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Biomedical subjects

C A Crowther

Publications and source records attributed to C A Crowther.

At least 37 records · Page 2Linked to original sources
PubMed2003

Reduction of the number of fetuses for women with triplet and higher order multiple pregnancies.

BACKGROUND: When couples are faced with the dilemma of a higher order multiple pregnancy there are three options. Termination of the entire pregnancy has generally not been acceptable to women, especially for those with a past history of infertility. Attempting to continue with all the fetuses is associated with inherent problems of preterm birth, survival and long term morbidity. The other alternative relates to reduction in the number of fetuses by selective termination. The acceptability of these options for the couple will depend on their social background and underlying beliefs. This review focused on reduction in the number of fetuses. OBJECTIVES: To assess a policy of multifetal reduction with a policy of expectant management of women with a triplet or higher order multiple pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (30 September 2002), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2002), and PubMed (to 30 September 2002). SELECTION CRITERIA: Randomized controlled trials with reported data that compared outcomes in mothers and babies who were managed expectantly with outcomes in women who underwent selective fetal reduction of a triplet or higher order multiple pregnancy. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: There were no randomised controlled trials identified. REVIEWER'S CONCLUSIONS: There are insufficient data available to support a policy of pregnancy reduction procedures for women with a triplet or higher order multiple pregnancy. While randomised controlled trials will provide the most reliable evidence about the risks and benefits of fetal reduction procedures, reduction in the number of fetuses by selective termination may not been acceptable to women, especially for those with a past history of infertility. The acceptability of this option, and willingness to undergo randomisation will depend on the couple's social background and beliefs, and consequently, recruitment to such a trial may prove exceptionally difficult.

Female↗
PubMed2003

Repeat doses of prenatal corticosteroids for women at risk of preterm birth for preventing neonatal respiratory disease.

BACKGROUND: Infants born preterm are at high risk of neonatal lung disease and its sequelae. A single course of prenatal corticosteroids has not been shown to be of benefit in babies who are born more than seven days after treatment. It is not known whether there is benefit in repeating the dose of prenatal corticosteroids to women who remain at risk of preterm birth more than seven days after an initial course. OBJECTIVES: To assess the effectiveness and safety of a repeat dose(s) of prenatal corticosteroids, given to women who remain at risk of preterm birth seven or more days after an initial course of prenatal corticosteroids. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (January 2003), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2003), MEDLINE (1965 to January 2003), EMBASE (1988 to January 2003), Current Contents (1997 to January 2003). SELECTION CRITERIA: Randomised controlled trials of women who have already received a single course of corticosteroid seven or more days previously, and who are still considered to be at risk of preterm birth; outcomes compared for women randomised to receive a repeat dose(s) of prenatal corticosteroids, with women given no further prenatal corticosteroids. DATA COLLECTION AND ANALYSIS: We assessed trial quality and extracted the data independently. MAIN RESULTS: Five hundred and fifty one women were recruited into the three included trials between 24 and 30 weeks' gestation. Fewer infants in the repeat dose(s) of corticosteroids group had severe lung disease compared with infants in the placebo group (relative risk (RR) 0.64, 95% confidence interval (CI) 0.44 to 0.93, 1 trial, 500 infants). No statistically significant differences were seen for any of the other primary outcomes that included other measures of respiratory morbidity, small-for-gestational-age at birth, perinatal death, periventricular haemorrhage, periventricular leucomalacia and maternal infectious morbidity. Fewer infants in the repeat dose(s) of corticosteroids group received surfactant compared with infants in the placebo group (RR 0.64, 95% CI 0.44 to 0.93, 2 trials, 537 infants). REVIEWER'S CONCLUSIONS: Repeat dose(s) of prenatal corticosteroids may reduce the severity of neonatal lung disease. However, there is insufficient evidence on the benefits and risks to recommend repeat dose(s) of prenatal corticosteroids for women at risk of preterm birth for the prevention of neonatal respiratory disease. Further trials are required.

Adrenal Cortex Hormones↗
PubMed2003

Birth outcomes: utility values that postnatal women, midwives and medical staff express.

