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Ashton-Miller J. Letter to the editor of heliyon re: 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:e31361. [PMID: 38831808 PMCID: PMC11145477 DOI: 10.1016/j.heliyon.2024.e31361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 06/05/2024] Open
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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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Doumouchtsis SK, de Tayrac R, Lee J, Daly O, Melendez-Munoz J, Lindo FM, Cross A, White A, Cichowski S, Falconi G, Haylen B. An International Continence Society (ICS)/ International Urogynecological Association (IUGA) joint report on the terminology for the assessment and management of obstetric pelvic floor disorders. Int Urogynecol J 2023; 34:1-42. [PMID: 36443462 PMCID: PMC9834366 DOI: 10.1007/s00192-022-05397-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
AIMS The terminology of obstetric pelvic floor disorders should be defined and reported as part of a wider clinically oriented consensus. METHODS This Report combines the input of members of two International Organizations, the International Continence Society (ICS) and the International Urogynecological Association (IUGA). The process was supported by external referees. Appropriate clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 12 main rounds of internal and 2 rounds of external review was involved to exhaustively examine each definition, with decision-making by consensus. RESULTS A terminology report for obstetric pelvic floor disorders, encompassing 357 separate definitions, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it usable by different specialty groups and disciplines involved in the study and management of pregnancy, childbirth and female pelvic floor disorders. Clinical assessment, investigations, diagnosis, conservative and surgical treatments are major components. Illustrations have been included to supplement and clarify the text. Emerging concepts, in use in the literature and offering further research potential but requiring further validation, have been included as an Appendix. As with similar reports, interval (5-10 year) review is anticipated to maintain relevance of the document and ensure it remains as widely applicable as possible. CONCLUSION A consensus-based Terminology Report for obstetric pelvic floor disorders has been produced to support clinical practice and research.
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Affiliation(s)
- Stergios K. Doumouchtsis
- grid.419496.7Department of Obstetrics and Gynaecology, Epsom and St. Helier University Hospitals NHS Trust, Epsom, UK
- grid.264200.20000 0000 8546 682XSt. George’s University of London, London, UK
- grid.5216.00000 0001 2155 0800Laboratory of Experimental Surgery and Surgical Research “N.S. Christeas”, National and Kapodistrian University of Athens, Medical School, Athens, Greece
- grid.464520.10000 0004 0614 2595School of Medicine, American University of the Caribbean, Cupecoy, Sint Maarten
- School of Medicine, Ross University, Miramar, FL USA
| | - Renaud de Tayrac
- grid.411165.60000 0004 0593 8241Nimes University Hospital, Nimes, France
| | - Joseph Lee
- grid.1005.40000 0004 4902 0432University New South Wales, Sydney, Australia
| | - Oliver Daly
- grid.417072.70000 0004 0645 2884Western Health, Melbourne, Australia
| | - Joan Melendez-Munoz
- grid.411295.a0000 0001 1837 4818Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Fiona M. Lindo
- grid.63368.380000 0004 0445 0041Houston Methodist Hospital, Texas A&M University College of Medicine, Houston Methodist Hospital, Houston, TX USA
| | - Angela Cross
- grid.415534.20000 0004 0372 0644Middlemore Hospital, Auckland, New Zealand
| | - Amanda White
- grid.89336.370000 0004 1936 9924University of Texas at Austin, Austin, TX USA
| | - Sara Cichowski
- grid.5288.70000 0000 9758 5690Oregon Health & Sciences University, Portland, OR USA
| | - Gabriele Falconi
- grid.413009.fComplex Operative Unit of Gynecology, Fondazione Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Bernard Haylen
- grid.1005.40000 0004 4902 0432University New South Wales, Sydney, Australia
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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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Nóbrega MA, Pereira GMV, Brito LGO, Luz AG, Lajos GJ. Severe Perineal Trauma in a Brazilian Southeastern Tertiary Hospital: A Retrospective Cohort Study. Female Pelvic Med Reconstr Surg 2021; 27:e301-e305. [PMID: 32576733 DOI: 10.1097/spv.0000000000000910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the prevalence of severe perineal trauma (obstetric and anal sphincter injury [OASIS]) in a tertiary high-risk pregnancy facility and the associated factors. METHODS A retrospective electronic chart review on perineal lacerations was performed from the period of April 2017 to February 2019. Obstetric and anal sphincter injury was diagnosed by a rectal examination. Primary outcome was the prevalence of OASIS (third- and fourth-degree perineal tear). Independent variables were maternal, intrapartum, and neonatal characteristics. Univariate and multivariate analyses with logistic regression models were performed. A P value lower than 0.05 was considered significant. RESULTS The prevalence of OASIS (third/fourth-degree laceration) was 1.51% (43/2846) in our population. Our population was mostly white (66.3%) and mostly primiparous (52.1%). By comparison, the prevalence of first/second-degree laceration was 43% (1223/2846). Selective episiotomy occurred in 18.73% (517/2761) of patients, and it was not associated with OASIS (P = 0.211). Advanced maternal age (P = 0.196), higher number of vaginal examinations (P = 0.169), fetal presentation (P = 0.533), and duration of second stage (P = 0.757) were not associated with OASIS. Univariate analysis has found that forceps delivery (odds ratio [OR], 3.68 [1.74-7.79]; P = 0.001), neonatal macrossomy (OR, 3.42 [1.02-11.43]; P = 0.045), and larger head circumference (OR, 1.15 [1.02-1.32]; P = 0.026) were risk factors for OASIS, whereas higher gravidity reduced the risk (OR, 0.61 [0.42-0.91] for OASIS. However, after multivariate analysis, only head circumference (OR, 1.86 [1.10-3.14]; P = 0.020) remained as a risk factor. CONCLUSIONS Larger neonatal head circumference increased in 86% the risk for severe perineal trauma in this cohort of women.
