[ozmidwifery] trials
At least they asked the womens preference. Guess what they chose? MM Oral misoprostol for induction of labour at term: randomised controlled trial-BMJ,vol 332, no 7540, 4 March 2006, pp 509-511Dodd JM; Crowther CA; Robinson JS-(2006)OBJECTIVE: To compare oral misoprostol solution with vaginal prostaglandin gel (dinoprostone) for induction of labour at term to determine whether misoprostol is superior. DESIGN: Randomized double blind placebo controlled trial. SETTING: Maternity departments in three hospitals in Australia.Population Pregnant women with a singleton cephalic presentation at /=36+6 weeks' gestation, with an indication for prostaglandin induction of labour. INTERVENTIONS: 20 microg oral misoprostol solution at two hourly intervals and placebo vaginal gel or vaginal dinoprostone gel at six hourly intervals and placebo oral solution. MAIN OUTCOME MEASURES: Vaginal birth within 24 hours; uterine hyperstimulation with associated changes in fetal heart rate; caesarean section (all); and caesarean section for fetal distress. RESULTS: 741 women were randomised, 365 to the misoprostol group and 376 to the vaginal dinoprostone group. There were no significant differences between the two treatment groups in the primary outcomes: vaginal birth not achieved in 24 hours (misoprostol 168/365 (46.0%) v dinoprostone 155/376 (41.2%); relative risk 1.12, 95% confidence interval 0.95 to 1.32; P=0.134), caesarean section (83/365 (22.7%) v 100/376 (26.6%); 0.82, 0.64 to 1.06; P=0.127), caesarean section for fetal distress (32/365 (8.8%) v 35/376 (9.3%); 0.91, 0.57 to 1.44; P=0.679), or uterine hyperstimulation with changes in fetal heart rate (3/365 (0.8%) v 6/376 (1.6%); 0.55, 0.14 to 2.21; P=0.401). Although there were differences in the process of labour induction, there were no significant differences in adverse maternal or neonatal outcomes. CONCLUSIONS: This trial shows no evidence that oral misoprostol is superior to vaginal dinoprostone for induction of labour. However, it does not lead to poorer health outcomes for women or their infants, and oral treatment is preferred by women. Trial registration National Health and Medical Research Council, Perinatal Trials, PT0361. (11 references) (Author)
RE: [ozmidwifery] trials
Title: Message vaginal birth not achieved in 24 hours misoprostol 46.0% v dinoprostone 41.2% okay so if 46% did not birth vaginally and 22.7% had cs what happened to the other23.3% that didn't birth vaginally Also, are women going to be told that they havealmost a 50% chance of needing a cs with an induction?That inductions fail almost half the timegee I know, lets do what the prominent OB from Adelaide is suggesting and induce all women at 39 weeks andalmost double our cs rate! caesarean section 22.7% v 26.6% and we wonder why we have a national cs rate of over 25%!!! caesarean section for fetal distress 8.8% v 9.3% uterine hyper stimulation with changes in fetal heart rate 0.8% v 1.6% and yet the risk of rupture being an estimated 0.3% is too high to offer vbac as an optionlets give these women a drug that can hyper stimulate their uteri and increase the chance of serious morbidity or mortality and potentially leave them with a ruptured uterus despite not having a previous scar. *sigh* I seriously wonder sometimes how these academics get funded! Oh sorry, this was a drug company who will benefit from this study...not women. I have a suggestion: why doesn't someone get funding to do atrial into spontaneous non-interventative (minus the actual medical need)birthvs. active management and compare the outcomes? Lets actually see if natural noninvasive supported and educated birth is fraught with the dangers that we get thrown at us. grr grr grr Jo -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Mary MurphySent: Saturday, March 04, 2006 7:08 PMTo: ozmidwifery@acegraphics.com.auSubject: [ozmidwifery] trials At least they asked the women’s preference. Guess what they chose? MM Oral misoprostol for induction of labour at term: randomised controlled trial-BMJ,vol 332, no 7540, 4 March 2006, pp 509-511Dodd JM; Crowther CA; Robinson JS-(2006)OBJECTIVE: To compare oral misoprostol solution with vaginal prostaglandin gel (dinoprostone) for induction of labour at term to determine whether misoprostol is superior. DESIGN: Randomized double blind placebo controlled trial. SETTING: Maternity departments in three hospitals in Australia.Population Pregnant women with a singleton cephalic presentation at /=36+6 weeks' gestation, with an indication for prostaglandin induction of labour. INTERVENTIONS: 20 microg oral misoprostol solution at two hourly intervals and placebo vaginal gel or vaginal dinoprostone gel at six hourly intervals and placebo oral solution. MAIN OUTCOME MEASURES: Vaginal birth within 24 hours; uterine hyperstimulation with associated changes in fetal heart rate; caesarean