Po1345 Maternal-Foetal Complications In Water Births – Evidence Based Review

Ana Sara Machado1, Ana Bela Antunes1 e Sérgio Miranda1
1USF Freamunde
INTRODUCTION Currently there are several options when planning a child-birth. One of them is the environment of delivery, like water birth. However there’s no consensus on this topic. For this reason the authors considered pertinent to conduct an evidence-based review to determine whether there are differences concerning maternal-fetal complications between water births and other birth environments. METHODS A literature research was performed in November 2013 to identify all relevant Systematic reviews (SR), meta-analyses, randomized controlled trials (RCT), cohort studies (CS) and Clinical Guidelines in the databases of National Guideline Clearinghouse, NHS Evidence, CMA Infobase, Cochrane Library, CRD Database, Bandolier, Pubmed and Portuguese Medical Journals Index. The research was limited to articles published between January 2009 and November 2013 in Portuguese, English, Spanish and German languages using the MeSH terms "pregnancy", "water" and "parturition". To evaluate the levels of evidence and strength of recommendation the assignment scale Strength of Recommendation Taxonomy (SORT) of American Family Physician was used.
RESULTS Five of the 52 found articles were chosen by the previously defined inclusion and exclusion criteria. Relatively to water births: One CS did not show differences in the maternal-fetal complications’ number except that there were less episiotomies, more cases with an APGAR score less than 7 at 1st minute, but without differences at 5th minute, and more admissions to the special care nurseries (EL2). One RCT concluded that there may be more neonatal morbidity after water birth (EL2). Another RCT suggests that water births involve less labour time, less pain and less necessity of medical intervention during labour (EL 2). Two SR revealed statistical significance for less need for analgesia/anaesthesia during labour without statistical significant differences in the APGAR score at 5th minute or neonatal and/or maternal infections (EL 2).
DISCUSSION The results found are not consensual. For this reason we cannot concluded that there is a greater or lesser number of maternal and fetal complications in water births (SORT B). Thus it is necessary to conduct more studies with larger samples, to assess robust conclusions about which maternal and fetal complications exists and which are the associated morbidity and mortality.
Pregnancy; Water; Birth