Re: Switching patients**41 plus
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Thu Aug 26 21:35:36 2004
Thanks, Art. You are a gentleman and scholar.
Garry
At Thu, 26 Aug 2004, art fougner, md wrote:
>
>Obstet Gynecol. 2003 Jun;101(6):1312-8.
>Labor induction versus expectant management for postterm pregnancies: a
>systematic review with meta-analysis.
>
>Sanchez-Ramos L, Olivier F, Delke I, Kaunitz AM.
>
>Department of Obstetrics and Gynecology, University of Florida,
>Jacksonville, Florida, USA. luis.sanchez@jax.ufl.ede
>
>OBJECTIVE: To compare routine labor induction with expectant management
>for patients who reach or exceed 41 weeks' gestation. DATA SOURCES:
>Computerized databases, references in published studies, and textbook
>chapters in all languages were used to identify randomized controlled
>trials (RCTs) evaluating induction and expectant management of labor for
>postterm pregnancies. METHODS OF STUDY SELECTION: We identified RCTs
>that compared induction and expectant management for uncomplicated,
>singleton, live pregnancies of at least 41 weeks' gestation and
>evaluated at least one of the following: perinatal mortality, mode of
>delivery, meconium-stained fluid, meconium aspiration syndrome, meconium
>below the cords, fetal heart rate (FHR) abnormalities during labor,
>cesarean deliveries for FHR abnormalities, abnormal Apgar scores, and
>neonatal intensive care unit (NICU) admissions. The primary outcomes
>assessed were cesarean delivery rate and perinatal mortality.
>TABULATION, INTEGRATION, AND RESULTS: Sixteen studies met inclusion
>criteria for this review. For each study with binary outcomes, an odds
>ratio (OR) with 95% confidence intervals (CIs) was calculated for
>selected outcomes. Estimates of ORs for dichotomous outcomes were
>calculated using fixed and random-effects models. Homogeneity was
>tested across the studies. Compared with women allocated to expectant
>management, those who underwent labor induction had lower cesarean
>delivery rates (20.1% versus 22.0%) (OR 0.88; 95% CI 0.78, 0.99).
>Although subjects whose labor was induced experienced a lower perinatal
>mortality rate (0.09% versus 0.33%) (OR 0.41; 95% CI 0.14, 1.18), this
>difference was not statistically significant. Similarly, no significant
>differences were noted for NICU admission rates, meconium aspiration,
>meconium below the cords, or abnormal Apgar scores. CONCLUSION: A
>policy of labor induction at 41 weeks' gestation for otherwise
>uncomplicated singleton pregnancies reduces cesarean delivery rates
>without compromising perinatal outcomes.
>
>art
>
>At Thu, 26 Aug 2004, Garry E. Siegel, M.D. wrote:
>>
>>Ignoring the social conundrum here, Lenora, I would be a bit reluctant
>>to send home someone who is 41+, favorable, and doesn't want to go home.
>>While it is very unlikely, any poor outcome would lead to the
>>question--why didn't you keep her.
>>
>>I disagree with your commment about no medical indication, as she is
>>41+, and that is an indication. Sanchez, I believe, did a meta-analysis
>>in the Green Journal in 11/03 and the conclusion was that delivery at 41
>>weeks irrespective of cervical exam and parity led to the best outcomes.
>>
>>Garry
>>>
>>>---A former patient comes in to L&D in false/prodromal labor. She is 41+
>>>weeks with a favorable cervix (3/70/-1) and does not want to go home--the FHTs
>>>are reassuring. She knows me and asks to be induced. She can't understand
>>>why I tell her to go home and see her own obstetrician on Monday (this is
>>>Sat.) when he comes back from vacation. If she were our patient I would grant
>>>her wish, but don't feel it appropriate to induce Dr. M.'s patient with no
>>>medical indication.
>>>
>>--
>>Garry E. Siegel, M.D.
>>Private Practice
>>Roswell, GA
>>
>--
>art fougner, md
>ich bin ein New Yorker
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
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