section (all); and caesarean section for fetal distress. RESULTS: 741 women were randomised, 365 to the misoprostol group and 376 to the vaginal dinoprostone group. There were no significant differences between the two treatment groups in the primary outcomes: vaginal birth not achieved in 24 hours (misoprostol 168/365 (46.0%) v dinoprostone 155/376 (41.2%); relative risk 1.12, 95% confidence interval 0.95 to 1.32; P=0.134), caesarean section (83/365 (22.7%) v 100/376 (26.6%); 0.82, 0.64 to 1.06; P=0.127), caesarean section for fetal distress (32/365 (8.8%) v 35/376 (9.3%); 0.91, 0.57 to 1.44; P=0.679), or uterine hyperstimulation with changes in fetal heart rate (3/365 (0.8%) v 6/376 (1.6%); 0.55, 0.14 to 2.21; P=0.401). Although there were differences in the process of labour induction, there were no significant differences in adverse maternal or neonatal outcomes. CONCLUSIONS: This trial shows no evidence that oral misoprostol is superior to vaginal dinoprostone for induction of labour. However, it does not lead to poorer health outcomes for women or their infants, and oral treatment is preferred by women. Trial registration National Health and Medical Research Council, Perinatal Trials, PT0361. (11 references) (Author) --No virus found in this incoming message.Checked by AVG Free Edition.Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006
[ozmidwifery] Pelvic floor
Mode of Delivery and Pelvic Floor Dysfunction: a Systematic Review of the Literature on Urinary and Fecal Incontinence and Sexual Dysfunction by Mode of Delivery CME/CE Authors: Joshua Press, MD; Michael C. Klein, MD, CFPC, FCFP, FAAP (Neonatal-Perinatal), FCPS, ABFP; Peter von Dadelszen, DPhil, FRCSC, FRCOG Disclosures Release Date: January 17, 2006; Valid for credit through January 17, 2007 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] trials
Title: Message I attended a birth at home early this morning as 2nd midwife. Primip, vaginal water birth, non -directed second stage, physiologic 3rd stage. Small 2nd deg. Tear, sutured by midwife. A beautiful birth of a.3.7kg baby. I was speaking to a midwife who works in the birth suite of our large teaching hospital where about 5,000 women give birth. Some high risk but most potentially normal birth. She was thrilled to hear about the birth. She said she never sees anything like it where she works. How sad,. MM Subject: RE: [ozmidwifery] trials vaginal birth not achieved in 24 hours misoprostol 46.0% v dinoprostone 41.2% okay so if 46% did not birth vaginally and 22.7% had cs what happened to the other23.3% that didn't birth vaginally Also, are women going to be told that they havealmost a 50% chance of needing a cs with an induction?That inductions fail almost half the timegee I know, lets do what the prominent OB from Adelaide is suggesting and induce all women at 39 weeks andalmost double our cs rate! caesarean section 22.7% v 26.6% and we wonder why we have a national cs rate of over 25%!!! caesarean section for fetal distress 8.8% v 9.3% uterine hyper stimulation with changes in fetal heart rate 0.8% v 1.6% and yet the risk of rupture being an estimated 0.3% is too high to offer vbac as an optionlets give these women a drug that can hyper stimulate their uteri and increase the chance of serious morbidity or mortality and potentially leave them with a ruptured uterus despite not having a previous scar. *sigh* I seriously wonder sometimes how these academics get funded! Oh sorry, this was a drug company who will benefit from this study...not women. I have a suggestion: why doesn't someone get funding to do atrial into spontaneous non-interventative (minus the actual medical need)birthvs. active management and compare the outcomes? Lets actually see if natural noninvasive supported and educated birth is fraught with the dangers that we get thrown at us. grr grr grr Jo -Original Message- From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Mary Murphy Sent: Saturday, March 04, 2006 7:08 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] trials At least they asked the womens preference. Guess what they chose? MM Oral misoprostol for induction of labour at term: randomised controlled trial-BMJ,vol 332, no 7540, 4 March 2006, pp 509-511Dodd JM; Crowther CA; Robinson JS-(2006)OBJECTIVE: To compare oral misoprostol solution with vaginal prostaglandin gel (dinoprostone) for induction of labour at term to determine whether misoprostol is superior. DESIGN: Randomized double blind placebo controlled trial. SETTING: Maternity departments in three hospitals in Australia.Population Pregnant women with a singleton cephalic presentation at /=36+6 weeks' gestation, with an indication for prostaglandin induction of labour. INTERVENTIONS: 20 microg oral misoprostol solution at two hourly intervals and placebo vaginal gel or vaginal dinoprostone gel at six hourly intervals and placebo oral solution. MAIN