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Re: A caseFrom: John Robertson (jsrobert@uniserve.com)Sun Dec 8 19:36:14 1996
At 22:51 05/12/96 -0600, you wrote: >In message <199612060225.SAA12055@unixg.ubc.ca> writes: >> > >> With respect to your last sentence. If the induction fails they are >> delivered by other means. I do not practice serial inductions, I only >> induce patients that need to be delivered. If they do not deliver >> vaginally then they will deliver abdominally. >> > >So at 41 weeks, you routinely try induciton, and if it fails you then will >routinely section, even if there are no indications of fetal compromise? > >You certainly can't derive justification for this practice from the Hannah >study. Is there any evidentiary support for it? > >I'll also note that you must surely wipe out one of the major claims that you >made for induction over monitoring: the reduced c-section rate. Remember that in >the Hannah study the rate was 24.5% in the monitored group, and 21.2% in the >induction group, an obviously small--though statistically >significant--difference. If I am understanding your practice correctly, it seems >inevitable that you will end up with a *higher* section rate than you would if >you didn't routinely induce. This means that the only possible justification for >your policy of routine induction is the potential for lower perinatal mortality, >which, as you know, was not shown by the study you are relying on as the basis >of your protocol! > >I do hope I have misunderstood your explanation. Actually you are aguing against yourself, the C/S rate was lower in the Induction group, if this is a small though statistically sig difference, then I should induce all patients at 41 weeks (as I do). If you can explain how serial inductions improve your section rate I would certainly like to see the data, because everything I have read so far does not agree with that. I do not induce patients that do not need to be delivered, therefore if an induction fails I deliver abdominally. And, no my C/S rate is not high, it runs between 15 and 17%. Why did we used to induce at 43 or 42 weeks? Because of the M&M graphs which show that the nadir of the curve is at 40 weeks. The Canadian guidlines are based on Hannah's Study and recommend routine induction at 41 weeks to avoid foetal distress and decrease your C/S rate. What is going to improve at 42 weeks that you are more likely to get a vaginal delivery if you failed at 41 weeks? Is the baby going to get smaller from poorer placental function as the placenta ages? Is that what you want to happen?
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