xiao cao

and 13 more

Abstract Background Perineal trauma refers to damage to the genitalia during the birthing process and can occur spontaneously or as a result of an episiotomy or female genital mutilation (FGM). Objective To perform a systematic review and network meta-analysis investigating the effectiveness of different PFMT relevant strategies in the prevention of perineal trauma. Search strategy PubMed, Embase, the Cochrane Library, CINAHL, CNKI, CBM, WANFANG DATABASE, and ClinicalTrials.gov were searched for citations published in any language from inception to 1 July 2021. Selection criteria Randomised controlled trials (RCTs) of PFMT relevant prevention strategy to prevent perineal trauma in pregnant women. Data collection and analysis Data were independently extracted by two reviewers. Relative treatment effects were estimated using network meta-analysis (NMA). Main results Of 12632 citations screened, 21 RCTs were included. Comparing with usual care, “PFMT combine with perineal massage” and PFMT alone showed more superiority in intact perineum (RR=5.37, 95%CI: 3.79 to 7.60, moderate certainty; RR=2.58, 95%CI: 1.34 to 4.97, moderate certainty), episiotomy (RR=0.26, 95%CI: 0.14 to 0.49, very low certainty; RR=0.63, 95%CI: 0.45 to 0.90, very low certainty), and OASIS (RR=0.35, 95%CI: 0.16 to 0.78, moderate certainty; RR=0.49, 95%CI: 0.28 to 0.85, high certainty). “PFMT combine with perineal massage” show superiority in reducing perineal tear (RR=0.41, 95%CI: 0.20 to 0.85, moderate certainty). Conclusion In this systematic review, the finding on the perineal trauma indicated that “PFMT combine with perineal massage” and PFMT showed more superiority to prevent perineal trauma.

xiao cao

and 6 more

Background Hyperemesis gravidarum (HG) is a severe complication of pregnancy affecting around 1% of pregnancies globally. Objective To investigate whether ondansetron use during pregnancy is associated with increased rates of abnormal pregnancy outcomes. Search strategy PubMed, Embase, the Cochrane Library, CINAHL, CNKI, CBM, WANFANG, and ClinicalTrials.gov were searched for citations published in any language from inception to 15 December 2021. Selection criteria Eligible studies included any observational study. Data collection and analysis We used odds ratios (ORs) and 95% confidence intervals (CIs) as a measure of the association between ondansetron and abnormal pregnancy outcomes. Main results Of 1,558 citations screened, 19 articles were included. No significant increased risk for overall congenital malformations (OR=1.10,95% CI:0.94–1.29, Low certainty), cleft palate (OR=0.78,95% CI:0.37–1.64, Very Low certainty), stillbirth (OR=0.60,95% CI:0.40–0.91, Low certainty) or preterm birth (OR=0.78,95% CI:0.37–1.64, Low certainty) were identified in our primary analysis. However, the results of our primary analysis indicated that ondansetron use during pregnancy was associated with significantly increased rates of heart defects (OR=1.06,95% CI:1.02–1.11, Moderate certainty) and other organ malformations (OR=1.09,95% CI:1.03–1.16, Moderate certainty) when exposed infants were compared with healthy or disease-matched controls. Conclusion Ondansetron use during pregnancy was associated with a significant increase in rate of some abnormal pregnancy outcomes in our primary analysis. In conclusion, our review found that ondansetron should not use as first-line treatment for NVP. But for sever and incurable NVP, clinician can consider use moderate amount ondansetron to treat NVP with close monitoring.

Qiuyu Yang

and 13 more

Background Different techniques have been reported to prevent perineal lacerations, but the effects of the use of lubricant have been unclear and is still subject of debate. Objective To assess the effect of lubricants on reducing perineal trauma during vaginal delivery. Search strategy PubMed, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), WanFang databases, ClinicalTrials.gov in 25 June 2021. Selection criteria Randomized controlled trials published in English or Chinese that compared the vaginal application of lubricant with standard care in women with cephalic presentation at vaginal delivery were included . Data collection and analysis Two independent reviewers selected eligible trials and extracted data on perineal trauma, duration of the second-stage labor, postpartum hemorrhage and Apgar score for meta-analysis. Main results Nineteen trials enrolling 5445 pregnant women were included. Compared with standard care, women using lubricants had a lower incidence of perineal trauma (RR 0.84, 95%CI 0.76 to 0.93), second-degree perineal laceration (RR 0.72, 95%CI 0.64 to 0.82) and episiotomy (RR 0.77, 95%CI 0.62 to 0.96), had a shorter duration of the second-stage labor (MD -13.72 minutes, 95%CI -22.68 to -4.77). Subgroup analysis indicated that women with obstetric gel had a shorter duration of the second-stage (MD -16.9 minutes, 95%CI -27.03 to -6.78 vs MD -8.38 minutes, 95%CI -11.11 to -5.65; P interaction=0.02) when compared with liquid wax. Conclusions Compared with standard care, lubricants could reduce the incidence of perineal trauma, especially second-degree perineal laceration, and shorten the duration of the second-stage labor.