OBJECTIVE: To determine if and to what extent postnatal women's preferences for birth outcomes differ from those of midwives and medical staff, and whether any variations in utility scores are associated with demographic variables. DESIGN: Cross sectional cohort study. SETTING: The Women's and Children's Hospital, Adelaide. POPULATION: A total of 180 participants which included 90 postnatal women, 59 midwives and 31 medical staff. METHODS: Preferences (utility scores) were measured by direct interviews using utility techniques: the visual analogue scale and the standard gamble. MAIN OUTCOMES MEASURES: Preferences (utility scores) for eight birth outcomes. RESULTS: Women assigned higher utility scores for the five birth outcomes of jaundice requiring phototherapy, admission to neonatal nursery, shoulder dystocia, nerve palsy and transient neurological symptoms than midwives, which suggested that women regarded these outcomes as less severe (P < 0.01). Utility scores for the women and medical staff were similar. The majority of postnatal women, midwives and medical staff preferred permanent neurological sequelae to perinatal death. Eighty-nine percent of postnatal women preferred permanent neurological sequelae to perinatal death compared with 71% of midwives (P < 0.01), and 68% of medical staff (P < 0.01). CONCLUSION: Utility values for important birth outcomes varied between women who had recently given birth and health professionals. Clinical practice should recognise and respect the preferences of women, with appropriate balance between their preferences, those of health professionals and the known benefits of care.

Adult↗
PubMed2002

Magnesium sulphate for preventing preterm birth in threatened preterm labour.

BACKGROUND: Magnesium sulphate is used to inhibit uterine activity in women in preterm labour to prevent preterm birth. OBJECTIVES: To assess the effectiveness and safety of magnesium sulphate therapy given to women in threatened preterm labour with the aim of preventing preterm birth and its sequelae. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (May 2002) and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2002). SELECTION CRITERIA TYPES OF PARTICIPANTS: Women thought to be in preterm labour. Types of interventions: Magnesium sulphate as the only tocolytic, administered intravenously or orally, compared with either placebo, no treatment or alternative tocolytic therapy. Types of outcome measures: Measures of effectiveness, complications, women's satisfaction with their care and health service use. DATA COLLECTION AND ANALYSIS: Assessments of trial eligibility, quality and data extractions were done by at least two of the reviewers. MAIN RESULTS: Over 2000 women were recruited into the 23 included trials. Only nine trials were rated of high quality for the concealment of allocation. In the magnesium sulphate versus control (all studies) no difference was seen for the risk of birth within 48 hours of treatment for women given magnesium sulphate compared with controls when using a random effects model (relative risk (RR) 0.85, 95% confidence interval (CI) 0.58-1.25, 11 trials, 881 women). No benefit was seen for magnesium sulphate on the risk of giving birth preterm (<37 weeks) or very preterm (<34 weeks). The risk of death (fetal and paediatric) was higher for infants exposed to magnesium sulphate (RR 2.82, 95% CI 1.20-6.62, 7 trials, 727 infants). There were only two fetal deaths, both in the magnesium sulphate group in one study. The six other trials reported there were no fetal deaths. No differences for total paediatric mortality were shown in the six trials with data. No beneficial effect was seen from using magnesium sulphate on the risk of other neonatal morbidity. A non-significant reduction in the risk of cerebral palsy was reported at follow up at 18 months corrected age (RR 0.14, 95% CI 0.01-2.60, 1 trial, 99 children). REVIEWER'S CONCLUSIONS: Magnesium sulphate is ineffective at delaying birth or preventing preterm birth, and its use is associated with an increased mortality for the infant. Any further trials should be of high quality, large enough to assess serious morbidity and mortality, compare different dose regimens, and provide neurodevelopmental status of the child.

Female↗
PubMed2002

Who remains undelivered more than seven days after a single course of prenatal corticosteroids and gives birth at less than 34 weeks?

