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Secondary and trace elements may be limiting soil microbial functioning, albeit microbial demand and content remain largely unknown and methods for their in situ detection are limited. Thus, the objective of the present study was to take the first step towards the method development for the assessment of the soil microbial ionome, that is, the elemental composition of soil microbial communities. Chloroform (CHCl3) fumigation extraction was used for the detection of microbial CHCl3‐labile secondary and trace element concentrations in soils. The suitability of two extractants (NH4NO3, CaCl2) for the quantification of CHCl3‐labile concentrations of phosphorus, sulphur, potassium, sodium, and magnesium, as well as selenium, iron, zinc, manganese, copper, cobalt, nickel, molybdenum, vanadium, boron, silicon, barium, arsenic, and cadmium, were tested in six agricultural soils. Additionally, three soil to extractant ratios (1:5, 1:10, and 1:20) and two extraction durations, 1 or 2 h, were tested in a subset of two soils. Out of the two extractants tested, 0.01 M CaCl2 was found to be the best‐suited extractant. For CaCl2, a soil‐to‐extractant ratio of 1:20 with an extraction time of 1 h was best for the majority of elements in the two soils tested. In a limited number of agricultural soils, we were able to show that CHCl3 fumigation extraction can successfully be applied to the elements phosphorus, sulphur, potassium, sodium, magnesium, zinc, manganese, copper, nickel, vanadium, boron, silicon, and barium to yield a CHCl3‐labile element fraction. Conversion values to microbial biomass, accounting for elements contained in the cell envelope components, which are mostly not extractable, and to account for adsorption to soil colloids during extraction are yet to be determined in a larger variety of soils. To overcome some of the limitations of the fumigation extraction approach for secondary and trace elements, a pre‐extraction step may provide a suitable solution. [ABSTRACT FROM AUTHOR]

Current management of bladder pain syndrome (BPS) was evaluated through a prospective electronic questionnaire posted on three patient support groups and sent to all members on the British Society of Urogynaecology (BSUG) database. Methods of diagnosis and treatment were assessed. 133 patients and 69 clinicians participated in the survey. Patients reported their main symptom to be pain when their bladder was full in 80% (n = 107) and the most bothersome symptom was pelvic pain (22%, n = 29). 93% (n = 64) of clinicians made their diagnosis by history and cystoscopy. 78% (n = 54) of clinicians treated patients with amitriptyline and 75% (n = 52) by dietary modification while 77% (n = 102) of patients reported using simple analgesia, 74% (n = 98) dietary modification and 62% (n = 83) low-dose long-term antibiotics. There is wide variation in diagnostic methods and treatments of BPS used by clinicians and experienced by patients with no obvious consensus. National guidance is needed to help standardise care. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Fox C, Khan K, Coomarasamy A. How to interpret randomised trials of test–treatment combinations: a critical evaluation of research on uterine Doppler test to predict, and aspirin to prevent, pre-eclampsia. BJOG 2010;117:801–808. The methodology to evaluate either a test or treatment is well developed and understood. However, the design, conduct and interpretation of a combination of a test and a treatment in a single study are fraught with complexities. There are two distinct study designs to evaluate test–treatment combinations, with randomisation occurring either before or after the test. We present critical issues that need to be considered when evaluating and appraising test–treatment combinations, using the example of research on the uterine artery Doppler test to predict, and aspirin to prevent, pre-eclampsia. [ABSTRACT FROM AUTHOR]

Postgraduate training programmes have gradually been focusing on a learner-centred approach. We developed a 2-year rolling postgraduate educational programme in obstetrics and gynaecology to equip trainees with the knowledge, skills and attitudes necessary to promote self-directed learning. Its aim was to achieve this through critical analysis, application of knowledge and the attainment of skills relating to presentation, facilitation, feedback and assessment. Its evaluation using a trainees' feedback questionnaire ( n = 21) showed that content of the pre-course work was scored favourably by 20 trainees, however one-third of trainees raised concerns about effectiveness and feasibility of the work. Lectures were preferred as the method of teaching by 17 compared with small group activity preferred by 14 trainees. The median scores for all items evaluated were above the threshold for concern. Our evaluation concluded that postgraduate teaching programmes based on principles of adult learning and reflective practice promote self-directed learning of professionally relevant objectives. Continuous evaluation helps to improve them further. [ABSTRACT FROM AUTHOR]

We set out to determine the quality of existing systematic reviews on multiple pregnancies. We conducted an electronic search in MEDLINE (1951 – 2005), EMBASE (1974 – 2005) and the Cochrane Database for Systematic reviews (2005:2) and a hand-search of reference lists without any language restrictions to identify relevant reviews. Two reviewers independently selected review articles in which a publicly available database was searched for studies concerning multiple pregnancies, and assessed them for quality of methods of review. Information was extracted on framing of question, literature search and data synthesis. Of 342 citations 14 (4%) eligible reviews were identified. Only 8/14 reviews specified the review question. Adequate literature search without language restriction and the use of a reference list was found in 7/14 reviews, but the risk of missing studies was assessed in only 1/14 reviews. Quality assessment of included studies was reported in 7/14 and tabulation of their findings was reported in 8/14 reviews, but heterogeneity of results was evaluated in only 4/14 reviews. Meta-analysis was employed in 3/14 reviews. Systematic reviews of existing studies on multiple pregnancies are infrequent and it is difficult to generate robust inferences from them as they lack good methodology. [ABSTRACT FROM AUTHOR]

Just as systematic reviews of quantitative research have developed over the last two decades, the use of a systematic review is also superseding narrative non-systematic reviews in qualitative research in an attempt to bring rigour to reviewing research evidence. Qualitative research is concerned with the subjective world and the way in which people interpret and make sense of the reality of their lives. This paper describes procedures for conducting a systematic review on qualitative research, and the methods for assessing the quality of qualitative research papers, using published qualitative research on endometriosis as an example to demonstrate these. The conclusion from the systematic review carried out is that the values and methods utilised for a systematic review can usefully be applied to qualitative research. The review of endometriosis research revealed that despite the impact of endometriosis on the lives of women sufferers, little qualitative research has been conducted, and much of that which exists lacks rigour in a number of key areas. [ABSTRACT FROM AUTHOR]

We assessed the feasibility of a new educational programme to teach critical appraisal of the medical literature to postgraduate trainees. The new programme used a journal club format where selection of topics and articles was driven by clinical problems arising in day-to-day practice. Papers were appraised critically according to validated guidelines using computer software for appraisal, electronic storage and retrieval. Over the initial 4-month period the journal club produced 17 critically appraised topics, two of which were published in peer-reviewed journals. During the study, trainees' reading time improved from a median of 2.0 hours (range 1-5 hours) to 3.5 hours (range 2-8 hours) (P = 0.026) and their knowledge scores improved from a mean of 50.8 (SD 4.0) to 62.9 (SD 4.3) (P = 0.003). We conclude that a journal club supported by electronic means of critical appraisal and dissemination of appraised information can be used to encourage the practice of evidence-based medicine. [ABSTRACT FROM AUTHOR]

