European journal of obstetrics, gynecology, and reproductive biology
-
Eur. J. Obstet. Gynecol. Reprod. Biol. · Nov 2009
Review Meta AnalysisTo close or not to close? A systematic review and a meta-analysis of peritoneal non-closure and adhesion formation after caesarean section.
Many gynaecologists do not currently close the peritoneum after caesarean section (CS). Recently, several studies examining adhesion formation after repeat CS appear to favour closure of the peritoneum after caesarean section. We performed a systematic review of the current available evidence with regard to the long-term outcome, mainly in terms of adhesion formation after closure versus non-closure of peritoneum during CS. ⋯ Meta-analysis was performed using the two randomised studies plus (i) the unadjusted estimate from the non-randomised study and (ii) the reported adjusted estimate, adjusted for baseline differences in the groups. Non-closure of the peritoneum during CS resulted in a significantly increased likelihood of adhesion formation in both meta-analyses--OR (95% CI): (i) 2.60 (1.48-4.56) and (ii) 4.23 (2.06-8.69). This systematic review has demonstrated that according to current data in the literature, there is some evidence to suggest that non-closure of the peritoneum after caesarean section is associated with more adhesion formation compared to closure.
-
Eur. J. Obstet. Gynecol. Reprod. Biol. · Nov 2009
ReviewPrevention of postpartum haemorrhage with the oxytocin analogue carbetocin.
Postpartum haemorrhage is the leading cause of maternal mortality worldwide: 67-80% of cases are caused by uterine atony. Preventive measures include prophylactic drug use to aid uterine contraction after delivery, thus avoiding severe blood loss and reducing maternal morbidity and mortality. Carbetocin is a synthetic analogue of oxytocin with a half-life approximately 4-10 times longer than that reported for oxytocin. ⋯ In addition to being an effective treatment for the prevention of postpartum haemorrhage following caesarean delivery, carbetocin may also become the drug of choice for postpartum haemorrhage prevention after vaginal delivery in high-risk women and those who suffer from hypertensive disorders in pregnancy. Preeclampsia is still a contraindication to the administration of carbetocin in the EU, and further studies would be required to assess the cardiovascular effects of carbetocin before it can be advocated for routine use in preeclamptic patients. Further research is required to assess whether prophylactic carbetocin is superior to conventional uterotonic agents following vaginal delivery in low-risk women.
-
Eur. J. Obstet. Gynecol. Reprod. Biol. · Nov 2009
Attitude towards cessation among French pregnant smokers: explaining the poor uptake of specialised support.
This study investigated pregnant smokers' profile and attitude towards cessation to explain who stops smoking during pregnancy and who is unsuccessful. ⋯ Despite being offered professional help, many pregnant heavy smokers do not feel ready to stop smoking. Their attitude towards cessation illustrates ambivalence. There is thus a need for coordinated efforts between antenatal care providers and smoking treatment specialists in order to enhance pregnant smokers' motivation to quit.