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  1. Article ; Online: Surgeon-administered ilio-inguinal and pudendal nerve blocks for major vulval surgery: An observational study with visual analogue pain scoring.

    Shahabuddin, Y / Gleeson, N / Maguire, P J

    European journal of obstetrics, gynecology, and reproductive biology

    2021  Volume 268, Page(s) 87–91

    Abstract: Surgical excision of the groin and vulva is a painful procedure. Traditionally following general or regional anaesthesia, local anaesthetic was infiltrated around the wound. Thedistribution varied and the somatic pain control was not reliable. Inspired ... ...

    Abstract Surgical excision of the groin and vulva is a painful procedure. Traditionally following general or regional anaesthesia, local anaesthetic was infiltrated around the wound. Thedistribution varied and the somatic pain control was not reliable. Inspired by the success of the application of peripheral nerve blocks for postoperative pain control with open abdominal procedures, we introduced blockade of the ilioinguinal nerve (IIN) and pudendal nerve (PN) into our vulval surgery to assess the requirement for parenteral and oral analgesia in the postoperative period. This is an observational study of all patients undergoing major vulval and/or related groin surgery. Sampling biopsies were excluded. Levobipuvicaine 0.25% (2.5 mg/ml) or 0.5% (5 mg/ml) was used for and dosage was calculated based on the patient's weight with no more than 2 mg/kg. For example, using 0.25% of levobupivacaine (2.5 mg/ml) for a 70 kg patient, 56 ml is administered divided into 4, giving 14mls at each site (2 sites abdominally for IIN block and 2 sites for pudendal block). Eighteen women were included in the analysis. Median age was 67 (range 34-81) years and thirteen (72%) were >60 years. Visual analogue scores (VAS) ranged from 0 to 3 for seventeen patients from day 0 to day 1 and fifteen patients from day 2 to day 5. Two patients had pain scores >4 on one or more postoperative days: one had chronic arthralgia and one had received a lower volume of bupivacaine. This observational study demonstrates that ilioinguinal and pudendal nerve LA blocks may be a valuable addition to the multimodal postoperative analgesic pathway for women undergoing major surgical excision in the vulva and groin.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Anesthetics, Local ; Bupivacaine ; Female ; Groin ; Hernia, Inguinal ; Humans ; Middle Aged ; Nerve Block ; Pain, Postoperative/prevention & control ; Pudendal Nerve/surgery ; Surgeons ; Vulva/surgery
    Chemical Substances Anesthetics, Local ; Bupivacaine (Y8335394RO)
    Language English
    Publishing date 2021-11-27
    Publishing country Ireland
    Document type Journal Article ; Observational Study
    ZDB-ID 190605-7
    ISSN 1872-7654 ; 0301-2115 ; 0028-2243
    ISSN (online) 1872-7654
    ISSN 0301-2115 ; 0028-2243
    DOI 10.1016/j.ejogrb.2021.11.429
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

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  2. Article ; Online: Cervical ripening and labour induction: A critical review of the available methods.

    Shahabuddin, Yulia / Murphy, Deirdre J

    Best practice & research. Clinical obstetrics & gynaecology

    2021  Volume 79, Page(s) 3–17

    Abstract: Induction of labour is one of the most common interventions experienced by pregnant women. There are two overlapping components to labour induction, which include cervical ripening and the initiation of regular contractions. A large number of clinical ... ...

    Abstract Induction of labour is one of the most common interventions experienced by pregnant women. There are two overlapping components to labour induction, which include cervical ripening and the initiation of regular contractions. A large number of clinical studies have been conducted for evaluating the methods used for induction of labour, their effectiveness and safety, and pregnancy outcomes. Randomised controlled trials (RCTs) provide the strongest form of evidence for clinical practice. These data are brought together in systematic reviews and have been incorporated into national and international guidelines. Despite this, there is considerable variation in the recommendations between guidelines. Heterogeneity between studies, inconsistency in the definitions of trial outcomes, and underpowered sample size contribute to the difficulty in making robust recommendations. There are pharmacological and non-pharmacological approaches that can be compared with each other and with placebo or no treatment. There are also complementary therapies that may appeal to women but lack evidence of their effectiveness. These issues have been addressed in the current chapter, with a critical review of the research evidence presented in clinical trials and systematic reviews.
    MeSH term(s) Cervical Ripening ; Female ; Humans ; Labor, Induced/methods ; Oxytocics/therapeutic use ; Pregnancy ; Systematic Reviews as Topic
    Chemical Substances Oxytocics
    Language English
    Publishing date 2021-11-20
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 2050090-7
    ISSN 1532-1932 ; 1521-6934
    ISSN (online) 1532-1932
    ISSN 1521-6934
    DOI 10.1016/j.bpobgyn.2021.11.008
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Fetal scalp stimulation for assessing fetal well-being during labour.

    Murphy, Deirdre J / Devane, Declan / Molloy, Eleanor / Shahabuddin, Yulia

    The Cochrane database of systematic reviews

    2023  Volume 1, Page(s) CD013808

    Abstract: Background: Continuous fetal heart rate monitoring by cardiotocography (CTG) is used in labour for women with complicated pregnancies. Fetal heart rate abnormalities are common and may result in the decision to expedite delivery by caesarean section. ... ...

