Clinical Question: Does Medical Evidence Support Routine Oronasopharyngeal Suction at Delivery?

Oronasopharyngeal suction (ONPS) is regularly performed in neonates at delivery in many hospitals across the country today. Although ONPS is a technique that has essentially become habitual for most obstetricians, its theorized usefulness to help promote expeditious lung aeration after delivery by removal of amniotic fluid, meconium, mucus and blood that may otherwise be aspirated by the newborn, is currently not recommended. ONPS can cause vagal stimulation-induced bradycardia and thus hypercapnea, iatrogenic infection due to mucous membrane injury, and development of subsequent neonatal brain injury due to changes in cerebral blood flow regulation, particularly in premature infants. Multiple studies that have been performed comparing routine use of ONPS to no intervention controls indicate that newborns receiving ONPS took a longer time to achieve normal oxygen saturations, caused apneic episodes, and caused disturbances in heart rate (mainly bradycardia) compared to the control groups. Although the ONPS groups revealed no significantly different APGAR scores at 1 and 5 minutes, the ONPS groups took longer than the control group to reach an arterial oxygen saturation greater than or equal to 92% in the first minutes of life. Currently, Neonatal Resuscitation Program guidelines discourage the use of or meconium-stained amniotic fluid and in the absence of obvious obstruction. Furthermore, this manuscript highlights various literature sources revealing that the routine use of ONPS at the time of delivery can cause more harm than good, if any good at all.

Spontaneous Renal Rupture During Pregnancy: A Contemporary Literature Review and Guide to Management.

IMPORTANCE: Spontaneous renal rupture is a rare pregnancy complication, which requires a high index of suspicion for a timely diagnosis to prevent a poor maternal or fetal outcome. OBJECTIVE: This review highlights risk factors, pathophysiology, symptoms, diagnosis, management, and complications of spontaneous renal rupture in pregnancy. EVIDENCE ACQUISITION: A literature search was carried out by research librarians using the PubMed and Web of Science search engines at 2 universities. Fifty cases of spontaneous renal rupture in pregnancy were identified and are the basis of this review. RESULTS: The first case of spontaneous renal rupture in pregnancy was reported in 1947. Rupture occurs more commonly on the right side and during the third trimester. Pain was a reported symptom in every case reviewed. Treatment usually consists of stent or nephrostomy tube placement. Conservative management has been reported. CONCLUSIONS: When diagnosed early and managed appropriately, maternal and fetal outcomes are favorable. Preterm delivery is the most common complication. RELEVANCE: Our aim is to increase the awareness of spontaneous renal rupture in pregnancy and its associated complications in order to improve an accurate diagnosis and maternal and fetal outcomes.

Evaluation of spin in the abstracts of systematic reviews and meta-analyses on breast cancer treatment, screening, and quality of life outcomes: A cross-sectional study.

BACKGROUND: While spin - i.e., a reporting practice that embellishes positive findings and understates negative ones - is prevalent in randomized controlled trials, it has yet to be investigated in the context of systematic reviews. Owing to their significant role in clinical decision making and patient outcomes, this study seeks to identify and evaluate the severity of spin in the abstracts of systematic reviews on breast cancer. METHODS: We searched MEDLINE and Embase for systematic reviews and meta-analyses focused on breast cancer treatment, screening, and post-treatment quality of life between 1987 and 2020. Investigators independently screened for study selection, extracted spin data, and appraised the methodological quality of reviews using AMSTAR 2. In this cross-sectional study, 11,717 articles were identified, of which 581 met inclusion criteria. Following randomization, the first 200 were evaluated and 21 % contained evidence of at least one of nine types of spin. RESULTS: We identified spin types one, three, four, five, and six but not two, seven, eight, or nine. In particular, pharmacological (AOR 4.36, 95 % CI [1.18-16.01]) and surgical (AOR, 10.10 95 % CI [1.60-63.68]) intervention-type studies were highly associated with spin. There were no other associations between study characteristics and spin. While these results are significant, they contain a wide confidence interval and the reader should draw conclusions accordingly. CONCLUSIONS: There is evidence of spin in meta-analyses and systematic reviews regarding breast cancer treatment and quality of life outcomes. Accordingly, readers of systematic review abstracts related to breast cancer could be misled by distorted presentation of findings. POLICY SUMMARY: This study aims to improve the standards of reporting in systematic reviews and meta-analyses related to cancer.

The impact of maternal body mass on the effectiveness of 17 alpha-hydroxyprogesterone caproate.

OBJECTIVE: To examine the impact of maternal prepregnancy body mass index (BMI) on rates of recurrent preterm delivery (PTD) in women receiving 17alpha-hydroxyprogesterone caproate (17P) prophylaxis. STUDY DESIGN: The study population was identified from a large perinatal database containing prospectively collected information from women at high risk for PTD. We included patients with a current singleton pregnancy and a history of PTD who received weekly nursing visits and 17P 250 mg intramuscular injections beginning at 16.0 to 20.9 weeks' gestation. The data were stratified by number of prior PTDs (1 or >1) and maternal prepregnancy BMI (lean, normal, overweight and obese). Primary study outcomes included the rates of recurrent PTD at <35 and 32 weeks' gestation, and pregnancy loss at <24 weeks' gestation. RESULTS: Delivery outcomes for 606 women receiving 17P were analyzed. There were no significant differences found in the incidence of preterm labor, the rates of recurrent PTD or pregnancy loss at <35, 32 or 24 weeks between the BMI groups. CONCLUSION: Maternal prepregnancy BMI does not appear to influence the rates of recurrent PTD in women with singleton gestation receiving 17P prophylaxis. Larger studies are needed to confirm our findings.