Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Oct 2012
ReviewLong versus short course treatment with metformin and clomiphene citrate for ovulation induction in women with PCOS.
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among reproductive-aged women. Apart from infertility, women with PCOS often have other endocrine disorders, including insulin resistance, hyperinsulinaemia and hyperandrogenism. Metformin,combined with clomiphene citrate (CC), has been shown to be more effective in ovulation induction when compared with clomiphene citrate alone. The optimal duration for metformin pretreatment before initiation of clomiphene citrate, however, is unknown. ⋯ There are insufficient data to determine whether short-course metformin pretreatment is as effective as the conventional long-course metformin pretreatment before initiation of clomiphene citrate for ovulation induction in infertile women with PCOS. A well-designed randomised controlled trial is needed to answer this important clinical question.
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Cochrane Db Syst Rev · Oct 2012
ReviewCyclo-oxygenase (COX) inhibitors for preventing preterm labour.
Preventing preterm labour is the most important step in preventing preterm birth. Prostaglandins play an important role in labour and birth. Prostaglandin production can be obstructed by inhibition of the cyclo-oxygenase (COX) enzyme and this may arrest uterine contraction. A Cochrane review on COX inhibitors for the treatment of preterm labour found insufficient data to draw conclusions about its effectiveness. ⋯ There was very little evidence about using COX inhibitors for preventing preterm labour. There are inadequate data to make any recommendation about using COX inhibitor in practice to prevent preterm labour. Future research should include follow-up of the babies to examine the short-term and long-term effects of COX inhibitors.
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Cochrane Db Syst Rev · Oct 2012
ReviewAlternative injectable materials for vocal fold medialisation in unilateral vocal fold paralysis.
Patients with unilateral vocal fold paralysis (UVFP) usually present with dysphonia, but can also be breathless and have problems with their swallowing. Speech and language therapy forms the initial mainstay of management in cases of UVFP, since up to 60% of cases will resolve spontaneously. If vocal fold paralysis persists surgery, in the form of injection medialisation, has been shown to be an effective intervention. What is currently unclear is which is the most effective material available for injection. ⋯ There is currently insufficient high-quality evidence for, or against, specific injectable materials for patients with UVFP. Future RCTs should aim to provide a direct comparison of the alternative materials currently available for injection medialisation.
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Cochrane Db Syst Rev · Oct 2012
ReviewTrial of instrumental delivery in theatre versus immediate caesarean section for anticipated difficult assisted births.
The majority of women have spontaneous vaginal births, but some women need assistance in the second stage with delivery of the baby, using either the obstetric forceps or vacuum extraction. Rates of instrumental vaginal delivery range from 5% to 20% of all births in industrialised countries. The majority of instrumental vaginal deliveries are conducted in the delivery room, but in a small proportion (2% to 5%), a trial of instrumental vaginal delivery is conducted in theatre with preparations made for proceeding to caesarean section. ⋯ There is no current evidence from randomised trials to influence practice.