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AbstractObjective: To provide guidelines for the use of antenatal magnesium sulphate (MgSO 4 ) for fetal neuroprotection of the preterm infant .Options: Antenatal MgSO 4 administration should be considered for fetal neuroprotection when women present at ≤ 31+6 weeks with imminent preterm birth, defined as a high likelihood of birth because of active labour with cervical dilatation ≥ 4 cm, with or without preterm pre-labour rupture of membranes, and/or planned preterm birth for fetal or maternal indications .There are no other known fetal neuroprotective agents .Outcomes: The outcomes measured are the incidence of cerebral palsy (CP) and neonatal death . Values: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1) .Benefits, harms, and costs: Antenatal magnesium sulphate for fetal neuroprotection reduces the risk of "death or CP" (RR 0 .85; 95% CI 0 .74 to 0 .98; 4 trials, 4446 infants), "death or moderatesevere CP" (RR 0 .85; 95% CI 0 .73 to 0 .99; 3 trials, 4250 infants), "any CP" (RR 0 .71; 95% CI 0 .55 to 0 .91; 4, trials, 4446 infants), "moderate-to-severe CP" (RR 0 .60; 95% CI 0 .43 to 0 .84; 3 trials, 4250 infants), and "substantial gross motor dysfunction" (inability to walk without assistance) (RR 0 .60; 95% CI 0 .43 to 0 .83; 3 trials, 4287 women) at 2 years of age . Results were consistent between trials and across the meta-analyses . There is no anticipated significant increase in health care-related costs, because women eligible to receive antenatal MgSO 4 will be judged to have imminent preterm birth .
Objective: To examine the ability of three different proteinuria assessment methods (urinary dipstick, spot urine protein:creatinine ratio [Pr/Cr], and 24-hour urine collection) to predict adverse pregnancy outcomes
Methods:We performed a prospective multicentre cohort study, PIERS (Preeclampsia Integrated Estimate of RiSk), in seven academic tertiary maternity centres practising expectant management of preeclampsia remote from term in Canada, New Zealand, and Australia Eligible women were those admitted with preeclampsia who had at least one antenatal proteinuria assessment by urinary dipstick, spot urine Pr/Cr ratio, and/or 24-hour urine collection Proteinuria assessment was done either visually at the bedside (by dipstick) or by hospital clinical laboratories for spot urine Pr/Cr and 24-hour urine collection We calculated receiver operating characteristic area under the curve (95% CI) for each proteinuria method and each of the combined adverse maternal outcomes (within 48 hours) or adverse perinatal outcomes (at any time) Models with AUC ≥ 070 were considered of interest Analyses were run for all women who had each type of proteinuria assessment and for a cohort of women ("ALL measures") who had all three proteinuria assessmentsResults: More women were proteinuric by urinary dipstick (≥ 2+, 614%) than by spot urine Pr/Cr (≥ 30g/mol, 504%) or 24-hour urine collection (≥ 03g/d, 347%) Each proteinuria measure evaluated had some discriminative power, and dipstick proteinuria (categorical) performed as well as other methods No single method was predictive of adverse perinatal outcome
Conclusion:The measured amount of proteinuria should not be used in isolation for decision-making in women with preeclampsia Dipstick proteinuria performs as well as other methods of assessing proteinuria for prediction of adverse events
Results: there were no deaths. time to functional recovery was median 2 (interquartile range 2-3) days. the overall 30-day postoperative morbidity was 14.5% after bowel resection and 0% after sacrocolporectopexy. relaparotomy rate was 3.6% and 30-day readmission rate 7.2%. Postoperative hospital stay was median 3 days after small bowel and ileo-colic resection, 4 days after segmental colectomy, and 6 days after rectal resection and subtotal colectomy. Patient's body mass index > 30 kg/m 2 , malignant disease, complexity of surgery, recovery of bowel function later than 2 days after surgery, time to functional recovery > 2 days and postoperative morbidity were patient-and treatment-related determinants increasing postoperative hospital stay. Protocol compliance-related determinants increasing postoperative hospital stay were intake of normal food and mobilization ≥ 6 h/ day later than 2 days after surgery and removal of urinary catheter later than 1 day after surgery.
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