The grades of evidence (I-III) and levels of recommendation (A-C) are defined at the end of the "Major Recommendations" field.
The following recommendations are based on good and consistent scientific evidence (Level A):
- Patients should be counseled that walking during labor does not enhance or improve progress in labor nor is it harmful.
- Continuous support during labor from caregivers should be encouraged because it is beneficial for women and their newborns.
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
- Active management of labor may shorten labor in nulliparous women, although it has not consistently been shown to reduce the rate of cesarean delivery.
- Amniotomy may be used to enhance progress in active labor, but may increase the risk of maternal fever.
- X-ray pelvimetry alone as a predictor of dystocia has not been shown to have benefit, and, therefore, is not recommended.
The following recommendations are based primarily on consensus and expert opinion (Level C):
- Intrauterine pressure catheters may be helpful in the management of dystocia in selected patients, such as those who are obese.
- Women with twin gestations may undergo augmentation of labor.
Definitions:
Grades of Evidence
I: Evidence obtained from at least one properly designed randomized controlled trial.
II-1: Evidence obtained from well-designed controlled trials without randomization.
II-2: Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.
II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Levels of Recommendations
Level A — Recommendations are based on good and consistent scientific evidence.
Level B — Recommendations are based on limited or inconsistent scientific evidence.
Level C — Recommendations are based primarily on consensus and expert opinion.
