The Experts below are selected from a list of 321 Experts worldwide ranked by ideXlab platform
Lehana Thabane - One of the best experts on this subject based on the ideXlab platform.
-
using Tocolysis in pregnant women with symptomatic placenta praevia does not significantly improve prenatal perinatal neonatal and maternal outcomes a systematic review and meta analysis
Systematic Reviews, 2018Co-Authors: Frederick Morfaw, Mercy Fundoh, Jessica J Bartoszko, Lawrence Mbuagbaw, Lehana ThabaneAbstract:Placenta praevia refers to a placenta located in the lower segment of the uterus. This abnormal location predisposes the placenta to abnormal bleeding with an increased risk of premature labour. The merits of tocolytic drugs (Tocolysis) to calm uterine contractions and prolong pregnancy in women with placenta praevia are uncertain. The primary objective is to determine the effects of Tocolysis versus no Tocolysis on pregnancy prolongation. Secondary objectives include to determining the effects of Tocolysis versus no Tocolysis on gestational age at delivery, maternal hospitalisations, recurrent vaginal bleeding, prematurity, admissions into neonatology, and perinatal deaths. We searched MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, reference lists of pertinent articles and trial registries for randomised controlled trials comparing Tocolysis to no Tocolysis or placebo in patients with placenta praevia. Risk of bias and data extraction was done independently by two reviewers. We pooled data using a random-effects model. We used the GRADE system to assess the certainty of evidence for each outcome. There is no significant difference in pregnancy prolongation with the use of Tocolysis in cases of placenta praevia (mean difference [MD] 11.51 days; 95% CI, − 1.75, 24.76; 3 trials, 253 participants; low certainty evidence). Tocolysis has no significant effect on gestational age at delivery (MD 0.33 weeks [95% CI − 1.53, 2.19]: 2 trials, 169 participants, moderate certainty evidence), birthweight (MD 0.12 kg [95% CI − 0.26, 0.5 kg]: 2 trials, 169 participants, moderate certainty evidence), risk of premature delivery (risk ratio [RR] 1.04; 95% CI 0.56, 1.94): 2 trials, 169 participants, low certainty evidence), risk of repeat vaginal bleeding (RR 1.05 [95% CI 0.73, 1.51]: 2 trials, 169 participants, moderate certainty evidence). Tocolysis has no significant effect on the risk of perinatal death (risk difference [RD]: 0.00 [95% CI − 0.04, 0.03]: 2 trials, 169 women; low certainty evidence), number of days of maternal hospitalisation (MD 0.60 days [95% CI − 0.79, 1.99]: 1 trial, 109 women; low certainty evidence), risk of fetal admissions into neonatology (RR 1.30 [95% CI 0.80, 2.12]: 1 trial, 109 participants, low certainty evidence) and on the duration of stay in neonatology units (MD 0.70 days [95% CI − 5.26, 6.66]: 1 trial, 109 participants, low certainty evidence). In women with symptomatic placenta praevia, there is no significant effect on pregnancy prolongation with the use of Tocolysis. Tocolysis has no significant effect on other prenatal, perinatal, neonatal and maternal outcomes among women with symptomatic placenta praevia. PROSPERO CRD42018091513
-
Using Tocolysis in pregnant women with symptomatic placenta praevia does not significantly improve prenatal, perinatal, neonatal and maternal outcomes: a systematic review and meta-analysis
BMC, 2018Co-Authors: Frederick Morfaw, Mercy Fundoh, Jessica J Bartoszko, Lawrence Mbuagbaw, Lehana ThabaneAbstract:Abstract Background Placenta praevia refers to a placenta located in the lower segment of the uterus. This abnormal location predisposes the placenta to abnormal bleeding with an increased risk of premature labour. The merits of tocolytic drugs (Tocolysis) to calm uterine contractions and prolong pregnancy in women with placenta praevia are uncertain. Objectives The primary objective is to determine the effects of Tocolysis versus no Tocolysis on pregnancy prolongation. Secondary objectives include to determining the effects of Tocolysis versus no Tocolysis on gestational age at delivery, maternal hospitalisations, recurrent vaginal bleeding, prematurity, admissions into neonatology, and