Review Antidepressant treatment for postnatal depression (February 2021) found that “there remains limited evidence regarding the effectiveness and safety of antidepressants in the management of postnatal depression, particularly for those with more severe depression.”

Cochrane Clinical Answer: How do selective serotonin reuptake inhibitors (SSRIs) compare with placebo for women with postnatal depression?

Tube feeding preterm and low birth weight infants

The Cochrane Review Monitoring of gastric residual volume during enteral nutrition (September 2021) concludes that “The evidence is very uncertain about the effect of GRV [gastric residual volume] on clinical outcomes including mortality, pneumonia, vomiting, and length of hospital stay.”

Cochrane Clinical Answers:

Reducing perinatal and maternal deaths

Cochrane Clinical Answer: Do perinatal and maternal death reviews and audits reduce perinatal and maternal mortality?

Patient questionnaires

Using patient questionnaires for improving clinical management and outcomes – an interview with Cochrane review author Christopher Gibbons about their recent Cochrane Review to find out whether healthcare workers who receive information from questionnaires completed by their patients give better health care and whether their patients have better health.

Opportunities and events

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.

Hundreds of health leaders and experts met on October 14 to recommend the international community urgently mount stronger evidence-based responses to global health emergencies.  Recordings from this event are now available on this page: Cochrane Convenes recordings available: the world must learn from pandemic lessons to avoid future catastrophes.

Please note that this page includes a round-up of material  published between September 2021 until the end of December 2021, and it will not be 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.



Evidence for Maternity Care: new evidence and resources – January 2022 by Sarah Chapman and Selena Ryan-Vig

is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International

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