UNLABELLED: Minimal information exists as to how women who give birth more than seven days after initial corticosteroid treatment, who may benefit from repeat prenatal corticosteroids, differ from women who give birth within seven days, at < 34 weeks gestation. OBJECTIVES: To examine the differences, if any, between women who received a single course of prenatal corticosteroids and remained undelivered more than seven days later and women who gave birth within seven days of treatment, at < 34 weeks gestation. DESIGN: Retrospective cohort. SETTING: Women's and Children's Hospital, Adelaide. POPULATION: Women who gave birth at < 34 weeks gestation from 1 January 1994 to 31 December 1996. METHODS: Data were extracted from medical records and retrieved from the hospital's database. MAIN POTENTIAL PREDICTORS COLLECTED: Prenatal corticosteroid exposure, reason for risk of preterm birth, maternal demographics and previous and current obstetric history. RESULTS: Of the 506 women, 122 (24%) remained undelivered more than seven days following prenatal corticosteroid therapy Initial corticosteroid treatment was given on average 1.6 weeks earlier to women who remained undelivered more than seven days after treatment. Women who were given prenatal corticosteroids for placenta praevia (RR 6.03, 95% CI 2.67-13.61, p < 0.01) or cervical incompetence (RR 3.40, 95% CI 1.06-10.95, p = 0.04) were more likely to give birth more than seven days after corticosteroid treatment. CONCLUSIONS: Women who give birth very preterm, who remain undelivered more than seven days after prenatal corticosteroids, differ in the reasons for and timing of their first course from women who give birth within seven days.

Adrenal Cortex Hormones↗
PubMed2002

Patterns of vitamin, mineral and herbal supplement use prior to and during pregnancy.

At the antenatal clinic, 211 women were interviewed to assess vitamin, mineral and herbal use pre-conceptually and in the three trimesters of pregnancy. The majority of women (62%) used both a vitamin or mineral supplement and a herbal preparation during the course of pregnancy. Folate (70%), iron (38%) and multivitamins (27%) were the vitamin and mineral supplements most frequently taken by pregnant women. Ginger (20%) and raspberry leaf (9%) were the most frequently used herbal preparations. Women relied on advice from friends and relatives in deciding to use herbal preparations.

Adult↗
PubMed2001

Acupuncture for induction of labour.

BACKGROUND: This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology. The use of complementary therapies is rising and some women look to complementary therapies during pregnancy and childbirth to be used alongside conventional medical practice. Acupuncture involves the insertion of very fine needles into specific points of the body. The limited observational studies to date suggest acupuncture for induction of labour appears safe, has no known teratogenic effects, and may be effective. The evidence regarding the clinical effectiveness of this technique is limited. OBJECTIVES: To determine the effects of acupuncture for third trimester cervical ripening or induction of labour. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and bibliographies of relevant papers. SELECTION CRITERIA: The criteria for inclusion included the following: (1) clinical trials comparing acupuncture used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods; (2) random allocation to the treatment or control group; (3) adequate allocation concealment; (4) violations of allocated management not sufficient to materially affect conclusions; (5) clinically meaningful outcome measures reported; (6) data available for analysis according to the random allocation; (7) missing data insufficient to materially affect the conclusions. DATA COLLECTION AND ANALYSIS: A strategy has been developed to deal with the large volume and complexity of trial data relating to labour induction. This involves a two-stage method of data extraction. The initial data extraction is done centrally, and incorporated into a series of primary reviews arranged by methods of induction of labour, following a standardised methodology. The data will then be extracted from the primary reviews into a series of secondary reviews, arranged by category of woman. To avoid duplication of data in the primary reviews, the labour induction methods have been listed in a specific order, from one to 25. Each primary review includes comparisons between one of the methods (from two to 25) with only those methods above it on the list. MAIN RESULTS: No trials met the inclusion criteria for the systematic review. REVIEWER'S CONCLUSIONS: There is a need for a well designed randomised controlled trial to evaluate the role of acupuncture to induce labour.

Acupuncture↗
PubMed2001

Guideline use for gestational diabetes mellitus and current screening, diagnostic and management practices in Australian hospitals.

