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Community‐based intervention packages for preventing maternal and newborn illness and death and improving neonatal outcomes

While women, newborn and under‐five child death rates in developing countries have declined significantly in the past two to three decades, newborn mortalities have hardly changed. It is now been recognised that almost half of newborn deaths can be prevented by tetanus toxoid immunisation of the mothers; clean and skilled care at the birth; newborn resuscitation; exclusive breastfeeding; clean umbilical cord care; and management of infections in the newborns. In developing countries, almost two‐thirds of births occur at home and only half are attended by a trained birth attendant. It has also been known that a large proportion of these deaths and diseases can be potentially addressed by developing community‐based packaged interventions that should be integrated with local health systems.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Vaginal Birth After Cesarean: New Insights

To synthesize the published literature on vaginal birth after cesarean (VBAC). Specifically, to review the trends and incidence of VBAC, maternal benefits and harms, infant benefits and harms, relevant factors influencing each, and the directions for future research.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: March 2010
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Maternal adverse effects of different antenatal magnesium sulphate regimens for improving maternal and infant outcomes: a systematic review

BACKGROUND: Antenatal magnesium sulphate, widely used in obstetrics to improve maternal and infant outcomes, may be associated with adverse effects for the mother sufficient for treatment cessation. This systematic review aimed to quantify maternal adverse effects attributed to treatment, assess how adverse effects vary according to different regimens, and explore women's experiences with this treatment.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Critical incident audit and feedback to improve perinatal and maternal mortality and morbidity

Recording the number and the causes of deaths of pregnant women and babies is essential health information to identify problem areas. Effective management of the health of a population is dependent on basic statistics that allow for the identification of problem areas. Recording the number and causes of deaths of pregnant women and babies falls into this category and is essential. No randomised controlled trials were identified; therefore, the depth of examination of these deaths and the methods of feeding back that information to health workers to obtain the most beneficial effect is not known.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

First versus second stage C/S maternal and neonatal morbidity: a systematic review and meta-analysis

The rates of cesarean section at full cervical dilatation (second stage cesarean sections) are currently increasing. The purpose of the present study is to compare maternal and neonatal morbidity and mortality among cases offered cesarean section at full dilatation to those offered cesarean section prior to full dilatation. We searched Medline, Scopus, Clinicaltrials.org, Popline, Cochrane CENTRAL, and Google Scholar search engines, along with reference lists from all included studies. The RevMan 5.0 software was used for all analyses. Primary maternal outcomes were defined as death, ICU admission and need for transfusion, while primary neonatal outcomes were defined as death, neonatal unit admission and 5min Apgar score less than 7. Ten studies were finally retrieved involving 23,104 singleton childbearing women (18,160 operated in the first stage and 4944 in the second stage of labor). Second stage cesarean section seems to lead to higher maternal admissions to ICU (OR 7.41, 95% CI 2.47-22.5) and higher transfusion rates (OR 2.60, 95% CI 1.49-2.54). Neonatal death rates were also increased (OR 5.20, 95% CI 2.49-10.85) along with admissions to neonatal unit (OR 1.63, 95% CI 0.91-2.91) and rates of Apgar score less than 7 in 5min (OR 2.77, 95% CI 1.02-7.50). Second stage cesarean section seems to result significantly increased morbidity for both mothers and neonates. It seems that a direct evaluation with forceps and vacuum extractors is imperative in order to establish its place in modern evidence-based practice.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Effects of intentional delivery on maternal and neonatal outcomes in pregnancies with preterm prelabour rupture of membranes between 28 and 34 weeks of gestation: a systematic review and meta-analysis

The authors concluded that intentional delivery for pre-labour rupture of membranes at between 28 and 34 weeks of gestation had no maternal and neonatal benefits, compared with expectant management, but it had higher risks of neonatal death and caesarean section. The conclusions of this generally well-conducted review reflect the limitations of the evidence presented.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Effects of calcium supplementation during pregnancy on maternal, fetal and birth outcomes

