WHO Recommendations on intrapartum care for a positive childbirth experience

Published by World Health Organization on Apr 3, 2025

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Abstract

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PICOS

PICO 10.1

Population
Women in labour, giving birth and in the immediate postpartum period
Intervention
RMC policy
Comparator
Usual practice
Outcomes

PICO 10.1

Population
Women during second stage of labour
Intervention
Duration of second stage of labour
Comparator
Outcomes

PICO 10.1

Population
Women in labour
Intervention
Comparator
Outcomes

PICO 20.1

Population
Women in labour
Intervention
Companionship during labour and childbirth
Comparator
Usual practice
Outcomes

PICO 20.1

Population
Women in labour
Intervention
Duration of latent phase in nulliparous
Comparator
Duration of latent phase in multiparous
Outcomes

PICO 20.1

Population
Women during second stage labour without epidural anaesthesia
Intervention
Upright position
Comparator
Recumbent position
Outcomes

PICO 20.2

Population
Women during second stage of labour without epidural (Sensitivity analysis based on trial quality)
Intervention
Upright position
Comparator
Recumbent position
Outcomes

PICO 30.1

Population
Women during labour
Intervention
Companionship during labour and childbirth
Comparator
Usual practice
Outcomes

PICO 30.1

Population
Women during second stage of labour without epidural
Intervention
Upright position
Comparator
Recumbent position
Outcomes

PICO 30.1

Population
Women during first stage of labour
Intervention
Diagnostic test accuracy of using the 1-cm/hour threshold
Comparator
Control
Outcomes

PICO 30.2

Population
Women during first stage of labour
Intervention
Cervical dilatation patterns with normal perinatal outcomes
Comparator
Control
Outcomes

PICO 30.2

Population
Women during labour (type of support person)
Intervention
Companionship during labour
Comparator
Usual practice
Outcomes

PICO 40.1

Population
Women during second stage of labour
Intervention
Spontaneous pushing
Comparator
Directed pushing
Outcomes

PICO 40.1

Population
Healthy pregnant women presenting in spontaneous labour at term
Intervention
Delaying admission for women in early labour following initial assessment
Comparator
Direct admission for women in early labour following initial assessment
Outcomes

PICO 50.1

Population
Healthy pregnant women presenting in labour
Intervention
Pelvimetry
Comparator
No pelvimetry
Outcomes

PICO 50.1

Population
Women during second stage of labour with epidural
Intervention
Delayed pushing
Comparator
Immediate pushing
Outcomes

PICO 60.1

Population
Women in labour
Intervention
CTG on admission
Comparator
Auscultation on admission
Outcomes

PICO 60.1

Population
Women during second stage of labour
Intervention
Perineal massage
Comparator
Control (hands off or care as usual)
Outcomes

PICO 60.2

Population
Women during second stage of labour
Intervention
Warm compresses
Comparator
Control (hands off or no warm compress)
Outcomes

PICO 60.3

Population
Women during second stage of labour
Intervention
Hands off (or poised)
Comparator
Hands on
Outcomes

PICO 60.4

Population
Women during second stage of labour
Intervention
Ritgen's manoeuvre
Comparator
Standard practice
Outcomes

PICO 70.1

Population
Women during second stage of labour
Intervention
Selective episiotomy
Comparator
Routine episiotomy
Outcomes

PICO 80.1

Population
Women during the second stage of labour
Intervention
Manual fundal pressure
Comparator
No fundal pressure
Outcomes

PICO 100.1

Population
Women during labour
Intervention
Continuous CTG
Comparator
Intermittent auscultation
Outcomes

PICO 110.1

Population
Women during first stage of labour
Intervention
Doppler
Comparator
Pindard
Outcomes

PICO 110.2

Population
Women during first stage of labour
Intervention
Intermittent cardiotocography (CTG)
Comparator
Pinard
Outcomes

PICO 110.3

Population
Intermittent auscultation (IA) of fetal heart rate in labour for fetal well-being
Intervention
Intensive Pinard
Comparator
Routine Pinard
Outcomes

PICO 120.1

Population
Women durign first stage of labour
Intervention
Epidural
Comparator
Placebo or no epidural analgesia
Outcomes

