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Lv A, Li M, Li J, Gai T, Feng Q, Deng W, Wang S. Effects of Labor Analgesia on Pelvic Floor Function at 6 to 8 Weeks after Delivery: A Prospective Cohort Study. Am J Perinatol 2024; 41:e348-e352. [PMID: 36113493 DOI: 10.1055/s-0042-1753499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The aim of the study is to determine whether the use of labor analgesia had a higher risk of pelvic floor functional problems after delivery. STUDY DESIGN All primiparas who delivered at our hospital between June 2019 and May 2020 were enrolled in the study. They were divided into two groups according to their choices: delivery with labor analgesia (analgesia group, n = 76), and delivery without labor analgesia (nonanalgesia group, n = 78). The primary outcome of the study was to test the pelvic floor function by electromyography (EMG) at postpartum 6 to 8 weeks. Participants also completed questionnaires including Pelvic Floor Distress Inventory (PFDI-20), International Consultation on Incontinent Questionnaire-Short Form (ICIQ-SF), and Overactive Bladder Symptom Score (OABSS) at postpartum 6 to 8 weeks. RESULTS Primiparas in the analgesia group experienced longer first and second stages of labor (p< 0.05), and had significantly higher PFDI-20 scores at postpartum 6 to 8 weeks (p< 0.05). But the differences in ICIQ-SF, OABSS scores, and Pelvic Organ Prolapse Quantification (POP-Q) system between the two groups were not significant (p > 0.05). No statistically significant difference was found in class II and class I muscles, scores of pretest resting baseline, and posttest resting baseline between primiparas with or without labor analgesia (p > 0.05). CONCLUSION Our results strongly confirmed that labor analgesia did not increase the risk of pelvic floor dysfunction up to 6 to 8 weeks after delivery, although symptom burden might be increased after labor analgesia. KEY POINTS · Labor analgesia did not increase risk of pelvic floor muscle dysfunction after delivery.. · There are longer first and second stages of labor in primiparas with labor analgesia.. · Primiparas with labor analgesia had more obvious subjective symptoms of PFD..
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Affiliation(s)
- Aiming Lv
- Department of Obstetrics and Gynecology, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, Beijing, PR China
| | - Min Li
- Department of Obstetrics and Gynecology, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, Beijing, PR China
| | - Junfeng Li
- Department of Obstetrics and Gynecology, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, Beijing, PR China
| | - Tianzi Gai
- Department of Obstetrics and Gynecology, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, Beijing, PR China
| | - Qing Feng
- Department of Obstetrics and Gynecology, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, Beijing, PR China
| | - Wenhui Deng
- Department of Obstetrics and Gynecology, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, Beijing, PR China
| | - Shaowei Wang
- Department of Obstetrics and Gynecology, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, Beijing, PR China
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Cohen WR, Friedman EA. The second stage of labor. Am J Obstet Gynecol 2024; 230:S865-S875. [PMID: 38462260 DOI: 10.1016/j.ajog.2022.06.014] [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: 01/18/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 03/12/2024]
Abstract
The second stage of labor extends from complete cervical dilatation to delivery. During this stage, descent and rotation of the presenting part occur as the fetus passively negotiates its passage through the birth canal. Generally, descent begins during the deceleration phase of dilatation as the cervix is drawn upward around the fetal presenting part. The most common means of assessing the normality of the second stage of labor is to measure its duration, but progress can be more meaningfully gauged by measuring the change in fetal station as a function of time. Accurate clinical identification and evaluation of differences in patterns of fetal descent are necessary to assess second stage of labor progress and to make reasoned judgments about the need for intervention. Three distinct graphic abnormalities of the second stage of labor can be identified: protracted descent, arrest of descent, and failure of descent. All abnormalities have a strong association with cephalopelvic disproportion but may also occur in the presence of maternal obesity, uterine infection, excessive sedation, and fetal malpositions. Interpretation of the progress of fetal descent must be made in the context of other clinically discernable events and observations. These include fetal size, position, attitude, and degree of cranial molding and related evaluations of pelvic architecture and capacity to accommodate the fetus, uterine contractility, and fetal well-being. Oxytocin infusion can often resolve an arrest or failure of descent or a protracted descent caused by an inhibitory factor, such as a dense neuraxial block. It should be used only if thorough assessment of fetopelvic relationships reveals a low probability of cephalopelvic disproportion. The value of forced Valsalva pushing, fundal pressure, and routine episiotomy has been questioned. They should be used selectively and where indicated.