Objectives To determine whether single or serial estimates of both the amniotic fluid index (AFI) or pulsatility index (PI) of the umbilical artery Doppler waveform can usefully identify infants with anthropometric features of intrauterine growth restriction (IUGR). Methods A total of 274 women underwent serial ante-natal ultrasound examinations at predetermined intervals. Four biophysical parameters were considered: AFI and PI prior to delivery and change in AFI and PI over a 28-day period in the third trimester. All values were expressed as standard deviation scores. IUGR was diagnosed if the neonate demonstrated skinfold thickness < 10th centile, ponderal index < 25th centile or mid-arm circumference to occipitofrontal circumference (MAC: OFC) <-1 SD. Receiver operator characteristic curves were used to determine an optimal cut-off point, and test performance of the biophysical parameters were expressed as likelihood ratios (LR). Results The test performances of all four ultrasound parameters for any of the three diagnostic criteria for IUGR was poor. The highest positive LR was only 2.5 (95% CI 1.5–4.1) for PI prior to delivery in the prediction of ponderal index < 25th centile. Conclusion Despite positive associations between single and serial estimates of AFI and PI with abnormal neonatal morphometry, the likelihood ratios remained low. The results of this study do not support the use of single or serial estimates of AFI or umbilical artery PI in the prediction of IUGR. [ABSTRACT FROM AUTHOR]

The article offers information about fetal lower urinary tract obstruction (LUTO). According to the author, LUTO is a heterogeneous group of pathologies which can be detected at autopsy after termination for ultrasound-diagnosed fetal anomaly. He emphasizes that if LUTO is untreated, it carries a mortality of up to 45 percent due to the severe oligohydramnios in the mid-trimester being associated with pulmonary hypoplasia.

Comments on the accuracy of the results of trials that are stopped early. Ethical obligation to ensure that clinical trials are conducted properly; Need for researchers to register their detailed trial protocols so that errors can be picked up and rectified before its too late; Recommendation for the interim analyses to be kept confidential and shown only to an independent data monitoring committee.

Growing evidence suggests that early symptoms of inattentiveness may affect the language development and academic success of young children. In the present study, we examined the extent to which profiles of inattentiveness and language could be discerned within a heterogeneous group of preschoolers attending early childhood special education programs (n = 461). Based on parent-reported observations of children's symptoms of inattentiveness and direct assessments of children's language skills (grammar, vocabulary, and narrative ability), three distinct profiles were identified. The three groups, representing levels of severity (at risk, almost average, above average), differed not only by their end of year performance, but also with respect to which their abilities changed over the course of the academic year. Children in the poorest performing profile had poorer mean scores in the spring of their preschool year on all measures, but exhibited patterns of gain that exceeded or equaled their peers in higher-performing groups, in the domains of vocabulary and grammar. Examination of subsequent kindergarten reading skills suggested that profile differences remained consistent. Findings underscore the associations between early symptoms of inattentiveness and language difficulties, and further indicate that these relations extend to the acquisition of early reading skills. Future research is needed to corroborate these findings with more robust measures of attention, and to understand the long-term associations between inattentiveness, language and literacy, and potential effects on these associations from early intervention. [ABSTRACT FROM AUTHOR]

We tested the accuracy of coded hospital information on the Patient Administration System (PAS), a major component of the Hospital Information Support System (HISS). This is the main electronic database used for healthcare research, audit, and planning in National Health Service hospitals in the UK. The accuracy of electronic records of diagnoses, interventions and diagnosis-intervention pairs was low. (Kappa agreement statistics [k] were 0·39, 0·30, and 0·21 respectively). A major source of error arose because the databases of maternities and surgical operations were not seamlessly linked to the PAS. [ABSTRACT FROM AUTHOR]

Conservation tillage and carbon sequestration are critical issues in rain-fed farming areas of Pakistan. Conservation tillage is not extensively used in developing countries on dryland soil where marginal farming is practiced. Therefore, primary purpose of this experiment was to determine the influence of conservation tillage practices on soil organic carbon (SOC), particulate organic matter (POC), mineral associated organic carbon (MOC), microbial biomass carbon (MBC) and dehydrogenase activity (Dha) in loess dry land Pothwar, Punjab, Pakistan. The tillage practices included zero tillage (ZT), minimum tillage (MT), reduced tillage (RT) and conventional tillage (CT) with mouldboardplough as a control in main plot and fallow-wheat (Triticumaestivum L.) and mungbean (Vigna radiate L.) crop rotation in sub plot as a split plot layout. The results indicated that ZT showed higher SOC (7.90 g kg-1), POC (2.35 g kg-1), MOC (5.1 g kg-1), MBC (359.37 μgg-1) and Dha (45.12 TPFμgg-1 dry weight) than CT. Among crop rotation, overall mungbean-wheat showed higher values as compared to fallow-wheat crop. The study indicated that conservation tillage practices with legume crop rotation have potential for improving soil organic carbon storage and hence carbon sequestration in soil. [ABSTRACT FROM AUTHOR]

Conservation tillage and carbon sequestration are critical issues in rain-fed farming areas of Pakistan. Conservation tillage is not extensively used in developing countries on dryland soil where marginal farming is practiced. Therefore, primary purpose of this experiment was to determine the influence of conservation tillage practices on soil organic carbon (SOC), particulate organic matter (POC), mineral associated organic carbon (MOC), microbial biomass carbon (MBC) and dehydrogenase activity (Dha) in loess dry land Pothwar, Punjab, Pakistan. The tillage practices included zero tillage (ZT), minimum tillage (MT), reduced tillage (RT) and conventional tillage (CT) with mouldboardplough as a control in main plot and fallow-wheat (Triticumaestivum L.) and mungbean (Vigna radiate L.) crop rotation in sub plot as a split plot layout. The results indicated that ZT showed higher SOC (7.90 g kg-1), POC (2.35 g kg-1), MOC (5.1 g kg-1), MBC (359.37 μgg-1) and Dha (45.12 TPFμgg-1 dry weight) than CT. Among crop rotation, overall mungbean-wheat showed higher values as compared to fallow-wheat crop. The study indicated that conservation tillage practices with legume crop rotation have potential for improving soil organic carbon storage and hence carbon sequestration in soil. [ABSTRACT FROM AUTHOR]

