Re: Legal impact on Medicine - was VBAC-New ACOG report on C/S
From: art fougner, md (evsono@pipeline.com)
Mon Aug 14 10:03:30 2000
EBM - ya gotta love it! LOL
art
At Mon, 14 Aug 2000, Bernard Cristalli wrote:
>
>Let's wait 10 years and we'll have an article with the conclusions: "It
>appears that elective cesarean sections are useless in preventing pelvic
>prolapse/incontinence. RCTs are strongly needed to clear that point."
>
>--
>Bernard Cristalli MD AMACOG
>AIHP - ACCA
>Paris France
>Bernard.Cristalli@CliniquedelEssonne.fr
>http://www.CliniquedelEssonne.fr
>http://www.obgyn.net/corresp/cristalli.htm
>http://www.gyneweb.fr
>'64 Mk2 3.8
>
>> De : evsono@pipeline.com (art fougner, md)
>> Répondre à : ob-gyn-l@obgyn.net
>> Date : Mon, 14 Aug 2000 08:32:30 -0500
>> À : Multiple recipients of list OB-GYN-L <ob-gyn-l@forum.obgyn.net>
>> Objet : Re: Legal impact on Medicine - was VBAC-New ACOG report on C/S
>>
>> 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:
>>>
>>> In a message dated 8/13/00 4:16:28 PM Eastern Daylight Time,
>>> jkulkin@mindspring.com writes:
>>>
>>> << No one said it shouldn't be, but for what reason? The higher rate is not
>>> associated with less perinatal mortality. As you know, C/S is associated
>>> with a
>>> 3-4 fold increase in morbidity and mortality though the rates are very low.
>>>>>
>>> Prevention of SUI, prolapse, rectal incontinence, ?lower rate of fetal
>>> cerebral hemorrhage......
>>> ( Just to be the devil's advocate)
>>>
>>> Robert Modugno MD MBA FACOG
>>> Marietta, GA
>>
>> --
>> art fougner, md
>>
>> A series of 1000 cases begins with but a single anecdote.
>>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
