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Re: Ob: Preterm laborFrom: DoctorJoe@aol.comMon Jan 29 08:46:14 2007
In a message dated 1/29/2007 8:20:54 A.M. Central Standard Time, rkaplan@triad.rr.com writes: I am a believer in evidenced based medicine and I believe that "preterm labor" is overdiagnosed and overtreated. Having said that, I expect that we all have had that one patient with a 3 cm/effaced cervix, 0 station, who with hospitalization and/or terb. pump managed to carry the pregnancy to 36 weeks and delivered as soon as she got up and about or as soon as the pump was stopped. I guess I'm trying to say that just because it is hard to prove that tocolysis "works" statistically, that doesn't mean that it might still be beneficial in some select cases. Exactly. The main problem is, IMHO, the studies of preterm labor and tocolysis have to be rigorously designed to exclude (as best as can be done, at least) those false positive cases so as not to be studying overdiagnosed illness (i.e. NON illness). So if you look at the definition of "preterm labor" in most published studies, the patients included are often too far along in labor for anything to work very well anyway. I think all seasoned obstetricians would grant you that a patient in established labor at 4-5cm is NOT going to respond to tocolytic therapy. But you can't take people with a soft, 1cm cervix and contractions as part of the study, or you'll be overdiagnosing and overtreating, as you say. So the studies in the published literature (which show no benefit) are designed such that they WON'T show any benefit. So in day to day practice, you're left with treating people earlier in the process, hoping that your overtreatment of some people doesn't cause more trouble/expense than the benefit of catching those people that it helps. I guess this is a kind of medical macro application of the Heisenberg Uncertainty Principle. I think it applies to cerclage, as well. But that's another story for another day, although it may well be related. Joe P. "Chuck Norris is the reason why Waldo is hiding."
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