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Objective: Induction of labor (IOL) is one of the most common obstetric interventions, with cervical ripening required for half of all inductions. Randomized clinical trials comparing balloon catheters and vaginal prostaglandins are generally underpowered for safety outcomes. We aim to compare effectiveness and safety by re-analyzing individual participant data from numerous trials comparing these two methods of cervical ripening. Study Design: Raw data was sought from eligible RCTs comparing balloon catheters and vaginal prostaglandins (PGE1 and/or PGE2). The primary outcomes were caesarean section (CS) and its indications (i.e., fetal compromise or failure to progress), a composite of adverse perinatal outcome (Apgar < 7 at 5 min, arterial umbilical cord pH < 7.1, admission to NICU, seizures, severe respiratory compromise, infection, neonatal death, or stillbirth), and a composite of adverse maternal outcome (admission to ICU, infection, severe postpartum hemorrhage, or death). The analysis followed intention-to-treat and considered clustering within trials. Result(s): We identified 13 eligible RCTs of which data was available from eight (3772 participants) with the data from three PROBAAT combined (PROBAAT 1+M+P). IOL with balloon catheters and vaginal prostaglandins did not have significantly different rates of CS (RR 1.09, 95% CI 0.97-1.22). However, balloon catheters were associated with significantly higher rates of CS for failure to progress (RR 1.23, 95% CI 1.01-1.51; Figure 1). CS for fetal compromise occurred less often, although the difference was not statistically significant (RR 0.85, 95% CI 0.66-1.09). Balloon catheters were associated with reduced composite adverse perinatal outcomes (Figure 2) compared to vaginal prostaglandins (RR 0.80, 95% CI 0.67-0.97). There were no differences noted for composite adverse maternal outcomes between the two methods (RR 1.00, 95% CI 0.86-1.16). Conclusion(s): For cervical ripening in IOL, balloon catheters and vagi

Objective: Induction of labor (IOL) is one of the most common obstetric interventions, with cervical ripening required for half of all inductions. Randomized clinical trials comparing balloon catheters and vaginal prostaglandins are generally underpowered for safety outcomes. We aim to compare effectiveness and safety by re-analyzing individual participant data from numerous trials comparing these two methods of cervical ripening. Study Design: Raw data was sought from eligible RCTs comparing balloon catheters and vaginal prostaglandins (PGE1 and/or PGE2). The primary outcomes were caesarean section (CS) and its indications (i.e., fetal compromise or failure to progress), a composite of adverse perinatal outcome (Apgar < 7 at 5 min, arterial umbilical cord pH < 7.1, admission to NICU, seizures, severe respiratory compromise, infection, neonatal death, or stillbirth), and a composite of adverse maternal outcome (admission to ICU, infection, severe postpartum hemorrhage, or death). The analysis followed intention-to-treat and considered clustering within trials. Result(s): We identified 13 eligible RCTs of which data was available from eight (3772 participants) with the data from three PROBAAT combined (PROBAAT 1+M+P). IOL with balloon catheters and vaginal prostaglandins did not have significantly different rates of CS (RR 1.09, 95% CI 0.97-1.22). However, balloon catheters were associated with significantly higher rates of CS for failure to progress (RR 1.23, 95% CI 1.01-1.51; Figure 1). CS for fetal compromise occurred less often, although the difference was not statistically significant (RR 0.85, 95% CI 0.66-1.09). Balloon catheters were associated with reduced composite adverse perinatal outcomes (Figure 2) compared to vaginal prostaglandins (RR 0.80, 95% CI 0.67-0.97). There were no differences noted for composite adverse maternal outcomes between the two methods (RR 1.00, 95% CI 0.86-1.16). Conclusion(s): For cervical ripening in IOL, balloon catheters and vagi

BACKGROUND: The objective of this study was to assess the level of knowledge of cervical cancer among Bangladeshi women and to assess their willingness to receive the human papillomavirus (HPV) vaccine. METHODS: A population-based, cross-sectional survey was conducted from July to December 2011 in one urban and one rural area of Bangladesh. A total of 2037 ever-married women, aged 14 to 64 years, were interviewed using a structured questionnaire. Data on socio-demographic characteristics and knowledge of cervical cancer were collected. Willingness to receive the HPV vaccine was assessed. Univariate analyses were completed using quantitative data collected. Multivariable logistic regression models were developed to identify factors associated with having heard of cervical cancer and the HPV vaccine. RESULTS: The majority of study participants reported to have heard of cervical cancer (urban: 89.7%, rural 93.4%; P = 0.003). The odds of having heard of cervical cancer were significantly higher in urban women aged 35-44 years (aOR: 2.92 (1.34-6.33) and rural women aged 25-34 years (aOR: 2.90 (1.24-6.73) compared to those aged less than 24 years. Very few women reported to have detailed knowledge on risk factors (urban:9.1%, rural: 8.8%) and prevention (urban: 6.4%, rural: 4.4%) of cervical cancer. In our sample, one in five urban women and one in twenty rural women heard about a vaccine that can prevent cervical cancer. Among urban women, secondary education or higher (aOR: 3.48, 95% CI: 1.67-7.25), age of 20 years and above at marriage (aOR: 2.83, 95% CI: 1.61-5.00), and high socioeconomic status (aOR: 2.25, 95% CI: 1.28-3.95) were factors associated with having heard of the HPV vaccine. Willingness to receive the HPV vaccine among study participants either for themselves (urban: 93.9%, rural: 99.4%) or for their daughters (urban: 91.8%, rural: 99.2%) was high. CONCLUSIONS: Detailed knowledge of cervical cancer among Bangladeshi women was found to be poor. Education on

BACKGROUND: There has been no population-based study on human papillomavirus (HPV) prevalence or its genotypes in Bangladesh; a country eligible for GAVI funding for HPV vaccine. METHODS: We used baseline survey data of a prospective cohort study that was conducted in one urban and one rural area of Bangladesh. A total of 997 urban and 905 rural married women, aged 13 to 64 years, were enrolled in the baseline during July-December, 2011. Information was collected on socio-demographic characteristics and potential risk factors for HPV infection followed by gynecological examination and collection of endocervical samples using the cervical cytobrush (Digene cervical sampler). HPV DNA testing was done by Polymerase Chain Reaction (PCR) using a consensus primer set. RESULTS: Prevalence of any HPV infection was 7.7% with no significant difference between urban and rural women. Most common high-risk genotypes were HPV16, HPV66, HPV18, HPV45, HPV31 and HPV53. Urban women working as housemaids or garment workers were at higher risk of any HPV infection (OR = 2.15, 95% CI: 1.13-4.11) compared to housewives. Rural women whose husband lived overseas were almost two times more likely to have any HPV infection (OR = 1.93; 95% CI 1.05-3.55) compared to women whose husbands lived with them. CONCLUSION: The prevalence of HPV infection among Bangladeshi women is similar to other regions of Asia. However, type-specific patterns are different. The study findings will inform the formulation of HPV vaccination policies in Bangladesh, monitoring the impact of vaccination programmes, and the identification of target populations for screening.