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Biomedical subjects

A M Gulmezoglu

Publications and source records attributed to A M Gulmezoglu.

12 recordsLinked to original sources
PubMed2001

Magnesium sulphate versus lytic cocktail for eclampsia.

BACKGROUND: Eclampsia, the occurrence of a seizure in association with pre-eclampsia, is a rare but serious complication of pregnancy. A number of different anticonvulsants are used to control eclamptic fits and to prevent further seizures. OBJECTIVES: The aim of this review was to compare the effects of magnesium sulphate with those of lytic cocktail when used for the care of women with eclampsia. SEARCH STRATEGY: The register of trials held by the Cochrane Pregnancy and Childbirth Group was searched for relevant trials. The Cochrane Controlled Trials Register in The Cochrane Library Issue 2, 2000 was also searched. SELECTION CRITERIA: Randomised trials recruiting women with eclampsia, and comparing any use of magnesium sulphate with any use of lytic cocktail. DATA COLLECTION AND ANALYSIS: Data were extracted from each report without any blinding of the results or of the treatments which women received. MAIN RESULTS: Two trials with 199 women were included in the review. These were both small and of average quality. Magnesium sulphate was better than lytic cocktail at preventing further fits (relative risk (RR) 0.09, 95% confidence interval (CI) 0.03-0.24; risk difference (RD) 0.43, 95% CI -0.53, -0.34; number needed to treat (NNT) 3, 95% CI 2-3) and was associated with less respiratory depression (RR 0.12, 95% CI 0.02-0.91). Magnesium sulphate was also associated with fewer maternal deaths than lytic cocktail, but the difference was not statistically significant (RR 0.25, 95% CI 0.04-1.43). REVIEWER'S CONCLUSIONS: Magnesium sulphate is the anticonvulsant of choice for women with eclampsia. Lytic cocktail should be abandoned.

Anticonvulsants↗
PubMed2000

Anticonvulsants for women with pre-eclampsia.

BACKGROUND: Pre-eclampsia is a relatively common complication of pregnancy. Anticonvulsants are used in the belief they help prevent eclamptic fits and subsequent poor outcomes for mother and infant. OBJECTIVES: The objective of this review was to assess the effects of anticonvulsants for women with pre-eclampsia on the women and their children. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register, and the Cochrane Controlled Trials Register, 1999 Issue 3. SELECTION CRITERIA: Randomised trials comparing anticonvulsants with placebo or no anticonvulsants or comparisons of different anticonvulsants in women with pre-eclampsia. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers. MAIN RESULTS: Nine studies were included. Comparing magnesium sulphate with placebo/no anticonvulsant the relative risk (RR) of eclampsia was 0.33, 95% confidence interval (CI) 0.11 to 1.02. There was no significant difference detected in the risk of caesarean section (RR 1.04, 95% CI 0.92 to 1.17). Magnesium sulphate appeared to be better than phenytoin at reducing the risk of eclampsia (RR 0.05, 95% CI 0.00 to 0.84). However there was an increased risk of caesarean section with magnesium sulphate compared to phenytoin (RR 1.21, 95% CI 1.05 to 1. 41). No statistically significant differences were reported for any other clinically important outcomes. Studies comparing magnesium sulphate and diazepam were too small for any reliable conclusions. REVIEWER'S CONCLUSIONS: There is not enough evidence to establish the benefits and hazards of anticonvulsants for women with pre-eclampsia. If an anticonvulsant is used, magnesium sulphate appears to be the best choice.

Anticonvulsants↗
PubMed2000

Pyridoxine (vitamin B6) supplementation in pregnancy.