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Affiliation(s)
- Marina Augusto Nóbrega
- From the Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
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Pardo E, Rotem R, Glinter H, Erenberg M, Yahav L, Yohay Z, Yohay D, Weintraub AY. Is there a correlation between pelvic floor dysfunction symptoms during pregnancy and the duration of the second stage of labor? J Matern Fetal Neonatal Med 2021; 35:4418-4423. [PMID: 33455478 DOI: 10.1080/14767058.2020.1850679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pelvic floor dysfunction (PFD) most commonly results from weakened or injured muscles and ligaments whose purpose is to support the pelvic floor. Many studies have placed vaginal delivery and prolonged second stage of labor (SSL) as major risk factors for PFD, supposedly through generating enhanced pressure in the pelvic area. Although many studies describe the effects of vaginal delivery and labor on structure and function of the pelvic floor, not much is known regarding PFD deriving from pregnancy and its prevalence and severity in the postpartum. We aimed to evaluate whether a correlation exists between PFD symptoms during pregnancy and the duration of the SSL. METHODS We conducted a cross sectional study of 200 women who gave birth at Soroka University Medical Center, Beer-Sheva, Israel. Those who had consented completed the Pelvic Floor Distress Inventory-20 (PFDI-20), a condition specific questionnaire developed to measure quality-of-life and the extent of injury to the pelvic floor in women with all forms of PFD. The duration of the SSL and clinical and obstetrical characteristics were retrieved from the participants' medical records. We assessed correlations using Spearman's correlation coefficient. RESULTS PFD during pregnancy was found to be correlated to the duration of the SSL (R = -0.183, p = .021). When evaluating each component of the PFDI-20 separately, CRAD was significantly correlated with the duration of the SSL (R = -0.195, p = .014). CONCLUSIONS There is a correlation between PFD symptoms during pregnancy, specifically symptoms of CRAD and the duration of the SSL.
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Affiliation(s)
- Ella Pardo
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel.,Joyce Irving Goldman Medical School, Ben Gurion University of the Negev, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University Medical School of Jerusalem, Beer Sheva, Israel
| | - Hannah Glinter
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
| | - Miriam Erenberg
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
| | - Lior Yahav
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
| | - Zehava Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
| | - David Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel.,Joyce Irving Goldman Medical School, Ben Gurion University of the Negev, Jerusalem, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel.,Joyce Irving Goldman Medical School, Ben Gurion University of the Negev, Jerusalem, Israel
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Lima CTS, Brito GA, Karbage SAL, Bilhar APM, Grande AJ, Carvalho FHC, Bezerra LRPS, Nascimento SL. Pelvic floor ultrasound finds after episiotomy and severe perineal tear: systematic review and meta-analysis. J Matern Fetal Neonatal Med 2020; 35:2375-2386. [PMID: 32660290 DOI: 10.1080/14767058.2020.1786049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM Vaginal delivery is a well-known risk factor for pelvic floor muscle (PFM) injuries, mainly when associated to prolonged labor, instrumental birth and perineal trauma such as episiotomy and perineal tears. The purpose of this meta-analysis was to test the hypothesis that episiotomy and severe perineal tear may increase the risk of pelvic floor damage. METHODS We performed a systematic literature search through electronic databases including MEDLINE via PubMed, LILACS via BVS, Embase via Elsevier and Cochrane Library up to January 2019. We included articles that reported as outcome one or more morphological aspects of the PFM evaluated by ultrasonography in primiparous women three to 24 months postpartum. This review is registered in the PROSPERO database (registration number: CRD42017075750). RESULTS the final selection was composed of 18 articles for the systematic review, and 10 for the meta-analysis. Women with levator ani muscle (LAM) avulsion were 1.77 times more likely to have undergone episiotomy (OR = 1.77, CI 95% 1.25-2.51, five trials), 4.31 times more likely to have severe perineal tear (OR = 4.31, CI 95% 2.34-7.91, two trials). Women with defects in the anal sphincters were 2.82 times more likely to have suffered severe perineal tear (OR = 2.82, 95% CI 1.71-4.67, three trials). CONCLUSIONS Both episiotomy and severe perineal tear are risk factors for LAM avulsion and anal sphincter injury, and this can be useful for identifying women who are at greater risk of developing PFM dysfunctions.