Summary: There is a lack of evidence evaluating cryoprecipitate transfusion in severe postpartum haemorrhage. We performed a pilot cluster‐randomised controlled trial to evaluate the feasibility of a trial on early cryoprecipitate delivery in severe postpartum haemorrhage. Pregnant women (>24 weeks gestation), actively bleeding within 24 h of delivery and who required at least one unit of red blood cells were eligible. Women declining transfusion in advance or with inherited clotting deficiencies were not eligible. Four UK hospitals were randomly allocated to deliver either the intervention (administration of two pools of cryoprecipitate within 90 min of first red blood cell unit requested plus standard care), or the control group treatment (standard care, where cryoprecipitate is administered later or not at all). The primary outcome was the proportion of women who received early cryoprecipitate (intervention) vs. standard care (control). Secondary outcomes included consent rates, acceptability of the intervention, safety outcomes and preliminary clinical outcome data to inform a definitive trial. Between March 2019 and January 2020, 199 participants were recruited; 19 refused consent, leaving 180 for analysis (110 in the intervention and 70 in the control group). Adherence to assigned treatment was 32% (95%CI 23–41%) in the intervention group vs. 81% (95%CI 70–90%) in the control group. The proportion of women receiving cryoprecipitate at any time‐point was higher in the intervention (60%) vs. control (31%) groups; the former had fewer red blood cell transfusions at 24 h (mean difference −0.6 units, 95%CI −1.2 to 0); overall surgical procedures (odds ratio 0.6, 95%CI 0.3–1.1); and intensive care admissions (odds ratio 0.4, 95%CI 0.1–1.1). There was no increase in serious adverse or thrombotic events in the intervention group. Staff interviews showed that lack of awareness and uncertainty about study responsibilities contributed to lower adherence in the intervention group. We conclude that a full‐scale trial may be feasible, provided that protocol revisions are put in place to establish clear lines of communication for ordering early cryoprecipitate in order to improve adherence. Preliminary clinical outcomes associated with cryoprecipitate administration are encouraging and merit further investigation. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Cooper N, Smith P, Khan K, Clark T. Does cervical preparation before outpatient hysteroscopy reduce women's pain experience? A systematic review. BJOG 2011;118:1292-1301. Background Studies examining the use of pharmaceutical (prostaglandins, antiprogestogens) and mechanical (osmotic dilators) dilatation of the cervix before hysteroscopy under general anaesthesia have produced conflicting results regarding their effect on cervical dilatation and trauma during the procedure. Objective To compare the effect on pain and need for cervical dilatation of various methods of cervical preparation before outpatient hysteroscopy. Search strategy MEDLINE, EMBASE and CINAHL were searched using a combination of the keywords 'hysteroscopy', 'vaginoscopy', 'cervical ripening', 'laminaria', 'progest*', 'prostaglandin', 'oestrogen''cervical preparation' and their associated Medical Subject Headings The Cochrane Library was searched using the keywords 'hysteroscopy' and 'cervical'. There were no limits or filters placed on the searches. Selection criteria Randomised controlled trials that examined women undergoing outpatient hysteroscopy, where the intervention was the use of cervical preparation versus a control or placebo and the outcome was pain assessment. Data collection and analysis Two reviewers independently selected trials. Data were extracted on pain, the effect on dilatation, adverse effects, trauma and feasibility. Data regarding pain and cervical dilatation were unsuitable for meta-analysis. Meta-analyses were performed for adverse effects and feasibility using the random effects models to calculate the Peto odds ratio. Results From 585 abstracts, six studies were selected for inclusion in the systematic review. The results suggest that there may be a benefit of using prostaglandins for postmenopausal women; however, there is no high-quality evidence that giving misoprostol before outpatient hysteroscopy reduces the pain experienced by women of reproductive age. There is some evidence that prostaglandins reduce the force and requirement for dilatation of the cervix beyond 5 mm. Author's conclusions There is no evidence to recommend the routine administration of mifepristone or misoprostol to women before outpatient hysteroscopy. Cervical priming with vaginal prostaglandins may be considered in postmenopausal women if using hysteroscopic systems >5 mm in diameter. [ABSTRACT FROM AUTHOR]

A systematic review was carried out to study the hypothesis that bladder wall thickness (BWT) on ultrasound is accurate in diagnosing detrusor overactivity (DO). Databases were searched from database inception to January 2009. Two reviewers independently selected articles and extracted data on study characteristics, quality and results. Five out of 190 screened studies were included. There were variations in the quality, methods of performing the ultrasound and urodynamics studies, and the format of reporting findings. BWT was more in women with DO than those with other types of incontinence in four out of five studies. Using a 5-mm cutoff (two studies), sensitivity varied between 40% and 84%, and specificity 78–89%. There is lack of data to reliably estimate accuracy of BWT in DO. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Cooper N, Smith P, Khan K, Clark T. Vaginoscopic approach to outpatient hysteroscopy: a systematic review of the effect on pain. BJOG 2010;117:532–539. Background Vaginoscopy, also known as the ‘no-touch’ technique, is an alternative method for performing hysteroscopy without the need for a vaginal speculum to view the cervix or cervical instrumentation to grasp and steady the cervix. Objective To examine the effect of a vaginoscopic approach to outpatient hysteroscopy on the patients’ experience of pain, compared with a traditional approach using a vaginal speculum. Search strategy MEDLINE, EMBASE, CINAHL and the Cochrane Library were searched for relevant articles. No filters or restrictions were placed on the searches. Selection criteria Randomised controlled trials (RCTs) that assess pain when comparing the vaginoscopic technique versus a traditional hysteroscopy in the outpatient setting. Data collection and analysis Two reviewers independently selected trials. Data were abstracted on quality, characteristics and results. Meta-analyses were performed using the random-effects model to calculate the standardised mean difference (SMD). Main results There were six trials (2851 participants). Data from four of these were meta-analysed, and we found that the use of the vaginoscopic approach to hysteroscopy was less painful than using the traditional technique (SMD −0.44, 95% CI from −0.65 to −0.22, I2 = 58%). There was no significant difference in the number of failed procedures between groups ( P = 0.38). Author’s conclusions The vaginoscopic approach to outpatient hysteroscopy is successful and significantly reduces the pain experienced by patients during the procedure, compared with traditional techniques using a vaginal speculum. Vaginoscopy should become standard practice for endoscopic instrumentation of the uterine cavity in the outpatient setting. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Morris R, Malin G, Khan K, Kilby M. Systematic review of the effectiveness of antenatal intervention for the treatment of congenital lower urinary tract obstruction. BJOG 2010;117:382–390. Background Congenital lower urinary tract obstruction is associated with high mortality and morbidity. Antenatal detection has improved with advances in ultrasound technology, and has allowed the option of antenatal intervention. Objectives To systematically review the literature to evaluate the effectiveness of antenatal interventions to improve perinatal survival and postnatal renal function in congenital lower urinary tract obstruction. Search strategy Extensive electronic searches (database inception 2009) using Medical Subject Headings (MeSH) and keywords, without restrictions. Reference lists of included studies were checked, and all authors were contacted. Selection criteria Studies were selected according to a predefined protocol. The included studies were observational or randomised trials, where an intervention was performed in utero to treat congenital lower urinary tract obstruction, compared with another intervention or no treatment. Data collection and analysis Data were extracted on study design, quality and results to construct 2 × 2 tables. Meta-analysis was performed where possible. Peto ORs with 95% CIs were computed. Main results Prenatal bladder drainage improved perinatal survival compared with no treatment (OR 3.86, 95% CI 2.00–7.45). This effect was amplified in a subgroup with poor predicted prognosis (OR 12.85, 95% CI 1.25–153.03). However, although treatment increases survival, it appears that the residual risk of poor long-term postnatal renal function is uncertain (OR 0.50, 95% CI 0.13–1.90). Author’s conclusions Antenatal bladder drainage appears to improve perinatal survival in cases of congenital lower urinary tract obstruction, but may confer a high residual risk of poor postnatal renal function, based on observational studies. Randomised research with long-term follow up is necessary to determine the role of antenatal treatment in clinical practice. [ABSTRACT FROM AUTHOR]

Objectives To estimate in a systematic review of the literature the diagnostic value of ultrasound and Doppler blood flow velocity in the evaluation of fetal anaemia. Study selection and data extraction Literature from 2000 to 2008 was identified using MEDLINE and EMBASE, the Cochrane Library and relevant specialist register of the Cochrane Collaboration, and by checking reference lists of known primary studies and review articles. Studies were selected if the accuracy of the fetal ultrasound parameters or Doppler studies of blood flow in the fetal vessels was estimated compared with a reference standard. Data from the selected studies were abstracted as 2 × 2 tables comparing the diagnostic test result with the reference standard. Results were pooled where appropriate. Diagnostic accuracy was expressed as likelihood ratios. Results Twenty-five primary studies were identified containing suitable data on middle cerebral artery Doppler peak systolic velocity (MCA-PSV). The largest group of studies whose data could be pooled containing nine studies gave a positive likelihood ratio of 4.30 (95% CI: 2.50 to 7.41) and a negative likelihood ratio of 0.30 (95% CI: 0.13 to 0.69) for 675 cases in detecting severe anaemia in the analysis. Discussion Although middle cerebral artery peak systolic velocity Doppler has limited diagnostic accuracy, it remains the gold standard for noninvasive screening of fetal anaemia. [ABSTRACT FROM AUTHOR]

