Most Read Articles
Smriti Rana, one year ago
Prolonged breastfeeding has a beneficial long term effect on a person’s intelligence quotient (IQ) in adulthood and may be associated with higher levels of education and income potential, a recent study has shown.
3 years ago

Over the past few decades, there has been widespread concern about the increasing proportion of births born by caesarean delivery. The rising rate of primary caesarean section has led to the increased number of obstetric population with a history of prior caesarean delivery. Although this group of women may be offered planned vaginal birth after previous caesarean section (VBAC) or elective repeat caesarean section (ERCS), the VBAC rate is generally low particularly in well-developed countries. In the United States, the VBAC rate has decreased to 8.5% by 2006, while the total caesarean rate has increased to 31.1%.1

Jenny Ng, one year ago
Further to the published recommendations for the treatment of breast cancer (BC) during pregnancy in 2010, experts from the German Cancer Society have offered updated recommendations for the use of carboplatin, dose-dense chemotherapy, trastuzumab, neoadjuvant therapy and sentinel lymph node biopsy (SLNB) in these patients. 
Tracy TC Kwan, BSc (Nursing), MPH; Hextan YS Ngan, MBBS, FHKAM (O&G), MD (HK), FRCOG, 3 years ago

Human papillomavirus (HPV) infection is a prevalent disease worldwide. Consequences of HPV infection vary, depending on the infected individuals and the HPV genotype involved. Life-threatening consequences are not uncommon, and cervical cancer is a clear demonstration of the virus’s potency. While the incidence of cervical cancer is heavily concentrated on developing countries,1 the impact of HPV-related diseases on developed countries has not ceased. In the United States alone, HPV infections are the most common sexually transmitted disease with an estimated 5 million new cases being diagnosed in 2000 among young adults, incurring nearly US$3 billion in terms of direct medical costs.2 A multinational study involving 18,498 women showed that cervical HPV prevalence varied greatly geographically, ranging from the low of 1.6% in North Vietnam to the high of 27% in Nigeria. In general, HPV prevalence peaked among young, sexually active women and declined with age. In selected countries, however, a second peak was noted in women older than 55 years.3 The high prevalence of HPV-related diseases incurs a heavy burden on the healthcare systems of developed and developing countries alike, which renders HPV research and prevention a global public health imperative. On an individual level, the afflictions caused by HPV-related diseases go beyond that of physical suffering to affecting the psychological well-being of the infected. This is the focus of our paper.

Prompt tranexamic acid administration reduces death due to postpartum haemorrhage

Roshini Claire Anthony
2 months ago

Women given tranexamic acid within three hours of giving birth appear to have a reduced risk of death due to postpartum haemorrhage (PPH), according to findings of the large, multinational WOMAN* trial.

Women given a 1 g dose of tranexamic acid had a significantly reduced risk of death due to bleeding compared with those given placebo (1.5 percent [n=155] vs 1.9 percent [n=191], risk ratio [RR], 0.81, 95 percent confidence interval [CI], 0.65–1.00; p=0.045). The risk of death due to bleeding was especially reduced in women given tranexamic acid within three hours of giving birth (1.2 percent [n=89]) compared with placebo (1.7 percent [n=127], RR, 0.69, 95 percent CI, 0.52–0.91; p=0.008), while there appeared to be no reduction in risk if tranexamic acid was administered after three hours (2.6 percent [n=66] vs 2.5 percent [n=63] in the tranexamic acid and placebo groups, respectively, RR, 1.07, 95 percent CI, 0.76–1.51; p=0.70). [Lancet 2017;doi:10.1016/S0140-6736(17)30638-4]

The risk of hysterectomy to control bleeding did not significantly differ between women given tranexamic acid or placebo (2.8 percent vs 3.0 percent, RR, 0.95; p=0.57), nor did the primary endpoint of death from all causes or hysterectomy within 42 days of giving birth (5.3 percent vs 5.6 percent, RR, 0.97; p=0.65). Laparotomy to control bleeding was more frequent in the placebo group compared with the tranexamic acid group (1.3 percent vs 0.8 percent, RR, 0.64; p=0.002).

