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Re: 4th degree tear/reconstructionFrom: Braun, R. Daniel (rbraun@iupui.edu)Sun Jun 18 08:49:26 2000
Does Dr. Bost propose how we are to weigh these babies before they are born? We are all aware of the inaccuracy of sonographic and clinical EFW. Especially in the range that we are talking about here. RDB -----Original Message----- From: RModugno@aol.com To: Multiple recipients of list OB-GYN-L Sent: 6/17/00 4:24 PM Subject: Re: 4th degree tear/reconstruction In a message dated 6/17/00 4:51:29 PM Eastern Daylight Time, jbulley@cheshire.net writes: << I just saw for a post op check, a woman whose bottom was not repaired correctly after a vaginal delivery of an LGA infant. It gaped open and made sex totally unenjoyable and resulted in air passing from the vagina because of the flappy walls - (not from a fistula). She had a hard time convincing anyone she had a medical problem and not just a plastic/cosmetic/sexual problem. She is delighted with the results. Pre-op it just gaped and now it has normal size, shape, direction and distendibility. Please - no male doc/female doc or doc/CNM issues here. The patient's delivery and 'repair' was by a woman doc. This is not a gender or CNM/Doc issue. I think (and I could be wrong....) that there are many folks at delivery who do a 'quick let's finish job' in the delivery room. my $0.02
Joanne
>> Just another case for elective cesarean section for LGA pregancies! See article below: Obstetricians urges physicians to offer C-sections to more women By Theresa Tamkins SAN FRANCISCO, May 24 - Nearly 60% of women who give birth vaginally will develop stress incontinence by age 50, and many will experience prolapsed uterus or fecal incontinence, according to a Texas researcher. More women should be offered cesarean section before or during delivery to avoid these long-term complications of vaginal deliveries, Dr. Brent W. Bost, of St. Elizabeth Hospital in Beaumont, said here at the American College of Obstetricians and Gynecologists meeting. Dr. Bost, who reported on his analysis of a number of studies of labor and delivery, maintained that cost-effectiveness studies have not looked at long-term complications such as incontinence or prolapse. He believes that women should be given a choice of delivery method, based on their risk factors. "A plethora of evidence indicates that vaginal delivery is the most significant predisposing factor for the development of pelvic prolapse and stress incontinence of urine and feces in adult women," he said. "It is equally clear that cesarean section performed prior to advanced labor is virtually 100% effective at eliminating these problems." A woman who has had oxytocin is 1.85 times as likely to have stress incontinence as a woman who has not, Dr. Bost said, and the risk of stress incontinence is three times higher if a woman is given oxytocin in two different pregnancies. Other risk factors for incontinence and pelvic support problems are higher parity, greater fetal size, prolonged second stage of labor, extensive episiotomy, and operative vaginal delivery. Even though cesarean sections can take longer to recuperate from and also carry a greater risk of complications, for some women, the risks outweigh the injuries, Dr. Bost said. He advised offering cesarean sections to all women who have fetuses at the 90th percentile for weight, those who have a family history of prolapse or incontinence, and those whose babies weigh more than 8 pounds, 13 ounces (4,000 grams). Robert Modugno MD MBA FACOG Marietta, GA
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