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1.
Digna R. Velez Edwards Frances E. Likis Jeffrey C. Andrews Alison L. Woodworth Rebecca N. Jerome Christopher J. Fonnesbeck J. Nikki McKoy Katherine E. Hartmann 《Archives of gynecology and obstetrics》2013,287(6):1059-1066
Purpose
Progestogen has been investigated as a preventive intervention among women with increased preterm birth risk. Our objective was to systematically review the effectiveness of intramuscular (IM), vaginal, and oral progestogens for preterm birth and neonatal death prevention.Methods
We included articles published from January 1966 to January 2013 and found 27 randomized trials with data for Bayesian meta-analysis.Results
Across all studies, only vaginal and oral routes were effective at reducing preterm births (IM risk ratio [RR] 0.95, 95 % Bayesian credible interval [BCI]: 0.88–1.03; vaginal RR 0.87, 95 % BCI: 0.80–0.94; oral RR 0.64, 95 % BCI: 0.49–0.85). However, when analyses were limited to only single births all routes were effective at reducing preterm birth (IM RR 0.77, 95 % BCI: 0.69–0.87; vaginal RR 0.80, 95 % BCI: 0.69–0.91; oral RR 0.66, 95 % BCI: 0.47–0.84). Only IM progestogen was effective at reducing neonatal deaths (IM RR 0.78, 95 % BCI: 0.56–0.99; vaginal RR 0.75, 95 % BCI: 0.45–1.09; oral RR 0.72, 95 % BCI: 0.09–1.74). Vaginal progestogen was effective in reducing neonatal deaths when limited to singletons births.Conclusions
All progestogen routes reduce preterm births but not neonatal deaths. Future studies are needed that directly compare progestogen delivery routes. 相似文献2.
Purpose
To evaluate the effect of MET on ovulation and reproductive outcomes in patients with polycystic ovary syndrome.Methods
Meta-analysis of available data from randomized controlled trials that examined the ovulation, pregnancy and live birth rate after the administration of clomiphene citrate (CC) or MET alone or combined.Results
The ovulation rate was found to be higher in the group treated with MET combined with clomiphene citrate (CC) than only with CC, odds ratio (OR): 1.27, 95 % confidence interval (95 % CI) (1.03–1.56), while the pregnancy and live birth rate showed no significant difference between the two groups, OR: 1.19, 95 % CI (0.99–1.42) and OR: 0.99, 95 % CI (0.84–1.17), respectively. The MET + CC group produced a higher ovulation and pregnancy rate than MET group, OR: 2.10, 95 % CI (1.89–2.34) and OR: 2.08, 95 % CI (1.55–2.80), respectively, while between two groups the live birth rate showed no significant difference, OR: 1.50, 95 % CI (0.75–3.00). The ovulation rate was lower in MET than in CC group, OR: 0.65, 95 % CI (0.43–0.995), while between the two groups the pregnancy and live birth rate showed no significant difference, OR: 0.86, 95 % CI (0.42–1.74) and OR: 0.89, 95 % CI (0.71–1.13).Conclusion
The current study indicated that combination of MET and CC could gain advantage over a single administration in the ovulation induction and pregnancy rate. 相似文献3.
Mojgan Asadi Nasim Matin Mitra Frootan Jaleh Mohamadpour Mostafa Qorbani Fatemeh Davari Tanha 《Archives of gynecology and obstetrics》2014,289(4):865-870
Purpose
To determine whether administration of vitamin D affects the success rates of intra uterine insemination (IUI) in infertile polycystic ovarian syndrome (PCOS) women and their endometrial thickness.Methods
This randomized, double-blind, placebo-controlled trial was conducted in an infertility clinic of Women’s Hospital, and 110 infertile PCOS patients undergoing IUI were randomly divided to receive vitamin D or placebo. Endometrial thickness, IUI results, number of dominant follicles, duration of IUI cycle, and dose of HMG used in IUI were determined.Results
The endometrial thickness was significantly different in the group treated with vitamin D versus the placebo group (p = 0.003). There was no statistical difference in pregnancy out come between the two groups (RR = 1.167, CI 95 % 0.70–1.93). No statistical difference was found in number of dominant follicles (p = 0.96), duration of IUI cycles (p = 0.70) and dose of HMG used for IUI (p = 0.95).Conclusions
It seems that administration of vitamin D induces endometrial proliferation in PCOS women during IUI cycle. 相似文献4.