Gestational hypertensive disorders are the second leading cause of maternal death worldwide. Epidemiological and clinical studies have shown that an inverse relationship exists between calcium intake and development of hypertension in pregnancy. The purpose of this review was to evaluate preventive effect of calcium supplementation during pregnancy on gestational hypertensive disorders and related maternal and neonatal morbidity and mortality. A literature search was carried out on PubMed, WHOLIS, PAHO and Cochrane Library. Only randomised trials were included in the review. Data were extracted into a standardised Excel sheet. Primary outcomes were pre-eclampsia, preterm birth and birthweight. Other neonatal outcomes such as neonatal mortality, small-for-gestational age and low birthweight were also evaluated. A total of 15 randomised controlled trials were included in this review. Pooled analysis showed that calcium supplementation during pregnancy reduced risk of pre-eclampsia by 52% [relative risk (RR) 0.48; 95% confidence interval (CI) 0.34, 0.67] and that of severe pre-eclampsia by 25% (RR 0.75 [95% CI 0.57, 0.98]). There was no effect on incidence of eclampsia (RR 0.73 [95% CI 0.41, 1.27]). There was a significant reduction for risk of maternal mortality/severe morbidity (RR 0.80 [95% CI 0.65, 0.97]). Calcium supplementation during pregnancy was also associated with a significant reduction in risk of pre-term birth (RR 0.76 [95% CI 0.60, 0.97]). There was an extra gain of 85 g in the intervention group compared with control (mean difference 85 g [95% CI 37, 133]). There was no effect of calcium supplementation on perinatal mortality (RR 0.90 [95% CI 0.74, 1.09]). There was a statistically non-significant increased risk of urolithiasis in the intervention group compared with control (RR 1.52 [95% CI 0.06, 40.67]). In conclusion, calcium supplementation during pregnancy is associated with a reduction in risk of gestational hypertensive disorders and pre-term birth and an increase in birthweight. There is no increased risk of kidney stones.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Preconception care for diabetic women to improve maternal and infant health

Current guidelines in many countries including Australia, the United Kingdom and United States recommend preconception care of diabetic women. Pregnant women with type I or type II diabetes are at a greater risk of adverse outcomes in pregnancy such as high blood pressure (gestational hypertension) and preterm births. Pregnancy can also accelerate the development of diabetic complications (retinopathy, nephropathy, neuropathy, ischaemic heart disease, cerebrovascular disease, peripheral vascular disease). Babies born to mothers with type I or type II diabetes diagnosed before pregnancy may be larger and are at greater risk of infant death and congenital abnormality (such as neural tube defects including anencephaly and spina bifida). These infants are also at risk of developing type II diabetes in the long term. Because of the strong association between good control of a woman’s blood sugars (glycaemic control), as measured by haemoglobin A1c, and reduced congenital anomalies, glycaemic targets are central to preconception care.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Specialised antenatal clinics for women with a multiple pregnancy for improving maternal and infant outcomes

'Specialised' antenatal clinics versus 'standard' antenatal care for women with a multiple pregnancy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antithrombotic therapy for improving maternal or infant health outcomes in women considered at risk of placental dysfunction

Pregnancy complications such as pre‐eclampsia and eclampsia, intrauterine fetal growth restriction and placental abruption are thought to be related to abnormalities in the development and function of the placenta. Treatment with heparin to prevent the development of blood clots within the placenta appears to be a promising intervention to prevent these complications. The numbers of pregnant women with pre‐eclampsia, preterm birth, perinatal death and a low birthweight infant (weighing less than the 10th centile for gestational age) were reduced with this treatment. Ten randomised trials involving 1139 women met the inclusion criteria for the review. Nine studies compared heparin (alone or in combination with dipyridamole) with no treatment; and one compared triazolopyrimidine with placebo. The most commonly recognised side effect for women related to this treatment was mild skin bruising. To date, important information about serious adverse infant and long‐term childhood outcomes with using anti‐clotting medications is unavailable. Further research is required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Postpartum misoprostol for preventing maternal mortality and morbidity

