WHO recommendations for augmentation of labour

Published by World Health Organization on Apr 4, 2025

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Abstract

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PICOS

PICO 10.1

Population
Women in spontaneous labour at term (maternal outcomes)
Intervention
Partograph (studies carried out in high- and low-resource settings)
Comparator
No partograph (studies carried out in high- and low-resource settings)
Outcomes

PICO 10.2

Population
Women in spontaneous labour at term (infant outcomes)
Intervention
Partograph (studies carried out in high- and low-resource settings)
Comparator
No partogram (studies carried out in high- and low-resource settings)
Outcomes

PICO 10.3

Population
Women in spontaneous labour at term (maternal outcomes)
Intervention
Partograph with 2-hour action line (studies carried out in a high-resource setting)
Comparator
Partogram with 4-hour action line (studies carried out in a high-resource setting)
Outcomes

PICO 10.4

Population
Women in spontaneous labour at term (infants outcomes)
Intervention
Partograph with 2-hour action line (studies carried out in a high-resource setting)
Comparator
Partograph with 4-hour action line (studies carried out in a high-resource setting)
Outcomes

PICO 10.5

Population
Women in spontaneous labour at term (maternal outcomes)
Intervention
Partograph with 2-hour action line (study carried out in a high-resource setting)
Comparator
Partograph with 3-hour action line (study carried out in a high-resource setting)
Outcomes

PICO 10.6

Population
Women in spontaneous labour at term (infant outcomes)
Intervention
Partograph with 2-hour action line (study carried out in a high-resource setting)
Comparator
Partograph with 3-hour action line (study carried out in a high-resource setting)
Outcomes

PICO 10.7

Population
Women in spontaneous labour at term (maternal outcomes)
Intervention
Partograph with 3-hour action line (study carried out in a high-resource setting)
Comparator
Partograph with 4-hour action line (study carried out in a high-resource setting)
Outcomes

PICO 10.8

Population
Women in spontaneous labour at term (infant outcomes)
Intervention
Partograph with 3-hour action line (study carried out in a high-resource setting)
Comparator
Partograph with 4-hour action line (study carried out in a high-resource setting)
Outcomes

PICO 10.9

Population
Women in spontaneous labour at term (maternal outcomes)
Intervention
Partograph with alert line only (study carried out in a low-resource setting)
Comparator
Partograph with alert line only versus partograph with alert and action line (study carried out in a low-resource setting)
Outcomes

PICO 10.10

Population
Women in spontaneous labour at term (infant outcomes)
Intervention
Partograph with alert line only (study carried out in a low-resource setting)
Comparator
Partograph with alert line only versus partograph with alert and action line (study carried out in a low-resource setting)
Outcomes

PICO 10.11

Population
Women in spontaneous labour at term (matenal outcomes)
Intervention
Earlier intervention (combined analysis for trials in high- and low resource settings)
Comparator
Later intervention (combined analysis for trials in high- and lowresource settings)
Outcomes

PICO 10.12

Population
Women in spontaneous labour at term (infant outcomes)
Intervention
Earlier intervention (combined analysis for trials in high- and low-resource settings)
Comparator
Later intervention (combined analysis for trials in high- and low-resource settings)
Outcomes

PICO 10.13

Population
Women in spontaneous labour at term (maternal outcomes)
Intervention
Partograph with latent phase
Comparator
Partograph without latent phase
Outcomes

PICO 10.14

Population
Women in spontaneous labour at term
Intervention
Partograph with latent phase
Comparator
Partograph without latent phase
Outcomes

PICO 10.15

Population
Women in active labour (maternal outcomes)
Intervention
Vaginal examination
Comparator
Rectal examination
Outcomes

PICO 10.16

Population
Women in active labour (infant outcomes)
Intervention
Vaginal examination
Comparator
Rectal examination
Outcomes

PICO 10.17

Population
Women active labour (maternal outcomes)
Intervention
Vaginal examinations 2 hourly
Comparator
Vaginal examination4 hourly
Outcomes

PICO 20.1

Population
Women in labour (maternal outcomes)
Intervention
Active management of labour
Comparator
Routine care
Outcomes

PICO 20.2

Population
Women in labour (infant outcomes)
Intervention
Active management of labour
Comparator
Routine care
Outcomes

PICO 20.3

Population
Women in labour (maternal outcomes)
Intervention
Early amniotomy and early oxytocin
Comparator
Routine care
Outcomes

PICO 20.4

Population
Women in labour (infant outcomes)
Intervention
Early amniotomy and early oxytocin
Comparator
Routine care
Outcomes

