Готові списки джерел за темами / Perinatal trial

Добірка наукової літератури з теми "Perinatal trial"

Автор: Grafiati

Опубліковано: 10 грудня 2022

Оновлено: 28 січня 2023

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Статті в журналах з теми "Perinatal trial"

HERBST, ANDREAS, and KARIN KÄLLÉN. "TERM BREECH DELIVERY." Fetal and Maternal Medicine Review 16, no. 4 (November 2005): 289–322. http://dx.doi.org/10.1017/s0965539505001634.

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In October 2000, Hannah et al published a randomised controlled trial comparing perinatal and maternal outcome between planned vaginal and planned caesarean deliveries of term breech pregnancies. The study was closed after an interim analysis, showing a reduced perinatal morbidity and mortality with planned caesarean section. The result was not unexpected, although a trial like this had been called for over many years to resolve the issue. Many cohort- and case-control studies, and two small randomised studies had been performed since 1959, when Wright reported a reduced perinatal mortality and morbidity with CS. A few large registry studies had shown a better perinatal outcome with caesarean delivery, whereas smaller studies often showed no statistically significant difference in outcome, often with the conclusion that vaginal delivery (VD) is safe.

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Semrau, Katherine EA, Kate A. Miller, Stuart Lipsitz, Jennifer Fisher-Bowman, Ami Karlage, Bridget A. Neville, Margaret Krasne, et al. "Does adherence to evidence-based practices during childbirth prevent perinatal mortality? A post-hoc analysis of 3,274 births in Uttar Pradesh, India." BMJ Global Health 5, no. 9 (September 2020): e002268. http://dx.doi.org/10.1136/bmjgh-2019-002268.

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BackgroundEvidence-based practices that reduce childbirth-related morbidity and mortality are core processes to quality of care. In the BetterBirth trial, a matched-pair, cluster-randomised controlled trial of a coaching-based implementation of the WHO Safe Childbirth Checklist (SCC) in Uttar Pradesh, India, we observed a significant increase in adherence to practices, but no reduction in perinatal mortality.MethodsWithin the BetterBirth trial, we observed birth attendants in a subset of study sites providing care to labouring women to assess the adherence to individual and groups of practices. We observed care from admission to the facility until 1 hour post partum. We followed observed women/newborns for 7-day perinatal health outcomes. Using this observational data, we conducted a post-hoc, exploratory analysis to understand the relationship of birth attendants’ practice adherence to perinatal mortality.FindingsAcross 30 primary health facilities, we observed 3274 deliveries and obtained 7-day health outcomes. Adherence to individual practices, containing supply preparation and direct provider care, varied widely (0·51 to 99·78%). We recorded 166 perinatal deaths (50·71 per 1000 births), including 56 (17·1 per 1000) stillbirths. Each additional practice performed was significantly associated with reduced odds of perinatal (OR: 0·82, 95% CI: 0·72, 0·93) and early neonatal mortality (OR: 0·78, 95% CI: 0·71, 0·85). Each additional practice as part of direct provider care was associated strongly with reduced odds of perinatal (OR: 0·73, 95% CI: 0·62, 0·86) and early neonatal mortality (OR: 0·67, 95% CI: 0·56, 0·80). No individual practice or single supply preparation was associated with perinatal mortality.InterpretationAdherence to practices on the WHO SCC is associated with reduced mortality, indicating that adherence is a valid indicator of higher quality of care. However, the causal relationships between practices and outcomes are complex.FundingBill & Melinda Gates Foundation.Trial registration detailsClinicalTrials.gov: NCT02148952; Universal Trial Number: U1111-1131-5647.

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Green, Sheryl M., Eleanor Donegan, Randi E. McCabe, David L. Streiner, Arela Agako, and Benicio N. Frey. "Cognitive behavioral therapy for perinatal anxiety: A randomized controlled trial." Australian & New Zealand Journal of Psychiatry 54, no. 4 (January 20, 2020): 423–32. http://dx.doi.org/10.1177/0004867419898528.

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Background: Up to one in five women meet diagnostic criteria for an anxiety disorder during the perinatal period (i.e. pregnancy and up to 1 year postpartum). While psychotropic medications are effective, they are associated with risks for mothers and babies. There is a growing demand for evidence-based non-pharmacological treatments for perinatal anxiety. Objective: To evaluate the effectiveness of a cognitive behavioral group therapy protocol for perinatal anxiety. Methods: In total, 96 women were randomized to cognitive behavioral group therapy or waitlist at a clinic specializing in women’s mental health. Participants were 22–41 years of age, pregnant or up to 6 months postpartum and had an anxiety disorder with or without comorbid depression. Results: Compared to waitlist, participants in cognitive behavioral group therapy reported significantly greater reductions in the primary outcome of anxiety (State-Trait Inventory of Cognitive and Somatic Anxiety, η2p = .19; Hamilton Anxiety Rating Scale, η2p = .16), as well as in secondary outcomes including worry (Penn State Worry Questionnaire, η2p = .29), perceived stress (Perceived Stress Scale, η2p = .33) and depressive symptoms (Edinburgh Postnatal Depression Scale, η2p = .27; Montgomery–Åsberg Depression Rating Scale, η2p = .11). Maternal status (pregnant, postpartum) and medication use were unrelated to treatment outcomes. All gains were maintained, or continued to improve, at 3-month follow-up. Conclusion: Cognitive behavioral group therapy was effective in improving anxiety and related symptoms among women with anxiety disorders in the perinatal period.

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Brocklehurst, P. "Role of external evidence in monitoring clinical trials: experience from a perinatal trial." BMJ 320, no. 7240 (April 8, 2000): 995–98. http://dx.doi.org/10.1136/bmj.320.7240.995.

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Minchin, Maureen. "Infant Formula: A Mass, Uncontrolled Trial in Perinatal Care." Birth 14, no. 1 (March 1987): 25–35. http://dx.doi.org/10.1111/j.1523-536x.1987.tb01445.x.

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FIELD, D. "Evidence in perinatal medicine: enough of trial and error?" Archives of Disease in Childhood - Fetal and Neonatal Edition 81, no. 3 (November 1, 1999): F161. http://dx.doi.org/10.1136/fn.81.3.f161.

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Haga, Silje Marie, Filip Drozd, Carina Lisøy, Tore Wentzel-Larsen, and Kari Slinning. "Mamma Mia – A randomized controlled trial of an internet-based intervention for perinatal depression." Psychological Medicine 49, no. 11 (September 7, 2018): 1850–58. http://dx.doi.org/10.1017/s0033291718002544.