Background Congenital urinary tract obstruction can lead to perinatal mortality and morbidity. Assessing antenatal ultrasound features may help identify fetuses likely to suffer complications. Objective To evaluate the accuracy of antenatal ultrasound in the prediction of postnatal renal function in cases of congenital lower urinary tract obstruction (LUTO). Search strategy We conducted electronic searches in MEDLINE, EMBASE, the Cochrane Library, MEDION, SIGLE, SCISEARCH Index of scientific and technical proceedings, National Research Register (database inception – 2008) and Medical Conferences register and searched reference lists. Selection criteria Two reviewers independently selected articles in which the accuracy of fetal ultrasound features were evaluated to predict postnatal renal function with no language restrictions. Data collection and analysis Data were extracted on study characteristics, quality and results to construct 2 × 2 tables. Likelihood ratios for positive (LR+) and negative (LR−) test results, sensitivity and specificity were generated for the different ultrasound parameters and reference standards. Main results Thirteen articles that met the selection criteria, including 215 women and 33 2 × 2 tables. Meta-analysis was performed using clinically similar subgroups to minimise clinical heterogeneity. The ultrasound parameter that showed the best predictive value for postnatal renal function in survivors was renal cortical appearance, sensitivity 0.57 (95% CI 0.37–0.76) and specificity 0.84 (95% CI 0.71–0.94), area under the curve 0.78. Conclusion Measurement of amniotic fluid volume and the appearance of the renal cortex at diagnosis of LUTO show promising predictive accuracy for poor postnatal renal function. [ABSTRACT FROM AUTHOR]

The author offers their thoughts on exercising clinical freedom to implement research findings. They posed that as clinicians collect new information, they are necessitated to put the information forward for implementation into practice. He also underscored that the transfer of research into clinical practice often takes a long process. They also mentioned that evidence-based-medicine (EBM) promotes integration of patient-oriented clinical research knowledge into decision-making.

Background Following single-twin death, the perinatal mortality and morbidity for the surviving co-twin is increased but difficult to quantify. We present data on prognosis from a systematic review. Objectives We aimed to determine the incidence of a) co-twin death, b) neurological abnormality and c) preterm delivery for the surviving co-twin following single-twin death after 14 weeks of gestation. Search strategy Literature was identified by searching two bibliographical databases and specialist journals between 1990 and 2005. Selection criteria The selected studies of ≥5 cases reported on perinatal death and/or neurodevelopmental delay of the surviving co-twin. Data collection and analysis Studies were assessed for quality and data extracted to allow computation of rates. The data were inspected for heterogeneity using a Forrest plot and examined statistically using the chi-square test. Data from individual studies were pooled within subgroups defined by prognosis. Main results The search strategy yielded 632 potentially relevant citations. Full manuscripts were retrieved for 54 citations and 28 studies were finally included in the review. Following the death of one twin, the risk of monochorionic and dichorionic co-twin demise was 12% (95% CI 7–11) and 4% (95% CI 2–7), respectively. The risk of neurological abnormality in the surviving monochorionic and dichorionic co-twin was 18% (95% CI 11–26) and 1% (95% CI 0–7), respectively. The risk of preterm delivery was 68% (95% CI 56–78) and 57% (95% CI 34–77), respectively. Where there was comparative data within studies, the odds of monochorionic co-twin intrauterine death was six times that of dichorionic twins (OR 6.04 [95% CI 1.84–19.87]). Neurological abnormality was also higher in monochorionic compared with dichorionic pregnancies (OR 4.07 [95% CI 1.32–12.51]). Author’s conclusions More prospective research is required to inform decision making on this subject, especially with data that allow stratification based upon chorionicity. [ABSTRACT FROM AUTHOR]

Background Guidelines exist for the management of endometriosis. Validated and reliable appraisal tools exist to assess the quality of guidelines. Objectives To systematically appraise the quality of guidelines for the management of pelvic pain associated with endometriosis. Search strategy Guidelines were identified using a prospective protocol through a systematic search of MEDLINE (1951–2005), EMBASE (1974–2005), the Cochrane Library (2005, issue 2), known guideline websites and the World Wide Web. Selection criteria Type of document: guideline, consensus statement, care protocol or healthcare technology assessment produced by national or international professional organisations and societies or governmental agencies; subject: managemant of pelvic pain associated with endometriosis. Data collection and analysis Two validated appraisal tools, Cluzeau and The Appraisal of Guidelines and Research and Evaluation (AGREE), were used to quantitatively assess the quality of guidelines. Areas evaluated included ‘rigour of development’, ‘context and content’ and ‘application.’ Main results Eight of 596 potentially relevant citations identified met our inclusion criteria. The Cluzeau instrument quality score were the following: rigour of development, 53% (range 5–65%); context and content, 69% (range 29–79%) and application 20% (range 0–20%). The aplication dimension achieved significantly lower quality scores (P = 0.026 versus rigour of development and P = 0.017 versus context and content). The AGREE instrument quality scores were the following: scope and purpose, 68% (range 17–89%); stakeholder involvement, 33% (range 13–63%); rigour of development, 49% (range 10–81%); clarity of presentation, 55% (range 42–67%); applicability, 14% (range 0–28%) and editorial independence, 28% (range 8–67%). The applicability domain achieved significantly lower quality scores (P = 0.001 versus scope and purpose and P = 0.009 versus rigour of development). Author’s conclusions Guidelines for the management of pelvic pain associated with endometriosis do not comply with the recommendations for high-quality standards. [ABSTRACT FROM AUTHOR]

Adenomyosis has been an elusive diagnosis until recently due to the need for a histological confirmation of diagnosis post-hysterectomy. This commentary focuses on the role of non-invasive imaging techniques that have become available for use in the diagnosis of adenomyosis in women with an intact uterus. These include magnetic resonance imaging (MRI) and transvaginal ultrasound (TVS). With improvements in imaging modalities it has now become feasible to establish a diagnosis of adenomyosis without hysterectomy, to exclude additional pathology and to institute conservative symptomatic treatment and monitoring. [ABSTRACT FROM AUTHOR]

The article reflects on the author's view regarding the prospect of fetal therapy for congenital obstructive uropathy. It was stated that the prospect of fetal therapy for said uropathy has engendered a great deal of clinical enthusiasm. In-utero vesico-amniotic drainage of several types has been described in the literature for over 30 years but systemic examination of the published literature confirms the scarcity of high-quality evidence to reliably inform current clinical practice.

The Internet has a great potential to provide useful as well as useless or misleading information. To assess the quality of information available on-line on female sterilisation, we performed a search of the Internet using seven search engines. We set out to assess the first 10 sites found by each of the most frequently used search engines. Our search revealed 12 relevant Web sites, none of which complied with all of the criteria for quality. Our assessment focused on credibility and content of each Web site. Credibility was assessed by source which was described in nine Web sites, currency in five sites and review process in none. We assessed the content by hierarchy and accuracy of evidence which was fulfilled by five sites and one site respectively. This makes it difficult for a lay person to assess which Web sites provide accurate and useful information and which do not. [ABSTRACT FROM AUTHOR]

Presents a case report of a successful conservative management of cervical ectopic pregnancy with combination of methotrexate, mifepristone, surgical evacuation and tamponade using a double balloon three-way catheter. Medical management of the patient to preserve fertility; Absence of hematoma in the cervix after discharge; Factors associated with failure of treatment using methotrexate.

The article discusses the choice of nifedipine, beta-agonists and atosiban for tocolysis in spontaneous preterm labour. The International Preterm Labour Council found considerable variations across national boundaries, even those in close proximity, with respect to the way spontaneous preterm labour (SPTL) is diagnosed, managed and treated with little or no agreement on the use of tocolytics. The International Preterm Labour Council aims to continue to provide systematic reviews to encourage the introduction of evidence-based practice to the management of SPTL, to maintain standards and support best practice.

