BJOG : an international journal of obstetrics and gynaecology
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Review Meta Analysis Comparative Study
Analgesia in labour and fetal acid-base balance: a meta-analysis comparing epidural with systemic opioid analgesia.
To assess the effect of epidural versus systemic labour analgesia on funic acid-base status at birth. ⋯ Umbilical artery pH is influenced by maternal hyperventilation. Base excess is therefore a better index of metabolic acidosis after labour. Epidural analgesia is associated with improved neonatal acid-base status, suggesting that placental exchange is well preserved in association with maternal sympathetic blockade and good analgesia. Although epidural analgesia may cause maternal hypotension and fever, longer second stage of labour and more instrumental vaginal deliveries, these potentially adverse factors appear to be outweighed by benefits to neonatal acid-base status.
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To conduct a cost effectiveness analysis of pre-operative gonadotrophin releasing hormone agonists (GnRHa) in women with uterine fibroids undergoing hysterectomy or myomectomy. ⋯ Although the pre-operative use of GnRHa results in benefits which include less frequent abdominal incisions in the case of hysterectomy and less frequent vertical incisions in the case of myomectomy, the benefits do not justify the costs. This study highlights the importance of considering both the benefits and costs in health care decisions.
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Randomized Controlled Trial Clinical Trial
Side effects of oral misoprostol during the first 24 hours after administration in the third stage of labour.
To evaluate the side effects of 600 microg misoprostol orally during the first 24 hours after administration in the third stage of labour. ⋯ The increased incidence of shivering and pyrexia that occurs with postpartum use of misoprostol persists up to 6 hours following delivery. Approximately 5% of women experience diarrhoea that starts after 1 hour and subsides within 12 hours.