Mesut Oktem Setenay Arzu Yilmaz Nuray Bozkurt Mehmet Erdem Ahmet Erdem 《Gynecological endocrinology》2014,30(12):909-912
Objective: This study aimed to evaluate the effect of luteal phase support on clinical pregnancy and live birth rates after ovulation induction and intrauterine insemination (IUI).Methods: 579 cycles from 2010 to 2013 were retrospectively evaluated. Ovarian stimulation was performed with gonadotropins, and rHCG was used for ovulation triggering. All patients received IUI. 451 cycles were supported by receiving vaginal micronized progesterone capsules (142 cycles) or vaginal progesterone gel (309 cycles) whereas 128 cycles were not supported.Results: Clinical pregnancy (20.6 versus 9.4%; p?=?0.004) and live birth rates (14 versus 7%; p?=?0.036) were higher for supported group than for unsupported group. Progesterone gel and micronized progesterone subgroups achieved similar clinical pregnancy and live birth rates (21.4 versus 19%, p?=?0.567 and 14.2 versus 13.4%, p?=?0.807; respectively).Conclusions: Luteal phase support improved the success of IUI cycles affecting both clinical pregnancy and live birth rates when gonadotropins were used for ovulation induction. The use of vaginal progesterone gel or micronized progesterone significantly improves clinical pregnancy rates. The live birth rates were higher in the progesterone gel group, but were similar in the micronized progesterone group compared to the unsupported group. 相似文献
5.
Purpose
This study evaluated the impact of route of progesterone administration as luteal phase support on the outcome of assisted conception cycles.Methods
Intramuscular progesterone in oil (IMP) at 100 mg daily was administered to 903 women following oocyte retrieval whereas vaginal progesterone gel (VMP) at 90 mg was administered twice daily to 1,110 women. Retrospective analysis was performed according to the type of GnRH analogue used. Implantation (IR), clinical pregnancy (CPR) and biochemical pregnancy rates (BPR) were main outcomes.Results
In GnRH agonist cycles, neither IR, CPR or BPR differed according to the route of progesterone. However, in GnRH antagonist cycles, IR and CPR were significantly lower in VMP group compared to IMP group. BPR also was significantly higher in VMP group compared to IMP group.Conclusion
Our results suggest that route of progesterone administration for luteal phase support can be an important prognostic factor according to the type of GnRH analogue used for controlled ovarian hyperstimulation. 相似文献6.
C. E. Boots M. Meister A. R. Cooper A. Hardi E. S. Jungheim 《Journal of assisted reproduction and genetics》2016,33(8):971-980
Purpose
The purpose of this study was to evaluate whether outcomes are different if controlled ovarian stimulation (COS) is started in the luteal phase rather than the follicular phase.Methods
A systematic review and meta-analysis was performed. Sixteen studies were included in the qualitative analysis, and eight studies with a total of 338 women were included in the quantitative analysis.Results
Cycles initiated in the luteal phase were slightly longer (WMD 1.1 days, 95 % CI 0.39–1.9) and utilized more total gonadotropins (WMD 817 IU, 95 % CI 489–1144). However, no differences were noted in peak estradiol levels (WMD ?411 pg/ml, 95 % CI ?906–84.7) or in the total number of oocytes retrieved (WMD 0.52 oocytes, 95 % CI ?0.74–1.7). There were slightly more mature oocytes retrieved in the luteal phase (WMD 0.77 oocytes, 95 % CI 0.21–1.3), and fertilization rates were significantly higher (WMD 10 %, 95 % CI 0.03–0.18). While only three studies reported pregnancy outcomes, no difference was noted in the FET pregnancy rates after COS in the luteal versus follicular phase (RR 0.95, 95 % CI 0.56–1.7).A post hoc power analysis revealed that a sample of this size was sufficient to detect a clinically meaningful difference of 2 oocytes retrieved with 93 % power.Conclusion
Although initiating COS in the luteal phase requires a longer stimulation and a higher dose of total gonadotropin, these differences are not clinically significant. Furthermore, COS initiated in the luteal phase does not compromise the quantity or quality of oocytes retrieved compared to outcomes of traditional stimulation in the follicular phase.7.
