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Trial obstetrics

Mary McGunigal, Ariel Pollock, John T Doucette, Jerry Liu, Manjeet Chadha, Tamara Kalir, Vishal Gupta
OBJECTIVES: Randomized trials have shown a local control benefit with adjuvant radiotherapy (RT) in high-intermediate-risk endometrial cancer patients, although not all such patients receive RT. We reviewed the National Cancer Data Base to investigate which patient/tumor-related factors are associated with delivery of adjuvant RT. METHODS: The National Cancer Data Base was queried for patients diagnosed with International Federation of Gynecology and Obstetrics 2009 stage I endometrioid adenocarcinoma from 1998 to 2012 who underwent surgery +/- adjuvant RT...
March 14, 2018: International Journal of Gynecological Cancer
Lilan Yi, Hongman Zhang, Jingwen Zou, Peng Luo, Jian Zhang
BACKGROUND: The benefits of adjuvant chemoradiotherapy (CRT) for high-risk endometrial cancer (HREC) in International Federation of Gynecology and Obstetrics (FIGO) stages I-III remain controversial. A systematic review and meta-analysis was conducted to evaluate the clinical effectiveness and safety of postoperative CRT over radiotherapy (RT) alone, exclusively for patients with HREC for the following key endpoints: overall survival (OS), progression-free survival (PFS), the local recurrence rate, the distant metastasis rate, cancer-specific survival (CSS), grade III/IV acute and late toxicities, and the small bowel obstruction rate...
March 9, 2018: Gynecologic Oncology
Sepideh Hamdamian, Soheila Nazarpour, Masoumeh Simbar, Sepideh Hajian, Faraz Mojab, Atefeh Talebi
BACKGROUND: Reducing labor pain and anxiety is one of the most important goals of maternity care. OBJECTIVE: This study aimed to assess the effects of aromatherapy with Rosa damascena on pain and anxiety in the first stage of labor among nulliparous women. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This was a randomized clinical trial of 110 nulliparous women. The eligible participants were randomly assigned to two groups of aromatherapy and control in an Iranian maternity hospital...
March 2018: Journal of Integrative Medicine
Sukhbir S Singh, Neeraj Mehra, Laura Hopkins
OBJECTIVE: To provide guidance on the implementation of a surgical safety checklist in the practice of obstetrics and gynaecology. OUTCOMES: Outcomes evaluated include the impact of the surgical safety checklist on surgical morbidity and mortality. EVIDENCE: Medline databases were searched for articles on subjects related to "surgical safety checklist" published in English from January 2001 to January 2011. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies...
March 2018: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Marie-Jocelyne Martel, Catherine Jane MacKinnon
OBJECTIVE: To provide evidence-based guidelines for the provision of a trial of labour (TOL) after Caesarean section. OUTCOME: Fetal and maternal morbidity and mortality associated with vaginal birth after Caesarean (VBAC) and repeat Caesarean section. EVIDENCE: MEDLINE database was searched for articles published from January 1, 1995, to February 28, 2004, using the key words "vaginal birth after Caesarean (Cesarean) section." The quality of evidence is described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on the Periodic Health Exam...
March 2018: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
A Kotaska
Based on prediction models and expert opinion, most obstetric venous thromboembolism guidelines recommend low-molecular-weight heparin for many postpartum women, including most delivering by caesarean. Scrutiny reveals major oversights: prediction models are based on studies that report asymptomatic deep vein thrombosis; risk estimates are not adjusted for time exposure; and harm caused by heparin has been overlooked. The benefits of heparin are exaggerated and its harms are under-appreciated. Estimates of the numbers-needed-to-treat and harm are universally lacking...
March 7, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
Natascha de Lange, Pim Schol, Marcus Lancé, Mallory Woiski, Josje Langenveld, Robbert Rijnders, Luc Smits, Martine Wassen, Yvonne Henskens, Hubertina Scheepers
BACKGROUND: Postpartum hemorrhage (PPH) is associated with maternal morbidity and mortality and has an increasing incidence in high-resource countries, despite dissemination of guidelines, introduction of skills training, and correction for risk factors. Current guidelines advise the administration, as fluid resuscitation, of almost twice the amount of blood lost. This advice is not evidence-based and could potentially harm patients. METHODS: All women attending the outpatient clinic who are eligible will be informed of the study; oral and written informed consent will be obtained...
