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Beer F, Kuppinger M, Schwab F, Hübner M, Kiefner B, Nacke A, Kelkenberg U, Schütze S, Lindner A, Hellmeyer L, Janni W, Metz M, Deniz M. Effect of postpartum pessary use on pelvic floor function: a prospective multicenter study. Arch Gynecol Obstet 2024:10.1007/s00404-024-07758-x. [PMID: 39390126 DOI: 10.1007/s00404-024-07758-x] [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: 07/24/2024] [Accepted: 09/21/2024] [Indexed: 10/12/2024]
Abstract
PURPOSE This study evaluates the restitution of pelvic floor function in postpartum women using the Restifem® pessary in a preventive and therapeutic approach. METHODS In this multicentre study all postpartum women independently of their parity, mode of delivery and existing pelvic floor symptoms were offered to use the Restifem® pessary from 6 weeks postpartum for 3 to 6 months. They completed the validated German pelvic floor questionnaire (GPFQpp) via online survey at 6 weeks, 6 months and 12 months postpartum and were divided, by their own choice, into users and non-users of the pessary. RESULTS Initially 857 women were enrolled. After 6 weeks 137 pessary users and 133 non-users, after 12 months 53 pessary users and 45 non-users submitted a completed questionnaire. Pessary users had significantly higher (worse) scores in all domains of the GPFQpp at 6 weeks postpartum. At 12 months postpartum pessary users still had a significantly higher bladder score, compared to non-users. There was a greater improvement in the bladder score (p = 0.005) and the pelvic organ prolapse score (p < 0.001) from 6 weeks to 12 months postpartum, among pessary users compared to non-users. CONCLUSION Pessary users had a significantly greater improvement in pelvic floor function from 6 weeks to 12 months postpartum, compared to non-users. This effect might be in part due to wearing the pessary but also due to greater scope for recovery, given the higher level of pelvic floor dysfunction in the pessary user group. TRIAL REGISTRATION The trial was registered in the German Clinical Trials Register (DRKS00024733) on 19 of April 2021.
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Affiliation(s)
- Franziska Beer
- Department of Obstetrics and Gynecology, University Hospital of Ulm, Ulm, Germany
| | - Madeleine Kuppinger
- Department of Obstetrics and Gynecology, University Hospital of Ulm, Ulm, Germany
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Hübner
- Department of Obstetrics and Gynecology, University Hospital of Freiburg, Freiburg, Germany
| | - Brenda Kiefner
- Department of Obstetrics and Gynecology, University Hospital of Ulm, Ulm, Germany
| | - Anna Nacke
- Department of Obstetrics, Vivantes Klinikum Friedrichshain, Berlin, Germany
| | - Ute Kelkenberg
- Departement of Obstetrics and Gynecology, Klinikum Bielefeld, Bielefeld, Germany
| | - Sabine Schütze
- Department of Obstetrics and Gynecology, University Hospital of Ulm, Ulm, Germany
| | - Anna Lindner
- Department of Obstetrics and Gynecology, University Hospital of Ulm, Ulm, Germany
| | - Lars Hellmeyer
- Department of Obstetrics, Vivantes Klinikum Friedrichshain, Berlin, Germany
| | - Wolfgang Janni
- Department of Obstetrics and Gynecology, University Hospital of Ulm, Ulm, Germany
| | - Melanie Metz
- Department of Sexual Health and Family Planning, Berlin, Germany
| | - Miriam Deniz
- Department of Obstetrics and Gynecology, University Hospital of Ulm, Ulm, Germany.
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Manzotti A, Fumagalli S, Zanini S, Brembilla V, Alberti A, Magli I, Buratti E, Coraglia N, De Fusco A, Zambù D, Zanotta V, Nespoli A. What is known about changes in pelvic floor muscle strength and tone in women during the childbirth pathway? A scoping review. Eur J Midwifery 2024; 8:EJM-8-42. [PMID: 39099673 PMCID: PMC11295251 DOI: 10.18332/ejm/189955] [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: 11/06/2023] [Revised: 02/04/2024] [Accepted: 06/12/2024] [Indexed: 08/06/2024] Open
Abstract
INTRODUCTION This scoping review aims to comprehensively explore the existing research on the changes in pelvic floor function that occur throughout the childbirth pathway (antenatal, intrapartum, and postnatal period). Furthermore, it seeks to identify new opportunities and directions for future research in this field. In particular, this review focuses on investigating pelvic floor muscle strength and tone in women during the childbirth pathway. METHODS The following databases were investigated from their inception: PubMed, OVID, Medline, ScienceDirect, The Cochrane Central Library, Scopus, Web of Science, PEDro, Scholar Google, Embase, and CINHAIL. Literature research was carried out from March to October 2022. Records identified through database searching were imported to Covidence. According to Arksey and O'Malley's five-stage scoping review framework, researchers screen titles and abstracts for eligibility and exclude records that do not meet the inclusion criteria. RESULTS A total of 40 studies were included in the data extraction phase. These articles underwent a review, with a specific emphasis on examining the tone, strength, and distensibility of the pelvic floor throughout the childbirth pathway. Among the selected studies, 22 investigated pelvic floor strength, 7 the distensibility, and 3 articles the tone. CONCLUSIONS This review identified both areas of agreement and disagreement across all three themes examined, with a particular emphasis on labor and the postpartum period. Notably, the review unveiled a significant scarcity of data concerning the tone of pelvic floor muscles throughout the childbirth pathway. Further studies to investigate the relationship between midwifery care and pelvic floor outcomes are required to improve clinical practice.
