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Welcome! to the SWITCH microjournal club...
...set up by Dr Liz Doxford-Hook. With weekly critical appraisal of research articles now occurring at the Friday afternoon teaching sessions, the below is a store of those articles that have been presented to date.
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ARTICLES
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This was a blind RCT across 27 UK obstetric units, with women allocated to receiving either a single dose IV co-amoxiclav or a placebo following operative vaginal birth. The study found significantly fewer women allocated to the antibiotic group had a confirmed/suspected infection, reported a reduced level of perineal pain, and were less likely to present with concerns regarding perineal issues.
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This randomised, double-blind, placebo-controlled study found pain at rest and during coughing and on movement was significantly reduced, as was opioid requirement and time spent in recovery unit in the ropivicaine group. The study was conducted at one university hospital involving 37 patients undergoing vaginal hysterectomy. Patients received either ropivicaine or saline infiltration. It is unclear how the difference in pain was calculated.
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This multicentre, randomised intergroup phase 3 trial found that 5-year overall survival and failure-free survival was significantly increased in chemoradiotherapy versus radiotherapy alone. 50% of women said chemoradiation was worth the side effects for 5% increased life expectancy, but that personalisation of cancer care was the ultimate goal.
Early Enteral Tube Feeding in Optimising Treatment of Hyperemesis Gravidarum: the MOTHER RCT
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This randomised, multicentre RCT across 3 university medical centres in Netherlands compared standard care to NGT feeding with standard care in patients admitted with hyperemesis between 5+0 and 19+6 weeks gestation. Between both groups, no significant difference was found in birth weight, maternal weight gain, duration of hospital stay, readmission rate, symptoms, quality of life, psychological distress, prematurity and small-for-gestational age. A large proportion of NGT feeds were discontinued early due to adverse effects.
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In this non-randomised, non-blinded study, 596 health full term babies were enrolled across 3 UK hospitals. Maternal and neonatal faecal samples were paired, with a high drop-out rate to 175 mothers and 178 babies. Mode of delivery was found to be the most significant factor to drive gut microbiota; breastfeeding and perinatal antibiotics exhibited a smaller effect.
Effect of Metformin on Maternal and Fetal Outcomes in Obese Pregnant Women (EMPOWaR)​
This multi-centre, randomised, double-blind, placebo-controlled trial was carried out in 15 antenatal clinics across the UK aimed to establish the effect of metformin on birth weight in non-diabetic obese pregnant women. No significant effect on birthweight was found between the two groups.
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This international, multi-centre, prospective observational study found that in women with PET between 34+0 - 36+6, PIGF, sFlt-1:PIGF and PREP-S did not satisfactorily predict the need for delivery in the next 7 days.
Predictive Value of the sFlt-1:PIGF Ratio in Women with Suspected Preeclampsia
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This international, multi-centre, prospective observational study found that in women with suspected PET at 24+0 - 36+6, an sFlt-1:PIGF ratio of 38 or less is very good at ruling out PET in the next week, whilst an sFlt-1:PIGF ratio >38 has some value for predicting PET in the next 4 weeks.
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This longitudinal, mixed-methods study found no statistically significant difference in parenting self-efficacy andmental wellbeing between app users and non-app users.
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Fourteen studies were included reporting 69 models for prediction, and found that models using maternal factors, blood tests and ultrasound could individualise stillbirth prevention, but existing models are at high risk of bias.
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This study, including over 400,000 women, found that increasing women's reporting of perception of RFM did not reduce incidence of stillbirth or perinatal mortality. It did, however, increase the frequency of IOL, birth by caesarean section and prolonged (>48 hours) neonatal unit admission period.
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This study collected data from four centres in the UK over 12 years, and included OASI sustained in primiparous women who had a singleton, term, cephalic delivery, and then a recorded subsequent delivery within this timeframe. OASI recurrence rate was 10.2%; birth weight >4000g increased the risk of repeat OASI by 2.5 fold, whereas mediolateral episiotomy at subsequent delivery decreased the risk of recurrence by 80%.
Exposure to Incivility Hinders Clinical Performance in a Simulated Operative Crisis
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This US-based observational blinded study used simulation to assess the affect of surgeons' civility on the anaesthetist's performance. Cohorts assigned to the "rude" surgeon performed worse across all domains: technical, non-technical and global performance. Self-rated performance between the intervention and control groups did not differ, however more of the intervention group stated that the surgeons' behaviour hindered their performance. Presence of uncivil behaviour also reduced the likelihood of anaesthetists asking for help.