PICO 120.2

Population
Women during first stage of labour
Intervention
Epidural analgesia
Comparator
Parenteral opioid analgesia
Outcomes

PICO 130.1

Population
Women during labour
Intervention
Pethidine IM
Comparator
Placebo
Outcomes

PICO 130.2

Population
Women during labour
Intervention
IV pethidine
Comparator
Placebo
Outcomes

PICO 130.3

Population
Women during labour
Intervention
Pentazocine IM
Comparator
Placebo
Outcomes

PICO 130.4

Population
Women during labour
Intervention
Tramadol IV
Comparator
No treatment
Outcomes

PICO 130.5

Population
Women during labour
Intervention
Fentanyl IV
Comparator
No analgesia
Outcomes

PICO 130.6

Population
Women in labour
Intervention
Meptazinol IM
Comparator
Pethidine IM
Outcomes

PICO 130.7

Population
Women during labour
Intervention
Tramadol IM
Comparator
Pethidine IM
Outcomes

PICO 130.8

Population
Women during labour
Intervention
Tramadol plus triflupromazine IM
Comparator
Pethidine plus triflupromazine IM
Outcomes

PICO 130.9

Population
Women during labour
Intervention
Diamorphine/morphine IM
Comparator
Pethidine IM
Outcomes

PICO 130.10

Population
Women during labour
Intervention
Diamorphine (IM) plus prochlorperazine
Comparator
Pethidine (IM) plus prochlorperazine
Outcomes

PICO 130.11

Population
Women during labour
Intervention
Dihydrocodeine IM
Comparator
Pethidine IM
Outcomes

PICO 130.12

Population
Women during labour
Intervention
Pentazocine IM
Comparator
Pethidine IM
Outcomes

PICO 130.13

Population
Women during labour
Intervention
Nalbuphine IM
Comparator
Pethidine IM
Outcomes

PICO 130.14

Population
Women during labour
Intervention
Phenazocine IM
Comparator
Pethidine IM
Outcomes

PICO 130.15

Population
Women during labour
Intervention
Butorphanol IM
Comparator
Pethidine IM
Outcomes

PICO 130.16

Population
Women during labour
Intervention
Fentanyl IV
Comparator
Pethidine IV
Outcomes

PICO 130.17

Population
Women during labour
Intervention
Nalbuphine IV
Comparator
Pethidine IV
Outcomes

PICO 130.18

Population
Women in labour
Intervention
Phenazocine IV
Comparator
Pethidine IV
Outcomes

PICO 130.19

Population
Women during labour
Intervention
Butorphanol IV
Comparator
Pethidine IV
Outcomes

PICO 130.20

Population
Women during labour
Intervention
Morphine IV
Comparator
Pethidine IV
Outcomes

PICO 130.21

Population
Women during labour
Intervention
Alphaprodine IV
Comparator
Pethidine IV
Outcomes

PICO 130.22

Population
Women during labour
Intervention
PCA pentazocine
Comparator
PCA pethidine
Outcomes

PICO 130.23

Population
Women during lbour
Intervention
PCA remifentanil
Comparator
PCA pethidine
Outcomes

PICO 130.24

Population
Women during labour
Intervention
PCA nalbuphine
Comparator
PCA pethidine
Outcomes

PICO 130.25

Population
Women during labour
Intervention
PCA fentanyl
Comparator
PCA pethidine
Outcomes

PICO 130.26

Population
Women during labour
Intervention
PCA meptazinol
Comparator
PCA pethidine
Outcomes

PICO 140.1

Population
Women during first stage of labour
Intervention
Relaxation
Comparator
Usual care
Outcomes

PICO 140.2

Population
Women during first stage of labour
Intervention
Yoga
Comparator
Control
Outcomes

PICO 140.3

Population
Women during labour
Intervention
Music
Comparator
Control
Outcomes

PICO 140.4

Population
Women during labour
Intervention
Audio-Analgesia
Comparator
Control
Outcomes

PICO 140.5

Population
Women during abour
Intervention
Mindfulness training
Comparator
Control
Outcomes

PICO 150.1

Population
Women during labour
Intervention
Massage techniques
Comparator
Usual care
Outcomes

PICO 150.2

Population
Women during labour
Intervention
Warm pack
Comparator
Usual care
Outcomes