Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Nov 2024
Review Meta AnalysisPsychostimulants for hypersomnia (excessive daytime sleepiness) in myotonic dystrophy.
Excessive daytime sleepiness is a common symptom of myotonic dystrophy. Psychostimulants are drugs that are increasingly used to treat hypersomnia in myotonic dystrophy. ⋯ In myotonic dystrophy, the effects of psychostimulants on excessive daytime sleepiness as assessed by the Maintenance of Wakefulness Test or Multiple Sleep Latency Test and on quality of life are very uncertain. Psychostimulants may improve hypersomnia as self-evaluated by the Epworth Sleepiness Scale and may increase the risk of adverse events. More randomised trials are needed to evaluate the efficacy and safety of psychostimulants in both the short and long term.
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Perineal trauma after vaginal birth is common and can be associated with short- and long-term health problems. Perineal hyaluronidase (HAase) injection has been widely used to reduce perineal trauma, perineal pain and the need for episiotomy since the 1950s. The administration of HAase is considered to be a simple, low risk, low cost and effective way to decrease perineal trauma without causing adverse effects. ⋯ Perineal HAase injection during the second stage of labour may result in a lower incidence of perineal trauma (tears or episiotomy, or both) compared with no intervention, but not compared with placebo injection, in women having a vaginal delivery. Meanwhile, perineal HAase injection likely reduces the incidence of perineal oedema 24 hours after vaginal delivery compared with placebo injection. The potential use of perineal HAase injection as a method to reduce perineal trauma and perineal oedema remains to be determined as the number of high-quality trials and outcomes reported was too limited to draw conclusions on its effectiveness and safety. Further rigorous randomised controlled trials are required to evaluate the role of perineal HAase injection in vaginal deliveries, including evaluating whether there is any differential effect based on the dose, frequency and positioning of HAase injection.
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Cochrane Db Syst Rev · Nov 2024
Review Meta AnalysisTranexamic acid for preventing postpartum haemorrhage after caesarean section.
Postpartum haemorrhage (PPH) is common and potentially life-threatening. The antifibrinolytic drug tranexamic acid (TXA) is recommended for treating PPH; it reduces the risk of death from haemorrhage by one-third when given soon after bleeding onset, but not overall risk of death. Interest in whether TXA may be effective in preventing PPH is growing. Evidence indicates that TXA given more than three hours after injury to bleeding trauma patients increases mortality. Potential harm becomes critical in prophylactic use of TXA. Reliable evidence of the effect and safety profile of TXA is required before widespread prophylactic use can be considered. ⋯ The published protocol and updates to the review can be accessed: Protocol (2009) DOI: 10.1002/14651858.CD007872 Original Review (2010) DOI: 10.1002/14651858.CD007872.pub2 Review Update (2015) DOI: 10.1002/14651858.CD007872.pub3.
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Cochrane Db Syst Rev · Nov 2024
Support for parents and families after stillbirth and neonatal death.
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To identify and assess the effect of support interventions focused on psychological, social, and emotional outcomes for bereaved parents (including birth and non-birthing mothers, fathers, partners) and family members of parents (e.g. grandparents; siblings) who have experienced stillbirth or neonatal death.