PICO 20.5

Population
Women in labour (maternal outcomes)
Intervention
Early amniotomy and early oxytocin (without active management of labour trials)
Comparator
Routine care
Outcomes

PICO 20.6

Population
Women in labour with epidural analgesia (maternal outcomes)
Intervention
Oxytocin
Comparator
Placebo
Outcomes

PICO 20.7

Population
Women in labour with epidural analgesia (infant outcomes)
Intervention
Oxytocin
Comparator
Placebo
Outcomes

PICO 20.8

Population
Women in spontaneous labour (maternal outcomes)
Intervention
Amniotomy (normal progression at randomization)
Comparator
No amniotomy
Outcomes

PICO 20.9

Population
Women in spontaneous labour (infant outcomes)
Intervention
Amniotomy
Comparator
No amniotomy
Outcomes

PICO 20.10

Population
Women in labour (maternal outcomes)
Intervention
Antispasmodics
Comparator
Control
Outcomes

PICO 20.11

Population
Women in labour (infant outcomes)
Intervention
Antispasmodics
Comparator
Control
Outcomes

PICO 20.12

Population
Women in labour
Intervention
Epidural
Comparator
Non-epidural
Outcomes

PICO 20.13

Population
Women in labour
Intervention
Local anaesthetic nerve block
Comparator
Opioids
Outcomes

PICO 20.14

Population
Women in labour
Intervention
Combined spinal-epidural
Comparator
Traditional epidural
Outcomes

PICO 20.15

Population
Women in labour
Intervention
Combined spinal-epidural
Comparator
Low-dose epidural
Outcomes

PICO 20.16

Population
Women in labour
Intervention
TENS
Comparator
Placebo TENS or routine care
Outcomes

PICO 20.17

Population
Women in labour
Intervention
Cranial TENS with epidural
Comparator
epidural alone
Outcomes

PICO 20.18

Population
Women in labour
Intervention
Relaxation
Comparator
Usual care
Outcomes

PICO 20.19

Population
Women in labour
Intervention
Yoga
Comparator
Control
Outcomes

PICO 20.20

Population
Womem in labour
Intervention
Music
Comparator
Control
Outcomes

PICO 20.21

Population
Women in labour
Intervention
Acupressure
Comparator
Control
Outcomes

PICO 20.22

Population
Women in labour
Intervention
Hypnosis
Comparator
Control
Outcomes

PICO 20.23

Population
Aromatherapy for pain management in labour
Intervention
Aromatherapy
Comparator
Standard care
Outcomes

PICO 20.24

Population
Women during labour
Intervention
Biofeedback
Comparator
No treatment
Outcomes

PICO 20.25

Population
Women in labour (maternal outcomes)
Intervention
Intravenous fluids and oral intake
Comparator
Intravenous fluids alone
Outcomes

PICO 20.26

Population
Women in labour (infant outcomes)
Intervention
Intravenous fluids and oral intake
Comparator
Intravenous fluids
Outcomes

PICO 20.27

Population
Women in labour (maternal outcomes)
Intervention
125 mL/hour intravenous fluids + oral intake
Comparator
250 mL/hour intravenous fluids + oral intake
Outcomes

PICO 20.28

Population
Women in labour (infants outcomes)
Intervention
125 mL/hour intravenous fluids + oral intake
Comparator
250 mL/hour intravenous fluids + oral intake
Outcomes

PICO 20.29

Population
Women in labour (maternal outcomes)
Intervention
125 ml/hour fluids (restricted oral intake)
Comparator
250 ml/hour fluids (restricted oral intake)
Outcomes

PICO 20.30

Population
Women during labour (infant outcomes)
Intervention
125 mL/hour fluids
Comparator
250 mL/hour fluids (restricted oral intake in both arms)
Outcomes

PICO 20.31

Population
Women in labour (maternal outcomes)
Intervention
Normal saline
Comparator
5% dextrose solutions
Outcomes

PICO 20.32

Population
Women in labour (infant outcomes)
Intervention
Normal saline
Comparator
5% dextrose solutions
Outcomes

PICO 20.33

Population
Women during labour (maternal outcomes)
Intervention
Any restriction of oral fluid and food
Comparator
Some fluid and food
Outcomes

PICO 20.34

Population
Women during labour (infant outcomes)
Intervention
Any restriction of oral fluid and food
Comparator
Some fluid and food
Outcomes

PICO 20.35

Population
Women during labour (maternal outcomes)
Intervention
Complete restriction of oral fluid and food (other than ice chips)
Comparator
Freedom to eat and drink
Outcomes

PICO 20.36

Population
Women during labour (infant outcomes)
Intervention
Complete restriction of oral fluid and food (other than ice chips)
Comparator
Freedom to eat and drink
Outcomes