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AbstractBackgroundStudies suggest that 10–15% of perinatal women experience depressive symptoms. Due to the risks, problems with detection, and barriers to treatment, effective universal preventive interventions are needed. The aim of this study was to assess the effectiveness of an automated internet intervention (‘Mamma Mia’) on perinatal depressive symptoms. Mamma Mia is tailored specifically to the perinatal phase and targets risk and protective factors for perinatal depressive symptoms.MethodsA total of 1342 pregnant women were randomized to an intervention (‘Mamma Mia’) and control group. Data were collected at gestational week (gw) 21–25, gw37, 6 weeks after birth, and 3 and 6 months after birth. We investigated whether (1) the intervention group displayed lower levels of depressive symptoms compared with the control group, (2) the effect of Mamma Mia changed over time, (3) the effect on depressive symptoms was moderated by baseline depressive symptoms, previous depression, and parity, and (4) this moderation changed by time. Finally, we examined if the prevalence of mothers with possible depression [i.e. Edinburgh Postnatal Depression Scale (EPDS)-score ⩾10] differed between the intervention and control group.ResultsParticipants in the Mamma Mia group displayed less depressive symptoms than participants in the control group during follow-up [F(1) = 7.03, p = 0.008]. There were indications that the effect of Mamma Mia was moderated by EPDS score at baseline. The prevalence of women with EPDS-score ⩾10 was lower in the Mamma Mia group at all follow-up measurements.ConclusionsThe study demonstrated the effects of the automated web-based universal intervention Mamma Mia on perinatal depressive symptoms.

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Johnson, Jennifer E., Ann B. Price, Alla Sikorskii, Kent D. Key, Brandon Taylor, Susan Lamphere, Christine Huff, Morgan Cinader, and Caron Zlotnick. "Protocol for the Healing After Loss (HeAL) Study: a randomised controlled trial of interpersonal psychotherapy (IPT) for major depression following perinatal loss." BMJ Open 12, no. 4 (April 2022): e057747. http://dx.doi.org/10.1136/bmjopen-2021-057747.

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IntroductionThis protocol describes a study testing the efficacy of interpersonal psychotherapy (IPT) for major depressive disorder following perinatal loss (early and late fetal death and early neonatal death). Perinatal loss is associated with elevated risk of major depressive disorder and post-traumatic stress disorder (PTSD). Perinatal loss conveys specific treatment needs. The trial will be the first fully powered randomised trial of treatment for any psychiatric disorder following perinatal loss.Methods and analysisA sample of 274 women in Flint and Detroit areas in Michigan who experience a major depressive episode following a perinatal loss will be randomised to group IPT for perinatal loss or to group coping with depression. We anticipate that 50% of the sample will have co-occurring PTSD. Assessments occur at baseline, mid-treatment (8 weeks), post-treatment (16 weeks) and follow-up (28 weeks). Clinical outcomes include time to recovery from major depressive episode (primary), depressive symptoms, PTSD symptoms and time to recovery from PTSD. Additional outcomes include social support, social role functioning (including parental functioning for those with living children), well-being, grief (including complicated grief and fault beliefs) and fear of subsequent pregnancies. Social support and grief are hypothesised mediators of IPT effects on time to recovery from major depressive episode.Ethics and disseminationThe trial was approved by Michigan State University’s Biomedical Institutional Review Board. It has a data and safety monitoring board and has been submitted to the community-based organisation partners community ethics review board. Written operating procedures outline methods for protecting confidentiality, monitoring and recording adverse events, and safeguarding participants. We will share study results with research and clinical communities, community organisations through which we recruited, and will offer results to study participants. Deidentified datasets will be available through the National Institute of Mental Health Data Archive and to qualified investigators on request.Trial registration numberNCT04629599.

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Kirton, A., J. Andersen, M. Herrero, L. Carsolio, A. Nettel-Aguirre, A. Mineyko, and M. Hill. "Brain stimulation and constraint for hemiparesis after perinatal stroke: The PLASTIC CHAMPS trial." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 42, S1 (May 2015): S8. http://dx.doi.org/10.1017/cjn.2015.67.

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Background: Perinatal stroke causes hemiparetic cerebral palsy. Constraint therapy (CIMT) improves function in congenital hemiparesis and adult stroke. Repetitive transcranial magnetic stimulation (rTMS) may improve function in adult stroke. The two have not been tested in perinatal stroke. Methods: PLASTIC CHAMPS (www.clinicaltrials.gov/NCT01189058) was a controlled factorial trial of rTMS and CIMT in perinatal-stroke hemiparesis. Children 6-18 years participated in a 2 week peer-supported motor learning camp, randomized to daily inhibitory rTMS (1200 stimulations, contralesional M1), CIMT, both or neither. Primary outcomes were Assisting Hand Assessment (AHA) and Canadian Occupational Performance Measure (COPM) at 1, 8, and 24 weeks. Quality-of-life, safety and tolerability were evaluated. Change was assessed across treatment groups over time (linear mixed effects model). Results: All forty-five subjects completed the trial (median 11.4yrs). COPM scores increased >100% with maximal gains at 6 months (p<0.002). Addition of rTMS and/or CIMT doubled the chances of clinically significant gains. Combined rTMS+CIMT resulted in larger AHA gains at all time points (6 months p=0.006). CIMT or rTMS alone had more modest effects. Neither treatment decreased function in either hand. Procedures were well tolerated. Conclusions: Children with hemiparesis participating in intensive, psychosocial rehabilitation programs perceive marked increases in function. Non-invasive brain stimulation may enhance motor learning therapy in perinatal stroke hemiparesis.

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Sun, Yaoyao, Yanyan Li, Juan Wang, Qingyi Chen, Alessandra N. Bazzano, and Fenglin Cao. "Effectiveness of Smartphone-Based Mindfulness Training on Maternal Perinatal Depression: Randomized Controlled Trial." Journal of Medical Internet Research 23, no. 1 (January 27, 2021): e23410. http://dx.doi.org/10.2196/23410.

