Effective maternity care quality improvement strategies: evidence-based practice current resources for evidence-based practice carol sakala, phd, msph, july/august 2007
EVIDENCE-BASED PRACTICE Current Resources for Evidence-Based Practice, July/August 2007
Published simultaneously in the Journal of Obstetric, Gyneco-
● Fetal movement counting for assessment of fetal well-
logic and Neonatal Nursing 2007;36(4).
● Probiotics for preventing preterm labour
IDENTIFYING EFFECTIVE MATERNITY CARE QUALITY Updated Systematic Reviews IMPROVEMENT STRATEGIES
● Antibiotics for treating bacterial vaginosis in preg-
Chaillet et al.1 recently published what may be the first
systematic review to identify effective strategies for
● Antihypertensive drug therapy for mild to moderate
improving the quality of maternity care. Although the
title references “guidelines,” some of the 33 included
● Antiretrovirals for reducing the risk of mother-to-child
studies measured a desired change rather than implemen-
tation of a formal guideline. The review included ran-
● Combined oral contraceptive pills for treatment of
domized controlled trials and observational designs.
Most studies examined physicians, and some considered
● Interventions for varicose veins and leg oedema in
Educational strategies were generally ineffective with
physicians and had mixed results with other health
professionals. Other strategies with mixed results across
● Treatment for primary postpartum haemorrhage
the included studies were the use of opinion leaders,academic detailing (topically focused outreach to indi-
Cochrane Reviews are available by subscription to The
vidual clinicians), and modification of existing systems
Cochrane Library, and review abstracts are available
and structures. Both audit and performance feedback and
without charge. For abstracts, access information and
multifacted interventions combining two or more strate-
gies to address a specific barrier were generally effective. Overall, studies that identified and addressed barriers
FROM DATABASE OF ABSTRACTS OF REVIEWS OF
were far more likely to lead to demonstrated improve-
EFFECTS (DARE)
The authors identified possible differences between
Recent Abstract Entries Assessing Quality of
obstetric and general medical contexts: whereas educa-
Systematic Reviews
tion achieved some success with non-physician maternity
● The accuracy of maternal anthropometry measure-
providers, it has generally been unsuccessful in other
ments as predictor for spontaneous preterm birth: A
contexts; audit and feedback appear to be more success-
ful in obstetrics than other contexts; and academic
● Assisted reproductive technologies and the risk of birth
detailing has been more successful in other contexts than
● Comparison of tamoxifen and clomiphene citrate for
1. Chaillet N, Dube E, Dugas M, Audibert F, Tourigny
C, Fraser WD, et al. Evidence-based strategies for
● Chemotherapy-induced cognitive impairment in women
implementing guidelines in obstetrics: A systematic re-
with breast cancer: A critique of the literature
view. Obstet Gynecol 2006;108:1234 – 45.
● Cognitive behavioral therapy techniques for distress
and pain in breast cancer patients: A meta-analysis
FROM COCHRANE DATABASE OF SYSTEMATIC REVIEWS
● Contemporary treatments for twin-twin transfusion syn-
(CDSR), ISSUE 1, 2007
● Evaluating effectiveness of complex interventions aimed
New Systematic Reviews
at reducing maternal mortality in developing countries
● Aromatase inhibitors for treatment of advanced breast
● Hormone therapy and cardiovascular disease: A sys-
Journal of Midwifery & Women’s Health • www.jmwh.org
1526-9523/07/$32.00 • doi:10.1016/j.jmwh.2007.05.001
● Learning from success and failure in psychosocial
measures that have been demonstrated to be effective
intervention: An evaluation of low birth weight pre-
through systematic review of the best available studies. Featured review: Demott K, Bick D, Norman R, Ritchie
● Liquid-based cytology for cervical screening
G, Turnbull N, Adams C, et al. Clinical guidelines and
● Lymphatic mapping and sentinel lymph node biopsy in
evidence review for post natal care: Routine post natal
early-stage breast carcinoma: A metaanalysis
care of recently delivered women and their babies.
● Menopausal hormone therapy and risk of breast can-
cer: A meta-analysis of epidemiological studies and
London: National Collaborating Centre for PrimaryCare and Royal College of General Practitioners, 2006.
