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Re: Degenerated fibroid and pregnancy From: Griffiths Malcolm (Malcolm.Griffiths@ldh-tr.anglox.nhs.uk) Thu May 31 03:10:05 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Griffiths Malcolm: "Re: Degenerated fibroid and pregnancy" Previous message: Griffiths Malcolm: "Re: Degenerated fibroid and pregnancy" Received: from exchange-1.smtp (hide195.nhs.uk [195.107.47.195]) by mail.medispecialty.com (8.9.3/8.9.3) with ESMTP id DAA32605 for <ob-gyn-l@obgyn.net>; Thu, 31 May 2001 03:10:01 -0500 Message-ID: <e59d7295ef6be0566b3c04f747eaabbd3b15fb7d@> From: "Griffiths Malcolm (RC9) Luton & Dunstable Hospital TR" <Malcolm.Griffiths@ldh-tr.anglox.nhs.uk> To: "'ob-gyn-l@obgyn.net'" <ob-gyn-l@obgyn.net> Subject: Re: 66% Induction Rate Date: Thu, 31 May 2001 09:06:28 +0100 MIME-Version: 1.0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: 8bit X-MIME-Autoconverted: from quoted-printable to 8bit by mail.medispecialty.com id DAA32605 If you guys are quoting a baseline CS rate of 25% and induction carries an increased risk of CS over and above this risk, it strikes me that the risk of CS with induction can't really be any lower than about 30% (if it is higher than 25%)! Of course the problem is that the 25% figure may not be what applies to normal pregnancies in a range of multips and primips who have reached 38 weeks gestation without having Severe IUGR, pre-eclampsia, breech, etc. There is a concept which has been promoted in the UK of the "normal primip" and looking at outcomes in terms of such cases using large databases and making valid comparisons between units or individual practices. It may be a useful concept in this matter. -----Original Message----- From: ainsron@msn.com [mailto:ainsron@msn.com] Sent: 30 May 2001 22:30 To: Multiple recipients of list OB-GYN-L Subject: Re: 66% Induction Rate The best data are probably in this article in the Green Journal, but they certainly don't support a 30% failure rate with induction. They do show a 40% increase in rate of cesarean section vs. expectant management in post dates pregnancies (increase from 14% to 19%). But the differences are due to risk factors, not induction per se. As they point out, it would take a much larger RCT to get all the answers. Objective: To determine the effects of labor induction on cesarean delivery in post-date pregnancies. Materials and Methods: A total of 1325 women who reached 41 weeks' gestation between December 1, 1997, and April 4, 2000, and who were scheduled for induction of labor at 42 weeks were included in this prospective observational study. Cesarean delivery rates were compared between those women who entered spontaneous labor and those who underwent induction. Women with any medical or obstetric risk factors were excluded. A power analysis was performed to determine how many patients would be required to show no effect of labor induction on cesarean delivery with a of .8 and an of .05. Approximately 5200 patients would be required, taking an estimated 28 years to accrue at our institution. Results: Admission to delivery was longer (5.7 compared with 11.1 hours, P = .001) and more likely to extend beyond 10 hours (55 compared with 24%, P = .001) in the induction group. Cesarean deliveries were increased in the induced group (19 compared with 14%, P < .001) due to cesarean for failure to progress (14 compared with 8%, P < .001). Independent risk factors for cesarean delivery included nulliparity, undilated cervix prior to labor, and epidural analgesia. Correction for these risk factors using logistic regression analysis revealed that it was the risk factors, and not induction of labor per se, that increased cesarean delivery. Conclusion: Risk factors intrinsic to the patient, rather than labor induction itself, are the cause of excess cesarean deliveries in women with prolonged pregnancies. University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA (Obstet Gynecol 2001:97:911-915. © 2001 by The American College of Obstetricians and Gynecologists.) > ><< Any induction carries with it a %30 failure rate leading to cesarean >section >> > >show me the data to support this statement. -- Ronald E. Ainsworth, MD ********************************************************************** This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you have received this email in error please notify the system manager. This footnote also confirms that this email message has been swept by MIMEsweeper for the presence of computer viruses. http://www.mimesweeper.com ********************************************************************** Next message: Griffiths Malcolm: "Re: Degenerated fibroid and pregnancy" Previous message: Griffiths Malcolm: "Re: Degenerated fibroid and pregnancy"

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