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Re: boston trial From: Suddoc@aol.com Wed Oct 25 19:34:45 1995 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: philip@ICSI.Net: "Re: tocolytics Drugs?!" Previous message: Guttenberg Primo: "tocolytics Drugs?!" Maybe in reply to: Charlie Chambers: "boston trial" Charlie Chambers in a message dated 95-10-25 08:41:30 EDT, you write: >Reading over the Boston trial on "active management", the results to me >seem somewhat tainted by the fact that both arms of the study had a >cesarean section rate of nearly 20%. Being that this only included >primigravidas seems especially disconcerting. I know the argument will be >that their center is a high risk tertiary care center, but 1 out of 5 >primigravidas with a cesearean seems especially aggressive, active >management or not. You should not be disconcerted over the exclusive use of primiparas. AMOL (active management of labor) refers to the management of primigravidas in protocols I am aware of. If the intent is to lower the C-Section rate then multiparas are unsuited for this type of management. The C-Section rate in multiparas is approximately 5%. You cannot expect to achieve beter results than this. Another reason is the risk of uterine rupture is increased in multiparas so the risks of potentially large doses of pitocin for a patient who has a 95% probability of vaginal delivery outweigh any benefits of trying to decrease an all ready negligible secton rate. Most C-Sections occur in Primiparas, so the focus is on this type of patient. I heard what I must term a rumor from someone in contact with the Boston group that the study was affected by what is called the "Hawthorne Effect". The control group was of course aware of the AMOL protocols, and in a normal attempt to practice good medicine, unconsciously? began to modify some of their behavior along the lines of the study group. This may or may not have affected their findings. I cannot confirm that this is true as it was a verbal communication from someone who participated in an AMOL study at another site that was successful in reducing the C-Section rate. The Dublin studies never claimed to reduce the C-Section rate; only to shorten the length of labor. The Boston study did confirm this. This subject needs further study in the US before drawing any definitive conclusions about C-Section rates. Stephen Sudler, M.D. Private Practice Haverhill, MA Next message: philip@ICSI.Net: "Re: tocolytics Drugs?!" Previous message: Guttenberg Primo: "tocolytics Drugs?!" Maybe in reply to: Charlie Chambers: "boston trial"

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