Ahizechukwu C. Eke

A systematic review and meta-analysis of progestogen use for maintenance tocolysis after preterm labor in women with intact membranes

The use of progestogens for maintenance tocolysis remains controversial, with randomized controlled trials having conflicting results on their efficacy.

Intra-abdominal saline irrigation at cesarean section: a systematic review and meta-analysis

Abstract Objective: The aim of this study was to examine the evidence guiding intraoperative saline irrigation at cesarean sections. Methods: We searched “cesarean sections”, “pregnancy”, “saline irrigation” and “randomized clinical trials” in ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, AJOL, MEDLINE, LILACS and CINAHL from inception of each database to April 2015. The primary outcomes were predefined as intraoperative nausea and emesis. The pooled results were reported as relative risk (RR) with 95% confidence interval (95% CI). Results: Three randomized trials including 862 women were analyzed. Intraoperative saline irrigation was associated with a 68% increased risk of developing intraoperative nausea (RR = 1.68, 95% CI 1.36–2.06), 70% increased risk of developing intraoperative emesis (RR = 1.70, 95% CI 1.28–2.25), 92% increased risk of developing post-operative nausea and 84% increased risk of using anti-emetics post-operatively (RR = 1.84, 95% CI 0.21–2.78) when compared with controls. There were no significant differences between intraoperative saline irrigation and no treatment for post-operative emesis (RR = 1.65, 95% CI 0.74–3.67), estimated blood loss, time to return of gastrointestinal function, postpartum endometritis (RR = 0.95, 95% CI 0.64–1.40), urinary tract infection and wound infection. Conclusion: Intraoperative saline irrigation at cesarean delivery increases intraoperative and post-operative nausea, requiring increasing use of anti-emetics without significant reduction in infectious, intraoperative and postpartum complications. Routine abdominal irrigation at cesarean section is not supported by current data.

A comparison of prophylactic intramuscular ergometrine and oxytocin for women in the third stage of labor.

To compare the efficacy and adverse effects of ergometrine and oxytocin given intramuscularly for the prevention of postpartum hemorrhage during the third stage of labor.

Diagnostic performance of placental alpha-microglobulin-1 test in women with prolonged pre-labour rupture of membranes

Abstract Objectives: To determine diagnostic performance of placental alpha-microglobulin-1 (PAMG-1) test compared to conventional clinical assessment (CCA) in women with prolonged pre-labour rupture of membranes (PROM). Methods: A double-blind study of women with symptoms and signs of PROM in Nnamdi Azikiwe University Teaching Hospital, Nnewi and University of Nigeria Teaching Hospital, Enugu, in south-east Nigeria using CCA for PROM and PAMG-1 test was done. Women were included if their symptoms, signs or complaints suggestive of PROM was more than 24 h duration. PROM was diagnosed if two out of three methods from CCA (pooling, positive nitrazine test or ferning) were present. Confirmation of PROM was done after delivery using any two of these clinical criteria: delivery in 48 h to 7 days, evidence of chorioamnionitis, membranes obviously ruptured at delivery and adverse perinatal outcomes strongly correlated with prolonged PROM. Results: Accuracy, specificity and sensitivity value for CCA were 72.5, 36.8 and 86.0% lower than for PAMG-1 test which were 95.7, 94.1 and 96.2%. In equivocal cases, PAMG-1 was significantly more accurate than CCA (92.3% versus 38.5%; p < 0.001). Conclusions: This study in women with prolonged PROM, confirms that PAMG-1 test has high diagnostic accuracy irrespective of the duration of PROM before clinical evaluation.

Perceptions of focused prenatal care among women attending two tertiary centers in Nigeria

To determine womens perceptions and expectations of focused prenatal care visits.

Intrauterine Cleaning After Placental Delivery at Cesarean Section: A Randomized Controlled Trial [27].

INTRODUCTION: To evaluate whether omission of intrauterine cleaning increases intraoperative and postoperative complications among women who deliver via cesarean section. METHODS: We randomized 206 women undergoing primary elective cesarean deliveries to intrauterine cleaning or omission of cleaning. Patients with spontaneous rupture of membranes before cesarean section, chorioamnionitis, poorly controlled diabetes mellitus, and immunosuppressive disorders were excluded. Postpartum endomyometritis rates were compared across groups as the primary outcome in an intention-to-treat analysis. We also examined a number of secondary outcomes. To detect a 20% difference in infection rate between the cleaned and the non-cleaned groups (two-tailed [&agr;]=0.05, [&bgr;]=0.2), 103 women were required per group. RESULTS: From June 2014 through July 2015, 312 women were screened and 206 were randomized as follows: 103 to intrauterine cleaning and 103 to omission of cleaning after placental delivery. Most characteristics were similar among groups. There were no statistically significant differences in the rate of endomyometritis between the two groups (2.0% vs 2.9%, RR 0.60; 95% CI 0.40–1.32). There were no statistically significant differences in postpartum hemorrhage rates (5.8% vs 7.7%, RR 0.75; 95% CI 0.6–1.2), hospital readmission rates (2.9% vs 3.8%, RR 0.75; 95% CI 0.5–1.6), mean surgical time, hospital length of stay, time to return of gastrointestinal function, need for repeat surgery, or quantitated blood loss between the two groups. CONCLUSION/IMPLICATIONS: Our randomized controlled trial provides evidence suggesting that omission of intrauterine cleaning during cesarean deliveries in women at low risk of infection does not increase intraoperative or postoperative complications.

Connect the Dots-August 2016.

This past week, in our Maternal-Fetal Medicine clinic at the North Carolina Women’s Hospital, a resident and I discussed the relative merits of recommending the use of intramuscular progesterone prophylaxis for women whose only prior delivery had occurred at 36 weeks of gestation. In this issue of Obstetrics & Gynecology, Yang et al (see page 364) analyze recurrence risks for preterm birth and early term birth using California vital statistics data, which would have helped to provide some evidence for consultation with this patient. Their Table 3 has one answer to our clinical question. Among the 4,246 women who delivered their first child at 36 weeks, 488 (11.5%) delivered their second child at less than 37 weeks. The adjusted odds ratio for delivery before 32 weeks in this group was 4.4. Compare this with the 2.7% rate of delivery before 37 weeks for those women who delivered at 39 weeks. The potential utility of reports such as this one in our daily care of patients is high. Even so, we need to understand the limitations of population-based research when we apply results to the patient in front of us. Does she fit the population studied? Are there data missing that would bias results? Do we know how patients in the study were treated? One way to be more certain is to make sure that the hazard ratios are within what Grimes and Schulz refer to as the zones of potential interest, which diminish the risks of introduced bias in the analysis. This article can be used to inform evidence-based, patient-centered counseling about one of the major public health problems we face in the United States—premature birth. It is worth a deep dive when you read it.