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anal incontinenceFrom: MajMahan@aol.comWed Apr 30 01:26:46 1997
Bob, good literature search. I have to add to it the review done in the green journal;Protecting the pelvic floor: Obstetric management to prevent incontinence and pelvic organ prolapse 88;3;96. A synopsis; It was authored by Ostergard among others. Incidence of incontinece was 4-50% with sphincter tears even after primary repair. Of interest was the finding that there was incontinence in 3% of patients without a recognized laceration. This information of course came also from Sultan's 1993 study which suggested occult sphincter tears as the etiology. These were identified by transanal ultrasound ( no description on the size of the probe). The findings of occult sphincter tears resulting in incontinence even with an intact perineum (tough certainly with less frequency than with identified sphincter damage) means that one cannot guarantee a patient that she will not have problems just because an episiotomy was not done. The review went on to suggest less forceps use, and that use of a vacuum extraction may be less traumatic. He also suggests allowing a more passive second stage, though he further states that doing so had not been examined prospectively. He doesn't go so far as to advocate elective c/s, but does make the statement in the review that "the long term impact and costs of pelvic floor injuries might outweigh the short term concerns" (referring to c/s complications). Rather, he suggests further research to identify women who would benefit from elective c/s. I also read an abstact from england the other day that dealt with physicians preferences concerning c/s. It reported that 31% of female physicians polled would desire an elective c/s mostly due to concerns regarding urinary and anal incontinence following vaginal birth. FWIW. Miles Mahan, Maj., MC Darnall Army Community Hospital Ft. Hood, Texas PS. Has anyone out there been to Kuwait? The army in it's infinite wisdom has decided to send me there June through August. I think it might get hot. :)
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