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Re: Breech Trail (or trial) From: Dr Eberhard Lisse (el@lisse.NA) Tue Jan 24 21:51:01 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr. Ainsworth: "Stillbirth" Previous message: Joanne Bulley, MD: "Re: 2006 ABOG Recertification Examination" In reply to: Raymond Stephen: "Re: Breech Trail (or trial)" Next in thread: Bernard Cristalli: "Re: Breech Trail (or trial)" Reply: Bernard Cristalli: "Re: Breech Trail (or trial)" Reply: Bernard Cristalli: "Re: Breech Trail (or trial)" Stephen, I actually share your sentiments. We *do* need a really good trial. However it is very difficult to do, nevermind that they "controlled" for many things. I even remember posting early after the trial that I was *VERY* impressed with the finding that inxperienced staff had more complications than experienced staff. However, this is different from BC stating Vaginal Breech Delivery is as safe as Normal Vertex Delivery, and saying that Radiopelvimetry is the solution to all problems. And, as long as Cochrane *AND* the RCOG hold that one should *OFFER* C/S I'll do just that. The complications from C/S are accepted by the patients very well. el on 1/25/06 6:18 AM Raymond Stephen said the following: > el, ever since the day the term breech trial was published I have been > uncomfortable with the recommendations because it seemed, even at the > time, that though the design of the trial was good its implementation > was far from "to protocol" and the idea that you could include cases > from such a variety of managements, skills and experience (in particular > Zimbabwe) just didn't seem to me to be conducive to vigorous scientific > analysis, no matter how good the statistical analysis. It turns out > that my fears were not unfounded, and what is really required is a trial > done in one set of circumstances and with one set of consultants, and > probably only within one country. For me all that it has shown is what > was already known, and published in textbooks since day one, that > breeches have their own potential complications and have to be handled > with care and attention. The conclusion that caesarean section reduces > complications of vaginal delivery is obvious and applies to all > deliveries, whether breech or cephalic, longitudinal, transverse or > oblique. The skill, as for all pregnancies, is in deciding which should > not be vaginal, otherwise it is computerised flow-chart medicine which > requires no intellectual input at all, and could be carried out by the > theatre attendant. > > I hear that the good Dr. Hannah has now turned her attention to whether > we should use tocolytics under any circumstances! > > Steve Next message: Dr. Ainsworth: "Stillbirth" Previous message: Joanne Bulley, MD: "Re: 2006 ABOG Recertification Examination" In reply to: Raymond Stephen: "Re: Breech Trail (or trial)" Next in thread: Bernard Cristalli: "Re: Breech Trail (or trial)" Reply: Bernard Cristalli: "Re: Breech Trail (or trial)" Reply: Bernard Cristalli: "Re: Breech Trail (or trial)"

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