OUTCOME MEASURES: Vaginal birth within 24 hours; uterine hyperstimulation with associated changes in fetal heart rate; caesarean section (all); and caesarean section for fetal distress. RESULTS: 741 women were randomised, 365 to the misoprostol group and 376 to the vaginal dinoprostone group. There were no significant differences between the two treatment groups in the primary outcomes: vaginal birth not achieved in 24 hours (misoprostol 168/365 (46.0%) v dinoprostone 155/376 (41.2%); relative risk 1.12, 95% confidence interval 0.95 to 1.32; P=0.134), caesarean section (83/365 (22.7%) v 100/376 (26.6%); 0.82, 0.64 to 1.06; P=0.127), caesarean section for fetal distress (32/365 (8.8%) v 35/376 (9.3%); 0.91, 0.57 to 1.44; P=0.679), or uterine hyperstimulation with changes in fetal heart rate (3/365 (0.8%) v 6/376 (1.6%); 0.55, 0.14 to 2.21; P=0.401). Although there were differences in the process of labour induction, there were no significant differences in adverse maternal or neonatal outcomes. CONCLUSIONS: This trial shows no evidence that oral misoprostol is superior to vaginal dinoprostone for induction of labour. However, it does not lead to poorer health outcomes for women or their infants, and oral treatment is preferred by women. Trial registration National Health and Medical Research Council, Perinatal Trials, PT0361. (11 references) (Author) -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date:
RE: [ozmidwifery] trials
Title: Message the sad thing is that she works at a teaching hospital where they have only one thing they are familiar with -managed birth...so they are perpetuating the status quo. it is sad Mary. -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006
[ozmidwifery] on the subject of induction
Title: Message Just seeking some advice from midwives out there-I know I will most likely forget to ask all of these when I go to the antenatal clinic or have my next midwife visit I am 35+something weeks and have started to show signs of cholestasis over the past few weeks. Blood results are fluctuating a bit they go high and the next one is about normal and then high again. I am preparing for the eventuality of an induced hospital birth (though still hoping to go into labor at home in the 36th week) Some part of me wants to be induced now so I dont have to deal with the stress of that stillbirth stat. anyway Can someone tell me? 1) Is it the syntocin in the IV that poses the greatest threat to me/we in terms of uterine hyper stimulation and fetal distress or can the prostaglandin gel and ARM cause that too? 2) Is the failed induction-requiring C/s rate really around 50%? Is there anything that I can do to minimize that risk if I am induced? Like staying up, walking around, asking to be left alone, requesting minimal monitoring that sort of stuff. And will they let me do that at a large teaching hosp? (I have the dream of asking to be left alone and sneaking off to the bathroom and giving birth in the water quietly without any interference--dont like my chances!) How much negotiating power do women really have in this circumstance? My view is that ultimately its my body, my baby, and my birth but I dont want to make it hard for us all by being hard line at a time when I need to go inside and give birth (I can see that back-firing on me). Its just hard to work out what the important stuff is-it all seems so important! Amy -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006
[ozmidwifery] Re: on the subject of induction/cholestasis
Hi Amy, Here are two articles you should read about Cholestasis. One is off this list and the other is from http://www.birthlove.com Gloria in Canada What Is Obstetric Cholestasis? -by Natalie Forbes Dash Homebirth Access Sydney Blue Mountains Homebirth Support CHOLESTASIS is a liver condition that involves pruritis (itching) and increased bile acid levels in the last trimester of pregnancy. Approximately 1% of pregnant women have this condition, which continues until delivery. Babies have an increased chance of meconium stained amniotic fluid, foetal distress, spontaneous preterm delivery and a 1 in 4 chance of being stillborn. Subsequent pregnancies are usually affected, getting worse with each. Quite often symptoms go unrecognised in first pregnancies, increasing babies risks. Cholestasis is caused by a blockage. When the liver has little capacity for absorption or excretion of bile, some of the normally excreted bile acids cause partial destruction of the liver cell membrane, allowing the toxins to enter the blood. Little is known, but there is evidence to show that oestrogen plays a large role. Patients with increased oestrogen levels, such as those carrying twins, have an increased incidence of the disease.There is also a chance that cholestasis could be hereditary. Symptoms may be difficult to diagnose until the patient is very sick., but if women