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Affiliation(s)
- Clara Taína Silva Lima
- Department of Women's, Child and Adolescent Health, Federal University of Ceara, Fortaleza, Brazil
| | | | | | - Andreisa Paiva Monteiro Bilhar
- Department of Women's, Child and Adolescent Health, Federal University of Ceara, Fortaleza, Brazil.,Maternity School Assis Chateaubriand, Fortaleza, Brazil
| | - Antônio José Grande
- Medicine and Sciences Department, State University of Mato Grosso do Sul, Brazil
| | - Francisco Herlânio Costa Carvalho
- Department of Women's, Child and Adolescent Health, Federal University of Ceara, Fortaleza, Brazil.,Maternity School Assis Chateaubriand, Fortaleza, Brazil
| | | | - Simony Lira Nascimento
- Department of Women's, Child and Adolescent Health, Federal University of Ceara, Fortaleza, Brazil.,Department of Physical Therapy, Federal University of Ceara, Fortaleza, Brazil.,Maternity School Assis Chateaubriand, Fortaleza, Brazil
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Appraisal of clinical practice guidelines on the management of obstetric perineal lacerations and care using the AGREE II instrument. Eur J Obstet Gynecol Reprod Biol 2020; 247:66-72. [DOI: 10.1016/j.ejogrb.2020.01.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
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Kimmich N, Yeo AT, Zimmermann R, Furrer E. How do sustained birth tears after vaginal birth affect birth tear patterns in a subsequent birth? J Perinat Med 2020; 48:/j/jpme.ahead-of-print/jpm-2020-0007/jpm-2020-0007.xml. [PMID: 32191625 DOI: 10.1515/jpm-2020-0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/21/2020] [Indexed: 11/15/2022]
Abstract
Background Tears are common after vaginal birth, and different impact factors are known. However, the impact of tears from a previous birth to the tears of a subsequent birth is unknown. Therefore, we aimed to evaluate the distribution of birth tear patterns according to the sustained tears in a previous birth, in addition to other impact factors. Methods In a retrospective cohort study, we evaluated all women up to parity 4 with subsequent vaginal, singleton births of vertex presentation at ≥37 + 0 gestational weeks between 1/2005 and 12/2016. Their tears were grouped into tear patterns and were analyzed by parity. Tear patterns in the subsequent births were analyzed in association to the patterns of the previous births and impact factors were evaluated. Results We counted 4017 births in 1855 women [P1: 1368 (34.1%), P2: 1730 (43.1%), P3: 741 (18.4%), P4: 178 (4.4%)]. The frequency of tears and episiotomies decreased with higher parity, whereas the frequency of intact perineum increased. Twenty-eight different unique tear patterns were found. We could show that birth tear patterns changed with increasing parity and were associated with sustained tears in a previous birth. In addition, some impact factors on tear patterns could be identified. Conclusion The distribution of the single tear types is in accordance with the current literature. However, it is new that distinct tear patterns are associated to sustained tear patterns of previous births. Furthermore, we demonstrated some weak associations of tear patterns to certain impact factors, such as more episiotomies, low-grade perineal or vaginal tears isolated or in combination with other tears with increasing fetal weight and head circumference in the higher parities, and with a longer duration of the second stage and the pushing phase in lower parities.
