Lois, Is this woman going by ultrasound dates or menstrual dates? Why are her dates doubtful?
There are risks to continuing pregnancy beyond term. The risk of perinatal death increases from 0.7 ongoing pregnancies at 37 weeks gestation to 2.4 ongoing pregnancies at 40 weeks, to 2.8 at 41 weeks, to 4.8 at 42 weeks to 5.8 ongoing pregnancies at 43 weeks gestation (Hilder et al 1998). The risk of perinatal death increases with the onset of labour (Enkin 2000). What remains controversial is whether induction of labour reduces the rate of perinatal mortality in women with post dates pregnancy. From the meta analysis of 11 RCT's conducted between 1969 and 1992 comparing induction of labour from 41 plus weeks to a conservative approach suggests a reduction in perinatal mortality with induction of labour (Caritis 1995, Kierse 1993). However, many reviews have been published recently questioning the validity of the results found from these studies (Menticoglou 2002, Caritis 1995 and Kierse 1993). After extensive reading of these articles and their arguments, the summary that I came up with was that there appears to be no justification for a routine policy on induction of labour beyond 42 completed weeks gestation, as research does not conclusively show that induction of labour decreases the rate of perinatal morbidity and mortality compared with a conservative approach to post dates pregnancy. >From my experience, most women choose induction of labour over a conservative approach to post dates pregnancy. Research hasn't been done on women's views associated with continuing with pregnancy beyond term (42 weeks), however the reason why I chose this topic for my masters project was that I came accross some women who did not want to be induced at 42 weeks. Some women had experienced induction at 42 weeks before and gave birth to healthy babies without any evidence that their babies were post dates. Did these women have naturally longer pregnancy gestations? Would a conservative approach put them at risk? These are the sort of questions I set out to try and answer. How can we identify the 4.8 per 1000 ongoing pregnancies at 42 weeks and the 5.8 per 1000 ongoing pregnancies that are going to end up resulting in perinatal death beyond 43 weeks gestation? CTG is of no benefit. One possible way of detecting post dates pregnancies which are becoming high risk is the use of doppler ultrasound. However, there have been no studies to date performed looking at the use of doppler ultrasound for women with post dates pregnancies specifically, just high risk pregnancy such as hypertension. The results from these high risk studies are pleasing in detecting pregnancies at risk, however the pathophysiology of post dates pregnancy (placental insufficiency) may be different to that of women with hypertension. I would be happy to e mail you my guidelines off list. I am hoping to publish my findings in ACMI journal soon. I don't want to publish the policy alone as the arguments to both approaches to post dates pregnancy need to be included with the publication. I know my response has been long winded, but hopefully it has been helpful for this woman. Regards, Juliana -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Lois Wattis Sent: Monday, 4 August 2003 10:03 AM To: [EMAIL PROTECTED] Subject: Re: [ozmidwifery] Any ideas for research and mosiac? Julianne, I would like to read your paper too. I have a client more that 3 weeks post dates at present, and agonising about what to do because she does not want to be induced. Her dates are doubtful, and I think she's just term now. Nevertheless, the pressure is on by the very supportive ob., and scarey stories about dangers of post maturity are abounding. Could you please provide some info based on your 'policy'? Thanks, Lois ----- Original Message ----- From: "sally westbury" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Sunday, August 03, 2003 9:20 PM Subject: RE: [ozmidwifery] Any ideas for research and mosiac? It would be great to see this policy you wrote. It is such hard choice. Love Sally -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Juliana Brennan Sent: Sunday, 3 August 2003 7:28 PM To: [EMAIL PROTECTED] Subject: RE: [ozmidwifery] Any ideas for research and mosiac? Dear Jo, Post dates pregnancy is one of the most common reasons cited for inducing labour. When I did my Masters last year I looked into the care of women with post dates pregnancy. I looked at Induction of labour as one approach and conservative care as the other. I didn't do any research as such, it was more a critical literature review and I then wrote a policy for the care of women with post dates pregnancy from a woman's choice perspective. ie a conservative approach vs induction of labour. I mainly concentrated on the risks and benefits of induction of labour vs an alternative approach to post dates pregnancy, cost of both approaches, perinatal mortality and morbidity associated with either approach, fetal surveillance methods used for conservative approaches and their