The objective of this systematic review was to estimate the efficacy and safety of high-dose vs low-dose oxytocin for labor augmentation on the risk of cesarean section and on indicators of maternal ...and neonatal morbidity. We searched PubMed, MEDLINE, EMBASE, and the Cochrane Library for randomized clinical trials published until January 2010. Ten randomized clinical trials, including 5423 women, met the inclusion criteria. High-dose oxytocin was associated with a moderate decrease in the risk of cesarean section (relative risk RR, 0.85; 95% confidence interval CI, 0.75–0.97), a small increase in spontaneous vaginal delivery (RR, 1.07; 95% CI, 1.02–1.12), and a decrease in labor duration (mean difference: –1.54 hours, 95% CI, –2.44 to –0.64). While hyperstimulation was increased with high-dose oxytocin (RR, 1.91; 95% CI, 1.49–2.45), there was no evidence of an increase in maternal or neonatal morbidity. We conclude that high-dose oxytocin for labor augmentation is associated with a decrease in cesarean section and shortened labor.
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.
Objective The objective of the study was to evaluate, in labors complicated by thick meconium-stained amniotic fluid, the association between specific fetal heart rate (FHR) patterns and adverse ...perinatal outcomes. Study Design A retrospective cohort study of patients with FHR tracing data (n = 1638) from a previously reported randomized controlled trial of amnioinfusion for the prevention of meconium aspiration syndrome. Results The presence of FHR tracing abnormalities was associated with an increased risk of perinatal mortality and/or neonatal morbidity (moderately abnormal: adjusted odds ratio OR, 1.67; 95% confidence interval CI, 1.18-2.37; markedly abnormal: adjusted OR, 2.97; 95% CI, 1.88-4.67). Specific abnormalities that were associated with the risk of perinatal mortality and/or neonatal morbidity included prolonged decelerations (OR, 1.22; 95% CI, 1.02-1.48), severe variable decelerations (OR, 1.08; 95% CI, 1.00-1.16), bradycardia (OR, 2.49; 95% CI, 1.02-6.11), and tachycardia (OR, 2.43; 95% CI, 1.49-3.94). Conclusion The presence of abnormal FHR tracing patterns in meconium-stained amniotic fluid patients is associated with an increased risk of adverse perinatal outcomes.
Abstract Purpose Pharmacovigilance studies of cancer treatment frequently monitor infections. Predictive values of algorithms identifying disease depend on prevalence of the disease in the population ...under study. We therefore estimated the positive predictive value (PPV) of primary inpatient diagnosis of infection among cancer patients in the Danish National Registry of Patients (DNRP). Methods The algorithm to identify infections in the DNPR was based on International Classification of Diseases , 10th revision (ICD-10) codes. A physician blinded to the type of sampled infection reviewed the medical charts and assessed the presence and type of infection. Using the physician global assessment as gold standard, we computed PPVs with and without requiring agreement on infection type. Results We retrieved 266 of 272 medical charts (98%). Presence of infection was confirmed in 261 patients, resulting in an overall PPV of 98% (95% confidence interval, 96%–99%). When requiring agreement on infection type, overall PPV was 77%. For skin infections, pneumonia, and sepsis, PPVs were 79%, 93% and 84%, respectively. For these infections, we additionally calculated PPVs using evidence-based criteria as the gold standard. PPV was similar for pneumonia, but lower for skin infections and sepsis. Conclusions The Danish National Registry of Patients is suitable for monitoring infections requiring hospitalization among cancer patients.
