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L M Byrd

Publications and source records attributed to L M Byrd.

4 recordsLinked to original sources
PubMed2005

Is it possible to predict or prevent third degree tears?

OBJECTIVES: This paper reviews the causes anal sphincter injury during vaginal delivery. It emphasises that they are not usually the result of poor obstetric care. The role of the colorectal surgeon in their management is discussed. METHODS: Medline was searched using the key words third degree tears, pregnancy, risk factors, prevention and recurrence risk. A hand search of journals and located articles was made. Two hundred and twenty three papers were identified, 84 are referenced. RESULTS: The reported incidence of anal sphincter tears is usually between 0.5% and 2.5% of vaginal deliveries. Maternal factors such as parity and age and obstetric factors such as mode of presentation, the use of forceps and the size of the baby all influence the incidence of sphincter tears. Predicting tears in individual women is inaccurate and midwifery practices can do little to prevent them. Reducing pelvic floor morbidity by increasing the caesarean section rate would require that a large number of caesarean sections be done to prevent a small number of tears. The recognition of perineal trauma is improved by training. Accurate apposition of the sphincters with antibiotic cover and post-operative laxatives are the important technical aspects of the repair. Colorectal follow up helps to identify those women with symptoms and allows advice about the advisability of subsequent vaginal deliveries. A previous third degree tears increases the risk of a subsequent one, although the overall risk remains low. A second vaginal delivery after a third degree tear that has resulted in a functional deficit predisposes to worsening function. When there is no residual anatomical defect and no functional loss, there is no evidence of increased risk of incontinence following another vaginal delivery. CONCLUSION: Vaginal delivery will continue to be the main method of delivery and will continue to generate a low incidence of pelvic floor morbidity. The management of injury to the anal sphincter is facilitated by close co-operation between obstetricians and colorectal surgeons.

Delivery, Obstetric↗
PubMed2002

Balloon ablation: is this an outpatient procedure?

Menorrhagia is associated with considerable health consequences. First-line therapy is medical, but when this proves unsuccessful a surgical procedure is often undertaken. It is estimated that as many as one in five women will have a hysterectomy before the age of 60 years. While a curative procedure this is a major operation with both morbidity and mortality associated with it. More conservative procedures have therefore been sought. Balloon therapy was developed in 1994 and it was introduced to Royal Bolton Hospital in 1998. Initially offered under general anaesthesia, an overall a success rate of 91% was achieved in this study, with amenorrhea in 18% of cases. Dysmenorrhea was improved in 60% of patients. Twenty-eight patients received outpatient therapy, under a paracervical block. All patients were given voltarol pretreatment. Subjectively the procedure was well tolerated by most, and objectively 89% of patients rated the procedure as acceptable. Sixty-one per cent of patients would be happy to undertake the procedure again under local anaesthesia. Findings from this study would indicate that balloon ablation does provide an effective, less invasive, alternative treatment for menorrhagia. Despite limited numbers, it would also seem appropriate, in selected patients, to offer this therapy as an outpatient procedure.

Adult↗