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Re: OB: Fetal Heart Monitoring Fails to Find Cerebral Palsy PrecursorLesionsFrom: Terrence.Jones@kp.orgWed Apr 7 12:01:03 2004
This is a multipart message in MIME format. --=_alternative 005C8B5688256E6F_ Content-Type: text/plain; charset="us-ascii" There were far more important findings discussed in Houston. Like educating the legislative mind to the difference between therapeutic stem cell cloning for disease, and the limitations of any reproductive use due to constraints of imprinted/regulated embryonic genes. Like proteomic markers and spectral analysis for detection of neoplasia in early stage (or, for the detection of pretty much any and everything). Like limitations of cell culture without attention to extracellular matrix, in terms of gene expression and cellular phenotype. To name a few. Rehashing the known limitations of FHR monitoring to detect CP, an event already rare, and 9/10ths of which occur before labor, seems a bit of a waste. The "gist" is - monitoring reduces intrapartum demise, and seizures. What comparison studies reveal, is that, as in animal studies, the chemoreceptor can be 'reset'. Reducing intervention by complimentary negative predictive value of scalp lactate, O2 sat, or ST segemnt changes - may be limited by indication, only. This topic 'isn't the droid You're looking for'. "Move along". tj evsono@pipeline.com (art fougner, md) Sent by: ob-gyn-l@obgyn.net 04/07/2004 07:14 AM Please respond to ob-gyn-l To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> cc: Subject: OB: Fetal Heart Monitoring Fails to Find Cerebral Palsy Precursor Lesions By Anthony J. Brown, MD NEW YORK (Reuters Health) Mar 26 - Electronic fetal heart monitoring is not useful in detecting the cerebral white matter injury that precedes cerebral palsy, according to findings presented Friday at the annual meeting of the Society for Gynecologic Investigation in Houston. This may help explain why the incidence of cerebral palsy has not fallen since this type of fetal monitoring was adopted. "Electronic fetal monitoring was introduced in the late 1960s and it was hoped that we could detect which babies were experiencing hypoxia during labor and then intervene," lead author Dr. Janyne Althaus, from Johns Hopkins University in Baltimore, told Reuters Health. "Such monitoring gradually became standard of care without ever having a true randomized controlled trial to see if it actually" helped prevent cerebral palsy. "In our study, we found no significant difference in any monitoring characteristics between infants diagnosed with brain injury in the neonatal period and healthy infants," Dr. Althaus noted. This suggests that "electronic fetal monitoring really can't tell us the status of the baby's brain." The findings stem from a case-control study of 40 brain injured infants and 40 control infants born at one tertiary hospital between July 1999 and September 2001. The analysis focused on heart tracings obtained for the last hour of the first stage of labor for vaginal deliveries and for the last hour prior to delivery for cesarean sections. As noted, no significant differences were seen between the groups in any monitoring parameter, including baseline fetal heart rate, time spent with a fast or slow heart rate, heart rate variability, and number of decelerations or accelerations. "Although these findings are somewhat discouraging, it's good for us to know the limitations of our technology," Dr. Althaus said. "The assumption has always been that fetal brain injury is something that should be easy to pick up. Apparently, it's not." -------------------------------------------------------------------------------- art -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -- art fougner, md ich bin ein New Yorker
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