and caregivers are aware of cholestasis it can be controlled. Pruritis (itching) usually starts on the soles of the feet and the palms, extending to the rest of the body. In some severe cases it can involve the face, ears, mouth and head. Itching is at its worst throughout the night, leading to sleep deprivation, exhaustion and physical and mental fatigue. Mild jaundice is shown in about 20% of patients and some babies are born jaundiced. Nausea and vomiting can be present throughout pregnancy, and 50% of mothers get urinary tract infections at the onset. In severe cases a cough may come on in the earlier stages before itching begins. Approximately 80% of patients show rises in liver levels after 30 weeks gestation. More severe cases come on earlier, last longer and have extreme symptoms, i.e. prickles, stinging, pain in the head and an increased chance of fatty liver disease, putting mother at risk. Although the outcome is mostly good for mum, this disease frequently leads to malabsorption of vitamins, worsening maternal nutrition status. Cholestasis has about a 20% risk of postpartum haemorrhage and the tendency towards bleeding may be caused by inadequate absorption of vitamin K, which is needed for the blood to clot. So far the treatments available to us are undesirable. We are only offered ways of suppressing the symptoms and the treatments only work if diagnosed early enough, or if it's a mild case and still side effects are not known. I was offered antihistamines and tranquillisers to supposedly help with pruritis, steroids to mature my baby's lungs and an induction or caesarean after establishment of foetal lung maturity at 34 wks. Unknown are the effects of these drugs on our livers. It's possible that they could be actually making the problem worse for baby or subsequent pregnancies for the mother. I took this disease very seriously, but was unable to accept these options. After researching cholestasis this is how I decided to manage my condition. Firstly I did the obvious and took out all fats from my diet, eating only fresh fruit and vegetables, preferably organic and drank 10 litres of purified water a day (the recommended amount of water is 2/3 litres per day) to flush the toxins out of my liver. I also drank fresh beetroot juice and vegetable soups. I took herbs to support my liver throughout my pregnancy and had a mix made up from my naturopath after cholestasis was confirmed, including Dandelion, St Mary's Thistle, Globe artichoke and Psyllium husks. I also did yoga and had Reiki to support my mind and body. Acupuncture was performed throughout my pregnancy for liver function, but more for use of induction in the final days before delivery. I had blood tests performed monthly until 20 weeks, every week from 30 weeks and every day from 32 weeks until birth. I also agreed to daily monitoring of baby's heartbeat. At 32 weeks I became aware of my liver cells dying and my levels indicated I was on my way to fatty liver disease, giving me a 20% chance of maternal mortality. I knew I had to take full responsibility for myself and my baby and putting drugs into our bodies would only of done us more harm. Unfortunately there is not much information about this disease and many doctors and midwives are unaware of the symptoms, making it very difficult to diagnose. Since my last baby was born, almost 3 yrs ago, I have continued to research this condition. There has been very little progress in the treatment offered from the medicos. Ursofalk acid is used in most cased, this
RE: [ozmidwifery] on the subject of induction
Title: Message Hi Amy, re the syntocinon. This can be controlled by turning up or down the delivery rate on the IVAC, so isnt really the problem with hyperstimulation. The Ptostin gel is put on the cervix and once there and absorbed cannot be controlled easily. So, it is the Gel that is the problem. The artificial rupture of membranes is not a problem for hyperstimulation but is always done for safety reasons when using Syntocinon infusion. As you know, this is not my area of expertise, so can only read the research. Thinking of you at this difficult time, Love Mary Murphy From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of adamnamy Sent: Saturday, 4 March 2006 8:32 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] on the subject of induction Just seeking some advice from midwives out there-I know I will most likely forget to ask all of these when I go to the antenatal clinic or have my next midwife visit I am 35+something weeks and have started to show signs of cholestasis over the past few weeks. Blood results are fluctuating a bit they go high and the next one is about normal and then high again. I am preparing for the eventuality of an induced hospital birth (though still hoping to go into labor at home in the 36th week) Some part of me wants to be induced now so I dont have