https://sites.tufts.edu/uscochranenetwork/

Tufts University, Affiliate of Cochrane US, 145 Harrison Avenue, Boston, MA (2025)

07/21/2022

Vitamin A deficiency is a pressing public health problem in low- and middle- income countries. It affects 190 million children under five years of age and leads to many adverse health outcomes including respiratory diseases, diarrhea, measles, and vision problems. ⁣
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Previous studies have suggested that giving synthetic vitamin A supplementation to children aged six months to five years can reduce the risk of death and some diseases. This review looked at the effect of synthetic vitamin A supplementation compared to placebo. Searching through relevant literature, reviewers combined the results of 47 RCTs representing 1,223,856 children in regions including Asia, Africa, Latin America, and Australia. ⁣
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The data indicated that vitamin A supplementation reduces overall risk of death and death due to diarrhea by 12%. It does not specifically reduce death due to measles, respiratory infections, or meningitis, but it can reduce new occurrences of those diseases. It does reduce the risk of night blindness and Bitot’s spots, tiny flakes of protein in the eye. The certainty of evidence using the GRADE approach was rated as high for benefits of vitamin A supplementation against overall risk of death and death due to diarrhea. ⁣
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Further reviews may investigate delivery channels for vitamin A supplements, including food-based routes and improved access to food or social programs to increase the uptake of vitamin A-rich foods.

07/11/2022

Many health issues for mothers and babies commonly occur or become apparent in the weeks following the birth. For mothers, this may include postpartum hemorrhage, fever, infection, pain, thromboembolism, or urinary tract complications as well as mental health challenges such as postnatal depression. Mothers may also need support to establish breastfeeding. Babies are at risk of challenges related to infection or breathing challenges.⁣
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Home visits by health professionals may prevent these health problems from becoming long-term. This review investigated different home-visiting schedules in the weeks following the birth. 16 RCTs were included with data for 12,080 women. the trials focused on comparing schedules involving more vs fewer visits, different models of care, and home versus facility check-ups. The evidence was uncertain about whether home visits reduce health issues for the mother or child, although, more individualized care improved women's mental health in one study and maternal satisfaction was better in two studies. ⁣
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Increasing the number of home visits may promote infant health as well as exclusive breastfeeding and more individualized care may improve outcomes for women. However, more research is necessary in this area.

06/28/2022

This review addresses an important, yet seemingly forgotten practice in operative delivery. Assisted va**nal birth is sometimes necessary late in labor when the mother may be exhausted, when clinicians suspect distress of the baby, or if the mother has a medical condition preventing prolonged pushing. This review used evidence from randomized controlled trials to assess the different forceps and vacuum suction cups used to achieve a va**nal birth. Two types of instruments are typically used for this procedure: forceps or vacuum suction cups. Forceps can be further divided into ‘ordinary forceps’ for when the baby’s head is in the correct position and ‘rotational forceps,’ which are used to turn the baby’s head into the correct position. Vacuum cups may have either rigid or flexible cups and may be handheld or connected to a foot-operated pump by a tube. There are, of course, circumstances in which the clinical situation demands a particular tool over another, but there may sometimes be a degree of choice. Researchers conducted analysis using 31 studies looking at a total of 5754 women and their babies. Low certainty evidence from twelve studies suggests that forceps are more likely to achieve va**nal birth, but with a greater number of perineal tears. Nine studies involving 1148 women compared rigid cups to soft cups on vacuum devices. These researchers found that rigid cups may be more likely to result in a successful delivery, while there is probably no evidence of a difference in the rate of perineal tears or postpartum hemorrhages. Indeed, the decision on which instrument to use depends on many factors and must consider the skills and resources available and the urgency of birth. This review allowed some insight into the clinical differences in the instruments used.

06/13/2022

Can corticosteroids prevent serious breathing problems in newborns after cesarean section at term? Infants born at term (at or after 37 weeks of pregnancy) by cesarean section are more likely to develop respiratory morbidity than infants born va**nally. Prophylactic corticosteroids administered to the mother can accelerate lung maturation and reduce the incidence of such respiratory complications. The objective of this review was to investigate if corticosteroids can reduce the rates of breathing problems prior to cesarean section without causing issues for the mother or infant. The reviewers searched medical literature for randomized controlled studies that compared the effects of corticosteroids against a placebo treatment. Confidence in the findings was rated based on factors such as number of studies, study methods, sample size, and the variability of the findings. One trial included 942 women and 942 babies from 10 hospitals. The women in the treatment group received two doses of the corticosteroid betamethasone by injection into muscle. In the control group, women received usual care. It is uncertain if corticosteroids reduce the risk of transient tachypnoea of the neonate, a mild breathing problem. However, antenatal corticosteroids probably reduce the risk of admission to neonatal special care for breathing complications compared with usual care. Further research could continue this investigation and consider assessing whether any benefits or harms identified by giving a course of antenatal corticosteroids are affected by the gestational age at which the planned cesarean section is performed.

