Is this really the new head obst at KEMH? mm > Australian and New Zealand Journal of Obstetrics and Gynaecology 2003; > 43: 261 Editorial comment The current relentless drive for 'evidence-based care' in medicine has > aims which must be applauded. However, the consequences are not always > beneficial to all, with a clear tendency, at time, for the 'evidence' to > be applied inappropriately. > Two manuscripts in this issue address the increasingly difficult > subject of breech presentation. 1, 2 The 'Term Breech' 3 study did show > that Caesarean section birth is associated with a higher likelihood of a > quality outcome for singleton term babies than vaginal breech birth. The > short-term maternal outcomes reported appeared to show that the > increased use of Caesarean section was not to the detriment of the > mothers. > However, it did not examine longer term issues arising from > Caesarean section, such as puerperal depression after discharge from > hospital, future changes in fertility, and increasing morbidity and > mortality in subsequent pregnancies. Equally, it did not (and could not) > examine the consequences of the study being applied to other breech > situations, such as multiple birth and preterm breech birth, and the > effect upon the training and experience of obstetricians who will, > inevitably, be faced with clinical situations such as the unexpected > rapidly progressing vaginal breech birth and the woman who exercises her > autonomous right to make and informed decision to attempt a term vaginal > breech birth. > Kaushik and Gudgeon 2 rightly remind us tat, if we are to follow > 'the evidence' and advise all women with breech presentations that > Caesarean section is the preferred mode of delivery, we have a > responsibility to temper this advice with explanation of alternatives, > including external cephalic version where appropriate. By implication, > methods of training obstetricians in the techniques of vaginal breech > birth must be found, to replace the experiential model used in the past. > > > Michael HUMPHREY > MB BS, PhD, FRANZCOG, FRCOG > References > > 1 Phipps H, Roberts CL, Nassar N, Raynes-Greenow CH, Peat B, Hutton > EK. The management of breech pregnancies in Australia and New Zealand. > Aust NZ J Obstet Gynaecol. 2003; 43: 294-297. > > 2 Kaushik V, Gudgeon G. Caesarean for breech: A paradigm shift? Aust > NZ J Obstet Gynaecol. 2003; 43: 298-301. > > 3 Hannah ME, Hannah WJ, Hewson SA, Hodnett ED. Saigon S, Willan AR. > Planned caesarean section versus planned vaginal birth for breech at > term; a randomised multi-centre trial. Term Breech Trial Collaborative > Group. Lancet. 2000; 356: 1375-1383. > > > > > > > ************************************************************************ > *********** > This email, including any attachments sent with it, is confidential and > for the sole use of the intended recipients(s). This confidentiality is > not waived or lost, if you receive it and you are not the intended > recipient(s), or if it is transmitted/received in error. > > Any unauthorised use, alteration, disclosure, distribution or review of > this email is prohibited. It may be subject to a statutory duty of > confidentiality if it relates to health service matters. > > If you are not the intended recipients(s), or if you have received this > e-mail in error, you are asked to immediately notify the sender by > telephone or by return e-mail. You should also delete this e-mail > message and destroy any hard copies produced. > ************************************************************************ > *********** > > > -- > 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. > >
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