Objective: To evaluate if the experience of psychological intimate partner violence (IPV) adversely affects breastfeeding rates.Design: A cohort study.Setting: Maternities in 15 public hospitals, drawn using cluster sampling of obstetric services in Andalusia, Spain.Population: A total of 779 consecutive mothers receiving antenatal care including ultrasound and giving birth during February-June 2010.Methods: Trained midwives gathered IPV data using the Index of Spouse Abuse validated in the Spanish language (score ranges: 0-100, higher scores reflect more severe IPV; cut-off: psychological IPV = 25). Sociodemographic data including lack of kin support, and obstetric and neonatal outcomes were collected. Multivariate logistic regression estimated adjusted odds ratios (aOR), with 95% confidence intervals (CI), of the relationship between psychological IPV and breastfeeding, controlling for sociodemographic characteristics and obstetric complications.Main Outcome Measure: Breastfeeding avoidance defined as lack of breastfeeding or pumping of breast milk to feed the new baby in the immediate post-partum period.Results: Response rate was 92.2%. A total of 70% (n = 545) of women initiated breastfeeding. Psychological IPV, reported by 21.0% (n = 151), increased the odds of breastfeeding avoidance (aOR = 2.0; 95% CI = 1.2-3.3) adjusting for the presence of obstetric complications (aOR = 1.6; 95% CI = 1.0-2.4).Conclusions: Mothers with psychological IPV avoid breastfeeding. Clinicians should be aware of the risks to infant arising from this deficiency due to IPV in pregnancy.Tweetable Abstract: Psychological intimate partner violence, reported by one in five mothers in this study, on average doubles the avoidance of breastfeeding. [ABSTRACT FROM AUTHOR]

Background: Randomised trials and their syntheses in meta-analyses offer a unique opportunity to assess the frequency and severity of adverse reactions.Objective: To assess safety reporting in pre-eclampsia trials.Search Strategy: Systematic search using bibliographic databases, including Cochrane Central Register of Controlled Trials, Embase, and MEDLINE, from inception to August 2017.Selection Criteria: Randomised trials evaluating anticonvulsant or antihypertensive medication for pre-eclampsia.Data Collection and Analysis: Descriptive statistics appraising the adequacy of adverse reaction and toxicity reporting.Main Results: We included 60 randomised trials. Six trials (10%) were registered with the International Clinical Trials Registry Platform, two registry records referred to adverse reactions, stating 'safety and toleration' and 'possible side effects' would be collected. Twenty-six trials (43%) stated the frequency of withdrawals within each study arm, and five trials (8%) adequately reported these withdrawals. Adverse reactions were inconsistently reported across eligible trials: 24 (40%) reported no serious adverse reactions and 36 (60%) reported no mild adverse reactions. The methods of definition or measurement of adverse reactions were infrequently reported within published trial reports.Conclusions: Pre-eclampsia trials regularly omit critical information related to safety. Despite the paucity of reporting, randomised trials collect an enormous amount of safety data. Developing and implementing a minimum data set could help to improve safety reporting, permitting a more balanced assessment of interventions by considering the trade-off between the benefits and harms.Funding: National Institute for Health Research (DRF-2014-07-051), UK; Maternity Forum, Royal Society of Medicine, UK.Tweetable Abstract: Developing @coreoutcomes could help to improve safety reporting in #preeclampsia trials. @NIHR_DC. [ABSTRACT FROM AUTHOR]

The emphasis on research quality has taken great strides in recent years. Publication of clinical trial protocols (i.e. SPIRIT guideline), prospective registration (e.g. ClinicalTrials. gov, WHO registry), high standards in research conduct (i.e. ICH-Good Clinical Practice guidelines) and transparent reporting of the findings (i.e. CONSORT guideline) are all becoming features of clinical effectiveness research. However, many more gains are possible to improve the efficiency of clinical research and therefore reduction of waste in health research, a problem that is estimated to consume 85% of the global medical research budget each year. This article is protected by copyright. All rights reserved. [ABSTRACT FROM AUTHOR]

Background: Preterm birth may leave the brain vulnerable to dysfunction. Knowledge of future neurodevelopmental delay in children born with various degrees of prematurity is needed to inform practice and policy.Objective: To quantify the long-term cognitive, motor, behavioural and academic performance of children born with different degrees of prematurity compared with term-born children.Search Strategy: PubMed and Embase were searched from January 1980 to December 2016 without language restrictions.Selection Criteria: Observational studies that reported neurodevelopmental outcomes from 2 years of age in children born preterm compared with a term-born cohort.Data Collection and Analysis: We pooled individual estimates of standardised mean differences (SMD) and odds ratios (OR) with 95% confidence intervals using a random effects model.Main Results: We included 74 studies (64 061 children). Preterm children had lower cognitive scores for FSIQ (SMD: -0.70; 95% CI: -0.73 to -0.66), PIQ (SMD: -0.67; 95% CI: -0.73 to -0.60) and VIQ (SMD: -0.53; 95% CI: -0.60 to -0.47). Lower scores for preterm children in motor skills, behaviour, reading, mathematics and spelling were observed at primary school age, and this persisted to secondary school age, except for mathematics. Gestational age at birth accounted for 38-48% of the observed IQ variance. ADHD was diagnosed twice as often in preterm children (OR: 1.6; 95% CI: 1.3-1.8), with a differential effect observed according to the severity of prematurity (I2 = 49.4%, P = 0.03).Conclusions: Prematurity of any degree affects the cognitive performance of children born preterm. The poor neurodevelopment persists at various ages of follow up. Parents, educators, healthcare professionals and policy makers need to take into account the additional academic, emotional and behavioural needs of these children.Tweetable Abstract: Adverse effect of preterm birth on a child's neurodevelopment persists up to adulthood. [ABSTRACT FROM AUTHOR]

Objective: Prospective registration of clinical trials has been required since 2005. We aimed to assess concordance between registered and reported sample sizes among prospectively registered randomised controlled trials (RCTs) in obstetrics and gynaecology.Design: Analysis of prospectively registered and published data.Setting: Women's health.Sample: Obstetrics and gynaecology RCTs published in eight journals in 2015.Methods: Specialist (Acta Obstet Gynecol Scand, BJOG, Obstet Gynecol and Am J Obstet Gynecol) and general (BMJ, N Engl J Med, JAMA and Lancet) journals were searched from 1 January to 31 December 2015 for main reports of obstetrics and gynaecology RCTs. Their corresponding registries and protocols were sought and data were extracted. Proportions and 95% CI were calculated using exact methods.Main Outcome Measures: Prospective registration of RCT and sample size concordance between RCTs and their registries within those where registration took place before patients were recruited.Results: Of the 75 relevant RCTs, 51 (68%, 95% CI 56-78%, P < 0.001 using a null hypothesis requiring 100% compliance) were prospectively registered, a feature found to be more common in general journals versus specialist journals (21/22 versus 30/53, 95% versus 57%, P = 0.001). Of the 51 prospectively registered RCTs, 31 (61%, 95% CI 46-74%, P = 0.003 using a null hypothesis requiring 40% of studies to achieve their stated sample size) did not reach the target sample size.Conclusions: There are gaps in universal adoption of the prospective trial registration rule. Inability to meet target sample size risks deficiencies in statistical power with unreliability in results.Tweetable Abstract: Only two-thirds of RCTs in women's health are prospectively registered, and over half fail to achieve target sample sizes. [ABSTRACT FROM AUTHOR]

