Analysis of a Current Research Article, Research Paper Example

Viswanathan, M (2008). Tailoring systematic reviews to meet critical priorities in maternal health in the intrapartum period. Paediatric and Perinatal Epidemiology, 22(Suppl.1): 10–17.

Introduction to problem being investigated

This study is a systemic literature review summarizing essential maternal health data highlighting research priorities with the aim of relating them to current studies. Subsequently, knowledge and research methodology gaps within the literature were identified for further systemic literature analysis. The researcher contends that contemporary nursing practice relies greatly on evidence based criteria for interventions. However, the degree to which systemic literature reviews address maternal health interventions was obscure (Viswanathan, 2008).

Consequently, the researcher undertook as an exploration into thedegree to which intrapartum health was given attention as a priority. One hundred and eight systemic reviews were retrieved from databases. They were published no later than five years and related maternal morbidities. Key terms ‘delivery and obstetrics’ were used to retrieve data. The main focus of this systemic literature review was to derive evidence based studies investigating health and research priorities; identify evidence as well as gaps in the body of knowledge (Viswanathan, 2008).

The problem of interest being investigated while embedded in evaluating maternal morbidity and mortality the researcher is not sure that interventions have a strong evidence based practice foundation. The assumption is that perhaps, enough research might not have been done on the subject to offer solidbackground to reasons why certain procedures are still being performed in the care of mothers prior during and after delivery (Viswanathan, 2008).

Detailed description of the study

Methodology

Thisresearcher chose the systemic literature review method.Published data on maternal morbidities were retrieved fromwebsites managed by organizations aligned to research priorities. Four hundred and eighty eight systemic reviews were taken from Medline of works published between 2002 and January 2007. Key terms delivery and obstetrics were used in evaluating the data selected. Links between health and research priorities; existing and missing evidence were assessed. The inclusion criteria pertained to studies written in English containing abstracts and in which the systemic reviews could be clearly identified. Specific to this study these systemic reviews had to maintain a particular scientific status for selection (Viswanathan, 2008).

This included utilization of systemic review criteria; synthesis/critical appraisal of evidence and an identifiable inclusion and exclusion criteria. These feature had to be relevant to the investigation being reviewed that of interventions in the intrapartum period. Ultimately, one hundred and eight abstracts were selected. Ninety-nine of them could have been accessed as full text articles. Twelve of these full text articles were discarded due to lack of comprehensive appraisals. Duplicates were found in four peer-reviewed studies retrieved, which originated from Cochrane analyses(Viswanathan, 2008).

Content exclusions were made in one study, which highlighted cervical cancer in the preconception phase of the pregnancy. Along withintrapartum interventions the researchers alluded to pain management during the maternal care; resulting in exclusion of three studies. Six studies did not adequately compare interventions’ risks and benefits. Conversely, it was found that five studies examined a broad spectrum of risks without addressing benefits. Two studies established outcomes without assessing value of interventions and had to be excluded. Another two report only care delivered by midwifery centers. These exclusions accounted for a total amount of 19 reviews, which were incompatible for this systemic study. Precisely, every study that was included focused on the interventions’ nature from the perspective of primary outcome as well as a sub-analysis pertaining to disparities occurring in each situation(Viswanathan, 2008).

Results

Sixty-four reviews were eligible for inclusion (17 studies/27%). They focused on the typeof delivery intervention and identifying comparative risks associated with adverse events during the mode of delivery. Importantly, these studies differentiated among modes of delivery for at risk groups and normal deliveries. At risk groups were classified as premature rupture of membranes; breech at term; post term low birth weight;near term twins; previous caesarean section deliveries; HIV mothers and mothers with hepatitis C infection (Viswanathan, 2008).

Two studies evaluated the implication of cesarean section requests by parents when there was no obstetrical indication form the surgery.Another two reports compared caesarean delivery with vaginal births. Gaps in evidence were identified in three reviews while elevated induction of labor in comparison to non-induction procedures emphasizing drug interactions such asmisoprostol,corticosteroids, vaginal prostaglandin and hyaluronidase. These reviews sought to establish a relationship between the drug administration and uterine atrophy (Viswanathan, 2008).

