17-alpha hydroxyprogesterone caproate for the prevention of recurrent preterm birth among singleton pregnant women with a prior history of preterm birth: a systematic review and meta-analysis of six randomized controlled trials

( Saeed Baradwan ),( Sahar Hassan Abdulghani ),( Mohammed Abuzaid ),( Khalid Khadawardi ),( Majed Saeed Alshahrani ),( Abdulrahman Al-matary ),( May A. Alrasheed ),( Najlaa Talat Miski ),( Aroob Abdul 대한산부인과학회 2021 Obstetrics & Gynecology Science Vol.64 No.6

To perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) that investigated the clinical benefits of 17-alpha hydroxyprogesterone caproate (17OHPC) in the prevention of recurrent preterm birth (PTB) among singleton pregnant women with a previous history of PTB. We searched four major databases up till April 2021 and assessed the risk of bias in the included studies. We meta-analyzed various maternal-neonatal endpoints (n=18) and pooled them as mean difference or risk ratio (RR) with 95% confidence interval (CI) using the random-effects model. Six RCTs met the inclusion criteria, comprising 2,573 patients (17OHPC=1,617, control=956). RCTs revealed an overall low risk of bias. The rates of PTB <35 weeks (n=5 RCTs; RR, 0.77; 95% CI, 0.63-0.93; P=0.008), PTB <32 weeks (n=3 RCTs; RR, 0.68; 95% CI, 0.51-0.91; P=0.009), neonates with low birth weight (<2.5 kg) at delivery (n=3 RCTs; RR, 0.63; 95% CI, 0.5-0.79; P<0.001), and neonatal death (n=4 RCTs; RR, 0.41; 95% CI, 0.20-0.84; P=0.02) were significantly reduced in the 17OHPC group compared with the control group. Moreover, 17OHPC treatment correlated with a significantly decreased rate of retinopathy (n=2 RCTs; RR, 0.42; 95% CI, 0.18-0.97; P=0.004). However, there were no significant differences in the rates of neonatal intensive care unit admission, cesarean delivery, and other pretermrelated complications between both the groups. Among singleton pregnant women with a prior history of PTB, 17OHPC may favorably decrease the risks of recurrent PTB and reduce the rate of neonatal death.

The effect of antioxidant supplementation on dysmenorrhea and endometriosis-associated painful symptoms: a systematic review and meta-analysis of randomized clinical trials

Saeed Baradwan,Abdulrahim Gari,Hussein Sabban,Majed Saeed Alshahrani,Khalid Khadawardi,Ibtihal Abdulaziz Bukhari,Abdullah Alyousef,Ahmed Abu-Zaid 대한산부인과학회 2024 Obstetrics & Gynecology Science Vol.67 No.2