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Affiliation(s)
- Andrea Manzotti
- RAISE Lab, Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | | | - Sonia Zanini
- RAISE Lab, Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Veronica Brembilla
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
- University of Milano-Bicocca, Monza, Italy
| | - Adele Alberti
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Ilaria Magli
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Elis Buratti
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | | | - Andrea De Fusco
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Daniel Zambù
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Valeria Zanotta
- Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
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Taibi KO, Armengaud C, Fauconnier A. [Vaginal laxity: Semiology, diagnosis and treatments]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:102-108. [PMID: 37951416 DOI: 10.1016/j.gofs.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Vaginal laxity concerns 24 to 38% of women but it's still poorly understood and studied. The objective of this study is to do an inventory of current scientific knowledge about its definition, its diagnostic criteria, and treatments. METHODS We conducted a non systematic review of literature including original articles in French and English about the definition, diagnostic criteria and treatments of vaginal laxity using data bases such as Cochrane, Embase, Medline, PubMed et Science Direct. RESULTS It is a feeling of excessive looseness that can alter the quality of sexual intercourses. The main risk factor is vaginal delivery. The feeling of vaginal laxity appears to be linked to an excessive distensibility of the levator ani muscle that can be evaluated during physical examination by the measure of the genital hiatus and the perineal body (GH and PB measures from the POP-Q classification) during vasalva or by the measure of genital hiatus area by translabial sonography during valsalva. Although pelvic muscle training is currently prescribed as a first line treatment, data are limited to confirm its effectiveness in this affection. Colpoperineorraphy with levator ani myorraphy which was mostly evaluated in case of genital prolapse is associated with a high success rate but is at risk of dyspareunia. New nonsurgical treatments such as radiofrequency and vaginal laser seems to lead to lower success rate than surgical treatments but they are less invasive. Their effectiveness and long-term effects are still unknown which restrict their application in this condition. CONCLUSION Vaginal laxity is a frequent condition that impacts on the quality of life and sexual function. Further studies should be conducted to better understand its physiopathology and the optimal treatment.
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Affiliation(s)
- Khalid Ouazzani Taibi
- Service de gynécologie-obstétrique, centre hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, 10, rue du champ Gaillard, 78303 Poissy cedex, France.
| | - Camille Armengaud
- Service de gynécologie-obstétrique, centre hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, 10, rue du champ Gaillard, 78303 Poissy cedex, France
| | - Arnaud Fauconnier
- Service de gynécologie-obstétrique, centre hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, 10, rue du champ Gaillard, 78303 Poissy cedex, France; Unité de recherche 7285 « Risques cliniques et sécurité en santé des femmes et en santé périnatale »(RISCQ), UVSQ, université Paris-Saclay, 78180 Montigny-le-Bretonneux, France
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Sigurdardottir T, Steingrimsdottir T, Geirsson RT, Halldorsson TI, Aspelund T, Bø K. Postpartum pelvic organ prolapse and pelvic floor muscle training: secondary analysis of a randomized controlled trial of primiparous women. Int Urogynecol J 2023:10.1007/s00192-023-05502-8. [PMID: 36995416 DOI: 10.1007/s00192-023-05502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 02/02/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic floor dysfunction is common after childbirth. We hypothesize that physiotherapist-guided pelvic floor muscle training (PFMT) is effective regarding pelvic organ prolapse (POP) symptoms during the first postpartum year. METHODS This was a secondary analysis from a randomized controlled trial (RCT), carried out at a physiotherapy clinic, Reykjavik. Participants were eighty-four primiparous women with a singleton delivery. They were screened for eligibility 6-13 weeks postpartum. Women in a training group conducted 12 weekly individual sessions with a physiotherapist within an RCT, starting on average 9 weeks postpartum. Outcomes were assessed after the last session (short term) and at approximately 12 months postpartum (long term). The control group received no instructions after the initial assessment. Main outcome measures were self-evaluated POP symptoms by the Australian Pelvic Floor Questionnaire. RESULTS Forty-one and 43 women were in the training and control groups, respectively. At recruitment, 17 (42.5%) of the training group and 15 (37%) of the control group reported prolapse symptoms (p = 0.6). Five (13%) from the training group and nine (21%) controls were bothered by the symptoms (p = 0.3). There was a gradual decrease in the number of women with symptoms and no significant short-term (p = 0.08) or long-term (p = 0.6) differences between the groups regarding rates of women with POP symptoms. The difference between groups regarding bother in the short (p = 0.3) or longer term (p = 0.4) was not significant. Repeated-measures analyses using Proc Genmod in SAS did not indicate a significant effect of the intervention over time (p > 0.05). CONCLUSIONS There was an overall decrease in postpartum symptoms of POP and bother during the first year. Physiotherapist-led PFMT did not change the outcomes. CLINICAL TRIAL REGISTRATION The trial was registered 30 March 2015 at https://register. CLINICALTRIALS gov (NCT02682212). Initial participant enrollment was on 16 March 2016 and reported following CONSORT guidelines for randomized controlled trials.
