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POSTPARTUM RUBELLA IMMUNIZATION Systematic Review of the Literature What do the RCT s tell us Elizabeth Shaw Assis

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POSTPARTUM RUBELLA IMMUNIZATION Systematic Review of the Literature What do the RCT s tell us Elizabeth Shaw Assis

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    3. and to this end, I would like to give credit to my colleagues, and the Bureau for Reproductive Health for supporting this project. In the interests of time, I have included little in presesntation which relates to the methodology, but it is included in your handout for your interest. Our basic inclusion criteria were interventions from birth to one year that included maternal outcomes. and to this end, I would like to give credit to my colleagues, and the Bureau for Reproductive Health for supporting this project. In the interests of time, I have included little in presesntation which relates to the methodology, but it is included in your handout for your interest. Our basic inclusion criteria were interventions from birth to one year that included maternal outcomes.

    4. These are the topic areas included in the "other category". We have completed the reviews for the first 6. As you can see,there is very little in the literature that directly addresses postpartum care in the hospital, other than as it relates to breastfeeding. The other issue that will become obvious to you, is the general paucity of good research in this are. There are few studies, and many of them are poor quality. After conversation with my co-presenter, and recognizing my time constraints, I have decided to present the data from Postpartum support, Postpartum depression and anxiety and early discharge, in the hopes that this will help to inform the discussion around quality indicators for postpartum care. These are the topic areas included in the "other category". We have completed the reviews for the first 6. As you can see,there is very little in the literature that directly addresses postpartum care in the hospital, other than as it relates to breastfeeding. The other issue that will become obvious to you, is the general paucity of good research in this are. There are few studies, and many of them are poor quality. After conversation with my co-presenter, and recognizing my time constraints, I have decided to present the data from Postpartum support, Postpartum depression and anxiety and early discharge, in the hopes that this will help to inform the discussion around quality indicators for postpartum care.

    6. INTRODUCTION Immunization to child-bearing women prevents congenital rubella syndrome Postpartum period - excellent opportunity to vaccinate non-immune women Currently no systematic review of the safety and efficacy of the rubella vaccine postpartum

    7. SEARCH RESULTS Two studies met inclusion criteria Both examined sero-conversion rates and adverse effects Two vaccines examined Candehill (Oxford, Lancet,1983) RA 27/3* (Vancouver, Lancet, 1997)

    8. METHODOLOGIC QUALITY Assessed using the Jadad scale Oxford 1/5 quasi-randomization (alternate months) blinding unclear Vancouver 5/5

    9. Postpartum Rubella Immunization Clinical question: What is the safety and efficacy of the rubella vaccines given immediately postpartum?

    10. Rubella Results Seroconversion Oxford 1983 97.6% seroconversion with RA 27/3 vs 82.2% with Candehill (p<.01) Side effects (immediate): painful joints (24%), soreness at injection site(11%) and fever (11%).

    11. Postpartum Rubella-Results Adverse Reactions Vancouver 1997 Small significant difference in acute adverse reactions between placebo (11,20, 10%) and vaccine: rash, arthralgia, adenopathy (25, 30 19%) Odds Ratio (CI) 2.57(1.58-4.21), 1.73(1.17-2.57),2.21(1.31-3.96) There is a significant increase in complaints of arthralgia at one year in vaccinated women 22 vs 15% OR 1.58 (1.01-2.45)

    12. Postpartum Rubella Conclusions: The RA 27/3 rubella vaccine is safe and effective in the postpartum period. Women should be counseled about the slight increased risk of arthralgia at one year. Questions: 1. Does this effect persist in other populations? 2. Does this effect persist beyond one year? 3. Is this specific to postpartum women?

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