82: Bladder arithmetic: can subtraction help determine the true urinary microbiome?

Abstract

81 Mode of delivery following prolapse surgery: a case series K. Buono, A. Novin, E. Whitcomb FPMRS, University of California Irvine, Orange, CA, OBGYN, Kaiser Permanente Los Angeles, Los Angeles, CA, FPMRS, Southern California Permanente Medical Group, Irvine, CA OBJECTIVES: There is limited data to inform physicians’ counseling regarding mode of delivery for pregnancies after surgery for pelvic organ prolapse (POP). The aim of this study was to review the medical decision making and clinical outcomes of patients delivering after prolapse surgery within a large healthcare organization. MATERIALS AND METHODS: We performed a retrospective case series of patients who were identified by Current Procedural Terminology (CPT) coding for POP surgery between 2007 and 2017. Identified electronic medical records were referenced against a live birth registry within the healthcare system. Demographic and clinical data were abstracted through extensive, standardized physician review of the identified electronic medical records. RESULTS: Twenty patients were included in the analysis. The distribution of surgeries was as follows: 17 patients had a posterior colporrhaphy, 10 patients had an anterior colporrhaphy, and 5 patients had an apical suspension. Seven patients (35%) had a concomitant midurethral sling. The mean interval between surgery and first delivery was 28.6 months (range 8.1 93.5). One patient (5%) endorsed recurrent prolapse symptoms between the POP surgery and pregnancy, and none of the remaining 19 patients reported recurrent prolapse symptoms before or during the pregnancy. There were no pregnancy complications related to the prior POP surgery. Nine of the patients (45%) were delivered by Cesarean section (CS). Four patients were counseled to have a CS due to the prior POP surgery, 3 patients electively chose to have a primary CS due to the POP surgery regardless of physician counseling, 1 patient chose to have an elective repeat CS, and 1 patient had a CS due to obstructed labor. A FPMRS provider was specifically consulted for delivery recommendations for 6 patients (30%), and recommended a CS for 3 of the 6 patients (50%). Eleven patients had spontaneous vaginal delivery and none of them sustained greater than a second degree perineal laceration. The mean interval follow-up after delivery was 42.1 months (range 1.9 86.7). Three patients (15%) reported subjective recurrent prolapse symptoms after delivery, and 2 of these patients were planning to proceed with surgery at time of this analysis. CONCLUSION: This case series corroborates previous series demonstrating the safety and durability of POP surgery during subsequent pregnancy. In this series, >75% of the patients who were delivered by CS were due to the physician’s or patient’s concerns regarding the prior prolapse surgery. Obstetrical physicians sought out the opinion of a FPMRS provider for delivery recommendations in only 30% of patients, and the recommendation varied by provider. Further research evaluating the durability of various reconstructive surgeries in subsequent pregnancies is needed to help guide FPMRS physicians’ recommendations.