EVIDENCE BASED OBSTETRICS GYNECOLOGY PDF
International Journal of Gynecology and Obstetrics () 89, — www. myavr.info EVIDENCE BASED OBSTETRICS AND GYNECOLOGY . International Journal of Gynecology and Obstetrics () 95, – www. myavr.info EVIDENCE BASED OBSTETRICS AND GYNECOLOGY . pdf Obstetrics & Gynaecology: An Evidence-based Text for MRCOG, Third Edition Free Download - download free books onliney
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Evidence based medicine: what, why, how? ▻ Review some of the existing evidence based practices in Obstetrics. ▻ Strategies and tools to. Obstetrics & Gynaecology: An Evidence-based Text for MRCOG, Third Edition David M. Luesley ebook. Publisher: Taylor & Francis Format: pdf. Read the latest articles of Evidence-based Obstetrics & Gynecology at myavr.info, Elsevier's leading September–December ; Download PDF.
Selection criteria: Only randomised trials comparing one surgical approach to hysterectomy with another were included. Data collection and analysis: Twenty-seven trials that included participants were included.
Independent selection of trials and data extraction were employed following Cochrane guidelines. Main results: There was statistical heterogeneity in many of the outcome measures when randomised trials were pooled for metaanalysis.
No other statistically significant differences were found. However, for some important outcomes, the analyses were underpowered to detect important differences, or they were simply not reported in trials. Data were notably absent for many important long-term outcome measures.
Significantly improved outcomes suggest VH should be performed in preference to AH where possible.
Where VH is not possible, LH may avoid the need for AH, however the length of the surgery increases as the extent of the surgery performed laparoscopically increases, particularly when the uterine arteries are divided laparoscopically and laparoscopic approaches require greater surgical expertise. The surgical approach to hysterectomy should be decided by a woman in discussion with her surgeon in light of the relative benefits and hazards.
Further research is required with full reporting of all relevant outcomes, particularly important long-term outcomes, in large RCTs, to minimise the possibility of reporting bias. Further research is also required to define the role of the newer approaches to hysterectomy such as TLH.
Search for a guideline
Surgical approach to hysterectomy for benign gynaecological disease. A substantive amendment to this systematic review was last made on 04 November Postpartum blood pressure BP is highest 3 to 6 days after birth when most women Abstracts of Cochrane Reviews have been discharged home.
A significant rise in BP may be dangerous e. To assess the relative benefits and risks of interventions to: Search strategy: We extracted the data independently and were not blinded to trial characteristics or outcomes. We contacted authors for missing data when possible. Six trials are included. There are insufficient data for conclusions about possible benefits and risks of these management strategies.
Most outcomes included data from only one trial. No trial reported severe maternal hypertension or breastfeeding. Treatment in two trials women; three comparisons , oral timolol or hydralazine were compared with oral methyldopa for treatment of mild to moderate postpartum hypertension.
Evidence-based Obstetrics & Gynecology
In one trial 38 women; one comparison , oral hydralazine plus sublingual nifedipine were compared with sublingual nifedipine for treatment of severe postpartum hypertension. The need for additional antihypertensive therapy did not differ between groups relative risk 4. No trial reported severe maternal hypertension or breastfeeding. Treatment in two trials women; three comparisons , oral timolol or hydralazine were compared with oral methyldopa for treatment of mild to moderate postpartum hypertension.
In one trial 38 women; one comparison , oral hydralazine plus sublingual nifedipine were compared with sublingual nifedipine for treatment of severe postpartum hypertension. The need for additional antihypertensive therapy did not differ between groups relative risk 4.
All were well tolerated. Future studies of prevention or treatment of postpartum hypertension should include information about use of postpartum analgesics and outcomes of severe maternal hypertension, breastfeeding, hospital length of stay, and maternal satisfaction with care.
Citation: Magee L, Sadeghi S. Prevention and treatment of postpartum hypertension. Background: The frameless intrauterine device IUD dispenses with the frame in the classical IUD and holds the device in the uterus by anchoring one end of a nylon thread in the fundal myometrium, to which copper sleeves are attached. Objectives: This review examines the hypothesis that the frameless IUD Gynefix reduces risk of expulsion and pregnancy, and the problems of bleeding and pain necessitating early removal.
Selection criteria: We selected for the review randomised trials that compared the frameless device to a classical framed device for contraception.
