Re: Vag delivery, c-section, and the pelvic floor
From: Andrew Folley (agfolley@hotmail.com)
Sun Dec 4 08:46:42 2005
Anna, Robert sees your Acog article and has raised you by the Urogynecologic
society. Are you in or out? andy
>From: RModugno@aol.com
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: Vag delivery, c-section, and the pelvic floor
>Date: Sat, 3 Dec 2005 22:32:47 -0600
>
>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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