A postal questionnaire investigating screening, diagnosis and management practices for gestational diabetes mellitus (GDM) and guidelines use for GDM, was sent to 544 Australian hospitals providing maternity care. Of these, 360 (66%) responded. Guidelines for GDM were available in 127 (39%) hospitals. Screening for GDM was undertaken by 284 (87%) hospitals and of these, 151 (53%) screened all women and 63 (22%) selectively screened women. Half (143, 50%) of the hospitals surveyed screened women using a 50 g oral glucose challenge test (OGCT) and 70 hospitals (25%) used a 75 g OGCT. A 75 g oral glucose tolerance test was most commonly used to diagnose GDM (207; 81%) and 126 hospitals (60%) recommended a 2 hour blood glucose level of > or = 8.0 mmol/l as diagnostic for GDM. In the management of women with GDM, levels for optimal glycaemic control varied. Postpartum testing for diabetes mellitus was recommended by the majority of hospitals (202; 72%). This study has shown the majority of Australian hospitals providing maternity care screening for GDM, but there is little consensus in screening practices.

Australia↗
PubMed2000

Prenatal thyrotropin-releasing hormone for preterm birth.

BACKGROUND: Adding thyrotropin-releasing hormones (TRH) to corticosteroids has been suggested as a way of improving fetal lung development. OBJECTIVES: The objective of this review was to assess the effect of giving prenatal TRH in addition to corticosteroids to women at risk of very preterm birth for the prevention of neonatal respiratory disease. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register, Cochrane Controlled Trials Register, and bibliographies. Date of last search: January 1999. SELECTION CRITERIA: Randomised controlled trials in women at sufficient risk of preterm birth to warrant the use of prenatal corticosteroids to promote lung maturity. TRH and corticosteroids were compared with corticosteroids with or without placebo. The main outcomes considered were fetal and neonatal mortality, neonatal morbidity, childhood development and maternal morbidity. DATA COLLECTION AND ANALYSIS: All assessments of trial eligibility, quality and data extractions were done by at least two authors independently. MAIN RESULTS: Over 4500 women were recruited into the 11 included trials. Five trials were rated of high quality. Overall, prenatal TRH, in addition to corticosteroids, did not reduce the risk of neonatal respiratory disease, chronic oxygen dependance, or improve fetal, neonatal or childhood outcome in any of the outcomes assessed by intention-to-treat analyses. Indeed, the data showed prenatal TRH to have adverse effects for women and their infants. All side effects monitored were more likely to occur in women receiving TRH. In the infants, prenatal TRH increased the risk of infants needing ventilation (relative risk (RR) 1.16, 95% confidence interval (CI) 1.03-1.29), having a low Apgar score at five minutes (RR 1.80, 95% CI 1.14-1.92) and, for the one trial providing data, was associated with poorer outcomes at the 12 month follow up. Sensitivity analyses by trial quality, or subgroups with differing times from entry to delivery, or different dose regimens of TRH, did not change these findings. REVIEWER'S CONCLUSIONS: On the basis of currently available evidence, prenatal TRH, in addition to corticosteroids, given to women at risk of very preterm birth cannot be recommended for clinical practice.

Female↗
PubMed2000

Anti-D administration in pregnancy for preventing rhesus alloimmunisation.