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Background Despite potential for benefit, mindfulness remains an emergent area in perinatal mental health care, and evidence of smartphone-based mindfulness training for perinatal depression is especially limited. Objective The objective of this study was to evaluate the effectiveness of a smartphone-based mindfulness training intervention during pregnancy on perinatal depression and other mental health problems with a randomized controlled design. Methods Pregnant adult women who were potentially at risk of perinatal depression were recruited from an obstetrics clinic and randomized to a self-guided 8-week smartphone-based mindfulness training during pregnancy group or attention control group. Mental health indicators were surveyed over five time points through the postpartum period by online self-assessment. The assessor who collected the follow-up data was blind to the assignment. The primary outcome was depression as measured by symptoms, and secondary outcomes were anxiety, stress, affect, sleep, fatigue, memory, and fear. Results A total of 168 participants were randomly allocated to the mindfulness training (n=84) or attention control (n=84) group. The overall dropout rate was 34.5%, and 52.4% of the participants completed the intervention. Mindfulness training participants reported significant improvement of depression (group × time interaction χ24=16.2, P=.003) and secondary outcomes (χ24=13.1, P=.01 for anxiety; χ24=8.4, P=.04 for positive affect) compared to attention control group participants. Medium between-group effect sizes were found on depression and positive affect at postintervention, and on anxiety in late pregnancy (Cohen d=0.47, –0.49, and 0.46, respectively). Mindfulness training participants reported a decreased risk of positive depressive symptom (Edinburgh Postnatal Depression Scale [EPDS] score>9) compared to attention control participants postintervention (odds ratio [OR] 0.391, 95% CI 0.164-0.930) and significantly higher depression symptom remission with different EPDS reduction scores from preintervention to postintervention (OR 3.471-27.986). Parity did not show a significant moderating effect; however, for nulliparous women, mindfulness training participants had significantly improved depression symptoms compared to nulliparous attention control group participants (group × time interaction χ24=18.1, P=.001). Conclusions Smartphone-based mindfulness training is an effective intervention in improving maternal perinatal depression for those who are potentially at risk of perinatal depression in early pregnancy. Nulliparous women are a promising subgroup who may benefit more from mindfulness training. Trial Registration Chinese Clinical Trial Registry ChiCTR1900028521; http://www.chictr.org.cn/showproj.aspx?proj=33474

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Більше джерел

Дисертації з теми "Perinatal trial"

Jokhio, Abdul Hakeem. "A cluster randomised controlled trial of reorganising maternal health care services in Sindh, Pakistan." Thesis, University of Birmingham, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.390759.

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A community-based randomised controlled trial was conducted in the district Larkana of Sindh province of Pakistan. The new model was based on reorganising the existing maternal health services. Three sub-districts were randomly assigned to the intervention group and four to the control group. The intervention consisted of integrating traditional birth attendants with the health care system, the use of safe delivery packs and the provision of antenatal care by doctors. Over one year 19,525 women were recruited and followed up. The proportion of referrals was higher in the intervention group (10.0 Vs 6.9 %; odds ratio 1.50 [95% Cl 1.26-1.74]). Significant differences were also found in some pregnancy complications including haemorrhage, obstructed labour and puerperal sepsis. Perinatal mortality in the intervention group was 83, compared to 118 per 1000 births for the control group, odds ratio 0.69 (95% Cl 0.53-0.85)(P

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Sikander, Khawaja Siham. "A Cluster Randomised Trial of a Psychosocial Intervention for Perinatal Deppression in Rural Pakistan." Thesis, University of Manchester, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.503736.

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Hughes, Marcus Wyndham. "A randomised, controlled trial of a perinatal psycho-social intervention for postnatal depression in Goa, India." Thesis, King's College London (University of London), 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.744236.

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Tohotoa, Jennifer Lynn. "The development, implementation and evaluation of a father inclusive perinatal support intervention to increase breastfeeding duration : a randomised controlled trial." Thesis, Curtin University, 2012. http://hdl.handle.net/20.500.11937/1542.

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Breastfeeding is the biological norm for infant feeding and the most efficient and cost-effective method of giving the required nutrition to infants. The World Health Organization, the American Academy of Paediatrics and the National Health and Medical Research Council recommend exclusive breastfeeding for six months and the continuation of complementary foods for up to two years. Although most developed countries maintain high initiation rates, the duration rates fail to meet these recommendations. The promotion of breast milk substitutes, changing societal values, urbanization, and the erosion of traditional support systems pose threats to breastfeeding. In Australia the breastfeeding initiation rates are between 85%-95% but fall to 20%-45% by six months. There is some evidence that fathers, the primary support to their partners, influence the initiation and maintenance of breastfeeding by their partners. There has been little research in this area, however, with little known about the nature of a father’s support required by the mother and few interventions have specifically targeted fathers.The present thesis describes the development, implementation and evaluation of a father inclusive perinatal support intervention at six weeks postnatal. The project was conducted over three years as a randomised controlled trial (RCT) across eight public maternity hospitals in Perth, Western Australia.

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Franzon, Ana Carolina Arruda. "PRENACEL - uma estratégia de comunicação móvel para melhorar a saúde materna e perinatal: pesquisa formativa e ensaio aleatorizado por conglomerados." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/17/17139/tde-29112018-102230/.