SUMMARY The aim of this review was to understand the landscape of serum ferritin in diagnosing iron deficiency in the aetiology of anaemia in pregnancy. Iron deficiency in pregnancy is a major public health problem leading to the development of anaemia. Reducing the global prevalence of anaemia in women of reproductive age is a 2025 global nutrition target. Bone marrow aspiration is the gold standard test for iron deficiency but requires an invasive procedure; therefore, serum ferritin is the most clinically useful test. We undertook a systematic search of electronic databases and trial registers from inception to January 2016. Studies of iron or micronutrient supplementation in pregnancy with pre-defined serum ferritin thresholds were included. Two independent reviewers selected studies, extracted data and assessed quality. There were 76 relevant studies mainly of observational study design (57%). The most commonly used thresholds of serum ferritin for the diagnosis of iron deficiency were <12 and <15 ng mL−1 (68%). Most primary studies provided no justification for the choice of serum ferritin threshold used, but 25 studies (33%) used thresholds defined by expert consensus in a guideline development process. There were five studies (7%) using a serum ferritin threshold defining iron deficiency derived from primary studies of bone marrow aspiration. Unified international thresholds of iron deficiency for women throughout pregnancy are required for accurate assessments of the global disease burden and for evaluating effectiveness of interventions addressing this problem. [ABSTRACT FROM AUTHOR]

Background: Previous reviews examining the effect of participation in trials on outcomes have not consistently shown benefit. Obstetrics and gynaecology is a unique disease area posing challenges for both researchers and patients.Objectives: To determine whether participation in randomised controlled trials (RCTs), compared with non-participation, has a beneficial effect on women's health.Search Strategy: Medline, Embase, the Cochrane Library, and PsycInfo were searched up to December 2015.Selection Criteria: We selected studies that reported the same clinical outcomes for participants in a women's health RCT and a comparable non-participant cohort.Data Collection and Analysis: Data were extracted on quality, characteristics and study results. Outcomes were compared using logistic regression.Main Results: There were 21 relevant studies (20 160 women, 4759 outcome events). Trial participants, compared with non-participants, had 25% better odds of improved outcomes on average (OR 0.75; 95% CI 0.64-0.87; I2  = 64.3%). The beneficial effect of participating in a trial was larger in comparisons where: RCTs were of high quality (OR 0.62; 95% CI 0.50-0.76) versus low (OR 0.92; 95% CI 0.74-1.16); and RCT intervention was not available to non-participants (OR 0.57; 95% CI 0.47-0.69) versus when it was (OR 1.13; 95% CI 0.89-1.44). The effect of trial participation was not influenced by effect size within the RCT (P = 0.48), whether funding was received or not (P = 0.13), whether non-participants received any treatment or not (P = 0.49), and the quality of the comparison of RCT participants with non-participants (P = 0.88).Conclusions: Women participating in RCTs on average experienced better outcomes compared with those outside trials.Tweetable Abstract: Participants in obstetric and gynaecology RCTs experience better outcomes compared with non-participants. [ABSTRACT FROM AUTHOR]

Background: There is a dearth of data on the clinical features and outcomes of active tuberculosis (TB) in pregnancy. Studies have shown varied results and the relationship between TB and adverse pregnancy outcomes remains unclear.Objectives: We conducted a systematic review and meta-analysis to evaluate pregnancy outcomes associated with TB.Search Strategy: Major databases were searched from inception until December 2015 without restrictions using the terms: 'TB', 'pregnancy', 'maternal morbidity', 'mortality' and 'perinatal morbidity', 'mortality'.Selection Criteria: We included studies that compared the outcomes of pregnant women with and without active TB.Data Collection and Analysis: We computed odds ratios for maternal and perinatal complications, and pooled them using a random effects model. We assessed for heterogeneity using chi-squared tests and evaluated its magnitude using the I2 statistic. We used the Newcastle-Ottawa scale for quality assessment.Main Results: Thirteen studies, including 3384 pregnancies with active TB and 119 448 without TB were included. Compared with pregnant women without TB, pregnant women with active TB was associated with increased odds of maternal morbidity [odds ratio (OR) 2.8, 95% CI 1.7-4.6; I2  = 60.3%], anaemia (OR 3.9, 95% CI 2.2-6.7; I2  = 29.8%), caesarean delivery (OR 2.1, 95% CI 1.2-3.8; I2  = 61.1%), preterm birth (OR 1.7, 95% CI 1.2-2.4; I2  = 66.5%), low birth weight (OR 1.7, 95% CI 1.2-2.4; I2  = 53.7%), birth asphyxia (OR 4.6, 95% CI 2.4-8.6; I2  = 46.3), and perinatal death (OR 4.2, 95% CI 1.5-11.8; I2  = 57.2%).Author's Conclusion: Active TB in pregnancy is associated with adverse maternal and fetal outcomes. Early diagnosis of TB is important to prevent significant maternal and perinatal complications.Tweetable Abstract: Active tuberculosis in pregnancy is associated with adverse maternal and perinatal outcomes. [ABSTRACT FROM AUTHOR]

Background: Syphilis in pregnancy can lead to fetal and neonatal death or congenital anomalies. Accurate on-site tests are an essential part of effective prevention of mother-to-child transmission of the disease.Objective: This systematic review assessed the accuracy of on-site tests to detect infection with Treponema pallidum in pregnant women.Search Strategy: Major databases were searched from inception to January 2016 using terms: 'pregnancy', 'antenatal', 'syphilis', 'Treponema pallidum' with their variations, and the search limit for the relevant study design.Selection Criteria: We included studies that used dual reference standard (non-treponemal and treponemal tests) to detected syphilis in pregnancy.Data Collection and Analysis: Extracted accuracy data were tabulated and pooled using hierarchical, bivariate random effects model.Main Results: Seven studies (combined sample 17 546) reporting the accuracy of four on-site tests met the eligibility criteria. On average, Determine™ and SD BioLine Syphilis 3.0 had the highest sensitivity of all the evaluated tests: 0.83 (95% CI 0.58, 0.98) and 0.86 (95% CI 0.82, 0.89), respectively, with a high specificity 0.96 (95% CI 0.89, 1.00) and 0.99 (95% CI 0.94, 1.00), respectively. The Qualitative Rapid Plasma Reagin card commonly used in clinical practice had a pooled sensitivity of 0.70 (95% CI 0.54, 0.88) and specificity of 0.97 (95% CI 0.96, 0.99).Conclusion: Immunochromatographic tests such as Determine™ and SD BioLine Syphilis 3.0 seem to be acceptable options in antenatal testing for syphilis, especially in resource-limited settings. Future research should seek more evidence to strengthen this claim.Tweetable Abstract: On-site test to detect syphilis-options during antenatal care. [ABSTRACT FROM AUTHOR]

