ObjectivesHigh-quality evidence-based clinical practice guidelines can guide diagnosis and treatment to optimise outcomes. The purpose of this study was to evaluate the quality and content of national and international guidelines on hypertensive disorders of pregnancy. Data Sources: The MEDLINE database, the National Guideline Clearinghouse and several international databases were searched for appropriate guidelines from the past 10 years. Study Appraisal and Synthesis Methods: Six guidelines met inclusion and exclusion criteria and were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.ResultsA total of 695 records were identified and screened by two authors. Disorder definitions, classifications, preventive measures and treatment recommendations were evaluated and compared among guidelines. AGREE II results varied widely across domains and categories. Only two guidelines received consistently high ratings across domains and few demonstrated a high level of methodological rigour. Recommendations regarding classification and treatment were similar across guidelines, while assessment of preventive measures varied widely.ConclusionsClinical practice guidelines for hypertensive disorders of pregnancy vary significantly in quality and with respect to assessment of preventive measures.
Background: Permanent sterilization is one of the most common methods of birth control in the United States and around the world. A small subset of women will regret their decision and desire future fertility. For these women, the options include in vitro fertilization (IVF) or surgical reversal. Surgical reversal, specifically via tubal reanastamosis, is an important choice to consider. Surgical reversal can be accomplished via three different general approaches including laparotomy, conventional laparoscopy, and robot-assisted approaches. Unfortunately, surgical reversal is becoming a lost art. Objective: To compare and contrast pregnancy success rates, ectopic pregnancy rates, and cost between the surgical methods and IVF. Methods: We conducted a literature review via Pubmed with keywords as listed below. Conclusion: Laparoscopic tubal reanastomosis is the best approach for women <40 years of age due to pregnancy outcomes that are comparable to other methods, cost effectiveness, and favorable safety profile of minimally invasive surgery.
Objectives: Pregnancy and vaginal delivery are risk factors for pelvic floor dysfunction. Abdominal binder use may increase intraabdominal pressure, affecting pelvic floor healing or function in recently traumatized postpartum pelvic floor muscle. This study assesses the prevalence of postpartum abdominal binder use, timing, and reasons for use.Methods: In this cross-sectional observational survey study, women who underwent a vaginal delivery at our institution were enrolled. Participants were excluded if they did not speak Spanish or English. Participants were recruited on the postpartum unit. Data were deidentified and analyzed as appropriate for each variable.Results: In total, 673 surveys were completed. Seven were excluded because they had cesarean deliveries. The average age was 26 years. Median gravidity and parity were 2 and 2. In total, 549 women (82%) planned to wear an abdominal binder postpartum. In all, 335 women provided a specific time when they would start use: 240 women (71%) would start at ≤2 days postpartum, 60 women (18%) would start at 3 to 7 days postpartum, and 35 women (11%) would start after 1 week postpartum. Common reasons reported for use included appearance, support, pain, swelling, weight loss, and recommendation.Conclusions: Among women delivering at our institution, planned abdominal binder use postvaginal delivery is common. The reasons cited include health and desire to return to prior body shape. The effects of using an abdominal binder in the postpartum period are unknown. More research is needed to better elucidate how increased postpartum intraabdominal pressure affects healing in traumatized pelvic floor muscles.
Texas counties with greater abortion-rate declines had more publicly funded contraceptive clinics and served more contraceptive clients than counties with lower abortion-rate declines.
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