Biomedical subjects

Andrew J Kotaska

Publications and source records attributed to Andrew J Kotaska.

2 recordsLinked to original sources

PubMed2006

Epidural analgesia associated with low-dose oxytocin augmentation increases cesarean births: a critical look at the external validity of randomized trials.

OBJECTIVE: Randomized controlled trials suggest epidural analgesia (EA) does not increase the frequency of cesarean births compared with opioid analgesia. We analyzed trials comparing EA with opioid analgesia to determine their external validity in contemporary North American practice. STUDY DESIGN: Randomized controlled trials comparing EA with opioid analgesia were identified from the Cochrane database and Medline and included if they reported labor outcomes and management protocols. Labor management was then compared with current obstetric practice determined from surveys of North American teaching maternity units and clinical practice guidelines. RESULTS: Of 19 trials identified, 8 were included. Seven trials used Active Management of Labor protocols that used high-dose oxytocin; each demonstrated no epidural-related increase in cesarean births. One trial that used low-dose oxytocin demonstrated a marked increase in cesarean births. Most large North American obstetric units use low-dose oxytocin. CONCLUSION: Randomized trials showing no effect of EA on cesarean section (CS) rate lack external validity in much of North American practice. The limited data available suggest EA and low-dose oxytocin used together increase the CS rate. Early detection of dystocia and high-dose oxytocin augmentation should be considered for women receiving EA; those delivering in low-dose oxytocin settings should be advised of a probable increase in the likelihood of CS.

Analgesia, Epidural↗

PubMed2003

Cervical cleaning improves Pap smear quality.

BACKGROUND: Cervical Papanicolaou (Pap) smear screening is an effective method of detecting cytological changes in the cervix before they lead to cervical cancer. However, the quality of a Pap smear can be compromised by inflammatory exudate, inadequate cellularity or failure to sample the transformation zone. We evaluated the effect of routine cervical cleaning on Pap smear quality. METHODS: In a primary care setting, we compared the quality of Pap smears obtained after cervical cleaning (with a dry, oversized cotton swab) with the quality of historical control slides obtained from the same women without prior cervical cleaning. The results for both groups were then compared with statistical averages for the province of British Columbia. RESULTS: Inflammatory exudate was reported in 1 (0.3%) of the 334 study smears and 72 (11.0%) of the 652 control smears (p < 0.001). Inadequate endocervical or metaplastic squamous cells were reported in 11 (3.3%) of the study smears and 90 (13.8%) of the control smears (p < 0.001). Inadequate cellularity was reported in 13 (3.9%) of the study smears and 9 (1.4%) of the control smears (p = 0.01). There were similar statistical differences between the study group and provincial averages. The results for the control group did not differ significantly from provincial averages (inflammatory exudate, 11.3%; inadequate endocervical cells, 14.7%; and poor cellularity, 2.7%). INTERPRETATION: Prior cervical cleaning with an oversized cotton swab was associated with a lower frequency of smears with inflammatory exudate or inadequate endocervical cells and, to a lesser degree, a higher frequency of smears with inadequate cellularity.

Adult↗