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Re: OB:Home Births in AustraliaFrom: Peter Wein (p.wein@obsgyn-mercy.unimelb.EDU.AU)Thu Aug 27 21:45:04 1998
At 07:58 PM 27/08/98 -0500, you wrote:
>> The point I was trying to make is that "non-reassuring" is a specific CTG term, usually implying decreased variability or some variable decelerations (in the FIGO intrapartum classification as "suspicious"). AN abnormality on auscultation would only usually be a major baseline bradycardia or tachycardia - which is a little more than "non-reassuring".
>I would hope that you're not routinely using electronic fetal monitoring No - we aren't - but maybe we should - I assume that you are aware that routine monitoring significantly decreases the risk of neonatal convulsions, an important indicator of HIE. Here is something about this - do you discuss it with all your patients? Continuous electronic fetal heart monitoring during labor Thacker SB, Stroup DF Objectives: To compare the efficacy and safety of routine continuous electronic fetal monitoring (EFM) during labor with intermittent auscultation, using the results of published randomized controlled trials (RCTs). Search strategy: We identified RCTs by searching the MEDLINE database for 1966-1994 and the register maintained by the Cochrane Pregnancy and Childbirth Group, and by contacting experts, and reviewing published references. Selection criteria: Our search identified 12 published RCTs addressing the efficacy and safety of continuous EFM; no unpublished studies were found. The studies included 58,855 pregnant women and their 59,324 infants in both high- and low-risk pregnancies from 10 clinical centers in the United States, Europe, Australia, and Africa. Data collection and analysis: Data were abstracted by one of us, and their accuracy were confirmed independently by a second person. A single reviewer assessed study quality based on criteria developed by others for RCTs. Data reported from similar studies were used to calculate a combined risk estimate for each of 9 outcomes. Main results: Overall, a statistically significant decrease was associated with routine EFM for a 1-minute Apgar score below 4 relative risk (RR) 0.82, confidence interval (CI) = 0.65,0.98 and neonatal seizures (RR=0.5, CI=0.30,0.82). .... Conclusions: The only clinically significant benefit from the use of routine continuous EFM was in the reduction of neonatal seizures. In view of the increase in Cesarean and operative vaginal deliveries, the long-term benefit of this reduction must be evaluated in the decision reached jointly by the pregnant woman and her clinician to use continuous EFM or intermittent auscultation during labor. Date of most recent amendment : 06 March 1998 Date of most recent substantive amendment : 27 June 1996 This review should be cited as : Thacker SB, Stroup DF. Continuous electronic fetal heart monitoring during labor (Cochrane Review). In: The Cochrane Library, Issue 3, 1998. Oxford: Update Software
>>>We also have practice standards about transport time from the home setting.
It is very uncommon here - only about 0.3% of all planned hospital births
are born before arrival - if your figure is higher, must not be educating
your patients about when to come in. In any case - regarding coping with
traffic etc for transfer in labour of planned home birth - this is a
foreseeable event, and so preventable, and the risk could be eliminated by
hospital delivery
> I was clearly and specifically referring to the Australian situation where the vast majority of deliveries are in level 3 or 2 hospitals - in Victoria 24% in level 3, 27% in metropolitan public level 2 and 26% in large rural level 2. 26% are in private hospitals, and most of the deliveries in private hospital are in those with level 2 facilities.
> Again - I was specifically referring to the paper and the Australian situation. Anyway - even in Ontario - what is to stop someone who is not a registered midwife and does hold herself out to be one to attend a delivery in the absence of a registered midwife?
>-- --
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