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Affiliation(s)
- Thorgerdur Sigurdardottir
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
- Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland.
| | - Thora Steingrimsdottir
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland
| | - Reynir T Geirsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland
| | - Thorhallur I Halldorsson
- Faculty of Food Sciences and Nutrition, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Thor Aspelund
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
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Zhao Y, Zhang C, Cui C, Zhang X, Zhao Q, Shen W. Longitudinal changes in pelvic organ support among primiparas with postpartum pelvic organ prolapse: A follow-up magnetic resonance imaging study. Int J Gynaecol Obstet 2023. [PMID: 36811173 DOI: 10.1002/ijgo.14718] [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: 05/18/2022] [Revised: 12/26/2022] [Accepted: 02/02/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To quantify morphological changes of pelvic floor in primiparas with postpartum pelvic organ prolapse (POP) during the early postpartum period. METHODS A total of 309 primiparas underwent pelvic floor magnetic resonance imaging (MRI) at 6 weeks postpartum. Those primiparas diagnosed with postpartum POP by MRI criterion were followed up at 3 and 6 months postpartum. Normal primiparas were enrolled in the control group. The puborectal hiatus line, muscular pelvic floor relaxation line, levator hiatus area, iliococcygeus angle, levator plate angle, uterus-pubococcygeal line, and bladder-pubococcygeal line were assessed on MRI. Longitudinal changes in pelvic floor measurements between the two groups were compared by repeated-measures analysis of variance. RESULTS Compared with the control group, enlarged puborectal hiatus line, levator hiatus area, and RICA and decreased uterus-pubococcygeal line were observed at rest in the POP group (all P < 0.05). All of the pelvic floor measurements were significantly different in the POP group compared with the control group at the maximum Valsalva maneuver (all P < 0.05). All of the pelvic floor measurements showed no significant change over time in both the POP and control groups (all P > 0.05). CONCLUSIONS Postpartum POP accompanied by poor pelvic floor support will persist in the early postpartum period.
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Affiliation(s)
- Yujiao Zhao
- Department of Radiology, The First Central Clinical College, Tianjin Medical University, Tianjin, China.,Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Cheng Zhang
- Department of Radiology, The First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Can Cui
- Department of Radiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Xiaodong Zhang
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Qian Zhao
- Department of Obstetrics and Gynaecology, Tianjin First Central Hospital, Tianjin, China
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
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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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Habitus and Pelvic Floor Symptoms and Support 1 Year Postpartum. Obstet Gynecol 2021; 137:821-830. [PMID: 33831903 DOI: 10.1097/aog.0000000000004349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/28/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the association between habitus measures and pelvic floor support and symptoms in primiparous women 1 year after term vaginal delivery. METHODS In this cross-sectional study including women enrolled at seven academic and community sites, we assessed pelvic floor support, weight, height, waist circumference, and percent fat using air displacement plethysmography and participants completed questionnaires, all at one year postpartum. We tested the association of quintiles of habitus measure, including body mass index (BMI), waist circumference, percent body fat, and waist/height ratio, with the primary outcomes: anatomic support, dichotomized as maximal vaginal descent less than 0 cm (better support) compared with 0 cm or more (worse support) per the pelvic organ prolapse quantification examination and symptom burden (positive with bothersome symptoms in two or more of six symptom domains), and on five secondary outcomes. The sample size provides 90% power to detect odds ratios (ORs) of 1.78 or greater between women at mean compared with mean+1 SD of habitus measure. RESULTS Of 592 participants, 55 (9.3%) demonstrated worse support and 321 (54.2%) symptom burden. In multivariable analyses, habitus measures were not significantly associated with anatomic support or, except for the highest waist/height ratio quintile, with symptom burden. Compared with women in the first quintile of each habitus measure, those in most higher quintiles demonstrated elevated odds of moderate to severe urinary incontinence (UI); increased odds for stress urinary incontinence (SUI) were mainly limited to the highest quintile. After adjusting for percent body fat, the increased odds for BMI on SUI (OR 2.47, 95% CI 1.43-4.28) were no longer significant (OR 1.38, 95% CI 0.54, 3.51). CONCLUSION Habitus in primiparous patients at 1 year postpartum was not associated with anatomic support or symptom burden. Habitus was more associated with moderate to severe UI than mild UI. The association of higher BMI with SUI was attenuated by fitness, reflected by fat percentage.
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Trajectories of Pelvic Floor Symptoms and Support After Vaginal Delivery in Primiparous Women Between Third Trimester and 1 Year Postpartum. Female Pelvic Med Reconstr Surg 2021; 27:507-513. [PMID: 34397607 DOI: 10.1097/spv.0000000000001068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The objectives of this study were to describe trajectories of pelvic floor symptoms and support from the third trimester to 1 year postpartum in primiparous women after vaginal delivery and to explore factors associated with their resolution between 8 weeks postpartum and 1 year postpartum. METHODS Five hundred ninety-seven nulliparous women 18 years or older who gave birth vaginally at term completed the Epidemiology of Prolapse and Incontinence Questionnaire and the Pelvic Organ Prolapse Quantification examination at the third trimester, 8 weeks postpartum, and 1 year postpartum. RESULTS At 1 year postpartum, 41%, 32%, and 23% of participants reported stress urinary incontinence, nocturia, and flatus incontinence, respectively, and 9% demonstrated maximal vaginal descent (MVD) ≥ 0 cm. For more common symptoms, incidence rates between the third trimester and 8 weeks postpartum ranged from 6% for urinary frequency to 22% for difficult bowel movements, and resolution rates between 8 weeks postpartum and 1 year postpartum ranged from 23% for stress urinary incontinence to 73% for pain. Between the third trimester and 8 weeks postpartum, 13% demonstrated de novo MVD ≥ 0 cm. For most symptoms, the presence of the same symptom before delivery decreased the probability of resolution between 8 weeks postpartum and 1 year. However, the sensitivities of predelivery vaginal bulge and MVD of 0 cm or greater for those outcomes at 1 year postpartum was overall low (10-12%). CONCLUSIONS One year postpartum, urinary and bowel symptoms are common in primiparous women who gave birth vaginally. A substantial portion of this burden is represented by symptoms present before delivery, while most of the prevalence of worse anatomic support is accounted for by de novo changes after delivery.
