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Re: Within or outside the standard of careFrom: Efrain Ramirez (eramirez@icepr.com)Wed May 30 16:46:54 2001
Dan -- I believe ACOG does not says that -- from ACOG Practice Bulletin -Nov./99 "Clinical Considerations and Recommendations What are the indications and contraindications to induction of labor? Indications for induction of labor are not absolute but should take into account maternal and fetal conditions, gestational age, cervical status, and other factors. Following are examples of maternal or fetal conditions that may be indications for induction of labor: Abruptio placentae Chorioamnionitis Fetal demise Pregnancy-induced hypertension Premature rupture of membranes Postterm pregnancy Maternal medical conditions (eg, diabetes mellitus, renal disease, chronic pulmonary disease, chronic hypertension) Fetal compromise (eg, severe fetal growth restriction, isoimmunization) Preeclampsia, eclampsia Labor also may be induced for logistic reasons, for example, risk of rapid labor, distance from hospital, or psychosocial indications. In such circumstances, at least one of the criteria in the box should be met or fetal lung maturity should be established (28). Medicine is neither black nor white - it is not a cookbook. In our group we seldom induce (in fact I don't recall when was my last elective induction)- but there are certain circumstances that it is permissible - even desirable -- like institutions with scant human resources -- "the physician whom the patient has good rapport will try to ensure that labor will occur when maximum physician, nursing, and support personnel coverage is available in case of labor complications" - One important thing to consider is to review outcomes - patient selection, etc.. "to insure that the induction procedure is not causing unexpected or preventable maternal or neonatal morbidity." In my view the practice of medicine is understanding both EBM and your own experience. We all know that there are poor articles written and - granted--poor experiences i.e. just "doing" ob-gyn through the years - Another point - IMHO - for what I've seen written by Garry Siegel - he does not write "utter nonsense" - Hope I didn't misspelled some words!!!
>ACOG defines elective induction of labor as "An induction done only for the
-- "Life is neither the notes nor the silence between the notes, but the music that arises out of sound and silence felt as a living whole. Stop choosing...between chaos and order, and live at the boundary between them, where rest and action move together..." David Whyte
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