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Abstract
Cervical length measurement for the prediction of preterm birth in multiple pregnancies: a systematic review and bivariate meta-analysis.
This is a recent meta-analysis that is published in 2011, reviewed the benefits assessment of the cervical length in asymptomatic women with multiple pregnancy. This meta-analysis included 21 studies in which 2757 women were included. In spite of the large variation in the gestational age, cut off points of cervical length and the exact definition of preterm labor, there was a good predictive value for the short cervical length in predicting preterm labor, as at cervical length of 35mm the sensitivity and specificity were 78% and 66% respectively at gestational age of 34 weeks. At the same gestational age with progressive shortening of the cervix there was reduction in the sensitivity but increased specificity; at cervical length 30mm the sensitivity 41% and specificity 87%, while at 25mm the sensitivity 36% and specificity 94% and at cervical length 20mm the sensitivity was 30% and the specificity was 94%. In conclusion, they summarized that cervical assessment in the second trimester is a good predictor of preterm labor.
Comparison of sublingual versus vaginal misoprostol for second-trimester pregnancy termination: A meta-analysis.
This is a 2011 published meta-analysis that concerned with induction of second trimestric abortion using misoprostol. The aim of this meta-analysis was to compare the sublingual and the vaginal routes as regards the efficacy and safety. The primary outcome as the abortion rate at 24 and 48 hours, while the secondary outcome was the side effects.
They found that both routs have the same efficacy after 24 hours of administration (pooled RR 0.78; 95% CI 0.71-0.87), however, after 48 hours there was significantly higher efficacy for vaginal misoprostol over the sublingual in both nulliparous and parous women (pooled RR 0.89; 95% CI 0.86-0.95) and (pooled RR 0.96; 95% CI 0.93-0.99) respectively.
In addition to that, they found that there were no significant difference between both routs as regards the side effects and safety margin. Hence, they concluded that in mid trimesteric abortion both vaginal and sublingual routs are as effective and safe as each others.
Recombinant versus urinary gonadotrophin for ovarian stimulation in assisted reproductive technology cycles.
A recent Cochrane review brought together all randomized studies to compare the effectiveness of recombinant gonadotrophin (rFSH) with the three main types of urinary gonadotrophins (i.e. HMG, FSH-P and FSH-HP) for ovarian stimulation in women undergoing IVF or ICSI treatment cycles. 42 trials with a total of 9606 couples were included. Comparing rFSH to any of the other gonadotrophins irrespective of the down-regulation protocol used did not result in any evidence of a statistically significant difference in live birth rate or in the OHSS rate. Clinical choice of gonadotrophin should depend on availability, convenience and costs. Further research on these comparisons is unlikely to identify substantive differences in effectiveness or safety.
OC pills can be detrimental in GnRH antagonist cycles.
Recent meta-analysis by Greisinger et al showed that ongoing pregnancy rate (PR) per randomized woman to be significantly lower in patients with oral contraceptive (OC) pill pretreatment (relative risk: 0.80, 95% confidence interval [CI]: 0.66-0.97; rate difference: -5%, 95% CI: -10% to -1%; fixed effects model) after pooling data from six randomized controlled trials encompassing 1,343 patients.
Duration of stimulation (weighted mean difference [WMD]: +1.33 days, 95% CI: +0.61-2.05) and gonadotrophin consumption (WMD: +360 IUs, 95% CI: +158-563) were significantly increased after OC pretreatment, but there was no statistically significant gain in the number of cumulus-oocyte complexes (WMD: +0.6 cumulus-oocyte complexes, 95% CI: -0.08-1.25). Accordingly, the use of oral contraceptive pills for cycle programming before antagonist cycle is not recommended. Surgical benefits of LARVH for Early stage IB cervical cancer. In recently released RCT published in BJOG, May, 2010, the authors evaluated perioperative surgical outcomes and resection size for laparoscopically assisted radical vaginal hysterectomy (LARVH) compared with radical abdominal hysterectomy (RAH). There were Statistically significant differences were found between LARVH and RAH, respectively: median duration of bladder catheterization, 4 days versus 21 days (P = 0.003); median operating time, 180 minutes versus 138 minutes (P = 0.05); median blood loss, 400 ml versus 1000 ml (P = 0.05), median hospital stay, 5 days versus 7 days (P = 0.04) and median opiate requirement in the first 36 hours postoperatively, 30 mg versus 53 mg (P = 0.004).
The mean resected lengths for LARVH versus RAH, respectively, were: mean resected vaginal cuff, 1.26 cm versus 2.16 cm (P = 0.014); mean resected cardinal ligament length, 1.30 cm versus 2.79 cm (P = 0.013) and mean resected uterosacral ligament length, 1.47 cm versus 4.68 cm (P = 0.034).
This study confirms the short-term surgical benefits of LARVH. In addition, LARVH has been shown to be a less radical procedure than RAH, supporting the need for strict patient selection and to restrict the procedure to small tumors.
