76 research outputs found
How labor induction methods have evolved throughout history, from the Egyptian era to the present day: evolution, effectiveness, and safety
No full textInduction of labor (IOL) is currently used for one in 10 pregnancies globally. Methods used for induction have shown major changes over time. Medical interventions trace their origins back to ancient civilizations, with evidence suggesting that they began over 5000 years ago in ancient Egypt. During this era, the Egyptians employed natural remedies such as castor oil and date fruits for the IOL. These early practices highlight the rich history and long-standing tradition of using natural substances in medical treatments, laying the foundation for the development of modern obstetric practices. After that, Hippocrates practiced mammary stimulation and mechanical cervical dilatation about 2500 years ago in Greece. Since then, there has been a marked change, especially over the last century, with the development of safer and more effective methods. Mechanical methods were the main method until the early 20th century, which were then substituted by pharmacological methods with more experiments in the mid to late 20th century. Nowadays, effectiveness, safety, cost, and client satisfaction are the main determinants of the methods used. This review summarizes how labor induction practices have evolved from the Egyptian era to the present-day randomized controlled trials and meta-analysis evidence, paying attention to their effectiveness, safety, and future directions.Malitha Patabendige, Daniel L. Rolnik, Wentao Li, Andrew D. Weeks, Ben W. Mo
Data-sharing and trustworthiness of trials evaluating cervical ripening in induction of labour: a meta-epidemiological study of randomised controlled trials
No full textBackground: Induction of labour is a common medical intervention in obstetrics, but its uptake is highly variable in well-resourced and low-resourced settings. Cervical ripening is the initial phase of prepping the cervix when it is not ‘ready’. Approximately 30% of women are induced in high-income countries, while this proportion is generally lower in low-resource settings. One way to assess the trustworthiness of randomised controlled trials (RCTs) is by examining individual participant data (IPD), but data sharing remains a significant challenge. It is still unclear whether there are substantial differences in trial characteristics, trustworthiness, effect sizes, and the certainty of evidence between RCTs that share data and those that do not. Methods: In this meta-epidemiological study of RCTs comparing different methods of induction of labour, we included nine IPD meta-analyses. RCTs in the shared and non-shared groups were assessed on the following criteria: trial characteristics, trial registration, trustworthiness (independently evaluated via the Trustworthiness in RAndomised Controlled Trials [TRACT] checklist by two investigators), excessive similarity or difference in baseline characteristics beyond what would be expected by chance, and statistical analysis results that cannot be reproduced with summary data. The TRACT checklist aims to identify and triage RCTs at risk of trustworthiness issues, and includes seven domains: governance, author group, plausibility of intervention usage, timeframe, drop-out rates, baseline characteristics, and outcomes. We performed random-effects meta-analyses separately for the two groups, followed by the GRADE approach, and compared their effect estimates using ratio of odds ratios (ROR). This study was prospectively registered at the Center for Open Science OSF registries network (WU93A) before data extraction. Findings: Of 265 eligible RCTs (65,115 women), 64 (24.2%) trials shared data, while 201 (75.8%) did not. Adequate trial registration (after 2010) was found in 44.0% (22/50) of shared RCTs vs 14.1% of (14/99) non-shared RCTs (p < 0.001). In the shared group, 84.4% (54/64) were considered to have no trustworthiness concerns, compared to 49.1% (87/177) in the non-shared RCTs (p < 0.001). Risk of bias assessment revealed that 20.3% (13/64) of shared RCTs had an overall high risk, compared to 28.4% (57/201) of non-shared RCTs (p = 0.20). In the shared RCTs, simulation-generated p-value distributions of baseline characteristics were likely consistent with the expected uniform distribution (p = 0.50), but not in the non-shared RCTs (p = 0.006). Proportions of RCTs with at least one inconsistently reported p-value that cannot be reproduced with summary data were not significantly different between shared and non-shared groups (for baseline characteristics: 17.2% vs 25.4%; for caesarean delivery: 42.2% vs 30.8%; for uterine hyperstimulation: 17.2% vs 12.9%, respectively). Non-shared RCTs showed exaggerated effect estimates