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Melhorar a saúde das gestantes é uma prioridade para as agências de saúde global e para os governos dos países de baixa e média renda. O desafio da erradicação e/ou redução das morbimortalidades materna e perinatal evitáveis vem colocando em destaque a necessidade de expandir as ações para prevenção de agravos para além da abordagem clínica das complicações obstétricas, a partir do fortalecimento dos sistemas de saúde e da valorização da autonomia das mulheres dentro das sociedades, implementando a abordagem de direitos humanos como um dos componentes da qualidade do cuidado à saúde reprodutiva. O objetivo desta pesquisa é determinar se um programa de educação em saúde e apoio às gestantes, adaptado à realidade do Sistema Único de Saúde brasileiro e às especificidades da telefonia celular, é um complemento útil ao acompanhamento pré-natal padrão. A pesquisa foi realizada em duas etapas, tendo início com a condução de uma pesquisa formativa, exploratória, para identificar barreiras e facilitadores da atenção ao pré-natal e parto, avaliar aceitação do uso de mensagens de texto como item complementar ao cuidado pré-natal padrão, e desenvolver e refinar a intervenção do programa PRENACEL. Esta compreende um programa de 148 mensagens de texto no celular com informações essenciais para o acompanhamento do ciclo gravídico-puerperal de mulheres saudáveis, em atendimento na rede pública de saúde. Foi desenvolvida com propósitode melhorar resultados maternos e perinatais. Sua efetividade foi avaliada por meio de um ensaio aleatorizado por conglomerados, realizado em 20 unidades de saúde que provêm assistência pré-natal em uma cidade da região sudeste do Brasil. Gestantes em acompanhamento pré-natal nas unidades de saúde sorteadas para o grupo intervenção foram convidadas a participar do PRENACEL. Em unidades de saúde alocadas ao grupo controle, as gestantes receberam a atenção pré-natal padrão. Os dados analisados foram coletados durante a internação para o parto em quatro maternidades públicas da mesma localidade. Para cada variável de interesse, foram realizadas análise por intenção de tratar e análise por protocolo, pelo cálculo dos riscos relativos, com 95% de intervalo de confiança. Ao final do seguimento da gestação, 1210 mulheres elegíveis à participação no estudo tiveram seus desfechos avaliados nas maternidades selecionadas para a pesquisa, por meio de revisão de prontuários, cartões de pré-natal e entrevista individual estruturada. Das mulheres incluídas nas análises, 770 eram provenientes das unidades de saúde do grupo intervenção e 440 das unidades controle. Receber informações do programa PRENACEL durante a gestação foi associado a um aumento na percepção das mulheres de sentirem-se melhor preparadas para o parto, e na percepção de que o pré-natal colabora para que se sintam mais preparadas. Também foram observados impactos no estabelecimento do contato pele-a-pele e aleitamento materno e no conhecimento sobre intervenções obstétricas. Não foram observadas diferenças nos demais desfechos maternos e perinatais avaliados, incluindo a satisfação das mulheres com o atendimento. Nossa conclusão é de que o PRENACEL pode contribuir para a ampliação do acesso das mulheres a informações que lhes sejam estratégicas para que se sintam melhor preparadas para a experiência do parto.
Improving maternal health is a priority for global health agencies and for governments in low- and middle-income countries. The challenge of reducing preventable maternal and perinatal morbidity and mortality has highlighted the need to expand actions to prevent injuries beyond the clinical approach to obstetric complications, through strengthening health systems and enhancing autonomy of women within societies, by implementing a human rights approach as one of the components of the quality of reproductive health care. The objective of this research is to determine if a program of health education and support to pregnant women, adapted to be used by Brazilian National Health System and delivered by short messages service (SMS) on the cell phone is a useful complement to standard prenatal follow-up. The research was carried out in two stages, starting with the conduction of a formative and exploratory research to identify barriers and facilitators of antenatal and delivery care, to evaluate the acceptance of the use of SMS as a complementary item to antenatal care and to develop and refine the PRENACEL program intervention. It comprises a program of 148 SMS with essential information from pregnancy to puerperium, for healthy pregnant women attending antenatal care. It was developed with the purpose of improving maternal and perinatal outcomes. Its effectiveness was evaluated through a cluster-randomized trial conducted in 20 health units that provide antenatal care in a city in the southeastern region of Brazil. Pregnant women from the health units drawn for the intervention group were invited to participate in PRENACEL. In health unitsallocated to the control group, pregnant women received standard antenatal care. Analyzed data were collected during admission to labor in four public maternity hospitals in the same locality. For each variable of interest, intention-to-treat analysis and analysis by protocol were carried out, as well as the relative risk, with 95% of confidence interval. At the end of the gestation follow-up, 1210 women eligible to participate in the study had their outcomes evaluated in the maternity wards, through their medical records review, antenatal cards review and individual structured interviews. Of the women included in the analyzes, 770 came from the health units of the intervention group and 440 from the control units. Receiving information from the PRENACEL program during pregnancy was associated with an increase in women\'s perception of better preparedness for delivery, and the perception that antenatal care helps them feel more prepared. Enhancement of the timing for early skin-to-skin contact and breastfeeding, and knowledge on obstetric interventions were also observed. No differences were observed in other maternal and perinatal outcomes evaluated, including women\'s satisfaction with care. We concluded that PRENACEL can contribute to increase women\'s access to information that are strategic to the improve their perception of feeling confident and better prepared for the childbirth experience.

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Kaboré, Wendyam Charles Paulin Didier. "Déterminants de la césarienne de qualité en Afrique de l'Ouest Determinants of non-medically indicated cesarean deliveries in Burkina Faso Maternal and perinatal outcomes associated with a trial of labour after previous caesarean section in sub-Saharan countries." Thesis, Paris 6, 2017. http://www.theses.fr/2017PA066399.

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Au Burkina Faso, le taux populationnel de césariennes reste encore faible (2% en 2012). Cependant, depuis l’exemption partielle (80%) pour les familles du paiement à l’acte en 2006, et la mise à disposition de médecins généralistes, sages-femmes et infirmiers formés à la pratique des césariennes dans les hôpitaux les plus reculés, on observe une augmentation constante des taux de césariennes dans les établissements de santé et il est difficile de savoir si toutes ces interventions sont réellement utiles. L’objectif principal de cette thèse est d’identifier les déterminants d’une césarienne de qualité en Afrique de l’Ouest pour orienter les politiques de santé reproductive dans les pays concernés. Les résultats des travaux menés dans le cadre de cette thèse montrent que le niveau de qualification du personnel de santé travaillant dans les hôpitaux du Burkina Faso et son expérience professionnelle déterminent globalement son niveau de connaissance en matière de gestion du travail et de l’accouchement compliqué. De plus, une supervision régulière de son travail semble améliorer sa performance. Le niveau de qualification du personnel de santé au Burkina Faso influence également la pratique de césariennes non médicalement justifiées. Mais l’environnement social joue aussi un rôle dans cette pratique abusive. Les résultats de cette recherche montrent enfin que la pratique systématique d’une césarienne après une césarienne antérieure n’est pas justifiée dans ce contexte. Les résultats de cette thèse ont permis de développer et de mettre en œuvre un essai d’intervention visant à réduire des césariennes sans raison médicale en Afrique de l’ouest
In Burkina Faso, the national caesarean section rate is still low (2% in 2012). However, since the introduction of caesarean user fee exemption in 2006 and the availability of trained staff to perform a caesarean section in the most remote hospitals, the institutional caesareans rates have risen steadily and it is unclear whether all of these interventions are necessary. The main objective of this thesis is to identify the determinants of an optimal practice of caesarean section in three western African countries that favour access to caesarean section. The results of the work carried out in the framework of this thesis show that the level of qualification of the health personnel working in Burkina Faso hospitals and his professional experience determine globally his level of knowledge in the management of labor and complicated childbirth. . In addition, regular supervision of his work by daily review of clinical records (partograms) seems to improve his performance. The level of qualification of health personnel in Burkina Faso also influences the practice of non-medically justified caesareans. But the social environment also plays a role in this abusive practice. The results of this research show that the systematic practice of cesarean section after an anterior caesarean section is not justified in this context. The results of this thesis led to the development and implementation of a multi-faceted intervention trial aimed at reducing caesareans without medical reason in West Africa

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Longstaff, Tessa. "Analysis of longitudinal data in perinatal trials when the length of follow-up is informative." Thesis, 2016. http://hdl.handle.net/2440/100192.

