Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Oct 2014
Bias due to selective inclusion and reporting of outcomes and analyses in systematic reviews of randomised trials of healthcare interventions.
Systematic reviews may be compromised by selective inclusion and reporting of outcomes and analyses. Selective inclusion occurs when there are multiple effect estimates in a trial report that could be included in a particular meta-analysis (e.g. from multiple measurement scales and time points) and the choice of effect estimate to include in the meta-analysis is based on the results (e.g. statistical significance, magnitude or direction of effect). Selective reporting occurs when the reporting of a subset of outcomes and analyses in the systematic review is based on the results (e.g. a protocol-defined outcome is omitted from the published systematic review). ⋯ Discrepant outcome reporting between the protocol and published systematic review is fairly common, although the association between statistical significance and discrepant outcome reporting is uncertain. Complete reporting of outcomes in systematic review abstracts is associated with statistical significance of the results for those outcomes. Systematic review outcomes and analysis plans should be specified prior to seeing the results of included studies to minimise post-hoc decisions that may be based on the observed results. Modifications that occur once the review has commenced, along with their justification, should be clearly reported. Effect estimates and CIs should be reported for all systematic review outcomes regardless of the results. The lack of research on selective inclusion of results in systematic reviews needs to be addressed and studies that avoid the methodological weaknesses of existing research are also needed.
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Cochrane Db Syst Rev · Oct 2014
ReviewAntibiotics prior to amniotomy for reducing infectious morbidity in mother and infant.
Amniotomy (the deliberate rupture of membranes) was described almost two centuries ago and since then has been used both for induction and augmentation of labour - which are common obstetric practices. Trends have shown a rise in the induction rates over the last decade and data suggest that the rate of labour inductions is increasing faster than the rate of pregnancy complications. Recent years have seen the emergence of a variety of other methods of induction of labour but amniotomy combined with oxytocin infusion remains the most commonly used method of augmentation of labour. The newer agents for induction are expensive and in resource-poor settings amniotomy is still the chosen method for both induction and augmentation.As with any invasive procedure amniotomy can lead to infection, ascending from the vagina into the uterine cavity and can contribute significantly to both maternal and neonatal infectious morbidity. ⋯ High-quality trials are needed to justify or refute the routine use of antibiotics at amniotomy for prevention of infection in the mother and infant.Future studies should be conducted, especially in resource-constrained settings where amniotomy is still used as a means of induction of labour, in order to evaluate the routine use of antibiotics at amniotomy in these settings. Future research in this area should include important maternal and infant outcomes listed in this review and also consider cost effectiveness and side effects of antibiotic use, including the emergence of antibiotic-resistant strains.