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Affiliation(s)
- Nina Kimmich
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - Audrey, T. Yeo
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute (EPBI), Zurich, Switzerland
| | - Roland Zimmermann
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - Eva Furrer
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute (EPBI), Zurich, Switzerland
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Pardo E, Rotem R, Glinter H, Erenberg M, Yahav L, Yohay Z, Yohay D, Weintraub AY. Recovery from pelvic floor dysfunction symptoms in the postpartum is associated with the duration of the second stage of labor. Arch Gynecol Obstet 2019; 300:127-133. [DOI: 10.1007/s00404-019-05173-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
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Zuchelo LTS, Santos EFDS, Dos Santos Figueiredo FW, Adami F, Bezerra IMP, Raimundo RD, Sorpreso ICE, de Abreu LC. Pelvic floor disorders in postpartum adolescents in the Western Amazon: a cross-sectional study. Int J Womens Health 2018; 10:477-486. [PMID: 30197542 PMCID: PMC6113915 DOI: 10.2147/ijwh.s169504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To analyze the postpartum pelvic floor disorders (PFD) and mode of delivery among adolescents, late adolescents, and young women from Western Amazon. PATIENTS AND METHODS Cross-sectional study was carried out in the urban area of Western Amazon in the city of Rio Branco, Acre, Brazil, from October 2016 to February 2017. This is a convenience sample of women up to 30 years who completed six months postpartum, separated in three groups according to maternal age: adolescents (age ≤19 years), late adolescents (20-24 years), and young women (25-30 years). Participants were home interviewed and answered Pelvic Floor Distress Inventory-20 (PFDI-20). Delivery clinical data were collected from patient's medical records. RESULTS In total, 285 participants were interviewed: 41 adolescents, 103 late adolescents, and 141 young women. After controlling for confounding factors, prevalences of PFD were higher in the adolescents' group compared with the young women's group (urinary incontinence [UI], prevalence ratio [PR] = 1.75, 95% CI 1.14-2.69; urge urinary incontinence [UUI], PR = 1.88, 95% CI 1.02-3.47; stress urinary incontinence, PR = 2.00, 95% CI 1.11-3.62; fecal incontinence [FI], PR = 4.40, 95% CI 1.36-14.27). PFDI-20 scores also presented higher values in the adolescent group (Pelvic Organ Prolapse Distress Inventory [POPDI], PR = 2.02, 95% CI 1.49-2.75; urinary distress inventory [UDI], PR = 2.09, 95% CI 1.47-2.98; PFDI, PR = 2.12, 95% CI 1.47-2.98). Analyzing the influence of cesarean section, adolescents have higher prevalence of UI (PR = 1.84, 95% CI 1.04-3.26, P=0.037), UUI (PR = 2.36, 95% CI 1.03-5.40, P=0.042), and FI (PR = 4.09, 95% CI 1.21-13.81, P=0.023). In addition, POPDI (PR = 2.15, 95% CI 1.60-2.89, P<0.001), UDI (PR = 2.25, 95% CI 1.61-3.16, P<0.001), and PFDI (PR = 2.27, 95% CI 1.68-3.08, P<0.001) scores are also higher among adolescents where the baby is born by cesarean section. CONCLUSION Adolescents present higher prevalence and symptoms of PFD; furthermore, cesarean delivery has a greater negative influence on the pelvic floor of adolescents when compared with young women. This reinforces the importance of PFD investigation among the adolescent population, mainly in developing countries which have high rates of adolescent pregnancy and cesarean section.