● Misoprostol in preventing postpartum hemorrhage: A
393 pages. Available without charge and with numer-
● Neoadjuvant versus adjuvant systemic treatment in
This team reviewed best available evidence to identify
● Nonhormonal therapies for menopausal hot flashes:
essential care for mothers and babies from birth through
6 to 8 weeks postpartum. The guideline identified core
● Osteoarthritis and the postmenopausal woman: Epide-
information, core care, and concerns with respect to
miological, magnetic resonance imaging, and radiolog-
maternal health, infant feeding, and infant health. The
detailed narrative describes a wealth of primary studies
● School-based teenage pregnancy prevention programs:
and includes attention to timing, type of personnel, and
A systematic review of randomized controlled trials
economics. Companion documents provide further de-
● Selective serotonin reuptake inhibitor (SSRI) use dur-
tail, summaries for professionals and the public, and
ing pregnancy and effects on the fetus and newborn: A
Comment: This evidence review, full guideline, and
● Skeletal consequences of hormone therapy discontinu-
companion documents provide a sweeping overview of
postpartum care issues that should be of great value for
● Smoking cessation in pregnancy: A review of postpar-
those who plan, provide, or receive postpartum care.
● Systematic review of the risk of uterine rupture with
Featured review: U.K. National Collaborating Centre
the use of amnioinfusion after previous cesarean de-
for Women’s and Children’s Health. Urinary inconti-nence: The management of urinary incontinence in
● Systematic review of the treatment of ovulatory infertility
women. London: RCOG Press, 2006. 221 pages. Avail-
with clomiphene citrate and intrauterine insemination
able without charge and with numerous compan-ion documents at
DARE abstracts are available without charge from:
A multidisciplinary team reviewed the best evidence and
EVIDENCE-BASED REVIEWS FROM OTHER SOURCES
developed guidelines to assess and treat stress, urge, andmixed incontinence and overactive bladder in women. Featured review: Coomarasamy A, Thangaratinam S,
Physical, behavioral, lifestyle, drug, complementary, and
Gee H, Khan KS. Progesterone for the prevention of
surgical treatments were included. First-line treatment
preterm birth: A critical evaluation of evidence. Eur J
for women with urge or mixed urinary incontinence is
Obst Gynecol Reprod Biol 2006;129:111– 8.
bladder training for at least 6 weeks to increase the
The authors carried out a cumulative meta-analysis of
interval between desire to void and actual void.
randomized controlled trials of progestational agents to
First-line treatment for women with stress and mixed
prevent preterm birth in women at elevated risk for this
urinary incontinence is supervised pelvic floor muscle
condition. The four trials available by 1975 demonstrated
training for at least 3 months. Such training is also an
the effectiveness of this intervention, and the four sub-
effective preventive measure during pregnancy. The
sequent trials further strengthened this association. The
guideline clarifies when and how other treatments
effect was found when looking just at highest quality
should be carried out if initial measures are inadequate
studies and at different levels of baseline risk. Depending
and identifies measures that are not of value. The
on baseline risk, one preterm birth is prevented from
report also covers coping strategies and research
treating 7 to 12 mothers. The included studies and other
referenced reports found no evidence of harm in use of
Comment: Urinary incontinence is prevalent in
women, with varying degrees of severity. Many effective
Comment: The U.S. prematurity rate has been steadily
treatments are available to help those with troublesome
rising. Progesterone is among a small number of preventive
Volume 52, No. 4, July/August 2007 Recent Evidence-Based Reviews
and adverse pregnancy outcomes in type 1 and type 2diabetes mellitus: Systematic review of observational
● Althabe F, Bergel E, Buekens P, Sosa C, Belizán JM.
studies. BMC Pregnancy Childbirth 2006;6:30. Avail-
Controlled cord traction in the third stage of labor:
Systematic review. Int J Gynecol Obstet 2006;94(Suppl
● Jaakkola JJ, Ahmed P, Ieromnimon A, Goepfert P,
● Altman MR, Lydon-Rochelle MT. Prolonged second
Laiou E, Quansah R, et al. Preterm delivery and
stage of labor and risk of adverse maternal and
asthma: A systematic review and meta-analysis. J
perinatal outcomes: A systematic review. Birth 2006;
Allergy Clin Immunol 2006;118:823–30.
● Badenhorst W, Riches S, Turton P, Hughes P. The
● Lee SJ, Steer PJ, Filippi V. Seasonal patterns and
psychological effects of stillbirth and neonatal death
preterm birth: A systematic review of the literature and
on fathers: Systematic review. J Psychosom Obstet
an analysis in a London-based cohort. BJOG 2006;
● Bamigboye AA, Hofmeyr GJ. Interventions for leg
● Ma H, Bernstein L, Pike MC, Ursin G. Reproductive
edema and varicosities in pregnancy: What evidence?
factors and breast cancer risk according to joint estro-
Eur J Obstet Gynecol Reprod Biol 2005;129:3– 8.
gen and progesterone receptor status: A meta-analysis
● Boomsma CM, Eijkemans MJ, Hughes EG, Visser
of epidemiological studies. Breast Cancer Res 2006;8:
GH, Fauser BC, Macklon NS. A meta-analysis of
pregnancy outcomes in women with polycystic ovary
syndrome. Hum Reprod Update 2006;12:673– 83.
