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Re: Vag delivery, c-section, and the pelvic floorFrom: art fougner, md (evsono@pipeline.com)Sun Dec 4 11:48:31 2005
At Sun, 4 Dec 2005, Anna Meenan, MD wrote: > >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. >
-- art fougner, md
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