The editor of the British Journal of Obstetrics and Gynaecology, Professor Phil Steer, was kind enough to publish a brief note on the causes of gynaecology in the UK this month in response to an important (technical) article on MR imaging of the pelvic floor (levator ani muscles). For copyright reasons I cannot repeat the whole piece but the important points are familiar to regular readers of this site.
….. The observation that ‘levator trauma at the time of first delivery is associated with vaginal delivery, forceps and a longer second stage concurs with Professor Sir Dugald Baird’s opinion in 1923 that, ‘the vast majority of ailments encountered in gynaecological practice are the result of infections and injuries contracted during parturition. …..
This is the important point for women in the UK who are suffering the lifelong consequences of terrible pelvic injuries sustained during their first labours. Most Chinese women suffer the consequences of three surgical terminations of pregnancy (as their one child is born by Caesarean section) in terms of adenomyosis of the lowere half of their uterus (from injuries during curettage – the surgeon “scrapes” too hard), posterior uterine wall fibroids (for the same reason) and endometriosis of the uterosacral ligaments (the surgeon pulls too hard on the cervix while the patient is under general anaesthesia). Chinese women pay for their Caesarean sections.
Next month there is a note on “The aetiology of deep infiltrating endometriosis” in response to an article describing high complication rates in women with this condition.