European journal of obstetrics, gynecology, and reproductive biology
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Feb 2010
Implementation of guidelines on oxytocin use at caesarean section: a survey of practice in Great Britain and Ireland.
Caesarean section is one of the most commonly performed major operations on women worldwide. Operative morbidity includes haemorrhage, anaemia, blood transfusion and in severe cases, maternal death. Various clinical guidelines address oxytocin use at the time of caesarean section. We previously reported wide variation in practice amongst clinicians in the United Kingdom in the use of oxytocin at caesarean section. The aim of this current study was to determine whether the variation in approach is universal across the individual countries of Great Britain and Ireland and whether this reflects differences in interpretation and implementation of clinical practice guidelines. ⋯ Clinicians' approach to the use of oxytocin at the time of caesarean delivery varies between countries. Even in countries with on-site visits to ensure guideline implementation (e.g. Clinical Negligence Scheme for Trusts in England), deviations from guideline recommendations exist. These variations may reflect a lack of robust evidence and the need for future research in this area.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Feb 2010
Arterial balloon occlusion of the internal iliac arteries for treatment of life-threatening massive postpartum haemorrhage: a series of 15 consecutive cases.
To evaluate arterial balloon occlusion of the internal iliac arteries for treatment of life-threatening massive postpartum haemorrhage. ⋯ Arterial balloon occlusion of the internal iliac arteries is a safe and in most cases effective procedure for treatment of massive life-threatening postpartum haemorrhage.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Dec 2009
Factors influencing delivery mode for nulliparous women with a singleton pregnancy and cephalic presentation during a 17-year period.
To evaluate the effects of maternal age, induction of labour, epidural analgesia and birth weight on mode of delivery in nulliparous women with a singleton pregnancy and cephalic presentation at > or =36 weeks gestation, and to describe how these factors and their influence have changed over a 17-year period from 1989 to 2005. ⋯ These data demonstrate that the increasing trend of unplanned abdominal delivery in nulliparous women with a singleton pregnancy and cephalic presentation may be partially explained by advancing maternal age, and other obstetric factors also play a significant role.
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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.
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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.