Data collection and analysis: Both authors extracted data independently. We contacted study author for additional data. We calculated rate ratios and rate differences for cumulative rates for each outcome at yearly intervals.
We used the inverse variance-based method to combine trials, and tested the results for heterogeneity. Main results: Four trials were included in the review involving women randomised to either a frameless device or TCu, with data up to 8 years for the largest, and with a total experience of 23, years.
Apart from one small trial, nulliparous women were excluded from the trials. The two earlier trials used a prototype introducer and there was a higher expulsion rate at 1 year relative risk 2.
However, between 2 and 6 years in the large WHO trial, the risk of pregnancy was lower with the frameless device relative risk 0. In a recent trial using GyneFix with a new introducer, early expulsions and pregnancies were not statistically different from the control device.
There was a tendency towards fewer removals for pain in early years but no difference at 6 years relative risk 1. Apart from that, the frameless device performs similarly to TCu, and appears to have a lower pregnancy rate in later years, although the absolute difference is small.
Professor Archie Cochrane, a Scottish epidemiologist commented in about the failure of Obstetricians and Gynaecologists to evaluate the effectiveness of their services in the health care [ 1 ]. He also called for up-to-date, systematic reviews of all relevant randomised controlled trials RCTs of the health care in every specialty.
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The Cochrane Collaboration, established in , was an apt response to his ideas of critical evaluation of healthcare practices. The concepts of the methodologies used to obtain the best evidence were established by the McMaster University research group led by David Sackett and Gordon Guyatt [ 1 ]. What Does EBM mean? Current best evidence is up-to-date information from relevant, valid research about the effects of different forms of health care, the potential for harm from exposure to particular agents, the accuracy of diagnostic tests and the predictive power of prognostic factors [ 6 ].
Individual clinical expertise refers to the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice. Individual clinical expertise and the best available external research evidence are complementary tools, and neither of them alone is enough. Unless there is adequate clinical expertise, even the best of the external evidence may become inapplicable or inappropriate for an individual patient.
At the same time, the lack of current best evidence may make the practice out of date and run the risk of causing harm to the patients. EBM continually seeks to assess the strength of evidence of the risks and benefits of treatments or lack of treatment and diagnostic tests.
This includes production of guidelines, policies and regulations to be followed by the healthcare staff. Over 2 million articles are published annually in the biomedical literature in more than 20, journals [ 9 ].
Evidence-Based Medicine: An Obstetrician and Gynaecologist’s Perspective
Do we have the time to go through all the studies or papers published in Obstetrics and Gynaecology all over the world on daily or weekly basis? The answer is definitely no. Studies show that we cannot afford more than a few seconds per patient for finding and assimilating evidence or to set aside more than half an hour of study per week [ 10 — 12 ].
It should not be much different in our specialty with the explosion of the medical literature, which has happened over the last few years.
What is needed therefore is a sound practice of EBM, which includes quick and efficient search for valid and relevant research for answering key clinical questions and providing the best clinical care for the patient. How do we then ensure uniform standards of care for each and every patient, and how do we determine who does the best for their patients and who does not? Aggressive marketing of therapeutic agents or industry-driven treatments have become a major concern in healthcare settings. EBM has the potential to challenge any such therapies or interventions which do not benefit patients but indeed may lead to harm.
EBM thus keeps us to be on our toes so that we can then offer the latest knowledge on the subject of interest to the patient. In fact, it is our duty towards our patients to ensure that they are well informed about their condition or treatment. It is also argued that there is, however, very little evidence for majority of what we do in medicine and so EBM may not be necessary. Others are worried that they will not know how to search for, critically appraise, analyse and implement the available evidence for the benefit of their patients.
EBM has been viewed as a cost-cutting tool implemented by the managers and administrative staff so as to bring forth policies which favour their budgets. It is also common for many clinicians to claim that they are too busy in their practice to spare any time for review of their practice. Although it is appreciated that clinical practice can get very busy especially in developing countries with lack of resources, it is to be borne in mind that where there is a will there is a way.Level III: Reza Radjabi and David L.
They are used to detect recurrences at an early asymptomatic stage. Level II EBM is a lifelong learning process and is an effort to make the most effective use of medical knowledge for best outcomes in terms of patient benefit and safety. However, a review of evidence shows that abdominal palpation has limited diagnostic accuracy to predict a small for gestational age SGA fetus [ 21 ] Rec.
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