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Re: Hanna's RCT: (was post-term:Jardosi) From: Robert J. Woolley (wooll005@tc.umn.edu) Tue Dec 29 22:47:14 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Robert J. Woolley: "Re: Definition of term" Previous message: Peter Wein: "Re: Definition of term" Next in thread: Luis Sanchez-Ramos, M.D.: "Re: Hanna's RCT: (was post-term:Jardosi)" Reply: Luis Sanchez-Ramos, M.D.: "Re: Hanna's RCT: (was post-term:Jardosi)" In message <199812300258.UAA23083@talk.obgyn.net> writes: > Once again I reviewed Hannah's multicenter RCT on Induction of labor as > compared with serial antenatal monitoring in post-term pregnancy (N Engl > J Med 1992;326:1587-92). As I previously stated, this trial cannot be > categorized as "flawed". Due to several comments made by listers, I > decided to carefully re-analyze the paper and make some comments with > regard to Dr. Gardosi's critique. > The study showed that in post-term pregancy (41-42 weeks' gestation), > the induction of labor results in a lower rate of cesarean than serial > antenatal monitoring. Correction: insert "combined with the uncontrolled [in the scientific sense] practices as to route of delivery of the attending obstetricians" into the middle of the previous sentence. IOW, the authors freely admit that the physicians may simply have had a lower threshold for bailing out into a section in those of greater gestational age, even if there was no objective difference in the fetal status. This is not a trivial point. If physicians simply scare more easily--but for no objectively valid reason in any given case--with more advanced gestation, then the decision not to induce is not the proximal cause of the higher c-sectino rate: physician paranoia is. This study design could not test between these two possibilities. > The percentage of cesarerans in each group performed for "fetal > distress" was similar for both groups i.e,141 of 418 33.7% vs 26.9% > (P=0.05). Also, of the patients with fetal distress in both groups, > those delivered by cesarean was simialr in both groups i.e, 97 of 175 > (55.4%)versus 141 of 218 (64.7%) (P=0.08) But when there is no standardized definition of "fetal distress" either in the study protocol or in general use, this doesn't mean much. > > >3. The actual difference in length of pregnancy between the two groups > resulting from the different regimes was, from memory, only about 3 days. > So: were the observed differences in CS rates really due to post-maturity, or > an artifact due to points 1 and 2. > Basically, this study shows that monitoring patients until 44 weeks > results in similar perinatal outcome when compared to induction at 41-42 > weeks. The cesarean rate may be higher in those managed conservatively, > however these results can be due to several biases. > > Luis Sanchez-ramos, MD Gee, I think I'd agree with that assessment of it. --------------------------------------------------------------------------- --------------------------------------------------------------------------- Bob Woolley -- --------------------------------------------------------------------------- St. Paul, Minnesota "Beware Of entrance to a quarrel, but being in, Bear't that the opposed may beware of thee." -- Lord Polonius Next message: Robert J. Woolley: "Re: Definition of term" Previous message: Peter Wein: "Re: Definition of term" Next in thread: Luis Sanchez-Ramos, M.D.: "Re: Hanna's RCT: (was post-term:Jardosi)" Reply: Luis Sanchez-Ramos, M.D.: "Re: Hanna's RCT: (was post-term:Jardosi)"

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