Objectives
To assess the effect of timing of folic acid (FA) supplementation during pregnancy on the risk of the neonate being small for gestational age (SGA).
Design
A population database study and ...a systematic review with meta‐analysis including the results of this population study.
Setting and data sources
A UK regional database was used for the population study and an electronic literature search (from inception until August 2013) for the systematic review.
Participants and included studies
Singleton live births with no known congenital anomalies; 111 736 in population study and 188 796 in systematic review.
Outcome measures, data extraction and analysis
The main outcome was SGA based on customised birthweight centile. Associations are presented as odds ratios (OR) and adjusted odds ratios (aOR), adjusted for maternal and pregnancy‐related characteristics.
Results
Of 108 525 pregnancies with information about FA supplementation, 92 133 (84.9%) had taken FA during pregnancy. Time of commencement of supplementation was recorded in 39 416 pregnancies, of which FA was commenced before conception in 10 036, (25.5%) cases. Preconception commencement of FA supplementation was associated with reduced risk of SGA <10th centile (aOR 0.80, 95% CI 0.71–0.90, P < 0.01) and SGA <5th centile (aOR 0.78, 95% CI 0.66–0.91, P < 0.01). This result was reproduced when the data were pooled with other studies in the systematic review, showing a significant reduction in SGA (<5th centile) births with preconception commencement of FA (aOR 0.75, 95% CI 0.61–0.92, P < 0.006). In contrast, postconception folate had no significant effect on SGA rates.
Conclusion
Supplementation with FA significantly reduces the risk of SGA at birth but only if commenced preconceptually independent of other risk factors.
Systematic review registration
This systematic review was prospectively registered with PROSPERO number CRD42013004895.
BackgroundGenital tract trauma is common with vaginal births and is associated with significant morbidity, particularly with obstetric anal sphincter injuries (OASIS). Debate continues regarding the ...effectiveness of perineal support during childbirth in reducing the risk of trauma.
ObjectivesThis review aimed to assess the effect of routine ‘hands on’/manual perineal support (MPS) during childbirth, versus ad hoc/no perineal support (‘hands off/poised’), on the risk and degree of perineal trauma.
Search strategyThis review is registered on PROSPERO (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007058). We searched the CENTRAL, Embase, Medline, CINAHL, and OVIDs midwifery and infant care databases (from inception to December 2014).
Selection criteriaPublished randomised controlled trials (RCTs) and non‐randomised studies (NRSs) evaluating any ‘hands on’ perineal support technique during childbirth.
Data collection and analysisTwo reviewers independently assessed trials for inclusion, data extraction, and methodological quality. Discrepancies were resolved by discussion with a third reviewer.
Main resultsWe included five RCTs and seven NRSs in the review. Meta‐analysis of RCTs did not demonstrate a statistically significant protective effect of MPS on the risk of OASIS (three studies, 6647 women; relative risk, RR 1.03; 95% confidence interval, 95% CI 0.32–3.36; statistical test for heterogeneity I2 = 71%). Meta‐analysis of NRSs showed a significant reduction in the risk of OASIS with MPS (three studies, 74 744 women; RR 0.45; 95% CI 0.40–0.50; I2 = 32%).
Conclusion
Current evidence is insufficient to drive change in practice. An adequately powered randomised trial with an efficient design to evaluate the complex interventions adopted as part of MPS policies, ensuring controlled childbirth, is urgently needed.
Tweetable
Manual perineal support at birth may be protective against anal sphincter injuries.
Background
There is variation in the reported incidence rates of levator avulsion (LA) and paucity of research into its risk factors.
Objective
To explore the incidence rate of LA by mode of birth, ...imaging modality, timing of diagnosis and laterality of avulsion.
Search strategy
We searched MEDLINE, EMBASE, CINAHL, AMED and MIDIRS with no language restriction from inception to April 2019.
Study eligibility criteria
A study was included if LA was assessed by an imaging modality after the first vaginal birth or caesarean section. Case series and reports were not included.
Data collection and analysis
RevMan v5.3 was used for the meta‐analyses and SW SAS and STATISTICA packages were used for type and timing of imaging analyses.
Results
We included 37 primary non‐randomised studies from 17 countries and involving 5594 women. Incidence rates of LA were 1, 15, 21, 38.5 and 52% following caesarean, spontaneous, vacuum, spatula and forceps births, respectively, with no differences by imaging modality. Odds ratio of LA following spontaneous birth versus caesarean section was 10.69. The odds ratios for LA following vacuum and forceps compared with spontaneous birth were 1.66 and 6.32, respectively. LA was more likely to occur unilaterally than bilaterally following spontaneous (P < 0.0001) and vacuum‐assisted (P = 0.0103) births but not forceps. Incidence was higher if assessment was performed in the first 4 weeks postpartum.
