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DeLancey JOL, Masteling M, Pipitone F, LaCross J, Mastrovito S, Ashton-Miller JA. Pelvic floor injury during vaginal birth is life-altering and preventable: what can we do about it? Am J Obstet Gynecol 2024; 230:279-294.e2. [PMID: 38168908 PMCID: PMC11177602 DOI: 10.1016/j.ajog.2023.11.1253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024]
Abstract
Pelvic floor disorders after childbirth have distressing lifelong consequences for women, requiring more than 300,000 women to have surgery annually. This represents approximately 10% of the 3 million women who give birth vaginally each year. Vaginal birth is the largest modifiable risk factor for prolapse, the pelvic floor disorder most strongly associated with birth, and is an important contributor to stress incontinence. These disorders require 10 times as many operations as anal sphincter injuries. Imaging shows that injuries of the levator ani muscle, perineal body, and membrane occur in up to 19% of primiparous women. During birth, the levator muscle and birth canal tissues must stretch to more than 3 times their original length; it is this overstretching that is responsible for the muscle tear visible on imaging rather than compression or neuropathy. The injury is present in 55% of women with prolapse later in life, with an odds ratio of 7.3, compared with women with normal support. In addition, levator damage can affect other aspects of hiatal closure, such as the perineal body and membrane. These injuries are associated with an enlarged urogenital hiatus, now known as antedate prolapse, and with prolapse surgery failure. Risk factors for levator injury are multifactorial and include forceps delivery, occiput posterior birth, older maternal age, long second stage of labor, and birthweight of >4000 g. Delivery with a vacuum device is associated with reduced levator damage. Other steps that might logically reduce injuries include manual rotation from occiput posterior to occiput anterior, slow gradual delivery, perineal massage or compresses, and early induction of labor, but these require study to document protection. In addition, teaching women to avoid pushing against a contracted levator muscle would likely decrease injury risk by decreasing tension on the vulnerable muscle origin. Providing care for women who have experienced difficult deliveries can be enhanced with early recognition, physical therapy, and attention to recovery. It is only right that women be made aware of these risks during pregnancy. Educating women on the long-term pelvic floor sequelae of childbirth should be performed antenatally so that they can be empowered to make informed decisions about management decisions during labor.
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Affiliation(s)
- John O L DeLancey
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
| | - Mariana Masteling
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI
| | - Fernanda Pipitone
- Faculty of Medicine, Hospital das Clinicas of the University of São Paulo, São Paulo, Brazil
| | - Jennifer LaCross
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Sara Mastrovito
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - James A Ashton-Miller
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI
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Changes in Saliva Analytes in Dairy Cows during Peripartum: A Pilot Study. Animals (Basel) 2021; 11:ani11030749. [PMID: 33803247 PMCID: PMC8000156 DOI: 10.3390/ani11030749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/23/2021] [Accepted: 03/03/2021] [Indexed: 02/02/2023] Open
Abstract
Simple Summary The use of saliva as a biological fluid to assess welfare and health status is gaining interest nowadays since it can be collected by non-invasive methods without specialized staff. The possibility of measuring analytes in saliva by techniques adapted to automated analyzers is cost-effective, reliable, and replicable. These analytes can provide information useful for the evaluation of welfare and health in dairy cows. In this pilot study, a total of 26 salivary analytes were measured in healthy dairy cows along their peripartum period to assess possible changes and associations with their inflammatory, energy, and milk yield status. Salivary analytes related to stress (cortisol, salivary alpha-amylase, butyrylcholinesterase, and total esterase), immunity (adenosine deaminase), oxidative status (Trolox equivalent antioxidant capacity and the advanced oxidation protein products), and general metabolism (creatine kinase, γ-glutamyl transferase, urea, triglycerides, glucose, and lactate) had significant changes throughout this period. This study indicated that the saliva of dairy cows shows changes in its composition during the transition period and potentially can be a source of biomarkers for monitoring health and welfare. Abstract This pilot study aimed to study the possible changes in a profile of 26 salivary analytes in thirteen healthy dairy cows along their peripartum period. Analytes associated with the stress (salivary cortisol, salivary alpha-amylase, butyrylcholinesterase, and total esterase), inflammation (adenosine deaminase), oxidative status (total antioxidant capacity and the advanced oxidation protein products), and general metabolism (creatine kinase, γ-glutamyl transferase, urea, triglycerides, glucose, and lactate) varied along the sampling times. A positive correlation between the white blood cells counts, and the lipase, Trolox equivalent antioxidant capacity, advanced oxidation protein products, and lactate levels in saliva were observed at the delivery. A linear association between selected salivary analytes at different sampling times and the milk yield after calving was observed. In conclusion, in our experimental conditions, it was observed that the peripartum period in dairy cows can induce changes in salivary analytes. Some of them were associated with inflammatory status and the capacity of milk production after calving.
