Methods We did a multicentre, non-inferiority, randomised controlled trial in 16 hospitals and two primary healthcare centres in Argentina, Egypt, India, Kenya, the Philippines, South Africa, Thailand, and Uganda. Women expecting to deliver singleton babies
vaginally (ie, not planned caesarean section) were randomly assigned (in a 1: 1 ratio) with a centrally generated allocation sequence, stratified by country, to placental delivery with gravity and maternal effort (simplified package) or controlled cord traction applied immediately after uterine contraction and cord clamping (full package). After randomisation, allocation could not be concealed from investigators, participants, or assessors. Oxytocin
10 IU was administered immediately after birth with cord clamping after 1-3 min. Uterine massage was done after placental delivery according to local policy. Staurosporine ic50 The primary (non-inferiority) outcome was blood loss of 1000 mL or more (severe haemorrhage). The non-inferiority margin for the risk ratio was 1.3. Analysis was by PU-H71 supplier modified intention-to-treat, excluding women who had emergency caesarean sections. This trial is registered with the Australian and New Zealand Clinical Trials Registry, ACTRN 12608000434392.
Findings Between June 1, 2009, and Oct 30, 2010, 12 227 women were randomly assigned to the simplified package group and 12 163 to the full package group. After exclusion of women who had emergency caesarean sections, 11 861 were in the simplified package group and 11 820 were in the full package group. The primary outcome of blood loss of 1000 mL or more had a risk ratio of 1.09 (95% CI 0.91-1.31) and the upper 95% CI limit crossed the pre-stated non-inferiority margin. One case of uterine inversion occurred in the full package group. Other adverse events were haemorrhage-related.
Interpretation
Although the hypothesis of non-inferiority was not met, omission of controlled cord traction has very little effect on the risk of severe haemorrhage. Scaling up of haemorrhage over prevention programmes for non-hospital settings can safely focus on use of oxytocin.”
“Objective: To examine whether socioeconomic status (SES), high school (HS) completion, IQ, and personality traits that predict delinquency in adolescence also could explain men’s delinquency-related (Dq-r) mortality risk across the life span. Methods: Through a 60-year Social Security Death Index (SSDI) follow-up of 1812 men from Hathaway’s adolescent normative Minnesota Multiphasic Personality Inventory (MMPI) sample, we examined mortality risk at various ages and at various levels of prior delinquency severity. We examined SES (using family rent level), HS completion, IQ, and MMP1 indicators simultaneously as mortality predictors and tested for SES (rent level) interactions with IQ and personality. Results: We ascertained 418 decedents.