effectiveness, accurate pregnancy dating, and the use of alternative practices to induce or augment labour. Good luck with your studies. Juliana -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Mrs Joanne M Fisher Sent: Sunday, 3 August 2003 5:18 PM To: [EMAIL PROTECTED] Subject: Re: [ozmidwifery] Any ideas for research and mosiac? Thankyou all of you that have given me suggestions for my research topic and my table. If there are any more ideas please send them to me. I'm not one to make quick decisions! An idea for research I had was to look at why there are so many inductions these days, does anyone know if there's been anything done on that? The ideas of Vit. K and Hep. B are also very good suggestions. The suggestions for my table have been fabulous although too bad I'm no good at drawing them which I'll need to do before I do the mosaic! Cheers, Joanne. ----- Original Message ----- From: "Robin Moon" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Sunday, August 03, 2003 8:43 AM Subject: Re: [ozmidwifery] Any ideas for research and mosiac? > Jo, what about using the goddess of fertility on your table? > > Colin Heaney in Byron Bay does a beautiful glass sculpture of her. I have > two of these little scuptures because they're so beautiful to hold and feel. > http://www.yoni.com/cheaney/goddesses1.shtml. > > Also, I too think we should be digging at the issue of routine Vitamin K. > Any research to stir the pot would be useful, as it's so entrenched in our > hospitals. Or, if you really want to stir people up, why not research the > current favourite policy of suggesting that ALL babies be Hep B immunised, > and the link into disturbance of estblishing breast feeding? > > cheers, > Robin > > ----- Original Message ----- > From: "Neretlis, Bethany" <[EMAIL PROTECTED]> > To: <[EMAIL PROTECTED]> > Sent: Saturday, August 02, 2003 6:42 PM > Subject: RE: [ozmidwifery] Any ideas for research and mosiac? > > > > jo, i can't think of any research ideas at the moment. however, and idea > for > > artwork i have been meaning to do myself but as a sculpture is the classic > > breastfeeding mother looking down on her babe, bubs hand on mothers > breast. > > > > love Bethany > > > > -----Original Message----- > > From: Lois Wattis [mailto:[EMAIL PROTECTED] > > Sent: Saturday, 2 August 2003 15:06 > > To: [EMAIL PROTECTED] > > Subject: Re: [ozmidwifery] Any ideas for research and mosiac? > > > > > > Hi Jo! (HUG!!) Great to hear from you. > > Idea's for a Masters.. hmmm - how about something about vitamin K > > administration (especially intramuscular injection at birth), and it's > > (suspected) link to increased rates of jaundice in newborns. Do babies > > given oral vit K have less incidence of jaundice requiring phototherapy? > Do > > babies who are not given vitamin K at all have the same or less incidence > of > > jaundice? It seems to me a high number of babies born in hospitals seem > to > > develop jaundice which requires phototherapy. Could the common > denominator > > be the IM Vit. K?? causing increased viscosity of the circulating blood, > so > > therefore increased deposition / slower elimination of unconjugated > > bilirubin? I wonder?..... > > > > Idea's for a mosaic? What about something similarly constructed to the > CMP > > logo - a picture of a woman and baby in the centre, with the houses and > > linked figures holding hands around the edge? You've got me thinking > about > > art work now! Take care my friend, love Lois > > > > > > ----- Original Message ----- > > From: Mrs Joanne M Fisher > > To: Ozmidwifery > > Sent: Saturday, August 02, 2003 9:50 AM > > Subject: [ozmidwifery] Any ideas for research and mosiac? > > > > > > Dear List, > > > > I've just returned to Brisbane and have re-joined the list again after > > spending time in Perth doing some observations for my studies with the > > fabulous midwives of the CMP - (Hi all you lovely ladies over there). > This > > is a wonderful list to be on and so educatonal. I've been asked by my > tutor > > to talk to the Grad Dip Mid students at ACU in Oct, so I'll be > > enthusiastically spreading the word of continuous midwifery care. She (my > > tutor) is also encouraging me to do my Masters, (not sure if I will yet), > so > > I was wondering if anyone out there had suggestions for me for subjects > that > > I could do a small research on. I've never done anything like this before > > and know nothing about research, (I'm a hospital midwife and have only > > recently embarked on university studies). I already have some vague ideas > > but I'm sure there are plenty of other ideas that I haven't thought of. > > I also want to mosiac my coffee table and would love to do something that > > symbolized birth/midwives etc, but being a hopeless artist I haven't been > > able to think of a simple design to do. Can anyone help??? > > > > Cheers, > > Joanne (Fisher) > > -- > > This mailing list is sponsored by ACE Graphics. > > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. 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