Persistent site-specific defects after reconstructive pelvic surgery.

Our objective was to determine the persistence rates of site-specific defects after reconstructive pelvic surgery. We conducted a retrospective analysis of the post-operative outcome for 77 patients with pelvic support defects. Forty-five patients in the abdominal group underwent a Burch procedure, paravaginal repair and sacral colpopexy when indicated; 32 patients in the vaginal group had a sacrospinous vault fixation with or without colporrhaphy. A chi2 test, Wilcoxon's two-sample test. Wilcoxon's signed-rank test and multivariate logistic regression model were used for data analysis. The two groups were similar in age, weight, parity and menopausal status. There was significant improvement of all defects except in the vaginal group, which showed a higher rate of persistent paravaginal defects (68.7 vs. 13.3%, P = 0.001). After adjusting for potential confounders, there was no difference in the rates of apical and anterior wall defects between the two groups. The odds ratio for persistent paravaginal defects in the vaginal group was 8.9 (95% CI: 2.3-34). The choice of surgical procedure is the most important factor determining the rate of persistent pelvic support defects. Lateral wall defects must be addressed at the time of reconstructive surgery.

The effect of induced abortion on the risks and outcome of a trial of labor after a previous cesarean birth.

Sixty-one women with previous cesarean deliveries who received prenatal care at Boston City Hospital or one of the neighborhood health centers affiliated with its obstetrical service elected to undergo a trial of labor (TOL) and attempt a vaginal birth after a cesarean (VBAC). Overall, 70 percent of these women achieved a vaginal delivery. When women who gave a history of a previous induced abortion were examined as a separate subgroup, they were able to achieve a vaginal birth not significantly different from those women in the overall group. There were no instances of uterine scar dehiscence or rupture in the series, leading to the conclusion that induced abortion, whether it occurs before or after the primary cesarean, is not a contraindication to a trial of labor with subsequent pregnancies.