Best practice & research. Clinical obstetrics & gynaecology
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Systematic reviews help people to make well-informed decisions about health care by bringing together the relevant evidence, appraising it and, where appropriate, combining it in a meta-analysis. The ultimate aim for a systematic review should be to present all relevant data on all participants in all research judged to be eligible for the review. ⋯ It allows the reviewer to overcome many of the problems associated with a reliance on published data alone, and some of the problems associated with using aggregate data supplied by the trialist, and will add to the analyses that can be performed. This chapter discusses the rationale for individual patient data reviews and describes some of their features.
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Best Pract Res Clin Obstet Gynaecol · Feb 2005
ReviewEvidence and practice: the magnesium sulphate story.
There is now strong evidence from systematic reviews of randomised trials to support the use of magnesium sulphate for the prevention and treatment of eclampsia. Magnesium sulphate more than halves the risk of eclampsia for women with pre-eclampsia (relative risk (RR) 0.41, 95% confidence interval (CI) 0.29-0.58; number needed to treat (NNT) 102 (95% CI 72-173) compared to placebo. For treatment of eclampsia, magnesium sulphate lowers the risk of maternal death (RR 0.59, 95% CI 0.37-0.94) and of recurrence of further fits (RR 0.44, 95% CI 0.34-0.57) compared to diazepam. Magnesium sulphate also reduces the risk of further fits compared to phenytoin (RR 0.31, 95% CI 0.20-0.47) and to lytic cocktail (RR 0.09, 95% CI 0.03-0.24).
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Advances in assisted reproductive technology and increases in the proportion of maternities in older women have both contributed to the steep increase in the incidence of twin pregnancies since the 1980s. Maternal and perinatal complications are higher in twins than in singleton pregnancies. A significant proportion of perinatal mortality and morbidity among twins is due to the high incidence of preterm delivery and the added complication of twin-to-twin transfusion syndrome (TTTS) in monochorionic twins. ⋯ Intrapartum management in the hospital setting with anaesthetic and neonatal facilities, as well as critical assessment of mode of delivery, have led to better outcomes. Ultrasonography is a valuable tool in the management of twin pregnancy. This chapter briefly summarises these topics, with a particular focus on recent literature.
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Problems associated with menstruation affect 75% of adolescent females and are a leading reason for visits to physicians. This chapter begins with a review of the timing and characteristics of normal menstruation during adolescence. ⋯ The differential diagnosis of dysmenorrhoea and the management of primary dysmenorrhoea and endometriosis are reviewed. The section on abnormal uterine bleeding contrasts anovulatory dysfunctional uterine bleeding (DUB) with bleeding secondary to problems of pregnancy, uterine pathology, exogenous hormone use and systemic bleeding disorders.
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Best Pract Res Clin Obstet Gynaecol · Oct 2002
ReviewThe genetic revolution: new ethical issues for obstetrics and gynaecology.
The genomic revolution inherently changes the paradigms that have informed the interactions between patient and physician. These changes obligate physicians both to continually learn about the advances occurring in genetic testing and to review their interactions in light of the changing ethical issues these advances uncover. ⋯ Furthermore, there are issues of justice raised by limited access to these technologies, research confidentiality, potential discrimination and the meaning of individuality in an era of potential genetic cloning. These changes require obstetrician/gynaecologists to advocate for the best interests of both their patients and those who may not be able to voice their interests, for example children-to-be and research subjects in developing countries.