    Abstract Background: Continuous fetal heart rate monitoring by cardiotocography (CTG) is used in labour for women with complicated pregnancies. Fetal heart rate abnormalities are common and may result in the decision to expedite delivery by caesarean section. Fetal scalp stimulation (FSS) is a second-line test of fetal well-being that may provide reassurance that the labour can continue.
    Objectives: To evaluate methods of FSS as second-line tests of intrapartum fetal well-being in cases of non-reassuring CTG. FSS and CTG were compared to CTG alone, and to CTG with fetal blood sampling (FBS).
    Search methods: We searched Cochrane Pregnancy and Childbirth's Trials Register (which includes trials from CENTRAL, MEDLINE, Embase, CINAHL, the WHO ICTRP and conference proceedings), ClinicalTrials.gov (18 October 2022), and reference lists of retrieved studies.
    Selection criteria: Eligible studies were randomised controlled trials (RCTs) that compared any form of FSS to assess fetal well-being in labour. Quasi-RCTs, cluster-RCTs and studies published in abstract form were also eligible for inclusion, but none were identified.
    Data collection and analysis: Two review authors independently assessed studies for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the certainty of the evidence using the GRADE approach.
    Main results: Two trials, involving 377 women, met the inclusion criteria for this review. Both trials were conducted in hospital settings and included women with singleton, term (37+0 weeks or more) pregnancies, a cephalic presentation, and abnormal CTG. Follow-up was until hospital discharge after the birth. A pilot trial of 50 women in a high-income country (Ireland) compared CTG and digital fetal scalp stimulation (dFSS) with CTG and fetal blood sampling (FBS). A single-centre trial of 327 women in a lower middle-income country (India) compared CTG and manual fetal stimulation (abdominal or vaginal scalp stimulation) with CTG alone. The two included studies were at moderate or unclear risk of bias. Both trials provided clear information on allocation concealment but it was not possible to blind participants or health professionals in relation to the intervention. Although objective outcome measures were reported, outcome assessment was not blinded or blinding was unclear. dFSS and CTG versus FBS and CTG There were no perinatal deaths and data were not reported for neurodevelopmental disability at >/= 12 months. The risk of caesarean section (CS) may be lower with dFSS compared to FBS (risk ratio (RR) 0.38, 95% confidence interval (CI) 0.16 to 0.92; 1 pilot trial, 50 women; very low-certainty evidence) but the evidence is very uncertain. There were no cases of neonatal encephalopathy reported. The evidence was also very uncertain between dFSS and FBS for assisted vaginal birth (RR 1.44, 95% CI 0.76 to 2.75; very low-certainty evidence) and for the spontaneous vaginal birth rate (RR 2.33, 95% CI 0.68 to 8.01, very low-certainty evidence). Maternal acceptability of the procedures was not reported. FSS and CTG versus CTG alone Manual stimulation of the fetus was performed either abdominally (92/164) or vaginally (72/164). There were no perinatal deaths and data were not reported for neurodevelopmental disability at >/= 12 months. There may be little differences in the risk of CS on comparing manual fetal stimulation and CTG with CTG alone (RR 0.83, 95% CI 0.59 to 1.18; 1 trial, 327 women; very low-certainty evidence), but again the evidence was very uncertain. There were no cases of neonatal encephalopathy reported. There may be no differences in the risk of assisted vaginal birth (RR 1.43, 95% CI 0.78 to 2.60; very low-certainty evidence) or in the rates of spontaneous vaginal birth (RR 1.01, 95% CI 0.85 to 1.21, very low-certainty evidence), but again the evidence is very uncertain. Maternal acceptability of abdominal stimulation/FSS was not reported although 13 women withdrew consent after randomisation due to concerns about fetal well-being.
    Authors' conclusions: There is very low-certainty evidence available which makes it unclear whether stimulating the fetal scalp is a safe and effective way to confirm fetal well-being in labour. Evidence was downgraded based on limitations in study design and imprecision. Further high-quality studies of adequate sample size are required to evaluate this research question. In order to be generalisable, these trials should be conducted in different settings, including broad clinical criteria at both preterm and term gestational ages, and standardising the method of stimulation. There is an ongoing study (FIRSST) that will be incorporated into this review in a subsequent update.
    MeSH term(s) Infant, Newborn ; Female ; Pregnancy ; Humans ; Scalp ; Labor, Obstetric ; Parturition ; Perinatal Death ; Fetus ; Brain Diseases
    Language English
    Publishing date 2023-01-10
    Publishing country England
    Document type Journal Article ; Review ; Systematic Review
    ISSN 1469-493X
    ISSN (online) 1469-493X
    DOI 10.1002/14651858.CD013808.pub2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Digital fetal scalp stimulation (dFSS) versus fetal blood sampling (FBS) to assess fetal wellbeing in labour-a multi-centre randomised controlled trial: Fetal Intrapartum Randomised Scalp Stimulation Trial (FIRSST NCT05306756).