Monica Gil Valerie Sar-Shalom Yolisid Melendez Sivira Ramon Carreras Miguel Angel Checa 《Journal of assisted reproduction and genetics》2013,30(4):479-485
Purpose
To determine whether the use of Magnetic Activated Cell Sorting (MACS) as a sperm selection technique improves ART success rates in couples undergoing assisted reproduction treatment.Methods
Systematic review and meta-analysis of prospective randomized trials. Two reviewers conducted study selection and data extraction independently.Results
Five studies (prospective randomized trials) that comprised 499 patients were included. Sperm selection using MACS resulted in statistically significant differences in pregnancy rates when compared with density gradient centrifugation and swim-up techniques (RR?=?1.50, 95 % CI 1.14–1.98). No differences were found between the groups according to the implantation (RR?=?1.03, 95 % CI 0.80–1.31) and miscarriage (RR?=?2.00, 95 % CI 0.19–20.90) rates.Conclusions
MACS appears to be a safe and efficient method to select functional sperm with consistently good results. This technique may improve pregnancy rates when used to complement standard sperm selection methods in ART. 相似文献8.
Objective
This study aimed at assessing the association of the relative risk (RR) of adverse pregnancy outcomes with previous treatment of loop electrosurgical excision procedure (LEEP) for the management of cervical intraepithelial neoplasia (CIN).Methods
Data sources were from MEDLINE, EMBASE, and SCI citation tracking. Selection criteria: The eligible studies had data on pregnancy outcomes of women with or without previous treatment for CIN. Considered outcomes were severe preterm delivery (<34/32 weeks), extreme preterm delivery (<28 weeks), low birth weight (<2,500 g), stillbirth, preterm spontaneous rupture of membranes, perinatal mortality, and neonatal mortality and induction.Results
36,954 cases and 1,794,174 controls in 4 prospective cohort and 22 retrospective studies were included in this meta-analysis. LEEP was associated with a higher risk of severe preterm delivery (<32 weeks, relative risk 1.98, 95 % CI [1.31, 2.98] 159/11,337 vs. 7,830/860,883), extreme preterm delivery (<28 weeks, RR, 2.33, 95 % CI [1.84, 2.94] 97/9,611 vs. 1,559/618,332), preterm premature rupture of the membranes (RR, 1.88, 95 % CI [1.54, 2.29] 126/2,837 vs. 7,899/313,094), and low birth weight (<2,500 g, RR, 2.48, 95 % CI [1.75, 3.51] 110/1,451 vs. 55/1,742). A cervical length of less than 3 cm was significantly increased in LEEP as compared with that of control group (RR, 4.88, 95 % CI [1.56, 15.25]), but increasing LEEP volume or depth was not associated with an increased rate of preterm birth <37 weeks. And LEEP was not associated with a significantly increased risk of perinatal mortality, cesarean section, stillbirth mortality, neonatal mortality, induction, and neonatal intensive care unit admission.Conclusions
LEEP is associated with an increased risk of subsequent preterm delivery (<32/34, <28 weeks) and other serious pregnancy outcomes. But increasing LEEP volume or depth is not associated with an increased rate of preterm birth. 相似文献9.
