Less Is More

Simpler & Better Medicine

Follow-up of ASCUS or LSIL: Colposcopy vs repeat cytology — February 14, 2017

Follow-up of ASCUS or LSIL: Colposcopy vs repeat cytology

Summary: For women between 22 to 27 years of age who have a pap test showing atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL), following up with repeat cervical cytology at 6 months may be associated with the same rates of invasive cervical cancer at 6.5 years as following up with colposcopy and biopsy at 6 months, at potentially lower cost.

https://www.ncbi.nlm.nih.gov/m/pubmed/27457115/

Strength of Recommendation = C

Short- and long-term outcomes of metformin compared with insulin alone in pregnancy. — February 3, 2017

Short- and long-term outcomes of metformin compared with insulin alone in pregnancy.

Summary: For women with gestational or Type 2 diabetes mellitus, using metformin during pregnancy may be associated with lower risks of neonatal hypoglycemia, large for gestational age babies, pregnancy-induced hypertension and total maternal pregnancy weight gain compared to using insulin; however there remains little information on long-term outcomes.

https://www.ncbi.nlm.nih.gov/m/pubmed/27150509/

Strength of Recommendation = B

Do unsutured second-degree perineal lacerations affect postpartum functional outcomes? — November 22, 2016

Do unsutured second-degree perineal lacerations affect postpartum functional outcomes?

Summary: For women sustaining second-degree perineal lacerations during delivery, an approach of not repairing the second-degree laceration may be associated with a decreased need for post-partum pain medication in hospital compared to an approach of suturing the second-degree laceration, without any increase in adverse long-term outcomes.

https://www.ncbi.nlm.nih.gov/m/pubmed/17823462/

Strength of Recommendation = B

Vaginal progesterone prophylaxis for preterm birth (OPPTIMUM study) — August 5, 2016

Vaginal progesterone prophylaxis for preterm birth (OPPTIMUM study)

Summary: For women at high-risk of pre-term birth, not using vaginal progesterone seems to be associated with the same rate of preterm birth as does the use of vaginal progesterone prophylaxis. (In otherwords, for women at high risk of pre-term birth, vaginal progesterone prophylaxis may not reduce that risk)

http://www.ncbi.nlm.nih.gov/m/pubmed/26921136/

Strength of Recommendation = A

Expectant Management or Labor Induction in Women 35 Years of Age or Older. — June 7, 2016

Expectant Management or Labor Induction in Women 35 Years of Age or Older.

Summary: For primigravid women age 35 or older expectant management and induction at 39 weeks may be associated with the same rates of cesarean delivery and operative vaginal delivery, and with the same risks of adverse maternal or neonatal outcomes; with expectant management affording the opportunity to avoid the interventions associated with labor induction.

http://www.ncbi.nlm.nih.gov/m/pubmed/26962902/

Strength of Recommendation = B

Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial) — May 20, 2016

Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial)

Summary: For adult, pregnant women singleton pregnancies and rupture of membranes before labor between 34 and 37 weeks, with no signs of infection, expectant management may lead to the same rates of neonatal sepsis, morbidity and mortality as immediate delivery, but expectant management may be associated with lower rates of respiratory distress, need for mechanical ventilation, and need for intensive care compared to immediate delivery.

http://www.ncbi.nlm.nih.gov/m/pubmed/26564381/

Strength of Recommendation = B

Routine weighing to reduce excessive antenatal weight gain: a randomised controlled trial. — March 28, 2016

Routine weighing to reduce excessive antenatal weight gain: a randomised controlled trial.

