Re: Vag delivery, c-section, and the pelvic floor
From: Anna Meenan, MD (annam@uic.edu)
Sun Dec 4 10:11:51 2005
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Not much of a poker player (though my sons are quite good at it). Just
saw it posted on Red State Moron and thought you guys might be
interested. I don't think the question has been answered conclusively
yet. Have seen other studies that question the connection but don't
have time to find them right now.
--
Anna Meenan, MD
At Sun, 04 Dec 2005, Andrew Folley wrote:
>
>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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