Document Detail

Obstetric-induced incontinence: a black hole of preventable morbidity.
MedLine Citation:
PMID:  17116049     Owner:  NLM     Status:  MEDLINE    
There is a detailed literature comprising clinical and anorectal physiological studies linking faecal incontinence to vaginal delivery. Specific risk factors are high infant birthweight, forceps delivery and prolonged second stage of labour. The onset of symptoms may be delayed for many years. Faecal incontinence occurs in more than 10% of adult females and urinary incontinence in about a third of multiparous women. This places a very large economic burden on the Australian health system. A conservative estimate for overall management of incontinence would be in excess of $A700 million but the actual amount is unknown. Preventative measures for avoiding pelvic floor injuries need to be established, and safe obstetric practice needs to be redefined in the light of current knowledge about incontinence. Outcome measures for safe birthing should not only include infant and maternal mortality and infant morbidity, but should also include the long-term effects of vaginal delivery on the pelvic floor, particularly urinary and faecal incontinence. Several state reports and one federal senate report on safe birthing have been lacking in this area. The safety of birthing centres and home birthing needs to be examined to provide birthing mothers with complete and appropriate information about safety in order that they may consider their options. Appropriate Caesarean section rates for optimal birthing safety are unknown and need to be re-examined. Calls for overall reduction in Caesarean section rates in Australia are inappropriate and cannot be justified until the effects of pelvic floor injury are added to the overall assessment.
Michelle J Thornton; David Z Lubowski
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Australian & New Zealand journal of obstetrics & gynaecology     Volume:  46     ISSN:  0004-8666     ISO Abbreviation:  Aust N Z J Obstet Gynaecol     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-11-22     Completed Date:  2007-02-13     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0001027     Medline TA:  Aust N Z J Obstet Gynaecol     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  468-73     Citation Subset:  IM    
St George Hospital - Colorectal Surgery, St George Medical Centre, Sydney, New South Wales, Australia.
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MeSH Terms
Birth Weight
Delivery, Obstetric* / methods
Fecal Incontinence / economics,  epidemiology,  prevention & control*
Labor Stage, Second
Obstetrical Forceps
Pelvic Floor / injuries,  innervation
Risk Factors
Treatment Outcome
Urinary Incontinence / economics,  epidemiology,  prevention & control*
Comment In:
Aust N Z J Obstet Gynaecol. 2007 Apr;47(2):86-90   [PMID:  17355294 ]
Aust N Z J Obstet Gynaecol. 2007 Apr;47(2):152; author reply 153-4   [PMID:  17355309 ]
Aust N Z J Obstet Gynaecol. 2007 Apr;47(2):152-3; author reply 153-4   [PMID:  17355308 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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