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Background: Most commonly used statistical methods assume that the data consist of independent observations. Clustered data occur in many settings, such as longitudinal studies, where outcomes are repeatedly measured over time on each subject. Observations from the same subject are dependent and hence form a cluster. Two commonly used methods of analysis for clustered data are mixed models and generalised estimating equations (GEEs). Additional complexity arises when analysing clustered data where the cluster size is informative; that is, where the cluster size is related to the outcome. Most methods of analysis for clustered data, including mixed models and GEEs, generally assume non informative cluster size and hence may not be suitable when the cluster size is informative. Aim: The aim of this thesis is to compare methods for analysing longitudinal data when the cluster size (length of follow up) is informative. Methods: Both real and simulated data were used to compare methods for analysing clustered data with informative cluster size. A range of methods were considered including: GEEs with independent, autoregressive or exchangeable working correlation structures; cluster weighted GEEs; and mixed models. The real data come from a perinatal trial (the POPPET trial), which investigated the effect of high versus standard protein content human milk fortifier on the growth of 60 preterm infants. This dataset was used to investigate different methods of analysis for estimating the effect of treatment on infant growth when informative cluster size was suspected. As real data cannot be used to show which methods of analysis are performing best in general, a simulation study was conducted to compare methods when the true parameter values were known. The data were simulated based on the POPPET trial. Different treatment effects, sample sizes, and correlations between the cluster size and the outcomes were considered. Results: For the POPPET trial, evidence of informative cluster size was found. Different methods of analysis produced quite different parameter estimates but similar conclusions about the effect of the intervention. The simulation results showed that when cluster size was non informative, all methods performed very well. When cluster size was informative, mixed models and autoregressive GEEs always performed well. However, the independence, exchangeable and cluster weighted GEEs often produced low coverage probabilities and model based standard errors that differed from the standard deviation of the parameter estimates. These methods generally performed better when the trial size was larger and when there was no correlation between individual growth trajectories and cluster size. Conclusions: It is recommended that mixed models or autoregressive GEEs be used to analyse longitudinal data with informative cluster size in general, including the POPPET trial data. Independence, exchangeable and cluster weighted GEEs should only be used when the sample size is large and there is no correlation between individual growth trajectories and cluster size.
Thesis (M.Phil.) -- University of Adelaide, School of Mathematical Sciences, 2016.

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Книги з теми "Perinatal trial"

Kenyon, Sara. Is consent informed?: An exploration of whether women gave informed consent when joining a perinatal trial in a given acute situation. Leicester: De Montfort University, 2000.

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Ruth, Vineta. Perinatal asphyxia: Biochemical parameters as indices of asphyxia at birth and predictors of brain damage, and a trial of preventing damage by phenobarbital. Helsinki: University of Helsinki, 1988.

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Sharma, Sandeep. Tribal perinatology. Delhi: Academic Excellence, 2006.

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Magee, Laura. "Best evidence-based" medicine in perinatal phamacology: Trials are not enough. Ottawa: National Library of Canada, 1996.

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National Perinatal Epidemiology Unit (Great Britain) and University of Oxford, eds. A Classified bibliography of controlled trials in perinatal medicine, 1940-84. Oxford [Oxfordshire]: Oxford University Press, 1985.

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Tribal Peinatology. Academic Excellence Publishers & Distributors, 2006.

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Wenzel, Amy, Scott Stuart, and Hristina Koleva. Psychotherapy for Psychopathology During Pregnancy and the Postpartum Period. Edited by Amy Wenzel. Oxford University Press, 2015. http://dx.doi.org/10.1093/oxfordhb/9780199778072.013.22.

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Psychotherapy is often the treatment of choice for perinatal women who wish to limit their fetus’s or infant’s medication exposure. The vast majority of empirical research that has examined psychotherapy for perinatal women has focused on depression. Interpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) have been examined in several studies to determine their efficacy in perinatal depression and anxiety. Recent research has begun to examine the manner in which psychotherapies can be delivered in alternative formats (e.g., teletherapy) in order to overcome problems with treatment retention and compliance. Suggestions for future research include large-scale randomized controlled trials that compare two active approaches to psychotherapy, mediation studies to uncover the mechanisms of change associated with the successful treatment of perinatal women, and randomized controlled trials evaluating the efficacy of psychotherapy for mental health disorders other than depression.

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The National Perinatal Epidemiology Unit. A Classified Bibliography of Controlled Trials in Perinatal Medicine 1940-1984. Oxford University Press, USA, 1986.

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Jacquemyn, Yves, and Anneke Kwee. Antenatal and intrapartum fetal evaluation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0006.

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Antenatal and intrapartum fetal monitoring aim to identify the beginning of the process of fetal hypoxia before irreversible fetal damage has taken place. Fetal movement counting by the mother has not been reported to be of any benefit. The biophysical profile score, incorporating ultrasound and fetal heart rate monitoring, has not been proven to reduce perinatal mortality in randomized trials. Doppler ultrasound allows the exploration of the perfusion of different fetal organ systems and provides data on possible hypoxia and fetal anaemia. Maternal uterine artery Doppler can be used to select women with a high risk for intrauterine growth restriction and pre-eclampsia but does not directly provide information on fetal status. Umbilical artery Doppler has been shown to reduce perinatal mortality significantly in high-risk pregnancies (but not in low-risk women). Adding middle cerebral artery Doppler to umbilical artery Doppler does not increase accuracy for detecting adverse perinatal outcome. Ductus venosus Doppler demonstrates moderate value in diagnosing fetal compromise; it is not known whether its use adds any value to umbilical artery Doppler alone. Cardiotocography (CTG) reflects the interaction between the fetal brain and peripheral cardiovascular system. Prelabour routine use of CTG in low-risk pregnancies has not been proven to improve outcome; computerized CTG significantly reduces perinatal mortality in high-risk pregnancies. Monitoring the fetus during labour with intermittent auscultation has not been compared to no monitoring at all; when compared with CTG no difference in perinatal mortality or cerebral palsy has been noted. CTG does lower neonatal seizures and is accompanied by a statistically non-significant rise in caesarean delivery. Fetal blood sampling to detect fetal pH and base deficit lowers caesarean delivery rate and neonatal convulsions when used in adjunct to CTG. Determination of fetal scalp lactate has not been shown to have an effect on neonatal outcome or on the rate of instrumental deliveries but is less often hampered by technical failure than fetal scalp pH. Analysis of the ST segment of the fetal ECG (STAN®) in combination with CTG during labour results in fewer vaginal operative deliveries, less need for neonatal intensive care, and less use of fetal blood sampling during labour, without a change in fetal metabolic acidosis when compared to CTG alone.

