BJOG : an international journal of obstetrics and gynaecology
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Multicenter Study
Specific second-line therapies for postpartum haemorrhage: a national cohort study.
To describe the characteristics, management and outcomes of women undergoing specific second-line therapies for postpartum haemorrhage (PPH). ⋯ Overall, a quarter of women treated had a hysterectomy as a rescue therapy. Uterine compression sutures and interventional radiological techniques have higher success rates than rFVIIa and pelvic vessel ligation. However, cases managed with rFVIIa and ligation tend to be more clinically complex.
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Comparative Study
Persistence of urgency and urge urinary incontinence in women with mixed urinary symptoms after midurethral slings: a multivariate analysis.
To determine risk factors for persistence of urgency or urge urinary incontinence following midurethral sling surgery. ⋯ Urodynamic parameters, baseline urgency symptom severity, midurethral sling route and concomitant prolapse operation are important predictors of persistent urgency or UUI following midurethral sling.
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Review of the literature regarding the relation between the timing of epidural analgesia and the rate of caesarean or instrumental vaginal deliveries. ⋯ This systematic review showed no increased risk of caesarean delivery or instrumental vaginal delivery for women receiving early epidural analgesia at cervical dilatation of 3 m or less in comparison with late epidural analgesia.
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To critically evaluate any benefit or harm for the mother and her baby of Valsalva pushing versus spontaneous pushing in the second stage of labour. ⋯ The evidence from our review does not support the routine use of Valsalva pushing in the second stage of labour. The Valsalva pushing method has a negative effect on urodynamic factors according to one study. The duration of the second stage of labour is shorter with Valsalva pushing but the clinical significance of this finding is uncertain. The primary studies are sparse, diverse and some flawed. Further research seems warranted. In the mean time supporting spontaneous pushing and encouraging women to choose their own method of pushing should be accepted as best clinical practice.