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- Intrapartum Electronic Fetal Monitoring: In high-risk pregnancies there is little sound scientific evidence to support the choice of EFM over intermittent auscultation (at least once every 15 minutes in the first stage of labour and at least once every 5 minutes in the second stage). This does not mean that EFM may not be beneficial in high-risk pregnancies; there is simply insufficient evidence for recommending the exclusion or inclusion of EFM rather than active clinical monitoring in all high-risk pregnancies. High-risk categories include low gestational age, high maternal age, placenta or cord problems, meconium in the amniotic fluid, hypertension, proteinuria, malpresentation, poor outcome in previous pregnancies and medical complications.
- Intrapartum Electronic Fetal Monitoring: There is fair evidence to exclude EFM from routine intrapartum care in low-risk pregnancies because studies have consistently shown no benefit in reducing the risk of perinatal complications and death, whereas they have shown an increased risk associated with cesearean section and other operative procedures among those monitored. Since the operative procedures are associated with a high risk of maternal complications and increased costs, the routine use of EFM could increase the risk and costs.
- Screening for Neonatal Herpes Simplex: On the basis of fair evidence from well-designed cohort studies, weekly culture for herpes simplex virus should be excluded from the routine prenatal care of women with a history of recurrent herpes simplex.
- Screening for Neonatal Herpes Simplex: Whether there is a history of genital herpes should be determined, and clinical evidence of infection at the time of delivery should be sought. If there is such evidence cesarean section is recommended, particularly if it is known before or within 4 to 6 hours after rupture of the membranes.
Intrapartum Electronic Fetal Monitoring: The recommendations pertain to the choice between EFM and active clinical monitoring, not between EFM and no monitoring. Active clinical monitoring requires that trained staff are available.