Re: What's next-steroids after 34 w
From: Efrain Ramirez (eramirezt@coqui.net)
Wed Apr 30 22:16:01 2008
Both.. that's THE problem!.. and lots of mothers.. with the ideas of
perfect babies and perfect statistics... go figure..
Ef
> At Wed, 30 Apr 2008, JD Stewart,MD wrote:
>
>Are we delivering babies or statistics?
>
>Are we working in an ideal world or do we deal with what is waiting on
>the ward?
>
>I don't imagine you tell your patients "I'm sorry, there hasn't been
>sufficient clinical randomised trial data in peer review journals to
>support me doing ANYTHING for you..we have been looking at this for 40
>years and still can't come up with THE proper answer. Too bad you
>aren't in an ivory tower halfway around the world so that a properly
>vetted, IRB approved and non-financially encumbered trial would be
>available, as the articles (published by the ivory towers) have taken as
>their new conclusion and recommendation mantra when they cannot show
>anything new, but wish to publish their meta-analyses.
>
>Evidence re: IUGR and known risks for prematurity abound. I've said
>nothing that isn't in any OB text.
>
>My point is the paralysis by analysis /committee/ insurance/lawyer
>medicine that allows us to be put into a corner in OB such as this where
>there IS no one right way out, as there is no risk free path in
>life...yet we are to produce perfect results every time, or someone is
>at fault.
>
>AH life! No one here gets out alive...
>
>At Wed, 30 Apr 2008, Dr Eberhard Lisse wrote:
>>
>>Is anything you say encumbered by evidence?
>>
>>el
>>
>>on 4/29/08 7:35 PM JD Stewart,MD said the following:
>> > Logic can prevail, if we allow...big studies/ Meta analyses showing
>> > a smaller head circ and 5% less average body weight have a fatal
>> > flaw inherent in the study populations in that they do not account
>> > for factors we know have such an effect- namely smoking ( cited at
>> > an average 8 ozs less at birth at term), maternal weight gain, drug
>> > abuse, use, work patterns, history of preterm births ..etc. Some
>> > have even included twins and anomalous babies.
>> >
>> > No long term growth deficits or developmental aberrations in all
>> > these children of moms with asthma or allergies or CT disorders who
>> > have been on large repeated doses of steroids have been shown in the
>> > last 40 years...
>> >
>> > Steroids work every day, just as they will continue to work until we
>> > are buried. The problem is a statistical matter (nearly impossible
>> > to gather enough data to show an p<.o5 improvement over a baseline
>> > 98-99% survival without problems..) not a biochemical or
>> > physiologic process that suddenly stops working on a magic date.
>> >
>> > Re: Should we dose/ redose at 34-35-even 36w? Ask yourself- What
>> > does it hurt? How sure can any of us be about gestational dating?
>> > If the baby does come "late preterm" and is that 1-2% with problems,
>> > who is going to defend your "not recognizing her risk for delivering
>> > early and and failing to offer
>> > steroids/progesterone/cerclage/smoking cessation/ aromatherapy
>> > SOONER?"
>> >
>> > Why tocolyse at 34-35-36 if doing so will not improve the outcome
>> > (unless you give steroids...)?
>> >
>> > Questions for article below: Hospitalization/ off work/ tocolysis
>> > for weeks has no economic cost?
>
>--
>JD. Stewart, MD
>MFM up too late all night, every night...still 10 years later
>
--
"I can accept failure, but I can't accept not trying." - Michael Jordan
|
|
