The Cochrane Handbook for Systematic Reviews of Interventions is the official document that describes in detail the process of preparing and maintaining Cochrane systematic reviews on the effects of healthcare interventions.

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Cochrane Handbook for Systematic Reviews of Interventions

Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.

Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)60820-4.pdf

National regional and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications.

Process evaluation is an essential part of designing and testing complex interventions. New MRC guidance provides a framework for conducting and reporting process evaluation studies

https://www.bmj.com/content/bmj/350/bmj.h1258.full.pdf

Process evaluation of complex interventions: Medical Research Council guidance

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673605710485.pdf

4 million neonatal deaths: When? Where? Why?

The WHO Reproductive Health Library: a Cochrane window on sexual and reproductive health.

Erratum: Maternal complications and perinatal mortality: Findings of the World Health Organization Multicountry Survey on Maternal and Newborn Health (BJOG: An International Journal of Obstetrics and Gynaecology (2014) 121)

Chlorhexidine washing of the vagina in labor effectively reduces bacterial colonization: A study by the global network for perinatal & reproductive health

BACKGROUND
Long-acting reversible contraception (LARC), including intrauterine devices (IUDs) and contraceptive implants, are highly effective, reversible methods of contraception. Providing LARC methods during the postpartum period is important to support contraceptive choice, and to prevent unintended pregnancy and short interpregnancy intervals. Delaying offering contraception to postpartum people until the first comprehensive postpartum visit, traditionally at around six weeks postpartum, may put some postpartum people at risk of unintended pregnancy, either due to loss to follow-up or because of initiation of sexual intercourse prior to receiving contraception. Therefore, immediate provision of highly effective contraception, prior to discharge from hospital, has the potential to improve contraceptive use and prevent unintended pregnancies and short interpregnancy intervals.


OBJECTIVES
To compare the initiation rate, utilization rates (at six months and 12 months after delivery), effectiveness, and adverse effects of immediate versus delayed postpartum insertion of implants and IUDs for contraception.


SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and POPLINE for eligible studies up to December 2020. We examined review articles and contacted investigators. We checked registers of ongoing clinical trials, citation lists of included studies, key textbooks, grey literature, and previous systematic reviews for potentially relevant studies.


SELECTION CRITERIA
We sought randomized controlled trials (RCTs) that compared immediate postpartum versus delayed insertion of contraceptive implant and IUDs for contraception.


DATA COLLECTION AND ANALYSIS
Two review authors (JS, SK) independently screened titles and abstracts of the search results, and assessed the full-text articles of potentially relevant studies for inclusion. They extracted data from the included studies, assessed risk of bias, compared results, and resolved disagreements by consulting a third review author (PL, SA or PP). We contacted investigators for additional data, where possible. We computed the Mantel-Haenszel or inverse variance risk ratio (RR) with 95% confidence interval (CI) for binary outcomes and the mean difference (MD) with 95% CI for continuous variables.


MAIN RESULTS
In this updated review, 16 studies met the inclusion criteria; five were studies of contraceptive implants (715 participants) and 11 were studies of IUDs (1894 participants). We identified 12 ongoing studies. We applied GRADE judgements to our results; the overall certainty of the evidence for each outcome ranged from moderate to very low, with the main limitations being risk of bias, inconsistency, and imprecision. Contraceptive implants Immediate insertion probably improves the initiation rate for contraceptive implants compared with delayed insertion (RR 1.48, 95% CI 1.11 to 1.98; 5 studies, 715 participants; I2 = 95%; moderate-certainty evidence). We are uncertain if there was a difference between the two groups for the utilization rate of contraceptive implants at six months after delivery (RR 1.16, 95% CI 0.90 to 1.50; 3 studies, 330 participants; I2 = 89%; very low-certainty evidence) or at 12 months after insertion (RR 0.98, 95% CI 0.93 to 1.04; 2 studies, 164 participants; I2 = 0%; very low-certainty evidence). People who received an immediate postpartum contraceptive implant insertion may have had a higher mean number of days of prolonged vaginal bleeding within six weeks postpartum (mean difference (MD) 2.98 days, 95% CI -2.71 to 8.66; 2 studies, 420 participants; I2 = 91%; low-certainty evidence) and a higher rate of other adverse effects in the first six weeks after birth (RR 2.06, 95% CI 1.38 to 3.06; 1 study, 215 participants; low-certainty evidence) than those who received a delayed postpartum insertion. We are uncertain if there was a difference between the two groups for prolonged bleeding at six months after delivery (RR 1.19, 95% CI 0.29 to 4.94; 2 studies, 252 participants; I2 = 0%; very low-certainty evidence). There may be little or no difference between the two groups for rates of unintended pregnancy at six months (RR 0.20, 95% CI 0.01 to 4.08; one study, 205 participants; low-certainty evidence). We are uncertain whether there was a difference in rates of unintended pregnancy at 12 months postpartum (RR 1.82, 95% CI 0.38 to 8.71; 1 study, 64 participants; very low-certainty evidence). There may be little or no difference between the two groups for any breastfeeding rates at six months (RR 0.97, 95% CI 0.92 to 1.01; 2 studies, 225 participants; I2 = 48%; low-certainty evidence). IUDs Immediate insertion of IUDs probably improves the initiation rate compared with delayed insertion, regardless of type of IUD (RR 1.27, 95% CI 1.07 to 1.51; 10 studies, 1894 participants; I2 = 98%; moderate-certainty evidence). However, people who received an immediate postpartum IUD insertion may have had a higher expulsion rate at six months after delivery (RR 4.55, 95% CI 2.52 to 8.19; 8 studies, 1206 participants; I2 = 31%; low-certainty evidence) than those who received a delayed postpartum insertion. We are uncertain if there was a difference between the two groups in the utilization of IUDs at six months after insertion (RR 1.02, 95% CI 0.65 to 1.62; 6 studies, 971 participants; I2 = 96%; very low-certainty evidence) or at 12 months after insertion (RR 0.86, 95% CI 0.5 to 1.47; 3 studies, 796 participants; I2 = 92%; very low-certainty evidence). Immediate IUDs insertion may reduce unintended pregnancy at 12 months (RR 0.26, 95% CI 0.17 to 0.41; 1 study, 1000 participants; low-certainty evidence). We are uncertain whether there was difference in any breastfeeding rates at six months in people receiving progestin-releasing IUDs (RR 0.90, 95% CI 0.63 to 1.30; 5 studies, 435 participants; I2 = 54%; very low-certainty evidence).