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Affiliation(s)
- Wayne R Cohen
- Department of Obstetrics and Gynecology, The University of Arizona College of Medicine, Tucson, AZ.
| | - Emanuel A Friedman
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
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Lichtman Y, Horev A, Matyashov T, Rotem R, Katz ME, Eshkoli T, Weintraub AY. Association between striae gravidarum and pelvic floor dysfunction symptoms during pregnancy. Int Urogynecol J 2022; 33:3441-3447. [PMID: 35666288 DOI: 10.1007/s00192-022-05249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Striae gravidarum are linear atrophic scars appearing on the abdomen of pregnant women reported to be related to pregnancy-induced changes in the connective tissue. Pelvic floor distress symptoms are also known to be linked to connective tissue weakness. Given that common pathophysiological pathways may play a role in both striae gravidarum and pelvic floor dysfunction symptoms, we sought to examine whether there is a correlation between them during pregnancy. METHODS A prospective observational study among third-trimester pregnant women who visited a tertiary medical center for routine pregnancy follow-up was conducted by using the Pelvic Floor Distress Inventory (PFDI-20) questionnaire to evaluate pelvic floor distress symptoms and the Davey method for evaluating striae gravidarum severity. Obstetrical characteristics as well as pelvic floor distress symptoms were compared between two groups according to the severity of striae gravidarum. Univariate analysis was carried out using appropriate tests; PFDI scores were compared between the groups using the Mann-Whitney test. RESULTS Women with striae gravidarum were significantly older (31.06 vs. 28.83 years, p < 0.01), had a lower body mass index (27.5 vs. 30.98, p < 0.01), and gave birth to smaller neonates (3155 vs. 3389 g, p < 0.01). In addition, the overall and median PFDI-20 scores differed between the groups (with severe SG having the highest median score of 20 and those with milder SG having a score of 16 compared to 14 in those without SG). A distinct association between the PFDI-20 score and SG severity was not demonstrated (p = 0.63). CONCLUSIONS In our population, an association was demonstrated between pelvic floor distress symptoms and the presence of striae gravidarum. However, following a linear regression model, no statistically significant association between SG severity and total PFD-20 score was seen. Our findings strengthen the hypothesis of common connective tissue involvement in the pathophysiology of both conditions.
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Affiliation(s)
- Yael Lichtman
- Department of Obstetrics and Gynecology, Soroka Medical Center, Beer-Sheva, Israel
| | - Amir Horev
- Pediatric Dermatology Services, Soroka Medical Center, Beer-Sheva, Israel. .,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Tamar Matyashov
- Department of Obstetrics and Gynecology, Soroka Medical Center, Beer-Sheva, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University Medical School of Jerusalem, 12 Bayit Street, 91031, Jerusalem, Israel
| | - Maayan Elnir Katz
- Department of Obstetrics and Gynecology, Soroka Medical Center, Beer-Sheva, Israel
| | - Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka Medical Center, Beer-Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Gross L, Ganer Herman H, Gonen N, Rockenshtein O, Ginath S, Kovo M. Is there an association between the length of the second stage of labour and urinary incontinence in multiparous women? Eur J Obstet Gynecol Reprod Biol 2022; 274:96-100. [PMID: 35623156 DOI: 10.1016/j.ejogrb.2022.05.016] [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: 10/26/2021] [Revised: 02/11/2022] [Accepted: 05/16/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES It is unclear whether the length of the second stage of labour plays a role in the development of urinary incontinence (UI). This study aimed to investigate the association between the cumulative length of the second stage of labour in multiparous women and UI. METHODS This was a longitudinal cohort study of women who had undergone three vaginal deliveries (VDs) between 2008 and 2017. UI was assessed using the Urinary Distress Inventory (UDI-6) questionnaire. Women with a cumulative length of the second stage of labour for three deliveries in the upper 90th percentile (study group) were compared with women with a cumulative length of the second stage of labour below the 90th percentile (control group). A sample size of 280 women was needed to detect a 15-point difference in the UDI-6 score between the groups. RESULTS Thirty-one women were included in the study group and 275 women were included in the control group. Demographic and obstetric characteristics were similar in both groups. There was no between-group difference in mean UDI-6 score: 12.3 ± 17.5 in the study group and 14.9 ± 18.2 in the control group (p = 0.55). No association was found between the cumulative length of the second stage of labour and the UDI score. A linear regression model revealed that maternal body mass index was independently associated with UDI-6 score (correlation coefficient 0.67, 95% confidence interval 0.19-1.15; p = 0.006). CONCLUSION The cumulative length of the second stage of labour in multiparous women is not associated with UI.
