Objective We sought to investigate whether prenatal vitamin C and E supplementation reduces the incidence of gestational hypertension (GH) and its adverse conditions among high- and low-risk women. ...Study Design In a multicenter randomized controlled trial, women were stratified by the risk status and assigned to daily treatment (1 g vitamin C and 400 IU vitamin E) or placebo. The primary outcome was GH and its adverse conditions. Results Of the 2647 women randomized, 2363 were included in the analysis. There was no difference in the risk of GH and its adverse conditions between groups (relative risk, 0.99; 95% confidence interval, 0.78–1.26). However, vitamins C and E increased the risk of fetal loss or perinatal death (nonprespecified) as well as preterm prelabor rupture of membranes. Conclusion Vitamin C and E supplementation did not reduce the rate of preeclampsia or GH, but increased the risk of fetal loss or perinatal death and preterm prelabor rupture of membranes.
To evaluate the contingent use of fetal fibronectin (fFN) testing and cervical length (CL) measurement to predict preterm delivery, and to validate the use of phosphorylated IGFBP-1 as a predictor of ...preterm delivery.
We recruited 71 women with a clinical diagnosis of preterm labour between 24 and 34 weeks, and tested for the presence of fFN and IGFBP-1 in the cervicovaginal secretions of all women immediately before CL measurement.
Among the 66 women with complete outcome, four were excluded from the final analysis as two had assessment for fFN but no CL measurement, and another two had CL measured but no screening for fFN. Among 62 women with complete results, the mean gestational age at recruitment was 29.4 +/- 2.5 weeks. Six women (9.6%) delivered within two weeks of assessment, and 14 (22.5%) delivered before 34 weeks. A positive fFN test resulted in a sensitivity of 83%, a specificity of 84%, a positive predictive value of 36%, and a negative predictive value of 98% for delivery within two weeks; for CL < 25 mm, these figures were 50%, 52%, 10%, and 91%, respectively, and for a positive IGFBP-1, they were 17%, 93%, 20%, and 91%, respectively. A policy of contingent use of fFN (in which the test was assumed to be positive if CL < or = 15 mm, and fFN was only measured if the CL was between 16 and 30 mm) gave sensitivity, specificity, positive and negative predictive values of 80%, 61%, 17%, and 97%, respectively for delivery within two weeks. Using this contingent use protocol, only one third of women needed fFN screening after CL measurement.
In this study, IGFBP-1 screening did not predict preterm delivery and fFN screening provided the best predictive capacity. A policy of contingent use of testing for fFN after CL measurement, or contingent use of CL measurement after fFN screening (depending on available resources) is a promising approach to limit use of resources.
Breech presentation is a complication in 3% to 4% of singleton pregnancies at term. On the strength of a large study published in the early 2000s, the American College of Obstetricians and ...Gynecologists (ACOG) recommended Caesarean section be routinely performed in such cases. However, French gynaecologists continue to perform vaginal breech deliveries. Through various observational studies, they have shown that their management approach, although different from the one used in North America, is safe. In 2006, the ACOG declared that vaginal delivery of a breech presentation may be acceptable under specific circumstances. In this analysis, we compare North American and French practices and present a protocol of care for the management of term breech presentation based on French recommendations.
To compare pain relief in postpartum women receiving analgesia administered by nurses with the relief achieved by use of self-administered medication (SAM).
This randomized trial included women in ...spontaneous or induced labour or admitted for elective Caesarean section (CS). Women were stratified according to the mode of delivery. In the standard group, nurses administered the medications. In the SAM group, women kept the medications at the bedside and recorded each dose. The women were asked to record their pain level with a validated scale before and one hour after the administration of analgesia. A global pain score was calculated using the mean of these scores, and the satisfaction of patients and nurses with the process was recorded.
We recruited 345 women for the study. Eleven women (3.15 %) were lost to follow-up. We analyzed data from 197 women in the vaginal delivery arm and 133 women in the CS arm. There was no difference between the global pain scores before and one hour after the administration of analgesia in each group, independent of the mode of delivery. Women who used SAM and had a vaginal delivery were significantly more likely to have used no medication (P = 0.02) or to have used acetaminophen (P = 0.008), and fewer of these women took naproxen (P = 0.05). No significant difference was seen in women who had CS. Narcotic use was similar in each group. Women who used SAM were more likely to indicate that they would choose this method again and recommend it to others. The level of satisfaction with SAM expressed by nurses did not change after the study.
Postpartum pain relief was similar for women who had standard administration of medication by nurses and those who had SAM. More women using SAM used either no medication or acetaminophen only, and more women using SAM were highly satisfied with their method of pain relief. Use of self-administered medication should be considered for every postpartum unit.
