Bmc Pregnancy Childb
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Bmc Pregnancy Childb · Dec 2019
Randomized Controlled TrialThe ED50 and ED95 of oxytocin infusion rate for maintaining uterine tone during elective caesarean delivery: a dose-finding study.
The 90% effective dose (ED90) of oxytocin infusion has been previously estimated to be 16.2 IU h- 1. However, bolus administration of oxytocin prior to the infusion may decrease the infusion dose required. The aim of this study was to estimate the ED95 for oxytocin infusion after a bolus at elective caesarean delivery (CD) in nonlaboring parturients. ⋯ In parturients who receive a 1 IU bolus of oxytocin during elective cesarean delivery, an infusion rate of oxytocin at 7.72 IU h- 1 will produce adequate uterine tone in 95% of parturients. These results suggest that the total dose of oxytocin administered in the postpartum period can be decreased when administered as an infusion after oxytocin bolus.
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Bmc Pregnancy Childb · Dec 2019
Meta AnalysisEffectiveness and cost-effectiveness of home-based postpartum care on neonatal mortality and exclusive breastfeeding practice in low-and-middle-income countries: a systematic review and meta-analysis.
Early postpartum facility discharge negatively impacts mothers' proper and effective use postnatal care. Cognizant of these facts, home-based postnatal care practices have been promoted to complement facility-based care to reduce neonatal mortality. This systematic review evaluated the effectiveness and cost-effectiveness of home-based postnatal care on exclusive breastfeeding practice and neonatal mortality in low-and-middle-income countries. ⋯ Home visits and community mobilization activities to promote neonatal care practices by community health workers is associated with reduced neonatal mortality, increased practice of exclusive breastfeeding, and cost-effective in improving newborn health outcomes for low-and-middle-income countries. However, a well-designed evaluation study is required to formulate the optimal package and optimal timing of home visits to standardize home-based postnatal interventions.
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Bmc Pregnancy Childb · Dec 2019
Multicenter StudyEffect of epidural analgesia in trial of labor after cesarean on maternal and neonatal outcomes in China: a multicenter, prospective cohort study.
The trial of labor after cesarean section (TOLAC) is a relatively new technique in mainland of China, and epidural analgesia is one of the risk factors for uterine rupture. This study aimed to evaluate the effect of epidural analgesia on primary labor outcome [success rate of vaginal birth after cesarean (VBAC)], parturient complications and neonatal outcomes after TOLAC in Chinese multiparas based on a strictly uniform TOLAC indication, management and epidural protocol. ⋯ Epidural analgesia could reduce labor pain, and no increased risk of postpartum bleeding or uterine rupture, as well as adverse effects in newborns were observed. The labor duration of multiparas was increased, but within acceptable range. In summary, epidural analgesia may be safe for both mother and neonate in the three studied hospitals.
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Bmc Pregnancy Childb · Dec 2019
Randomized Controlled TrialInduction of labor compared to expectant management in term nulliparas with a latent phase of labor of more than 8 hours: a randomized trial.
Prolonged latent phase of labor is associated with adverse maternal and neonatal outcomes. Preliminary data indicate that labor induction for prolonged latent phase may reduce cesarean delivery. We performed a study powered to Cesarean delivery to evaluate labor induction compared to expectant management in full term nulliparas hospitalized for persistent contractions but non-progressive to established labor after an overnight stay. ⋯ Induction of labor did not reduce Cesarean delivery rates but intervention to delivery and to hospital discharge durations are shorter. Patient satisfaction scores were similar. Induction of labor for prolonged latent phase of labor can be performed without apparent detriment to expedite delivery.
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Bmc Pregnancy Childb · Dec 2019
Quality appraisal of gestational diabetes mellitus guidelines with AGREE II: a systematic review.
Several societies and associations have produced and disseminated clinical practice guidelines (CPGs) for gestational diabetes mellitus (GDM). However, the quality of such guidelines has not been appraised so far. This study aims to evaluate the quality of CPGs for GDM published in the last decade using the AGREE II instrument. ⋯ In general, the methodological quality of GDM guidelines is high, and evidence-based guidelines are superior to expert consensus. However, the domains of Rigor of Development, Stakeholder Involvement and Editorial Independence still need improvement. A systematic approach in the development of these guidelines and updating timely is needed. In some regions, more attention for guideline adaptation is recommended.