perinatal deaths. Methods We searched MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, reference lists of pertinent articles and trial registries for randomised controlled trials comparing Tocolysis to no Tocolysis or placebo in patients with placenta praevia. Risk of bias and data extraction was done independently by two reviewers. We pooled data using a random-effects model. We used the GRADE system to assess the certainty of evidence for each outcome. Main results There is no significant difference in pregnancy prolongation with the use of Tocolysis in cases of placenta praevia (mean difference [MD] 11.51 days; 95% CI, − 1.75, 24.76; 3 trials, 253 participants; low certainty evidence). Tocolysis has no significant effect on gestational age at delivery (MD 0.33 weeks [95% CI − 1.53, 2.19]: 2 trials, 169 participants, moderate certainty evidence), birthweight (MD 0.12 kg [95% CI − 0.26, 0.5 kg]: 2 trials, 169 participants, moderate certainty evidence), risk of premature delivery (risk ratio [RR] 1.04; 95% CI 0.56, 1.94): 2 trials, 169 participants, low certainty evidence), risk of repeat vaginal bleeding (RR 1.05 [95% CI 0.73, 1.51]: 2 trials, 169 participants, moderate certainty evidence). Tocolysis has no significant effect on the risk of perinatal death (risk difference [RD]: 0.00 [95% CI − 0.04, 0.03]: 2 trials, 169 women; low certainty evidence), number of days of maternal hospitalisation (MD 0.60 days [95% CI − 0.79, 1.99]: 1 trial, 109 women; low certainty evidence), risk of fetal admissions into neonatology (RR 1.30 [95% CI 0.80, 2.12]: 1 trial, 109 participants, low certainty evidence) and on the duration of stay in neonatology units (MD 0.70 days [95% CI − 5.26, 6.66]: 1 trial, 109 participants, low certainty evidence). Conclusion In women with symptomatic placenta praevia, there is no significant effect on pregnancy prolongation with the use of Tocolysis. Tocolysis has no significant effect on other prenatal, perinatal, neonatal and maternal outcomes among women with symptomatic placenta praevia. Systematic review registration PROSPERO CRD4201809151
Frederick Morfaw - One of the best experts on this subject based on the ideXlab platform.
-
using Tocolysis in pregnant women with symptomatic placenta praevia does not significantly improve prenatal perinatal neonatal and maternal outcomes a systematic review and meta analysis
Systematic Reviews, 2018Co-Authors: Frederick Morfaw, Mercy Fundoh, Jessica J Bartoszko, Lawrence Mbuagbaw, Lehana ThabaneAbstract:Placenta praevia refers to a placenta located in the lower segment of the uterus. This abnormal location predisposes the placenta to abnormal bleeding with an increased risk of premature labour. The merits of tocolytic drugs (Tocolysis) to calm uterine contractions and prolong pregnancy in women with placenta praevia are uncertain. The primary objective is to determine the effects of Tocolysis versus no Tocolysis on pregnancy prolongation. Secondary objectives include to determining the effects of Tocolysis versus no Tocolysis on gestational age at delivery, maternal hospitalisations, recurrent vaginal bleeding, prematurity, admissions into neonatology, and perinatal deaths. We searched MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, reference lists of pertinent articles and trial registries for randomised controlled trials comparing Tocolysis to no Tocolysis or placebo in patients with placenta praevia. Risk of bias and data extraction was done independently by two reviewers. We pooled data using a random-effects model. We used the GRADE system to assess the certainty of evidence for each outcome. There is no significant difference in pregnancy prolongation with the use of Tocolysis in cases of placenta praevia (mean difference [MD] 11.51 days; 95% CI, − 1.75, 24.76; 3 trials, 253 participants; low certainty evidence). Tocolysis has no significant effect on gestational age at delivery (MD 0.33 weeks [95% CI − 1.53, 2.19]: 2 trials, 169 participants, moderate certainty evidence), birthweight (MD 0.12 kg [95% CI − 0.26, 0.5 kg]: 2 trials, 169 participants, moderate certainty evidence), risk of premature delivery (risk ratio [RR] 1.04; 95% CI 0.56, 1.94): 2 trials, 