This is a recent meta-analysis that is published in 2011, reviewed the benefits assessment of the cervical length in asymptomatic women with multiple pregnancy. This meta-analysis included 21 studies in which 2757 women were included. In spite of the large variation in the gestational age, cut off points of cervical length and the exact definition of preterm labor, there was a good predictive value for the short cervical length in predicting preterm labor, as at cervical length of 35mm the sensitivity and specificity were 78% and 66% respectively at gestational age of 34 weeks. At the same gestational age with progressive shortening of the cervix there was reduction in the sensitivity but increased specificity; at cervical length 30mm the sensitivity 41% and specificity 87%, while at 25mm the sensitivity 36% and specificity 94% and at cervical length 20mm the sensitivity was 30% and the specificity was 94%. In conclusion, they summarized that cervical assessment in the second trimester is a good predictor of preterm labor.
Comparison of sublingual versus vaginal misoprostol for second-trimester pregnancy termination: A meta-analysis.
This is a 2011 published meta-analysis that concerned with induction of second trimestric abortion using misoprostol. The aim of this meta-analysis was to compare the sublingual and the vaginal routes as regards the efficacy and safety. The primary outcome as the abortion rate at 24 and 48 hours, while the secondary outcome was the side effects.
They found that both routs have the same efficacy after 24 hours of administration (pooled RR 0.78; 95% CI 0.71-0.87), however, after 48 hours there was significantly higher efficacy for vaginal misoprostol over the sublingual in both nulliparous and parous women (pooled RR 0.89; 95% CI 0.86-0.95) and (pooled RR 0.96; 95% CI 0.93-0.99) respectively.
In addition to that, they found that there were no significant difference between both routs as regards the side effects and safety margin. Hence, they concluded that in mid trimesteric abortion both vaginal and sublingual routs are as effective and safe as each others.
Recombinant versus urinary gonadotrophin for ovarian stimulation in assisted reproductive technology cycles.
A recent Cochrane review brought together all randomized studies to compare the effectiveness of recombinant gonadotrophin (rFSH) with the three main types of urinary gonadotrophins (i.e. HMG, FSH-P and FSH-HP) for ovarian stimulation in women undergoing IVF or ICSI treatment cycles. 42 trials with a total of 9606 couples were included. Comparing rFSH to any of the other gonadotrophins irrespective of the down-regulation protocol used did not result in any evidence of a statistically significant difference in live birth rate or in the OHSS rate. Clinical choice of gonadotrophin should depend on availability, convenience and costs. Further research on these comparisons is unlikely to identify substantive differences in effectiveness or safety.
OC pills can be detrimental in GnRH antagonist cycles.
Recent meta-analysis by Greisinger et al showed that ongoing pregnancy rate (PR) per randomized woman to be significantly lower in patients with oral contraceptive (OC) pill pretreatment (relative risk: 0.80, 95% confidence interval [CI]: 0.66-0.97; rate difference: -5%, 95% CI: -10% to -1%; fixed effects model) after pooling data from six randomized controlled trials encompassing 1,343 patients.
Duration of stimulation (weighted mean difference [WMD]: +1.33 days, 95% CI: +0.61-2.05) and gonadotrophin consumption (WMD: +360 IUs, 95% CI: +158-563) were significantly increased after OC pretreatment, but there was no statistically significant gain in the number of cumulus-oocyte complexes (WMD: +0.6 cumulus-oocyte complexes, 95% CI: -0.08-1.25). Accordingly, the use of oral contraceptive pills for cycle programming before antagonist cycle is not recommended. Surgical benefits of LARVH for Early stage IB cervical cancer. In recently released RCT published in BJOG, May, 2010, the authors evaluated perioperative surgical outcomes and resection size for laparoscopically assisted radical vaginal hysterectomy (LARVH) compared with radical abdominal hysterectomy (RAH). There were Statistically significant differences were found between LARVH and RAH, respectively: median duration of bladder catheterization, 4 days versus 21 days (P = 0.003); median operating time, 180 minutes versus 138 minutes (P = 0.05); median blood loss, 400 ml versus 1000 ml (P = 0.05), median hospital stay, 5 days versus 7 days (P = 0.04) and median opiate requirement in the first 36 hours postoperatively, 30 mg versus 53 mg (P = 0.004).
The mean resected lengths for LARVH versus RAH, respectively, were: mean resected vaginal cuff, 1.26 cm versus 2.16 cm (P = 0.014); mean resected cardinal ligament length, 1.30 cm versus 2.79 cm (P = 0.013) and mean resected uterosacral ligament length, 1.47 cm versus 4.68 cm (P = 0.034).
This study confirms the short-term surgical benefits of LARVH. In addition, LARVH has been shown to be a less radical procedure than RAH, supporting the need for strict patient selection and to restrict the procedure to small tumors.