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Early postpartum physical activity and pelvic floor support and symptoms 1 year postpartum. Am J Obstet Gynecol 2021; 224:193.e1-193.e19. [PMID: 32798462 DOI: 10.1016/j.ajog.2020.08.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/27/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Risks of pelvic organ prolapse and urinary incontinence increase after the first vaginal delivery. During the early postpartum period, a time of active regeneration and healing of the pelvic floor, women may be particularly vulnerable to greater pelvic floor loading. OBJECTIVE This prospective cohort study aimed to determine whether objectively measured moderate to vigorous physical activity in the early postpartum period predicts pelvic floor support and symptoms 1 year after the first vaginal birth. STUDY DESIGN We enrolled nulliparous women in the third trimester, later excluding those who had a cesarean or preterm delivery. Participants wore triaxial wrist accelerometers at 2 to 3 weeks and 5 to 6 weeks postpartum for ≥4 days. Primary outcomes, assessed 1 year postpartum, included (1) pelvic floor support on Pelvic Organ Prolapse Quantification examination, dichotomized as maximal vaginal descent of <0 cm (better support) vs ≥0 cm (worse support); and (2) pelvic floor symptom burden, considered positive with report of ≥1 bothersome symptom in ≥2 of 6 domains, assessed using the Epidemiology of Prolapse and Incontinence Questionnaire. The primary predictor was average daily moderate to vigorous physical activity. Because we could not eliminate women with pelvic floor changes before pregnancy, we modeled prevalence, rather than risk, ratios for each outcome using modified Poisson regression. RESULTS Of 825 participants eligible after delivery, 611 completed accelerometry and 1-year follow-up; 562 completed in-person visits, and 609 completed questionnaires. The mean age was 28.9 years (standard deviation, 5.01). The mean for moderate to vigorous physical activity measured in minutes per day was 57.3 (standard deviation, 25.4) and 68.1 (standard deviation, 28.9) at 2 to 3 weeks and 5 to 6 weeks, respectively. One year postpartum, 53 of 562 participants (9.4%) demonstrated worse vaginal support and 330 of 609 participants (54.2%) met criteria for pelvic floor symptom burden. In addition, 324 (53.1%), 284 (46.6%), 144 (23.6%), and 25 (4.1%) reported secondary outcomes of stress urinary incontinence, overactive bladder, anal incontinence, and constipation, respectively, and 264 (43.4%), 250 (41.0%), and 89 (14.6%) reported no, mild, or moderate to severe urinary incontinence, respectively. The relationship between moderate to vigorous physical activity and outcomes was not linear. On the basis of plots, we grouped quintiles of moderate to vigorous physical activity into 3 categories: first and second quintiles combined, third and fourth quintiles combined, and fifth quintile. In final multivariable models, compared with women in moderate to vigorous physical activity quintiles 3 and 4, those in the lower 2 (prevalence ratio, 0.55; 95% confidence interval, 0.31-1.00) and upper quintile (prevalence ratio, 0.70; 95% confidence interval, 0.35-1.38)) trended toward lower prevalence of worse support. However, we observed the reverse for symptom burden: compared with women in quintiles 3 and 4, those in the lower 2 (prevalence ratio, 1.20; 95% confidence interval, 1.02-1.41) and upper quintile prevalence ratio 1.34 (95% confidence interval, 1.11-1.61) demonstrated higher prevalence of symptom burden. Moderate to vigorous physical activity did not predict any of the secondary outcomes. The presence of a delivery factor with potential to increase risk for levator ani muscle injury did not modify the effect of moderate to vigorous physical activity on outcomes. CONCLUSION Except for support, which was worse in women with moderately high levels of activity, early postpartum moderate to vigorous physical activity was either protective or had no effect on other parameters of pelvic floor health. Few women performed substantial vigorous activity, and thus, these results do not apply to women performing strenuous exercise shortly after delivery.