Enrico Papaleo Laura Corti Valeria Stella Vanni Luca Pagliardini Jessica Ottolina Francesca De Michele Antonio La Marca Paola Viganò Massimo Candiani 《Archives of gynecology and obstetrics》2014,290(1):169-176
Purpose
Modest increases of serum progesterone at human chorionic gonadotrophin (hCG) administration in controlled ovarian hyperstimulation (COH) cycles have been shown to have a negative impact on pregnancy outcomes. The aim of this study was to identify early predictors of progesterone elevation at hCG.Design
Pregnancy outcome of 303 consecutive patients undergoing COH and fresh day-3 embryo transfer was analysed. Considering the non-linear relationship between progesterone at hCG triggering and pregnancy outcomes, partial area under the curve (pAUC) analysis was used to implement marker identification potential of receiver operating characteristic (ROC) curve analysis. Multivariate logistic analysis was then performed to identify predictors of progesterone rise.Results
Pregnancy outcomes could be predicted by pAUC analysis (pAUC = 0.58, 95 % CI 0.51–0.66, p = 0.02) and a significant detrimental cut-off could be calculated (progesterone at hCG > 1.35 ng/ml). Total dose of rFSH administered, E2 level at hCG but mostly basal progesterone level (OR = 12.21, 95 % CI 1.82–81.70) were predictors of progesterone rise above the cut-off.Conclusion
Basal progesterone is shown to be the main prognostic factor for progesterone elevation. This observation should be taken into consideration in the clinical management of IVF/ICSI cycles to improve pregnancy outcomes. 相似文献10.
Meixiang Zhang Wenbin Niu Yu Wang Jiawei Xu Xiao Bao Linlin Wang Linqing Du Yingpu Sun 《Journal of assisted reproduction and genetics》2016,33(8):981-991
Purpose
We reviewed the influence of dehydroepiandrosterone (DHEA) supplementation in patients with poor ovarian response (POR) undergoing in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI).Methods
We searched Embase, MEDLINE, PubMed, and the Cochrane Library (1980–2015) for relevant papers and used the Newcastle–Ottawa Scale scoring system to evaluate study quality. Dichotomous data were expressed as pooled relative risk (RR) estimates with fixed or random effect models. Continuous variables were expressed as the weighted mean difference (WMD). All data were analyzed using Revman Software v. 5 and are shown with 95 % confidence intervals (CI).Results
Twenty-one studies met the inclusion criteria. DHEA pretreatment increased the clinical pregnancy rate (RR 1.53, 95 % CI 1.25–1.86), live birth rate (RR 1.87, 95 % CI 1.22–2.88), implantation rate (RR 1.56, 95 % CI 1.20–2.01), and antral follicle count (WMD 0.4, 95 % CI 0.14 to 0.66) while reducing miscarriages (RR 0.50, 95 % CI 0.27–0.90). After subgroup analysis, oocyte numbers and anti-Müllerian hormone levels were also enhanced after DHEA treatment. However, the endometrial thickness and estradiol levels on the day of injecting hCG to induce ovulation were similar between the DHEA supplementation groups and controls.Conclusions
Based on the limited available evidence, DHEA supplementation seems to improve ovarian reserves and IVF/ICSI outcome in patients with POR. Further research is required to clarify the effect of DHEA exposure in assisted reproduction technology.11.
Yetunde Ibrahim Miriam J. Haviland Michele R. Hacker Alan S. Penzias Kim L. Thornton Denny Sakkas 《Journal of assisted reproduction and genetics》2017,34(6):759-764
Purpose
The purpose of the study was to examine the association between serum progesterone levels on the day of hCG administration and birth weight among singleton live births after fresh embryo transfer.Methods
This study was conducted as a retrospective cohort database analysis on patients who underwent IVF treatment cycles from January 2004 to April 2012. The study was performed at a University affiliated private infertility practice. All cycles that had achieved a singleton live birth after fresh embryo transfer and for which progesterone was measured on the day of hCG administration were examined. Generalized linear models were used to calculate mean birth weight and z-scores.Results
We analyzed 817 fresh IVF embryo transfers in which birth weight, gestational age, and progesterone (ng/mL) level on day of hCG administration were documented. While there was a decrease in birth weight as progesterone quartile [≤0.54; >0.54 to ≤0.81; >0.81 to ≤1.17; >1.17 ng/mL] increased, the difference in mean birth weights among the four quartiles was not statistically significant (p = 0.11) after adjusting for maternal age and peak estradiol levels. When dichotomizing based on a serum progesterone considered clinically elevated, cycles with progesterone >2.0 ng/mL had a significantly lower mean singleton birth weight (2860 g (95% CI 2642 g, 3079 g)) compared to cycles with progesterone ≤2.0 ng/mL (3167 g (95% CI 3122 g, 3211 g) p = 0.007)) after adjusting for maternal age and estradiol.Conclusion
We demonstrated that caution should be exercised when performing fresh embryo transfers with elevated progesterone levels and in particular with levels (>2.0 ng/mL) as this may lead to lower birth weight.12.
