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• W4247156686 abstract "We want to thank Dr Frohlich for his comments on our article.1Patel D.A. Xu X. Thomason A.D. Ransom S.B. Ivy J.S. DeLancey J.O. Childbirth and pelvic floor dysfunction: an epidemiologic approach to the assessment of prevention opportunities at delivery.Am J Obstet Gynecol. 2006; 195: 23-28Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar There is a growing debate centering on the concept of cesarean delivery on maternal request (ie, cesarean delivery in the absence of medical or obstetric complications). Prevention of pelvic floor dysfunction (PFD) is cited frequently as a reason to offer or to elect cesarean section, despite limited evidence on short- and long-term maternal (and infant) outcomes. At the most fundamental level, research efforts are complicated by the lack of a common definition for elective cesarean section. Moreover, although a comparison of outcomes between various modes of delivery should use intent-to-treat methods, there have been no rigorously designed epidemiologic studies that have compared planned elective cesarean with planned vaginal delivery in low-risk populations.2Wax J.R. Cartin A. Pinette M.G. Blackstone J. Patient choice cesarean: an evidence-based review.Obstet Gynecol Surv. 2004; 59: 601-616Crossref PubMed Scopus (184) Google Scholar Studies of pelvic organ prolapse in relation to childbirth and, specifically, to mode of delivery are missing glaringly from the literature. The limited data that are available currently that compare elective cesarean and vaginal delivery have shown comparable severity of incontinence after either delivery mode.3Lal M. Prevention of urinary and anal incontinence: role of elective cesarean delivery.Curr Opin Obstet Gynecol. 2003; 15: 439-448Crossref PubMed Scopus (25) Google Scholar The role of elective cesarean section in the prevention of PFD warrants further investigation. Until then, policies that support cesarean delivery on maternal request remain unsubstantiated. The National Institutes of Health (NIH) recently convened a State-of-the-Science Conference to assess the available scientific evidence regarding trends in cesarean incidence, short- and long-term benefits and harms to mother and baby that are associated with cesarean delivery on maternal request relative to attempted vaginal delivery, and future research directions for making appropriate decisions regarding mode of delivery. The expert panel reached consensus that, currently, there is insufficient evidence to evaluate fully the benefits and risks of cesarean delivery on maternal request as compared to planned vaginal delivery. The full statement is available on-line at http://consensus.nih.gov/2006/CesareanProgramAbstractComplete.pdf. We hope that our article1Patel D.A. Xu X. Thomason A.D. Ransom S.B. Ivy J.S. DeLancey J.O. Childbirth and pelvic floor dysfunction: an epidemiologic approach to the assessment of prevention opportunities at delivery.Am J Obstet Gynecol. 2006; 195: 23-28Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar and the NIH consensus statement raise awareness of the need for the best possible epidemiologic data to guide the issue of cesarean delivery on maternal request. Significant gaps remain in our understanding of the role of childbirth-related factors in the development of PFD later in life that currently preclude women and their health care providers from making fully informed decisions regarding mode of delivery. Based on the epidemiologic evidence, we do not feel that a policy of routinely offering cesarean delivery on maternal request to prevent PFD that has not yet occurred and that is likely to occur in only a fraction of parous women is justifiable at this time. Long-term complications with major impact on the quality of life in an aging populationAmerican Journal of Obstetrics & GynecologyVol. 196Issue 3PreviewI read with interest the article entitled Childbirth and pelvic flood dysfunction: An epidemiologic approach to the assessment of prevention opportunities at delivery by Patel et al.1 Full-Text PDF" @default.
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