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Hitchcock R, Shaw JM, Niederauer S, Zhou J, Sheng X, Yang M, Nygaard IE. Association Between Measures of Trunk Recovery 5 to 10 Weeks Postpartum and Pelvic Floor Support and Symptoms 1 Year Postpartum in Primiparas Delivered Vaginally. Female Pelvic Med Reconstr Surg 2021; 27:e427-e435. [PMID: 32925422 DOI: 10.1097/spv.0000000000000953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine whether 2 aspects of trunk recovery after childbirth, intraabdominal pressure (IAP) generation and trunk flexor endurance (TFE), predict measures of pelvic floor health 1 year postpartum. METHODS In this prospective cohort study, we enrolled nulliparas in their third trimester and followed up those delivered vaginally for 1 year. We measured IAP while lifting a weighted car seat (IAPLIFT), IAP during TFE testing (IAPTFE), and TFE duration 5 to 10 weeks postpartum and assessed pelvic floor support and symptoms 1 year postpartum. RESULTS Mean age of the 624 participants was 28.7 years. At 5 to 10 weeks postpartum, mean (SD) maximal IAPLIFT and IAPTFE were 47.67 (11.13) and 51.57 (12.34) cm H2O, respectively. Median TFE duration was 126 seconds (Interquartile range, 74-211). At 1 year postpartum, 9.3% demonstrated worse support (maximal vaginal descent at or below hymen) and 54% met criteria for symptom burden (bothersome symptoms in ≥2 domains of Epidemiology of Prolapse and Incontinence Questionnaire). In multivariable models, neither IAPLIFT nor IAPTFE were associated with worse support or symptom burden (P = 0.54-1.00). Trunk flexor endurance duration increased prevalence of worse support (prevalence ratio, 1.05; 95% confidence interval, 1.01-1.08) per 60-second increase, P = 0.005) but not symptom burden (prevalence ratio, 1.00; 95% confidence interval, 0.98-1.03; P = 0.92). CONCLUSIONS These results provide some reassurance to early postpartum women, who are unlikely to perform routine activities that generate IAP far outside the range tested. Further research is needed to understand why women with long TFE durations have increased prevalence of worse support.
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Affiliation(s)
| | - Janet M Shaw
- Department of Health, Kinesiology, and Recreation, University of Utah, College of Health
| | | | - Jing Zhou
- Department of Family and Preventive Medicine, University of Utah School of Medicine, UT
| | | | - Meng Yang
- Department of Surgery, University of Utah
| | - Ingrid E Nygaard
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT
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Hage-Fransen MAH, Wiezer M, Otto A, Wieffer-Platvoet MS, Slotman MH, Nijhuis-van der Sanden MWG, Pool-Goudzwaard AL. Pregnancy- and obstetric-related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2020; 100:373-382. [PMID: 33064839 DOI: 10.1111/aogs.14027] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 09/05/2020] [Accepted: 10/08/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Risk factors for pelvic floor disorders are often related to pregnancy and delivery. Consistent evidence is needed to develop prevention strategies targeting risk factors. The objective of this study is to identify which pregnancy- and/or obstetric-related risk factors can predict urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life by means of a systematic review and meta-analysis. MATERIAL AND METHODS Systematic review Prospero number: CRD42019131758. Literature searches of PubMed, EMBASE, CINAHL, and Cochrane Library were conducted according to PRISMA guidelines (April 2020). Prospective cohort studies describing more than two pregnancy- and/or obstetric-related risk factors on urinary incontinence, fecal incontinence (including flatal incontinence), or pelvic organ prolapse were eligible. Risk of bias was assessed (using Quality In Prognosis Studies [QUIPS]). Studies with high risk of bias were excluded. Data were extracted and checked for accuracy with the CHARMS checklist. Sub-groups were used to distinguish between a short- and long-term follow-up period: <18 months (shortterm) and >18 months (long-term) postpartum. Odds ratios were calculated from reported prevalence rates. Log odds ratios were calculated using SPSS v.24. Variables were pooled using RevMan5. RESULTS Data were extracted from nineteen studies for urinary incontinence, nine for fecal incontinence, and two for pelvic organ prolapse. Multivariate analysis was not possible because of the heterogeneity of the population and outcome measures. Pooled univariate risk factors for urinary incontinence were: urinary incontinence during pregnancy, instrumental vaginal delivery, episiotomy, tears, and constipation. Pooled univariate risk factors for fecal incontinence were: fecal incontinence during pregnancy, maternal age over 35 years, prenatal body mass index over 30 kg/m2 , instrumental vaginal delivery, a spontaneous vaginal delivery, oxytocin augmentation, and when the weight of the newborn was more than 4000 g. Both studies for pelvic organ prolapse had a short-term follow-up period and cesarean section was the only risk factor that could be pooled. CONCLUSIONS Pregnancy- and obstetric-related risk factors predicting pelvic floor disorders postpartum are multifactorial and differ between pelvic floor disorders. The strongest risk factor for incontinence later in life was incontinence during pregnancy. Better quality research with long-term follow up is needed on this topic.
