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Re: Legal impact on Medicine - was VBAC-New ACOG report on C/SFrom: art fougner, md (evsono@pipeline.com)Mon Aug 14 08:31:40 2000
Thanks Dr. Modugno and here's a pertinent abstract - 1: Obstet Gynecol 2000 Apr 1;95(4 Suppl 1):S46 Should elective cesarean birth be offered at term as an alternative to labor and delivery for prevention of complications, including symptomatic pelvic prolapse, as well as stress urinary and fecal incontinence? Bost BW St. Elizabeth Hospital, Beaumont, TX, USA [Record supplied by publisher] Objective: To compare the short- and long-term complications of labor and expected vaginal delivery versus the alternative of elective cesarean birth to analyze recommendations for elective cesarean birth.Methods: The literature was researched on the following topics: effects of childbirth on pelvic organ support and continence mechanisms; incidence and treatment of pelvic support defects/incontinence; fetal and maternal consequences of vaginal delivery, vaginal birth after cesarean, and cesarean birth with and without labor; and preliminary financial data on the two alternative courses of action (labor and delivery versus elective cesarean birth) to assess the overall economic impact of altering recommendations for elective cesarean section.Results: Substantive evidence shows tissue injury at delivery is the primary cause of pelvic support problems/incontinence. Time and the diminishing effects of estrogen result in stress incontinence/ pelvic prolapse in approximately 50% of parous women, whereas rectal injuries leave 5-10% with inadequate rectal sphincter control. Specific risk factors identified include the following: fetal size, prolonged second stage of labor, extensive episiotomy, parity, and operative vaginal delivery. Elective cesarean birth is protective if performed before labor progresses.Conclusions: Elective cesarean birth should be recommended at term to patients with a fetus greater than 4,000 g or a strong family history of pelvic prolapse/incontinence, and should be offered when the estimated fetal weight is above the 90th percentile (large for gestational age). as an aside at a recent conference in our medical center the presenter, a specialist in pelvic reconstructive surgery, thanked the audience of ob-gyns for their efforts toward effecting more vaginal deliveries and thus insuring him plenty of work. the point here is that the forces at work directing a reduction in section rates are NOT medical but economic and political. What goes around truly comes around.
art
At Sun, 13 Aug 2000, RModugno@aol.com wrote:
>
-- art fougner, md
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