to deal with the stress of that stillbirth stat. anyway Can someone tell me? 1) Is it the syntocin in the IV that poses the greatest threat to me/we in terms of uterine hyper stimulation and fetal distress or can the prostaglandin gel and ARM cause that too? 2) Is the failed induction-requiring C/s rate really around 50%? Is there anything that I can do to minimize that risk if I am induced? Like staying up, walking around, asking to be left alone, requesting minimal monitoring that sort of stuff. And will they let me do that at a large teaching hosp? (I have the dream of asking to be left alone and sneaking off to the bathroom and giving birth in the water quietly without any interference--dont like my chances!) How much negotiating power do women really have in this circumstance? My view is that ultimately its my body, my baby, and my birth but I dont want to make it hard for us all by being hard line at a time when I need to go inside and give birth (I can see that back-firing on me). Its just hard to work out what the important stuff is-it all seems so important! Amy -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006
Re: [ozmidwifery] trials
On 3/4/06, Dean Jo [EMAIL PROTECTED] wrote: cs what happened to the other 23.3% that didn't birth vaginally What the research said was that 23.3% did not deliver within 24hours. So they either failed to be inducded at all or took longer than 24hours to birth their babies. Also, are women going to be told that they have almost a 50% chance of needing a cs with an induction? Obviously only 22.5% actually required a CS (Yes too high still acording to WHO guidlines) but where did you get 50% risk from? That inductions fail almost half the time Once again where does this percentage come from. You raise really valid issues but this trial seemed to me to be offering birthing women a better option for induction than the very invasive Vaginal option. Yes we do too many IOL'S and way too many C/S's. But many women don't know, don't care or don't have any choice and this particular peice of research might just give them one more option that is less invasive. As for the VBAC situation - women can choose a vbac, many choose elective C/S too. At least they asked the women's preference. Guess what they chose? MM Oral misoprostol for induction of labour at term: randomised controlled trial - BMJ , vol 332, no 7540, 4 March 2006, pp 509-511 Dodd JM; Crowther CA; Robinson JS - (2006) OBJECTIVE: To compare oral misoprostol solution with vaginal prostaglandin gel (dinoprostone) for induction of labour at term to determine whether misoprostol is superior. DESIGN: Randomized double blind placebo controlled trial. SETTING: Maternity departments in three hospitals in Australia.Population Pregnant women with a singleton cephalic presentation at /=36+6 weeks' gestation, with an indication for prostaglandin induction of labour. INTERVENTIONS: 20 microg oral misoprostol solution at two hourly intervals and placebo vaginal gel or vaginal dinoprostone gel at six hourly intervals and placebo oral solution. MAIN OUTCOME MEASURES: Vaginal birth within 24 hours; uterine hyperstimulation with associated changes in fetal heart rate; caesarean section (all); and caesarean section for fetal distress. RESULTS: 741 women were randomised, 365 to the misoprostol group and 376 to the vaginal dinoprostone group. There were no significant differences between the two treatment groups in the primary outcomes: vaginal birth not achieved in 24 hours (misoprostol 168/365 (46.0%) v dinoprostone 155/376 (41.2%); relative risk 1.12, 95% confidence interval 0.95 to 1.32; P=0.134), caesarean section (83/365 (22.7%) v 100/376 (26.6%); 0.82, 0.64 to 1.06; P=0.127), caesarean section for fetal distress (32/365 (8.8%) v 35/376 (9.3%); 0.91, 0.57 to 1.44; P=0.679), or uterine hyperstimulation with changes in fetal heart rate (3/365 (0.8%) v 6/376 (1.6%); 0.55, 0.14 to 2.21; P=0.401). Although there were differences in the process of labour induction, there were no significant differences in adverse maternal or neonatal outcomes. CONCLUSIONS: This trial shows no evidence that oral misoprostol is superior to vaginal dinoprostone for induction of labour. However, it does not lead to poorer health outcomes for women or their infants, and oral treatment is preferred by women. Trial registration National Health and Medical Research Council, Perinatal Trials, PT0361. (11 references) (Author) -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006 -- My photos online @ http://community.webshots.com/user/mike1962nz My Group online @ http://groups.yahoo.com/group/PSP_for_Photographers New Photo site@ Mike - http://mikelinz.dotphoto.com Lindsay - Http://likeminz.dotphoto.com Life is a sexually transmitted condition with 100% mortality and birth is as safe as it gets. Unknown -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
