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.

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Objective: To measure surgical judgment across the Obstetrics and Gynecology (OBGYN) continuum of practice and identify factors that correlate with improved surgical judgment. Methods: A 45-item written examination was developed using script concordance theory, which compares an examinee's responses to a series of ''ill-defined'' surgical scenarios to a reference panel of experts. The examination was administered to OBGYN residents, Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellows, practicing OBGYN physicians and FPMRS experts. Surgical judgment was evaluated by comparing scores against the experts. Factors related to surgical experience were measured for association with scores. Results: In total, 147 participants including 11 residents, 37 fellows, 88 practicing physicians and 11 experts completed the 45-item examination. Mean scores for practicing physicians (65.2 AE 7.4) were similar to residents (67.2 AE 7.1), and worse than fellows (72.6 AE 4.2, p50.

The patient is a 56-year-old woman with severe pelvic pressure and vaginal bulging. She had an abdominal hysterectomy and Burch colposuspension 20 years ago. She then had a history of some recurrent stress and urge incontinence; however, over the past 2 years, this has resolved, and she currently has to reduce her prolapse to empty her bladder. Complete vaginal eversion and a palpable enterocele were found on examination [pelvic organ prolapse quantification Stage IV; Aa +2, Ba +7, C +7, gh 5, pb 3, tvl 7, Ap +1, Bp +7; see Fig. 1a (resting) and b (straining)]. She is sexually active, is not interested in a pessary, and desires surgical correction of her prolapse. Discussant: Bobby ShullObstetrics and Gynecology Practice, Temple, TX, USA

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