New risk score predicts cesarean after induction
Source: Obstetrics & Gynecology 2006; 107: 227-33
Simple scoring system may help decision-making when considering induction of labor.
The risk of cesarean delivery after induction of labor can be predicted reasonably accurately using four simple measures, British obstetricians report.
Elisabeth Peregrine and team from University College London Hospitals sought to develop a clinical model for predicting the outcome of labor induction. They evaluated maternal and ultrasound parameters in 267 women at 36 or more weeks of gestation immediately before induction of labor.
The most frequent indication for induction was postdates, and 30 percent of the cohort subsequently required a cesarean delivery.
In logistic regression analysis, four factors emerged as significant predictors of cesarean delivery: parity (odds ratio [OR] = 20.56), body mass index (OR = 6.17), height (OR = 0.94), and ultrasonic transvaginal cervical length (OR = 1.07).
Peregrine's team used these to develop a simple risk scoring system, whereby a score of -65 to -55 indicates a more than 80 percent likelihood of cesarean delivery, and a score of -165 to -146 indicates a less than 1 percent chance.
The model has "reasonably good discriminatory ability," say the investigators, who conclude that it may allow more accurate counseling and better informed consent in the decision-making process when considering induction of labor.
Posted: 22 February 2006
Wednesday, March 01, 2006
Predicting Cesareans
Well, leave it to some bored researchers to try and find the crystal ball answers to why their cesarean rates are so high. Don't look at the obvious, prophilactic induction for postdate pregnancies which is clearly not evidence based, that would be to simple. No, let's look for reasons we can cause more iatrogenic cesarean outcomes!
I am receiving the study today via email from LWW because my online access is not working properly, but two of these are no-brainers IMO. Parity and cervical length (aka Bishop's Scores) are obvious. Primips have been proven to gestate longer than multips (average gestation 41 weeks), hello! As for BMI and height, this has piqued my interest greatly, especially in light of all of my maternal female relatives have all given birth very close to 40 weeks and my sister, the only one who is bordering on morbidly obese, who gave birth between 2 and 3 weeks postdates. Hmmm.
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More than one local, live and in person girlfriend planned their c-section at 40 weeks on the dot, because they feared postdate pregnancy, and according to these indicators, their "baby wasn't coming." Women buy this stuff! The medical people are simply covering their derriere, and whether they realize it or not, they are just cooking up more lame rationale as to why women's bodies don't "work," but then our lame outcomes in maternal child health are dismissed and blamed on the blacks and hispanics.
Did you see http://www.homeschoolblogger.com/HeartSchooling/92338/?
A Christian homeschool blogger died following complications from a c-section. I'll refrain from posting my comments on why amniotic fluid indexess are not a reliable indicator of fetal well-being.
I am so sorry to hear of Missy's death Anne. DIC is so rare, yet I know of two mothers who have died of it post-cesarean. Amniotic fluid indexes indeed, sigh. How incredibly sad that we have lost another mother.
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