1.
Carbetocin vs oxytocin for prevention of postpartum hemorrhage after vaginal delivery: A meta-analysis
Jin XH, Li D, Li X
Medicine. 2019;98(47):e17911
Abstract
OBJECTIVE To evaluate the efficacy and safety of carbetocin for prevention of postpartum hemorrhage in women undergoing vaginal delivery compared with oxytocin. METHODS We conducted a systemic literature search in PubMed, the Cochrane Library, and Embase without language restrictions from inception of each of database to November 18th, 2018. Randomized controlled trials with outcome measure of blood loss ≥500 ml were eligible if they compared carbetocin with oxytocin to prevent postpartum hemorrhage during the third stage of labor in women undergoing vaginal delivery. RESULTS This meta-analysis of 5 randomized controlled trials (30,314 women) indicated that there was no significant difference between carbetocin and oxytocin in blood loss ≥500 ml in women undergoing vaginal delivery (relative risks (RRs), 0.52; 95% confidence intervals (CIs), 0.24 to 1.15; P = .11; I = 69%). Sensitivity analyses showed the same results. No significant differences were found in blood loss ≥1000 ml, use of additional uterotonic agents, blood transfusion, uterine massage, flushing, vomiting, abdominal pain, nausea, dizziness, headache, palpitation, itching, and shivering. CONCLUSIONS This meta-analysis showed that carbetocin was as effective and safe as oxytocin for prevention of postpartum hemorrhage in women undergoing vaginal delivery, and the choice of carbetocin for routine prophylaxis will depend on cost-effectiveness.
2.
Effect and safety of timing of cord clamping on neonatal hematocrit values and clinical outcomes in term infants: a randomized controlled trial
Chen X, Li X, Chang Y, Li W, Cui H
Journal of Perinatology : Official Journal of the California Perinatal Association. 2017;38((3):):251-257
Abstract
OBJECTIVE To evaluate the effect and safety of different umbilical cord clamping (UCC) timing. STUDY DESIGN This was a randomized trial of 720 term mothers/infants from the Tianjin Central Hospital of Obstetrics and Gynecology delivered from December 2014 to May 2015 and randomized to immediate cord clamping (ICC) within 15 s, delayed cord clamping (DCC) by 30, 60, 90, 120, 150, or 180 s, or when the umbilical cord pulsation ceased. RESULTS 24 h after delivery, the mean infant hematocrit levels were 56.5, 57.3, 58.8, 59.7, 59.5, 59.7, 60.3, and 61.0% in the ICC, 30, 60, 90, 120, 150, and 180-second DCC, and no pulsation groups, respectively (P = 0.021, 0.001, 0.003, 0.001, <0.001, and <0.001, respectively; standard deviations ranging 5.4-8.7%). There was no significant difference between the 30-second DCC and ICC groups. No significant differences were found in other neonatal and maternal outcomes among these groups. CONCLUSION For term infants, DCC increases the hematocrit values, without apparent harmful effects on the infants and their mothers.
3.
Hepatitis B immunoglobulin injection in pregnancy to interrupt hepatitis B virus mother-to-child transmission-a meta-analysis
Shi Z, Li X, Ma L, Yang Y
International Journal of Infectious Diseases. 2010;14((7):):e622-34.
Abstract
OBJECTIVES To evaluate the efficacy and safety of using hepatitis B immunoglobulin (HBIG) during pregnancy to prevent hepatitis B virus (HBV) mother-to-child transmission (MTCT). METHODS We systematically reviewed the effect of HBIG in decreasing HBV MTCT from randomized controlled trials (RCTs) carried out between January 1990 and December 2008, in English and Chinese languages. Multiple databases were searched, and experts in this field were contacted. The methodological quality of each RCT was assessed by the Jadad score. We abstracted data on HBV intrauterine infection, MTCT, treatment methods, newborn immune prophylaxis methods, and adverse effects. A Mantel-Haenszel random-effects model was employed for all analyses using odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS Five thousand nine hundred newborns of asymptomatic hepatitis B surface antigen (HBsAg)-seropositive mothers from 37 qualified RCTs were included. Compared with the control group, newborns in the HBIG group had a lower intrauterine infection rate (indicated by HBsAg as OR 0.22, 95% CI [0.17, 0.29], from 32 RCTs; indicated by HBV DNA as OR 0.15, 95% CI [0.07, 0.30], from 13 RCTs; p<0.01 for both) and a higher protection rate (indicated by hepatitis B surface antibody (HBsAb) as OR 11.79, 95% CI [4.69, 29.61], from 15 RCTs; p<0.01). The same trend was found in MTCT by the time of 9-12 months after birth, indicated by HBsAg (OR 0.33, 95% CI [0.21, 0.51], from nine RCTs; p<0.01) and HBsAb (OR 2.49, 95% CI [1.55, 4.01], from 11 RCTs; p<0.01). HBIG appears to be safe, but a few RCTs have reported adverse events. CONCLUSION Multiple injections of HBIG in HBV carrier mothers with a high degree of infectiousness in late pregnancy, effectively and safely prevent HBV intrauterine transmission