BACKGROUND: A woman may develop Rh-negative antibodies during her first pregnancy when her fetus is Rh-positive. Antibodies develop most frequently after the 28th week of gestation. OBJECTIVES: The objective of this review was to asses the effects of giving antenatal anti-D immunoglobulin at 28 weeks or more of pregnancy on the incidence of RhD alloimmunisation when given to Rhesus negative mothers without anti-D antibodies. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register, Cochrane Controlled Trials Register, and bibliographies. Date of last search: December 1998. SELECTION CRITERIA: Randomised trials in Rhesus negative women without anti-D antibodies given anti-D after 28 weeks of pregnancy, compared with no treatment or placebo. DATA COLLECTION AND ANALYSIS: Data were extracted by one reviewer and double entered. MAIN RESULTS: Two eligible trials, which involved over 4500 women, compared anti-D prophylaxis with no treatment. Although the data suggested, when women receive anti-D at 28 and 34 weeks gestation, a reduced incidence of immunisation during pregnancy (0R O.44, 95% CI 0.18-1.12), after the birth of a Rhesus positive infant (OR 0.44, 95% CI 0.18-1.12), and within 12 months after birth of a Rhesus positive infant (OR 0.44, 95% CI 0.19-1.01), none of these differences were statistically significant. In the trial, which used the larger dose of anti-D (100ug; 500IU), there was a clear reduction in the incidence of immunisation at 2-12 months following birth in women who had received Anti-D at 28 and 34 weeks (OR 0.22 95% CI 0.05-0.88). No data were available for the risk of RhD alloimmunisation in a subsequent pregnancy. No differences were observed in the incidence of neonatal jaundice. REVIEWER'S CONCLUSIONS: The risk of RhD alloimmunisation during or immediately after a first pregnancy is about 1.5%. Administration of 100ug (500IU) anti-D at 28 weeks and 34 weeks gestation to women in their first pregnancy can reduce this risk to about 0.2% without, to date, any adverse effects. Although such a policy is unlikely to confer benefit or improve outcome in the present pregnancy, fewer women will have Rhesus D antibodies in their next pregnancy. Adoption of such a policy will need to consider the costs of prophylaxis against the costs of care for women who become sensitised and their affected infants, and local adequacy of supply of anti-D gammaglobulin.

Female↗
PubMed2000

Caesarean delivery for the second twin.

BACKGROUND: The optimal mode of delivery for a second twin in breech position is controversial, with support for both caesarean and vaginal delivery. OBJECTIVES: The objective of this review was to assess the effects of caesarean delivery compared with vaginal delivery of a second twin not presenting cephalically. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register, Cochrane Controlled Trials Register, and bibliographies up to December 1998. SELECTION CRITERIA: Randomised trials of Caesarean delivery compared with vaginal delivery in women with a twin pregnancy where the second twin is not presenting cephalically. DATA COLLECTION AND ANALYSIS: All assessments of trial eligibility, quality and data extractions were done by the author without blinding. MAIN RESULTS: One trial involving 60 pairs of twins was included. Maternal febrile morbidity were increased in women allocated to the caesarean group (relative risk (RR) 3.67, 95% confidence interval (CI) 1.15-11.69), and there was a trend to an increased need for use of general anaesthesia (RR 2.40, 95% CI 0. 98-5.88). No differences were detected in neonatal outcome. REVIEWER'S CONCLUSIONS: caesarean section for delivery of a second twin not presenting cephalically is associated with increased maternal febrile morbidity with, as yet, no identified improvement in neonatal outcome. This policy should not be adopted except within the context of further controlled trials

Breech Presentation↗
PubMed2000

Hospitalisation and bed rest for multiple pregnancy.

