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Evaluación y apoyo durante el trabajo de parto temprano para mejorar los resultados del parto

Information

DOI:
https://doi.org/10.1002/14651858.CD011516.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 20 April 2017see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Pregnancy and Childbirth Group

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Shinobu Kobayashi

    Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan

  • Nobutsugu Hanada

    Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan

  • Masayo Matsuzaki

    Department of Children and Women's Health, Osaka University Graduate School of Medicine, Osaka, Japan

  • Kenji Takehara

    Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan

  • Erika Ota

    Global Health Nursing, St. Luke's International University, Graduate School of Nursing Sciences, Tokyo, Japan

  • Hatoko Sasaki

    Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan

  • Chie Nagata

    Department of Education for Clinical Research, National Center for Child Health and Development, Setagaya‐ku, Japan

  • Rintaro Mori

    Correspondence to: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan

    [email protected]

Contributions of authors

Nobutsugu Hanada (NH) drafted the protocol with support from Erika Ota (EO), Masayo Matsuzaki (MM) and Rintaro Mori (RM).
NH, Shinobu Kobayashi (SK) and Kenji Takehara (KT) selected studies and extracted data. SK, KT, Hatoko Sasaki (HS) and EO conducted analysis and interpretation. EO, SK, KT, HS, MM, and Chie Nagata (CN) drafted the review.

Sources of support

Internal sources

  • National Center for Child Health and Development, Japan.

External sources

  • Ministry of Health, Labour and Welfare, Japan.

    Health Labour Sciences Research Grant (No.13800128)

  • UNDP‐UNFPA‐UNICEF‐WHO‐World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR), World Health Organization, Switzerland.

Declarations of interest

Nobutsugu Hanada: none known.
Masayo Matsuzaki: none known.
Erika Ota: none known.
Rintaro Mori: none known.
Shinobu Kobayashi: none known.
Kenji Takehara: none known.
Hatoko Sasaki: none known.
Chie Nagata: Chie Nagata's institution receives government funding from the Clinical Research Program for Child Health and Development, AMED, Japan to provide support for the Cochrane Pregnancy and Childbirth Satellite.

Acknowledgements

We thank Ms Emma Barber for her editorial support.

This project was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to Cochrane Pregnancy and Childbirth. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIIHR, NHS or the Department of Health.

Rintaro Mori's and Chie Nagata's institution receives government funding from the Clinical Research Program for Child Health and Development, AMED, Japan to provide support for the Pregnancy and Childbirth Satellite in Japan.

As part of the prepublication editorial process, this review has been commented on by four peers (an editor and three referees who are external to the editorial team), members of Cochrane Pregnancy and Childbirth's international panel of consumers and the Group's Statistical Adviser.

Version history

Published

Title

Stage

Authors

Version

2017 Apr 20

Assessment and support during early labour for improving birth outcomes

Review

Shinobu Kobayashi, Nobutsugu Hanada, Masayo Matsuzaki, Kenji Takehara, Erika Ota, Hatoko Sasaki, Chie Nagata, Rintaro Mori

https://doi.org/10.1002/14651858.CD011516.pub2

2015 Feb 06

Psychosocial and educational interventions in latent phase or early labour for improving birth outcomes

Protocol

Nobutsugu Hanada, Masayo Matsuzaki, Erika Ota, Rintaro Mori

https://doi.org/10.1002/14651858.CD011516

Differences between protocol and review

In our protocol (Hanada 2015), the types of participants were defined as pregnant women. We decided to focus on healthy pregnant women and redefined the types of participants as 'healthy pregnant women'. We may need to revise this further.

The title has changed to ‘Assessment and support in early labour for improving birth outcomes’.

The scope has changed slightly to early labour interventions only (five included studies, two excluded).

The background has been revised to include labour assessment as an intervention and the psychosocial aspect has been toned down.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

Comparison 1 Assessment vs direct admission in early labour, Outcome 1 Length of labour (hours).
Figures and Tables -
Analysis 1.1

Comparison 1 Assessment vs direct admission in early labour, Outcome 1 Length of labour (hours).