Incidence of thromboembolic events and deaths due to pulmonary embolism, organ failure, sepsis, eclampsia, and other causes were comparable between the two groups.

In this multicentre (193 hospitals in 21 countries), double-blind trial, women aged ≥16 years (n=20,060) diagnosed with PPH after a vaginal birth or Caesarean section were randomized to receive tranexamic acid (1 g administered intravenously at 1mL/min; n=10,051) or placebo (n=10,009) plus usual care. In the incidence of persistent bleeding (after 30 minutes) or cessation and resumption of bleeding (within 24 hours of the first dose), a second dose of tranexamic acid (1 g) or placebo was allowed. After accounting for withdrawals and exclusions, 10,037 and 9,975 women were administered the first dose of tranexamic acid and placebo, respectively.

A total of 483 maternal deaths occurred, 374 (77 percent) and 43 (9 percent) within 24 and 1 hour of randomization, respectively. Of these, 346 (72 percent) occurred as a result of bleeding. Of the 709 hysterectomies done, 81 percent (n=578) were to control bleeding.

Based on trials that demonstrated the efficacy of tranexamic acid in treating trauma-related bleeding, the World Health Organization, in 2012, recommended the use of tranexamic acid in treating PPH in the incidence of bleeding due to trauma or if uterotonics were insufficient to control bleeding, said the researchers.

“The WOMAN trial results show that the effect of tranexamic acid in [PPH] is consistent with the effects recorded in surgery and trauma,” said the researchers. “Our results support the inclusion of tranexamic acid ... for [PPH] but suggest that treatment should be given as soon as possible after onset,” they said, and called for studies into determining the efficacy of tranexamic acid following alternative administration routes to assess its feasibility of use in situations where intravenous administration may not be possible.

 

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Most Read Articles
Smriti Rana, one year ago
Prolonged breastfeeding has a beneficial long term effect on a person’s intelligence quotient (IQ) in adulthood and may be associated with higher levels of education and income potential, a recent study has shown.
3 years ago

Over the past few decades, there has been widespread concern about the increasing proportion of births born by caesarean delivery. The rising rate of primary caesarean section has led to the increased number of obstetric population with a history of prior caesarean delivery. Although this group of women may be offered planned vaginal birth after previous caesarean section (VBAC) or elective repeat caesarean section (ERCS), the VBAC rate is generally low particularly in well-developed countries. In the United States, the VBAC rate has decreased to 8.5% by 2006, while the total caesarean rate has increased to 31.1%.1

Jenny Ng, one year ago
Further to the published recommendations for the treatment of breast cancer (BC) during pregnancy in 2010, experts from the German Cancer Society have offered updated recommendations for the use of carboplatin, dose-dense chemotherapy, trastuzumab, neoadjuvant therapy and sentinel lymph node biopsy (SLNB) in these patients. 
Tracy TC Kwan, BSc (Nursing), MPH; Hextan YS Ngan, MBBS, FHKAM (O&G), MD (HK), FRCOG, 3 years ago

Human papillomavirus (HPV) infection is a prevalent disease worldwide. Consequences of HPV infection vary, depending on the infected individuals and the HPV genotype involved. Life-threatening consequences are not uncommon, and cervical cancer is a clear demonstration of the virus’s potency. While the incidence of cervical cancer is heavily concentrated on developing countries,1 the impact of HPV-related diseases on developed countries has not ceased. In the United States alone, HPV infections are the most common sexually transmitted disease with an estimated 5 million new cases being diagnosed in 2000 among young adults, incurring nearly US$3 billion in terms of direct medical costs.2 A multinational study involving 18,498 women showed that cervical HPV prevalence varied greatly geographically, ranging from the low of 1.6% in North Vietnam to the high of 27% in Nigeria. In general, HPV prevalence peaked among young, sexually active women and declined with age. In selected countries, however, a second peak was noted in women older than 55 years.3 The high prevalence of HPV-related diseases incurs a heavy burden on the healthcare systems of developed and developing countries alike, which renders HPV research and prevention a global public health imperative. On an individual level, the afflictions caused by HPV-related diseases go beyond that of physical suffering to affecting the psychological well-being of the infected. This is the focus of our paper.