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Re: Switching patients**41 plus From: art fougner, md (evsono@pipeline.com) Thu Aug 26 17:11:50 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley, MD: "Re: GYN: First pap smear" Previous message: RModugno@aol.com: "Re: GYN: =?ISO-8859-1?B?oEZpcnN0IHBhcCBzbWVhcg==?MIME-Version: 1.0" In reply to: Garry E. Siegel, M.D.: "Re: Switching patients**41 plus" Next in thread: Garry E. Siegel, M.D.: "Re: Switching patients**41 plus" Reply: Garry E. Siegel, M.D.: "Re: Switching patients**41 plus" Obstet Gynecol. 2003 Jun;101(6):1312-8. Labor induction versus expectant management for postterm pregnancies: a systematic review with meta-analysis. Sanchez-Ramos L, Olivier F, Delke I, Kaunitz AM. Department of Obstetrics and Gynecology, University of Florida, Jacksonville, Florida, USA. luis.sanchez@jax.ufl.ede OBJECTIVE: To compare routine labor induction with expectant management for patients who reach or exceed 41 weeks' gestation. DATA SOURCES: Computerized databases, references in published studies, and textbook chapters in all languages were used to identify randomized controlled trials (RCTs) evaluating induction and expectant management of labor for postterm pregnancies. METHODS OF STUDY SELECTION: We identified RCTs that compared induction and expectant management for uncomplicated, singleton, live pregnancies of at least 41 weeks' gestation and evaluated at least one of the following: perinatal mortality, mode of delivery, meconium-stained fluid, meconium aspiration syndrome, meconium below the cords, fetal heart rate (FHR) abnormalities during labor, cesarean deliveries for FHR abnormalities, abnormal Apgar scores, and neonatal intensive care unit (NICU) admissions. The primary outcomes assessed were cesarean delivery rate and perinatal mortality. TABULATION, INTEGRATION, AND RESULTS: Sixteen studies met inclusion criteria for this review. For each study with binary outcomes, an odds ratio (OR) with 95% confidence intervals (CIs) was calculated for selected outcomes. Estimates of ORs for dichotomous outcomes were calculated using fixed and random-effects models. Homogeneity was tested across the studies. Compared with women allocated to expectant management, those who underwent labor induction had lower cesarean delivery rates (20.1% versus 22.0%) (OR 0.88; 95% CI 0.78, 0.99). Although subjects whose labor was induced experienced a lower perinatal mortality rate (0.09% versus 0.33%) (OR 0.41; 95% CI 0.14, 1.18), this difference was not statistically significant. Similarly, no significant differences were noted for NICU admission rates, meconium aspiration, meconium below the cords, or abnormal Apgar scores. CONCLUSION: A policy of labor induction at 41 weeks' gestation for otherwise uncomplicated singleton pregnancies reduces cesarean delivery rates without compromising perinatal outcomes. art At Thu, 26 Aug 2004, Garry E. Siegel, M.D. wrote: > >Ignoring the social conundrum here, Lenora, I would be a bit reluctant >to send home someone who is 41+, favorable, and doesn't want to go home. >While it is very unlikely, any poor outcome would lead to the >question--why didn't you keep her. > >I disagree with your commment about no medical indication, as she is >41+, and that is an indication. Sanchez, I believe, did a meta-analysis >in the Green Journal in 11/03 and the conclusion was that delivery at 41 >weeks irrespective of cervical exam and parity led to the best outcomes. > >Garry >> >>---A former patient comes in to L&D in false/prodromal labor. She is 41+ >>weeks with a favorable cervix (3/70/-1) and does not want to go home--the FHTs >>are reassuring. She knows me and asks to be induced. She can't understand >>why I tell her to go home and see her own obstetrician on Monday (this is >>Sat.) when he comes back from vacation. If she were our patient I would grant >>her wish, but don't feel it appropriate to induce Dr. M.'s patient with no >>medical indication. >> >-- >Garry E. Siegel, M.D. >Private Practice >Roswell, GA > -- art fougner, md ich bin ein New Yorker Next message: Joanne Bulley, MD: "Re: GYN: First pap smear" Previous message: RModugno@aol.com: "Re: GYN: =?ISO-8859-1?B?oEZpcnN0IHBhcCBzbWVhcg==?MIME-Version: 1.0" In reply to: Garry E. Siegel, M.D.: "Re: Switching patients**41 plus" Next in thread: Garry E. Siegel, M.D.: "Re: Switching patients**41 plus" Reply: Garry E. Siegel, M.D.: "Re: Switching patients**41 plus"

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