Summary: For healthy women with singleton pregnancies, a practice of measuring weight only at the start of care and at 36 weeks (plus appropriate education regarding gestational weight gain guidelines) does not appear to be associated with any difference in maternal weight gain or maternal or neonatal morbidity compared to a practice of routine weight measurement at every prenatal visit.

http://www.ncbi.nlm.nih.gov/m/pubmed/26840637/

Strength of Recommendation = B

Electrocardiogram ST Analysis During Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials. — March 18, 2016

Electrocardiogram ST Analysis During Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Summary: For women with singleton pregnancies, there appears to be no difference in the rates of adverse perinatal outcomes or cesarean deliveries when standard cardiotocography compared to cardiotocography plus ST-segment analysis.

http://www.ncbi.nlm.nih.gov/m/pubmed/26646135/

Strength of Recommendation = A

Induction of labor at full term in uncomplicated singleton gestations: a systematic review and metaanalysis of randomized controlled trials. — February 26, 2016

Induction of labor at full term in uncomplicated singleton gestations: a systematic review and metaanalysis of randomized controlled trials.

Summary: For women with full-term, singleton, vertex pregnancies, a practice of expectant management appears to be associated with the same risk of cesarean delivery as is a practice of routine induction at term.

http://www.ncbi.nlm.nih.gov/m/pubmed/25882916/

Strength of Recommendation = A

Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial. — February 9, 2016

Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial.

Summary: For adult women with typical symptoms of a urinary tract infection (eg, dysuria, frequency, or urgency) and without any risk factors for complication (eg, fever, loin tenderness, pregnancy, kidney disease, or recent urinary infection or catheterization), treatment with ibuprofen 300 mg 3x daily for 3 days may provide the same likelihood of recovery as treatment with a single dose of fosfomycin, thus allowing treatment without the need for an antibiotic prescription (although women treated with ibuprofen may take about 1 day longer to achieve full remission of symptoms).

http://www.ncbi.nlm.nih.gov/m/pubmed/26698878/

Strength of Recommendation = B

A whole-of-population study of term and post-term gestational age at birth and children’s development. — November 6, 2015

A whole-of-population study of term and post-term gestational age at birth and children’s development.

Summary: Based on population-level data, it appears that for healthy pregnancies, a policy of nonintervention unless medically necessary up to 41 weeks’ gestation may be associated with a lower risk of the child having developmental vulnerability at school entry.

http://www.ncbi.nlm.nih.gov/m/pubmed/25754325/

Strength of Recommendation = C

When should the umbilical cord be clamped? — November 4, 2015
Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. — September 24, 2015

Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour.

Summary: For women in labor, use of continuous cardiotocography (CTG) rather than intermittent auscultation may be associated with an increased likelihood of having a caesarean section or an instrumental vaginal birth, without reducing the likelihood of cerebral palsy or infant mortality (however, CTG may be associated with a reduced risk of neonatal seizures).

http://www.ncbi.nlm.nih.gov/m/pubmed/23728657/

Strength of Recommendation = A

Episiotomy for vaginal birth. — August 3, 2015

Episiotomy for vaginal birth.

Summary: A practice of more restrictive use of episiotomy may lead to less posterior perineal trauma, less suturing and fewer complications, with no differences on most pain measures, compared to a practice of routine episiotomy for vaginal birth. (However, there may be an increased risk of anterior perineal trauma with restrictive episiotomy).

http://www.ncbi.nlm.nih.gov/m/pubmed/19160176

Strength of Recommendation = A

Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. — July 20, 2015

Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study.

Summary: Evidence from a prospective cohort study in England suggests that for women with a term, singleton pregnancy, planning birth in a midwifery unit (for nulliparous women), or planning birth either at home or in a midwifery unit (for multiparous women) may lead to fewer interventions than planning for birth in an obstetric unit. (In this study, nulliparous women who planned home births also had fewer interventions compared to planned delivery in an obstetric unit, but perinatal outcomes were poorer as well.)

http://www.ncbi.nlm.nih.gov/m/pubmed/22117057/

Strength of Recommendation = B

Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. — July 14, 2015
Performance of alternative strategies for primary cervical cancer screening in sub-Saharan Africa: systematic review and meta-analysis of diagnostic test accuracy studies — July 9, 2015

Performance of alternative strategies for primary cervical cancer screening in sub-Saharan Africa: systematic review and meta-analysis of diagnostic test accuracy studies

