Background: Caesarean section rates are over 20% in many developed countries. The main diagnosis contributing to the high rate in nulliparae is dystocia or prolonged labour. The present review assesses the effects of a policy of early amniotomy with early oxytocin administration for the prevention of, or the therapy for, delay in labour progress.
Objectives: To estimate the effects of early augmentation with amniotomy and oxytocin for prevention of, or therapy for, delay in labour progress on the caesarean birth rate and on indicators of maternal and neonatal morbidity.
Search Methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2013), MEDLINE (1966 to 4 July 2013), Embase (1980 to 4 July 2013), CINAHL (1982 to 4 July 2013), MIDIRS (1985 to 4 July 2013) and contacted authors for data from unpublished trials.
Selection Criteria: Randomized and quasi-randomized controlled trials that compared oxytocin and amniotomy with expectant management.
Data Collection And Analysis: Three review authors extracted data independently. We stratified the analyses into 'Prevention Trials' and 'Therapy Trials' according to the status of the woman at the time of randomization. Participants in the 'Prevention Trials' were unselected women, without slow progress in labour, who were randomized to a policy of early augmentation or to routine care. In 'Treatment Trials' women were eligible if they had an established delay in labour progress.
Main Results: For the 2013 update, we identified and excluded one new clinical trial. This updated review includes 14 trials, randomizing a total of 8033 women. The unstratified analysis found early intervention with amniotomy and oxytocin to be associated with a modest reduction in the risk of caesarean section; however, the confidence interval (CI) included the null effect (risk ratio (RR) 0.89; 95% CI 0.79 to 1.01; 14 trials; 8033 women). In prevention trials, early augmentation was associated with a modest reduction in the number of caesarean births (RR 0.87; 95% CI 0.77 to 0.99; 11 trials; 7753). A policy of early amniotomy and early oxytocin was associated with a shortened duration of labour (average mean difference (MD) - 1.28 hours; 95% CI -1.97 to -0.59; eight trials; 4816 women). Sensitivity analyses excluding four trials with a full package of active management did not substantially affect the point estimate for risk of caesarean section (RR 0.87; 95% CI 0.73 to 1.05; 10 trials; 5165 women). We found no other significant effects for the other indicators of maternal or neonatal morbidity.
Authors' Conclusions: In prevention trials, early intervention with amniotomy and oxytocin appears to be associated with a modest reduction in the rate of caesarean section over standard care.
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http://dx.doi.org/10.1002/14651858.CD006794.pub4 | DOI Listing |
Sci Rep
December 2024
Laboratório de Biologia de Tripanosomatídeos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Non-human primates (NHPs) are reported as exclusive hosts of Trypanosoma minasense, whose transmission cycle remains unknown. We investigated trypanosomatid infections in 194 NHPs of nine species from the Brazilian Southeast region. We evaluated the impact of landscape composition and forest fragmentation on T.
View Article and Find Full Text PDFProbl Radiac Med Radiobiol
December 2024
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD 20892, USA.
Objective: Scientific justification of the methodology for calculating radiation internal doses from 137Cs and 134Cs intake for residents of Ukrainian settlements radioactively contaminated as a result of the Chornobyl (Chernobyl) accident in which measurements of incorporated radiocesium isotopes in humans using whole-body counters (WBC) were not carried out.
Materials And Methods: The paper presents a new methodology for reconstructing doses due to internal irradiation from Chornobyl fallout for both surface (in 1986) and root (in 1987-2023) contamination of vegetation with 137Cs and 134Cs and their transfer into the human body. The methodology for calculating the dose due to surface contamination of vegetation was based on the theoretical model of the transfer of radiocesium isotopes through the food chain with further adjustment of this model to the results of WBC measurements carried out between 15 July and 31 December 1986.
JAMA Netw Open
December 2024
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
Importance: The Veterans Health Administration (VHA) reports multiple indicators of hospital surgical performance, including hospital risk-standardized 30-day readmission rates (RSRRs). Currently, most routinely reported measures do not include readmissions that occur outside VHA hospitals. The impact of readmissions outside the VHA on hospital RSRR is not known.
View Article and Find Full Text PDFAdv Biomed Res
November 2024
Vice Chancellery for Research and Technology, Isfahan University of Medical Sciences, Isfahan, Iran.
In the current century, air pollution is known as one of the most critical environmental problems and it is important to find the relations of air pollution and human health. Various air pollutants, such as volatile organic compounds (VOCs), can negatively affect women's fertility. An exhaustive electronic search was done from 2013 until July 2023 in PUBMED and The Cochrane Central Register of Controlled Trials.
View Article and Find Full Text PDFLancet Reg Health West Pac
December 2024
Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100091, China.
Background: Adverse childhood experiences (ACEs) are common and associated with mental disorders. However, the prevalence and co-occurrence of ACEs and their association with mental health outcomes among Chinese adults have not been well demonstrated.
Methods: China Mental Health Survey, a cross-sectional nationally representative survey consisting of 28,140 adults, was conducted from July 2013 to March 2015.
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