Obstetrics and gynecology
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Obstetrics and gynecology · Jan 2003
Randomized Controlled Trial Comparative Study Clinical TrialOil-soluble contrast during hysterosalpingography in women with proven tubal patency.
To determine if there are therapeutic advantages to oil-soluble contrast medium compared with water-soluble medium during hysterosalpingography. A randomized, controlled trial including 56 infertile patients undergoing hysterosalpingography was performed. After a hysterosalpingogram with water-soluble contrast demonstrated tubal patency, 30 patients were randomized to receive oil-soluble contrast medium (oil group) and 26 patients received no additional contrast medium (control group). ⋯ There were 18 (64%) pregnancies in the oil group and 14 (56%) pregnancies in the control group. Mean time to achieve pregnancy was shorter in the oil group: 3.8 months in the oil group compared with 6.1 months in the control group (P =.06) There was a clinically meaningful improvement in pregnancy rates between the oil group and the control group at 1 month postprocedure (relative risk [RR] 2.1, 95% confidence interval [CI] 0.6, 7.2). However, at 12 months postprocedure, the advantage was diminished. (RR 1.3, CI 0.8, 2.1)Eighteen months after hysterosalpingography, contrast does not appear to influence cumulative pregnancy rates; however, the addition of oil-soluble contrast medium to water-soluble contrast medium may have the potential to reduce the time to conception.
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Obstetrics and gynecology · Jan 2003
Post-cesarean delivery fever and uterine rupture in a subsequent trial of labor.
To evaluate the association of uterine rupture during a trial of labor after cesarean with postpartum fever after the prior cesarean delivery. ⋯ Postpartum fever after cesarean delivery is associated with an increased risk of uterine rupture during a subsequent trial of labor.
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Obstetrics and gynecology · Dec 2002
Review Comparative StudySystematic review of randomized controlled trials of misoprostol to prevent postpartum hemorrhage.
To assess the effects of prophylactic misoprostol use in the third stage of labor compared with injectable uterotonics or placebo or no treatment. ⋯ Injectable oxytocin or oxytocin-ergot preparations are more effective than misoprostol as part of the active management of the third stage of labor.
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Obstetrics and gynecology · Dec 2002
Randomized Controlled Trial Comparative Study Clinical TrialRandomized trial of lidocaine ointment versus placebo for the treatment of postpartum perineal pain.
To estimate the efficacy of lidocaine ointment in relieving pain after a vaginal delivery with an episiotomy or perineal laceration. ⋯ Topical application of 5% lidocaine ointment was not effective in relieving episiotomy or perineal laceration pain.
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Obstetrics and gynecology · Dec 2002
Review Comparative StudyPerspectives on the Women's Health Initiative trial of hormone replacement therapy.
The premature termination of one comparison in the Women's Health Initiative primary prevention trial due to stopping rules being reached necessitates a reconsideration of hormone replacement therapy (HRT). This part of the Women's Health Initiative trial, however, examined only one popular HRT regimen (conjugated equine estrogen [0.625 mg] and medroxyprogesterone acetate [2.5 mg] daily) in asymptomatic postmenopausal women. To help clinicians understand this large, complex trial, we describe several pervasive biases in earlier observational studies, review the principal findings of the trial, summarize recent systematic reviews, and offer clinical suggestions for HRT. ⋯ For women needing HRT, use of a low dose, with reassessments at least annually, appears prudent. Heart disease prevention strategies of proven value include exercise, weight control, blood pressure and lipid control, and avoidance of smoking. Hormone replacement therapy should not be used for this purpose.