This study aimed to review randomized controlled trials (RCTs) investigating the effects of dietary antioxidant supplements on the severity of endometriosis-related pain symptoms. The PubMed/Medline, Scopus, and Web of Science databases were searched until April 2022. Additionally, we manually searched the reference lists. Endpoints were summarized as standardized mean difference (SMD) with 95% confidence intervals (CIs) in a random-effects model. The I2 statistic was used to assess heterogeneity. Ten RCTs were included in this meta-analysis. Overall, 10 studies were related to dysmenorrhea, four to dyspareunia, and four to pelvic pain. Antioxidants significantly reduced dysmenorrhea (SMD, -0.48; 95% CI, -0.82 to -0.13; I2=75.14%). In a subgroup analysis, a significant reduction of dysmenorrhea was observed only in a subset of trials that administered vitamin D (SMD, -0.59; 95% CI, -1.13 to -0.06; I2=69.59%) and melatonin (SMD, -1.40; 95% CI, -2.47 to -0.32; I2=79.15%). Meta-analysis results also suggested that antioxidant supplementation significantly improved pelvic pain (SMD, -1.51; 95% CI, -2.74 to -0.29; I2=93.96%), although they seem not to have a significant beneficial impact on the severity of dyspareunia. Dietary antioxidant supplementation seems to beneficially impact the severity of endometriosis-related dysmenorrhea (with an emphasis on vitamin D and melatonin) and pelvic pain. However, due to the relatively small sample size and high heterogeneity, the findings should be interpreted cautiously, and the importance of further well-designed clinical studies cannot be overstated. This study aimed to review randomized controlled trials (RCTs) investigating the effects of dietary antioxidant supplements on the severity of endometriosis-related pain symptoms. The PubMed/Medline, Scopus, and Web of Science databases were searched until April 2022. Additionally, we manually searched the reference lists. Endpoints were summarized as standardized mean difference (SMD) with 95% confidence intervals (CIs) in a random-effects model. The I² statistic was used to assess heterogeneity. Ten RCTs were included in this meta-analysis. Overall, 10 studies were related to dysmenorrhea, four to dyspareunia, and four to pelvic pain. Antioxidants significantly reduced dysmenorrhea (SMD, -0.48; 95% CI, -0.82 to -0.13; I²=75.14%). In a subgroup analysis, a significant reduction of dysmenorrhea was observed only in a subset of trials that administered vitamin D (SMD, -0.59; 95% CI, -1.13 to -0.06; I²=69.59%) and melatonin (SMD, -1.40; 95% CI, -2.47 to -0.32; I²=79.15%). Meta-analysis results also suggested that antioxidant supplementation significantly improved pelvic pain (SMD, -1.51; 95% CI, -2.74 to -0.29; I²=93.96%), although they seem not to have a significant beneficial impact on the severity of dyspareunia. Dietary antioxidant supplementation seems to beneficially impact the severity of endometriosis-related dysmenorrhea (with an emphasis on vitamin D and melatonin) and pelvic pain. However, due to the relatively small sample size and high heterogeneity, the findings should be interpreted cautiously, and the importance of further well-designed clinical studies cannot be overstated.

Prophylactic tranexamic acid to reduce blood loss and related morbidities during hysterectomy: a systematic review and meta-analysis of randomized controlled trials

Ahmed Abu-Zaid,Saeed Baradwan,Ehab Badghish,Rayan AlSghan,Ahmed Ghazi,Bayan Albouq,Khalid Khadawardi,Nora F AlNaim,Latifa F AlNaim,Meshael Fodaneel,Fatimah Shakir Abualsaud,Mohammed Ziad Jamjoom,Abdul 대한산부인과학회 2022 Obstetrics & Gynecology Science Vol.65 No.5

To perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) that evaluated the efficacyand safety of prophylactic tranexamic acid (TXA) versus a control (placebo or no treatment) during hysterectomy forbenign conditions. Six databases were screened from inception to January 23, 2022. Eligible studies were assessed forrisk of bias. Outcomes were summarized as weighted mean differences and risk ratios with 95% confidence intervalsin a random-effects model. Five studies, comprising six arms and 911 patients were included in the study. Two andthree studies had an overall unclear and low risk of bias, respectively. Estimated intraoperative blood loss, requirementfor postoperative blood transfusion, and requirement for intraoperative topical hemostatic agents were significantlyreduced in a prophylactic TXA group when compared with a control group. Moreover, postoperative hemoglobinlevel was significantly higher in the prophylactic TXA group than in the control group. Conversely, the frequencyof self-limiting nausea and vomiting was significantly higher in the prophylactic TXA group than in the control group. There were no significant differences between the groups in terms of surgery duration, hospital stay, and diarrhearate. All the RCTs reported no incidence of major adverse events in either group, such as mortality, thromboembolicevents, visual disturbances, or seizures. There was no publication bias for any outcome, and leave-one-out sensitivityanalyses demonstrated stability of the findings. Among patients who underwent hysterectomy for benign conditions,prophylactic TXA appeared largely safe and correlated with substantial reductions in estimated intraoperative bloodloss and related morbidities.