compared to the shared group, with statistically significant RORs ranging from 2.36 to 1.29 in three out of nine induction of labour comparisons. The GRADE assessment showed higher certainty of evidence for nine effect estimates and equal certainty for seven when comparing the shared groups to nonshared groups across all IPD meta-analysis projects on caesarean section and hyperstimulation. This was more pronounced among RCTs without trustworthiness concerns (than in RCTs with trustworthiness concerns), demonstrating greater certainty of evidence of RCTs without such trustworthiness issues. Interpretation: RCTs on labour induction without IPD-sharing are more likely to have lower quality, more trustworthiness concerns, and exaggerated effect estimates than those with shared IPD. IPD-sharing and IPD meta-analyses should be encouraged. Trustworthiness and quality assessment should be prioritised whenever using RCTs for evidence synthesis and clinical guidelines development to ensure better evidence informs clinical practice.Malitha Patabendige, Daniel Lorber Rolnik, Wanlin Li, Ben Willem Mol, and Wentao Li
P13.06: Ultrasound evaluation of saftly of postpartum hemorrhage (PPH) compression belt in reduction of uterine, internal iliac and femoral artery blood flow in healthy postpartum women
No full textTwo potentially lethal conditions of probable immune origin occurring in a pregnant woman: a case report
No full textFoley catheter for cervical priming in induction of labour at University Obstetrics Unit, Colombo, Sri Lanka: a clinical audit with a patient satisfaction survey
No full textAbstract Background Intracervical insertion of a Foley catheter (FC) has shown to be a safe, effective and relatively feasible mechanical method of cervical priming in induction of labour (IOL). We evaluated indications, effectiveness, patient acceptability and outcomes of FC use in IOL adhering to the ward protocol in our unit. Methods A clinical audit with a patient satisfaction survey conducted between July and September 2013 in University Obstetric Unit, Colombo, Sri Lanka. Patients selected for IOL for obstetric reasons were primed with Foley as per ward protocol. All had singleton pregnancies with cephalic presentation, intact membranes and period of gestation of 37 weeks or above. Women with a history of more than one caesarean section or uterine surgery, low-lying placenta and fetal growth restriction were excluded. Subjects who had a Modified Bishop Score (MBS) of less than 3, a 16Fr FC was inserted into cervical canal. Catheter was left undisturbed until spontaneous expulsion or no longer than 48 h. In women with MBS of less than 6 at 48 h after FC insertion, 3 mg prostaglandin E2 vaginal tablet was used subsequently. Artificial membrane rupture with or without oxytocin was used if MBS of 6 or more and in women not in labour 24 h after prostaglandins. Patient satisfaction for Foley insertion was assessed with regards to the degree of comfort using a validated visual analogue scale (0–10). Results There were a total of 910 deliveries during the study period. Fifty-six women were primed with FC. Thirty-two (57%) were nulliparous. During induction of labour, 53(95%) reported mild or no discomfort. MBS of 6 or more was achieved in 36/56 (64%) Foley insertions. Twenty needed further intervention with prostaglandins. FC only group had 5 caesarean sections and 31 vaginal deliveries and Foley/prostaglandin group had 7 caesarean sections and 13 vaginal deliveries. Of the 24 women who were induced due to completion of 41 weeks of gestation with otherwise uncomplicated pregnancies, 17 had MBS >6 post priming with Foley and 20 (83%) delivered vaginally. Subjects who had Foley only had a lesser chance of having a caesarean delivery compared to subjects who had Foley followed by prostaglandin (relative risk = 0.40, 95% CI = 0.15–1.09, P = 0.09). Discussion FC is a good choice for pre-induction cervical priming with high patient comfort. FC becomes more important in IOL cost reduction in our setting. FC alone seems to be an effective for IOL in women who have completed 41 weeks of gestation with otherwise uncomplicated pregnancies
Two potentially lethal conditions of probable immune origin occurring in a pregnant woman: a case report