Objective: To develop a set of core outcomes for studies on pregnant women with epilepsy.Design: Delphi consensus study.Population: Healthcare professionals, and patient representatives with lived experience of epilepsy in the UK.Methods: We used a modified Delphi method and a consultation meeting to achieve consensus. Potential outcomes were identified by systematic review, and were scored using a Likert scale anchored between 1 (least important) and 5 (most important). We included outcomes that scored ≥4 by >70% of participants, and outcomes that scored ≤2 by <15% of participants.Main Outcome Measures: Outcomes in studies on epilepsy in pregnancy.Results: Seventy-five healthcare professionals completed the first round, 48 (64%) completed the second round, and 37 (49%) completed the third round of the survey. Twenty-four patient representatives participated. The final core outcome set included 31 outcomes in three domains: neurological, offspring, and obstetric. Outcomes in the neurological domain were seizure control in pregnancy and postpartum, status epilepticus, maternal mortality, drowning, sudden unexpected death in epilepsy, postnatal depression, and quality of life. Offspring domain included congenital abnormalities (major and minor), fetal anticonvulsant syndrome, neurodevelopment, autism disorder, neonatal clinical complications, admission to a neonatal intensive care unit, and anthropometric measurements. The obstetric domain included live birth, stillbirth, miscarriage, ectopic, termination of pregnancy, admission to a high dependency or intensive care unit, breastfeeding, mode of delivery, preterm birth, pre-eclampsia, and eclampsia. Outcomes specific for studies on anti-epileptic drugs (AEDs) included maternal AED toxicity, AED compliance, neonatal withdrawal symptoms, and neonatal haemorrhagic disease.Conclusion: Embedding this core set in future clinical trials will promote the standardisation of reporting to inform clinical practice.Tweetable Abstract: A Delphi method identifying core outcomes for epilepsy in pregnancy. Final core set includes 31 outcomes. [ABSTRACT FROM AUTHOR]

The article deals with the role of the patient and public involvement (PPI) initiatives in promoting research and improving healthcare outcomes in the fields of pregnancy and child birth. Topics addressed include the inclusion of a diverse group individuals in the research process, the source of research funds and approvals, and the study methodology. The necessity of training PPI in research is emphasized.

Background: The development of a non-invasive and accurate diagnostic biomarker for endometriosis is urgently needed.Objective: Evaluate the diagnostic accuracy of serum cancer antigen 125 (CA 125) for endometriosis.Search Strategy: We searched EMBASE, MEDLINE, and Web of Science from inception to January 2016.Selection Criteria: Diagnostic accuracy studies of serum CA 125 (index test) for histologically confirmed endometriosis (reference standard) were included.Data Collection and Analysis: Two authors independently selected trials, extracted study characteristics and data. Methodological quality was assessed using Quality Assessment of Comparative Diagnostic Accuracy Studies (QUADAS-2) checklist.Main Results: Twenty-two studies (16 cohort, six case-control), 3626 participants, were identified. Bivariate hierarchical models were used to pool accuracy data of 14 studies (2920 participants) using CA 125 ≥ 30 units/ml. Pooled specificity was 93% (95% CI 89-95%) and sensitivity 52% (95% CI 38-66%). CA 125 was significantly more sensitive for the diagnosis of moderate or severe endometriosis compared with minimal disease (63%, 95% CI 47-77% versus 24%, 95%CI 19-32%, P-value = 0.001).Conclusions: CA 125 performs well as a rule-in test facilitating expedited diagnosis and ensuring investigation and treatment can be confidently tailored for the management of endometriosis. Unfortunately, a negative test, CA 125 < 30 units/ml, is unable to rule out endometriosis.Tweetable Abstract: Blood test CA 125: a rule-in test for the diagnosis of women presenting with symptoms of endometriosis. [ABSTRACT FROM AUTHOR]

The article reports on obstetrics which focuses on identification of pregnancies at risk of adverse outcomes to plan targeted intervention. Topics discussed include prognostic models provide individualized judge risk for clinically important outcomes in diseased patients, prediction model development for adverse outcomes in women with pre-eclampsia pose challenges in obstetrics and methods could address bias from treatment paradox such as standardization of treatment and predictor substitution.

Objective: To evaluate, among medical students learning the female pelvic examination, the added benefits of training by gynaecological teaching associates compared with training involving a manikin only.Design: Randomised controlled trial.Setting: Nine university teaching hospitals.Population: Ninety-four medical students recruited prior to commencing a 4-week obstetrics and gynaecology rotation.Methods: The control training consisted of lectures, demonstration of the pelvic examination on a manikin, and opportunities to practise on this low-fidelity simulation (n = 40). The experimental group received additional gynaecological teaching associate training, delivered by pairs of experienced associates to groups of four medical students (n = 54).Main Outcome Measures: Outcomes measured at the end of the rotation included knowledge of the correct order of examination components (Yes/No), and student comfort [Likert scales anchored between 1 (very uncomfortable) and 4 (very comfortable) on four items] and confidence [Likert scales anchored between 1 (No) and 3 (Yes) on six items]. The primary outcome, measured at the end of the academic year, was the objective structured clinical examination of a female pelvis (score range 0-54).Results: At baseline, the groups were similar in age, gender, and ethnicity. At the end of the clinical rotation, when compared with the control intervention, the experimental intervention had a moderate effect on student knowledge [difference 29.9% (95% CI 11.2-48.6%); P = 0.002] and confidence [difference 1 (95% CI 0-2); P < 0.001], and a large effect on student comfort [difference 1.8 (95% CI 0.6-3.0); P = 0.004]. At the end of the academic year, the experimental intervention had no impact on skills compared with the control [difference 2 (95% CI-1 to 4); P = 0.26].Conclusions: Among medical students taught the female pelvic examination by low-fidelity simulation, additional training by gynaecology teaching associates improved knowledge, comfort, and confidence at the end of the clinical rotation but did not improve examination skills at end of the academic year. [ABSTRACT FROM AUTHOR]

Objective: To determine the relationship of interpregnancy interval with maternal and offspring outcomes.Design: Retrospective study with data from the Perinatal Information System database of the Latin American Centre for Perinatology and Human Development, Uruguay.Setting: Latin America, 1990-2009.Population: A cohort of 894 476 women delivering singleton infants.Methods: During 1990-2009 the Perinatal Information System database of the Latin American Centre for Perinatology identified 894 476 women with defined interpregnancy intervals: i.e. the time elapsed between the date of the previous delivery and the first day of the last normal menstrual period for the index pregnancy. Using the interval 12-23 months as the reference category, multiple logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) of the association between various interval lengths and maternal and offspring outcomes.Main Outcome Measures: Maternal death, pre-eclampsia, eclampsia, puerperal infection, fetal death, neonatal death, preterm birth, and low birthweight.Results: In the reference interval there was 0.05% maternal death, 1.00% postpartum haemorrhage, 2.80% pre-eclampsia, 0.15% eclampsia, 0.28% puerperal infection, 3.45% fetal death, 0.68% neonatal death, 12.33% preterm birth, and 9.73% low birthweight. Longer intervals had increased odds of pre-eclampsia (>72 months), fetal death (>108-119 months), and low birthweight (96-107 months). Short intervals of <12 months had increased odds of pre-eclampsia (aOR 0.80; 95% CI 0.76-0.85), neonatal death (aOR 1.18; 95% CI 1.08-1.28), and preterm birth (aOR 1.16; 95% CI 1.11-1.21). Statistically, the interval had no relationship with maternal death, eclampsia, and puerperal infection.Conclusions: A short interpregnancy interval of <12 months is associated with pre-eclampsia, neonatal mortality, and preterm birth, but not with other maternal or offspring outcomes. Longer intervals of >72 months are associated with pre-eclampsia, fetal death, and low birthweight, but not with other maternal or offspring outcomes.Tweetable Abstract: A short interpregnancy interval of <12 months is associated with neonatal mortality and preterm birth. [ABSTRACT FROM AUTHOR]