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Affiliation(s)
| | - Maaike Wiezer
- Physical Therapy Practice Fysi-Unique, Amersfoort, the Netherlands
| | - Amy Otto
- Faculty of Behavior Human Movement Sciences, Amsterdam Movement Sciences, VU University Amsterdam, Amsterdam, the Netherlands
| | | | | | | | - Annelies L Pool-Goudzwaard
- Faculty of Behavior Human Movement Sciences, Amsterdam Movement Sciences, VU University Amsterdam, Amsterdam, the Netherlands.,Somt University of Physiotherapy, Amersfoort, the Netherlands
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Gachon B, De Tayrac R, Schmitz T, Mahmood T, Nizard J, Fritel X. Should we advise women that pre-labor caesarean section prevents pelvic floor dysfunction? Eur J Obstet Gynecol Reprod Biol 2020; 244:31-34. [DOI: 10.1016/j.ejogrb.2019.10.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/30/2019] [Accepted: 10/22/2019] [Indexed: 01/04/2023]
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Gachon B. [Cesarean section and perineal protection: CNGOF Perineal Prevention and Protection in Obstetrics Guidelines]. ACTA ACUST UNITED AC 2018; 46:968-985. [PMID: 30377093 DOI: 10.1016/j.gofs.2018.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The endpoint was to assess the interest of planned cesarean section in primary and secondary obstetrical perineal prevention. METHODS This is a review of the literature about the impact of the mode of delivery in urinary incontinence (UI), anal incontinence (AI), pelvic organ prolapse (POP), sexual disorders de novo or prior to delivery and history of obstetric anal sphincter injuries (OASI). RESULTS The studies about UI, AI and sexual disorders report a potential protective impact of cesarean section but with a possible selection bias and an inadequate comparability of the groups. Randomized trials do not report any protective effect of planned cesarean section for these 3 disorders. The literature about POP reports a higher risk for the women who delivered vaginally but still with a possible selection bias et there is no randomized trial for this outcome. About the secondary prevention of OASI, there is no evidence in the literature for a benefit of a systematic planned cesarean section for all women. For symptomatic women, the mode of delivery has to be discussed individually. In secondary prevention of UI, AI, POP and sexual disorders, there is no evidence in the literature for a benefit of planned cesarean section even if there is a history of surgical procedure for the disorder. CONCLUSION Planned cesarean section is not recommended in order to prevent primary or secondary obstetrical perineal disorders except for symptomatic OASI for whom an individual discussion about the mode of delivery is recommended.
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Affiliation(s)
- B Gachon
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
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Abstract
OBJECTIVES The aim of this study was to investigate knowledge and demographic factors associated with a lack of knowledge proficiency about urinary incontinence (UI) and pelvic organ prolapse (POP) among pregnant and postpartum women. METHODS This was a cross-sectional survey of women receiving antepartum and postpartum care at 9 Connecticut sites. Knowledge was assessed using the validated Prolapse and Incontinence Knowledge Questionnaire. Lack of knowledge proficiency was defined as less than 80% and less than 50% correct responses on the Prolapse and Incontinence Knowledge Questionnaire UI and POP subscales. Logistic regression was used to evaluate unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs). P < 0.05 was considered statistically significant. RESULTS Surveys from 399 diverse pregnant and postpartum women were analyzed. Three quarters showed a lack of knowledge proficiency about UI and POP (74.2%, 70.6%). After adjustment, increased odds of lacking UI knowledge proficiency were associated with primiparity versus nulliparity (OR, 4.73; 95% CI, 2.24-9.98), Hispanic versus white race (OR, 2.72; 95% CI, 1.18-6.01), and having a high school diploma/General Education Development/less (OR, 3.17; 95% CI, 1.34-7.48) or some college (OR, 2.55; 95% CI, 1.08-6.01) versus bachelor's degree; greater lack of POP knowledge proficiency was associated with having a high school diploma/General Education Development versus bachelor's degree (OR, 2.11; 95% CI, 1.05-4.26) and never seeing a urologist/urogynecologist versus those who had (OR, 0.30; 95% CI, 0.12-0.77). Women working in a medical field versus those who did not demonstrated decreased odds of lacking UI and POP knowledge proficiency (ORs, 0.26 [95% CI, 0.13-0.52] and 0.38 [95% CI, 0.21-0.70]). CONCLUSIONS Pregnant and postpartum women lack knowledge about UI and POP. Preconceptional counseling provides an opportunity for educational intervention.
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Van Geelen H, Ostergard D, Sand P. A review of the impact of pregnancy and childbirth on pelvic floor function as assessed by objective measurement techniques. Int Urogynecol J 2018; 29:327-338. [DOI: 10.1007/s00192-017-3540-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/06/2017] [Indexed: 12/22/2022]
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17
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Jean Dit Gautier E, Mayeur O, Lepage J, Brieu M, Cosson M, Rubod C. Pregnancy impact on uterosacral ligament and pelvic muscles using a 3D numerical and finite element model: preliminary results. Int Urogynecol J 2017; 29:425-430. [DOI: 10.1007/s00192-017-3520-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 11/08/2017] [Indexed: 12/28/2022]
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18
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Association between vaginal bulge and anatomical pelvic organ prolapse during pregnancy and postpartum: an observational study. Int Urogynecol J 2017; 29:441-448. [DOI: 10.1007/s00192-017-3407-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 06/19/2017] [Indexed: 12/15/2022]
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Nygaard IE, Clark E, Clark L, Egger MJ, Hitchcock R, Hsu Y, Norton P, Sanchez-Birkhead A, Shaw J, Sheng X, Varner M. Physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery: a protocol for a mixed-methods prospective cohort study. BMJ Open 2017; 7:e014252. [PMID: 28073797 PMCID: PMC5253561 DOI: 10.1136/bmjopen-2016-014252] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary incontinence, and faecal incontinence, are common and arise from loss of pelvic support. Although severe disease often does not occur until women become older, pregnancy and childbirth are major risk factors for PFDs, especially POP. We understand little about modifiable factors that impact pelvic floor function recovery after vaginal birth. This National Institutes of Health (NIH)-funded Program Project, 'Bridging physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery', uses mixed-methods research to study the influences of intra-abdominal pressure, physical activity, body habitus and muscle fitness on pelvic floor support and symptoms as well as the cultural context in which women experience those changes. METHODS AND ANALYSIS Using quantitative methods, we will evaluate whether pelvic floor support and symptoms 1 year after the first vaginal delivery are affected by biologically plausible factors that may impact muscle, nerve and connective tissue healing during recovery (first 8 weeks postpartum) and strengthening (remainder of the first postpartum year). Using qualitative methods, we will examine cultural aspects of perceptions, explanations of changes in pelvic floor support, and actions taken by Mexican-American and Euro-American primipara, emphasising early changes after childbirth. We will summarise project results in a resource toolkit that will enhance opportunities for dialogue between women, their families and providers, and across lay and medical discourses. We anticipate enrolling up to 1530 nulliparous women into the prospective cohort study during the third trimester, following those who deliver vaginally 1 year postpartum. Participants will be drawn from this cohort to meet the project's aims. ETHICS AND DISSEMINATION The University of Utah and Intermountain Healthcare Institutional Review Boards approved this study. Data are stored in a secure password-protected database. Papers summarising the primary results and ancillary analyses will be published in peer-reviewed journals.