169 participants, low certainty evidence), risk of repeat vaginal bleeding (RR 1.05 [95% CI 0.73, 1.51]: 2 trials, 169 participants, moderate certainty evidence). Tocolysis has no significant effect on the risk of perinatal death (risk difference [RD]: 0.00 [95% CI − 0.04, 0.03]: 2 trials, 169 women; low certainty evidence), number of days of maternal hospitalisation (MD 0.60 days [95% CI − 0.79, 1.99]: 1 trial, 109 women; low certainty evidence), risk of fetal admissions into neonatology (RR 1.30 [95% CI 0.80, 2.12]: 1 trial, 109 participants, low certainty evidence) and on the duration of stay in neonatology units (MD 0.70 days [95% CI − 5.26, 6.66]: 1 trial, 109 participants, low certainty evidence). In women with symptomatic placenta praevia, there is no significant effect on pregnancy prolongation with the use of Tocolysis. Tocolysis has no significant effect on other prenatal, perinatal, neonatal and maternal outcomes among women with symptomatic placenta praevia. PROSPERO CRD42018091513
-
Using Tocolysis in pregnant women with symptomatic placenta praevia does not significantly improve prenatal, perinatal, neonatal and maternal outcomes: a systematic review and meta-analysis
BMC, 2018Co-Authors: Frederick Morfaw, Mercy Fundoh, Jessica J Bartoszko, Lawrence Mbuagbaw, Lehana ThabaneAbstract:Abstract Background Placenta praevia refers to a placenta located in the lower segment of the uterus. This abnormal location predisposes the placenta to abnormal bleeding with an increased risk of premature labour. The merits of tocolytic drugs (Tocolysis) to calm uterine contractions and prolong pregnancy in women with placenta praevia are uncertain. Objectives The primary objective is to determine the effects of Tocolysis versus no Tocolysis on pregnancy prolongation. Secondary objectives include to determining the effects of Tocolysis versus no Tocolysis on gestational age at delivery, maternal hospitalisations, recurrent vaginal bleeding, prematurity, admissions into neonatology, and perinatal deaths. Methods We searched MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, reference lists of pertinent articles and trial registries for randomised controlled trials comparing Tocolysis to no Tocolysis or placebo in patients with placenta praevia. Risk of bias and data extraction was done independently by two reviewers. We pooled data using a random-effects model. We used the GRADE system to assess the certainty of evidence for each outcome. Main results There is no significant difference in pregnancy prolongation with the use of Tocolysis in cases of placenta praevia (mean difference [MD] 11.51 days; 95% CI, − 1.75, 24.76; 3 trials, 253 participants; low certainty evidence). Tocolysis has no significant effect on gestational age at delivery (MD 0.33 weeks [95% CI − 1.53, 2.19]: 2 trials, 169 participants, moderate certainty evidence), birthweight (MD 0.12 kg [95% CI − 0.26, 0.5 kg]: 2 trials, 169 participants, moderate certainty evidence), risk of premature delivery (risk ratio [RR] 1.04; 95% CI 0.56, 1.94): 2 trials, 169 participants, low certainty evidence), risk of repeat vaginal bleeding (RR 1.05 [95% CI 0.73, 1.51]: 2 trials, 169 participants, moderate certainty evidence). Tocolysis has no significant effect on the risk of perinatal death (risk difference [RD]: 0.00 [95% CI − 0.04, 0.03]: 2 trials, 169 women; low certainty evidence), number of days of maternal hospitalisation (MD 0.60 days [95% CI − 0.79, 1.99]: 1 trial, 109 women; low certainty evidence), risk of fetal admissions into neonatology (RR 1.30 [95% CI 0.80, 2.12]: 1 trial, 109 participants, low certainty evidence) and on the duration of stay in neonatology units (MD 0.70 days [95% CI − 5.26, 6.66]: 1 trial, 109 participants, low certainty evidence). Conclusion In women with symptomatic placenta praevia, there is no significant effect on pregnancy prolongation with the use of Tocolysis. Tocolysis has no significant effect on other prenatal, perinatal, neonatal and maternal outcomes among women with symptomatic placenta praevia. Systematic review registration PROSPERO CRD4201809151
Vincenzo Berghella - One of the best experts on this subject based on the ideXlab platform.
