scholarly journals The importance of experience in using cervical pessary for prevention of preterm birth

2021 ◽  
Vol 12 (2) ◽  
pp. 94-98
Author(s):  
Marcelo Santucci Franca ◽  
Alan Roberto Hatanaka ◽  
Antonio Fernandes Moron
Keyword(s):  
Clinical Practice ◽  
Preterm Birth ◽  
Learning Curve ◽  
Pelvic Pain ◽  
Preterm Labor ◽  
Vaginal Discharge ◽  
Open Space ◽  
Best Management ◽  
Cervical Pessary ◽  
New Treatment

Cervical pessary is a new treatment for preterm birth and have obtained a lot of space in clinical practice because its real efficacy, which unconsidered the bias produced by some research. There is a lack of evidence about cervical pessary in many aspects and only those who handle this device every day can note and call for attention. Experience is the central point about cervical pessary in this article, and important centers with training and expertise must be taken the front of this issue, because low experience probably is one of the causes of contradictory results in literature. In fact, we have a lot of aspects that need attention and never were treated because always the efficacy is questioned and do not open space for other important aspects. We have a lot of o issues to discuss during this article such as the indication of a cervical pessary, the needs of guidelines about pessary, including a learning curve of pessary treatment, the relevant aspects about insertion of the device, its association with other medications, needs for hospitalization, which is the best management for the vaginal discharge pessary related, how to handle the pelvic pain after insertion, the urinary symptoms, the obstipation, and the inhibition of preterm labor during pessary treatment, and finally, what are the relevant aspects about the withdrawal of cervical pessary?

scholarly journals Cervical Length Measurement in Obstetrics: From Academic Luxury to Clinical Practice

2012 ◽  
Vol 6 (1) ◽  
pp. 93-96
Author(s):  
Badreldeen Ahmed ◽  
Zohra Hasnani
Keyword(s):  
Clinical Practice ◽  
Preterm Birth ◽  
High Risk ◽  
Amniotic Fluid ◽  
Pregnant Women ◽  
Preterm Delivery ◽  
Preterm Labor ◽  
Cervical Length ◽  
Length Measurement ◽  
Cervical Length Measurement

ABSTRACT Preterm birth is the main cause of perinatal mortality and morbidity and can be very costly to the healthcare system. Although improvements in neonatal care have led to higher survival of very premature infants, there is a need for the development of a sensitive method with which to identify women at high risk of preterm delivery and find an effective strategy for the prevention of preterm labor.1 Considering the increased incidence of preterm birth, it has become more important now to be able to early diagnose this problem. The measurement of cervical length to predict the risk of preterm birth can be extremely useful in diagnosing this condition. The use of transvaginal ultrasound in measuring cervical length is safe, reliable and well accepted by women.2 The use of vaginal progesterone has shown to be effective in the prevention of preterm delivery in women with short cervix. Tocolytics are used to delay labor for a minimum of 24 to 48 hours3 for up to 1 week but they have not shown to improve neonatal outcomes and most have undesirable side effects. Steroids can assist with fetal lung maturity when the diagnosis of preterm labor is made,3 they can be used unnecessarily when preterm labor is misdiagnosed. The measurement of cervical length can also be helpful in patients with preterm premature rupture of membrane and in patients with the presence of amniotic fluid (AF) sluge.4 Therefore, performing cervical length measurements in all pregnant women and use it as a screening tool at around 20 weeks of pregnancy to identify patients at high risk of preterm labor can assist with true diagnosis. There is a great expectation from cervical assessment and subsequent addition of progesterone to reduce preterm birth and have better neonatal outcomes. The aim of this review is to bring forward evidence that highlights the importance of performing cervical length measurement in midpregnancy in all pregnant women to predict the risk of preterm birth. Medline, PubMed, MD Consult and Science Direct were searched using the terms cervical length measurement, ‘preterm delivery’, ‘amniotic fluid sludge’ and ‘treatment for preterm birth’. How to cite this article Ahmed B, Hasnani Z. Cervical Length Measurement in Obstetrics: From Academic Luxury to Clinical Practice. Donald School J Ultrasound Obstet Gynecol 2012;6(1):93-96.

scholarly journals Emergency management of the paediatric patient with convulsive status epilepticus

2021 ◽  
Vol 26 (1) ◽  
pp. 50-57
Author(s):  
Kyle C McKenzie ◽  
Cecil D Hahn ◽  
Jeremy N Friedman
Keyword(s):  
Clinical Practice ◽  
Status Epilepticus ◽  
Emergency Management ◽  
Treatment Algorithm ◽  
Position Statement ◽  
Convulsive Status Epilepticus ◽  
Pharmacological Management ◽  
The Past ◽  
New Treatment ◽  
New Evidence

Abstract This guideline addresses the emergency management of convulsive status epilepticus (CSE) in children and infants older than 1 month of age. It replaces a previous position statement from 2011, and includes a new treatment algorithm and table of recommended medications based on new evidence and reflecting the evolution of clinical practice over the past several years. This statement emphasizes the importance of timely pharmacological management of CSE, and includes some guidance for diagnostic approach and supportive care.

Evaluating New Treatments and Diagnostic Technologies in Obstetrics: Practical Problems, Ethics, and Solutions

1989 ◽  
Vol 5 (3) ◽  
pp. 459-472 ◽  
Author(s):  
Richard J. Lilford
Keyword(s):  
Clinical Practice ◽  
Decision Theory ◽  
Treatment Effect ◽  
Conventional Therapy ◽  
Inexpensive Method ◽  
Less Invasive ◽  
New Treatment ◽  
New Treatments ◽  
Diagnostic Technologies ◽  
Clinical Experiments

This article develops arguments for the use of decision theory, rather than intuition, to determine the size of trials. It is wrong to expect doctors to ignore personal preferences in favor of clinical experiments unless the trial is capable of showing differences in treatment effect that would influence clinical practice substantially. It follows from our analysis that if delta (the treatment effect that the trial is designed to detect) is sufficient to alter clinical practice, then the alpha and beta errors of a trial should be equal. This applies even if a new treatment is to be compared with conventional therapy or if a treatment with high “costs” is compared with a less invasive or more inexpensive method.

Does “idiopathic” preterm labor resulting in preterm birth exist?

1993 ◽  
Vol 168 (5) ◽  
pp. 1480-1485 ◽  
Author(s):  
Luanna Lettieri ◽  
Anthony M. Vintzileos ◽  
John F. Rodis ◽  
S. Mark Albini ◽  
Carolyn M. Salafia
Keyword(s):  
Preterm Birth ◽  
Preterm Labor
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