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Частини книг з теми "Perinatal trial"

MacDonald, D. "Randomized trial of fetal monitoring." In Perinatal Medicine, 3–8. Dordrecht: Springer Netherlands, 1985. http://dx.doi.org/10.1007/978-94-009-4918-8_1.

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Burger, Huibert, Claudi L. H. Bockting, Chantal Beijers, Tjitte Verbeek, A. Dennis Stant, Johan Ormel, Ronald P. Stolk, Peter de Jonge, Mariëlle G. van Pampus, and Judith Meijer. "Pregnancy Outcomes After a Maternity Intervention for Stressful Emotions (PROMISES): A Randomised Controlled Trial." In Perinatal Programming of Neurodevelopment, 443–59. New York, NY: Springer New York, 2014. http://dx.doi.org/10.1007/978-1-4939-1372-5_21.

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Tsuji, Masahiro, and Haruo Shintaku. "Clinical Trial of Autologous Cord Blood Cell Therapy for Neonatal Hypoxic Ischemic Encephalopathy (HIE)." In Cell Therapy for Perinatal Brain Injury, 1–15. Singapore: Springer Singapore, 2018. http://dx.doi.org/10.1007/978-981-10-1412-3_1.

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Whitelaw, A. "The role of collaborative clinical trials for auditing perinatal practice." In Perinatal Medicine, 247–50. Dordrecht: Springer Netherlands, 1985. http://dx.doi.org/10.1007/978-94-009-4918-8_47.

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Takahashi, Noriko, and Rintaro Mori. "Clinical Trials on Cell Therapy for Perinatal Brain Injury: Challenges and Opportunities." In Cell Therapy for Perinatal Brain Injury, 131–43. Singapore: Springer Singapore, 2018. http://dx.doi.org/10.1007/978-981-10-1412-3_13.

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Dennis, Cindy-Lee, and Therese Dowswell. "Psychosocial and psychological interventions for the prevention of postpartum depression: An updated systematic review." In Perinatal Psychiatry. Oxford University Press, 2014. http://dx.doi.org/10.1093/oso/9780199676859.003.0008.

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The author gratefully acknowledges Dr Debra Creedy who assisted Dr Dennis with the first version of this review in 2004. The author also wishes to thank: Julie Weston for her data extraction, independent evaluation of trial quality, contacting trial authors as necessary, and data entry; Danni Li for translating Sun 2004; Tang 2009; and Xu 2003. Edward Plaisance Jr for translating Ajh 2006. Alison Balmfirth, Laura Wills, Ed Doragh, and Nivene Raafat for translating Bittner 2009. Aoife Fogarty for translating Kleeb 2005. Francesca Gatenby, Nick Jones, and Juliet Sheath for translating Urech 2009; and the many study authors who were very helpful in responding to queries and providing additional data. Depression is a major cause of disability for all ages and both sexes worldwide. Postpartum depression is often defined as depression occurring within the first year following childbirth. In most studies this includes those women for whom the depression may be a continuation of that experienced during pregnancy, as well as those for whom it is a new onset. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) does not recognize postpartum depression as diagnostically distinct from depression at other times, although does allow for the addition of a ‘postpartum-onset specifier’ in women with an onset within 4 weeks of birth. A recent systematic review of postpartum depression found the period prevalence of all depression to be 19.2% in the first 12 weeks postnatally, with a period prevalence for major depression of 7.1% (Gaynes et al. 2005). This review also identified depression to be common during pregnancy with a period prevalence of 18.4% across the 9 months of pregnancy, with 12.7% having an episode of major depression during this time. Not surprisingly, antenatal depression is a strong risk factor of postpartum depression. The cause of postpartum depression suggests a multifactorial aetiology (Beck 2001; O’Hara and Swain 1996). Despite considerable research, no single causative factor has been isolated. However, meta-analytic findings consistently highlight the importance of psychosocial variables such as stressful life events, marital conflict, and the lack of social support.

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Morrison, Samantha, and Hugh Ehrenberg. "Planned Cesarean Section Versus Planned Vaginal Birth for Breech Presentation at Term." In 50 Studies Every Obstetrician-Gynecologist Should Know, 69–73. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780190947088.003.0013.

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The Term Breech Trial was an international randomized control trial to compare a policy of planned cesarean delivery versus planned vaginal delivery for the singleton term breech fetus. The primary outcome was a composite of perinatal and neonatal mortality and neonatal morbidity. Secondary outcomes were serious maternal morbidity or mortality. The odds of the primary outcome were significantly lower for the planned cesarean section group than for the planned vaginal birth group. This risk reduction was greatest at centers located in industrialized countries with overall low perinatal mortality rates. There were no significant differences in maternal outcomes. The article reviews this hallmark trial and places its findings in context within the current landscape of obstetrics.

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Abel, Kathryn M. "Pregnancy prescribing of psychotropic drugs: Keeping pace in a contemporary landscape." In Perinatal Psychiatry. Oxford University Press, 2014. http://dx.doi.org/10.1093/oso/9780199676859.003.0009.

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Pregnant women and their fetuses are more likely than ever to be exposed to antipsychotic medications; perhaps to the newer agents in particular. Drugs like clozapine, olanzapine, risperidone, and quetiapine are increasingly used in women of reproductive age for a range of psychiatric and behavioural disorders other than schizophrenia (Buchanan et al. 2009). Reproductive safety data remain surprisingly incomplete and guideline recommendations lend limited support to clinical risk-benefit analyses (Howard 2005; McKenna et al. 2005; NICE 2007). This is a problem not least because the gold standard randomized controlled trial is considered unethical for assessing psychotropic medication use during pregnancy, while other available observational studies are generally underpowered, with biased samples and therefore remain unfit for purpose in a rapidly changing prescribing landscape (NICE 2007). In a UK population approaching 66 million, –3,000–4,000 births per year may be exposed to antipsychotics or other psychotropic medications. This chapter provides a critical summary of current knowledge about potential risks of fetal antipsychotic and antiepileptic drug exposure and proposes how future observational studies might fill crucial gaps in the evidence. Most incident cases of severe mental illness (schizophrenia, related disorders, and bipolar disorder) occur during the reproductive years and most are treated with continuous psychotropic pharmacotherapy (Buchanan et al. 2009). Better care, deinstitutionalization and the use of newer agents with fewer effects on fertility means that women with psychotic disorders maybe increasingly likely to become pregnant (Howard 2005; NICE 2007), while the use of newer ‘atypical’ antipsychotics for other mental disorders common among women of childbearing age is also expanding (McKenna et al. 2005). For these reasons, psychotropic medications is increasingly likely to be prescribed to mothers during pregnancy (Newport et al. 2007). It is surprising then that reproductive safety data for psychotropic agents remains so incomplete (Barnes 2008; Webb et al. 2004) and guideline recommendations lend limited support to women, their partners and their treating clinicians in difficult clinical risk-benefit analyses (NICE 2007). Recent reports conclude that prospective studies are needed which can access unbiased, reliable (large enough) samples of ill mothers exposed to psychotropic medication and take account of key maternal characteristics (e.g. psychiatric diagnosis, smoking, pregnancy weight) in the estimation of risk (Barnes 2008; NICE 2007).