Andreja Trojner-Bregar Nataša Tul Ivan Verdenik Živa Novak Isaac Blickstein 《Archives of gynecology and obstetrics》2013,288(3):551-554
Objective
To evaluate the puerperal complications following twin deliveries.Study design
We conducted a population-based analysis of puerperal delivery-related complications of twins born in Slovenia for comparing three groups of births (vaginal, elective and emergent cesarean).Results
A total of 1,001 elective, 1,109 emergent cesarean sections, and 2,204 vaginal twin births were evaluated. No differences were found between the complications after emergent and elective cesareans. Uterine atony was more frequent after vaginal births (OR 1.8–2.0, 95 % CI 1.1–1.2, 2.9–3.3). Vaginal births had a higher frequency of endometritis compared with elective cesarean (OR 4.1, 95 % CI 1.2, 13.6). Conversely, vaginal deliveries were less frequently associated with anemia, hematoma formation, and need for blood transfusion as compared to both modes of cesarean deliveries.Conclusion
No solid data exist to show a clear advantage or disadvantage in terms of puerperal complications of an elective cesarean over vaginal birth for twins. 相似文献13.
Background
Membrane sweeping (MS) could increase the likelihood of spontaneous labor within 48 h. However, the rationale for performing routinely an intervention with the potential to induce labor in women with an uneventful pregnancy at 38 weeks of gestation is, at least, questionable. We conducted a meta-analysis of randomized controlled trial (RCT) studies to assess evaluated the effect of MS added to formal induction method on the spontaneous vaginal delivery, compared with formal induction alone.Methods
PubMed, Embase, Cochrane Library databases, Web of Science, and Clinical Trials were searched from their inception to March 8, 2017. We estimate summarized relative risk (RR) and 95% confidence intervals (CIs) for dichotomous outcomes. The primary outcome was vaginal delivery, and second outcomes (side effects of MS) included meconium-stained liquor, admission to the neonatal unit, instrumental delivery.Results
Four RCTs with a total of 1377 participants were identified. The summary RR in the overall group was 1.12 (95% CI 1.05–1.18), with moderate heterogeneity (P = 0.22, I2 = 33%). The summary RR in the nulliparas’ subgroup was 1.32 (95% CI 1.18–1.48), with no heterogeneity (P = 0.79, I2 = 0%). MS did not increase the risk of side effects.Conclusions
MS added to formal induction significantly increased vaginal delivery rates, especially in nulliparas compared with formal induction alone. Notably, there are no obvious side effects of MS. Meanwhile, more RCTs studies are needed to investigate the side effects of MS on instrumental delivery, postpartum hemorrhage, and cervical laceration.14.
Amr M. Salaheldin Abdelhamid 《Archives of gynecology and obstetrics》2013,288(3):673-678
Objective
The aim of this work was to compare the pregnancy rates during IUI cycles with or without endometrial sampling.Study design
A prospective, randomized study.Patients and methods
150 patients were recruited. They were classified into three groups. Each comprised 50 patients. Group 1 was considered the control group and underwent IUI with no endometrial sampling. Group 2 underwent Tao Brush endometrial sampling on day 8–9 of the uterine cycle that preceded the stimulation cycle, and finally, Group 3 underwent Tao Brush endometrial sampling on day 8–9 of the same IUI cycleOutcome of the study
A positive pregnancy test.Results
Pregnancy percentages were 18, 38, and 36 % for group 1, group 2, and group 3, respectively. The paired t test was used to compare each two individual group means. The results show a highly significant value for the paired t test of the control group and group 2 of the patients (p = 0.001), as well as a highly significant results (p = 0.002) for the group 3 and the control group. No significant value was present between the group 2 and 3 of patients (p = 0.322).Conclusion
Endometrial sampling significantly increases pregnancy rates in IUI procedures when it is done in the proliferative phase of the IUI cycle, or the cycle prior to IUI, than pregnancy rates with IUI alone. 相似文献15.