Ten other studies reviewed analgesic administration during labor and its effects on the fetus and mother in the post delivery period. In nine reviews a distinct comparison between vaginal and cesarean delivery was pursued. Specific evaluations of closure to caesarean site, episiotomy incisions’ closure as well as anal sphincter repair conducted to prevent shoulder dystocia were assessed in these studies. Six reviews focused on preventing fetalmalrepresentations in cephalic version prior to delivery. Four studies were retrieved that assessed non-surgical safety measures; three more reviewed antibiotic use in perineum healing and caesarean section post infection prevention therapy. The final four reviews highlighted diagnostic testing and prognosis declarations (Viswanathan, 2008).

Conclusions

This researcher concluded that these systemic literature reviews on maternal priorities studies highlighting past five years events contained data mainly on reducing harm during delivery. Further, it was concluded that if these articles are to effectively evaluate critical perinatal health issues, it is imperative that researchers thoroughly assess the impact of adverse events from a preventions perspective. An attempted explanation sited the challenge of low serious intranatal complication incidence negating research in the preventative mechanisms of adverse outcomes (Viswanathan, 2008).

Critical analysis

Two important issues were raised in this systemic review article. Firstthe main focus was to derive evidence based studies investigating health and research priorities; identify evidence as well as gaps in the body of knowledge. The contention is that while contemporary nursing practice relies greatly on evidence based criteria for interventions, the degree to which systemic literature reviews address maternal health interventions was obscure(Viswanathan, 2008).

A second assumption is released in the conclusion when the researcher advances that if systemic literature reviews are to effectively evaluate critical perinatal health issues, it is imperative that researchers thoroughly assess the impact of adverse events from a prevention perspective. An explanation was then sited implying a low serious intranatal complication incidence negating research in the preventative mechanisms of adverse outcomes as was discovered in the review (Viswanathan, 2008).

In critically commenting on the first assumption regarding systemic literature reviews providing obscure evidence regarding maternal interventionsDiana Gil-González, Mercedes Carrasco-Portiño, and Maria Teresa Ruiz (2006) conducted a systemic literature review confirming knowledge gaps in scientific literature on maternal mortality. These researchers reviewed studies published between 2000 -2004. They contend that maternal mortality has garnered much empirical and theoretical data. However the data revealed seems insignificant because maternal mortality continues to rise in America with no relevant solutions(Gil-González,Carrasco-Portiño& Ruiz, 2006).

This conclusion seems to negate the second assumption made by Meera Viswanathan (2008) concluding that there is low serious intranatal complication incidence. Maybe, maternal mortality is not classified a serious intranatal complication. Besides,these researchers explained that scientific research on maternal mortality investigates clinical factors; an approach, which they believed was not valuable to the science(Gil-González et.al, 2006).

Health care providers require an understanding of this dysfunction from a much broader perspective, they argued. It should encompass the impact of political, economic and social macrostructural factors influencing maternal mortality in America. In their report many causes of maternal deaths were supported utilizing World Health Organization data. The comparative burden of maternal death globally was highlighted in this report. Precisely, unsafe abortions associated with hemorrhage and obstructed labour is grossly underrepresented in the scientific literature. In concluding the researchers again confirmed a shortage of published data regarding the political and cultural determinants of maternal mortality (Gil-González et.al, 2006).

Personal conclusions after analysis

My personal conclusions are in support of a wider perspective of health outcomes regarding maternity care in America. This article as many other give a narrow view of the problem related to maternal health in United States of America. When Diana Gil-González, Mercedes Carrasco-Portiño, and Maria Teresa Ruiz (2006) speak of the political, cultural, economic and macrostructural effects of maternal mortality this was a major exclusion factor in Meera Viswanathan (2008) systemic literature review efforts of  determining the extent to which systemic literature reviews address maternal health interventions when nursing science relies on this evidence for safe practice.

References

Gil-González, D. Carrasco-Portiño, M., & Ruiz, T. (2006).Knowledge gaps in scientific literature on maternal mortality: a systematic review.Bull World Health Organ. 84(11); 903–909

Viswanathan, M (2008). Tailoring systematic reviews to meet critical priorities in maternal health in the intrapartum period. Paediatric and Perinatal Epidemiology, 22(Suppl.1): 10–17.