Background Caesarean section rates are increasing globally. The factors contributing to this increase are complex, and identifying interventions to address them is challenging. Non-clinical interventions are applied independently of a clinical encounter between a health provider and a patient. Such interventions may target women, health professionals or organisations. They address the determinants of caesarean births and could have a role in reducing unnecessary caesarean sections. This review was first published in 2011. This review update will inform a new WHO guideline, and the scope of the update was informed by WHO's Guideline Development Group for this guideline. Objectives To evaluate the e ectiveness and safety of non-clinical interventions intended to reduce unnecessary caesarean section. Search methods We searched CENTRAL, MEDLINE, Embase, CINAHL and two trials registers in March 2018. We also searched websites of relevant organisations and reference lists of related reviews. Selection criteria Randomised trials, non-randomised trials, controlled before-a er studies, interrupted time series studies and repeated measures studies were eligible for inclusion. The primary outcome measures were: caesarean section, spontaneous vaginal birth and instrumental birth. Non-clinical interventions for reducing unnecessary caesarean section (Review)

Endocrine complications in patients with thalassemia major in developing countries may be frequent due to suboptimal iron chelation. Data from developing countries are scant. We prospectively evaluated growth, growth hormone (GH), insulin-like growth factor I, thyroid hormone, cortisol and glucose tolerance in 84 patients over one year. Height standard deviation (SD) score of patients > 8 years (-2.2 +/- 1.5 against National Center for Health Statistics references) was significantly lower than that of normal controls (-1.0 +/- 0.7, p < 0.001). 51% of patients had GH deficiency, 13% hypocortisolism and 7.9% diabetes/impaired glucose tolerance. Ten of 11 adolescents/young adults had hypogonadism. Of 54 preadolescent children who underwent dynamic testing, 18 (33%) had at least one endocrine deficiency other than short stature. We conclude that hypogonadism and hypocortisolism form important causes for morbidity in our thalassemic children. Thalassemic patients in developing countries may be at risk for endocrine deficiencies at younger ages.

ObjectiveThe objective of this study is to evaluate the sensitivity of routine trans vaginal ultrasound (TVUS) compared to expert-guided transvaginal ultrasound (ETVUS) for the diagnosis of endometriosis.MethodsA retrospective chart review performed at a Canadian tertiary center specializing in the diagnosis and management of endometriosis. All cases with surgically confirmed endometriosis and an ETVUS completed at a single center were included for review and compared to routine TVUS performed for the same indication.ResultsForty cases met the inclusion criteria. Mean patient age of the study population at first surgical diagnosis was 31.2 ± 6.9 years. Dysmenorrhea (76.9 %) and chronic pelvic pain (74.3 %) were the most common presenting symptoms. Sensitivity of routine TVUS was 25 % (10/40), compared to 78 % (31/40) with ETVUS, (P < 0.01). Comparisons were made based on site of disease. Routine TVUS and ETVUS detected bladder involvement in (0/40) vs. 5 % (2/40); ureter (0/40) vs. 7.5 % (3/40); ovary 25 % (10/40) vs. 72.5 % (29/40); retrocervical area (0/40) vs. 60 % (24/40), rectosigmoid 5 % (2/40) vs. 77.5 % (31/40), respectively. Specific endometriotic lesions recognized by TVUS versus ETVUS, were: ovarian endometriomas in 25 % (10/40) vs. 45 % (18/40), adhesions leading to abnormal anatomy in 2.5 % (1/40) vs. 77.5 % (31/40); endometriotic implants or plaques in 2.5 % (1/40) vs. 70 % (28/40); and endometriotic nodules in 2.5 % (1/40) vs. 35 % (14/40), respectively. Routine TVUS diagnosis relied on the presence or absence of endometrioma (10/10), whereas ETVUS showed additional sites of disease in 97 % (30/31) patients.ConclusionsETVUS is more sensitive than routine TVUS to diagnose endometriosis, identifying lesions other than endometrioma and is of assistance in surgical planning and patient counseling.

No abstract