Jennifer Sleep

Pelvic floor exercises in postnatal care

Abstract 1800 women recruited within 24 hours of vaginal delivery, were randomly allocated to one of two pelvic floor exercise policies aimed at preventing urinary incontinence. Nine hundred women received instruction currently available to all postnatal women in the West Berkshire Health District and 900 were encouraged to follow a more intensive regime endorsed by the use of a 4-week exercise diary. When assessed 10 days and 3 months after delivery, women allocated to the intensive policy were more likely to be persevering with their exercises. There were no differences between the two groups in terms of the prevalence or severity of urinary or faecal incontinence, but women in the intensive exercise group were less likely to report perineal pain and feelings of depression 3 months after delivery. These findings raise questions about the content of current postnatal exercise programmes. The components of these should now be formally evaluated in further randomised trials.

Ultrasound and pulsed electromagnetic energy treatment for perineal trauma. A randomized placebo‐controlled trial

Ultrasound and pulsed electromagnetic energy therapies arc increasingly used for perineal trauma sustained during childbirth. The study included 414 women with moderate or severe perineal trauma randomly allocated to receive active ultrasound, or active pulsed electromagnetic energy, or corresponding placebo therapies; the allocation was double‐blind for each machine. Overall, more than 90% thought that treatment made their problem better. There were no clear differences between the groups in outcome either immediately after treatment, or 10 days or 3 months postpartum, other than more pain associated with pulsed electromagnetic energy treatment at 10 days. Bruising looked more extensive after ultrasound therapy but then seemed to resolve more quickly. Neither therapy had an effect on perineal oedema or haemorrhoids. The place of these new therapies in postnatal care should be clarified by further controlled trials before they become part of routine care.

A randomized comparison of glycerol-impregnated chromic catgut with untreated chromic catgut for the repair of perineal trauma.

Summary. Glycerol‐impregnated chromic catgut and untreated chromic catgut were compared in a randomized controlled trial involving 737 consecutive women who required repair of perineal trauma following spontaneous vaginal delivery. Medical staff preference was equally divided between the two materials. More untreated chromic catgut sutures required removal both by 10 days and by 3 months postpartum. Women whose perineal trauma was repaired with glycerol‐impregnated chromic catgut were 10% more likely to have perineal pain at 10 days and 33% more likely to suffer from dyspareunia in the 3 months following delivery. The high rates of maternal morbidity associated with glycerol‐impregnated chromic catgut appear to preclude its use for perineal repair.

The what and how of teaching research

Abstract Within the last decade nurse educators have been required to introduce research into the curriculum of every pre- and post-registration programme. This has lead to a debate concerning what practitioners need to know about research and about the best way to teach the research component of any educational programme. Two main approaches may be identified: facilitating research awareness and learning research by ‘doing’. Both approaches raise a number of logistical and ethical problems. Certain of these problems are compounded by the large numbers of nurses who may be required to undertake a research project as a course component. Moreover, the absence of research evidence about the most effective means of educating nurses to become discerning consumers of research leaves the teacher without a sound framework to guide educational practice. In the light of recent educational reforms, this paper considers the unprecedented opportunities for nurse and midwife teachers to explore the role of research in the curriculum and in teaching.

Dyspareunia associated with the use of glycerol‐impregnated catgut to repair perineal trauma. Report of a 3‐year follow‐up study

A randomized controlled trial, which compared glycerol impregnated chromic catgut with untreated chromic catgut used for cell layers in the repairs of perineal trauma of delivery, was performed 3 years after, 516 women conservered a questionnaire on dyspareunia, and outcome of a eventuel subsequent delivery

Weighing up the evidence: The contribution of critical literature reviews to the development of practice

Over the past decade there has been increasing awareness of the importance of using sound research evidence to assist clinicians, patients and clients to make informed decisions about aspects of care. The recent drive towards promoting evidence-based healthcare has provided an added impetus, highlighting the important and unique contribution of systematic reviews to this decision-making process. This paper argues that healthcare professionals should also draw on evidence and insights derived from a broader range of research traditions rather than relying on synthesised evidence from randomised controlled trials. The potential of other types of literature is explored.

A randomized controlled trial to compare three types of fetal scalp electrode

Objectives To compare three scalp electrodes in respect of need for reapplication, trace quality and scalp trauma.