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4/ Grade A evidence requires an RCT. RCT’s are designed treat context as a contaminant in order to answer a singular question—as a result, a large trial conducted at academic medical centers may not apply to the more resource-constrained hospitals where most Americans are born.
5/ The ARRIVE trial found that induction at 39 weeks without medical indication does not reduce perinatal death but does marginally decrease cesarean rates (at academic medical centers) https://www.nejm.org/doi/full/10.1056/NEJMoa1800566
6/ Based on these data, and contrary to the AJOG authors, I actually believe replacing the term “elective” with “risk reducing” for 39 week inductions without medical indication is misleading...
7/ for most community hospitals a high volume of prolonged inductions can be challenging to safely maintain
hospitals have real resource constraints which is why we aim to prioritize those who need those resources most...this is the right thing to do https://pubmed.ncbi.nlm.nih.gov/29476560/
hospitals have real resource constraints which is why we aim to prioritize those who need those resources most...this is the right thing to do https://pubmed.ncbi.nlm.nih.gov/29476560/
8/Also, the specific risk in question obviously matters.
Those with medical indications face starker risks than those who do not.
Based on the data, the AJOG authors appear to be equating the risk of cesarean with the risk of perinatal death.
Those with medical indications face starker risks than those who do not.
Based on the data, the AJOG authors appear to be equating the risk of cesarean with the risk of perinatal death.
9/ so yes...we should revisit the term "elective"
and also...let's not call interventions "risk reducing" without being clear about the specific risks we're talking about and the important context that drives them
and also...let's not call interventions "risk reducing" without being clear about the specific risks we're talking about and the important context that drives them
curious what MD colleagues think... @DocElovitz @cmpettker @JudetteLouis @janevandis @CatchTheBaby @drcynthiagyamfi @ChrisHanMFM @blairwylie @cclareMDMPH @jackie_parchem @astuebe @JasmineRJohnson @DrBrianIriye @MelissaWongMD @MetzTorri @LizHowellMD @alshanks @chitra_mdmba
pretty sure I already know what midwifery colleagues think :) @kanelow @sheena_byrom @hannahdahlen @FrankaCadee @robyncnm @godfrey_isaacs @indiek1 @JennieJoseph @BirthPlaceLab @mi_niles @Humanisingbirth @JennytheM @ABurnett_StMW @Mayra_K11 @decdevane