Bleeding from the uterus or womb after childbirth is normal, but excessive bleeding (haemorrhage) is an important cause of death and can be reduced by medication that causes the uterus to contract. Misoprostol is one such medication and is a tablet marketed to treat certain stomach ulcers but which also contracts the uterus and reduces bleeding. It may also have harmful side effects, in particular raised body temperature (pyrexia) and shivering. Misoprostol can more easily be distributed at community level than less stable, injectable medication such as oxytocin to prevent or treat severe bleeding in woman after giving birth (postpartum haemorrhage). This review investigated whether giving misoprostol to women after birth to prevent or treat excessive bleeding reduces maternal deaths and severe complications other than blood loss (which is covered in separate reviews). We included 78 randomised controlled studies involving 59,216 women. The variety of study designs, populations studied, routes of administration and co‐interventions, as well as the exceptionally high incidence of hyperpyrexia in Ecuador were limiting factors. Maternal deaths, and the combined outcome, death or severe illness resulting in major surgery, admission to intensive care or vital organ failure (excluding very high fever) were not reduced by misoprostol. The known side effects of misoprostol (fever and very high fever) were worse with dosages of 600 µg or more than with lower dosages. Therefore, the review supports the use of the lowest effective misoprostol dose to prevent or treat maternal bleeding after the birth of the baby, and calls for more research to find out the optimal dosage, with continued surveillance for serious side effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Evaluating effectiveness of complex interventions aimed at reducing maternal mortality in developing countries

This review assessed the effects of complex interventions aimed at reducing maternal mortality in developing countries. The authors justly concluded that although most studies found a reduction in maternal mortality with the interventions, the findings should be treated with caution because of the limitations of the included studies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis

The authors stated that women's groups practising participatory learning and action led to substantial reductions in new-born and maternal death rates in rural, low-resource settings (developing countries). Despite some concerns about variation in the results, the authors' conclusions reflect the findings and are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Preconception care for diabetic women for improving maternal and fetal outcomes: a systematic review and meta-analysis

The review concluded that preconception care for women with pre-existing type 1 or 2 diabetes mellitus was effective in reducing diabetes-related congenital malformations, pre-term delivery and maternal hyperglycaemia in the first trimester of pregnancy. The review was well conducted, but differences in study results and the small number of studies in some analyses limits the reliability of the authors’ conclusions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Routine iron/folate supplementation during pregnancy: effect on maternal anaemia and birth outcomes

The authors concluded that preventative iron supplementation significantly reduced the incidence of anaemia in mothers and low birthweight in infants. Differences between the included studies and the studies' unclear quality mean the authors' conclusions should be treated with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis

The maternal and newborn safety of planned home and planned hospital birth were compared.The authors concluded that less medical intervention during planned home birth was associated with a tripling of neonatal mortality. The conclusions should be interpreted with some caution as they did not reflect all the evidence presented and there was unexplained variability between studies for several outcomes.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Effect of n-3 long-chain polyunsaturated fatty acid intake during pregnancy on maternal, infant, and child health outcomes: a systematic review

The authors concluded that infants born to women taking omega-3 long-chain polyunsaturated fatty acids were slightly heavier and less likely to be born before 34 weeks gestation, than those born to controls. There were clinical differences between the trials and there was no high-quality evidence, so the reliability of these conclusions is unclear.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Interventions to Reduce or Prevent Obesity in Pregnant Women: A Systematic Review

Around 50% of women of childbearing age are either overweight [body mass index (BMI) 25–29.9 kg/m2] or obese (BMI ≥ 30 kg/m2). The antenatal period provides an opportunity to manage weight in pregnancy. This has the potential to reduce maternal and fetal complications associated with excess weight gain and obesity.

Health Technology Assessment - NIHR Journals Library.

Version: July 2012
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Interventions in Primary Care to Promote Breastfeeding: A Systematic Review [Internet]

Breastfeeding decreases the risks of many diseases in mothers and infants. About 70 percent of US children have ever been breastfed. Thus, it is important to examine interventions that could promote and support breastfeeding in an effort to increase the breastfeeding rates and impact the public health.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: October 2008
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Outcomes of Maternal Weight Gain

The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) systematically reviewed evidence on outcomes of gestational weight gain and their confounders and effect modifiers, outcomes of weight gain within or outside the 1990 Institute of Medicine (IOM) guidelines, risks and benefits of weight gain recommendations, and anthropometric measures of weight gain.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: May 2008
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Medical Encyclopedia

  • Drug Class Review: Newer Antihistamines: Final Report Update 2 [Internet]
    Antihistamines inhibit the effects of histamine at H1 receptors. They have a number of clinical indications including allergic conditions (e.g., rhinitis, dermatoses, atopic dermatitis, contact dermatitis, allergic conjunctivitis, hypersensitivity reactions to drugs, mild transfusion reactions, and urticaria), chronic idiopathic urticaria (CIU), motion sickness, vertigo, and insomnia.
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Systematic Reviews in PubMed

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