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Affiliation(s)
- Ingrid E Nygaard
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Erin Clark
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Lauren Clark
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Marlene J Egger
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Robert Hitchcock
- Department of Bioengineering, College of Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Yvonne Hsu
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Peggy Norton
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | - Janet Shaw
- Department of Health, Kinesiology, and Recreation, College of Health, University of Utah, Salt Lake City, Utah, USA
| | - Xiaoming Sheng
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Michael Varner
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Comparison of pelvic floor muscle strength in nulliparous women and those with normal vaginal delivery and cesarean section. Int Urogynecol J 2016; 28:1171-1175. [DOI: 10.1007/s00192-016-3239-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/07/2016] [Indexed: 01/08/2023]
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21
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Gachon B, Desseauve D, Fradet L, Decatoire A, Lacouture P, Pierre F, Fritel X. [Changes in pelvic organ mobility and ligamentous laxity during pregnancy and postpartum. Review of literature and prospects]. Prog Urol 2016; 26:385-94. [PMID: 26952013 DOI: 10.1016/j.purol.2016.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The role of pregnancy in pelvic floor disorders occurrence remains poorly known. It might exist a link between changes in ligamentous laxity and changes in pelvic organ mobility during this period. Our objective was to conduct a non-systematic review of literature about changes in pelvic organ mobility as well as in ligamentous laxity during pregnancy and postpartum. METHODS From the PubMed, Medline, Cochrane Library and Web of Science database we have selected works which pertains clinical assessment of pelvic organ mobility (pelvic organ prolapse quantification), ultrasound assessment of levator hiatus and urethral mobility, ligamentous laxity assessment during pregnancy and postpartum. RESULTS Clinical assessments performed in these works show an increase of pelvic organ mobility and perineal distension during pregnancy followed by a recovery phase during postpartum. Pelvic floor imaging shows an increase of levator hiatus area and urethral mobility during pregnancy then a recovery phase in postpartum. Different authors also report an increase of ligamentous laxity (upper and lower limbs) during pregnancy followed by a decrease phase in postpartum. CONCLUSION Pelvic organ mobility, ligamentous laxity, levator hiatus and urethral mobility change in a similarly way during pregnancy (increase of mobility or distension) and postpartum (recovery). LEVEL OF EVIDENCE 3.
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Affiliation(s)
- B Gachon
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; CNRS UPR 3346, Futuroscope, institut Pprime - Axe RoBioSS, université de Poitiers ENSMA, 86360 Futuroscope, France.
