''Pain in the assets'' : the effects of commercialization and professionalization on the management of injury in english rugby union

In women with a history of preeclampsia, low plasma volume (</=1373 mL/m(2)) is associated with recurrent preeclampsia and chronic hypertension. Interventions that improve volume reserve may reduce these risks in formerly preeclamptic women. In this study, we examined the effects of aerobic exercise training on venous reserves in 24 normotensive formerly preeclamptic women and 20 controls. Before and after 12-week aerobic exercise training, we measured plasma volume with albumin indicator dilution technique and venous compliance with venous occlusion plethysmography. Venous compliance and hemodynamic responses were assessed dynamically during graded head-up tilt (HUT). Formerly preeclamptic women had lower pretraining plasma volume and venous compliance than controls (1348+/-78 versus 1529+/-112 mL/m(2); P<0.01 and 0.04+/-0.02 versus 0.07+/-0.01 mL.dL(-1).mm Hg(-1); P<0.01, respectively). Blood pressure decreased comparably between groups in response to HUT (P=0.11); the increase in heart rate in response to HUT was however more pronounced in preeclamptic women than in controls (P=0.01) Training increased plasma volume comparably in both groups (+180 versus +135 mL/m(2), P=0.22) and similarly physical fitness (+3.4 and +3.7 mL.min(-1).kg(-1), P=0.43). Venous compliance increased twice as much in formerly preeclamptic women than in controls (supine +0.02 versus +0.01 mL.dL(-1).mm Hg(-1); P<0.01). After training, HUT decreased mean blood pressure comparable with pretraining responses in both groups, whereas both groups fulfilled the HUT testing at a persistently lower heart rate. These results demonstrate that 12 weeks of aerobic exercise training improve venous reserve in postpartum women. Training normalized plasma volume and venous compliance in formerly preeclamptic women to pretraining levels of controls. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00900458

External validation of a model for periconceptional prediction of recurrent early-onset preeclampsia

Objective: To validate a previously published prediction model for recurrent early-onset preeclampsia (PE). Methods: We included 229 pregnant women with a history of early-onset PE and computed their risk using the prediction model, compared the predicted risk to their pregnancy outcomes and assessed performance of the model. Results: Early-onset PE recurred in 6.6% of participants. The area under the receiver operating characteristic curve was 59% (95% CI: 45-73). The model created groups that were only moderately different in terms of their risk. Conclusions: The model's discriminate ability was poor and predictive performance insufficient to classify women into relevant risk groups

17 alpha-hydroxyprogesterone caproate for the prevention of adverse neonatal outcome in multiple pregnancies

OBJECTIVE: To estimate whether administration of 17 alpha-hydroxyprogesterone caproate can prevent neonatal morbidity in multiple pregnancies by reducing the preterm birth rate. METHODS: We conducted a multicenter, double-blind, placebo-controlled randomized trial in 55 obstetric clinics in the Netherlands. Women with a multiple pregnancy were randomized to weekly injections of either 250 mg 17 alpha-hydroxyprogesterone caproate or placebo, starting between 16 and 20 weeks of gestation and continuing until 36 weeks of gestation. The main outcome measure was adverse neonatal outcome. Secondary outcome measures were gestational age at delivery and delivery before 28, 32, and 37 weeks of gestation. RESULTS: We randomized 671 women. A composite measure of adverse neonatal outcome was present in 110 children (16%) born to mothers in the 17 alpha-hydroxyprogesterone caproate group, and in 80 children (12%) of mothers in the placebo group (relative risk [RR] 1.34; 95% confidence interval [CI] 0.95-1.89). The mean gestational age at delivery was 35.4 weeks for the 17 alpha-hydroxyprogesterone caproate group and 35.7 weeks for the placebo group (P =.32). Treatment with 17 alpha-hydroxyprogesterone caproate did not reduce the delivery rate before 28 weeks (6% in the 17 alpha-hydroxyprogesterone caproate group compared with 5% in the placebo group, RR 1.04; 95% CI 0.56-1.94), 32 weeks (14% compared with 10%, RR 1.37; 95% CI 0.91-2.05), or 37 weeks of gestation (55% compared with 50%, RR 1.11; 95% CI 0.97-1.28). CONCLUSION: 17 alpha-hydroxyprogesterone caproate does not prevent neonatal morbidity or preterm birth in multiple pregnancies