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Oakley, Ann. "Who’s Afraid of the Randomized Controlled Trial?" In Social Support and Motherhood, 137–68. Policy Press, 2018. http://dx.doi.org/10.1332/policypress/9781447349457.003.0006.

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This chapter details the design of the Social Support and Pregnancy Outcome (SSPO) study. It describes the ‘hybrid’ nature of the study, which made it difficult for the author to secure funding for it. The Department of Health eventually agreed to fund the SSPO study for three years from September 1985. By then, the author had left the National Perinatal Epidemiology Unit, with its resource of medical and epidemiological expertise, and the final protocol named a collaborator there, Dr Adrian Grant, who had extensive experience in the randomized controlled trial field, and was willing to help at all stages of the study.

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Ross, Lainie Friedman. "When, If Ever, Is It Ethical to Do Research in Developing Countries That Could Not Be Done Ethically in Developed Countries?" In Ethics and Research with Children, 122–44. Oxford University Press, 2018. http://dx.doi.org/10.1093/med-psych/9780190647254.003.0007.

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In this chapter, three studies performed in the 1990s in three developing countries focused on three neonatal infectious diseases are discussed. The studies were (a) a randomized, double-blind, placebo-controlled trial to reduce perinatal transmission of HIV in Thailand; (b) a randomized, double-blind, placebo-controlled trial to prevent Haemophilus influenzae type b pneumonia in infants in The Gambia; and (c) a nonrandomized cluster trial to reduce neonatal mortality rate from sepsis in infants born at home in India. The chapter examines the ethical controversies raised by these studies and concludes that location and intention matter. Although these studies could not have been performed in the United States or United Kingdom, they were designed to answer a question relevant to the community in which the research was being conducted. Finally, the chapter explores the different ethical scrutiny these studies received and what lessons can be learned.

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Тези доповідей конференцій з теми "Perinatal trial"

Li, Qing. "115 Preventing perinatal teen dating violence through relationship education at nurse home visiting: secondary analyses of a randomized controlled trial." In SAVIR 2022 Conference Abstracts. BMJ Publishing Group Ltd, 2022. http://dx.doi.org/10.1136/injuryprev-2022-savir.106.

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O’Brien, Eileen, Sharleen O’Reilly, Lucille Sheehy, Lorraine O’Hagan, Denise McGuinness, Barbara Coughlan, Denise O’Brien, et al. "P514 LatchOn: A multi-centre, randomised controlled trial of perinatal support to improve breastfeeding outcomes in women with overweight and obesity." In Faculty of Paediatrics of the Royal College of Physicians of Ireland, 9th Europaediatrics Congress, 13–15 June, Dublin, Ireland 2019. BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health, 2019. http://dx.doi.org/10.1136/archdischild-2019-epa.850.

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Aflahiyah, Shiva, Didik Gunawan Tamtomo, and Hanung Prasetya. "A Meta-Analysis on the Effectiveness of Prenatal Yoga in Reducing Cortisol Hormone in Pregnancy." In The 7th International Conference on Public Health 2020. Masters Program in Public Health, Universitas Sebelas Maret, 2020. http://dx.doi.org/10.26911/the7thicph.05.47.

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ABSTRACT Backgrund: A growing body of evidence suggests that activity of the stress-responsive hypothalamic-pituitary-adrenal axis and its end-product cortisol also may be associated with perinatal emotional well-being. A number of preventive interventions, such as Yoga, targeting psychosocial and physiological risk factors for perinatal depression have utilized mind-body practices, which embody the idea that the mind interacts with the body to influence physical functioning, improve symptoms, and promote health. This study aimed to investigate effectiveness of prenatal yoga in reducing cortisol hormone in pregnancy Subjects and Method: This was a meta-analysis and systematic review. This study collected published articles during 2000 to 2020 from PubMed, Science Direct, Springer, Proquest, and Chocrane electronic databases. The inclusion criteria were full text, randomized controlled trial, and prenatal yoga intervention. The study subjects were pregnant women who received prenatal yoga for 8 to 20 weeks. Outcome was cortisol hormone reduction during pregnancy. The selected articles were analyzed by PRISMA flow chart and RevMan 5.3. Results: 5 articles from America and Asia were met the inclusion criteria. This study had high heterogeneity (I2=88%; p<0.001). Therefore, this study used random effect model (REM). Prenatal yoga reduced cortisol level 0.59 times in pregnancy (Mean Difference= -0.59; 95% CI= 1.18 to 0.01; p= 0.050). Conclusion: Prenatal yoga is effective to reduce cortisol level in pregnant women. Keywords: prenatal yoga, cortisol hormone, pregnant women Correspondence: Shiva Aflahiyah. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: shivaafla@gmail.com. DOI: https://doi.org/10.26911/the7thicph.05.47

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Dadiz, Rita, Megan M. Gray, Eric Zucker, Susan Izatt, Maria Gillam-Krakauer, Melissa M. Carbajal, Lindsay Johnston, et al. "A Randomized Controlled Trial: How Do Flipped Classrooms and Traditional Didactics Compare for Knowledge Acquisition and Retention among Neonatal-Perinatal Medicine Fellows?" In AAP National Conference & Exhibition Meeting Abstracts. American Academy of Pediatrics, 2021. http://dx.doi.org/10.1542/peds.147.3_meetingabstract.761.

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Murphy, Vanessa E., Megan Jensen, Elizabeth Holliday, Warwick Giles, Helen Barrett, Leonie Callaway, Andrew Bisits, et al. "Late Breaking Abstract - Management of asthma in pregnancy using fractional exhaled nitric oxide (FENO) to adjust inhaled corticosteroid (ICS) dose did not improve perinatal outcomes: the Breathing for Life Trial (BLT)." In ERS International Congress 2020 abstracts. European Respiratory Society, 2020. http://dx.doi.org/10.1183/13993003.congress-2020.138.

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Bergner, M., H. Stepan, U. Schneider, S. Seeger, G. Seliger, and M. Tchirikov. "Multimodales Monitoring des fetalen Inflammationsrisikos beim frühen vorzeitigen Blasensprung (MuMfI-PPROM-Trial) Darstellung erster Zwischenergebnisse." In 28. Deutscher Kongress für Perinatale Medizin. Georg Thieme Verlag KG, 2017. http://dx.doi.org/10.1055/s-0037-1607675.