| | - D Desseauve
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; CNRS UPR 3346, Futuroscope, institut Pprime - Axe RoBioSS, université de Poitiers ENSMA, 86360 Futuroscope, France
| | - L Fradet
- CNRS UPR 3346, Futuroscope, institut Pprime - Axe RoBioSS, université de Poitiers ENSMA, 86360 Futuroscope, France
| | - A Decatoire
- CNRS UPR 3346, Futuroscope, institut Pprime - Axe RoBioSS, université de Poitiers ENSMA, 86360 Futuroscope, France
| | - P Lacouture
- CNRS UPR 3346, Futuroscope, institut Pprime - Axe RoBioSS, université de Poitiers ENSMA, 86360 Futuroscope, France
| | - F Pierre
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - X Fritel
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Inserm CIC-P 1402, centre d'investigation clinique pluri-thématique du CHU de Poitiers, 86021 Poitiers, France; CESP UMR Inserm U1018, équipe 7 : genre, santé sexuelle et reproductive, 94270 Kremlin-Bicêtre, France
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22
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Chen Y, Johnson B, Li F, King WC, Connell KA, Guess MK. The Effect of Body Mass Index on Pelvic Floor Support 1 Year Postpartum. Reprod Sci 2015; 23:234-8. [DOI: 10.1177/1933719115602769] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yi Chen
- Department of Obstetrics and Gynecology, The Third People’s Hospital, Wenzhou Medical College, Zhejiang, China
| | - Benjamin Johnson
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Fangyong Li
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - William C. King
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Kathleen A. Connell
- Department of Obstetrics and Gynecology, Section of Reconstructive Pelvic Surgery, University of Colorado, Aurora, Colorado, USA
| | - Marsha K. Guess
- Department of Obstetrics and Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, Yale School of Medicine, New Haven, CT, USA
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Naidoo TD, Moodley J. Authors' response to 'Commentary on Obstetric perineal injury …'. Trop Doct 2015; 45:256. [PMID: 26446189 DOI: 10.1177/0049475515576651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Influence of Geometry and Mechanical Properties on the Accuracy of Patient-Specific Simulation of Women Pelvic Floor. Ann Biomed Eng 2015. [PMID: 26215307 DOI: 10.1007/s10439-015-1401-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The woman pelvic system involves multiple organs, muscles, ligaments, and fasciae where different pathologies may occur. Here we are most interested in abnormal mobility, often caused by complex and not fully understood mechanisms. Computer simulation and modeling using the finite element (FE) method are the tools helping to better understand the pathological mobility, but of course patient-specific models are required to make contribution to patient care. These models require a good representation of the pelvic system geometry, information on the material properties, boundary conditions and loading. In this contribution we focus on the relative influence of the inaccuracies in geometry description and of uncertainty of patient-specific material properties of soft connective tissues. We conducted a comparative study using several constitutive behavior laws and variations in geometry description resulting from the imprecision of clinical imaging and image analysis. We find that geometry seems to have the dominant effect on the pelvic organ mobility simulation results. Provided that proper finite deformation non-linear FE solution procedures are used, the influence of the functional form of the constitutive law might be for practical purposes negligible. These last findings confirm similar results from the fields of modeling neurosurgery and abdominal aortic aneurysms.
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Reimers C, Staer-Jensen J, Siafarikas F, Saltyte-Benth J, Bø K, Ellström Engh M. Change in pelvic organ support during pregnancy and the first year postpartum: a longitudinal study. BJOG 2015; 123:821-9. [DOI: 10.1111/1471-0528.13432] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 12/17/2022]
Affiliation(s)
- C Reimers
- Department of Obstetrics and Gynaecology; Akershus University Hospital; Lørenskog Norway
- Faculty Division, Akershus University Hospital; University of Oslo; Oslo Norway
| | - J Staer-Jensen
- Department of Obstetrics and Gynaecology; Akershus University Hospital; Lørenskog Norway
| | - F Siafarikas
- Department of Obstetrics and Gynaecology; Akershus University Hospital; Lørenskog Norway
- Faculty Division, Akershus University Hospital; University of Oslo; Oslo Norway
| | - J Saltyte-Benth
- Faculty Division, Akershus University Hospital; University of Oslo; Oslo Norway
| | - K Bø
- Department of Sports Medicine; Norwegian School of Sport Sciences; Oslo Norway
| | - M Ellström Engh
- Department of Obstetrics and Gynaecology; Akershus University Hospital; Lørenskog Norway
- Faculty Division, Akershus University Hospital; University of Oslo; Oslo Norway
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Fritel X. [Outbreak of caesarean sections and fear of birth injury]. ACTA ACUST UNITED AC 2015; 43:483-4. [PMID: 25921508 DOI: 10.1016/j.gyobfe.2015.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Indexed: 11/16/2022]
Affiliation(s)
- X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, Inserm CIC1402, CHU de Poitiers, faculté de médecine et pharmacie, université de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
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Bø K, Hilde G, Stær-Jensen J, Siafarikas F, Tennfjord MK, Engh ME. Postpartum pelvic floor muscle training and pelvic organ prolapse--a randomized trial of primiparous women. Am J Obstet Gynecol 2015; 212:38.e1-7. [PMID: 24983687 DOI: 10.1016/j.ajog.2014.06.049] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 05/16/2014] [Accepted: 06/20/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Pelvic organ prolapse (POP) is a common and distressing condition. The aim of the present study was to evaluate the effect of pelvic floor muscle training (PFMT) on prevention and treatment of symptoms and signs of POP in primiparous postpartum women. STUDY DESIGN This was a parallel group assessor blind randomized controlled trial. One hundred seventy-five primiparous postpartum women, mean age 29.8 years (standard deviation 4.1), stratified on major levator ani defects or no defect diagnosed by 3-/4-dimensional ultrasound, participated in a 4-month PFMT starting at 6-8 weeks' postpartum or control. All participants had thorough individual instruction and assessment of ability to perform correct pelvic floor muscle contractions. The PFMT group followed a supervised, weekly group training program and performed 3 sets of 8-12 daily maximal contractions at home. Main outcome was POP stage II or greater assessed by POP quantification and bladder neck position assessed by 3-/4- dimensional transperineal ultrasonography. Secondary outcome was symptoms of vaginal bulge using International Consultation on Incontinence Vaginal Symptoms questionnaire. RESULTS Ninety-six percent of the intervention group adhered to ≥80% of both group and home training sessions. At postintervention, there was no significant risk difference in POP (rational ratio, 1.62; 95% confidence interval, 0.55-4.75), bladder neck position or symptoms of vaginal bulging. CONCLUSION No effect was found of postpartum PFMT on POP in primiparous women. More randomized controlled trials are needed before strong conclusions can be drawn on the effect of PFMT on POP in the particular population.
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