PICO 20.37

Population
Women during labour (maternal outcomes)
Intervention
Water only
Comparator
Specific oral fluid and food
Outcomes

PICO 20.38

Population
Women during labour (infant outcomes)
Intervention
Water only
Comparator
Specific oral fluid and food
Outcomes

PICO 20.39

Population
Women during labour (maternal outcomes)
Intervention
Water only
Comparator
Oral carbohydrate based fluids
Outcomes

PICO 20.40

Population
Women during labour (infant outcomes)
Intervention
Water only
Comparator
Oral carbohydrate based fluids
Outcomes

PICO 20.41

Population
Women during first stage labour without epidural (maternal outcomes)
Intervention
Upright and ambulant positions
Comparator
Recumbent positions and bed care
Outcomes

PICO 20.42

Population
Women during first stage labour without epidural (infant outcomes)
Intervention
Upright and ambulant positions
Comparator
Recumbent positions and bed care
Outcomes

PICO 20.43

Population
Women with epidural during first stage labour (maternal outcomes)
Intervention
Upright and ambulant positions
Comparator
Recumbent positions and bed care
Outcomes

PICO 20.44

Population
Women with epidural during first stage labour (infant outcomes)
Intervention
Upright and ambulant positions
Comparator
Recumbent positions and bed care
Outcomes

PICO 20.45

Population
Women during childbirth (maternal outcomes)
Intervention
Continuous support
Comparator
Usual care
Outcomes

PICO 20.46

Population
Women during childbirth (infant outcomes)
Intervention
Continuous support
Comparator
Usual care
Outcomes

PICO 20.47

Population
Women during labour (maternal outcomes)
Intervention
Enema
Comparator
No enema
Outcomes

PICO 20.48

Population
Women during labour (infant outcomes)
Intervention
Enema
Comparator
No enema
Outcomes

PICO 30.1

Population
Women during first stage of labour with slow progress of labour (maternal outcomes)
Intervention
Intravenous oxytocin
Comparator
No treatment
Outcomes

PICO 30.2

Population
Women during first stage of labour with slow progress of labour (infant outcomes)
Intervention
Intravenous oxytocin
Comparator
No treatment
Outcomes

PICO 30.3

Population
Women during first stage of labour with slow progress of labour (maternal outcomes)
Intervention
Early use of intravenous oxytocin
Comparator
Delayed use
Outcomes

PICO 30.4

Population
Women during first stage of labour with slow progress of labour (infant outcomes)
Intervention
Early use of intravenous oxytocin
Comparator
Delayed use
Outcomes

PICO 30.5

Population
Women in delayed labour (maternal outcomes)
Intervention
High dose of oxytocin
Comparator
Low dose of oxytocin
Outcomes

PICO 30.6

Population
Women in delayed labour (infant outcomes)
Intervention
High dose of oxytocin
Comparator
Low dose of oxytocin
Outcomes

PICO 30.7

Population
Women during delayed labour (maternal outcomes)
Intervention
Titrated misoprostol (20 mcg dose)
Comparator
Intravenous oxytocin
Outcomes

PICO 30.8

Population
Women in delayed labour (infant outcomes)
Intervention
Titrated misoprostol (20 mcg dose)
Comparator
Intravenous oxytocin
Outcomes

PICO 30.9

Population
Women in delayed labour (maternal outcomes)
Intervention
Titrated misoprostol (75 mcg dose)
Comparator
Intravenous oxytocin
Outcomes

PICO 30.10

Population
Women in delayed labour (infant outcomes)
Intervention
Titrated misoprostol (75 mcg dose)
Comparator
Intravenous oxytocin
Outcomes

PICO 30.11

Population
Women in delayed labour (maternal outcomes)
Intervention
Amniotomy
Comparator
No amniotomy
Outcomes

PICO 30.12

Population
Women in delayed labour (infant outcomes)
Intervention
Amniotomy
Comparator
No amniotomy
Outcomes

PICO 30.13

Population
Women in delayed labour (maternal outcomes)
Intervention
Early amniotomy and early oxytocin
Comparator
Routine care
Outcomes

PICO 30.14

Population
Women in delayed labour (infant outcomes)
Intervention
Early amniotomy and early oxytocin
Comparator
Routine care
Outcomes

PICO 40.1

Population
Women in augmented labour (maternal outcomes)
Intervention
Internal tocodynamometry
Comparator
External tocodynamometry
Outcomes

PICO 40.2

Population
Women in augmented labour (infant outcomes)
Intervention
Internal tocodynamometry
Comparator
External tocodynamometry
Outcomes