Comparison 1 Assessment vs direct admission in early labour, Outcome 2 Rate of caesarean section.
Figures and Tables -
Analysis 1.2

Comparison 1 Assessment vs direct admission in early labour, Outcome 2 Rate of caesarean section.

Comparison 1 Assessment vs direct admission in early labour, Outcome 3 Rate of instrumental vaginal birth.
Figures and Tables -
Analysis 1.3

Comparison 1 Assessment vs direct admission in early labour, Outcome 3 Rate of instrumental vaginal birth.

Comparison 1 Assessment vs direct admission in early labour, Outcome 4 Baby born before arrival at hospital or unplanned home birth.
Figures and Tables -
Analysis 1.4

Comparison 1 Assessment vs direct admission in early labour, Outcome 4 Baby born before arrival at hospital or unplanned home birth.

Comparison 1 Assessment vs direct admission in early labour, Outcome 5 Augmentation of labour.
Figures and Tables -
Analysis 1.5

Comparison 1 Assessment vs direct admission in early labour, Outcome 5 Augmentation of labour.

Comparison 1 Assessment vs direct admission in early labour, Outcome 6 Use of epidural or any regional anaesthesia.
Figures and Tables -
Analysis 1.6

Comparison 1 Assessment vs direct admission in early labour, Outcome 6 Use of epidural or any regional anaesthesia.

Comparison 1 Assessment vs direct admission in early labour, Outcome 7 Maternal satisfaction (score).
Figures and Tables -
Analysis 1.7

Comparison 1 Assessment vs direct admission in early labour, Outcome 7 Maternal satisfaction (score).

Comparison 1 Assessment vs direct admission in early labour, Outcome 8 Apgar score < 7 at 5 minutes.
Figures and Tables -
Analysis 1.8

Comparison 1 Assessment vs direct admission in early labour, Outcome 8 Apgar score < 7 at 5 minutes.

Comparison 2 Home support vs telephone triage, Outcome 1 Length of labour (hours).
Figures and Tables -
Analysis 2.1

Comparison 2 Home support vs telephone triage, Outcome 1 Length of labour (hours).

Comparison 2 Home support vs telephone triage, Outcome 2 Rate of caesarean section.
Figures and Tables -
Analysis 2.2

Comparison 2 Home support vs telephone triage, Outcome 2 Rate of caesarean section.

Comparison 2 Home support vs telephone triage, Outcome 3 Rate of instrumental vaginal birth.
Figures and Tables -
Analysis 2.3

Comparison 2 Home support vs telephone triage, Outcome 3 Rate of instrumental vaginal birth.

Comparison 2 Home support vs telephone triage, Outcome 4 Baby born before arrival at hospital or unplanned home birth.
Figures and Tables -
Analysis 2.4

Comparison 2 Home support vs telephone triage, Outcome 4 Baby born before arrival at hospital or unplanned home birth.

Comparison 2 Home support vs telephone triage, Outcome 5 Serious maternal morbidity.
Figures and Tables -
Analysis 2.5

Comparison 2 Home support vs telephone triage, Outcome 5 Serious maternal morbidity.

Comparison 2 Home support vs telephone triage, Outcome 6 Augmentation of labour.
Figures and Tables -
Analysis 2.6

Comparison 2 Home support vs telephone triage, Outcome 6 Augmentation of labour.

Comparison 2 Home support vs telephone triage, Outcome 7 Use of epidural or any regional anaesthesia.
Figures and Tables -
Analysis 2.7

Comparison 2 Home support vs telephone triage, Outcome 7 Use of epidural or any regional anaesthesia.

Comparison 2 Home support vs telephone triage, Outcome 8 Duration of hospital stay (prolonged postpartum stay in hospital > 5 days).
Figures and Tables -
Analysis 2.8

Comparison 2 Home support vs telephone triage, Outcome 8 Duration of hospital stay (prolonged postpartum stay in hospital > 5 days).

Comparison 2 Home support vs telephone triage, Outcome 9 Maternal satisfaction (score).
Figures and Tables -
Analysis 2.9

Comparison 2 Home support vs telephone triage, Outcome 9 Maternal satisfaction (score).

