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Re: OB: Second twin From: art fougner, md (evsono@pipeline.com) Sun Jun 14 17:28:56 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr Eberhard W Lisse: "Re: OB: Second twin" Previous message: Malcolm Griffiths: "Re: OB: Second twin" In reply to: Malcolm Griffiths: "Re: OB: Second twin" Next in thread: Dr Eberhard W Lisse: "Re: OB: Second twin" Reply: Dr Eberhard W Lisse: "Re: OB: Second twin" Peter may be on to something here, especially with regard to elective Cesarean and risk of maternal death. in the US, where section rates have skyrocketed, deaths associated with sections have certainly not. Cesarean section-related maternal mortality in Massachusetts, 1954-1985. Obstet Gynecol 1988 Mar;71(3 Pt 1):385-8 (ISSN: 0029-7844) Sachs BP; Yeh J; Acker D; Driscoll S; Brown DA; Jewett JF [Find other articles with these Authors] Department of Obstetrics and Gynecology, Charles A. Dana Research Institute, Boston, Massachusetts. We analyzed the data of the Maternal Mortality Committee of the Massachusetts Medical Society to investigate cesarean section-associated maternal deaths. Between 1954-1985, the number of cesarean section-related deaths per 100,000 live births did not significantly change despite a quadrupling of the cesarean section rate. Between 1976-1984, there were 649,375 births and 121,217 cesarean sections in the state. Seven deaths were directly related to cesarean section, a rate of 5.8 per 100,000 cesarean sections. In contrast, the rate for vaginal deliveries was 10.8 per 100,000 vaginal deliveries. We conclude that the risk of maternal death from cesarean section is low. perhaps your quote of 1/1000 might be overstating your case? art At Sun, 14 Jun 1998, Malcolm Griffiths wrote: > >In message <199806112317.JAA22837@ariel.ucs.unimelb.EDU.AU>, Peter Wein ><p.wein@obsgyn-mercy.unimelb.EDU.AU> writes >>Actually Malcolm I didn't pluck the 1/1,000 figure out of the air - >>Patricia Crowley reported this figure at a conference in Australia last >>year based on a survey she did of pregnant women - she asked them at what >>risk to the fetus would they want to have a caesarean section. This >>probably has relevance to breeches, multiple pregnancies and perhaps trial >>of scar - it may be that elective C/S ( Lilford has written on this) is >>safer than labour with its at least 30% ( in these circumstances) chance of >>the more dangerous emergency C/S - worth thinking about? > >I was aware of similar attempts at estimating mother's views on level of >risk. I am particularly familiar with Lilford's work on the subject - >though it doesn't feel right. There is a problem with how these figures >are arrived at - I am aware that Lilford and colleagues went through a >complicated series of decisions to narrow down to a value of acceptable >risk. Even this though is too simplistic. The assumption tends to be >have a CS and everything will be fine, don't have CS and baby will die >or be handicapped. Clearly not all babes delivered by CS do well. On the >basis of my previous quote about (very approx) 1:1,000 women having >emergency CS will die, and all of them will have a scarred uterus, with >increased risk of CS and problems/risks next time around. > >Secondly, my impression is (and Lilford's group has acknowledged this) >peopel just aren't good at thinking about, risk, relative and really >understanding small risks of 1:100 or less. If they were no-one would >buy lottery tickets or ride motor-bikes! >Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt >Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK. >Tel: 01582-497459 (office) Fax: 01582-497376 > 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk >http://www.obgyn.net/board/griffith.htm >"CLINICAL FREEDOM IS THE LAST REFUGE OF THE CLINICALLY INCOMPETENT!" >(Someone [1997]) -- art fougner, md SonoScan/Genetic Sciences forest hills, ny evsono@pipeline.com Next message: Dr Eberhard W Lisse: "Re: OB: Second twin" Previous message: Malcolm Griffiths: "Re: OB: Second twin" In reply to: Malcolm Griffiths: "Re: OB: Second twin" Next in thread: Dr Eberhard W Lisse: "Re: OB: Second twin" Reply: Dr Eberhard W Lisse: "Re: OB: Second twin"

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