Skip to main content

Towards Evidence-based Management

  • Chapter
Intrauterine Growth Restriction

Abstract

Although evidence-based medicine (EBM) describes a type of practice with which no-one can seriously disagree [1], it has also become a buzzword that irritates some doctors who see it eroding their clinical freedom. I hope to describe some of the key features of EBM as applied to fetal growth restriction and to demonstrate that the latter view is mistaken. The problem in clinical practice is mainly to do with information, and EBM is mainly concerned with dealing with information in a sensible way [2]. Sackett [1] defined EBM as converting information needs into answerable questions, tracking down the best evidence to answer them, critically appraising the evidence for its validity (closeness to truth) and its usefulness (clinical applicability), applying the results in clinical practice and evaluating our performance.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ 1996;312(7023):71–2.

    Article  PubMed  CAS  Google Scholar 

  2. Cooke IE, Sackett DL. Evidence based obstetrics and gynaecology. In: Cooke IE, Sackett DL, editors. Evidence-based obstetrics and gynaecology. Bailliere’s Clin Obstet Gynaecol 1996;10:535–49.

    Google Scholar 

  3. Cox DN, Wittman BK, Hess M, Ross AG, Lind J, Lindahl S. The psychological impact of diagnostic ultrasound. Obstet Gynecol 1987;70:673–6.

    PubMed  CAS  Google Scholar 

  4. Johnson N. Development and potential of fetal pulse oximetry. Contemp Rev Obstet Gynaecol 1992;3:193–200.

    Google Scholar 

  5. Thornton JG, Lilford RJ. Do we need randomised trials of antenatal tests of fetal wellbeing? Br J Obstet Gynaecol 1993;100:197–200.

    Article  PubMed  CAS  Google Scholar 

  6. Manning FA, Platt LD, Sipos L. Antepartum fetal evaluation: development of a fetal biophysical profile. Am J Obstet Gynecol 1980;136:787–95.

    PubMed  CAS  Google Scholar 

  7. Manning FA, Morrison I, Lange IR, Harman CR, Chamberlain PF. Fetal assessment based on fetal biophysical profile scoring: experience in 12,620 referred high–risk pregnancies 1. Perinatal mortality by frequency and etiology. Am J Obstet Gynecol 1985;151:343–50.

    Google Scholar 

  8. Tyrell S, Obaid AH, Lilford RJ. Umbilical artery Doppler velocimetry as a predictor of fetal hypoxia and acidosis at birth. Obstet Gynecol 1989;74:332–7.

    Google Scholar 

  9. Spence JE, Perciaccante RG, Greig GM, Willard HF, Ledbetter DH, Hejtmancik JF, et al. Uniparental disomy as a mechanism for human disease. Am J Hum Genet 1988;42:217–26.

    PubMed  CAS  Google Scholar 

  10. Hall JG. Genomic imprinting: review and relevance to human diseases. Am J Hum Genet 1990;46:857–73.

    PubMed  CAS  Google Scholar 

  11. Koistinen HA, Koivisto VA, Andersson S, Karonen SL, Kontula K, Oksanen L, et al. Leptin concentration in cord blood correlates with intrauterine growth. J Clin Endocrinol Metab 1997;82:3328–30.

    Article  PubMed  CAS  Google Scholar 

  12. Liebel RL. And finally genes for human obesity. Nat Genet 1997;16:218–20.

    Article  Google Scholar 

  13. Johanson R, Lindow SW, van der Eist C, Jaquire Z, van der Westhuizen S, Tucker A. A prospective randomised comparison of the effect of continuous 02 therapy and bedrest on fetuses with absent end–diastolic flow on umbilical artery Doppler waveform analysis. Br J Obstet Gynaecol 1995;102(8):662–5.

    Article  PubMed  CAS  Google Scholar 

  14. Grimes DA. Randomisation controlled trials: “it ain’t necessarily so”. Obstet Gynecol 1991;78:703–4.

    PubMed  CAS  Google Scholar 

  15. Schulz KF, Chalmers I, Grimes DA, et al. Assessing the quality of randomization from reports of controlled trials published in obstetrics and gynecology journals. JAMA 1994;272:125–8.