06/03/2022

Modern ultrasound technology has allowed for the increasing diagnosis of antenatal fetal abnormalities and complications, several of which can be remedied with in-utero treatment for the benefit of the neonate as well as the mother. Such procedures require fetal immobilization, which can occur via medication to the mother or directly to the fetus for optimal safety and efficacy. The objective of this review was to assess the effects of pharmacological interventions for fetal immobilization during fetal surgery and invasive procedures on post-treatment fetal and maternal health. Evidence from a study comparing two intravenous medications for fetal immobilization suggested that one such drug, remifentanil, may reduce fetal movement more than another drug, diazepam. A study was conducted at a European hospital that included 54 participants, each in their second trimester with a multiple pregnancy. These mothers were all undergoing fetoscopic surgery, wherein fetal immobilization was advantageous. The researchers looked at fetal movements at specific times during treatment using a visual scoring system of gross body and limb movements analyzed using ultrasound. Although remifentanil appears to be superior at reducing fetal movements, it is not without its drawbacks. Maternal sedation and depression of breathing may be worsened by treatment with remifentanil. Certainly, more high-quality trials are needed to increase our knowledge regarding the longer term effects of medications used for fetal immobilization for in-utero procedures, as well as different medications which may be suitable for use. These treatments may greatly improve pregnancy and newborn outcomes, especially for multiple pregnancy complications such as twin-twin transfusion syndrome, where there is unequal sharing of the one placenta between twins, or issues with the fetal heart or lungs.

05/02/2022

INSTRUMENTS FOR ASSISTED VAGINAL BIRTH
Late in labour, when the cervix (neck of the womb) is fully dilated, it is sometimes necessary to assist the birth of the baby through the va**na with an instrument. This may be because the mother is exhausted, suspected distress of the baby, or the mother has a medical condition preventing prolonged pushing.Two types of instruments can be used: forceps or vacuum suction cups. Forceps are further divided into 'ordinary forceps' for when the baby's head is in the correct position and 'rotational forceps', which are used to turn the baby's head into the correct position. Vacuum cups can be divided into ones with rigid or flexible cups and into ones containing a handheld suction device or ones connected to a foot-operated or electric pump by a tube. All types of instruments can cause complications for the mother or baby and all can also fail. It is therefore important to choose the correct instrument for the clinical situation with the best chance of ensuring a successful va**nal birth with the least risk of significant complications.
This review provides low-certainty evidence that forceps may be more likely to achieve va**nal birth and have lower rates of fetal trauma, but at a greater risk of perineal trauma and higher pain relief requirements compared with vacuum cups. There was low-certainty evidence that rigid vacuum cups may be more likely to achieve a va**nal birth than soft cups but with more fetal trauma, whilst handheld vacuum cups had similar success rates compared to other cups. There was no evidence of a difference in the rates of third- or fourth-degree tears or postpartum haemorrhages between types of cups, but wide confidence intervals around the estimates indicate further research is needed in this area.

04/18/2022

COMPLEMENTARY AND ALTERNATIVE THERAPIES FOR POST-CAESAREAN PAIN
Pain after caesarean sections (CS) can affect the well-being of the mother and her interaction with her baby. To manage pain relief during this period, most women receive analgesic drugs. However, these medications can potentially cause side effects in the mother and her baby. The objective of this review is to assess the effects of the Complementary alternative therapies (CAM) for post-caesarean pain. 37 studies (3076 women) which investigated eight different CAM therapies for post-CS pain relief were included. Some CAM therapies may help reduce post-CS pain for up to 24 hours. The evidence on adverse events is too uncertain to make any judgements on safety and we have no evidence about the longer-term effects on pain. Since pain control is the most relevant outcome for post-CS women and their clinicians, it is important that future studies of CAM for post-CS pain measure pain as a primary outcome, preferably as the proportion of participants with at least moderate (30%) or substantial (50%) pain relief.

