Oral Poster 27: The Exclusion of Elderly Women From Published Randomized Trials of Surgery for Stress Urinary Incontinence

Abstract

OBJECTIVE:To determine if a decrease in the episiotomy rate over time is associated with a corresponding decrease in the anal sphincter laceration rate. METHODS: Our institution began use of restrictive episiotomy in 1998, with decreasing rates over 4 consecutive academic years (1998 -99 to 2001-02). We obtained data from all women delivered during this period, and excluded cesarean and vaginal twin or breech deliveries. Rates of episiotomy, anal sphincter laceration (3 rd and 4 th degree tears), and other confounding variables were compared between 1998 -99 and 2001-02. Logistic regression was used to estimate the odds ratio of anal sphincter lacerations due to episiotomy and other variables in the first and last years of the study. RESULTS: The episiotomy rate decreased each of the 4 years, from 37.4% in 1998 -99 to 16.5% in 2001-02 (pϽ0.001). Similarly, the anal sphincter laceration rate decreased from 9.7% to 5.4% (pϽ0.001). There were no changes in age, race, nulliparity, duration of the second stage of labor, birthweight, or macrosomia, but oxytocin use decreased (37% to 31%, pϭ0.002), epidural use decreased (80% to 76%, pϭ0.02), and operative vaginal deliveries increased (8.9% to 11.2%, pϭ0.03). At spontaneous vaginal delivery, the episiotomy and anal sphincter laceration rates decreased over four years from 33% to 14% (pϽ0.001), and from 6.6% to 2.8% (pϽ0.001), respectively. Similarly, at operative vaginal delivery, the episiotomy and anal sphincter laceration rates decreased from 81% to 37% (pϽ0.001), and from 42% to 27% (pϭ0.007), respectively. Between the first and last years of the study, the adjusted odds ratio of anal sphincter laceration due to episiotomy decreased from 6.5 (95% CI 3.8, 11.1) to 2.9 (95% CI 1.7, 5.0). Conversely, the adjusted odds ratio for operative vaginal delivery increased from 4.4 (95% CI 2.7, 6.9) to 6.3 (95% CI 3.6, 11.1), but did not change for the other independent risk factors for anal sphincter laceration: nulliparity (from 2.9 to 2.9), prolonged second stage (from 2.0 to 2.1), and macrosomia (from 1.9 to 2.6). CONCLUSION: With restricted use of episiotomy, our episiotomy rate at vaginal delivery decreased by 56%, and our anal sphincter laceration rate decreased by 44%. These decreases occurred for spontaneous vaginal delivery as well as operative vaginal delivery. In addition, the risk of anal sphincter laceration due to episiotomy was reduced OBJECTIVE: To determine the prevalence, risk factors and impact upon quality of life of anal incontinence (AI) in women aged 18 to 65. METHODS: Consecutive women presenting for general gynecologic care to one of 6 tertiary centers were given a self-administered, anonymous bowel function questionnaire. Women responding positively to the question "Have you had any accidental leakage of bowel movements or gas in the last 12 months?" were prompted to complete the Fecal Incontinence Severity Index (FISI, 51 point scale) and the Fecal Incontinence Quality of Life Scale (FIQL, 0 -5 point scales). A higher score on the FISI indicates wor...