Comparison 2 Home support vs telephone triage, Outcome 10 Postpartum depression (EPDS score ≥ 13).
Figures and Tables -
Analysis 2.10

Comparison 2 Home support vs telephone triage, Outcome 10 Postpartum depression (EPDS score ≥ 13).

Comparison 2 Home support vs telephone triage, Outcome 11 Perinatal death.
Figures and Tables -
Analysis 2.11

Comparison 2 Home support vs telephone triage, Outcome 11 Perinatal death.

Comparison 2 Home support vs telephone triage, Outcome 12 Neonatal admission to special care.
Figures and Tables -
Analysis 2.12

Comparison 2 Home support vs telephone triage, Outcome 12 Neonatal admission to special care.

Comparison 2 Home support vs telephone triage, Outcome 13 Apgar score < 7 at 5 minutes.
Figures and Tables -
Analysis 2.13

Comparison 2 Home support vs telephone triage, Outcome 13 Apgar score < 7 at 5 minutes.

Comparison 2 Home support vs telephone triage, Outcome 14 Exclusive breastfeeding at discharge.
Figures and Tables -
Analysis 2.14

Comparison 2 Home support vs telephone triage, Outcome 14 Exclusive breastfeeding at discharge.

Comparison 2 Home support vs telephone triage, Outcome 15 Exclusive breastfeeding at six weeks.
Figures and Tables -
Analysis 2.15

Comparison 2 Home support vs telephone triage, Outcome 15 Exclusive breastfeeding at six weeks.

Comparison 3 One‐to‐one structured care vs usual care, Outcome 1 Rate of caesarean section.
Figures and Tables -
Analysis 3.1

Comparison 3 One‐to‐one structured care vs usual care, Outcome 1 Rate of caesarean section.

Comparison 3 One‐to‐one structured care vs usual care, Outcome 2 Rate of instrumental vaginal birth.
Figures and Tables -
Analysis 3.2

Comparison 3 One‐to‐one structured care vs usual care, Outcome 2 Rate of instrumental vaginal birth.

Comparison 3 One‐to‐one structured care vs usual care, Outcome 3 Serious maternal morbidity.
Figures and Tables -
Analysis 3.3

Comparison 3 One‐to‐one structured care vs usual care, Outcome 3 Serious maternal morbidity.

Comparison 3 One‐to‐one structured care vs usual care, Outcome 4 Use of epidural or any regional anaesthesia.
Figures and Tables -
Analysis 3.4

Comparison 3 One‐to‐one structured care vs usual care, Outcome 4 Use of epidural or any regional anaesthesia.

Comparison 3 One‐to‐one structured care vs usual care, Outcome 5 Perinatal death.
Figures and Tables -
Analysis 3.5

Comparison 3 One‐to‐one structured care vs usual care, Outcome 5 Perinatal death.

Comparison 3 One‐to‐one structured care vs usual care, Outcome 6 Neonatal admission to special care.
Figures and Tables -
Analysis 3.6

Comparison 3 One‐to‐one structured care vs usual care, Outcome 6 Neonatal admission to special care.

Comparison 3 One‐to‐one structured care vs usual care, Outcome 7 Apgar score < 7 at 5 minutes.
Figures and Tables -
Analysis 3.7

Comparison 3 One‐to‐one structured care vs usual care, Outcome 7 Apgar score < 7 at 5 minutes.

Summary of findings for the main comparison. Assessment compared to direct admission in early labour for improving birth outcomes

Assessment compared with direct admission in early labour for improving birth outcomes

Patient or population: healthy pregnant women
Setting: large hospital in Canada (high resource setting), study published 1996
Intervention: assessment
Comparison: direct admission to hospital in early labour

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with direct admission in early labour

Risk with assessment

Length of labour (hours)

The mean length of labour (hours) was 8.3 hours in the intervention group and 13.5 hours in the control group

MD 5.2 lower
(7.06 lower to 3.34 lower)

209
(1 RCT)

⊕⊕⊝⊝
LOW 1, 2

This outcome relates to the length of labour in hospital

Rate of caesarean section

Study population

RR 0.72
(0.30 to 1.72)

209
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1, 3

106 per 1000

76 per 1000
(32 to 182)

