Re: Breech Trail (or trial)
From: Bernard Cristalli (bcrist@club-internet.fr)
Tue Jan 24 23:51:13 2006
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Wait till tonite, no time now to answer.
B
Dr Eberhard Lisse a écrit :
>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
>>
>