AUTHORS' CONCLUSIONS
Evidence from this updated review indicates that immediate postpartum insertion improves the initiation rate of both contraceptive implants and IUDs by the first postpartum visit compared to delayed insertion. However, it is not clear whether that there are differences in utilization rates at six and 12 months postpartum. We are uncertain whether there is any difference in the unintended pregnancy rate at 12 months. Provision of progestin-releasing implants and IUDs immediately postpartum may have little or no negative impact on breastfeeding. However, the expulsion rate of IUDs and prolonged vaginal bleeding associated with immediate implants appears to be higher.

Immediate versus delayed postpartum insertion of contraceptive implant and IUD for contraception.

OBJECTIVE : 1To  study  knowledge  and  attitude  towards  thalassemia  in reproductive women  who   have the  disease  or  are  carriers. 2. To  assess factors  affecting  knowledge. 3. To  study  knowledge  and  attitude  towards  prenatal  diagnosis  in these women. STUDY  DESIGN :  A descriptive  study. SETTING : University  Hospital. SUBJECTS : 150 reproductive  women  with  thalassemic  disease  or  who  are  carriers.  They  were  either  mothers  of  thalassemic  children or  were  found  to have  thalassemic  disease  found  to  be  carrier  in the  antenatal  clinic. MAIN  OUTCOME  MEASURES : knowledge  was  evaluated  by  a  pretested  questionnaire  co7ntaining   16  questions.  Women  were  classified  as  having  adequate  knowledge  in  thalassemia  if  they  answered  at  least  10  questions  correctly.  Attitude  was  assessed  also  by  a  pretested  questionnaire  containing  14  questions.  Factors  associated  with  knowledge  were  assessed  by  univariate  analysis  using  Chi-square  statistics.  Multiple  logistic  regression  analysis  was  used  as  a  control  for  potential  confounding  effects. RESULTS : Sixty  women  (40.0%)  were  defined  as  having  adequate  knowledge.  Concerning  attitude,  the 150  women  had  a  good  attitude  towards  thalassemia.  Factors  affecting  knowledge  significantly  (p<0.05)  were  occupation, sources  of  knowledge,  perception  of  their  thalassemic   status,  duration  after  being  diagnosed.  In the  case  of  prenatal  diagnosis,  50. 7%  of  the  women  knew  that  thalassemia  can  be  diagnosed  before  birth, 18.7%  knew  that  prenatal  diagnosis  has  minimal  complications  and  46.0%  knew  that  pregnancy  with  severe  forms  of  thalassemia  should  be  terminated. CONCLUSION : A  large  proportion  of  reproductive  women  thalassemic  disease  or  who  were  carriers  did  not  have  adequate  knowledge  about  thalassemia.  We  should  put  more  effort  in  giving  knowledge  to  these  groups  of  women.  Special  emphasis  should  be  placed  on  topics  which  they  knew  less  namely : the  effect  of  having  a  thalassemic  child,  inheritance  pattern,  prevention  and  control,  treatment,  and  prenatal  diagnosis.  Further  research  to  choose  effective  media  for  giving  the  knowledge  should  be  conducted.

Pisake Lumbiganon

Papers

The WHO Reproductive Health Library: a Cochrane window on sexual and reproductive health.

Erratum: Maternal complications and perinatal mortality: Findings of the World Health Organization Multicountry Survey on Maternal and Newborn Health (BJOG: An International Journal of Obstetrics and Gynaecology (2014) 121)

Chlorhexidine washing of the vagina in labor effectively reduces bacterial colonization: A study by the global network for perinatal & reproductive health

Immediate versus delayed postpartum insertion of contraceptive implant and IUD for contraception.

Knowledge and Attitude towards Thalassemia in Reproductive Women with Thalassemic Disease or Carrier