Rate of instrumental vaginal birth

Study population

RR 0.86
(0.58 to 1.26)

209
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1, 3

356 per 1000

306 per 1000
(206 to 448)

Serious maternal morbidity

Study population

(0 RCTs)

Serious maternal morbidity was not reported

see comment

See comment

Use of epidural or any regional anaesthesia

Study population

RR 0.87
(0.78 to 0.98)

209
(1 RCT)

⊕⊕⊝⊝
LOW 1, 2

904 per 1000

786 per 1000
(705 to 886)

Neonatal admission to special care

Study population

see comment

See comment

Apgar score < 7 at 5 minutes

Study population

RR 2.97
(0.12 to 72.12)

209
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1, 4

0 per 1000

0 per 1000
(0 to 0)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; RCT: randomized controlled trial; RR: risk ratio;

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: we are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: we have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Single trial with design limitations (lack of blinding) (‐1)

2 Single trial with small sample size (‐1)

3 Wide 95% CI crossing the line of no effect and small sample size (‐2)

4 Wide 95% CI crossing the line of no effect, small sample size and low event rate (‐2)

Figures and Tables -
Summary of findings for the main comparison. Assessment compared to direct admission in early labour for improving birth outcomes
Summary of findings 2. Home support compared to telephone triage for improving birth outcomes

Home support compared with telephone triage for improving birth outcomes

Patient or population: healthy pregnant women
Setting: studies in Canada (2 multi‐centre studies) and the UK (1 study) (high resource settings); studies published 2003‐2008
Intervention: home support
Comparison: telephone triage

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with telephone triage

Risk with home support

Length of labour (hours)

The mean length of labour (hours) was 9.66 in the intervention group and 9.37 in the control group

MD 0.29 higher
(0.14 lower to 0.72 higher)

3474
(1 RCT)

⊕⊕⊝⊝
LOW 1, 2

Criteria for start of labour were not clearly described

Rate of caesarean section

Study population

RR 1.05
(0.95 to 1.17)

5170
(3 RCTs)

⊕⊕⊕⊝
MODERATE 3

215 per 1000

226 per 1000
(204 to 252)

Rate of instrumental vaginal birth

Study population

RR 0.95
(0.79 to 1.15)

4933
(2 RCTs)

⊕⊕⊝⊝
LOW 3, 4

233 per 1000

222 per 1000
(184 to 268)

Serious maternal morbidity

Study population

RR 0.93
(0.61 to 1.42)

3474
(1 RCT)

⊕⊕⊝⊝
LOW 1, 2

25 per 1000

23 per 1000
(15 to 35)

Use of epidural or any regional anaesthesia

Study population

RR 0.95
(0.87 to 1.05)

5168
(3 RCTs)

⊕⊕⊝⊝
LOW 3, 5

505 per 1000

480 per 1000
(439 to 530)

Neonatal admission to special care

Study population

RR 0.84
(0.50 to 1.42)

5170
(3 RCTs)

⊕⊝⊝⊝
VERY LOW 2, 3, 6

58 per 1000

49 per 1000
(29 to 82)

Apgar score < 7 at 5 minutes

Study population

RR 1.19
(0.71 to 1.99)

5170
(3 RCTs)

⊕⊕⊝⊝
LOW 2, 3

10 per 1000

12 per 1000
(7 to 20)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RCT: randomized controlled trial; RR: Risk ratio; MD: mean difference

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: we are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: we have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Study with design limitations (lack of blinding) (‐1)

2 Wide 95% CI crossing line of no effect (‐1)

3 All studies contributing data had design limitations (lack of blinding) (‐1)

4 High heterogeneity (I2 69%) (‐1)

5 High heterogeneity (I2 60%) (‐1)

6 High heterogeneity (I2 71%) (‐1)

Figures and Tables -
Summary of findings 2. Home support compared to telephone triage for improving birth outcomes
Summary of findings 3. One‐to‐one structured care compared to usual care for improving birth outcomes

One‐to‐one structured care compared to usual care for improving birth outcomes

Patient or population: healthy pregnant women
Setting: multi‐centre study in North American and UK hospitals (high resource settings). Study published 2008
Intervention: one‐to‐one structured care
Comparison: usual care