Introduction
Office hysteroscopy (OH) allows assessment of the uterine cavity. The aim of this study is to investigate uterine cavity of infertile patients with OH, to treat pathologies and to measure the impact of OH on live birth rates and IVF treatment costs.Materials and methods
498 IVF patients were selected for this study. Control group (398 patients) underwent IVF without OH evaluation. OH group (100 patients) was assessed prior to IVF and detected intrauterine pathologies were treated. OH group was divided into two subgroups: patients with normal uterine cavity (59 patients) and patients who had intrauterine pathologies (41 patients). Number needed to treat (NNT) was also measured.Results
When live birth rates of the control and OH groups were compared, OH group’s rate was significantly higher (18.3 vs. 26 %; p > 0.05). 41 % of the patients in the OH group had intrauterine pathologies. When live birth rates of control group and the subgroups were compared, it was significantly higher in the subgroups (p < 0.05). When live birth rates of the subgroups were compared, there was a statistically significant difference in intrauterine pathology subgroup (p < 0.05). NNT measures showed that 13 OH interventions were needed to achieve one additional pregnancy [NNT 13.05; relative risk (RR) 1.418], while five pathologies had to be found and treated with OH to achieve one additional pregnancy (NNT 5; RR 1.962).Conclusion
Usage of OH can play an important role in detecting intrauterine pathologies in IVF patients. Therefore, it may have a positive impact on pregnancy outcome and treatment costs. 相似文献16.
Ayla Sargın Oruç Nafiye Yılmaz Umit Görkem Hasan Ali Inal Berna Seçkin Cavidan Gülerman 《Archives of gynecology and obstetrics》2014,289(1):207-212
Purpose
To evaluate the influence of ultrasound guidance during intrauterine insemination (IUI) on pregnancy rates (PRs). The impacts of two different groups of providers were also investigated.Methods
Study population consisted of 387 gonadotropin stimulated IUI cycles performed for unexplained infertility. The patients were randomized into two groups as ultrasound-guided IUI (n = 180) and classical IUI (n = 207). Pregnancy rates were compared. Two groups were further analyzed based on the experience of the provider (senior versus junior subgroups) who performed IUI.Results
Pregnancy rates were higher in the ultrasound-guided IUI group (17.2 %) compared to the classical IUI (10.1 %) (p = 0.042). In further analysis based on the experience of the provider; in the classical IUI group, PRs were similar for both subgroups, however, in the ultrasound-guided group it was higher when IUI was performed by a senior physician (21.7 versus 9.2 %, p = 0.033). Logistic regression revealed that the experience of the provider was the independent variable for improved PRs.Conclusions
Ultrasound guidance improves PRs only when a senior provider performs the IUI procedure. It seems that the experience of the provider physician is one of the determinants of IUI success. 相似文献17.
Lei Guo Chen Luo Song Quan Leining Chen Hong Li Yangchun Guo Zhiming Han Xianghong Ou 《Journal of assisted reproduction and genetics》2013,30(12):1589-1594
Purpose
To study the influence of post-thawed culture (2–4 h and 20–24 h) on the outcome of frozen-thawed embryo transfer (FET) cycle.Methods
In this retrospective study, a total of 1,353 patients were undergoing the FET treatment at the reproductive medical center between June 2010 and July 2012. 3,398 frozen-thawed embryos were divided in two study groups, depending on their post-thawed culture period: short culture (2–4 h) group and long culture (20–24 h) group. Groups were compared including clinical pregnancy rate, implantation rate, spontaneous abortion rate, ectopic pregnancy rate, multiple pregnancy rate, live birth rate and birth weight.Results
When embryos including at least one grade I embryo after thawed transferred, the clinical pregnancy rate, implantation rate, multiple pregnancy rate, abortion rate, ectopic pregnancy rate, live birth rate and birth weight were similar in the short culture group compared with these in the long culture group.Conclusions
The outcomes of the two approaches (short culture and long culture) are no different in FET cycles. 相似文献18.
