Re: Ob: Preterm labor
From: Efrain Ramirez (eramirezt@coqui.net)
Thu Feb 1 10:47:55 2007
Ditto..
Ef
At Wed, 31 Jan 2007, zygote@icsi.net wrote:
>
>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
>
>"Life is difficult"
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