BJOG : an international journal of obstetrics and gynaecology
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Comparative Study
Planned vaginal delivery or planned caesarean delivery in women with extreme obesity.
To compare the outcomes of planned vaginal versus planned caesarean delivery in a cohort of extremely obese women (body mass index ≥ 50 kg/m(2)). ⋯ This study does not provide evidence to support a routine policy of caesarean delivery for extremely obese women on the basis of concern about higher rates of delivery complications, but does support a policy of individualised decision-making on the mode of delivery based on a thorough assessment of potential risk factors for poor delivery outcomes.
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Randomized Controlled Trial
Acupuncture for pain relief during induced labour in nulliparae: a randomised controlled study.
To assess the role of acupuncture for analgesia during labour. ⋯ Using the protocols studied, there was no analgesic benefit with acupuncture for pain relief during induced labour in nulliparae.
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In the triennium 2006-2008, 261 women in the UK died directly or indirectly related to pregnancy. The overall maternal mortality rate was 11.39 per 100,000 maternities. Direct deaths decreased from 6.24 per 100,000 maternities in 2003-2005 to 4.67 per 100,000 maternities in 2006–2008 (p = 0.02). ⋯ Many of the identified avoidable factors remain the same as those identified in previous Enquiries. Recommendations for improving care have been developed and are highlighted in this report. Implementing the Top ten recommendations should be prioritised in order to ensure the overall UK maternal mortality rate continues to decline.
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To determine with hysteroscopy or hysterosalpingogram the risk of uterine synechiae following uterine compression sutures for major postpartum haemorrhage (PPH) caused by uterine atony. ⋯ This study suggests a significant risk of uterine synechiae after placement of compression sutures for PPH that transverse the uterine cavity. Postoperative uterine synechiae might be underestimated, and their prevalence and clinical significance should be assessed in long-term follow-up studies.
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Randomized Controlled Trial
Administration of misoprostol by trained traditional birth attendants to prevent postpartum haemorrhage in homebirths in Pakistan: a randomised placebo-controlled trial.
to determine if misoprostol is safe and efficacious in preventing postpartum haemorrhage (PPH) when administered by trained traditional birth attendants (TBA) at home deliveries. ⋯ postpartum administration of 600 microg oral misoprostol by trained TBAs at home deliveries reduces the rate of PPH by 24%. Given its ease of use and low cost, misoprostol could reduce the burden of PPH in community settings where universal oxytocin prophylaxis is not feasible. Continual training and skill-building for TBAs, along with monitoring and evaluation of programme effectiveness, should accompany any widespread introduction of this drug.