BACKGROUND: Bed rest used to be widely advised for women with a multiple pregnancy. OBJECTIVES: The objective was to assess the effect of bed rest in hospital for women with a multiple pregnancy for prevention of preterm birth and other fetal, neonatal and maternal outcomes. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and reference lists of relevant articles were searched. Date of last search: January 1999. SELECTION CRITERIA: Randomised trials which compare outcomes in women with a multiple pregnancy and their babies who were offered bed rest in hospital with women only admitted to hospital if complications occurred. DATA COLLECTION AND ANALYSIS: Assessment for inclusion and methodological quality of the trials was done by the reviewer. Data were extracted by the reviewer and double entered. All eligible trials were included in the initial analysis. Prespecified sensitivity analyses have been carried out to evaluate the effect of trial quality, the effects of hospitalisation for bed rest in women with an uncomplicated twin pregnancy, in women with a triplet pregnancy and in women with a twin pregnancy complicated by cervical effacement and dilatation prior to labour. MAIN RESULTS: Six trials were included which involved over 600 women and 1400 babies. (1) Analyses of all trials. Routine bed rest in hospital for multiple pregnancy did not reduce the risk of preterm birth, or perinatal mortality. There was a trend to a decreased number of low birth weight infants born to women in the routinely hospitalised group, which became significant when the trial using alternate allocation was excluded (odds ratio (OR) 0.79; 95% confidence interval (CI) 0.63-0.99). No differences were seen in the number of very low birth weight infants. No support for the policy was found in other neonatal outcomes. No information is available on developmental outcomes for infants in any of the trials. Women's views about the care they received were reported rarely. (2) Analyses of hospitalisation for bed rest in women with an uncomplicated twin pregnancy. The risk of preterm birth was not reduced. Indeed significantly more women delivered very preterm (<34 weeks gestation) (OR 1.84; 95% CI 1.01-3.34). No differences were seen in perinatal mortality, or in other neonatal outcomes. Women receiving hospitalisation for bed rest had a decreased risk of developing hypertension (OR 0.55; 95% CI 0.32-0.97), although this effect was no longer apparent when the trial using alternate allocation was excluded. (3) Analyses of hospitalisation for bed rest in women with a triplet pregnancy. Most of the comparisons made between the hospitalised and control groups suggest beneficial treatment effects from routine hospitalisation for bed rest. However all the differences observed between the experimental and control groups were compatible with chance variation. (4) Analyses of hospitalisation for bed rest in women with a twin pregnancy complicated by cervical effacement and dilatation prior to labour. No differences were seen in the risk of preterm birth, perinatal mortality, fetal growth or in other neonatal outcomes. REVIEWER'S CONCLUSIONS: There is currently not enough evidence to support a policy of routine hospitalisation for bed rest in multiple pregnancy. No reduction in the risk of preterm birth or perinatal death is evident, although there is a suggestion that fetal growth is improved. For women with an uncomplicated twin pregnancy the results of this review suggest that it may be harmful in that the risk of very preterm birth is increased. Until further evidence is available to the contrary, the policy cannot be recommended for routine clinical practice.

Bed Rest↗
PubMed2000

Phenobarbital prior to preterm birth for preventing neonatal periventricular haemorrhage.

BACKGROUND: Preterm infants are at risk of periventricular haemorrhage. This can damage the brain and lead to neurodevelopmental abnormalities, including cerebral palsy. Phenobarbital might prevent ischaemic injury or reduce fluctuations in blood pressure and blood flow in the brain. OBJECTIVES: The objective of this review was to assess the benefits and harms of giving phenobarbital to women at risk of imminent very preterm birth with the primary aim of preventing periventricular haemorrhage in the infant. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and bibliographies. Date of last search: December 1998. SELECTION CRITERIA: Randomised trials with reported data which compare outcomes, such as neonatal mortality, neonatal neurological and other morbidity, longterm neurodevelopment and maternal morbidity, following prenatal exposure to phenobarbital, with outcomes in controls with or without placebo. DATA COLLECTION AND ANALYSIS: Assessments of trial eligibility, quality and data extractions were done by the two authors independently. Eligible trials were included in the initial analysis and prespecified sensitivity analyses done to evaluate the effect of trial quality. MAIN RESULTS: Over 1600 women were entered into the eight trials included. Analyses showed a significant reduction in the rates of all grades of periventricular haemorrhage (PVH) (relative risk 0.75, 95% confidence interval 0.65 to 0.88) and severe grades PVH (3 and 4) (relative risk 0.49, 95% confidence interval 0.32 to 0.74) in infants whose mothers had been given prenatal phenobarbital. These results were influenced by the earlier trials which were of poorer quality and contributed excessive weight in the analysis due to their higher rates of severe PVH. Over time, and with improved trial quality, these beneficial effects disappeared. No difference was found in the incidence of neurodevelopmental abnormalities at paediatric follow-up assessed between 18-36 months of age. Maternal sedation was more likely in women receiving phenobarbital. REVIEWER'S CONCLUSIONS: Phenobarbital administration to women prior to preterm birth cannot be recommended for routine clinical practice. Any future trials should examine the effects of phenobarbital prior to preterm birth at gestational ages with a high risk of PVH, stratify for gestational age and ensure minimal exclusions after randomisation. Neurodevelopmental status at follow-up should be measured as the most important outcome.

Central Nervous System Agents↗
PubMed2000

Vitamin K prior to preterm birth for preventing neonatal periventricular haemorrhage.

