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Consortium
for the Evidence-based practice of Obstetrics --
C.E.O. is dedicated to bringing science-based
maternity care to all childbearing women
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Quotes
and Excerpts from www.eObGynNews.com
and
other respected sources of professional information
on safety, complications & practice trends for obstetricians
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Bibliography, Recommended Reading and Scientific
Citation from obstetrical sources:
The Connection ~ Cesareans & Electronic Fetal Monitoring
A Scar is Born –
every 39 seconds – Cesarean rate in 1995 /
advertisement for a silicone sheeting product to reduce scarring in Cesarean incision; Ob.Gyn.News,
April 15, 1998
Why
the C-section rate is rising –
Editorial, Medical Economics, Oct 2000;
Who Speaks for Science in Court?
Peter Huber, Geo C. Marshall Institute
2001
C-Section to Prevent
Cerebral Palsy: Results May Be a Wash;
Ob.Gyn.News;
Apr15,2002, Vol
38, No 8
Excerpt
~
“Neonatal Encephalopathy & Cerebral Palsy”
by the ACOG Task Force
Documentation
Important in CP Deliveries,
Ob.Gyn.News
July 1, 2002 Vol 37, No 13;
Why
the C-section rate is rising – Editorial
by Dr. Steven Drosman, MD, obstetrician-gynecologist in San Diego, CA; Medical Economics, Oct 2000;
Dr. Drosman is "otherwise known as MD 23%" for his 23%
Cesarean section rate
Probably
the biggest C-section motivator, however is fear of a lawsuit. The
rational is simple: At worst, you'll be criticized for performing a C-section
but you can be roasted for delaying one!
When
a patient is hooked up to a fetal monitor, it initiates an unholy
trinity--the anxious patient, the hovering nurse and the paranoid physician.
The tension escalates as monitoring
devices are added: the fetal scalp electrode, the fetal pulse oximeter, and
intrauterine pressure catheter. Add some more Pitocin to the mix,
and the action begins.
The
labor and delivery nurse watches the monitor and observes decreased
variability and persistent late decelerations. The obstetrician is notified,
wipes the perspiration from his forehead and pops a handful of
antacids.
The
patient and her family are informed of the potential crisis, and the can of
worms has been opened. More
likely than not this
"electronically
compromised" fetus will be delivered by emergency C-section, with
perfect Apgar scores.
Excerpt
~
Who Speaks for Science in Court?
Peter Huber, attorney, Geo C. Marshall Institute
2001
C-Section
to Prevent
Cerebral Palsy: Results May Be a Wash;
Ob.Gyn.News;
Apr15,2002, Vol
38, No 8
“Performing cesarean section
for abnormal fetal heart rate patterns in an effort to prevent cerebral palsy
is likely to cause as least
as many bad outcomes as it prevents”
…..the false-positive rate
for these abnormal fetal heart
patterns was 99.8%
(N.Engl. J. Med 334[10:613-19, 1996)
“Extrapolating from this
study, Dr. Hankins calculated that
a physician would have to perform 500
C-sections for multiple late decelerations or reduced beat-to-beat
variability to prevent a single case
of cerebral palsy. But since
Cesarean section carries a roughly 0.5% risk of future uterine rupture, those
500 C-sections would result on average in 2.5 uterine ruptures.
This in
turn would cause one case of neonatal death or
cerebral palsy….”
“So
I’ve prevented one case of cerebral palsy and I’ve caused one.”
Concluded Dr. Hankins, professor and vice chair of ob.gyn at the University of
Texas, Galveston.
Moreover, those 500 women who
underwent C-section because of an abnormal fetal heart rate pattern face substantial
morbidity related to their surgery, including a 5 to 10 fold increase in
relative risk of infection, a 5-fold increase in [blood clots] as well as a
10- to 20-fold increase in future risk of placenta previa and acreta,
he added.
[*placenta accreta is when the placenta
grows abnormally into the deep structure of the uterus or even grow through
the uterus and attaches to the bladder or bowel (known as a ‘percreta’).
Accreta or percreta is a life threatening complication and frequently
requires an emergency hysterectomy to stop the bleeding]
Excerpt
~
“Neonatal Encephalopathy & Cerebral Palsy” by the ACOG Task
[This
report was several years in the making and had the endorsements and support of 6 major federal agencies and
professional organizations, including the Center for Disease Control &
Prevention (CDC), the March of Dimes and the obstetrical professions in
Australia, New Zealand and Canada. It is described as the "most
extensive peer-reviewed document on the subject published to date".]
"Since the advent of fetal heart rate monitoring,
there has
been no change in the incidence of cerebral palsy"
"... the
majority of newborn brain injury
does
not occur during labor and
delivery.
Instead,
most instances of neonatal encephalopathy and cerebral palsy are
attributed to events that occur prior to
the onset of labor".
Documentation
Important in CP Deliveries,
Ob.Gyn.News
September 15,
2003 Vol 38, No
18;
A
growing number of studies suggest that infection
and infectious processes play a greater rolesin the development of cerebral
palsy than previously thought...
The
idea that infection might play an important role in CP development evolved
over the years as it became apparent that in most cases the condition cannot
be linked with the birth process.
"The
increasing cesarean delivery rate that occurred in conjunction with fetal
monitoring has not been shown to be associated with any reduction
in the CP rate..."
In
other studies, including one involving more the 155,000 babies, only
9% of CP cases could be linked to birth-related processes.
"
... only 0.19% of all those in the study had a nonreassuring fetal heart
rate pattern....
If used for identifying CP risk, a nonreassuring
heart rate pattern would have had a
99.8% false positive rate....".