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Building the Evidence Base for Postoperative and Postpartum Advice

Minig, Lucas, MD1; Trimble, Edward L., MD, MPH1; Sarsotti, Carlos, MD2; Sebastiani, Mario M., MD3; Spong, Catherine Y., MD4

doi: 10.1097/AOG.0b013e3181b6f50d
Current Commentary

Recommendations for activity after obstetric and gynecologic procedures remain based on tradition and anecdote. After reviewing the current evidence base, guidelines, and practice for postdischarge instructions related to physical activity after the most common obstetric and gynecologic surgical procedures, we conclude that the available data do not support many of the recommendations currently provided. Restrictions on lifting and climbing stairs should likely be abandoned. Guidance on driving should focus on the concern regarding cognitive function and analgesics rather than concerns of wound separation/dehiscence. Given the impact of these recommendations on daily life events, consistent, evidence-based advice on when and how women can safely resume exercise, driving, working, and sexual intercourse is critical. The evidence base informing advice for most of these issues is minimal; we need prospective, well-designed studies to help guide us and our patients.

We need to strengthen the base of evidence supporting the advice given to patients after obstetric and gynecologic procedures.

From the 1Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; 2Grupo para el estudio de las disfunciones y rehabilitación del piso pélvico, Buenos Aires, Argentina; 3Obstetrics department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 4Pregnancy and Perinatology Branch, Eunice Kennedy Shriver, National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, Maryland.

Dr. Spong, Associate Editor of Obstetrics & Gynecology, was not involved in the review or decision to publish this article.

Corresponding author: Lucas Minig, MD, National Cancer Institute, National Institutes of Health, Bldg 10 B3B406, Bethesda, MD; e-mail: lucasminig@yahoo.com.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.