Acta obstetricia et gynecologica Scandinavica
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Acta Obstet Gynecol Scand · Apr 2016
Randomized Controlled Trial Multicenter StudyCervical pessaries to prevent preterm birth in women with a multiple pregnancy: a per-protocol analysis of a randomized clinical trial.
We recently showed that a cervical pessary prevents preterm birth and reduces poor neonatal outcomes in women with a twin pregnancy and a short cervix (<38 mm). The objective of this study was to evaluate the full potential treatment effect of the pessary in the whole group and in women with a short cervix. ⋯ The analysis confirms the principal findings of the intention-to-treat analysis. Time to delivery was longer in the pessary group than in the control group when censored data were used. This implies the pessary should not be removed until labor is evident.
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Acta Obstet Gynecol Scand · Apr 2016
Review Meta AnalysisEnhanced recovery pathways in abdominal gynecologic surgery: a systematic review and meta-analysis.
Enhanced recovery pathways have been widely accepted and implemented for different types of surgery. Their overall effect in abdominal gynecologic surgery is still underdetermined. A systematic review and meta-analysis were performed to provide an overview of current evidence and to examine their effect on postoperative outcomes in women undergoing open gynecologic surgery. ⋯ The available evidence based on a broad range of non-randomized studies at high risk of bias suggests that enhanced recovery pathways may reduce length of postoperative hospital stay in abdominal gynecologic surgery.
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Acta Obstet Gynecol Scand · Mar 2016
Outcome of attempted vaginal delivery after a previous vacuum extraction: a population-based study.
Few studies have investigated long-term effects of a first vaginal instrumental delivery on subsequent mode of delivery. We investigated risks of repeat vacuum extraction and risk factors associated with a repeat vacuum extraction delivery. ⋯ Nine of ten women who attempted a vaginal birth after a primary vacuum extraction succeeded in having a spontaneous vaginal delivery at second delivery. Compared with women with a primary spontaneous vaginal delivery, women with a primary vacuum extraction were at increased risk of repeat vacuum extraction and emergency cesarean section in subsequent delivery although their risk was not as high as that of women with a primary emergency cesarean section.
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Acta Obstet Gynecol Scand · Jan 2016
Review Meta AnalysisTranexamic acid for preventing postpartum blood loss after cesarean delivery: a systematic review and meta-analysis of randomized controlled trials.
There are several published clinical trials of the use of tranexamic acid (TXA) in an obstetric setting, but no consensus on its use or guidelines for management. ⋯ Prophylactic TXA given before cesarean skin incision in women undergoing cesarean delivery, under spinal or epidural anesthesia, significantly decreases blood loss, including postpartum hemorrhage and severe postpartum hemorrhage, in addition to the standard prophylactic oxytocin given after delivery of the neonate. The effect of TXA on thromboembolic events and mortality as well as its use in high-risk women should be investigated further.
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Acta Obstet Gynecol Scand · Jan 2016
Review Meta Analysis Comparative StudyST waveform analysis versus cardiotocography alone for intrapartum fetal monitoring: a systematic review and meta-analysis of randomized trials.
ST waveform analysis was introduced to reduce metabolic acidosis at birth and avoid unnecessary operative deliveries relative to conventional cardiotocography. Our objective was to quantify the efficacy of ST waveform analysis vs. cardiotocography and assess the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation tool. ⋯ Absolute effects of ST waveform analysis were minor, and the clinical significance of the observed reduction in metabolic acidosis is questioned. There is not enough evidence to justify the use of ST waveform analysis in contemporary obstetrics.