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Hesham H, Orejuela F, Rood KM, Turrentine M, Casey B, Khandelwal M, Dajao R, Azad S, Rosen T, Hoffman MK, Wang EY, Hart L, Sheen JJ, Grisales T, Gibson KS, Torbenson V, Williams SF, Evantash E, Dietz HP, Wapner RJ. Effect of an Intrapartum Pelvic Dilator Device on Levator Ani Muscle Avulsion During Primiparous Vaginal Delivery: A Pilot Randomized Controlled Trial. Int Urogynecol J 2024; 35:1839-1849. [PMID: 39096389 PMCID: PMC11420311 DOI: 10.1007/s00192-024-05881-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/30/2024] [Indexed: 08/05/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate the safety and effectiveness of an intrapartum electromechanical pelvic floor dilator designed to reduce the risk of levator ani muscle (LAM) avulsion during vaginal delivery. METHODS A multicenter, randomized controlled trial enrolled nulliparous participants planning vaginal delivery. During the first stage of labor, participants were randomized to receive the intravaginal device or standard-of-care labor management. The primary effectiveness endpoint was the presence of full LAM avulsion on transperineal pelvic-floor ultrasound at 3 months. Three urogynecologists performed blinded interpretation of ultrasound images. The primary safety endpoint was adverse events (AEs) through 3 months. RESULTS A total of 214 women were randomized to Device (n = 113) or Control (n = 101) arms. Of 113 Device assignees, 82 had a device placed, of whom 68 delivered vaginally. Of 101 Control participants, 85 delivered vaginally. At 3 months, 110 participants, 46 Device subjects who received full device treatment, and 64 Controls underwent ultrasound for the per-protocol analysis. No full LAM avulsions (0.0%) occurred in the Device group versus 7 out of 64 (10.9%) in the Control group (p = 0.040; two-tailed Fisher's test). A single maternal serious AE (laceration) was device related; no neonate serious AEs were device related. CONCLUSIONS The pelvic floor dilator device significantly reduced the incidence of complete LAM avulsion in nulliparous individuals undergoing first vaginal childbirth. The dilator demonstrated an acceptable safety profile and was well received by recipients. Use of the intrapartum electromechanical pelvic floor dilator in laboring nulliparous individuals may reduce the rate of LAM avulsion, an injury associated with serious sequelae including pelvic organ prolapse.
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Affiliation(s)
- Helai Hesham
- Department of Obstetrics & Gynecology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Francisco Orejuela
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Kara M Rood
- Department of Obstetrics & Gynecology, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Mark Turrentine
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Brian Casey
- Department of Obstetrics & Gynecology, University Medical Center, University of Alabama, Tuscaloosa, AL, USA
| | - Meena Khandelwal
- Department of Obstetrics & Gynecology, Cooper University Hospital, Camden, NJ, USA
| | - Rori Dajao
- Department of Obstetrics & Gynecology, Cooper University Hospital, Camden, NJ, USA
| | - Sarah Azad
- El Camino Women's Medical Group, El Camino Health, Mountain View, CA, USA
| | - Todd Rosen
- Department of Obstetrics, Gynecology and Reproductive Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Matthew K Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, USA
| | - Eileen Y Wang
- Department of Obstetrics & Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Laura Hart
- Department of Obstetrics, Gynecology and Reproductive Medicine, Temple University, Philadelphia, PA, USA
| | - Jean-Ju Sheen
- Department of Obstetrics & Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Tamara Grisales
- Department of Obstetrics & Gynecology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Kelly S Gibson
- Division of Fetal Maternal Medicine, The Metro-Health System, Cleveland, OH, USA
| | - Vanessa Torbenson
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Shauna F Williams
- Department of Obstetrics, Gynecology and Reproductive Health, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Hans P Dietz
- Sydney Urodynamic Centres, Sydney, NSW, Australia
| | - Ronald J Wapner
- Department of Obstetrics & Gynecology, Columbia University Irving Medical Center, New York, NY, USA
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Gan B, Zheng S, Wu X, Li X. The predicting value of the ratio of levator hiatus diameter to fetal head circumference in pregnant women at 37 weeks of gestation in the progression of the second stage of labor and levator ani injury 6 weeks postpartum. Heliyon 2024; 10:e25636. [PMID: 38384544 PMCID: PMC10878860 DOI: 10.1016/j.heliyon.2024.e25636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/23/2024] Open
Abstract