-
vaginal progesterone for maintenance Tocolysis a systematic review and metaanalysis of randomized trials
American Journal of Obstetrics and Gynecology, 2015Co-Authors: Anju Suhag, Gabriele Saccone, Vincenzo BerghellaAbstract:Objective We sought to evaluate the efficacy of maintenance Tocolysis with vaginal progesterone compared to control (placebo or no treatment) in singleton gestations with arrested preterm labor (PTL) in a metaanalysis of randomized controlled trials. Study Design Searches were performed in MEDLINE, OVID, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials with the use of a combination of key words and text words related to "progesterone," "Tocolysis," and "preterm labor" from 1966 through November 2014. We included all randomized trials of singleton gestations that had arrested PTL and then were randomized to maintenance Tocolysis treatment with either vaginal progesterone or control (either placebo or no treatment). All published randomized studies on progesterone Tocolysis were carefully reviewed. Exclusion criteria included maintenance Tocolysis in women with preterm premature rupture of membrane, maintenance Tocolysis with 17-alpha-hydroxyprogesterone caproate, and maintenance Tocolysis with oral progesterone. The summary measures were reported as relative risks (RRs) with 95% confidence interval (CI). The primary outcome was preterm birth (PTB) Results Five randomized trials, including 441 singleton gestations, were analyzed. Women who received vaginal progesterone maintenance Tocolysis for arrested PTL had a significantly lower rate of PTB Conclusion Maintenance Tocolysis with vaginal progesterone is associated with prevention of PTB, significant prolongation of pregnancy, and lower neonatal sepsis. However, given the frequent lack of blinding and the generally poor quality of the trials, we do not currently suggest a change in clinical care of women with arrested PTL. We suggest instead well-designed placebo-controlled randomized trials to confirm the findings of our metaanalysis.
-
17 alpha hydroxyprogesterone caproate for maintenance Tocolysis a systematic review and metaanalysis of randomized trials
American Journal of Obstetrics and Gynecology, 2015Co-Authors: Gabriele Saccone, Anju Suhag, Vincenzo BerghellaAbstract:We sought to evaluate the efficacy of maintenance Tocolysis with 17-alpha-hydroxyprogesterone caproate (17P) compared to control (either placebo or no treatment) in singleton gestations with arrested preterm labor (PTL), in a metaanalysis of randomized trials. Electronic databases (MEDLINE, OVID, Scopus, ClinicalTrials.gov , and the Cochrane Central Register of Controlled Trials) were searched from 1966 through July 2014. Key words included “progesterone,” “Tocolysis,” “preterm labor,” and “17-alpha-hydroxyprogesterone caproate.” We performed a metaanalysis of randomized trials of singleton gestations with arrested PTL and treated with maintenance Tocolysis with either 17P or control. Primary outcome was preterm birth (PTB)
-
tocolytics for preterm premature rupture of membranes
Cochrane Database of Systematic Reviews, 2014Co-Authors: Dhanya A Mackeen, Jolene Seibelseamon, Jacqueline Muhammad, Jason K Baxter, Vincenzo BerghellaAbstract:Background In women with preterm labor, Tocolysis has not been shown to improve perinatal mortality; however, it is often given for 48 hours to allow for the corticosteroid effect for fetal maturation. In women with preterm premature rupture of membranes (PPROM), the use of Tocolysis is still controversial. In theory, Tocolysis may prolong pregnancy in women with PPROM, thereby allowing for the corticosteroid benefit and reducing the morbidity and mortality associated with prematurity. Objectives To assess the potential benefits and harms of Tocolysis in women with preterm premature rupture of membranes. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 January 2014). Selection criteria We included pregnant women with singleton pregnancies and PPROM (23 weeks to 36 weeks and six days). We included any tocolytic therapy compared to no tocolytic, placebo, or another tocolytic. Data collection and analysis All review authors assessed the studies for inclusion. We extracted and quality assessed data. Main results We included eight studies with a total of 408 women. Seven of the studies compared Tocolysis to no Tocolysis. One study compared nifedipine to terbutaline. Compared to no Tocolysis, Tocolysis was not associated with a significant effect on perinatal mortality in women with PPROM (risk ratio (RR) 1.67; 95% confidence interval (CI) 0.85 to 3.29). Tocolysis was associated with longer latency (mean difference (MD) 73.12 hours; 95% CI 20.21 to 126.03; three trials of 198 women) and fewer births within 48 hours (average RR 0.55; 95% CI 0.32 to 0.95; six trials of 354 women; random-effects, Tau² = 0.18, I² = 43%) compared to no Tocolysis. However, Tocolysis was associated with increased five-minute Apgar of less than seven (RR 6.05; 95% CI 1.65 to 22.23; two trials of 160 women) and increased need for ventilation of the neonate (RR 2.46; 95% CI 1.14 to 5.34; one trial of 81 women). In the subgroup analysis comparing betamimetic to no betamimetics, Tocolysis was associated with increased latency and borderline significance for chorioamnionitis. Prophylactic Tocolysis with PPROM was associated with increased overall latency, without additional benefits for maternal/neonatal outcomes. For women with PPROM before 34 weeks, there was a significantly increased risk of chorioamnionitis in women who received Tocolysis. However, neonatal outcomes were not significantly different. There were no significant differences in maternal/neonatal outcomes in subgroup analyses comparing cox inhibitor versus no Tocolysis, calcium channel blocker versus betamimetic, antibiotic, corticosteroid or combined antibiotic/corticosteroid. Authors' conclusions Our review suggests there is insufficient evidence to support tocolytic therapy for women with PPROM, as there was an increase in maternal chorioamnionitis without significant benefits to the infant. However, studies did not consistently administer latency antibiotics and corticosteroids, both of which are now considered standard of care.