04/15/2022

REPEAT DOSES OF PRENATAL CORTICOSTEROIDS FOR WOMEN AT RISK OF PRETERM BIRTH FOR IMPROVING HEALTH OUTCOMES IN THEIR BABIES
Infants born preterm (before 37 weeks' of pregnancy) are at risk of difficulty breathing and lung disease because their lungs are not fully developed. One course of prenatal (administered during pregnancy) corticosteroids, given to women who may give birth early, helps develop the baby's lungs and improves survival. Preterm birth is common, affecting approximately one in nine babies worldwide. In addition to breathing difficulties after birth, preterm babies who survive the early weeks after birth are at risk of long-term disabilities such as delays in their development, epilepsy (fits) and cerebral palsy (weakness and problems in the muscles that affects movement and co-ordination). This review shows that a repeat dose of prenatal corticosteroids given to women who remain at risk of an early birth after an initial course of prenatal corticosteroids helps the baby's lungs and reduces serious health problems in the first few weeks of life without harm on health or development up to mid-childhood. Further research is needed on the long-term benefits or harms for the baby into adulthood.

04/01/2022

ROUTINE VAGINAL EXAMINATIONS IN LABOUR
Labour is usually monitored to ensure that it is progressing as expected, and that there are no signs of abnormal progress that might be harmful to mother or baby. The method most commonly used is routine va**nal examination (undertaken at regular time intervals), which provides information on how dilated the woman's cervix is and the position of the baby. Very slow labours can be a sign of underlying problems that may require interventions to speed up labour and birth (augmentation).
The aim of this Cochrane Review was to find out if routine va**nal examinations for assessing labour progress are effective and acceptable to women, and to compare the use of these examinations to other methods of assessing labour progress. Review included four studies, with data for 744 women and babies. we cannot be certain which method is most effective or acceptable for assessing labour progress. Further large-scale RCT trials are required. These should include essential clinical and experiential outcomes. This may be facilitated through the development of a tool to measure positive birth experiences. Data from qualitative studies are also needed to fully assess whether methods to evaluate labour progress meet women's needs for a safe and positive labour and birth, and if not, to develop an approach that does.
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03/20/2022

IS IT SAFER TO DELIVER A BABY IMMEDIATELY OR WAIT IF THE MOTHER HAS HIGH BLOOD PRESSURE AFTER 34 WEEKS OF PREGNANCY THAT IS NOT PERSISTENTLY SEVERE?
Objectives: To assess the benefits and risks of a policy of planned early delivery versus a policy of expectant management in pregnant women with hypertensive disorders, at or near term (from 34 weeks onwards). included five studies (involving 1819 women) in this review.

Women who have high blood pressure (hypertension) during pregnancy or who develop pre-eclampsia (high blood pressure with protein in the urine or other organ systems involvement, or both) can develop serious complications. For women suffering from hypertensive disorders of pregnancy after 34 weeks, planned early delivery is associated with less composite maternal morbidity and mortality. There is no clear difference in the composite outcome of infant mortality and severe morbidity; however, this is based on limited data (from two trials) assessing all hypertensive disorders as one group.

Further studies are needed to look at the different types of hypertensive diseases and the optimal timing of delivery for these conditions. These studies should also include infant and maternal morbidity and mortality outcomes, caesarean section, duration of hospital stay after delivery for mother and duration of hospital stay after delivery for baby.

03/11/2022

Please see information attached regarding Cochrane Systematic Review Standard Author Training which will take place in July 2022. Seats are limited so please register in advance!

03/02/2022

RELIEF OF PAIN CAUSED BY UTERINE CRAMPING OR INVOLUTION AFTER GIVING BIRTH
Women may experience differing types of pain and discomfort following birth, including cramping pain (often called after-birth pain) associated with uterine involution, where the uterus contracts to reduce blood loss and return the uterus to its non-pregnant size. THE OBJECTIVE IS To assess the effectiveness and safety of pharmacological and non-pharmacological pain relief/analgesia for the relief of after-birth pains following va**nal birth.
Authors include 28 studies (involving 2749 women). The evidence identified in this review comes from middle- to high-income countries.
NSAIDs may be better than placebo and are probably better than opioids at relieving pain from uterine cramping/involution following va**nal birth. NSAIDs and paracetamol may be as effective as each other, whereas opioids may be more effective than placebo. Due to low-certainty evidence, we are uncertain about the effectiveness of other forms of pain relief. Future trials should recruit adequate numbers of women and ensure greater generalizability by including breastfeeding women. In addition, further research is required, including a survey of postpartum women to describe appropriately their experience of uterine cramping and involution. We identified nine ongoing studies, which may help to increase the level of certainty of the evidence around pain relief due to uterine cramping in future updates of this review.

Tufts University, Affiliate of Cochrane US

07/21/2022

07/11/2022

06/28/2022

06/13/2022

06/03/2022

05/02/2022

04/18/2022

04/15/2022

04/01/2022

03/20/2022

03/11/2022

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