Objective: To assess the predictive accuracy for stillbirth of second-trimester uterine artery Doppler.Methods: We searched MEDLINE, EMBASE and The Cochrane Library databases from inception until March 2015 without language restrictions. The included studies were those that assessed the association of abnormal uterine artery Doppler parameters and stillbirth. Two independent reviewers selected the studies, extracted data and assessed quality. Results for studies that were performed in the second trimester were pooled and summary estimates of sensitivity, specificity, likelihood ratios and their 95% confidence intervals were obtained. An overall summary of test accuracy was provided by the diagnostic odds ratio. Subgroup analysis was performed according to whether the study population was high risk or unselected.Results: Literature searches returned 338 relevant citations with 32 considered in full. Thirteen studies met our search criteria (85 845 women, 508 stillbirths) and were included in the review. Bivariate pooled estimate for sensitivity was 65% (95% CI, 38-85%) and for specificity 82% (95% CI, 72-88%). The positive likelihood ratio was 3.5 (95% CI, 2.3-5.5) and negative likelihood ratio 0.43 (95% CI, 0.22-0.85). The diagnostic odds ratio was 8.3 (95% CI, 3.0-22.4). Heterogeneity was high in the studies of high-risk women.Conclusions: Abnormal uterine artery Doppler indices are associated with a three- to four-fold increase in the risk of stillbirth. The heterogeneity was particularly high in the high-risk group rendering it impossible to draw firm conclusions. In view of this, there is a role for individual patient data meta-analysis to define which Doppler parameter and threshold value should be measured. [ABSTRACT FROM AUTHOR]

Water scarcity and land degradation are emerging threats to global food production. The dry land regions of world are affected by climate change to a greater extent and facing food insecurity. The current pattern of food production has been estimated to be inadequate to meet demands of growing population and required around 38% increase to meet world`s food demands by 2025. Food insecurity in erosion hit dry land regions of Pakistan also demands development of resource-efficient cropping systems to meet the food needs of population growing. The research studies involved different cropping patterns such as fallow-wheat, mungbeanwheat, sorghum-wheat, fallow-lentil, mungbean-lentil, sorghum-lentil, fallowbarley, mungbean-barley and sorghumbarley. The organic amendments involved farmyard manure, NPK, poultry manure, compost and inoculation by phosphorus solubilizing microbes. The effect of cropping systems and soil amendments were evaluated at field scale in terms of water use efficiency measured in terms of economic terms. The results of the studies revealed that double cropping (mungbean-lentil and mungbean-barley) was feasible option in the dryland regions of Pakistan if integrated with the use of poultry manure as alternate environmental-friendly strategy to cut down the use of mineral fertilizers and eliminate summer fallowing. [ABSTRACT FROM AUTHOR]

Objective: To describe influences on decision-making and prognostic variables in the prenatal management of fetal lower urinary tract obstruction (LUTO).Methods: This was a prospective registry study of pregnant women with a male fetus with LUTO from centers within the British Isles and The Netherlands. Women and/or their clinicians were given the treatment option of either conservative management or vesicoamniotic shunting (VAS). Baseline characteristics of women in the registry, reasons for entry to the registry and pregnancy outcomes were assessed. The main study outcomes were survival to 28 days after delivery, further survival to 2 years and renal function. Logistic regression analysis was used to examine prognostic variables that affected outcome. Results were compared with those of women in a randomized controlled trial (RCT) who were allocated randomly to a treatment option.Results: Forty-five women were registered, of whom 78% (35/45) underwent conservative management. Twenty-seven women entered the registry owing to their clinician's preference for management and 18 because of their own preference. Compared to the conservative-management group of the RCT, a higher proportion of women in the registry opting for conservative management had a normal amniotic fluid volume at diagnosis (P = 0.05) and a diagnosis of LUTO ≥ 24 weeks' gestation (P = 0.003). On multivariable logistic regression analysis, these variables showed a significant association with perinatal survival (P < 0.001). Survival to 28 days after delivery was higher in the conservative-management group, at 69% (24/35), compared to 40% (4/10) in the VAS group (P = 0.02) but this difference had limited statistical significance owing to small study size (relative risk, 0.58 (95% CI, 0.26-1.29); P = 0.14).Conclusion: In our prospective registry, the majority of fetuses with LUTO received conservative management, which was associated with better short- and long-term outcomes. A significant proportion of these pregnancies had normal amniotic fluid volume and a gestational age at diagnosis of ≥ 24 weeks, characteristics shown to be associated with improved survival. [ABSTRACT FROM AUTHOR]

Background: Health outcomes throughout the life course have been linked to fetal growth restriction and low birthweight. A variety of measures exist to define low birthweight, with a lack of consensus regarding which predict adverse outcome.Objectives: To evaluate the relationship between birthweight standards and childhood and adult outcomes in term-born infants (≥37 weeks' gestation).Search Strategy: MEDLINE (1966-January 2011), EMBASE (1980-January 2011), and the Cochrane Library (2011:1) and MEDION were included.Selection Criteria: Studies comprising live term-born infants (gestation ≥37 completed weeks), with weight or other anthropometric measurements recorded at birth along with childhood and adult outcomes.Data Collection and Analysis: Data were extracted to populate 2 × 2 tables relating birthweight standard with outcome, and meta-analysis was performed where possible.Main Results: Fifty-nine articles (2 600 383 individuals) were selected. There was no significant relationship between birthweight <2.5 kg (odds ratio [OR] 0.98, 95% confidence intervals [CI] 0.87-1.10) and composite measure of childhood morbidity. Weight <10th centile on the population nomogram showed a small association (OR 1.49, 95% CI 1.02-2.19) for the same outcome. There was no significant association between either of the above measures and adult morbidity. The relationship between other measures and individual outcomes varied.Author's Conclusions: The association between low birthweight, by any definition, and childhood and adult morbidity was inconsistent. None of the current standards of low birthweight was a good predictor of adverse outcome. [ABSTRACT FROM AUTHOR]

SUMMARY Background The prevalence of anaemia in pregnancy in Europe is 25% and that resulting from iron deficiency is estimated at 40%. The maternal and fetal morbidity of non-anaemic iron deficiency ( NAID) in pregnancy is likely to be significant. Objectives To determine the views and opinions of health service users and clinicians concerning NAID in pregnancy in order to inform future research. Methods Two semi-structured focus groups were carried out to determine health service users' views on anaemia and NAID in pregnancy. A questionnaire was administered to obstetricians, haematologists, midwives and anaesthetists to elucidate their views on NAID in pregnancy. Results The study indicated that health service users and clinicians were interested in implementing testing for NAID in pregnancy with serum ferritin, if proven to be effective at reducing the effects of anaemia and improving maternal and neonatal outcomes. Clinicians had reservations in the use of intravenous iron supplementation for NAID in pregnancy. Conclusion NAID is now accepted as a target condition for research by health service users and clinicians. The focus of future research should be on screening for NAID and its treatment. [ABSTRACT FROM AUTHOR]

Genetic variability and inheritance mechanism for some forage quality traits were analyzed in 9 sorghum crosses along with their 6 parents in randomized complete block design with 3 repeats under irrigated conditions. All the characters under investigation showed highly significant differences for genotype, general combining ability and specific combining ability. However, the specific combining ability variances were greater than the general combining ability variances in all the traits under study. All the characters under evaluation showed lesser additive variance than the dominant variance and degree of dominance was greater than unity. The sorghum line CVS-13 indicated highest general combining ability effects in the desired directions for total sugar content and crude fiber, V-1 for total ash, SV-6 for total cyanide content and TSS-9 for crude protein. The cross SPV-462 x YSS-9 showed significant and positive mid parent as well as better parent heterosis for total sugar content, crude protein and crude fat but significant and negative average heterosis was observed for total cyanide content. This investigation revealed that progress in forage quality is possible due to sufficient genetic variability among genotypes, general combining ability effects in the desired direction and significant heterobeltiosis for almost all the traits under evaluation. [ABSTRACT FROM AUTHOR]