73 research outputs found

    Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

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    Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

    Equal before Allah, unequal before man? : negotiating gender hierarchies in Islam and international law

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    This study engages in a conceptual analysis of human rights in Islam and international law, and the application of this analytical discourse to explore the nature of women's human rights in the Islamic tradition. It has been argued that women's human rights in Islam are not entirely irreconcilable with current formulations of international human rights instruments emanating from the United Nations. The basic premise of the argument stems from a recognition that the Islamic legal tradition is not a monolithic entity. On the basis of its main sources, namely the Quran, Hadith, Ijma and Qiyas, Islamic law lends itself to a variety of interpretations that have far reaching implications for women's human rights in Islam. (Part I)A further factor raised in this study is the disparity between the theoretical perspectives on women's human rights, and, its application to Muslim jurisdictions determined by elements of cultural practices, socio-economic realities and political expediencies on the part of governments. The present study uses the example of Pakistan to demonstrate the divergence between theory and practice of Islamic law in these jurisdictions. The concept of what has been termed an emerging 'operative' Islamic law, consisting of a combination of elements including principles of Islamic law, secular codes of law and popular custom and usage has also been introduced. (Part II)Part III of the thesis is devoted to an evaluation of the development of the international norm of non-discrimination on the basis of sex and some 'Islamic' human rights documents affecting women's human rights. The analysis provides an insight into the response of Muslim States to international human rights instruments affecting women through a discussion in the light of reservations to the Women's Convention. The study concludes by posing the question whether a move towards convergence between international and Islamic schemes of women's human rights is discernible or not

    To register or not to register? Reflections on Muslim marriage practices in Britain

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    Mit dem Jahrbuch für Islamische Rechtswissenschaft wollen die Herausgeber Themen des traditionellen wie des modernen islamischen Rechts, seiner Quellen, seiner philosophischen und sozioökonomischen und soziokulturellen Grundlagen und seiner Bezüge zur Theologie ebenso behandeln wie die besondere Situation in säkularen Gesellschaften mit mehrheitlich nicht-muslimischer Bevölkerung. Alledem sind die Universalien juristischen und allgemeinem normativen Denkens zugrunde zu legen. Auch islamisches Recht ist Recht und gehorcht dessen spezifischen Ordnungsaufgaben und Argumentationsstrukturen – damit wird es auch der rechtsvergleichenden Betrachtung zugänglich. In dieser Hinsicht ist es ein Kernanliegen des Jahrbuchs, islamisches Recht mit den Denkstrukturen des Rechts zu entschlüsseln und nicht wie bislang in Europa ganz überwiegend mit – im Einzelnen noch so gründlichen – philologischen oder religionswissenschaftlichen Studien ohne Erschließung der juristischen Hintergründe. So versteht sich dieses Jahrbuch auch nicht als Konkurrenz zu etablierten islamwissenschaftlichen Zeitschriften, sondern als fachspezifische Ergänzung mit Beiträgen, die ein peer review durchlaufen habe

    Gender and human rights in Islam and international law : equal before Allah, unequal before man?

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    "This study offers a conceptual analysis of gender and human rights under Islamic law, state law and international law, and extends this analysis to a specific examination of the nature of women's rights in the Islamic tradition. It explores the disparity between the theoretical perspective on women's rights and its application to Muslim jurisdictions, determined by elements of cultural practices, socio-economic Read more..

    Part 1: Conceptual framework

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