No full textAbstract Background Thrombotic thrombocytopenic purpura and peripartum cardiomyopathy are potentially lethal complications of pregnancy. We describe a case in which both of these developed in the same patient. The etiologies of both conditions remain uncertain, but they share immune hyperreactivity as a possible cause. Case presentation A 33-year-old Lankan primigravida gave birth at 38 weeks of gestation by cesarean section when she presented with right-sided abdominal pain and a provisional diagnosis of appendicitis. Her pain persisted postoperatively, and on the second postoperative day, she physicaly collapsed suddenly with abdominal distention. Immediate laparotomy revealed generalized oozing from the peritoneum resulting in hemoperitoneum and intestinal hemorrhage. Her laboratory reports showed microangiopathic hemolytic anemia and thrombocytopenia. She also had elevated liver enzyme, lactate dehydrogenase, and creatinine concentrations. A diagnosis of thrombotic thrombocytopenic purpura was made. After a steady recovery, she was discharged from the hospital on the 16th postoperative day, but 12 hours later, she was readmitted with acute-onset progressively worsening shortness of breath. Echocardiography confirmed peripartum cardiomyopathy. She was treated with a bromocriptine and heart failure regimen. At 6 weeks postpartum, her laboratory test results and cardiac function had improved. Conclusions A possible autoimmune association might have caused both conditions in our patient. This case report serves as a warning message that pregnant women with one possible condition with autoimmune association could go on to develop other similar conditions
Improvements of post caesarean section pain management following the introduction of a new pain management protocol
No full textPiloting of WHO Safe Childbirth Checklist using a modified version in Sri Lanka
No full textAbstract Objectives Data was gathered to study the impact of a context-specific modified WHO Safe Childbirth Checklist (mSCC) at two tertiary care settings in Sri Lanka, as a part of an implementation program. Data description We provide data sets of a prospective observational study which was conducted in the University Obstetrics Unit at De Soysa Hospital for Women (DSHW), Colombo and two Obstetric Units at Teaching Hospital, Mahamodara, Galle (THMG), Sri Lanka. These consist of demographic and checklist implementation details and data on the level of acceptance. The study was conducted over 8 weeks at DSHW and over 4 weeks at THMG. Checklists were kept attached to clinical records at admission and collected on discharge. Level of acceptance was assessed using a self-administered questionnaire. Outcome measures were adoption rate (percentage of deliveries where mSCC was used), adherence to practices (mean percentage of items checked in each checklist), response rate (percentage of staff members who responded to questionnaire) and level of acceptance (percentage of “strongly agree/agree” in Likert scale to five questions regarding acceptance of modified SCC)
CHILD ABUSE AND NEGLECT IN SRILANKA
No full textChild abuse and neglect are the most common types of child maltreatment that impact child well-being. The main aim of this thesis was to find out about the current prevalence of child abuse and neglect issues in Sri-Lanka. In addition, it was aimed to reveal the lacking policies, legislations and services to prevent children from child abuse.
The qualitative research was carried out using primary and secondary data. Two child- care professionals from ChildFund Sri Lanka involved in the interviews using face to face video conversations. The guiding questions for the interview have been generated by the author. The information that has been collected through the interviews and secondary sources was organized and analysed systematically using thematic analysis.
The findings of this study revealed that child sexual abuse, neglect, and corporal punishment are the most commonly prevailing child protection issues in the country. Moreover, findings revealed that poverty is the main root cause for the majority of child prostitution and child sex tourism, and all other forms of child abuse and neglect problems. Furthermore, the lack of policies, cultural norms, and poor awareness of people on child protection issues have worsened the situation. Despite currently established policies and laws related to child protection, Sri Lanka has a long way to go to achieve globally accepted child protection standards
Appearances Are Deceptive: Two Case Reports in Teenagers on the Conservative Laparoscopic Surgery for Adnexal Torsion with Apparent Infarction
No full textIntroduction. Torsion of the ovary, tube, or both is estimated to be responsible for 2-7% of all gynaecological emergencies. Oophorectomy is commonly performed for adnexal torsion with a possible negative impact on fertility in women of reproductive age. Case Presentations. We report two cases of teenage girls presented with adnexal torsion describing their laparoscopy features. Detorsion without additional surgical intervention could save their ovaries. Discussion. Detorsion is a more conservative surgical approach that should be considered in all younger women with ovarian torsion
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