Trauma in pregnancy clinical practice guidelines: systematic review.

PURPOSE: To objectively evaluate the methodological quality and clinical heterogeneity robustness of the published clinical practice guidelines (CPGs) on the management of trauma in pregnancy. MATERIALS AND METHODS: Pubmed, Google Scholar, UpToDate, and Scopus Database were searched. The risk of bias and quality assessment of the included CPGs were performed using "The Appraisal Of Guidelines for Research and Evaluation (AGREE II)" tool. The following points relating to the management of trauma during pregnancy were addressed: quality of evidence assessment, classification of recommendations, main causes of trauma in pregnancy, importance of correct use of seat belts, ultrasound scans and/or pregnancy test in every female of reproductive age, description of physiological changes in pregnancy, classification in primary and secondary survey, primary survey based on ABCD Approach, fetus viable based on the weeks, radiographic studies for maternal evaluation, duration of fetal monitoring, use of anti-D immunoglobulin in rhesus-D-negative pregnant trauma patients, description of dose of RhD-Ig, the way to define gestational age if it was undetermined, descriptions of obstetrical complications, use of tetanus vaccination, and timing to perimortem cesarean section (CS). RESULTS: Six CPGs were included. Quality of evidence assessment was described in 16.7% of CPGs (1/6), while it was not reported in 83.3% (5/6). Classification of recommendations was reported in 50% (3/3) of the CPGs. Motor vehicle crash was reported as the main cause of trauma in pregnancy in all the CPGs included in the present review, despite that the importance of a correct use of seat belts was described only in the 50% (3/6). Definition of fetal viability was also different among the included CPGs; in 50% (3/6) defined a fetus viable when it from 23 weeks, 33.3% (2/6) from 24 weeks, and 16.7% (1/6) from 20 weeks of gestation. Regarding the type of fetal monitoring, 33.3% (2/6) CPGs recommended CTG assessment at least every 4 h, 16.7% (1/6) at least every 6 h, 33.3% for 24 h if there are not reassuring signs and 16.7% (1/6) did not specify the duration of monitoring. Recommendations about the use of anti-D-immunoglobulin in rhesus-D-negative pregnant were also heterogeneous: 50% (3/6) of the CPGs suggested administration in all rhesus-D-negative pregnant women, 16.7% (1/6) only according to gestational age at trauma or in case of significant abdominal trauma, and 16.7% (1/6) only in case of positive Kleihauer test while 16.7% (1/6) did not specify it. Administration of tetanus vaccination was suggested in in 33.3% (2/6) of CPGs. Finally, there were different descriptions of timing to perimortem CS: 33.3% (2/6) of CPGs claims to do CS no later than 4 min, 50% (3/6) no later than 5 min, and 16.7% (1/6) does not describe timing for CS. The AGREE II standardized domain scores for the first overall assessment (OA1) had a mean of 69%. Only three CPGs scored more than 60% and revealed a consensus agreement between the reviewers on recommending the use of these CPGs. CONCLUSION: There is clinical heterogeneity in some of the most relevant aspects of the management of pregnant women with trauma. The findings from this systematic review highlight the need for up to date and shared guidelines promoted by the main body societies in order make management of pregnant women with trauma homogenous.

Force levels of fiber-reinforced composites and orthodontic stainless steel wires: a 3-point bending test.

INTRODUCTION: The purpose of this study was to evaluate the force levels of 2 sizes (diameters, 0.6 and 1.2 mm) of fiber-reinforced composites (FRCs) (Ever Stick; Stick Teck Ltd, Turku, Finland) compared with orthodontic stainless steel wires (sections, 0.016, 0.018, 0.017 x 0.025, and 0.019 x 0.026 in) under the same testing conditions. METHODS: The samples were divided into 12 groups, each consisting of 10 specimens. Each sample was evaluated with a 3-point bending test on a universal testing machine. The FRC groups were light-cured by hand with a halogen curing unit (Optilux 501; SDS Kerr, Danbury, Conn) for 40 seconds. Groups 1 through 6 were tested at 1-mm deflection, and groups 7 through 12 at 2-mm deflection. RESULTS: The results of ANOVA indicated significant differences among the various groups (P = .000). The post-hoc test showed that the 2-mm deflection groups had significantly higher load values than the 1-mm deflection groups (P = .000). The highest force levels were recorded with the 1.2-mm FRCs, followed by the 0.019 x 0.026-in stainless steel wires. No significant differences were found between the 0.6-mm FRCs and the 0.017 x 0.025-in wires. The lowest load values were reported with the 0.016-in stainless steel wires. CONCLUSIONS: The 1.2-mm FRCs showed higher load values than the other stainless steel wires and the FRCs, whereas no significant difference was found between the 0.6-mm FRCs and the 0.017 x 0.025-in stainless steel wires. Thus, FRCs can be considered a viable esthetic alternative to full-size stainless steel wires to rigidly join dental segments to form anchorage units or units for active tooth movement.

Flexural strengths of fiber-reinforced composites polymerized with conventional light-curing and additional postcuring.

INTRODUCTION: The purpose of this study was to evaluate the effect of hand light-curing (Optilux 501; SDS Kerr, Danbury, Conn) and secondary oven polymerization (Liculite; Dentsply, Dreieich, Germany) on the mechanical properties of 2 sizes (diameters, 0.6 and 1.2 mm) of fiber-reinforced composites (FRCs) (Ever Stick; Stick Tech, Turku, Finland). METHODS: The FRC samples were divided into 8 groups. Each group consisted of 10 specimens. Each FRC sample was evaluated with a 3-point bending test with a universal testing machine. Groups 1, 3, 5, and 7 were hand light-cured with a halogen curing unit for 40 seconds. Groups 2, 4, 6, and 8 were light-cured with the same curing unit for 40 seconds, followed by polymerization for 15 minutes in a light-curing oven. Groups 1 through 4 were tested at 1-mm deflection, and groups 5 through 8 at 2-mm deflection. RESULTS: The results of ANOVA indicated significant differences among the various groups (P = .000). The post-hoc test showed that the 2-mm deflection groups had significantly higher flexural strengths than the 1-mm deflection groups (P = .000). Moreover, the 1.2-mm FRCs showed significantly higher flexural strength than the 0.6-mm FRCs (P = .000). No significant differences (P >.05) were found between the hand light-cured and the oven-polymerized groups. CONCLUSIONS: This investigation demonstrated that oven postcuring does not increase the flexural strength values of 0.6- and 1.2-mm FRCs compared with conventional hand light-curing. Thus, hand light-curing of FRCs is recommended directly in the mouth for orthodontic purposes.