● Nelson RL, Westercamp M, Furner SE. A systematic
● Crane JMG, Butler B, Young DC, Hannah ME. Miso-
review of the efficacy of cesarean section in the
prostol compared with prostaglandin E for labour induc-
preservation of anal continence. Dis Colon Rectum
tion in women at term with intact membranes and
unfavourable cervix: A systematic review. BJOG 2006;
● Pattenden S, Antova T, Neuberger M, Nikiforov B, De
Sario M, Grize L, et al. Parental smoking and chil-
● da Silva Dal Pizzol T, Knop FP, Mengue SS. Prenatal
dren’s respiratory health: Independent effects of pre-
exposure to misoprostol and congenital anomalies:
natal and postnatal exposure. Tobacco Control 2006;
Systematic review and meta-analysis. Reprod Toxicol
● Pratt TC, McGloin JM, Fearn NE. Maternal cigarette
● Dean N, Herbison P, Ellis G, Wilson D. Laparoscopic
smoking during pregnancy and criminal/deviant be-
colposuspension and tension-free vaginal tape: A sys-
havior: A meta-analysis. Int J Offender Ther Comp
tematic review. BJOG 2006;113:1345–53.
● Dennis C-L, Chung-Lee L. Postpartum depression
● Rischitelli G, Nygren P, Bougatsos C, Freeman M,
help-seeking barriers and maternal treatment prefer-
Helfand M. Screening for elevated lead levels in child-
ences: A qualitative systematic review. Birth 2006;33:
hood and pregnancy: An updated summary of evidence
for the US Preventive Services Task Force. Pediatrics
● Der G, Batty GD, Deary IJ. Effect of breast feeding on
2006;118:1867-95. Available without charge at
intelligence in children: Prospective study, sibling
pairs analysis, and meta-analysis. BMJ 2006;333:945.
● Sharma A, Menon U, Ledermann J. Ovarian cancer
(advanced). Clin Evid 2006;15:1–16. [Interventions to
● Di Castelnuovo A, Costanzo S, Bagnardi V, Donati
MB, Iacoviello L, de Gaetano G. Alcohol dosing and
● Souza JP, Miquelutti MA, Cecatti JG, Makuch MY.
total mortality in men and women. Arch Int Med
Maternal position during the first stage of labor: A
systematic review. Reprod Health 2006;3:10. Avail-
● Geifman-Holtzman O, Grotegut CA, Gaughan JP. Diag-
nostic accuracy of noninvasive fetal Rh genotyping from
maternal blood: A meta-analysis. Am J Obstet Gynecol
● Stokes-Lampard H, Wilson S, Waddell C, Ryan A,
Holder R, Kehow S. Vaginal vault smears after hys-
● Illuzzi JL, Bracken MG. Duration of intrapartum
terectomy for reason other than malignancy: A system-
prophylaxis for neonatal group B streptococcal dis-
atic review of the literature. BJOG 2006;113:1354 – 65.
ease: A systematic review. Obstet Gynecol 2006;108:1254 – 65.
Carol Sakala, PhD, MSPH, is Director of Programs at Childbirth Connection,which works with health professionals and other audiences to promote
● Inkster ME, Fahey TP, Donnan PT, Leese GP, Mires
GJ, Murphy DJ. Poor glycated haemoglobin control
Journal of Midwifery & Women’s Health • www.jmwh.org
Viaggio teatrale per musica: un mosaico di citazioni, un tessuto nella memoria, un intreccio di riflessioni, un dialogo sul mito della donna. Grazie a Euripide, Seneca, Götter, Klinger, Romani, Grillparzer, Wolf . inconsapevoli. Memoria. Medea, Giasone, coro: ciascuno da sé Se racconto a un altro la fiaba della mia vita mi sembra che sia un altro a parlare: è come se stessi ad ascoltar
Comments on “BIOIDENTICAL HORMONES” - March, 2009 Below is an article that was published in the Wall Street Journal on Mar 16th, 2009. Two of my patients have been kind enough to give me a copy of the article, to warn me of what’s out there. My comments are dispersed throughout the article. This type of article is exactly why there is so much “confusion, ignorance and misinformation”
EVIDENCE-BASED PRACTICE