Importance Uterine dehiscence is a separation of the uterine musculature with intact uterine serosa. Uterine dehiscence can be encountered at the time of cesarean delivery, be suspected on obstetric ultrasound, or be diagnosed in between pregnancies. Management is a conundrum for obstetricians, regardless of timing of onset. Evidence Acquisition A literature search was undertaken by our research librarian using the search engines PubMed, CINAHL, and Web of Science. The search term used was “uterine dehiscence.” The search was limited to the English language, and there was no limit on the years searched. Results The search identified 152 articles, 32 of which are the basis for this review. Risk factors, treatment, and management in subsequent pregnancies are discussed. The number of prior cesarean deliveries is the greatest risk factor for uterine dehiscence. Unrepaired uterine dehiscence can cause symptoms outside of pregnancies and may require repair for alleviation of these symptoms. Dehiscence should also be repaired prior to subsequent pregnancies. Conclusion and Relevance Planned delivery prior to the onset of labor with careful monitoring of maternal symptoms is the preferred management strategy of women with prior uterine dehiscence. Careful attention should be paid to the lower uterine segment thickness when ultrasonography is performed in women with prior cesarean delivery. Relevance Statement An evidence-based review of uterine dehiscence in pregnancy and how to manage subsequent pregnancies following uterine dehiscence. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to identify the risks of pregnancy following uterine dehiscence; explain treatment of uterine dehiscence; and describe symptoms of unrepaired uterine dehiscence.
Background: Under reporting of clinical trial results can lead to negative consequences that include inhibiting propagation of knowledge, limits understanding of how devices work, affect conclusions of meta-analyses, and fails to acknowledge patient participation. Therefore clinical trial transparency, through publication of trial results on ClinicalTrials.gov or in manuscript form, is important. We aimed to examine clinical trial transparency in endoscopic clinical trials. Methods: The ClinicalTrials.gov database was searched for endoscopy trials up to October of 2019. Adherence to reporting of results to the database or in publication form was recorded for each trial. Results: The final analysis included 923 trials of which 801 were completed and 122 were either terminated or suspended. Results were available either on ClinicTrials.gov or in publication for 751 (81.37%) out of 923 trials. Other fields have reported a publication rate of 40-63%. Results were available on clinicaltrials.gov for 168 (18.2%) trials and in the form of a publication for 717 (77.68%) trials. Conclusions: Compared to other fields in medicine, endoscopy clinical trials have a high rate of clinical trial transparency. However there is room for improvements as close to one-fifth of trials fail to report results and 81.8% do not report results to ClinicalTrials.gov.
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