Re: 66% Induction Rate
From: Larry Glazerman (l.glazerman@rcn.com)
Wed May 30 15:48:55 2001
I'm not sure I agree with the 30% failure rate for inductions. I'm not
convinced the evidence would show that a multip with a favorable cervix
being induced has a 30% section rate.
At 07:43 AM 5/30/01 -0500, you wrote:
>Any induction carries with it a %30 failure rate leading to cesarean
>section and of course the morbidities that entails, if this MD did 66%
>inductions and had the %30 failure rate then if he had 100 deliveries a
>year at his induction rate he would have 22 c/sxn from failed
>inductions; add that to 25% baseline average c/sxn rate from the
>remainder of the deliveries he did not induce (25% of 34= ~8) therefore
>he may have a rough c/sxn rate of about 32 (rought estimate), this is
>higher than the baseline ob 25% c/sxn rate which if one did 100
>deliveries they would have 25. What is your colleagues overall c/sxn
>rate compared to the group? compare that against the morbidities he
>encounters because of the extra c/sxn, and of course infections of both
>the neonate and mother, and finally do the neonatal outcomes differ in
>terms of morbidity (days in the NICU) and mortality. Bottom line is
>usually to compare neonatal morbidity and of course financial cost.
>At Wed, 30 May 2001, Steve & Eryl Raymond wrote:
> >
> >Of course it should be looked into. There is usually a reason why
> >patterns of practice evolve, usually they are based on medical evidence
> >about what procedures have the lowest risk. If somebody falls outside
> >of the range of usual practice of his peers, then either he has found
> >out something the others haven't; his practice population (case-mix) is
> >significantly different from the others; or he is practising high risk
> >procedures which other doctors would avoid.
> >
> >In order to avoid picking on an individual and thus risking shouts of
> >persecution, look at all inductions prospectively for a period of time
> >and make some comparisons and assessments on how many are medical and
> >how many are not.
> >
> >stray
> >
> >mark decker wrote:
> >
> >> pretty much exactly the question - just not directed at this one doc
> >> - as it seems people think the focus is on the one doc - it is not my
> >> main question at all..
> >>
> >> while he has the 66% induction rate - that IS NOT the issue -
> >> the issue - or more accurately the question is..
> >>
> >> does this rate <one individual or many> lead to higher morbidity -
> >> complications etc for mom and baby?
> >>
> >> if not - not so bad..
> >> but still - if it does not reduce risk either -...???
> >>
> >> does the list really feel it is perfectly ok to induce at say 66 or
> >> 75% or 100% if there is no benefit?
> >>
> >> is it really ok to have a rate of induction >50% if it does not lead
> >> to reduced risks and better outcomes?
> >>
> >> cost of induction over spontaneous labor?
> >> risk of suit if a maloccurence presents itself?
> >
> >Dr.S.H. Raymond
> >Head of Department of O & G
> >Empangeni Hospital
> >South Africa 3880
> >Phone: (+27) 35-7721111
> >Fax: (+27) 35-7922596
>
>--
>Vik MD, NY
--
Larry R. Glazerman, MD
Ob-Gyn at Trexlertown
610-402-0161
l.glazerman@rcn.com