    Murphy, D J / Shahabuddin, Y / Yambasu, S / O'Donoghue, K / Devane, D / Cotter, A / Gaffney, G / Burke, L A / Molloy, E J / Boland, F

    Trials

    2022  Volume 23, Issue 1, Page(s) 848

    Abstract: Background: Cardiotocography (CTG) is a screening test used to detect fetal hypoxia in labour. It has a high false positive rate resulting in many potentially unnecessary caesarean sections. Fetal blood sampling (FBS) is a second-line test of the acid- ... ...

    Abstract Background: Cardiotocography (CTG) is a screening test used to detect fetal hypoxia in labour. It has a high false positive rate resulting in many potentially unnecessary caesarean sections. Fetal blood sampling (FBS) is a second-line test of the acid-base status of the fetus. It is used to provide either reassurance that it is safe for labour to continue or objective evidence of compromise so that delivery can be expedited. Digital fetal scalp stimulation (dFSS) to elicit a fetal heart rate acceleration is an alternative less invasive second-line test of fetal wellbeing. This study aims to provide robust evidence on the role of these two second-line tests in assessing fetal wellbeing and potentially preventing operative delivery.
    Methods: A multi-centre parallel group randomised controlled trial (RCT) is planned in four maternity centres in Ireland. The study aims to recruit 2500 nulliparous women with a term (≥37+0 weeks) singleton pregnancy who require a second-line test of fetal wellbeing in labour due to an abnormal CTG. Women will be allocated randomly to dFSS or FBS on a 1:1 ratio. The primary outcome is caesarean section. With 1250 women in each arm, the study will have 90% power to detect a difference of 5-6%, at a two-sided alpha significance level of 5%, assuming a caesarean section rate of at least 20% in the dFSS group.
    Discussion: If the proposed study shows evidence that dFSS is a safe, reliable and effective alternative to FBS, this would have ground-breaking implications for labour management worldwide. It could potentially lead to a reduction in invasive procedures and emergency caesarean sections.
    Trial registration: ClinicalTrials.gov NCT05306756. Registered on 31 March 2022. The trial commenced enrolment on 10 May 2022. Ethical committee approval has been granted by the Research Ethics Committee (REC) of each hospital: Dublin/CWIUH REC: 12.06.2019; Cork/UCC REC: 29.11.2019; Galway/NUIG REC: 06.09.2019; Limerick/UL REC: 30.09.2019.
    MeSH term(s) Cardiotocography/methods ; Female ; Fetal Blood ; Heart Rate, Fetal/physiology ; Humans ; Labor, Obstetric ; Pregnancy ; Scalp
    Language English
    Publishing date 2022-10-04
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Randomized Controlled Trial
    ZDB-ID 2040523-6
    ISSN 1745-6215 ; 1468-6694 ; 1745-6215
    ISSN (online) 1745-6215
    ISSN 1468-6694 ; 1745-6215
    DOI 10.1186/s13063-022-06794-9
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Severe lymphoedema in gynaecological cancers: Impact of pneumatic compression on quality of life.

    Freyne, Aoife / Donoghue, Niamh O / Shahabuddin, Yulia / Baker, Roisin / Murtagh, Claire / Gleeson, Noreen

    Gynecologic oncology reports

    2021  Volume 39, Page(s) 100902

    Abstract: Objective: Good survival rates from gynaecological cancers focus our attention on the quality of survivorship. Lymphoedema is a common complication that affects many aspects of quality of life (QOL). We undertook a prospective audit of QOL of patients ... ...

    Abstract Objective: Good survival rates from gynaecological cancers focus our attention on the quality of survivorship. Lymphoedema is a common complication that affects many aspects of quality of life (QOL). We undertook a prospective audit of QOL of patients with higher grade lymphoedema using home compression pneumatic devices. The aim of this study was to assess QOL in a mixed gynaecological cancer cohort before and after at least eight weeks of home compression treatment.
    Methods: Thirteen patients with the most severely disabling lower limb lymphoedema based on routinely collected QOL scores or a history of hospital admissions with related infection were invited to participate. QOL was assessed using the EORTC QLQ-C30 Version 3.0 and a supplementary gynaecological cancer-specific lymphoedema questionnaire. Home compression therapy was introduced not sooner than 3 months after primary cancer treatment. All patients applied compression treatment for at least one hour per day. Descriptive statistics and Wilcoxon signed-rank test were applied. A p-value < 0.05 was considered statistically significant.
    Results: All participants' functional and symptom scores improved with compression therapy with the exception of sexual function.
    Conclusions: Self-management with pneumatic compression devices at home is a useful adjunct in the management of severe lymphoedema. Our preliminary experience showed a substantial improvement in most QOL parameters. We cannot say if domiciliary treatment with this compression device would have broader application or a role in primary or secondary prevention of lymphoedema if introduced at an earlier stage.
    Language English
    Publishing date 2021-12-07
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2818505-5
    ISSN 2352-5789
    ISSN 2352-5789
    DOI 10.1016/j.gore.2021.100902
    Database MEDical Literature Analysis and Retrieval System OnLINE

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