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Finsterer J, Scorza FA, Scorza CA. Significance of Asymptomatic Hyper Creatine-Kinase Emia. J Clin Neuromuscul Dis 2019; 21:90-102. [PMID: 31743252 DOI: 10.1097/cnd.0000000000000269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Whether asymptomatic hyper-CKemia (AHCE) should prompt a thorough work-up for muscle disease or not is controversially discussed. This review aims at summarizing and discussing recent findings concerning the cause, frequency, evolution, and work-up of conditions manifesting as AHCE and normal or abnormal electromyography (EMG) respectively muscle biopsy. METHODS Systematic PubMed search. RESULTS There are numerous primary (hereditary) and acquired myopathies that manifest with permanent, recurrent, or temporary AHCE with/without myopathic EMG or muscle biopsy. AHCE particularly occurs at onset of these conditions, which include dystrophinopathies, myotilinopathies, calpainopathy, caveolinopathy, dysferlinopathy, central core disease, multicore disease, desminopathy, MD1, MD2, hypoPP, malignant hyperthermia susceptibility, Pompe disease, McArdle disease, myoadenylate deaminase-deficiency, CPT2-deficiency, mitochondrial disorders, or myopathy with tubular aggregates. Most likely, other primary myopathies manifest with AHCE as well, without having been reported. Patients with AHCE should be taken seriously and repeated CK determination must be conducted. If hyper-CKemia is persisting or recurrent, these patients should undergo an EMG and eventually muscle biopsy. If noninformative, genetic work-up by a panel or whole exome sequencing should be initiated, irrespective of the family history. Patients with AHCE should avoid excessive exercise, require sufficient hydration, require counseling with regard to the risk of malignant hyperthermia, and should inform anesthesiologists and surgeons about their condition before elective surgery. CONCLUSIONS Recurrent AHCE should be taken seriously and managed with conventional work-up. If noninformative, genetic work-up should follow irrespective of the family history.
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Affiliation(s)
- Josef Finsterer
- Krankenanstalt Rudolfstiftung, Messerli Institute, Vienna, Austria
| | - Fulvio A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicine/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Carla A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicine/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
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Rempel LA, Vallet JL, Nonneman DJ. Characterization of plasma metabolites at late gestation and lactation in early parity sows on production and post-weaning reproductive performance. J Anim Sci 2018; 96:521-531. [PMID: 29385465 DOI: 10.1093/jas/skx066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/19/2017] [Indexed: 11/12/2022] Open
Abstract
Lactation is a very energy demanding period for sows. The current study provides a better understanding of the biochemical response of first- (n = 246) or second-parity (n = 127) sows during late gestation through lactation and assesses relationships with piglet production and dam reproductive performance. Plasma samples were collected from first- or second-parity dams at late gestation (110 d gestation [d110G]), d 1 post-farrowing (d1PF), and weaning (WN) then analyzed for various stress and protein metabolism compounds, including; creatine, creatine phosphokinase (CPK) activity, creatinine, urea nitrogen, albumin, and lactate. Litter performance was measured as number of piglets nursed and piglet ADG. Post-weaning reproductive performance was assessed by measuring weaning-to-estrus interval (WEI) and subsequent ovulation rate collected at time of harvest. Plasma creatine and CPK activity increased (P < 0.05) between d110G and d1PF. Plasma creatinine decreased (P < 0.05) from d110G through WN in first-parity dams, but remained similar between d110G and d1PF before declining (P < 0.05) at WN in second-parity dams. Plasma urea nitrogen increased (P < 0.05) over the course of the study and was negatively (P < 0.05) associated with piglet ADG at d110G and d1PF and with ovulation rate at d110G (P < 0.05). Similarly, plasma albumin increased (P < 0.05) in first-parity dams over the course of the study, whereas it plateaued (P < 0.05) at d1PF and remained similar (P > 0.10) through WN in second-parity dams. First-parity dams had less (P < 0.05) plasma lactate at d110G than at d1PF or WN. However, second-parity dams had increased (P < 0.05) plasma lactate at d110G and d1PF, then decreased (P < 0.05) levels at WN. Plasma lactate at WN was positively (P < 0.05) associated with WEI in first-parity dams, but negatively (P < 0.05) related to WEI at d1PF in second-parity dams. Plasma lactate levels at all time points were positively (P < 0.05) associated with ovulation rate in second-parity dams. The biochemical profile of these dams differed by parity and merits further investigations into these differences to identify methods to improve physiological response to lactation for improved animal welfare, production, and reproductive performance.