Summary: For primary cervical cancer screening in sub-Saharan Africa, use of visual inspection with acetic acid (VIA) or visual inspection with Lugol’s iodine (VILI) may be more specific than human papillomavirus (HPV) testing with hybrid capture or PCR, although all appear equally (highly) sensitive.

http://www.ncbi.nlm.nih.gov/m/pubmed/26142020/

Strength of Recommendation = B

Improving women’s experience during speculum examinations at routine gynaecological visits: randomised clinical trial. — June 26, 2015

Improving women’s experience during speculum examinations at routine gynaecological visits: randomised clinical trial.

Summary: For adult women undergoing routine pelvic examination and cervical cancer screening, conducting the examination WITHOUT stirrups (placing the feet on the corners of a fully deployed table extension rather than using stirrups), may lead to a reduction in the woman’s sense of vulnerability and a reduction in her physical discomfort, without any decrease in the quality of cervical smears obtained.

http://www.ncbi.nlm.nih.gov/m/pubmed/16803941

Strength of Recommendation = B

Is it necessary to suture all lacerations after a vaginal delivery? — June 24, 2015

Is it necessary to suture all lacerations after a vaginal delivery?

Summary: For women with minor perineal lacerations due to spontaneous vaginal delivery (less than 2 cm deep x 2 cm long), allowing spontaneous healing without suturing may give the same healing outcomes by 8 weeks postpartum, with spontaneous healing associated with less need for postpartum analgesia and less perceived interference with breastfeeding than a sutured repair.

http://www.ncbi.nlm.nih.gov/m/pubmed/11251483

Strength of Recommendation = B

Antibiotics for prelabour rupture of membranes at or near term. — June 18, 2015

Antibiotics for prelabour rupture of membranes at or near term.

Summary: For women with pre-labor rupture of membranes occurring after 36 weeks’ gestation (who do not have a confirmed infection), use of antibiotics does not appear to reduce the risks of endometritis, early-onset neonatal sepsis, maternal infectious morbidity, stillbirth, or neonatal mortality; but use of antibiotics in this situation may be associated with increased rates of cesarean delivery and maternal length of stay in hospital, and potentially could be associated with adverse medication side effects from antibiotic use and the potential for the development of resistant organisms. (In other words, avoiding antibiotic use for prelabor rupture of membranes after 36 weeks’ gestation unless there is a confirmed maternal infection, may be associated with lower risks adverse antibiotic effects, lower rates of cesarean delivery, and shorter maternal stay in hospital; without increasing the risks of any neonatal or maternal morbidity or mortality.)

http://www.ncbi.nlm.nih.gov/m/pubmed/25352443/

Strength of Recommendation = B

Outcomes of planned home births and planned hospital births in low-risk women in Norway between 1990 and 2007: a retrospective cohort study. — June 12, 2015

Outcomes of planned home births and planned hospital births in low-risk women in Norway between 1990 and 2007: a retrospective cohort study.

Summary: Based on retrospective data, planned home birth may be associated with reduced risks for assisted or operative vaginal delivery, epidural analgesia, episiotomy, anal sphincter tears, dystocia, and postpartum hemorrhage; without any increase in perinatal or neonatal mortality.

http://www.ncbi.nlm.nih.gov/m/pubmed/23182447/

Strength of Recommendation = B

Outcomes of routine episiotomy: a systematic review. — May 11, 2015

Outcomes of routine episiotomy: a systematic review.

Summary: Evidence from clinical trials suggests that short-term maternal outcomes of routine episiotomy, such as severity of perineal laceration, pain, and pain medication use, are not better than those with restrictive use of episiotomy; relevant studies demonstrate no benefit from episiotomy for prevention of fecal and urinary incontinence, and pain with intercourse may be more common among women with episiotomy. In short, evidence does not support maternal benefits traditionally ascribed to routine episiotomy.

http://www.ncbi.nlm.nih.gov/m/pubmed/15870418

Strength of Recommendation = A

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