BACKGROUND: Pyridoxine (vitamin B6) contributes to the development of the central nervous system and may influence brain development and cognitive function. It may also prevent dental caries and protect the placental vascular bed. OBJECTIVES: The objective of this review was to assess the effects of vitamin B6 supplementation during pregnancy and labour. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised trials of pyridoxine administration compared to a control group. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted by two reviewers. MAIN RESULTS: One trial involving 371 women was included. Pyridoxine supplementation either as oral capsules (odds ratio 0.63, 95% confidence interval 0. 41 to 0.95) or lozenges (odds ratio 0.33, 95% confidence interval 0. 22-0.51) was associated with decreased incidence of dental decay in pregnant women. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate pyridoxine supplementation during pregnancy, although the results of one trial suggest that it may have a beneficial effect on dental decay.

Dietary Supplements↗
PubMed2000

Vitamin D supplementation in pregnancy.

BACKGROUND: Vitamin D deficiency can occur in people whose diet is relatively low in the vitamin and those who are not exposed to much sunlight. OBJECTIVES: The objective of this review was to assess the effects of vitamin D supplementation on pregnancy outcome. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register (October 1998). SELECTION CRITERIA: Acceptably controlled trials of vitamin D supplementation during pregnancy. DATA COLLECTION AND ANALYSIS: One reviewer assessed trial quality and extracted data. MAIN RESULTS: Two trials involving 232 women were included. In one trial the mothers had higher mean daily weight gain and lower number of low birthweight infants. In the other trial the supplemented group had lower birthweights. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the effects of vitamin D supplementation during pregnancy.

Dietary Supplements↗
PubMed2000

Vaginal misoprostol for cervical ripening and labour induction in late pregnancy.

BACKGROUND: Although not yet registered for such use, misoprostol has been widely used for obstetric and gynaecological indications, such as induction of abortion and of labour. OBJECTIVES: The objective of this review was to assess the effects of vaginal misoprostol for third trimester cervical ripening or induction of labour. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and reference lists of articles were searched. SELECTION CRITERIA: Randomised trials comparing vaginal misoprostol with other methods of cervical ripening or labour induction, placebo or no treatment in women due for third trimester induction of labour. DATA COLLECTION AND ANALYSIS: Trial quality assessment and data extraction were done by both reviewers. MAIN RESULTS: Twenty-six studies were included. Compared to placebo, misoprostol was associated with increased cervical ripening (relative risk of unfavourable or unchanged cervix after 12 to 24 hours with misoprostol 0.20, 95% confidence interval 0.07 to 0.61). It was also associated with a reduced need for oxytocin (relative risk 0.47, 95% confidence interval 0.23 to 0.96). Misoprostol was more effective than prostaglandin E2 for labour induction (relative risk of failure to achieve vaginal delivery in 24 hours 0.70, 95% confidence interval 0.62 to 0.79). Oxytocin augmentation was used less often with misoprostol than with prostaglandin E2 (relative risk 0.64, 95% confidence interval 0.58 to 0.71). Uterine hyperstimulation and meconium stained liquor were more common with misoprostol than with prostaglandin E2. Lower doses of misoprostol compared to higher doses did not show significant differences except for more need for oxytocin augmentation and less uterine hyperstimulation without fetal heart rate changes. REVIEWER'S CONCLUSIONS: Vaginal misoprostol appears to be more effective in inducing labour than conventional methods of cervical ripening and labour induction. The apparent increase in uterine hyperstimulation is of concern. The studies were not large enough to exclude the possibility of rare but serious adverse effects.

Cervical Ripening↗
PubMed2000

Symphysis fundus height measurements during labour: a prospective, descriptive study.

This study was conducted to determine the correlation between symphysis fundus height (SFH) measurements and infant weight. It was also to examine whether descent of the fetus or rupture of the membranes affects the relationship and to calculate a simple formula for estimation of fetal weight. A descriptive prospective study design was used. The setting was the teaching hospitals in Johannesburg. Results show that there is a good correlation between SF measurements and birthweight (r = 0.56) and also between the product of SF measurements and abdominal girth (r = 0.57). The correlation of abdominal girth alone and birthweight was less significant (r = 0.47). Rupture of the membranes has minimal effect on the measurements. The correlation of SF measurements with birthweight was highest when subtracting engagement of the head (in fifths above the pelvic brim) from the SF measurement (r = 0.64). In conclusion, fundal height among women with similar size fetuses varies widely. The formula created from the observations was not sufficiently accurate to be clinically useful. The primary value of SF measurements is to assess fetal growth over time by repeated measurements in individual pregnancies.