March 6, 2018: Trials
Weina Guo, Jing Cai, Min Li, Hongbo Wang, Yi Shen
BACKGROUND: Despite that pelvic and para-aortic lymphadenectomy (PPaLND) is recommended as part of accurate surgical staging by International Federation of Gynecology and Obstetrics (FIGO) in endometrial cancer, the impact of para-aortic lymphadenectomy on survival remains controversial. The aim of this work is to evaluate the survival benefits or risks in endometrial cancer patients who underwent surgical staging with or without para-aortic lymphadenectomy using meta-analysis. METHODS: Literature search was undertaken using PubMed, Embase, and Cochrane Library databases for relevant articles published between January 1, 1990, and January 1, 2017, without language restriction...
January 2018: Medicine (Baltimore)
Dazhi Fan, Qing Xia, Shuzhen Wu, Shaoxin Ye, Li Liu, Wen Wang, Xiaoling Guo, Zhengping Liu
BACKGROUND: Cesarean delivery has already become a very common method of delivery around the world, especially in low-income countries. Hypertrophic scars and wound infections have affected younger mothers and frustrated obstetricians for a long time. Mesenchymal stem cells (MSCs) have strong potential for self-renewal and differentiation to multilineage cells. Previous studies have demonstrated that MSCs are involved in enhancing diabetic wound healing. Therefore, this study is designed to investigate the safety and efficacy of using MSCs in the treatment of Cesarean section skin scars...
March 2, 2018: Trials
Amritha Bhat, Johnny Mao, Jürgen Unützer, Susan Reed, Jennifer Unger
OBJECTIVE: Mental health care integrated into obstetric settings improves access to perinatal depression treatments. Digital interactions such as text messaging between patient and provider can further improve access. We describe the use of text messaging within a perinatal Collaborative Care (CC) program, and explore the association of text messaging content with perinatal depression outcomes. METHODS: We analyzed data from an open treatment trial of perinatal CC in a rural obstetric clinic...
January 31, 2018: General Hospital Psychiatry
John N Cranmer, Julia Dettinger, Kimberly Calkins, Minnie Kibore, Onesmus Gachuno, Dilys Walker
BACKGROUND: Globally, the rate of reduction in delivery-associated maternal and perinatal mortality has been slow compared to improvements in post-delivery mortality in children under five. Improving clinical readiness for basic obstetric emergencies is crucial for reducing facility-based maternal deaths. Emergency readiness is commonly assessed using tracers derived from the maternal signal functions model. OBJECTIVE-METHOD: We compare emergency readiness using the signal functions model and a novel clinical cascade...
2018: PloS One
Friday Okonofua, Lorretta Ntoimo, Rosemary Ogu, Hadiza Galadanci, Rukiyat Abdus-Salam, Mohammed Gana, Ola Okike, Kingsley Agholor, Eghe Abe, Adetoye Durodola, Abdullahi Randawa
BACKGROUND: The paucity of human resources for health buoyed by excessive workloads has been identified as being responsible for poor quality obstetric care, which leads to high maternal mortality in Nigeria. While there is anecdotal and qualitative research to support this observation, limited quantitative studies have been conducted to test the association between the number and density of human resources and risk of maternal mortality. This study aims to investigate the association between client-provider ratios for antenatal and delivery care and the risk of maternal mortality in 8 referral hospitals in Nigeria...
February 22, 2018: Reproductive Health
Jian Li, Q Wu, Xiao-Ke Wu, Zhong-Ming Zhou, Ping Fu, Xiu-Hua Chen, Ying Yan, Xin Wang, Zheng-Wang Yang, Wei-Li Li, Elisabet Stener-Victorin, Richard S Legro, Ernest Hung-Yu Ng, Heping Zhang, Ben Willem J Mol, Chi Chiu Wang
STUDY QUESTION: Does second-hand smoke (SHS) exposure from husbands have adverse effects on sex hormones, metabolic profiles, clinical phenotypes and fertility outcomes in women with polycystic ovary syndrome (PCOS) undergoing ovulation induction? SUMMARY ANSWER: SHS exposure is associated with worsened biochemical hyperandrogenism, higher incidence of metabolic syndrome and reduced conception rates in women with PCOS. WHAT IS KNOWN ALREADY: Smoking in women impairs fecundity at some stages of the reproductive process including folliculogenesis, embryo transport, endometrial angiogenesis and uterine blood flow...
February 20, 2018: Human Reproduction
Li Li, Qingqing Zhuang, Zeyi Cao, Rutie Yin, Yaping Zhu, Lirong Zhu, Xing Xie, Youzhong Zhang, Li Li, Qiang Wu, Jianhua Zheng, Qi Zhou, Xiaoping Li, Lingying Wu, Youji Feng, Changyu Wang
The multi-center, randomized, open-label, phase III trial discussed in the present study was performed to compare the clinical outcomes of nedaplatin (NDP) plus paclitaxel, and carboplatin (CBP) plus paclitaxel for the treatment of epithelial ovarian cancer (EOC). In the current study, 182 patients with International Federation of Gynecology and Obstetrics (FIGO) stage II-IV EOC were randomly assigned to receive NDP plus paclitaxel or CBP plus paclitaxel at 3-week intervals for a total of six courses. The primary endpoints were progression-free survival rate (PFS) and overall survival rate (OS)...
