Chart documentation of informed consent for operative vaginal delivery: is it adequate?

Objectives: To determine the documentation frequency of informed consent for women undergoing a trial of nonemergent instrumental delivery.

Study Design: A retrospective chart review of instrumented vaginal deliveries from 1992 to 2005 was performed. Cases were identified from a Labor and Delivery database and hospital records were reviewed for documentation of associated risks, general consent for the procedure, indication, and option of cesarean delivery (CD).

Anal incontinence in women with and those without pelvic floor disorders.

Objective: To compare the prevalence of anal incontinence and anal sphincter injury in women with pelvic floor disorders (cases) with those in a group of normal control subjects and to evaluate the relationship between sphincter injury and anal incontinence in each group.

Methods: We previously reported the results of a cross-sectional study of 100 women with pelvic floor disorders (> or = stage II pelvic organ prolapse and/or urinary incontinence). In this study, we compared those cases with 90 controls (stage 0 or I pelvic organ prolapse and no urinary incontinence) who completed the Rockwood-Thompson fecal incontinence severity index, in which scoring (0-61) is based on the frequency and type of anal incontinence.

Anal sphincter injury in women with pelvic floor disorders.

Objective: 1) To estimate the rate of anal incontinence and anal sphincter injury in a group of women with pelvic floor disorders; 2) to evaluate the relationship between anal incontinence and anal sphincter injury as demonstrated by endoanal ultrasonography; 3) to explore any associations between operative vaginal delivery and anal sphincter injury in this population.

Methods: A cohort of 100 women with stage II or greater pelvic organ prolapse and/or urinary incontinence completed the Rockwood-Thompson Fecal Incontinence Severity Index Questionnaire (FISI). Pelvic organ prolapse was recorded using the Pelvic Organ Prolapse Quantification system.

Thermal balloon endometrial ablation for management of acute uterine hemorrhage.

Background: Life-threatening abnormal uterine bleeding can be managed by a variety of techniques, which include intravenous estrogen, dilation and curettage, endometrial ablation, uterine artery embolization, or hysterectomy. Thermal balloon endometrial ablation has been used in the management of chronic dysfunctional uterine bleeding but has not been described in a case of acute uterine hemorrhage.

Case: A 44-year-old woman with end-stage liver disease presented with vaginal bleeding and fever.