Adult↗
PubMed1996

Amnioinfusion.

Abnormal amniotic fluid volume may be both the result and the cause of complications at various stages of pregnancy. This review focuses on evidence from randomised trials of the effectiveness of amnioinfusion. Attempts to prevent the development of pulmonary hypoplasia by means of transabdominal amnioinfusion to correct severe oligohydramnios in the middle trimester of pregnancy have not been evaluated by randomised trials. Long-term transcervical amnioinfusion for prelabour rupture of the membranes has shown promising results in prospective studies, but has also not been subjected to randomised evaluation. Transcervical amnioinfusion during labour is a relatively simple procedure. Normal saline is infused through an intrauterine catheter, preferably one with a catheter-tip pressure transducer. Once an adequate volume of amniotic fluid has been achieved, it is maintained by means of a slow continuous infusion or repeated bolus infusions. Amnioinfusion has been used to prevent or treat fetal heart rate (FHR) decelerations thought to be due to oligohydramnios. In several rather small randomised trials, amnioinfusion has been associated with a reduction in FHR decelerations, caesarean sections, low Apgar scores, low umbilical arterial pH values and postpartum endometritis. Amnioinfusion has also been used to dilute thick meconium-staining of the amniotic fluid. In trials for this indication, amnioinfusion has been associated with similar benefits, and in addition a reduction in meconium presence below the vocal cords, meconium aspiration syndrome and the need for neonatal ventilation. Larger trials are needed to determine whether amnioinfusion is associated with an effect on perinatal mortality, and whether complications such as umbilical cord prolapse are increased.

Amnion↗
PubMed1995

Companionship in labour: do the personality characteristics of labour supporters influence their effectiveness.

Recent research has revealed beneficial post-partum, psychosocial effects on the mother following labour which was accompanied by supportive companions. Whether these effects are obtained as a result of having companionship during labour or because of specific personality characteristics of the companions provided is important and is explored in this paper. Although findings revealed few differences in adjustment between women who were supported by different companions, some variability in the postpartum state anxiety and depression scores were noted which suggest that selection of an appropriate supporter is an important aspect of such programmes.

Adolescent↗
PubMed1994

Umbilical vein injection for retained placenta: clinical feasibility study of a new technique.

Intraumbilical oxytocin infusion for retained placenta is a relatively new and promising technique. We have tested the clinical feasibility of different infusion techniques in this study. Nine patients had intraumbilical infusions through a mucus aspiration catheter and 12 by an 18 gauge needle. Infusion was successful in 7(77.7%) of 9 cases following catheterisation and in 7(58.3%) of 12 cases following direct injection. Both techniques were clinically feasible, but direct injection was somewhat easier than catheterisation. The importance of non-operative management of retained placenta, particularly in areas with limited medical facilities, is discussed and an approach to the management of retained placenta proposed.

Adult↗
PubMed1993

Do cabbage leaves prevent breast engorgement? A randomized, controlled study.

A randomized, controlled trial was conducted to evaluate the effect of cabbage leaves on mothers' perceptions of breast engorgement and the influence of this treatment on breastfeeding practices. The subjects, 120 breastfeeding women 72 hours postpartum, were randomly allocated to an experimental group who received application of cabbage leaves to their breasts, or to a control group who received routine care. The experimental group tended to report less breast engorgement, but this trend was not statistically significant. At six weeks, women who received the cabbage leaf application were more likely to be breastfeeding exclusively, 76 and 58 percent (35/46 vs 29/50; P = 0.09), and their mean duration of exclusive breastfeeding was longer (36 vs 30 days; P = 0.04). The greater breastfeeding success in the experimental group may have been due to some beneficial effect of cabbage leaf application, or may have been secondary to reassurance and improved confidence and self-esteem in these mothers.

Attitude to Health↗