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Affiliation(s)
- Lea A Rempel
- USDA-ARS, U.S. Meat Animal Research Center, Clay Center, NE
| | | | - Dan J Nonneman
- USDA-ARS, U.S. Meat Animal Research Center, Clay Center, NE
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Mori da Cunha MGMC, Giacomazzi G, Callewaert G, Hympanova L, Russo F, Vande Velde G, Gijsbers R, Albersen M, Sampaolesi M, Deprest J. Fate of mesoangioblasts in a vaginal birth injury model: influence of the route of administration. Sci Rep 2018; 8:10604. [PMID: 30006567 PMCID: PMC6045600 DOI: 10.1038/s41598-018-28967-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 07/03/2018] [Indexed: 12/13/2022] Open
Abstract
Currently cell therapy is considered as an experimental strategy to assist the healing process following simulated vaginal birth injury in rats, boosting the functional and morphologic recovery of pelvic floor muscles and nerves. However, the optimal administration route and dose still need to be determined. Mesangioblasts theoretically have the advantage that they can differentiate in skeletal and smooth muscle. We investigated the fate of mesoangioblasts transduced with luciferase and green fluorescent protein reporter genes (rMABseGFP/fLUC) using bioluminescence, immunofluorescence and RT-PCR in rats undergoing simulated birth injury. rMABseGFP/fLUC were injected locally, intravenously and intra-arterially (common iliacs and aorta). Intra-arterial delivery resulted in the highest amount of rMABseGFP/fLUC in the pelvic organs region and in a more homogeneous distribution over all relevant pelvic organs. Sham controls showed that the presence of the injury is important for recruitment of intra-arterially injected rMABseGFP/fLUC. Injection through the aorta or bilaterally in the common iliac arteries resulted in comparable numbers of rMABseGFP/fLUC in the pelvic organs, yet aortic injection was faster and gave less complications.
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Affiliation(s)
- Marina Gabriela Monteiro Carvalho Mori da Cunha
- Centre for Surgical Technologies, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Giorgia Giacomazzi
- Translational Cardiomyology Lab, Stem Cell Biology and Embryology Unit, Department Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Geertje Callewaert
- Centre for Surgical Technologies, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Pelvic Floor Unit, University Hospitals KU Leuven, Leuven, Belgium
| | - Lucie Hympanova
- Centre for Surgical Technologies, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Institute for the Care of the Mother and Child, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Francesca Russo
- Centre for Surgical Technologies, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | | | - Rik Gijsbers
- Laboratory for Molecular Virology and Gene Therapy, KU Leuven, Flanders, Belgium
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Maurilio Sampaolesi
- Translational Cardiomyology Lab, Stem Cell Biology and Embryology Unit, Department Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Jan Deprest
- Centre for Surgical Technologies, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.
- Department of Development and Regeneration, Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.
- Pelvic Floor Unit, University Hospitals KU Leuven, Leuven, Belgium.
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Neels H, De Wachter S, Wyndaele JJ, Wyndaele M, Vermandel A. Does pelvic floor muscle contraction early after delivery cause perineal pain in postpartum women? Eur J Obstet Gynecol Reprod Biol 2016; 208:1-5. [PMID: 27875777 DOI: 10.1016/j.ejogrb.2016.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/04/2016] [Accepted: 11/10/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Pelvic floor muscle training is effective and necessary in the prevention and treatment of pelvic floor dysfunction during pregnancy and after childbirth. But because of the high prevalence of perineal pain observed in women after childbirth, many women and caregivers fear to start pelvic floor muscle training immediately after childbirth. However, it is unknown whether pelvic floor muscle contractions (PFMC) provoke perineal pain in women shortly after childbirth. Therefore, the main objective is to study whether PFMC performed immediately after childbirth is painful or not. STUDY DESIGN Observational longitudinal study. Perineal pain was assessed (1-6 days and 9 weeks postpartum) using a visual analogue scale (VAS 0-10) during PFMC and during several activities of daily living (ADL), during micturition and defecation. Descriptive statistics, Wilcoxon and McNemar tests were used. RESULTS A total of 233 women participated (148 primiparous and 85 multiparous). Immediately postpartum the prevalence and intensity of pain during ADL (73%; VAS 4.9 (±2.3)), micturition (47%; VAS 3.4 (±1.7)) and defecation (19%; VAS 3.6 (±2.2)) were significantly higher (all p<0.000) than during PFMC (8%; VAS 2.2 (±0.9)). At 9 weeks postpartum, 30% experienced perineal pain during sexual intercourse (VAS 4.6 +/- 2.3) and 18% during defecation (VAS 4.7 +/- 2.3), but none during PFMC. CONCLUSION Perineal pain is highly prevalent immediately after childbirth during ADL, micturition and defecation, but not during PFMC (only 8%). In case perineal pain occurs during PFMC, the intensity of pain is low (VAS 2). These results show that fear of perineal pain should not discourage women to start pelvic floor muscle training shortly after childbirth.
