Epidural analgesia associated with low-dose oxytocin augmentation increases cesarean births: a critical look at the external validity of randomized trials.

Objective: Randomized controlled trials suggest epidural analgesia (EA) does not increase the frequency of cesarean births compared with opioid analgesia. We analyzed trials comparing EA with opioid analgesia to determine their external validity in contemporary North American practice.

Study Design: Randomized controlled trials comparing EA with opioid analgesia were identified from the Cochrane database and Medline and included if they reported labor outcomes and management protocols.

Cervical cleaning improves Pap smear quality.

Background: Cervical Papanicolaou (Pap) smear screening is an effective method of detecting cytological changes in the cervix before they lead to cervical cancer. However, the quality of a Pap smear can be compromised by inflammatory exudate, inadequate cellularity or failure to sample the transformation zone. We evaluated the effect of routine cervical cleaning on Pap smear quality.