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Re: Vag delivery, c-section, and the pelvic floorFrom: RModugno@aol.comSat Dec 3 21:30:45 2005
In a message dated 12/3/2005 10:41:20 PM Eastern Standard Time, annam@uic.edu writes: Check this out, those of you who think you're protecting pelvic floors by doing elective primary c-sections: http://www.acog.org/from_home/publications/press_releases/nr11-30-05-1.cfm Anna Meenan, MD Ok, check this out: Highlights of the 26th Annual Meeting of the America Urogynecology Society, Atanta, Sept 2005: The Contribution of Pregnancy and Vaginal Delivery to the Development of Pelvic Floor Dysfunction A number of epidemiologic studies presented data supporting the role of pregnancy and vaginal delivery in the pathophysiology of pelvic floor disorders. Dr. Lukacz and colleagues from Kaiser Permanente in San Diego, California, won the Best Paper prize for their study of 12,200 women characterized by the Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ). In their population, the risk of pelvic floor dysfunction was independently associated with vaginal parity, but not with pregnancy. Delivery by cesarean section offered a protective effect. Interestingly, pelvic floor dysfunction associated with parity included overactive bladder and anal incontinence in addition to stress incontinence, as well as pelvic organ prolapse. Dr. Ghetti and colleagues' case control study from McGee Women's Hospital corroborated these findings. They found that women undergoing surgery for pelvic organ prolapse or urinary incontinence were 3.7 times more likely to be vaginally parous than control s. In addition to demonstrating associations between vaginal parity and pelvic floor dysfunction, several studies provided new information on the associations between fecal incontinence and anal sphincter disruption and pelvic floor dysfunction. Dr. Nichols and her colleagues, from Virginia Commonwealth University, Richmond, reported a case-control study that compared 90 controls without pelvic organ prolapse or urinary incontinence to 100 women with urinary incontinence or stage 2 or higher pelvic organ prolapse. The women with pelvic floor dysfunction were more likely to report fecal incontinence (OR 5.1), scored higher on the Rockwood-Thompson fecal incontinence severity index, and had 21% more anal sphincter disruptions at the time of endoanal ultrasonography than controls (51% vs 30%, P = .007). Fecal incontinence was associated with sphincter disruption and operative vaginal delivery. Nulliparity, episiotomy, and operative vaginal delivery have been touted as risk factors for anal sphincter disruption in the past, but Dr. Lowder and colleagues, from McGee Women's Hospital, reported that vaginal birth after cesarean section (VBAC) is a more significant risk factor than these. In their cross-sectional analysis, women undergoing a VBAC had a similar risk of anal sphincter disruption to that of nulliparous women, but were 5 times more likely to have a sphincter disruption than women undergoing their second vaginal birth.
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