The effect of alpha-lipoic acid supplementation on anthropometric, glycemic, lipid, oxidative stress, and hormonal parameters in individuals with polycystic ovary syndrome: a systematic review and meta-analysis of randomized clinical trials

Ahmed Abu-Zaid,Saeed Baradwan,Ibtihal Abdulaziz Bukhari,Abdullah Alyousef,Mohammed Abuzaid,Saleh A. K. Saleh,Heba M. Adly,Osama Alomar,Ismail Abdulrahman Al-Badawi 대한산부인과학회 2024 Obstetrics & Gynecology Science Vol.67 No.1

This systematic review and meta-analysis aimed to examine the effect of the antioxidant alpha-lipoic acid (ALA) on various cardiometabolic risk factors and hormonal parameters in patients with polycystic ovary syndrome (PCOS). We searched PubMed, EMBASE, SCOPUS, Cochrane Library, and Web of Science databases without language restrictions until May 2023 to find randomized controlled trials (RCTs) that assessed the impact of ALA supplementation on anthropometric, glycemic, lipid, oxidative stress, and hormonal parameters in women with PCOS. Outcomes were summarized using the standardized mean difference (SMD) and 95% confidence interval (CI) in a random-effects model. An I2 statistic of >60% established significant between-study heterogeneity. The overall certainty of the evidence for each outcome was determined using the grading of recommendations, assessment, development, and evaluations system. Seven RCTs met the inclusion criteria. The ALA group had significant reductions in fasting blood sugar (fasting blood sugar (FBS), n=7 RCTs, SMD, -0.60; 95% CI, -1.10 to -0.10; I2=63.54%, moderate certainty of evidence) and homeostatic model assessment for insulin resistance (homeostatic model assessment of insulin resistance (HOMA-IR), n=4 RCTs, SMD, -2.03; 95% CI, -3.85 to -0.20; I2=96.32%, low certainty of evidence) compared with the control group. However, significant differences were observed between the groups in body mass index, insulin, estrogen, follicle-stimulating hormone, luteinizing hormone, testosterone, low-density lipoprotein, highdensity lipoprotein, triglyceride, total cholesterol, malondialdehyde, or total antioxidant capacity profiles. ALA supplementation improves FBS and HOMA-IR levels in women with PCOS. ALA consumption is an effective complementary therapy for the management of women with PCOS.

Preemptive pregabalin for postoperative analgesia during minimally invasive hysterectomy: a systematic review and meta-analysis of randomized controlled trials

Ahmed Abu-Zaid,Osama Alomar,Nora F AlNaim,Fatimah Shakir Abualsaud,Mohammed Ziad Jamjoom,Latifa F AlNaim,Abdullah AMA Almubarki,Saeed Baradwan,Saud Abdullah Saud Aboudi,Faisal Khalid Idris,Meshael Fod 대한산부인과학회 2022 Obstetrics & Gynecology Science Vol.65 No.2

We aimed to perform a systematic review and meta-analysis of all randomized placebo-controlled trials (RCTs)that examined the analgesic benefits of preemptive pregabalin among patients undergoing minimally invasivehysterectomy. Five major databases were systematically screened from inception until August 29, 2021 Relevantstudies were evaluated for risk of bias. Endpoints were analyzed using the random-effects model and pooled asthe mean difference or risk ratio with a 95% confidence interval. Four studies with seven treatment arms met theinclusion criteria. The total sample size was 304 patients: 193 and 111 patients were allocated to the pregabalin andplacebo groups, respectively. Overall, the included studies revealed a low risk of bias. The summary results revealedthat the mean postoperative pain scores at rest were significantly lower in the pregabalin group than in the controlgroup at 0, 2, 4, 6, 12, and 24 hours. Moreover, the mean postoperative pain scores on movement/coughing weresignificantly lower in the pregabalin group than in the control group at 12 and 24 hours. The rate of patients whowere opioid-free postoperatively was significantly higher in the pregabalin group than in the control group. Therewas no significant difference between the groups in terms of the mean postoperative time to first rescue analgesicand the rates of adverse events. Compared with placebo, preemptive pregabalin was largely safe, and was correlatedwith superior analgesic effects in terms of lower postoperative pain scores and higher opioid-sparing effects. Additional RCTs are needed to confirm these findings.