Showing papers by "Peter Brocklehurst published in 2000"

Interventions for treating bacterial vaginosis in pregnancy.

Abstract: BACKGROUND: Bacterial vaginosis has been associated with poor perinatal outcome. Since the infections are amenable to treatment, identification during pregnancy and treatment may reduce the risk of preterm birth and its consequences. OBJECTIVES: The objective of this review was to assess the effects of antibiotic treatment of bacterial vaginosis in pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. SELECTION CRITERIA: Randomised trials comparing one antibiotic regimen with placebo or no treatment, or which compare two or more alternative antibiotic regimens in pregnant women with bacterial vaginosis. DATA COLLECTION AND ANALYSIS: Trial quality assessments and data extraction were done independently by three reviewers. Study authors were contacted for additional information. MAIN RESULTS: Five trials involving 1504 women were included. These trials were of good quality. Antibiotic therapy was highly effective at eradicating infection during pregnancy as judged by 'test-of-cure' following therapy (odds ratio 0.22, 95% confidence interval 0.17 to 0.27). The effect of treating bacterial vaginosis during pregnancy showed a trend to less births before 37 weeks gestation (odds ratio 0.78, 95% confidence interval 0.60 to 1.02). The prevention of preterm birth less than 37 weeks gestation was most marked in the subgroup of women with a previous preterm birth (odds ratio 0.37, 95% confidence interval 0.23 to 0. 60). REVIEWER'S CONCLUSIONS: The current evidence does not support screening and treating all pregnant women for bacterial vaginosis to prevent preterm birth and its consequences. For women with a history of a previous preterm birth there is some suggestion that detection and treatment of bacterial vaginosis early in pregnancy may prevent a proportion of these women having a further preterm birth. It is not known whether this is associated with an improvement in neonatal well-being.

Are we prescribing multiple courses of antenatal corticosteroids? A survey of practice in the UK - Authors' reply

Abstract: A postal questionnaire concerned with prescribing antenatal corticosteroids was sent to one named clinician at each of 279 obstetric units in the UK. They were asked whether their unit prescribed repeated courses, the indications for which these would be prescribed, the interval between courses, the drugs and regimens used and whether they would be willing to participate in a proposed randomised controlled trial. The response rate was 75%. Of the respondents, 98% prescribed repeated courses; the indications most commonly cited by units who prescribed steroids were prelabour spontaneous rupture of membranes (84.2%), and suspected preterm labour (81.8%). 70.6% of units were willing to participate in the proposed trial.

Role of external evidence in monitoring clinical trials: experience from a perinatal trial

Abstract: The randomised controlled trial is the most scientifically rigorous way of evaluating interventions whose effects on important clinical outcomes are uncertain.1 Before conducting such a trial, investigators should undertake a systematic review of thevidence from existing trials, including, if appropriate, a meta-analysis. This prevents trials being carried out unnecessarily when the answer to the clinical question is already known.A priori power calculations should be made to determine how many participants will be required to answer the research question,2 and this process is increasingly being required by research ethics committees and funding bodies, among others.3 Nevertheless, under some circumstances recruitment to a trial may be halted before the planned sample size has been reached because The process for stopping a trial early because of indications from internal data is well accepted and recognised and the statistical methodology has been discussed at length, but this is not the case for external evidence. The process by which trial investigators should consider external evidence and make decisions concerning further recruitment is unclear. #### Summary points Principal investigators of clinical trials should be responsible for obtaining relevant information emerging from other studies Investigators should seek unpublished confidential information, but this requires sensitive handling Meta-analysis is useful for incorporating ongoing trial data with existing and emerging evidence The trial data monitoring committee is responsible for reviewing both internal and external information, but the trial steering committee should decide whether to modify or stop a trial We describe our recent experience of stopping a large international trial because of external evidence …

Effects of multiple courses of antenatal steroids are uncertain.

Abstract: EDITOR—Spencer and Neales highlight the uncertainty surrounding the risks and benefits of giving multiple courses of antenatal steroids to pregnant women at risk of preterm delivery.1 They refer to our survey of practice carried out in 1997,2 and it would be helpful to clarify some of the figures that they quote. Firstly, the survey did not find that 98% of women at risk of preterm birth receive prophylactic antenatal corticosteroids; rather, it found that 98% of obstetric units …