Objective This study investigated the predicting value of the ratio of levator hiatus diameter (LHS) to fetal head circumference (HC) in pregnant women at 37 weeks of gestation in the progression of the second stage of labor and levator ani injury 6 weeks postpartum. Methods A total of 120 first-time women who gave vaginal delivery at 37 weeks of pregnancy were selected as the subjects in our hospital during March 2021 to March 2022. The subjects were divided into the second stage of labor > 1 h group and the second stage of labor ≤ 1 h group, according to the delivery time of the second stage of labor. According to the 6-week postpartum follow-up ultrasound examination with or without levator ani injury, they were divided into levator ani injury group and no injury group. All primipara women underwent three-dimensional ultrasonography at 37 weeks of gestation, and the resting LHS, Valsalva LHS, fetal HC and the ratio of resting LHS and fetal HC were compared. The correlation between these factors and the length of the second labor stage was analyzed using Pearson correlation analysis. The value of these factors in predicting labor progression and postpartum levator ani injury was assessed by receiver operating characteristic (ROC) curves. Results The resting LHS, Valsalva LHS and the ratio of resting LHS and fetal HC in the levator ani injury group were lower than these in the no injury group, while fetal HC in the levator ani injury group was higher than that in the no injury group (P < 0.05). The resting LHS, Valsalva LHS and the ratio of resting LHS and fetal HC in the second stage of labor > 1 h group were lower than these in the second stage of labor ≤ 1 h group, while fetal HC in the second stage of labor > 1 h group was higher than that in the second stage of labor ≤ 1 h group (P < 0.05). A significant negative correlation was observed between resting LHS/HC and total labor process (=-0.333, P < 0.01). ROC curve analysis showed that the AUCs of resting LHS, Valsalva LHS, HC, and resting LHS/HC ratio in predicting prolongation of the second stage of labor were 0.741, 0.740, 0.702, and 0.843 respectively. Besides, the AUCs of resting LHS, Valsalva LHS, HC, and resting LHS/HC ratio in predicting the total labor process were 0.657, 0.684, 0.768, and 0.836 respectively. The AUCs of resting LHS, Valsalva LHS, HC, and resting LHS/HC ratio in predicting postpartum levator ani muscle injury were 0.769, 0.773, 0.747, and 0.885 respectively.These results suggested that the ratio of resting LHS and fetal HC may have certain clinical value in predicting levator ani injury in pregnant women. Conclusion LHS, fetal HC and the ratio of resting LHS and fetal HC are significantly correlated with labor progression and postpartum levator ani injury, which have certain value in predicting labor progress and postpartum levator ani injury. Therein, the ratio of resting LHS and fetal HC has the highest predictive value, and early detection of the ratio of resting LHS and fetal HC is helpful to guide the selection of appropriate delivery mode.
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Affiliation(s)
- Bei Gan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shan Zheng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiuyan Wu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xuemei Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Vogel JP, Jung J, Lavin T, Simpson G, Kluwgant D, Abalos E, Diaz V, Downe S, Filippi V, Gallos I, Galadanci H, Katageri G, Homer CSE, Hofmeyr GJ, Liabsuetrakul T, Morhason-Bello IO, Osoti A, Souza JP, Thakar R, Thangaratinam S, Oladapo OT. Neglected medium-term and long-term consequences of labour and childbirth: a systematic analysis of the burden, recommended practices, and a way forward. Lancet Glob Health 2024; 12:e317-e330. [PMID: 38070535 PMCID: PMC10805007 DOI: 10.1016/s2214-109x(23)00454-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 01/22/2024]
Abstract
Over the past three decades, substantial progress has been made in reducing maternal mortality worldwide. However, the historical focus on mortality reduction has been accompanied by comparative neglect of labour and birth complications that can emerge or persist months or years postnatally. This paper addresses these overlooked conditions, arguing that their absence from the global health agenda and national action plans has led to the misconception that they are uncommon or unimportant. The historical limitation of postnatal care services to the 6 weeks after birth is also a contributing factor. We reviewed epidemiological data on medium-term and long-term complications arising from labour and childbirth beyond 6 weeks, along with high-quality clinical guidelines for their prevention, identification, and treatment. We explore the complex interplay of human evolution, maternal physiology, and inherent predispositions that contribute to these complications. We offer actionable recommendations to change the current trajectories of these neglected conditions and help achieve the targets of Sustainable Development Goal 3. This paper is the third in a Series of four papers about maternal health in the perinatal period and beyond.