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Gross, MM, S. Grylka-Baeschlin, F. Bahlmann, M. Fleisch, P. Hillemanns, C. Kaisenberg, F. Koch, RL Schild, M. Clarke, and C. Begley. "Results of the German part of OptiBIRTH (ISRCTN10612254): A cluster randomised trial to increase vaginal birth after one previous caesarean section." In 28. Deutscher Kongress für Perinatale Medizin. Georg Thieme Verlag KG, 2017. http://dx.doi.org/10.1055/s-0037-1607690.

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Haiduk, C., M. Riemer, K. Chaoui, G. Seliger, and M. Tchirikov. "Kontinuierliche Amnioninfusion über ein implantiertes Kathetersystem beim vorzeitigen Blasensprung (PPROM) mit Oligo-/Anhydramnion zwischen 22+0 und 26+0 SSW: eine prospektiv randomisierte, multizentrische BMBF-Studie (ClinicalTrials.gov NCT04696003, German Clinical Trials Register DRKS00024503)." In 30. Kongress der Deutschen Gesellschaft für Perinatale Medizin – „Wandel als Herausforderung“. Georg Thieme Verlag, 2021. http://dx.doi.org/10.1055/s-0041-1739833.

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Звіти організацій з теми "Perinatal trial"

McDonagh, Marian, Andrea C. Skelly, Amy Hermesch, Ellen Tilden, Erika D. Brodt, Tracy Dana, Shaun Ramirez, et al. Cervical Ripening in the Outpatient Setting. Agency for Healthcare Research and Quality (AHRQ), March 2021. http://dx.doi.org/10.23970/ahrqepccer238.

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Objectives. To assess the comparative effectiveness and potential harms of cervical ripening in the outpatient setting (vs. inpatient, vs. other outpatient intervention) and of fetal surveillance when a prostaglandin is used for cervical ripening. Data sources. Electronic databases (Ovid® MEDLINE®, Embase®, CINAHL®, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews) to July 2020; reference lists; and a Federal Register notice. Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) and cohort studies of cervical ripening comparing prostaglandins and mechanical methods in outpatient versus inpatient settings; one outpatient method versus another (including placebo or expectant management); and different methods/protocols for fetal surveillance in cervical ripening using prostaglandins. When data from similar study designs, populations, and outcomes were available, random effects using profile likelihood meta-analyses were conducted. Inconsistency (using I2) and small sample size bias (publication bias, if ≥10 studies) were assessed. Strength of evidence (SOE) was assessed. All review methods followed Agency for Healthcare Research and Quality Evidence-based Practice Center methods guidance. Results. We included 30 RCTs and 10 cohort studies (73% fair quality) involving 9,618 women. The evidence is most applicable to women aged 25 to 30 years with singleton, vertex presentation and low-risk pregnancies. No studies on fetal surveillance were found. The frequency of cesarean delivery (2 RCTs, 4 cohort studies) or suspected neonatal sepsis (2 RCTs) was not significantly different using outpatient versus inpatient dinoprostone for cervical ripening (SOE: low). In comparisons of outpatient versus inpatient single-balloon catheters (3 RCTs, 2 cohort studies), differences between groups on cesarean delivery, birth trauma (e.g., cephalohematoma), and uterine infection were small and not statistically significant (SOE: low), and while shoulder dystocia occurred less frequently in the outpatient group (1 RCT; 3% vs. 11%), the difference was not statistically significant (SOE: low). In comparing outpatient catheters and inpatient dinoprostone (1 double-balloon and 1 single-balloon RCT), the difference between groups for both cesarean delivery and postpartum hemorrhage was small and not statistically significant (SOE: low). Evidence on other outcomes in these comparisons and for misoprostol, double-balloon catheters, and hygroscopic dilators was insufficient to draw conclusions. In head to head comparisons in the outpatient setting, the frequency of cesarean delivery was not significantly different between 2.5 mg and 5 mg dinoprostone gel, or latex and silicone single-balloon catheters (1 RCT each, SOE: low). Differences between prostaglandins and placebo for cervical ripening were small and not significantly different for cesarean delivery (12 RCTs), shoulder dystocia (3 RCTs), or uterine infection (7 RCTs) (SOE: low). These findings did not change according to the specific prostaglandin, route of administration, study quality, or gestational age. Small, nonsignificant differences in the frequency of cesarean delivery (6 RCTs) and uterine infection (3 RCTs) were also found between dinoprostone and either membrane sweeping or expectant management (SOE: low). These findings did not change according to the specific prostaglandin or study quality. Evidence on other comparisons (e.g., single-balloon catheter vs. dinoprostone) or other outcomes was insufficient. For all comparisons, there was insufficient evidence on other important outcomes such as perinatal mortality and time from admission to vaginal birth. Limitations of the evidence include the quantity, quality, and sample sizes of trials for specific interventions, particularly rare harm outcomes. Conclusions. In women with low-risk pregnancies, the risk of cesarean delivery and fetal, neonatal, or maternal harms using either dinoprostone or single-balloon catheters was not significantly different for cervical ripening in the outpatient versus inpatient setting, and similar when compared with placebo, expectant management, or membrane sweeping in the outpatient setting. This evidence is low strength, and future studies are needed to confirm these findings.

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Community involvement in the prevention of mother-to-child transmission of HIV: Insights and recommendations. Population Council, 2001. http://dx.doi.org/10.31899/hiv2001.1008.

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Mother-to-child transmission is the primary route of HIV infection in children under 15 years of age. Since the beginning of the HIV epidemic, an estimated 5.1 million children worldwide have been infected with HIV. Clinical trials in several countries have shown that mother-to-child transmission of HIV can be greatly reduced through administering antiretroviral therapy to pregnant women. These trials culminated in a recommendation by UNAIDS and its partners in the Interagency Task Team for the Prevention of Mother-to-Child Transmission that prevention of perinatal transmission should be a part of the standard package of care for HIV-positive women and their children. Moreover, prevention programs can enhance communities’ response to HIV. In 1999, the Population Council and the International Center for Research on Women initiated activities to identify mechanisms for enhancing community involvement in efforts to prevent mother-to-child transmission. The organizations reviewed the literature on community involvement in the introduction of technologies and assessed community views on preventing mother-to-child transmission in Botswana and Zambia. The literature review provided information about community involvement in earlier introductions of technologies. As noted in this report, that information can guide appropriate and effective community involvement.

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