Menstrual disturbances

No Abstract

Surgical versus expectant management in women with an incomplete evacuation of the uterus after treatment with misoprostol for miscarriage:the MisoREST trial

<p>Background: Medical treatment with misoprostol is a non-invasive and inexpensive treatment option in first trimester miscarriage. However, about 30% of women treated with misoprostol have incomplete evacuation of the uterus. Despite being relatively asymptomatic in most cases, this finding often leads to additional surgical treatment (curettage). A comparison of effectiveness and cost-effectiveness of surgical management versus expectant management is lacking in women with incomplete miscarriage after misoprostol.</p><p>Methods/Design: The proposed study is a multicentre randomized controlled trial that assesses the costs and effects of curettage versus expectant management in women with incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage. Eligible women will be randomized, after informed consent, within 24 hours after identification of incomplete evacuation of the uterus by ultrasound scanning. Women are randomly allocated to surgical or expectant management. Curettage is performed within three days after randomization. Primary outcome is the sonographic finding of an empty uterus (maximal diameter of any contents of the uterine cavity <10 millimeters) six weeks after study entry. Secondary outcomes are patients' quality of life, surgical outcome parameters, the type and number of re-interventions during the first three months and pregnancy rates and outcome 12 months after study entry.</p><p>Discussion: This trial will provide evidence for the (cost) effectiveness of surgical versus expectant management in women with incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage.</p>

Revisões sistemáticas de antibioticoprofilaxia em cesarianas Systematic reviews of antibiotic prophylaxis in cesareans

O objetivo do trabalho foi analisar a evidência científica disponível sobre os efeitos da antibioticoprofilaxia em cesarianas. As presentes revisões sistemáticas compreenderam um exame detalhado da qualidade do desenho e da execução assim como da heterogeneidade clínica entre os ensaios. A meta-análise dos ensaios placebo-controlados (27 estudos) apontou eficácia aproximada de 65% para ambos os desfechos estudados, endometrite e infecção da ferida cirúrgica (IFC), correspondendo a uma queda da incidência de 11% e 5%, respectivamente. As análises de sensibilidade mostraram efeitos sumários semelhantes aos observados para o conjunto dos ensaios. O subgrupo dos 12 ensaios de cesáreas não eletivas indicou benefício importante da antibioticoprofilaxia para ambos os desfechos, correspondente a uma queda de 14% (endometrite) e 5% (IFC). Para cesáreas eletivas (dois ensaios), não foi mostrado benefício relevante. A evidência obtida dos ensaios comparativos de doses foi limitada devido a falhas metodológicas importantes e ao pequeno número de pacientes envolvidas (três ensaios). Os ensaios comparativos de antimicrobianos (sete estudos) não evidenciaram diferença de eficácia entre os dois esquemas analisados, cefalosporinas de 1ª e de 2ª geração.<br>This study reviews the available evidence on the efficacy of antibiotic prophylaxis in cesarean sections. The study included a detailed analysis of the quality of design and performance and the clinical heterogeneity of selected clinical trials. Meta-analysis of placebo-controlled trials estimated an efficacy of some 65% for the two study endpoints, endometritis and surgical wound infection, corresponding to a decrease in infection rates of some 11% and 5%, respectively. Sensitivity analyses showed summary effects similar to those observed for all studies. Results for the non-elective cesarean sections subgroup (12 studies) indicated a relevant benefit for both endpoints, corresponding to a decrease in incidence rates of some 14% (endometritis) and 5% (surgical infection wound). For elective surgeries (two trials), no relevant benefit was found. Evidence from comparative trials on number of doses was limited due to important methodological shortcomings and to the small number of patients enrolled (three trials). Comparative drug trials (seven studies) did not show evidence of different performance between first and second-generation cephalosporins

Fetal Physiologically-Based Pharmacokinetic Models:Systems Information on Fetal Biometry and Gross Composition

Background: Postulating fetal exposure to xenobiotics has been based on animal studies; however, inter-species differences can make this problematic. Physiologically-based pharmacokinetic models may capture the rapid changes in anatomical, biochemical, and physiological parameters during fetal growth over the duration of pregnancy and help with interpreting laboratory animal data. However, these models require robust information on the longitudinal variations of system parameter values and their covariates. Objective: The objective of this study was to present an extensive analysis and integration of the available biometric data required for creating a virtual human fetal population by means of equations that define the changes of each parameter with gestational age. Methods: A comprehensive literature search was carried out on the parameters defining the growth of a fetus during in-utero life including weight, height, and body surface area in addition to other indices of fetal size, body fat, and water. Collated data were assessed and integrated through a meta-analysis to develop mathematical algorithms to describe growth with fetal age. Results: Data for the meta-analysis were obtained from 97 publications, of these, 15 were related to fetal height or length, 32 to fetal weight, 4 to fetal body surface area, 8 to crown length, 5 to abdominal circumference, 12 to head circumference, 14 to body fat, and 12 to body water. Various mathematical algorithms were needed to describe parameter values from the time of conception to birth. Conclusion: The collated data presented in this article enabled the development of mathematical functions to describe fetal biometry and provide a potentially useful resource for building anthropometric features of fetal physiologically-based pharmacokinetic models.</p