From Class to Clinic

As a graduate student, one of my least favorite classes was my research class (said with all due respect, Dr. Lipovac. As the famous adage goes, it wasn’t you, it was me). I was more interested in anatomy, physiology, neurological rehabilitation, kinesiology, and, of course, my musculoskeletal classes.

Ironically enough, the topic of research moved to the top of my priority list as soon as I left the classroom and entered the clinic. Suddenly, I was faced with many clinical questions, and my ever-curious mind began seeking answers. For example, is sexual dysfunction more prevalent in societies where premarital intercourse is discouraged? Is there a connection between patients who have had eating disorders and pelvic floor dysfunction? Is pelvic organ prolapse (POP) more prevalent among women who have had vaginal deliveries as opposed to cesarean section (c-section) deliveries?

Before I knew it, I was perusing PubMed and the NIH websites for fun, during my free time, to explore evidenced based research for these and other answers. I found myself offering to help doctors with clinical trials that they were conducting. Research is now an integral focus of my time and energy, and it is one of the reasons that I write this blog- to encourage myself to remain abreast of the latest research as well as share it with you.

Considering this background about the history of my relationship with research, you can imagine how excited I was when a colleague of mine, Chayala Englard, shared an article with me from BJOG: An International Journal of Obstetrics & Gynaecology (January 2013) which answered one of the aforementioned questions.

The article explores the prevalence of symptomatic POP in women twenty years after either one vaginal delivery or one c-section delivery. Women who delivered vaginally were twice as likely to experience POP compared to women who delivered via c-section (14.6% vs. 6.3%). Furthermore, infant birth-weight and mother’s current BMI were found to be risk factors associated with POP after vaginal delivery. Mothers shorter than 160 cm (approximately 5’3”) whose infants weighed more than 4,000 grams (approximately 8 lb. 13 oz.) were twice as likely to develop prolapse compared to mothers of the same height who delivered infants weighing less than 4,000 grams. In addition, POP prevalence increased 3% with each unit increase of the mother’s BMI as well as 3% for every 100 gram (approximately 3.5 oz) increase of the infant’s birth-weight.

In addition, urinary incontinence was more prevalent among women who demonstrated prolapse compared to women who did not. However, episiotomy, vacuum extraction, and second-degree laceration (or greater) were not correlated with increased POP prevalence compared to women who delivered spontaneously.

Does this mean that all women should request elective c-section deliveries? Absolutely not! C-section delivery is a surgery and is accompanied by the same risks and complications of any surgery. However, this evidenced based research indicates that it may be worth discussing with your doctor if you have a personal history or family history of prolapse. It is valuable information that can help you and your doctor make an informed decision together.

And so, another clinical question gets answered thanks to research! Onto the many others that are continuously developing day by day.

Gyhagen, M., Bullarbo, M., Nielsen, T. and Milsom, I. (2013), Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG: An International Journal of Obstetrics & Gynaecology, 120: 152–160. doi:10.1111/1471-0528.12020