This placebo-controlled study over 5 weeks shows that 57% of the men who suffered from erectile dysfunction had an effect from LI-ESWT. After 24 weeks, seven (19%, active group) and nine (23%, active placebo group) men were still able to have intercourse without medication. This study shows a possible cure in some patients, but more research, longer follow-up in the placebo group and an international multicentre randomized study are needed.
Discontinuing IV oxytocin stimulation after the active phase of labour has been established may reduce caesarean delivery but the evidence for this was low certainty. When restricting our analysis to those trials that separately reported participants who reached the active phase of labour, our results showed there is probably little or no difference between groups. Discontinuing IV oxytocin may reduce uterine tachysystole combined with abnormal FHR.Most of the trials had 'Risk of bias' concerns which means that these results should be interpreted with caution. Our GRADE assessments ranged from very low certainty to moderate certainty. Downgrading decisions were based on study limitations, imprecision and indirectness.Future research could account for all women randomised and, in particular, note those who delivered before the point at which they would be eligible for the intervention (i.e. those who had caesareans in the latent phase), or because labour was so rapid that the infusion could not be stopped in time.Future trials could adopt the outcomes listed in this review including maternal and neonatal mortality, maternal satisfaction, and breastfeeding.
Objective To investigate whether discontinuation of oxytocin infusion increases the duration of the active phase of labour and reduces maternal and neonatal complications.Design Randomised controlled trial.Setting Department of Obstetrics and Gynaecology, Regional Hospital of Randers, Denmark.Population Women with singleton pregnancy in the vertex position undergoing labour induction or augmentation.Methods Two hundred women were randomised when cervical dilation was ≤4 cm to either continue or discontinue oxytocin infusion when cervical dilation reached 5 cm.Main outcome measures The primary outcome was duration of the active phase of labour, defined as the time period from 5 cm of cervical dilation until delivery. Secondary outcomes were mode of delivery, uterine tachysystole, hyperstimulation, abnormalities in fetal heart rate, postpartum haemorrhage rate, perineal tears, and neonatal outcomes.Results The active phase of labour was longer by 41 minutes (95% confidence interval 11-75 minutes) in the discontinued group (median 125 minutes in 85 women who had reached the active phase and delivered vaginally) versus the continued group (median 88 minutes in 78 women). The incidence of fetal heart rate abnormalities (51 versus 20%) and uterine hyperstimulation (12 versus 2%) was significantly greater in the continued than the discontinued oxytocin group. The incidence of tachysystole, caesarean deliveries, postpartum haemorrhage, third degree perineal tears and adverse neonatal outcomes was higher in the continued group, but did not reach significance.Conclusions Discontinuation of oxytocin infusion in the active phase of labour may improve some labour outcomes but has the disadvantage of increasing the duration of the active phase of labour.Keywords Active phase of labour, caesarean delivery, discontinuation of oxytocin, fetal heart rate abnormalities, hyperstimulation.Tweetable abstract Stopping oxytocin in the active phase seems to make labour less complicated but lengthens duration.Please cite this paper as: Bor P, Ledertoug S, Boie S, Knoblauch NO, Stornes I. Continuation versus discontinuation of oxytocin infusion during the active phase of labour: a randomised controlled trial. BJOG 2016;123:129-135.
Objective To assess the risk of stillbirth in low‐risk in vitro fertilisation (IVF) pregnancies. Design Register‐based national cohort study. Setting Denmark 2003–2013. Population Cohort of 425 732 singleton pregnancies including 10 235 conceived following IVF/intracytoplasmic sperm injection (ICSI), 4521 conceived following intrauterine insemination (IUI), and 410 976 spontaneously conceived. Methods Information on pregnancy, obstetrical risk factors, stillbirth, and fertility treatment was obtained from the Danish national health registers for all pregnancies after gestational week 21+6. We estimated the overall and gestational age‐specific risk of stillbirth in low‐risk term pregnancies following IVF, ICSI, and IUI. Further, we estimated the association between stillbirth and IVF and ICSI respectively as well as fresh or frozen‐thawed embryo transfer. Main outcome measures Risk of stillbirth. Results The number of stillbirths in spontaneously conceived and IVF/ICSI low‐risk term pregnancies was 525 (0.1%) and 35 (0.3%), respectively. In multivariate analysis, the risk of stillbirth in pregnancies following IVF/ICSI was increased (odds ratio 2.1, 95% CI 1.4–3.1). The risk of stillbirth was correspondingly increased in time‐to‐event analyses taking risk time for each fetus into account from gestational week 37 and onwards (hazard ratio 2.4, 95% CI 1.6–3.6). In sub‐analyses, the risk of stillbirth was increased for pregnancies following ICSI (odds ratio 2.2, 95% CI 1.2–3.1), but not IVF (odds ratio 1.7, 95% CI 0.9–3.1). Conclusion We found a systematically increased risk of stillbirth in low‐risk term pregnancies following IVF/ICSI. Whether the risk was related to the treatment or to underlying subfertility is uncertain. The results may indicate a need for obstetrical surveillance for these pregnancies when reaching term. Tweetable abstract Increased risk of stillbirth in low‐risk term pregnancies following fresh cycle IVF/ICSI.
Background When determining optimal treatment regimens, patient reported outcomes including satisfaction are increasingly appreciated. It is well established that the birth experience may affect the postnatal attachment to the newborn and the management of subsequent pregnancies and deliveries. As we have no robust validated Danish tool to evaluate the childbirth experience exists, we aimed to perform a transcultural adaptation of the Childbirth Experience Questionnaire (CEQ) to a Danish context. Methods In accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN), we translated the Swedish-CEQ to Danish. The Danish-CEQ was tested for content validity among 10 new mothers. In a population of women who have had their labour induced, we then assessed the electronic questionnaire for validity and reliability using factor analytical design, hypothesis testing, and internal consistency. Based on these data, we determined criterion and construct responsiveness in addition to floor and ceiling effects. Results The content validation resulted in minor adjustments in two items. This improved the comprehensibility. The electronic questionnaire was completed by 377 of 495 women (76.2%). The original Swedish-CEQ was four-dimensional, however an exploratory factor analysis revealed a three-dimensional structure in our Danish population (Own capacity, Participation, and Professional support). Parous women, women who delivered vaginally, and women with a labour duration <12 hours had a higher score in each domain. The internal PLOS ONE
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