Re: OB: NICE advises against caesarean section on demand
From: Efrain Ramirez (eramirezt@coqui.net)
Sun May 2 10:53:01 2004
Umbilical artery pH measurement
Umbilical artery pH, neonatal Apgar and neonatal encephalopathy are the
most reliable short term markers of poor longer term outcome such as
neurodevelopment disability, cerebral palsy and perinatal death.2
Guidelines on electronic fetal monitoring recommend that umbilical
artery pH is assessed following emergency CS2 and paired umbilical
artery and vein measurements are
taken. [evidence level 4] This information can be used to review fetal
wellbeing and to guide on-going care. It is can also be used for risk
management and audit purposes.
RECOMMENDATION
Umbilical artery pH should be performed after all CS for suspected fetal
compromise to allow review of fetal wellbeing and guide ongoing care of
the baby.
Slowly but surely --- it's a matter of time..
>At Fri, 30 Apr 2004, art fougner, md wrote:
>
>BMJ 2004;328:1031 (1 May), doi:10.1136/bmj.328.7447.1031
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>Collections under which this article appears:
>Pregnancy
>Guidelines
>News
>NICE advises against caesarean section on demand
>Zosia Kmietowicz
>London
>
>Pregnant women who request a caesarean section should not automatically
>get one if there are no medical reasons to support it, say new
>guidelines.
>
>Instead they should be properly counselled about the merits and demerits
>of caesarean section and vaginal birth and how labour can be managed so
>that they can make a fully informed choice about the best care for
>themselves and their baby. If a doctor still thinks that a caesarean
>section is inappropriate then the request can be declined, but the woman
>should be referred to another doctor.
>
>The new guidelines, published by the National Collaborating Centre for
>Women's and Children's Health for the National Institute for Clinical
>Excellence, outline the possible benefits and risks of caesarean section
>on the basis of available research.
>
>They also suggest how rates of caesarean section can be reduced—for
>example, by introducing fetal blood sampling alongside more standard
>tests, such as fetal heart monitoring, or by using external cephalic
>version at 36 weeks' gestation for women with a breech presentation.
>
>The rate of caesarean sections has been climbing for the past 25 years,
>and many people with an interest in obstetrics feel it is too high.
>
>Figures from the national sentinel caesarean section audit carried out
>for 2001 show that 21.5% of pregnant women in England and Wales had a
>caesarean section, although the rates varied—from 18% to 25%—around both
>countries. Of those women who did have a caesarean section, 7%
>(representing 1.5% of all births) were the result of the mother's
>request.
>
>Professor David James, professor of fetomaternal medicine and director
>of medical education at Queen's Medical Centre in Nottingham, estimates
>that 10% of indications for caesarean section are invalid. Since 2001,
>his unit has reduced its rate of caesarean deliveries from 29% to
>21-22%. It has done this by reducing the incidence of unnecessary
>induction of labour, moving from a two hourly to four hourly review of
>progress during labour, and encouraging women who have had a previous
>caesarean to opt for a vaginal birth.
>
>"There is no doubt that a smaller number of women having vaginal birth
>have complications than do those who have a caesarean section, but there
>are risks associated with both types of birth. If there was clear
>evidence that one way was better than another we would not need a
>guideline," said Professor James.
>
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>The guidelines can be accessed at www.rcog.org.uk or www.nice.org.uk
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>art fougner, md
>ich bin ein New Yorker
>
--
"The opposite of a correct statement is a false statement.
But the opposite of a profound truth may well be another profound truth."
Niels Bohr (1885 - 1962)