Larissa Jennings André Sourou Yebadokpo Jean Affo Marthe Agbogbe 《BMC pregnancy and childbirth》2010,10(1):1-13
Background
Most women use some method of pain relief during labour. There is extensive research evidence available of pharmacological pain relief during labour; however this evidence is not readily available to pregnant women. Decision aids are tools that present evidence based information and allow preference elicitation.Methods
We developed a labour analgesia decision aid. Using a RCT design women either received a decision aid or a pamphlet. Eligible women were primiparous, ≥ 37 weeks, planning a vaginal birth of a single infant and had sufficient English to complete the trial materials. We used a combination of affective (anxiety, satisfaction and participation in decision-making) and behavioural outcomes (intention and analgesia use) to assess the impact of the decision aid, which were assessed before labour.Results
596 women were randomised (395 decision aid group, 201 pamphlet group). There were significant differences in knowledge scores between the decision aid group and the pamphlet group (mean difference 8.6, 95% CI 3.70, 13.40). There were no differences between decisional conflict scores (mean difference -0.99 (95% CI -3.07, 1.07), or anxiety (mean difference 0.3, 95% CI -2.15, 1.50). The decision aid group were significantly more likely to consider their care providers opinion (RR 1.28 95%CI 0.64, 0.95). There were no differences in analgesia use and poor follow through between antenatal analgesia intentions and use.Conclusions
This decision aid improves women's labour analgesia knowledge without increasing anxiety. Significantly, the decision aid group were more informed of labour analgesia options, and considered the opinion of their care providers more often when making their analgesia decisions, thus improving informed decision making.Trial Registration
Trial registration no: ISRCTN52287533 相似文献19.
Tamara?K.?Parissenti Gundula?Hebisch Wieland?Sell Patricia?E.?Staedele Volker?Viereck Mathias?K.?Fehr
Purpose
To identify risk factors for emergency caesarean section in women attempting a vaginal breech delivery at term.Methods
Data from 1092 breech deliveries performed between 1998 and 2013 at a Swiss cantonal hospital were extracted from an electronic database. Of the 866 women with a singleton, full term pregnancy, 464 planned a vaginal breech delivery. Fifty-seven percent (265/464) were successful in delivering vaginally. Multivariate regression analyses of risk factors were performed, and neonatal and maternal complications were compared.Results
Risk factors for failed vaginal delivery were peridural anaesthesia (OR 2.05; 95 % CI 1.09–3.84; p = 0.025), nulliparity (OR 2.82; 95 % CI 1.87–4.25; p < 0.001), high birth weight (OR 1.17; 95 % CI 1.04–1.30; p = 0.006) and induction of labour (OR 1.56; 95 % CI 1.003–2.44; p = 0.048). Maternal age, height and weight; gestational age; or newborn length and head circumference were not associated with an unplanned caesarean section. The rate of successful vaginal delivery in the low risk sub-group (multiparous women without induction of labour) was 58–83 %, depending on birth weight category. The likelihood of success for the high risk sub-group (nulliparous women with induction of labour) fell below a third at neonatal birth weights >3250 g. Complication rates were low in the cohort.Conclusions
Use of peridural anaesthesia, nulliparity, high birth weight and induction of labour were risk factors for unsuccessful vaginal breech delivery requiring an unplanned caesarean section. Awareness of these risk factors is useful when counselling women who are considering a vaginal breech delivery.20.
Alexis P Melnick Robert Setton Logan D. Stone Nigel Pereira Kangpu Xu Zev Rosenwaks Steven D. Spandorfer 《Journal of assisted reproduction and genetics》2017,34(10):1325-1331