Kavita Nanda - One of the best experts on this subject based on the ideXlab platform.
-
magnesium sulfate Tocolysis time to quit
Obstetrics & Gynecology, 2007Co-Authors: David A Grimes, Kavita NandaAbstract:Intravenous magnesium sulfate Tocolysis remains a North American anomaly. This therapy rose to prominence based on poor science and the recommendations of authorities. However, a Cochrane systematic review concluded that magnesium sulfate is ineffective as a tocolytic. The review found no benefit in
-
magnesium sulfate Tocolysis time to quit
Obstetrics & Gynecology, 2007Co-Authors: David A Grimes, Kavita NandaAbstract:Intravenous magnesium sulfate Tocolysis remains a North American anomaly. This therapy rose to prominence based on poor science and the recommendations of authorities. However, a Cochrane systematic review concluded that magnesium sulfate is ineffective as a tocolytic. The review found no benefit in preventing preterm or very preterm birth. Moreover, the risk of total pediatric mortality was significantly higher for infants exposed to magnesium sulfate (relative risk 2.8; 95% confidence interval 1.2-6.6). Given its lack of benefit, possible harms, and expense, magnesium sulfate should not be used for Tocolysis. Any further use of magnesium sulfate for Tocolysis should be restricted to formal clinical trials with approval by an institutional review board and signed informed consent for participants. Should Tocolysis be desired, calcium channel blockers, such as nifedipine, seem preferable.
Paul G Tomich - One of the best experts on this subject based on the ideXlab platform.
-
the effect of tocolytic use in the management of symptomatic placenta previa
American Journal of Obstetrics and Gynecology, 1995Co-Authors: Richard E Besinger, Charles W Moniak, Linda S Paskiewicz, Susan G Fisher, Paul G TomichAbstract:Abstract Objective: The null hypothesis is that Tocolysis has no effect on pregnancy prolongation in the aggressive expectant management of symptomatic preterm placenta previa. Study design: One hundred twelve preterm pregnancies with confirmed placenta previa and an initial episode of acute vaginal bleeding were selected for this retrospective analysis. Exclusion criteria included gestational age ≥ 35 weeks, delivery within 24 hours of admission, prior treatment for bleeding or preterm labor, and containdications to tocolytic use. Tocolysis was prescribed, at the discretion of the treating clinical staff, in selected pregnancies with significant uterine contractions after admission of the patient. The majority of treated patients (85%) received intravenous magnesium sulfate and/or oral or subcutaneous β-sympathormimetics within 24 hours of admission. Most patients remained hospitalized until delivery under this aggressive expectant management protocol. Both treated and untreated control study groups were similar at inclusion with regard to parity, gestational age, contraction frequency, and degree of initial bleeding. Outcome variables for each treatment group were obtained from final chart review. Continuous and categoric variables were compared with Student t test or x 2 analysis—Fisher's exact test, respectively. Results: The clinical use of Tocolysis in symptomatic placenta previa was associated with a clinically significant delay of preterm delivery. Significant improvement in clinical parameters such as interval from admission to delivery (39.2 vs 26.9 days, p p p p p Conclusions: This retrospective analysis suggests that tocolytic intervention in cases of symptomatic preterm previa may be associated with clinically significant prolongation of pregnancy and increased birth weight. Tocolytic therapy in these cases does not appear to have an impact on frequency or severity of recurrent vaginal bleeding. Further prospective analysis may delineate the role of Tocolysis in the aggressive expectant management of symptomaticf placenta previa. 1995; 172:1770–1778.)