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Affiliation(s)
- Hedwig Neels
- Department Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium; Department of Urology, Antwerp University Hospital, Edegem, Belgium.
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, University of Antwerp, Wilrijk, Belgium
| | | | - Michel Wyndaele
- Department of Urology, University of Antwerp, Wilrijk, Belgium
| | - Alexandra Vermandel
- Department Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium; Department of Urology, Antwerp University Hospital, Edegem, Belgium
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Chen HY, Chen CJ, Lin YN, Chen YH, Chen WC, Chen CM. Proteomic analysis related to stress urinary incontinence following vaginal trauma in female mice. Eur J Obstet Gynecol Reprod Biol 2013; 171:171-9. [DOI: 10.1016/j.ejogrb.2013.08.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 07/28/2013] [Accepted: 08/13/2013] [Indexed: 11/26/2022]
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Chen HY, Lin YN, Chen YH, Chen WC. Stress urinary incontinence following vaginal trauma involves remodeling of urethral connective tissue in female mice. Eur J Obstet Gynecol Reprod Biol 2012; 163:224-9. [PMID: 22572217 DOI: 10.1016/j.ejogrb.2012.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 03/25/2012] [Accepted: 04/17/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The molecular mechanisms underlying stress urinary incontinence (SUI) are not clear. This study was conducted to evaluate molecular alterations in the urethras of mice with experimentally induced SUI. STUDY DESIGN Eighteen virgin female mice were equally distributed into three groups as follows: two groups undergoing vaginal distension (VD) for 1 h with 3 mm and 8 mm dilators each, and a non-instrumented control group. Changes in leak point pressure (LPP), morphology, lysyl oxidase (LOX) expression and the metabolism of urethral connective tissue were assessed. RESULTS The LPP was significantly decreased in the 3 mm and 8 mm VD groups compared with that in the control group. Collagen and elastin expression in the urethra was significantly decreased in the 8 mm VD group compared with that in the control group, while LOX expression was significantly enhanced. CONCLUSIONS SUI following vaginal trauma involves over-expression of LOX and decreased synthesis of extracellular matrix components or increased proteolysis in the urethra.
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Affiliation(s)
- Huey-Yi Chen
- Department of Obstetrics and Gynecology, Sex Hormone Research Center, China Medical University Hospital, Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
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MRI findings in patients considered high risk for pelvic floor injury studied serially after vaginal childbirth. AJR Am J Roentgenol 2010; 195:786-91. [PMID: 20729461 DOI: 10.2214/ajr.09.3508] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The purpose of this article is to characterize pelvic floor injury after vaginal childbirth with serial MRI. SUBJECTS AND METHODS MR images (3-T) were obtained early (1 month) and late (7 months) after first childbirth in 19 women with risk factors for pelvic floor injury. All women underwent multiplanar intermediate-weighted sequences, and 11 women underwent fluid-sensitive sequences. MR images were evaluated for levator edema and tears and for pubic abnormalities. RESULTS Three women had unilateral high-grade tears, three had unilateral low-grade tears, and one had bilateral high- and low-grade tears of the levator ani muscles. All tears were focal at the pubis. Levator edema was present in all women on initial imaging and was resolved at follow-up. Six women had bone marrow edema, five with fracture line. None showed a pattern indicating nerve damage separate from muscle tears. CONCLUSION MRI showed focal levator ani muscle tears at the pubis with bone marrow edema and fracture in patients at risk for pelvic floor injury.
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Scown TM, Santos EM, Johnston BD, Gaiser B, Baalousha M, Mitov S, Lead JR, Stone V, Fernandes TF, Jepson M, van Aerle R, Tyler CR. Effects of Aqueous Exposure to Silver Nanoparticles of Different Sizes in Rainbow Trout. Toxicol Sci 2010; 115:521-34. [DOI: 10.1093/toxsci/kfq076] [Citation(s) in RCA: 259] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Scown TM, van Aerle R, Johnston BD, Cumberland S, Lead JR, Owen R, Tyler CR. High Doses of Intravenously Administered Titanium Dioxide Nanoparticles Accumulate in the Kidneys of Rainbow Trout but with no Observable Impairment of Renal Function. Toxicol Sci 2009; 109:372-80. [DOI: 10.1093/toxsci/kfp064] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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