Non Landmark - Obs Flashcards
Predictive accuracy of CPR for adverse perinatal and neurodevelopmental outcomes in suspected FGR: sys r/v and meta-analysis
Aim: determine accuracy of CPR for predicting adverse perinatal and neurodevelopmental outcomes in suspected FGR
Methods: sys r/v meta anal
Results: best predictive accuracy of CPR was for perinatal death send 93% spec 76%; worst for neonatal acidosis
No data on CPR for predicting neurodevelopmental outcome
Cochrane review antenatal corticosteroids (Roberts et al 2017)
Benefits: Perinatal death NND RDS IVH NEC Mec vent Systemic infection in the first 48 hours of life
No effect: Chronic lung disease Mean bw Death in childhood Developmental delay Death in adulthood
No increased risk of:
Chorio
Endometritis
Maternal death
Cochrane Review mag sulph for neuroprotection
2009
Antenatal mgso4 given to women at risk of PTB reduced risk of CP RR 0.68
No effect on perinatal mortality
Reduction in the risk of substantial gross motor dysfunction RR 0.61
Nil other differences noted
4 trials looking at neuroprotection
1 trial looking at eclampsia prevention
Cochrane Review: Fish oil PTB
2018
Assess effects of omega-3 LCPUFA during pregnancy on maternal, perinatal, and neonatal outcomes
Looked at RCTs comparing omega 3 with placebo or no omega-3
PTB <37 and <34 reduced with omega-3; possibly reduced risk of perinatal death and NICU admit, reduced risk LBW and increased risk LGA
Likely increases post term pregnancies
Risk of bias mixed
Need long term follow up
Repeated steroids: effect on CP and childhood behavior
2004
Nonrandomized
Very PT infants from singletons alive at 3 years
Increasing numbers of steroids-reduction in CP
3 or more courses: increased rates of aggressive, distractingly, and hyperkinetic behavior
Intelligence not affected
Repeated steroids may protect against CP but are associated with hyperactivity later in childhood
Cholestasis meta-analysis. Ovadia.
2019
Looked at all studies on OC; 23 studies
Bile salts >100 increased risk of SB
Bile salts >40 significant risk 0.28%
Bile salts < 40 same as background population
Advise repeat bile testing until delivery
ECV cochrane r/v 2015
8 randomized trials of ecv at term
Compared those who had no attempt at ECV
ECV reduced risk of non-cephalon presentation at birth by 60% (0.42)
Reduced risk of cesarean delivery by 40% (0.57)
Epidural versus non-epidural or no analgesia for pain management in labour Cochrane 2018
40 trials - RCTs only comparing all types of epidural with any form of pain relief not involving regional blockade, or no pain relief in labour
Results
Lower pain scores
Reduction in need for more pain relief
More vaginal birth - but negated
Women experienced more hypotension, motor blockage, fever, and urinary retention
Longer first and second stages of labour
More likely to have oxy
Less risk of resp distress requiring oxygen
Less likely to have n&v than those getting opioids
* this shows that there isn’t an increased in assisted delivery!* (studies after 2005)
-though no different to morphine for c/s rates
Pain management for women in labour: an overview of systematic reviews 2012
15 cochrane reviews (255 trials) and 3 non-cochrane (55 trials)
Looking at efficacy and safety of non-pharmacological and pharmacological interventions to manage pain in labour
What works: epidural, CSE, and inhaled analgesia, but more adverse effects
What may work: water immersion, relaxation, acupuncture, massage and la nerve blocks or non-opioid drugs —>less adverse effects
Insufficient evidence: TENS, IV opioids, aromatherapy, sterile water infection, hypnosis, biofeedback
Non-pharm efficacy unknown due to limited high quality evidence
TERMPROM study
1996
Randomized
Compared IOL with oxy vs expectant management
Higher rates in expectant group of: Clinical chorio Intrapartum fever Postpartum fever Antibiotics before/during labour Longer NICU stay
Recent meta-analysis shows similar results
Cochrane of PROM 2017 (Planned early birth vs expectant management)
Expectant:
Reduced rate caeser (non significant trend)
Early intervention:
Reduced infection - both maternal and fetal
Less early-onset neonatal sepsis (non-statistical)
Reduced chorio and PP septicaemia
Less NICU admission
Less need for neonatal abx
Non-statistical reduced perinatal mortality
Antibiotic prophylaxis for term or near-term PROM - meta-analysis of RCTs
2015
Routine administration of abx non significant reduction in chorio, endometritis, maternal infection, and neonatal sepsis
BUT if PROM>12 hours
Lower rate chorio by 50%
Lower rate endometritis by 88%
ARRIVE trial - labour induction vs expectant management in low risk nullips
2018
Multicentre trial
Randomly assigned at 38 to 38+6 to either IOL at 39-39+4 or expectant management
Primary outcome:perinatal death, severe neonatal complications
Secondary outcome: ceaser
Results: reduction in rate of caeser 18.6 vs 22%
Cochrane Review - IOL from improving birth outcomes for women at or beyond term
2018
30 RCTs with women at or beyond term, comparing a policy of IOL vs expectant
Low risk women only
IOL-fewer perinatal deaths NNTB(with beneficial outcome) was 426 Fewer caesers More instrumentals No difference perineal trauma or PPH Less NICU admits Fewer babies with apgars <7 No difference neonatal trauma
**No clear differences between timing of IOL <41 weeks - >41 weeks for anything but more instrumentals
Moderate to low quality evidence
Cochrane IOL beyond term
2012
RCTs
Comparing IOL with spontaneous labour
22 trials (9383 women)
Results: fewer perinatal deaths (0.31 RR)
NNTB 410
No differences between timing of IOLs-most were 41 weeks
Fewer meconium aspiration
Less caesers
NO difference NICU admission