March 2018: Oncology Letters
Gabriella Comunián-Carrasco, Guiomar E Peña-Martí, Arturo J Martí-Carvajal
BACKGROUND: Gonorrhoea is a sexually transmitted infection that is caused by Neisseria gonorrhoeae, and is a major public health challenge today. N gonorrhoeae can be transmitted from the mother's genital tract to the newborn during birth, and can cause gonococcal ophthalmia neonatorum as well as systemic neonatal infections. It can also cause endometritis and pelvic sepsis in the mother. This review updates and replaces an earlier Cochrane Review on antibiotics for treating this infectious condition...
February 21, 2018: Cochrane Database of Systematic Reviews
Dympna Gallagher, Barak Rosenn, Tatiana Toro-Ramos, Charles Paley, Sonia Gidwani, Michelle Horowitz, Janet Crane, Susan Lin, John C Thornton, Xavier Pi-Sunyer
OBJECTIVE: The objective of this study was to determine the effectiveness of controlling maternal gestational weight gain (GWG) in the second and third trimesters on neonate body composition. METHODS: Two hundred ten healthy women with overweight (25 > BMI < 30) or obesity (BMI ≥ 30) were randomly assigned to a lifestyle intervention (LI) program focused on controlling GWG through nutrition and activity behaviors or to usual obstetrical care (UC). Infant fat and fat-free mass (FFM) at birth were measured by using air displacement plethysmography (PEA POD) and by using quantitative magnetic resonance (QMR)...
March 2018: Obesity
Franziska Hampel, Peter Hallscheidt, Christof Sohn, Bettina Schlehe, Kerstin A Brocker
AIMS: To perform pelvimetry in nulliparous and primiparous women using 3 Tesla magnetic resonance imaging (3T MRI). METHODS: Twenty-five nulliparous volunteers and 25 primiparous women underwent pelvic 3T MRI within one week after vaginal childbirth in a prospective clinical single-center trial. The pelvimetric parameters interspinous distance (ISD), intertuberous distance (ITD), sagittal outlet (SO), obstetric conjugate (OC), and coccygeal curved length (CCL) were adapted from anthropometric measurements as well as from sonographic and computed tomography-based pelvimetry performed on high-resolution T2-weighted images...
February 21, 2018: Neurourology and Urodynamics
Jiamei Lin, Shengqiang Wang, Yunlin Feng, Weihong Zhao, Weilu Zhao, Foquan Luo, Namin Feng
Propofol is widely used in clinical practice, including non-obstetric surgery in pregnant women. Previously, we found that propofol anaesthesia in maternal rats during the third trimester (E18) caused learning and memory impairment to the offspring rats, but how about the exposure during early pregnancy and the underlying mechanisms? Histone acetylation plays an important role in synaptic plasticity. In this study, propofol was administered to the pregnant rats in the early pregnancy (E7). The learning and memory function of the offspring were tested by Morris water maze (MWM) test on post-natal day 30...
February 20, 2018: Journal of Cellular and Molecular Medicine
Roshni Kulkarni, Andra H James, Miranda Norton, Amy Shapiro
BACKGROUND: A high-purity, plasma-derived factor X concentrate (pdFX) is approved to treat hereditary factor X deficiency, an autosomal recessive disorder. OBJECTIVE: Post hoc assessment of pdFX pharmacokinetics, safety, and efficacy in women and girls with hereditary factor X deficiency. PATIENTS/METHODS: Subjects aged ≥12 years with moderate/severe factor X deficiency (plasma factor X activity <5 IU/dL) received on-demand or preventive pdFX (25 IU/kg) for ≤2 years...
February 20, 2018: Journal of Thrombosis and Haemostasis: JTH
Roy Lauterbach, Cara Ferrer Sokolovski, Jenia Rozenberg, Amir Weissman
STUDY OBJECTIVES: The aims of the present study were to evaluate acupuncture as an alternative treatment to an indwelling catheter for women with postpartum urinary retention, and to evaluate the accuracy of sonographic estimation of bladder volume by portable bedside equipment in women postpartum. STUDY BACKGROUND: Post-partum urinary retention is a common obstetric complication. The accepted method for diagnosing post void residual bladder volume is by ultrasound or catheterization...
January 31, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
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