BJOG : an international journal of obstetrics and gynaecology
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Review Meta Analysis
Should oral misoprostol be used to prevent postpartum haemorrhage in home-birth settings in low-resource countries? A systematic review of the evidence.
Using misoprostol to prevent postpartum haemorrhage (PPH) in home-birth settings remains controversial. ⋯ The finding that the distribution of oral misoprostol through frontline health workers is effective in reducing the incidence of PPH could be a significant step forwards in reducing maternal deaths in low-resource countries. However, given the limited number of high-quality studies in this review, further randomised controlled trials are required to confirm the association, particularly in different implementation settings. Adverse effects have not been systematically captured, and there has been limited consideration of the potential for inappropriate or inadvertent use of misoprostol. Further evidence is needed to inform the development of implementation and safety guidelines on the routine availability of misoprostol.
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Severe maternal morbidity or 'near miss' is a promising indicator to improve quality of obstetric care. ⋯ There is growing interest in the application of the maternal near-miss concept as an adjunct to maternal mortality. However, in the literature published before 2011 there was still important variation in the criteria used to identify maternal near-miss cases. The World Health Organization recently published criteria based on markers of management and of clinical and organ dysfunction which would enable systematic data collection on near miss and development of summary estimates. Comparing the rates over time and across regions, it is clear that different approaches are needed to lower the rates of near miss and that interventions must be developed with the local context in mind.
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Descriptions of the effects of moderate alcohol consumption during pregnancy on adverse pregnancy outcomes have been inconsistent. ⋯ Dose-response relationship indicates that heavy alcohol consumption during pregnancy increases the risks of all three outcomes whereas light to moderate alcohol consumption shows no effect. Preventive measures during antenatal consultations should be initiated.
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Review Meta Analysis
Acupuncture for pain relief in labour: a systematic review and meta-analysis.
Acupuncture is frequently used for pain relief in labour, but the evidence is not clear. ⋯ The evidence from RCTs does not support the use of acupuncture for controlling labour pain. The primary studies are diverse and often flawed. Further research seems warranted.
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Review Meta Analysis
A systematic review of the effectiveness of training in emergency obstetric care in low-resource environments.
Training of healthcare workers can play an important role in improving quality of care, and reducing maternal and perinatal mortality and morbidity. ⋯ Training programmes may improve quality of care, but strong evidence is lacking. Policymakers need to include evaluation and reporting of effects in project budgets for new training programmes.