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Affiliation(s)
- Lotem Gross
- Department of Obstetrics and Gynaecology, Edith Wolfson Medical Centre, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Ganer Herman
- Department of Obstetrics and Gynaecology, Edith Wolfson Medical Centre, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Gonen
- Department of Obstetrics and Gynaecology, Edith Wolfson Medical Centre, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Rockenshtein
- Department of Obstetrics and Gynaecology, Edith Wolfson Medical Centre, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimon Ginath
- Department of Obstetrics and Gynaecology, Edith Wolfson Medical Centre, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynaecology, Edith Wolfson Medical Centre, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Hübner M, Rothe C, Plappert C, Baeßler K. Aspects of Pelvic Floor Protection in Spontaneous Delivery - a Review. Geburtshilfe Frauenheilkd 2022; 82:400-409. [PMID: 35392067 PMCID: PMC8983111 DOI: 10.1055/a-1515-2622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
The necessity of increasingly addressing aspects of pelvic floor protection, i.e., prevention of the most frequent female pelvic floor disorders, such as urinary incontinence, faecal incontinence and pelvic organ prolapse, is the result of the steadily improving understanding of the association of pregnancy and delivery with the prevalence of these disorders. About a quarter of all women experience one or more such symptoms during their life. Apart from age and weight, pregnancies and births play an important part. While initial discussion of pelvic floor protection often focused very rapidly on the mode of delivery and elective caesarean section as a possible protective intervention, it has become apparent in the last few decades how varied and wide-ranging the options are that can be used to protect against pelvic floor disorders. The mode of delivery as such is "only" one element among numerous other considerations and has diminished markedly in importance. Interprofessionality and interdisciplinarity undoubtedly represent an important development as resulting recommendations must always be incorporated in an overall context that considers mother and child at the same time. Considering the pelvic floor only certainly does not make sense. This review article will analyze in greater detail important pre-, intra- and postpartum aspects that in their entirety can provide insight into the various aspects of pelvic floor protection. The authors regard the following article as an additional basis for discussion on achieving a sustained reduction in the incidence and prevalence of female pelvic floor disorders.
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Affiliation(s)
- Markus Hübner
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
- Medizinische Fakultät der Universität Tübingen, Tübingen, Germany
| | | | - Claudia Plappert
- Institut für Gesundheitswissenschaften, Abt. Hebammenwissenschaft, Universität Tübingen, Tübingen, Germany
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6
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Effect of prolonged second stage of labor on pelvic floor function: A prospective cohort study. Int Urogynecol J 2022; 33:1633-1638. [PMID: 35267059 DOI: 10.1007/s00192-022-05136-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/09/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate the effect of the second stage of labor (SSL) lasting > 2 h on pelvic floor function. METHODS This single-center prospective cohort study included primiparous women with SSL > 2 h treated at Tongji Hospital between January 2018 and December 2019 (case group). A matched group of women with similar newborn weight and SSL < 2 h were recruited simultaneously (control group). Stress urinary incontinence (SUI) and pelvic floor muscle (PFM) characteristics were measured at 6 weeks, 6 months, and finally 1 year postpartum. RESULTS A total of 63 pairs of primiparous women completed 1-year follow-up. The incidence of SUI in the case group was significantly higher than that in the control group at 6 weeks postpartum (P = 0.020); however, the differences were not significant at 1 year postpartum (P=1.00). PFM endurance was significantly lower in the case group at 6 weeks (P = 0.000), 6 months (P = 0.000), and 1 year (P = 0.011) after childbirth. There was no difference in PFM strength between the two groups. The maximal voluntary contraction (MVC) of PFM was significantly lower in the case group at 6 weeks postpartum (P = 0.007), but the differences were not significant at 1 year postpartum (P = 0.197). PFM endurance and MVC were higher at 1 year than at 6 weeks postpartum in both groups. CONCLUSIONS The SSL > 2 h increased the incidence of SUI at 6 weeks postpartum and decreased PFM endurance for 1 year.