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Affiliation(s)
- Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia.
| | - Jenny Jung
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Tina Lavin
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Grace Simpson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Dvora Kluwgant
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Edgardo Abalos
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | - Virginia Diaz
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Soo Downe
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ioannis Gallos
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Hadiza Galadanci
- Africa Center of Excellence for Population Health and Policy, Bayero University, Kano, Nigeria
| | - Geetanjali Katageri
- S Nijalingappa Medical College and HSK Hospital & Research Centre, Bagalkot, India
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana; University of the Witwatersrand and Walter Sisulu University, East London, South Africa
| | - Tippawan Liabsuetrakul
- Department of Epidemiology and Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Imran O Morhason-Bello
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences and Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Alfred Osoti
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - João Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Olufemi T Oladapo
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Chang SD, Hsieh WC, Chiu SYH, Ng KL, Liang CC. Factors determining the persistence of prenatal stress urinary incontinence 12 months postpartum. Taiwan J Obstet Gynecol 2023; 62:40-44. [PMID: 36720548 DOI: 10.1016/j.tjog.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE Whilst many studies have explored the mechanisms of stress urinary incontinence (SUI) following various modes of delivery, few have examined outcomes of postpartum SUI in women who experienced new-onset SUI during their pregnancy. Our primary objective was to investigate the risk factors for persistent postpartum SUI in women with new-onset SUI during pregnancy at 1-year follow-up following vaginal delivery. MATERIALS AND METHODS 303 women with new-onset SUI during pregnancy who underwent vaginal delivery in a university hospital between 2014 and 2015 were included. In-person interviews were conducted for all participants on the second postpartum day, followed by phone interviews at 12 months postpartum, with completion of structured questionnaires, including Urogenital Distress Inventory Short Form (UDI-6) and Incontinence Impact Questionnaire Short Form (IIQ-7). Demographic, obstetrics and questionnaire scores were analyzed and compared between the group of women who experienced persistent postpartum SUI and the group who did not. RESULTS At 12 months postpartum, 16.5% (n = 50) of women had persistent postpartum SUI, with 83.5% (n = 253) experiencing resolution of SUI symptoms. Maternal age ≥35 years (aOR = 2.62; 95% CI, 1.40-4.87, P = 0.002), gestational age at birth ≥40 weeks (aOR = 2.21; 95% CI, 1.12-4.37, P = 0.022), and severe perineal lacerations (aOR = 2.32; 95% CI, 1.27-4.45, P = 0.013) were independent risk factors for persistent postpartum SUI for women following vaginal delivery at 1-year follow-up. CONCLUSION The prevalence of persistent postpartum SUI at 1-year following vaginal delivery is 16.5%, with advanced maternal age, gestational age at birth ≥40 weeks and severe perineal lacerations being independent risk factors.
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Affiliation(s)
- Shuenn-Dhy Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wu-Chiao Hsieh
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan; Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kai-Lyn Ng
- Department of Obstetrics and Gynecology, Mount Elizabeth Novena Hospital, Singapore; Division of Urogynaecology, National University Hospital, Singapore
| | - Ching-Chung Liang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Barger MK. Current Resources for Evidence-Based Practice, July/August 2021. J Midwifery Womens Health 2021; 66:540-547. [PMID: 34338411 DOI: 10.1111/jmwh.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
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Bovbjerg ML. Current Resources for Evidence-Based Practice, July 2021. J Obstet Gynecol Neonatal Nurs 2021; 50:485-495. [PMID: 34147485 DOI: 10.1016/j.jogn.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of how fetal monitoring may lead to overuse of birth-related interventions, commentaries on reviews focused on bedsharing, and women's lifetime estrogen exposure and risk of cardiovascular mortality.
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