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with usual care

Risk with one‐to‐one structured care

Length of labour (hours)

See comment

(0 study)

Not reported

Rate of caesarean section

Study population

RR 0.93
(0.84 to 1.02)

4996
(1 RCT)

⊕⊕⊕⊕
HIGH

242 per 1000

225 per 1000
(203 to 247)

Rate of instrumental vaginal birth

Study population

RR 0.94
(0.82 to 1.08)

4996
(1 RCT)

⊕⊕⊕⊕
HIGH

145 per 1000

136 per 1000
(119 to 156)

Serious maternal morbidity

Study population

RR 1.13
(0.84 to 1.52)

4996
(1 RCT)

⊕⊕⊕⊝
MODERATE 1

32 per 1000

36 per 1000
(27 to 48)

Use of epidural or any regional anaesthesia

Study population

RR 1.00
(0.99 to 1.01)

4996
(1 RCT)

⊕⊕⊕⊕
HIGH

955 per 1000

955 per 1000
(946 to 965)

Neonatal admission to special care

Study population

RR 0.98
(0.80 to 1.21)

4989
(1 RCT)

⊕⊕⊕⊕
HIGH

69 per 1000

67 per 1000
(55 to 83)

Apgar score < 7 at 5 minutes

Study population

RR 1.07
(0.64 to 1.79)

4989
(1 RCT)

⊕⊕⊕⊝
MODERATE 1

11 per 1000

12 per 1000
(7 to 20)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RCT: randomized controlled trial; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: we are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: we have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Wide 95% CI crossing line of no effect (‐1)

Figures and Tables -
Summary of findings 3. One‐to‐one structured care compared to usual care for improving birth outcomes
Table 1. Labour diagnosis algorithm versus routine care (Cheyne 2008)

OUTCOME

Intervention (after )

n = 892

Control (after)

n = 1279

Difference between groups adjusted for baseline differences between clusters with 95% CI

P value

Spontaneous vertex delivery

526

785

‐3.2 (‐15.1 to 8.7)

0.6

ARM

401

500

5.6 (‐2.2 to 13.4)

0.1

Electronic fetal monitoring

557

820

‐0.1 (‐14.2 to 14.1)

1.0

Assisted vaginal delivery

241

323

Caesarean section

123

168

3rd or 4th degree tear

7

8

Epidural

290

441

2.1 (‐8.0 to 12.2)

0.7

Additional analgesia required

Opiate

532

649

1.5 (‐4.6 to 7.6)

0.6

Additional analgesia required

Epidural and opiate

177

225

4.4 (‐2.8 to 11.7)

0.2

Any maternal complication

439

596

3.9 (‐9.4 to 17.2)

0.5

PP haemorrhage (specify)

Intrapartum

Post partum

5

10

7

20

Labour augmentation with oxytocin

343

484

0.3 (‐9.2 to 9.8)

0.9

Unplanned birth out of hospital

11

11

Fetal distress

166

242

2.4 (‐6.6 to 11.3)

0.6

Meconium stained liquor

133

211

‐0.5 (‐7.2 to 6.3)

0.9

Neonatal resuscitation

106

145

‐0.9 (‐6.4 to 4.7)

0.7

Admission to special care

29

60

‐0.4 (‐2.6 to 1.8)

0.7

Apgar score < 7 at 5 minutes

9

13

Admission to hospital at first presentation (1 admission)

One presentations before admission in labour

Two presentations before admission in labour

Three or more presentations before admission in labour

398

305

149

35

795

366

88

20

‐19.2 (‐29.9 to ‐8.6)

0.002

Failure to progress 1st stage

Failure to progress 2nd stage

42

142

59

119

‐3.4 (‐15.3 to 8.6)

15.2 (‐4.5 to 34.9)

0.5

0.1

Figures and Tables -
Table 1. Labour diagnosis algorithm versus routine care (Cheyne 2008)
Table 2. Labour diagnosis algorithm versus routine care (Cheyne 2008) (Continuous data)

