Greenness, civil environment, and pregnancy outcomes: perspectives with a systematic review and meta-analysis.

BACKGROUND: Various maternal conditions, especially in utero conditions and prenatal exposure to environments with air pollution and greenness, have been reviewed to address the enhancement and prevention of susceptibility to health risks, including low birthweight, preterm delivery, and preeclampsia. This study aimed to qualitatively and quantitatively investigate the associations between pregnancy outcomes and the characteristics of surrounding living environment, including greenness, air pollution, and civilization. METHODS: A secondary search of the MEDLINE, EMBASE, Cochrane Library, K-eArticles, and CINAHL databases was conducted without language restrictions to identify the relevant publications from the time of inception of the databases to April 2019. RESULTS: A total of 89 studies were identified, and 10 were included in the quantitative synthesis. The greenness of the environment within 100-, 250- and 500-m buffers, after adjusting for the air quality and civilization factors, was weakly but positively associated with birthweight. The pooled regression slope was 0.00134 (95% confidence interval [CI], 0.000, 0.0020). The greenness of the environment was also associated with a significant decrease in the incidence of poor pregnancy outcomes, namely, low birthweight, small for gestational age (odds ratio [OR] 0.94; 95% CI, 0.92, 0.97), and preterm delivery (OR 0.98; 95% CI, 0.97, 0.99). CONCLUSIONS: The greenness of the environment had a positive effect on the pregnancy outcomes, despite poor air quality and civilization. Following urbanization, planning for greenness management, environmental medicine, and public health is important and thus should be proposed as preventive methods as way of increasing birthweight and life expectancy.

Perspective of the comparative effectiveness of non-pharmacologic managements on postpartum hemorrhage using a network meta-analysis.

OBJECTIVE: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and is both unpredictable and inevitable. While uterotonic drugs are routinely recommended, there is ongoing debate on the ideal intervention to control uterine bleeding. This review aims to compare the use of non-pharmacologic treatments with peripartum hysterectomy in cases of life-threatening uncontrolled obstetric hemorrhage. The review's objective is to use a network meta-analysis to help prevent maternal deaths and rank the treatments according to success rates. METHODS: We searched MEDLINE (PubMed), Embase, and the Cochrane Library, from January 2014 until December 2018. A second search was carried out in April 2019 before the final data analysis. Network meta-analysis allows for the calculation of the effect size between treatment groups through indirect treatment comparison. RESULTS: We confirmed that balloon-assisted management is the best intervention for uncontrolled postpartum bleeding with pharmacologic treatment. This is followed by uterine artery embolization and surgical procedures, which can help avoid the need for a hysterectomy. The balloon tamponade demonstrated lower failure rate than the surgical procedure with odds ratio (OR) of 0.44 and 95% confidence intervals (CIs) 0.50-30.54. Uterine artery embolization had a lower risk for hysterectomy than the surgical procedure group (OR, 0.74; 95% CI, 0.22-2.50). CONCLUSION: For the quick treatment of postpartum bleeding, balloon tamponade is the best method for uncontrolled postpartum bleeding with pharmacologic treatment, followed by uterine artery embolization and surgical procedures.