Cost-effectiveness of induction of labor at term with a Foley catheter compared to prostaglandin E2 gel (based on the PROBAAT trial; registration NTR 1646)

Obstetric

[Foley catheter versus prostaglandin E2 gel for induction of labour at term: the PROBAAT study]

Objective To study the effectiveness and safety of induction of labour with a Foley catheter compared with vaginal prostaglandin E2 gel in full term pregnant women. Design Multicentre, randomised, open-label trial in 12 hospitals in the Netherlands between February 2009 and May 2010. Methods Women scheduled for induction of labour at full term singleton pregnancy in cephalic presentation, intact membranes, and an unripe cervix (Bishop score < 6) were enrolled by means of an on-line system. Participants were randomly allocated to induction of labour with a transcervical Foley catheter or vaginal prostaglandin E2 gel. The primary outcome was caesarean section rate. Secondary outcomes were maternal and neonatal morbidity and time from induction to birth. Results A total of 824 women were allocated to induction of labour with a Foley catheter (n = 412) or prostaglandin E2 (n = 412). Caesarean section rates were comparable (23% versus 20%, RR 1.13, 95% CI 0.87 to 1.47). In the Foley catheter group fewer instrumental deliveries for foetal distress were performed (12% versus 18%, RR 0.68, 95% CI 0.49 to 0.95). Time to delivery (median hours (IQR)) was longer (29 (15-35) versus 18 (12-33)). Fewer mothers had suspected intrapartum infection (2% versus 4%, RR 0.41, 95% CI 0.17-0.98). Significantly fewer neonates were admitted toaneonatal ward after induction with a Foley catheter (12% versus 20%, RR 0.60, 95% CI 0.43 to 0.83). Conclusion In women with an unripe cervix at term, induction of labour with a Foley catheter does not reduce caesarean section rates, but there are fewer side-effects

[Foley catheter versus prostaglandin E2 gel for induction of labour at term: the PROBAAT study]

Item does not contain fulltextObjective To study the effectiveness and safety of induction of labour with a Foley catheter compared with vaginal prostaglandin E2 gel in full term pregnant women. Design Multicentre, randomised, open-label trial in 12 hospitals in the Netherlands between February 2009 and May 2010. Methods Women scheduled for induction of labour at full term singleton pregnancy in cephalic presentation, intact membranes, and an unripe cervix (Bishop score < 6) were enrolled by means of an on-line system. Participants were randomly allocated to induction of labour with a transcervical Foley catheter or vaginal prostaglandin E2 gel. The primary outcome was caesarean section rate. Secondary outcomes were maternal and neonatal morbidity and time from induction to birth. Results A total of 824 women were allocated to induction of labour with a Foley catheter (n = 412) or prostaglandin E2 (n = 412). Caesarean section rates were comparable (23% versus 20%, RR 1.13, 95% CI 0.87 to 1.47). In the Foley catheter group fewer instrumental deliveries for foetal distress were performed (12% versus 18%, RR 0.68, 95% CI 0.49 to 0.95). Time to delivery (median hours (IQR)) was longer (29 (15-35) versus 18 (12-33)). Fewer mothers had suspected intrapartum infection (2% versus 4%, RR 0.41, 95% CI 0.17-0.98). Significantly fewer neonates were admitted toaneonatal ward after induction with a Foley catheter (12% versus 20%, RR 0.60, 95% CI 0.43 to 0.83). Conclusion In women with an unripe cervix at term, induction of labour with a Foley catheter does not reduce caesarean section rates, but there are fewer side-effects

Foley Catheter Versus Vaginal Prostaglandin E2 Gel for Induction of Labor at Term (PROBAAT Trial): An Open-Label, Randomized Controlled Trial EDITORIAL COMMENT

Obstetric