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Re: Cesariana eletivaFrom: Dr. Sergio P. Ramos (Sergio.Ramos@medispecialty.com)Wed, 2 Oct 2002 08:09:56 -0300
A discussão sobre Parto Normal e Cesarana não é só nossa: Labor support does not reduce C-section rate in North American hospitals By Anthony J. Brown, MD NEW YORK (Reuters Health) - In hospitals with high rates of routine intrapartum interventions, continuous labor support by nurses does not reduce the C-section rate or improve peripartum outcomes, according to new study findings published in the September 18th issue of the Journal of the American Medical Association. Previous reports have suggested that continuous labor support may improve labor and birth outcomes, including reduced likelihood of cesarean delivery. In fact, the results of a multi-trial Cochrane Review have actually been incorporated into practice guidelines in the US, Canada, and the UK. Still, it was unclear if the findings were really applicable to North American hospitals. In the current study, Dr. Ellen D. Hodnett, from the University of Toronto, and colleagues assessed the outcomes of 6915 pregnant women who were randomized to receive usual care or continuous support by a specially trained nurse during labor. The women were drawn from 13 US and Canadian hospitals with annual C-section rates of 15% or higher. The C-section rate in the intervention group was 12.5%, almost identical to the 12.6% rate in the usual-care group, the researchers note. Furthermore, the type of labor support received did not have an effect on any other labor or birth outcomes. "The conclusion of the Cochrane Review was that all women should have continuous labor support," Dr. Hodnett told Reuters Health. "But two questions remained: can nurses effectively provide such support within the context of North American hospitals, and can such care be provided in a cost-effective way," she noted. "In our study, we addressed both issues by specifically training nurses in continuous labor support and by including hospitals that had successfully implemented such care without an increase in staffing costs," Dr. Hodnett explained. "Despite our efforts, we found no evidence that continuous labor support improves peripartum outcomes." However, when surveyed, women in both groups indicated that they would prefer continuous labor support if pregnant again. "It is clear that women prefer continuous support to usual care," Dr. Hodnett said, "but the beneficial effects noted in the Cochrane Review were not evident." The reason why continuous support was beneficial in the Cochrane Review but not in the current study may relate to the different hospital settings, Dr. Hodnett noted. "Compared with hospitals in the Cochrane Review, those in the current study had high rates of routine medical interventions that may have overpowered the effects of labor support." JAMA 2002;288:1373-1381.
Voltar para Administrador da lista: flavio.monteiro.desouza@obgyn.net Solicitações à lista: obstet-l-request@obgyn.net Última atualização: Mon May 19 16:34:35 2008 |
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