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Re: Induction for post term From: art fougner, md (evsono@pipeline.com) Fri Jun 15 07:19:37 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DoctorJoe@aol.com: "Re: GEN: Thoughts for Father's Day" Previous message: art fougner, md: "GEN: Thoughts for Father's Day" In reply to: Garry E. Siegel, M.D.: "Re: Induction for post term" Next in thread: Henry Gregor: "Re: Induction for post term" 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. 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. In other words, the best antepartum is a post-partum. Art At Thu, 14 Jun 2007, Garry E. Siegel, M.D. wrote: > >FWIW, I believe that there was a big study (meta analysis) in the green, >by Luis Sanchez-Ramos, among others, that basically showed that the best >outcomes and lowest section rates were by inducing at 41 weeks >irrespective of parity and bishop score. > >Garry > >At Wed, 13 Jun 2007, DoctorJoe@aol.com wrote: >> >>In a message dated 6/13/07 12:37:55 PM, agfolley@hotmail.com writes: >> >>> What are you saying, Joe, that there is higher incidence of fetal morbidity >>> and mortaility at 41 than 40 weeks? agf >>> >>No. The J-shaped curve has its nadir at 41-41.5 (decimal) weeks or so and >>then starts to rise. So after 41 weeks, things start to go south again, just has >>they go bad BEFORE 41 weeks. >> >>The philosophy I have is, at 41 weeks start "talking" about NSTs and >>inductions and stuff. By the time you get things moving, you're past 41.5 weeks and >>you're doing the right thing. >> >>Joe P. >> >>-- >>************************************** >> >>************************************** > >-- >Garry E. Siegel, M.D. >Private Practice >Roswell, GA > -- art fougner, md "May The Wings of Liberty Never Lose a Feather." - Jack Burton Next message: DoctorJoe@aol.com: "Re: GEN: Thoughts for Father's Day" Previous message: art fougner, md: "GEN: Thoughts for Father's Day" In reply to: Garry E. Siegel, M.D.: "Re: Induction for post term" Next in thread: Henry Gregor: "Re: Induction for post term"

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