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Affiliation(s)
- Lea Tami Suzuki Zuchelo
- Study Design and Scientific Writing Laboratory, ABC Medical School (FMABC), Santo André, SP, Brazil,
- School of Physiotherapy, Universida Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
| | - Edige Felipe de Sousa Santos
- Study Design and Scientific Writing Laboratory, ABC Medical School (FMABC), Santo André, SP, Brazil,
- Department of Epidemiology, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Francisco Winter Dos Santos Figueiredo
- Study Design and Scientific Writing Laboratory, ABC Medical School (FMABC), Santo André, SP, Brazil,
- Epidemiology and Data Analysis Laboratory, ABC Medical School (FMABC), Santo André, SP, Brazil
| | - Fernando Adami
- Epidemiology and Data Analysis Laboratory, ABC Medical School (FMABC), Santo André, SP, Brazil
| | - Italla Maria Pinheiro Bezerra
- Study Design and Scientific Writing Laboratory, ABC Medical School (FMABC), Santo André, SP, Brazil,
- Nursing Department, School of Sciences of Santa Casa de Misericórdia de Vitoria (EMESCAM), Vitória, ES, Brazil
| | | | - Isabel Cristina Esposito Sorpreso
- Study Design and Scientific Writing Laboratory, ABC Medical School (FMABC), Santo André, SP, Brazil,
- Gynecology Discipline, Obstetrics and Gynecology Department, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil,
| | - Luiz Carlos de Abreu
- Study Design and Scientific Writing Laboratory, ABC Medical School (FMABC), Santo André, SP, Brazil,
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García-Mejido JA, de la Fuente-Vaquero P, Aquise-Pino A, Castro-Portillo L, Fernández-Palacín A, Sainz-Bueno JA. Can we predict levator ani muscle avulsion in instrumental deliveries through intrapartum transperineal ultrasound? J Matern Fetal Neonatal Med 2018; 32:3137-3144. [PMID: 29577793 DOI: 10.1080/14767058.2018.1457642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Introduction: To determine whether intrapartum translabial ultrasound (ITU) is useful for the prediction of levator ani muscle (LAM) avulsions in instrumental deliveries (vacuum and forceps). Materials and methods: Prospective, observational study, including (1/2016 - 5/2016) 77 nulliparous women, with singleton pregnancies of ≥37 weeks of gestation and with cephalic presentation, who required vacuum or forceps instrumentation to complete the delivery. The ITU parameters evaluated were Angle of Progression (AoP), Progression Distance (PD), Head Direction (HD), and Midline Angle (MLA), both at rest and with maternal push. Evaluation of LAM avulsion was performed at 6 months postpartum with 3-4D transperineal ultrasound. Complete avulsion was defined as an abnormal insertion of LAM in the lower pubic branch identified in all three central slices. Results: Data from 48 nulliparous women were finally included in the study (34 vacuum and 14 forceps). We observed no difference in obstetric parameters between the two study groups (group with avulsion of LAM -14 cases, 29.2% - and group without avulsion of LAM -34 cases, 70.8%). The "LAM avulsion group" had an AoP and a PD of 136.7 ± 22.4 and 43.5 ± 15.6, respectively, versus 141.6 ± 21.3 and 47.2 ± 16.8 recorded in the group without avulsion (NS), respectively. We obtained a ROC curve for AoP and PD with a push of 0.66 (95% CI, 0.28-1.00) and 0.57 (95% CI, 0.39-0.75), respectively. Conclusions: ITU is not a useful technique to predict the occurrence of LAM avulsion in instrumental deliveries with vacuum or forceps.
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Affiliation(s)
| | | | - Adriana Aquise-Pino
- c Harris Birthright Research Centre for Fetal Medicine , King's College Hospital , London , UK
| | - Laura Castro-Portillo
- a Department of Obstetrics and Gynecology , Valme University Hospital , Seville , Spain
| | - Ana Fernández-Palacín
- d Biostatistics Unit, Department of Preventive Medicine and Public Health , University of Seville , Seville , Spain
| | - José Antonio Sainz-Bueno
- a Department of Obstetrics and Gynecology , Valme University Hospital , Seville , Spain.,e Department of Obstetrics and Gynecology , University of Seville , Seville , Spain
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A constitutive model description of the in vivo material properties of lower birth canal tissue during the first stage of labor. J Mech Behav Biomed Mater 2017; 79:213-218. [PMID: 29310074 DOI: 10.1016/j.jmbbm.2017.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/06/2017] [Accepted: 12/22/2017] [Indexed: 11/21/2022]
Abstract
Remarkable changes must occur in the pelvic floor muscles and tissues comprising the birth canal to allow vaginal delivery. Despite these preparatory adaptations, approximately 13% of women who deliver vaginally for the first time (nulliparas) sustain tears near the origin of the pubovisceral muscle (PVM) which can result in pelvic organ prolapse later in life. To investigate why these tears occur, it is necessary to quantify the viscoelastic behavior of the term pregnant human birth canal. The goal of this study was to quantify the in vivo material properties of the human birth canal, in situ, during the first stage of labor and compare them to published animal data. The results show that pregnant human, ovine and squirrel monkey birth canal tissue can be characterized by the same set of constitutive relations; the interspecies differences were primarily explained by the long time constant, τ2, with its values of 555s, 1110s, and 2777s, respectively. Quantification of these viscoelastic properties should allow for improved accuracy of computer models aimed at understanding birth-related injuries.
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DeLancey JO. "Mommy, how will the baby get out of your tummy? Will it hurt you?". Am J Obstet Gynecol 2017; 217:110-111. [PMID: 28778286 DOI: 10.1016/j.ajog.2017.05.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 05/23/2017] [Indexed: 12/30/2022]
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