BJOG : an international journal of obstetrics and gynaecology
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Ascending bacterial infection is implicated in about 40-50% of preterm births. The human vaginal microbiota in most women is dominated by lactobacilli. ⋯ The enhanced proliferation of pathogenic bacteria plus degradation of the cervical barrier increase bacterial passage into the endometrium and amniotic cavity and trigger preterm myometrial contractions. Evaluation of protocols to detect the absence of lactobaciili dominance in pregnant women by self-measuring vaginal pH, coupled with measures to promote growth of lactobacilli are novel prevention strategies that may reduce the occurrence of preterm birth in low-resource areas.
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Review Meta Analysis
Effectiveness of progestogens to improve perinatal outcome in twin pregnancies: an individual participant data meta-analysis.
In twin pregnancies, the rates of adverse perinatal outcome and subsequent long-term morbidity are substantial, and mainly result from preterm birth (PTB). ⋯ In unselected women with an uncomplicated twin gestation, treatment with progestogens (intramuscular 17Pc or vaginal natural progesterone) does not improve perinatal outcome. Vaginal progesterone may be effective in the reduction of adverse perinatal outcome in women with a cervical length of ≤25 mm; however, further research is warranted to confirm this finding.
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Progress in maternal survival in sub-Saharan Africa has been poor since the Millennium Declaration. ⋯ Essential Obstetric and Newborn Care has merit as an intervention package to reduce maternal mortality in rural sub-Saharan Africa.
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The inappropriate and inconsistent selection of primary outcomes (POs) in randomised controlled trials (RCTs) and systematic reviews (SRs) can make evidence difficult to interpret, limiting its usefulness to inform clinical practice. ⋯ There is a lack of consistency in the choice and definitions of POs in clinical research related to preterm birth prevention. SRs are more likely to report morbidity and mortality as POs, whereas RCTs tend to use length of gestation. Researchers are urged to review the outcomes reported in RCTs and SRs in their respective areas of interest to highlight discrepancies and facilitate the development of core outcome sets.
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Pregnant and postpartum women with severe hypertension are at increased risk of stroke and require blood pressure (BP) reduction. Parenteral antihypertensives have been most commonly studied, but oral agents would be ideal for use in busy and resource-constrained settings. ⋯ Oral nifedipine, and possibly labetalol and methyldopa, are suitable options for treatment of severe hypertension in pregnancy/postpartum.