Assistance Publique-Hôpitaux de Paris and the University of Geneva.

No abstract

Objective: Oral iron substitution has shown to be insuffi cient for treatment of severe iron defi ciency anemia in pregnancy. Ferric carboxymaltose is a new intravenous (i.v.) iron formulation promising to be more effective and as safe as iron sucrose. We aimed to assess side effects and tolerance of ferric carboxymaltose compared to i.v. iron sucrose in pregnant women. Methods:We performed a retrospective analysis of 206 pregnant women who were treated either with ferric carboxymaltose or iron sucrose for iron-defi ciency anemia with into lerability to oral iron substitution, or insuffi cient hemoglobin increase after oral iron treatment, or need for rapid hemoglobin reconstitution. Primary endpoint was to evaluate the maternal safety and tolerability. Secondary endpoint was to assess effi cacy of the treatment and exclude safety concerns for the fetus. Results: The incidence of drug-related adverse events was low and mostly mild in both groups. Mild adverse events occurred in 7.8 % for ferric carboxymaltose and in 10.7 % for iron sucrose. The mean rise of hemoglobin value was 15.4 g/L for ferric carboxymaltose and 11.7 g/L for iron sucrose. Conclusion: Ferric carboxymaltose administration in pregnant women is well tolerated and is not associated with any relevant clinical safety concerns. Ferric carboxymaltose has a comparable safety profi le to iron sucrose but offers the advantage of a much higher iron dosage at a time reducing the need for repeated applications and increasing patients ' comfort. Ferric carboxymaltose is the drug of choice, if i.v. iron treatment becomes necessary in the second or third trimester of pregnancy.

29 per 1000 (13 to 65) M oderate 29 per 1000 29 per 1000 (13 to 65)* The risk in the intervention group (and its 95% conf idence interval) is based on the assum ed risk in the com parison group and the relative effect of the intervention (and its 95% CI).CI: Conf idence interval; RR: Risk ratio; OR: Odds ratio;GRADE Working Group grades of evidence High quality: We are very conf ident that the true ef f ect lies close to that of the estim ate of the ef f ect M oderate quality: We are m oderately conf ident in the ef f ect estim ate: The true ef f ect is likely to be close to the estim ate of the ef f ect, but there is a possibility that it is substantially dif f erent Low quality: Our conf idence in the ef f ect estim ate is lim ited: The true ef f ect m ay be substantially dif f erent f rom the estim ate of the ef f ect Very low quality: We have very little conf idence in the ef f ect estim ate: The true ef f ect is likely to be substantially dif f erent f rom the estim ate of ef f ect 1 Studies contributing data were at risk of bias (lack of blinding) 2 Wide 95% CI crossing the line of no ef f ect 3 We downgraded this outcom e f or lack of blinding (clinical assessm ent of dystocia could be af f ected by lack of blinding) 4 Wide 95% CI crossing the line of no ef f ect and low event rate 5 Not downgraded f or low event rates due to f airly large sam ple, and 95% CI not crossing the line of no ef f ect, and we considered this outcom e was less likely to be af f ected by lack of blinding 6 Induction of labour at or near term for suspected fetal macrosomia (Review)

Objective To compare a shortened hospital stay with midwife visits at home to usual hospital care after delivery. Design Randomised controlled trial.Setting Maternity unit of a Swiss teaching hospital.Population Four hundred and fifty-nine women with a single uncomplicated pregnancy at low risk of caesarean section. Methods Women were randomised to either home-based (n ¼ 228) or hospital-based postnatal care (n ¼ 231).Home-based postnatal care consisted of early discharge from hospital (24 to 48 hours after delivery) and home visits by a midwife; women in the hospital-based care group were hospitalised for four to five days. Main outcome measures Breastfeeding 28 days postpartum, women's views of their care and readmission to hospital. Results Women in the home-based care group had shorter hospital stays (65 vs 106 hours, P < 0.001) and more midwife visits (4.8 vs 1.7, P < 0.001) than women in the hospital-based care group. Prevalence of breastfeeding at 28 days was similar between the groups (90% vs 87%, P ¼ 0.30), but women in the homebased care group reported fewer problems with breastfeeding and greater satisfaction with the help received. There were no differences in satisfaction with care, women's hospital readmissions, postnatal depression scores and health status scores. A higher percentage of neonates in the home-based care group were readmitted to hospital during the first six months (12% vs 4.8%, P ¼ 0.004). Conclusions In low risk pregnancies, early discharge from hospital and midwife visits at home after delivery is an acceptable alternative to a longer duration of care in hospital. Mothers' preferences and economic considerations should be taken into account when choosing a policy of postnatal care.