Conclusions
LA incidence rates following caesarean, spontaneous, vacuum and forceps deliveries were 1, 15, 21 and 52%, respectively. Ultrasound and magnetic resonance imaging were comparable tools for LA diagnosis.
Tweetable
Levator avulsion incidence rates after caesarean, spontaneous, vacuum and forceps deliveries were 1, 15, 21 and 52%, respectively.
Tweetable
Levator avulsion incidence rates after caesarean, spontaneous, vacuum and forceps deliveries were 1, 15, 21 and 52%, respectively.
This article includes Author Insights, a video available at: https://vimeo.com/bjog/authorinsights16837
Please cite this paper as: Kalis V, Laine K, de Leeuw J, Ismail K, Tincello D. Classification of episiotomy: towards a standardisation of terminology. BJOG 2012;119:522–526.
Seven episiotomy ...incisions are described in the literature, although only midline, mediolateral or lateral episiotomies are commonly used. Recent research has demonstrated variations in both site and direction of the incision, and differences between the angle of incision at the time of crowning of the fetal head and the angle of the scar once the wound has been repaired. We review this evidence and suggest that this variation may undermine the reliability of much published work. We suggest a standardised definition of each type of episiotomy to establish uniformity going forward, so that future studies are amenable to comparison and meta‐analysis.
The effect of systematic increase of Ni content on the electrochemical behavior of the Cu–Ni alloys in neutral chloride solutions was investigated. The pitting corrosion behavior of Cu–Ni alloys with ...different Ni contents, namely, 5, 10, 30 and 65
mass% Ni, in a stagnant 0.6
mol
dm
−3 NaCl solution of pH 7.0 was studied. The effect of chloride ion concentration on the electrochemical behavior of these alloys was also investigated. The results show that the increase in nickel content decreases the corrosion rate of the alloys in the neutral chloride solution. The increase of chloride concentration up to 0.3
mol
dm
−3 increases the corrosion rate. At higher concentrations (Cl
−
>
0.3
mol
dm
−3) the corrosion rate decreases due to the hydrolysis of Cu(I) chloride to form the passive Cu(I) oxide film. The breakdown potential depends on the chloride ion concentration and the nickel content of the alloy. For these investigations conventional electrochemical techniques and electrochemical impedance spectroscopy (EIS) were used. The impedance measurements have shown that the increase of the Ni content and the immersion time of the alloys in the chloride solution increase the corrosion resistance of the alloys. The experimental impedance data were fitted to theoretical values according to a proposed equivalent circuit model.
Women-centred maternity PRO measures can generate outcome measures that will allow benchmarking of service delivery using meaningful outcomes that will drive service improvement to ensure commitment ...to a culture of openness, patient satisfaction, patient safety and the delivery of clinically effective care. Moreover, they can generate new insights into women’s perspectives of healthcare delivery, allowing changes in attitude, practice and organisational services. Once developed, the adoption of PRO measures within units is likely to come at additional cost. However, the expected benefits in improved woman and family satisfaction, reduced legal claims and the presence of an early indicator of compromised quality of care will have the potential to save a significant amount of money for individual units and the wider health economy.
The electrochemical behavior of brasses with various Zn content (5.5–38
mass%) and brass (Cu–38Zn) with different Pb contents (1–3.4
mass%) in 0.6
M NaCl was investigated. The effects of temperature, ...immersion time, and concentration of chloride ions on the behavior of the different alloys were studied. The pitting corrosion behavior of Cu–Zn alloys and leaded–brass alloys in 0.6
M NaCl solution was also investigated. Open-circuit potential measurements (OCP), polarization techniques and electrochemical impedance spectroscopy (EIS) were used. The results show that the increase in the Zn content increases the corrosion rate of the brass alloys in chloride solutions, while the increase of Pb content in Cu–38Zn–Pb decreases the corrosion rate of the alloy. Long immersion time of the alloys in the aqueous electrolyte improves their stability due to the formation of passive film on the alloy surface. The breakdown potential is shifted to more negative direction with increasing the Zn content, whereas it shifts towards positive values with increasing Pb content. Equivalent circuit model for the electrode/electrolyte interface under different conditions was proposed to illustrate the electrochemical processes taking place at the interface. The electrochemical behavior of the different alloys was discussed in view of the fitting results.
The conventional heating methods of milk did not cause any significant increase in the trans isomer content, with the exception of milk heated at 63±1.0°C for 30min and milk microwaved for 5min, ...which were significantly increased by 19 and 31%, respectively. The chemical changes of lipids were generally accelerated with the severity of the heat treatment and duration of storage. The conjugated linoleic acid content of cheese heated in a microwave oven for 5min decreased by 21%, and microwave heating for 10min caused a decrease of 53% compared with that of freshly boiled cheese.
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