OUTCOME

Intervention n =892

Mean

SD

Control n=1279

Mean

SD

Difference between groups adjusted for baseline differences between clusters

P value

Duration of labour from admission to labour ward to delivery

9.6

11.29

8.06

5.41

0.75 (‐0.55 to 2.05)

0.2

Mean number of vaginal examinations

3.67

Range 0‐11

3.46

Range 0‐11

0.2 (‐0.3 to 0.7)

0.3

Figures and Tables -
Table 2. Labour diagnosis algorithm versus routine care (Cheyne 2008) (Continuous data)
Comparison 1. Assessment vs direct admission in early labour

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Length of labour (hours) Show forest plot

1

209

Mean Difference (IV, Fixed, 95% CI)

‐5.20 [‐7.06, ‐3.34]

2 Rate of caesarean section Show forest plot

1

209

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.30, 1.72]

3 Rate of instrumental vaginal birth Show forest plot

1

209

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.58, 1.26]

4 Baby born before arrival at hospital or unplanned home birth Show forest plot

1

209

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Augmentation of labour Show forest plot

1

209

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.37, 0.86]

6 Use of epidural or any regional anaesthesia Show forest plot

1

209

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.78, 0.98]

7 Maternal satisfaction (score) Show forest plot

1

201

Mean Difference (IV, Fixed, 95% CI)

16.0 [7.53, 24.47]

8 Apgar score < 7 at 5 minutes Show forest plot

1

209

Risk Ratio (M‐H, Fixed, 95% CI)

2.97 [0.12, 72.12]

Figures and Tables -
Comparison 1. Assessment vs direct admission in early labour
Comparison 2. Home support vs telephone triage

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Length of labour (hours) Show forest plot

1

3474

Mean Difference (IV, Fixed, 95% CI)

0.29 [‐0.14, 0.72]

2 Rate of caesarean section Show forest plot

3

5170

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.95, 1.17]

3 Rate of instrumental vaginal birth Show forest plot

2

4933

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.79, 1.15]

4 Baby born before arrival at hospital or unplanned home birth Show forest plot

1

3474

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [0.30, 5.95]

5 Serious maternal morbidity Show forest plot

1

3474

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.61, 1.42]

6 Augmentation of labour Show forest plot

2

1694

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.88, 1.04]

7 Use of epidural or any regional anaesthesia Show forest plot

3

5168

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.87, 1.05]

8 Duration of hospital stay (prolonged postpartum stay in hospital > 5 days) Show forest plot

1

3474

Risk Ratio (M‐H, Fixed, 95% CI)

1.15 [0.83, 1.60]

9 Maternal satisfaction (score) Show forest plot

1

423

Mean Difference (IV, Fixed, 95% CI)

3.47 [1.00, 5.94]

10 Postpartum depression (EPDS score ≥ 13) Show forest plot

1

2584

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.82, 1.42]

11 Perinatal death Show forest plot

1

3474

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.42, 2.40]

12 Neonatal admission to special care Show forest plot

3

5170

Risk Ratio (M‐H, Random, 95% CI)

0.84 [0.50, 1.42]

13 Apgar score < 7 at 5 minutes Show forest plot

3

5170

Risk Ratio (M‐H, Fixed, 95% CI)

1.19 [0.71, 1.99]

14 Exclusive breastfeeding at discharge Show forest plot

1

3474

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.96, 1.04]

15 Exclusive breastfeeding at six weeks Show forest plot

1

3474

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.97, 1.14]

Figures and Tables -
Comparison 2. Home support vs telephone triage
Comparison 3. One‐to‐one structured care vs usual care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Rate of caesarean section Show forest plot

1

4996

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.84, 1.02]

2 Rate of instrumental vaginal birth Show forest plot

1

4996

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.82, 1.08]

3 Serious maternal morbidity Show forest plot

1

4996

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.84, 1.52]

4 Use of epidural or any regional anaesthesia Show forest plot

1

4996

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.99, 1.01]

5 Perinatal death Show forest plot

1

4989

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Neonatal admission to special care Show forest plot

1

4989

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.80, 1.21]

7 Apgar score < 7 at 5 minutes Show forest plot

1

4989

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.64, 1.79]

Figures and Tables -
Comparison 3. One‐to‐one structured care vs usual care