    Article  PubMed  CAS  Google Scholar 

  16. McDonough PG. “Leaky randomization”: standard practice–but is it correct? Fertil Steril 1995;64:216–17.

    Google Scholar 

  17. Grimes DA, Schulz KF. Methodology citations and the quality of RCTs in obstetrics and gynecology. Am J Obstet Gynecol 1996;174:1312–15.

    Article  PubMed  CAS  Google Scholar 

  18. CLASP Collaborative Group. CLASP: a randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women. Lancet 1994;343: 619–29.

    Article  Google Scholar 

  19. Nelson KB, Ellenberg JH. Antecedents of cerebral palsy. Multivariate analysis of risk. New Engl J Med 1986;315:81–6.

    Google Scholar 

  20. Naeye RL, Peters EC. Antenatal hypoxia and low IQ values. Am J Dis Child 1987;141:50–4.

    PubMed  CAS  Google Scholar 

  21. Sung I-K, Vohr B, Oh W. Growth and neurodevelopmental outcome of very low birth weight infants with intrauterine growth retardation: comparison with control subjects matched by birth weight and gestational age. J Paediatr 1993;123:618–24.

    Google Scholar 

  22. Todd AL, Trudinger BJ, Cole MJ, Cooney GH. Adverse fetal welfare and outcome at 2 years. J Matern Fetal Investl991;l(2):101.

    Google Scholar 

  23. Soothill PW, Ajayi RA, Campbell E, Ross EM, Candy JDCA, Snijders RM, et al. Relationship between fetal acidemia at cordocentesis and subsequent neurodevelopment. Ultrasound Obstet Gynaecol 1992;2(2):80–3.

    Article  CAS  Google Scholar 

  24. Gaudier FL, Goldenberg RL, Nelson KG, Peralta-Carcelen M, Johnson SE DuBard MB, et al. Acid base status and subsequent neurosensory impairment in surviving 500 to 1000 gm infants Am J Obstet Gynecol 1994;170:48–53.

    Google Scholar 

  25. Goldstein RF, Thompson RJ, Oehler JM, Brazy JE. Influence of acidosis, hypoxemia, and hypotension on neurodevelopmental outcome in very low birth weight infants. Pediatrics 1995;95: 238–43.

    PubMed  CAS  Google Scholar 

  26. Hagberg B, Hagberg G, Olow I, Von Wendt L. The changing panorama of cerebral palsy in Sweden. Acta Paediatr Scand 1989;78:283–90.

    Article  PubMed  CAS  Google Scholar 

  27. Stanley FJ, Watson L. The cerebral palsies in western Australia: trends, 1968–1981. Am J Obstet Gynecol 1988;158:89–93.

    PubMed  CAS  Google Scholar 

  28. Pharoah POD, Cooke T, Cooke RWI, Rosenbloom L. Birthweight specific trends in cerebral plasy. Arch Dis Child 1990;65:602–6.

    Article  PubMed  CAS  Google Scholar 

  29. Griffiths R. The abilities of young children. A comprehensive system of mental measurement for the first eight years of life. High Wycombe, Bucks: The Test Agency, 1970.

    Google Scholar 

  30. GRIT Study Group. When do obstetricians recommend delivery for a high-risk preterm growth-retarded fetus? Eur J Obstet Gynaecol Reprod Biol 1996;67:121–6.

    Article  Google Scholar 

  31. Thornton JG, Lilford RJ. Preterm breech babies, and randomised trials of rare conditions [commentary]. Br J Obstet Gynaecol 1996;103:611–13.

    Article  PubMed  CAS  Google Scholar 

  32. Lilford RJ, Braunholz D. The statistical basis of public policy: a paradigm shift is overdue. BMJ 1996;313:603–7.

    Article  PubMed  CAS  Google Scholar 

  33. Freedman L. Bayesian statistical methods. BMJ 1996;313:569–70.

    CAS  Google Scholar 

  34. Thornton JG, Lilford RJ, Johnson N. Decision analysis in medicine. BMJ 1992;304:1099–103.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2000 Springer-Verlag London Limited

About this chapter

Cite this chapter

Thorton, J.G., Hornbuckle, J. (2000). Towards Evidence-based Management. In: Kingdom, J., Baker, P. (eds) Intrauterine Growth Restriction. Springer, London. https://doi.org/10.1007/978-1-4471-0735-4_22

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-0735-4_22

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-1191-7

  • Online ISBN: 978-1-4471-0735-4

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics