Re: Ob: Preterm labor
From: zygote@icsi.net
Wed Jan 31 21:36:44 2007
AMEN to the MAN! RJC
>
> 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, Iexpect 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 thattocolysis "works" statistically, that doesn't mean that itmight still be >
beneficial in some select cases.
>
> From the Man! On 29 Jan 2007 at 9:48, DoctorJoe@aol.com wrote:
> Exactly. The main problem is, IMHO, the studies of preterm labor and
tocolysishave 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, althoughit may well be > related.
>
> Joe P.
>
> "Chuck Norris is the reason why Waldo is hiding."
>
Robert J. Carpenter, Jr. MD
6624 Fannin, #2720
Houston, TX 77030
(O) 713-795-4600
(F) 713-795-4422
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