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Many national and international OBGYN organisations issue and regularly update guidelines for the management of a range of clinical problems. These are usually evidence-based, but supplemented and interpreted by a panel of experts, in the light of national history and priorities. Differences between countries and changes over time may be illuminating. In this section of the EJOG Resource Centre we publish full versions of guidelines in three areas, preterm labour, induction of labour and post-partum haemorrhage.
Calcium channel blockers and atosiban are the most recommended tocolytics, but alternatives such as beta-mimetics, indomethacin and magnesium sulphate remain recommended alternatives in some national guidelines.
Most guidelines recommend PGE2 in the form of tablets, gel or controlled release pessary for cervical ripening prior to labour induction. Dinoprostone gel via the intracervical route is also favoured in Italy. Recommendations with regard to misoprostol vary from “recommending with care” (Spain), noting that its use is “off label” (Germany) to “contraindicated” (France and Italy). In the UK misoprostol is only recommended for use in the presence of a dead fetus. In most guidelines cervical ripening by catheter is mentioned but not recommended. The exception is the Netherlands where the Foley catheter is recommended.
Most country guidelines recommend use of prophylactic oxytocics for the third stage and all recommend their use in high risk labours. The choice between oxytocin, ergometrine, misoprostol and carbetocin, and the recommended doses of each vary widely.