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Weiss A, Yohay NZ, Daya K, Elnir Katz M, Yohay Z, Hasan M, Baumfeld Y, Elharar D, Weintraub AY, Eshkoli T. Validation of the hebrew version of the prolapse and incontinence knowledge questionnaire (PIKQ) during pregnancy. Int Urogynecol J 2022; 33:3123-3128. [PMID: 35088091 DOI: 10.1007/s00192-021-05038-9] [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: 08/24/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pregnancy and delivery have a major effect on pelvic floor disorders. Assessing knowledge regarding pelvic floor disorders in childbearing age women and appropriate interventions will enable women to seek appropriate medical advice once pelvic floor disorders have developed. The purpose of this study was to validate the prolapse and incontinence knowledge questionnaire in the Hebrew language. METHODS Translation of the prolapse and incontinence knowledge questionnaire to the Hebrew language according to international recommended guidelines. A study was conducted to validate the questionnaire. The study took place between June to September 2020 in a tertiary medical center in Israel. A total of 240 third trimester pregnant women completed the Hebrew version of the prolapse and incontinence knowledge questionnaire. Construct validity, criterion validity and reliability tests were performed. RESULTS Factor analysis of the Hebrew version of the prolapse and incontinence knowledge questionnaire demonstrated 12 strong positive factor loadings to one principal factor in the prolapse and incontinence knowledge questionnaire-pelvic organ prolapse domain (FL > 0.3) and 10/12 in the prolapse and incontinence knowledge questionnaire-urinary incontinence domain. The Hebrew prolapse and incontinence knowledge questionnaire was found to have internal consistency, with Cronbach alpha coefficient of 0.745 for the urinary incontinence domain and 0.796 for the pelvic organ prolapse domain. CONCLUSIONS The Hebrew version of the prolapse and incontinence knowledge questionnaire is a new, reliable, consistent, and valid instrument to examine the level of knowledge regarding pelvic floor disorders in Hebrew-speaking pregnant women.
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Affiliation(s)
- Ari Weiss
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.
| | - Neriya Zion Yohay
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Medical Corps, Israel Defense Forces, Tel Aviv, Israel
| | - Kochav Daya
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Maayan Elnir Katz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Zehava Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Mahmod Hasan
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Debi Elharar
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel
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Yan M, Lv X, Jin X, Li S, Shen X, Zhang M, Su S, Chen J, Yang H. The mediating effect of the prolonged second stage of labor on delivery mode and urinary incontinence among postpartum women: evidence from Shandong, China. Int Urogynecol J 2021; 33:1549-1556. [PMID: 34842940 DOI: 10.1007/s00192-021-05007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/27/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study was aimed at exploring the mediating role of the prolonged second stage of labor (PSSL) in the association between delivery mode and urinary incontinence (UI) among postpartum women in Shandong, China. METHODS A cross-sectional study involving postnatal women from the Women's Pelvic Floor Functional Health Center in Shandong, China, was conducted. An electronic questionnaire was used to collect the data between June 2020 and February 2021. UI was assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Logistic regression and multiple linear regression were employed to explore the association among delivery mode, PSSL, and UI, and the mediating role of PSSL. RESULTS Among the total of 5,586 postpartum women included in this study, the prevalence of UI was 13.3%. Among the 742 patients with UI, the prevalence of stress urinary incontinence (78.3%) was greater than urge urinary incontinence (8.6%), mixed urinary incontinence (9.3%), and others (3.8%). After adjusting for controlling variables, delivery mode was found to be significantly associated with PSSL, whereby women with vaginal delivery were more likely to be in PSSL, and women with PSSL had a higher probability of suffering from UI. PSSL played a partial mediating effect in delivery mode and UI. CONCLUSIONS This study provided evidence that the effect of delivery mode on UI was partially mediated by PSSL among postpartum women in Shandong, China. Strategies to prevent PSSL should be actively adopted to reduce the risk of UI in women.
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Affiliation(s)
- Miaomiao Yan
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Xiaoyang Lv
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Xuli Jin
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Shu Li
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Xin Shen
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Miqing Zhang
- Women's Pelvic Floor Functional Health Center, Yunshi Health Industry, Jinan, 250000, Shandong, China
| | - Sha Su
- Women's Pelvic Floor Functional Health Center, Yunshi Health Industry, Jinan, 250000, Shandong, China
| | - Jie Chen
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
| | - Huijun Yang
- Key Laboratory of Birth Regulation and Control Technology of National Health Commission of China, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, 250014, Shandong, China.