BACKGROUND: Preterm infants are at risk of periventricular haemorrhage. This can damage the brain and lead to neurodevelopmental abnormalities, including cerebral palsy. It has been suggested that vitamin K might improve coagulation in preterm infants. OBJECTIVES: The objective of this review was to assess the effects of vitamin K administered to women at risk of imminent very preterm birth to prevent periventricular haemorrhage and associated neurological injury in the infant. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register, Cochrane Controlled Trials Register, and bibliographies up to January 1999. SELECTION CRITERIA: Randomised or quasi-randomised trials of vitamin K administered parenterally or orally to women at risk of imminent preterm birth. The primary outcomes were neonatal mortality, neonatal neurological morbidity, as measured by the presence of periventricular haemorrhage (PVH) on ultrasound during the first week of life, and long term neurodevelopment. Secondary outcomes included other neonatal morbidity and any maternal side effects. DATA COLLECTION AND ANALYSIS: Eligibility, trial quality assessment and data extraction were done independently by two reviewers. MAIN RESULTS: Five trials were included, involving more than 420 women. The trials were of variable quality. Antenatal vitamin K was associated with a non-significant trend to a reduction in all grades of periventricular haemorrhage (relative risk (RR) 0.82, 95% confidence interval (CI) 0.67-1.00) and in severe PVH (grades 3 and 4) (RR 0.75, 95% CI 0.45-1.25) for babies receiving prenatal vitamin K compared with control babies. This trend disappeared when poorer quality trials were excluded. Information on neurodevelopment was given for a small sample of children in one trial and no differences were seen. REVIEWER'S CONCLUSIONS: Vitamin K administered to women prior to very preterm birth does not appear to be able to significantly prevent periventricular haemorrhages in preterm infants.

Cerebral Hemorrhage↗
PubMed2000

Magnesium supplementation in pregnancy.

BACKGROUND: Many women, especially those from disadvantaged backgrounds, have intakes of magnesium below recommended levels. Magnesium supplementation during pregnancy may be able to reduce fetal growth retardation and pre-eclampsia, and increase birthweight. OBJECTIVES: The objective of this review was to assess the effects of magnesium supplementation during pregnancy on maternal, neonatal and paediatric outcomes. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised and quasi-randomised trials of dietary magnesium supplementation during pregnancy. DATA COLLECTION AND ANALYSIS: Suitability for inclusion and methodological quality were separately assessed by each reviewer. Data were independently extracted by two reviewers. MAIN RESULTS: Six trials involving 2637 women were included. Only one of these trials was judged to be of high quality. Compared with placebo, oral magnesium treatment from before the 25th week of gestation was associated with a lower incidence of preterm birth (odds ratio 0.71, 95% confidence interval 0.52 to 0.95). There was also less maternal hospitalisation during pregnancy, fewer cases of antepartum haemorrhage, a lower incidence of low birthweight and small for gestational age infants. Poor quality trials are likely to have resulted in a bias favouring magnesium supplementation. REVIEWER'S CONCLUSIONS: There is not enough high quality evidence to show that dietary magnesium supplementation during pregnancy is beneficial.

Dietary Supplements↗
PubMed2000

Magnesium for preventing preterm birth after threatened preterm labour.

BACKGROUND: Magnesium therapy is sometimes continued after an episode of threatened preterm labour in an attempt to prevent the onset of further preterm contractions. OBJECTIVES: The objective of this review was to assess the effects of magnesium maintenance therapy on preventing preterm birth after threatened preterm labour. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised controlled trials of magnesium therapy given to women after threatened preterm labour. DATA COLLECTION AND ANALYSIS: Trial quality assessment and data extraction were done independently by two reviewers. MAIN RESULTS: Two trials were included. Both were of poor quality and neither study included any long-term follow up of infants. The incidence of preterm birth or perinatal mortality was not reduced by magnesium maintenance therapy compared to alternative therapy or no treatment. REVIEWER'S CONCLUSIONS: There is not enough evidence to show that magnesium maintenance therapy is effective in preventing preterm birth after an episode of threatened preterm labour.

Female↗