Landmarks

Question 1

Zhang 2005 NEJM

Comparison medical vs surgical management for early pregnancy failure

Answer 1

70% success miso D3, 84% miso D8
97% success ERPOC
No difference in acceptability

RCT
652 participants
800mcg PV miso

Faults: unblinded, didnt include heavy bleeding, anembryonic overrepresented, one country

Question 2

SPIN 2010 Blood

LMWH and aspirin in recurrent pregnancy loss

Answer 2

Aspirin 75mg + LMWH 40mg + Monitoring VS monitoring alone

294 participants. RCT.
No improvement in unexplained pregnancy loss (both ~20%)

Faults: unblinded, no definition pregnancy loss, looked at 2 rather than 3 previous miscarriages

Question 3

ALIFE 2010 Kandoorp, NEJM

Aspirin + heparin live birth rate

Answer 3

Aspirin 80mg + LMWH vs Aspirin vs Placebo
NO difference in live birth rate (both ~55%)

RCT
Faults: 2 rather than 3 mc, only 85% adherence, use of LMWH not blinded

Question 4

Million Women 2003 Lancet

effect of HRT on breast ca incidence + mortality

Answer 4

COHORT study, breast cancer and HRT
Women recruited from breast screening, UK, 50-64

After 10 years of HRT: breast cancer +5/1000 E, +19/1000 E+P (6/1000 @ 5years for E+P)
Tibolone also increased risk of breast cancer
Past users at time of randomisation were not at increased risk of breast cancer

Question 5

WHI E+P 2002 JAMA

Risks benefits HRT on 1 (CHD + Breast Ca)

Answer 5

RCT
CHD +7 (*)
Breast ca +8
Stroke +8, PE +8

Total extra risk events: 19 per 10 000 woman years

DECREASED: colon -6, hip # -5.

Question 6

WHI E only 2004 JAMA

Answer 6

NO difference: CHD, breast ca, mortality
INcrease: Stroke, DVT
Decrease: hip #

Question 7

SROM related landmarks (4)

Answer 7

TERMPROM: IOL vs expectant, no change NN sepsis or CS, reduces chorio RR 0.5
PPROMPT: increases RDS + CS, no reduce NN sepsis
ORACLE: erythromycin improved (death, CLD, uss)
ORACLE FU: no diff in diff abx

Question 8

PTB related (3)

Answer 8

PROGESTERONE @ risk PTB: RR 0.5 (100mg PV)
PROGESTERONE SHORT CX <15mm: RR 0.5
MGS04 Neuro: CP RR 0.68, Gross motor RR 0.61

Question 9

STEROIDS (3)

Answer 9

L8 preterm: RR0.8, less severe resp
ASTECS (elCS >37): less SCBU RR 0.46
ACTORDS (repeat <32): Less RDS + morbidity

Question 10

DIABETES (2)

Answer 10

HAPO: increased BSL increase adverse (LGA, CS< hypoG, C peptide)
ACHOIS: Rx GDM RR perinatal morbid (NND,birth injury) RR 0.33

Question 11

PET (3)

Answer 11

CLASP: no change in PET/SGA, but less PTB
HYPITAT: IOL>36,improved mat outcome RR 0.71
MAGPIE: RR 0.42 for eclamptic seizures

Question 12

DELIVERY (4)

Answer 12

ARRIVE: IOL 39-39+4, reduce CS rate, no change NN perimort
TRUFFLE: survival highest for DV w no A wave change
TERM BREECH: less perinatal mort RR 0.23, morbid RR 0.36
CS TWINS: CS does not alter NN death/serious morbid mort if leading ceph
WOMAN: less death from bleeding if within 3 hours RR 0.8

Question 13

Markov model

Answer 13

Simulates large hypothetical cohorts of patients that are followed through the model over time

Ovarian conservation at time of hysterectomy for benign disease

Chosen because women may enter or exit various health states after surgery

Question 14

Ovarian conservation at time of hysterectomy for benign disease

Answer 14

Markov model

40-80yo
4 strategies: oophorectomy with or without oestrogen replacement, conservation with or without estrogen replacement

Primary outcome: survival to age 80, ovarian, CHD, hip fracture, breast cancer, stroke

Results
<55 removal caused 8.58% increase in all cause mortality by age 89
<59 = 3.92% increase

Retaining ovaries until at least 65 has long term survival benefits for women at average risk ovarian cancer