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Borges AC, Sousa N, Sarabando R, Vieira C, Ribeiro B, Barbosa P, Miranda A, Reis I, Nogueira-Silva C. Pelvic floor dysfunction after vaginal delivery: MOODS-a prospective study. Int Urogynecol J 2021; 33:1539-1547. [PMID: 34562133 DOI: 10.1007/s00192-021-04982-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Labor is a known risk factor for pelvic floor dysfunction (PFD); however, the impact of operative vaginal delivery (OVD), particularly spatulas, remains unclear. The aim of this study was to compare postpartum PFD symptoms in women undergoing spontaneous vaginal delivery (SVD) and those undergoing OVD. METHODS An observational prospective study (MOODS: Maternal-neonatal Outcomes in Operative Vaginal Delivery) was enrolled at Hospital de Braga from February to October 2018. All singleton term OVD (Thierry spatulas and vacuum extractor) and a convenience SVD sample were recruited, in a 2:1 ratio. To assess PFD symptoms Pelvic Floor Distress Inventory-20 (PFDI-20) was applied at 3, 6, and 12 months postpartum. The questionnaire is divided into three subscales: Urinary (UDI), Colorectal-Anal (CRADI), and Pelvic Organ Prolapse Distress Inventory (POPDI). RESULTS Of the 304 women recruited, 207 were included, 34.3% with SVD and 65.7% with OVD. Thierry spatulas were used in 53.7% of women undergoing OVD. Frequency of nulliparous (p < 0.001), episiotomy (p < 0.001), neuraxial anesthesia (p < 0.001), postpartum pain (p = 0.001) and occiput-posterior fetal position (p < 0.001) were significantly higher in OVD. Second phase of labor duration was longer in OVD (p = 0.001). At 3 months postpartum, women undergoing OVD and spatula-assisted delivery had higher UDI score, POPDI score, and global score, with no differences at 6 months and 1 year. After controlling for confounding variables, OVD and spatulas were still associated with greater POPDI scores at 3 months postpartum. CONCLUSIONS Operative vaginal delivery, particularly with spatulas, seems to be associated with a higher prevalence of early PFD symptoms, mainly regarding pelvic organ prolapse.
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Affiliation(s)
- Ana Catarina Borges
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal.
| | - Natacha Sousa
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Rita Sarabando
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Catarina Vieira
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Bárbara Ribeiro
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Paulina Barbosa
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Alexandra Miranda
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Isabel Reis
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - Cristina Nogueira-Silva
- Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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10
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Gimovsky AC, Phillips JM, Amero M, Levine J, Berghella V. Prolonged second stage effect on pelvic floor dysfunction: a follow up survey to a randomized controlled trial. J Matern Fetal Neonatal Med 2021; 35:5520-5525. [PMID: 33586572 DOI: 10.1080/14767058.2021.1887122] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pelvic floor dysfunction is a group of disorders that can significantly impact quality of life due to persistent urinary and anal incontinence. Data evaluating the effect of prolonged second stage of labor and postpartum pelvic floor dysfunction is heterogenous and limited. OBJECTIVE To evaluate whether extending the length of labor in nulliparous women with prolonged second stage affects the presence of self-reported pelvic floor dysfunction after a randomized controlled trial of prolonged second stage. STUDY DESIGN We conducted a planned follow up survey to our randomized controlled trial of prolonged second stage of labor using the Pelvic Floor Distress Inventory-20 (PFDI-20). The primary outcome was the PFDI-20 summary score. Secondary outcomes included urinary and fecal incontinence, prolapse, and patient satisfaction. Women surveyed were nulliparous patients with epidural anesthesia, previously enrolled in a randomized controlled trial that assigned them to extended labor, at least 1 additional hour in the second stage if they were undelivered after three hours, or to usual labor, defined as expedited delivery after three hours in the second stage. Women were surveyed at 12 - 36 months postpartum. RESULTS Thirty-four of the seventy-eight women responded to the survey (43.6%). 17 women (50.0%) were from the extended labor group and 17 from the usual labor group (50.0%). Maternal demographic data were not significantly different between groups. The PFDI-20 summary score was 13.8 ± 23.3 in the extended labor group and 13.1 ± 20.9 in the usual labor group (p = 0.9). The Pelvic Organ Prolapse Distress Inventory-6 was 1.2 ± 2.9 in the extended labor group and 2.7 ± 6.4 in the usual labor group (p = 0.4). The Colorectal-Anal Distress Inventory-8 was 0.8 ± 2.8 in the extended labor group and 2.1 ± 4.0 in the usual labor group (p = 0.6). The Urinary Distress Inventory-6 was 11.8 ± 21.1 in the extended labor group and 8.3 ± 14.5 in the usual labor group (p = 0.6). Maternal and neonatal outcomes, as well as patient satisfaction, were not statistically significantly different between groups. CONCLUSION Extending the length of labor in nulliparas with singleton gestations, epidural anesthesia, and prolonged second stage did not have an impact on PFDI-20 scores at 12-36 months postpartum. However, our study was underpowered to detect small, but potentially clinically important, differences. CLINICAL TRIAL NUMBER NCT02101515 (Study Registration Date March 28, 2014) https://clinicaltrials.gov/ct2/show/NCT02101515.
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Affiliation(s)
- Alexis C Gimovsky
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Jaclyn M Phillips
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Women's Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Molly Amero
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Vincenzo Berghella
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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