Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2000
ReviewEnergy/protein restriction for high weight-for-height or weight gain during pregnancy.
To assess the effects of prescribing a low-energy diet to pregnant women who are either overweight, or who exhibited high weight gain earlier in gestation, on subsequent weight gain, pre-eclampsia, and the outcome of pregnancy. ⋯ Protein/energy restriction of pregnant women who are overweight or exhibit high weight gain is unlikely to be beneficial and may be harmful to the developing fetus.
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Cochrane Db Syst Rev · Jan 2000
ReviewMaternal antigen avoidance during lactation for preventing atopic eczema in infants.
To assess the effects of prescribing an antigen avoidance diet to lactating mothers of infants with atopic eczema on the severity of the eczema. ⋯ The unimpressive results of this single trial should be interpreted with caution both because of its small size (n=17) and because the trial compared exposure to cow milk and egg with exposure to soya milk (soya can itself be allergenic). Maternal reports of changes in the severity of their breast-fed infants' eczema following ingestion of certain foods should be pursued by performing multiple (preferably double-blinded) challenges and dechallenges with the suspected foods.
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Because placenta praevia is implanted unusually low in the uterus, it may cause major, and/or repeated, antepartum haemorrhage. The traditional policy of care of women with symptomatic placenta praevia includes prolonged stay in hospital and delivery by caesarean section. ⋯ There are insufficient data from trials to recommend any change in clinical practice. Available data should, however, should encourage further work to address the safety of more conservative policies of hospitalisation for women with suspected placenta praevia, and the possible value of insertion of a cervical suture.
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Cochrane Db Syst Rev · Jan 2000
ReviewNimodipine for primary degenerative, mixed and vascular dementia.
Dementia is an age-related condition in which Alzheimer's disease (AD) and cerebrovascular disease account for the bulk of cases. The role played by calcium in regulating brain functions is well known - the calcium ion links membrane excitation to subsequent intracellular enzymatic response. Change in calcium homeostasis is one important effect of aging with repercussions on higher cortical functions. Nimodipine is an isopropyl calcium channel blocker which can easily cross the blood brain barrier. Its primary action is to reduce the number of open channels, thus restricting influx of calcium ions into the cell. The usefulness of nimodipine in patients with Alzheimer's disease and vascular dementia and unspecified dementia is still controversial with mixed results. In spite of the uncertainties about its efficacy in dementia, nimodipine is currently a frequently prescribed drug for cognitive impairment and dementia in several European countries. This review will be conducted in two phases; the current review is based on evidence from published data only. The second phase will be based on individual-patient data analysed centrally and added to this review in due course. ⋯ This review provides no convincing evidence that nimodipine is a useful treatment for the symptoms of dementia, either unclassified or according to the major subtypes - Alzheimer's disease, vascular, or mixed Alzheimer's and vascular dementia. (ABSTRACT TRUNCATED)
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Cochrane Db Syst Rev · Jan 2000
ReviewActive versus expectant management in the third stage of labour.
Expectant management of the third stage of labour involves allowing the placenta to deliver spontaneously or aiding by gravity or nipple stimulation. Active management involves administration of a prophylactic oxytocic before delivery of the placenta, and usually early cord clamping and cutting, and controlled cord traction of the umbilical cord. ⋯ Routine 'active management' is superior to 'expectant management' in terms of blood loss, post partum haemorrhage and other serious complications of the third stage of labour. Active management is, however, associated with an increased risk of unpleasant side effects (eg nausea and vomiting), and hypertension, where ergometrine is used. Active management should be the routine management of choice for women expecting to deliver a baby by vaginal delivery in a maternity hospital. The implications are less clear for other settings including domiciliary practice (in developing and industrialised countries).