1,721,529 research outputs found
Calcium channel blockers for inhibiting preterm labour
No full textThe definitive version may be found at www.wiley.comBackgroundPreterm birth is a major contributor to perinatal mortality and morbidity and affects approximately six to seven per cent of births in developed countries. Tocolytics are drugs used to suppress uterine contractions. The most widely tested tocolytics are betamimetics. Although they have been shown to delay delivery, betamimetics have not been shown to improve perinatal outcome, and they have a high frequency of unpleasant and even fatal maternal side effects. There is growing interest in calcium channel blockers as a potentially effective and well tolerated form of tocolysis.ObjectivesTo assess the effects on maternal, fetal and neonatal outcomes of calcium channel blockers, administered as a tocolytic agent, to women in preterm labour.Search strategyWe searched the Cochrane Pregnancy and Childbirth Group's specialised register of controlled trials, the Cochrane Controlled Trials Register (February 2002), MEDLINE, EMBASE, and Current Contents. We also contacted recognised experts and cross referenced relevant material.Selection criteriaAll published and unpublished randomised trials in which calcium channel blockers were used for tocolysis for women in labour between 20 and 36 weeks gestation.Data collection and analysisStandard methods of the Cochrane Collaboration and the Cochrane Pregnancy and Childbirth Group were used. Evaluation of methodological quality and trial data extraction were undertaken independently by three authors. Additional information was sought to enable assessment of methodology and conduct of intention-to-treat analyses. Meta-analysis was conducted assessing the effects of calcium channel blockers compared with any other tocolytic agent. Results are presented using relative risk for categorical data and weighted mean difference for continuous data.Main resultsEleven randomised controlled trials involving 870 women were included. When compared with any other tocolytic agent (mainly betamimetics), calcium channel blockers reduced the number of women giving birth within 48 hours (relative risk (RR) 0.73; 95% confidence interval (CI) 0.54, 0.98) and within seven days (RR 0.76; 95% CI 0.59, 0.99). Calcium channel blockers also reduced the requirement for women to have treatment ceased for adverse drug reaction (RR 0.15; 95% CI 0.06, 0.43), the frequency of neonatal respiratory distress syndrome (RR 0.64; 95% CI 0.45, 0.91) and neonatal jaundice (RR 0.73; 95% CI 0.57, 0.93).Reviewer's conclusionsWhen tocolysis is indicated for women in preterm labour, calcium channel blockers are preferable to betamimetic agents. Further research should address the effects of different dosage regimens and formulations of nifedipine on maternal and neonatal outcomes.King JF, Flenady VJ, Papatsonis DNM, Dekker GA, Carbonne
Challenges in developing prediction models for stillbirth
No full textStillbirth is a major global public health problem, but in the absence of a robust method to predict a woman's individualized risk of stillbirth, identifying women at increased risk remains a challenge. Awareness of factors that increase risk is a necessary step in improving care through better communication and shared decision-making, with the goal of reducing stillbirths. Despite a high proportion of unexplained stillbirths, many women have one or more risk factors that are often unrecognized (Flenady, V. et al Lancet 2011, 377, 1331-40)
Response to 'The drugs we deserve'
No full textDNM Papatsonis, VJ. Flenady, GA. Dekker, B. Carbonne, JF Kin
Consistent evidenced based information for women about fetal movements is important
No full textV. Flenady, M. Weller, F. Boyle, P. Middleto
Reply to Dr Lamont - letter to the editor
No full textThe definitive version is available at www.blackwell-synergy.comJames F. King, Vicki Flenady, Dimitri Papatsonis, Gus Dekker, Bruno Carbonn
Severe hypotension and fetal death due to tocolysis with nifedipine - Correspondence
No full textDimitri N. M. Papatsonis, Bruno Carbonne, Gustaaf A. Dekker, Vicki Flenady & James F. Kin
Response to Letter to the Editor 'Adverse perinatal outcomes in the Australian Indigenous population, the role of asthma'
No full textLetter to the EditorAbstract unavailableVicki L. Clifton, Jui Das, Vicki Flenady, Kym Ra
Towards respectful supportive care after stillbirth for every woman
No full textStillbirth is a persistent public health problem with enormous impacts on parents, families and communities (de Bernis et al, The Lancet, 2016, Vol 387: 703-716). The care of health workers and community is vital to parents' recovery after stillbirth (Flenady et al, BJOG, 2014, Vol 121: 137-140). However, care is often suboptimal, particularly in limited-resource settings. Close linkages between poverty, women's education and disempowerment mean that women who have lost a baby are especially vulnerable. Mothers of stillborn babies in Africa, a region with one of the highest stillbirth rates, are often forbidden from mourning and mistreated (Kiguli et al, The Lancet, 2016, Vol 387: e16-e16)
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