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Kuittinen T, Mentula M, Tulokas S, Brummer T, Jalkanen J, Tomas E, Mäkinen J, Sjöberg J, Härkki P, Rahkola-Soisalo P. Recurrent pelvic organ prolapse after hysterectomy; a 10-year national follow-up study. Arch Gynecol Obstet 2024:10.1007/s00404-024-07615-x. [PMID: 38976021 DOI: 10.1007/s00404-024-07615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE Hysterectomy may be a risk factor for pelvic organ prolapse (POP). We assessed the risk of recurrent POP (operations and visits) after hysterectomy among women with previous POP. We also studied patient and operation related risk factors for POP recurrence. METHODS This retrospective cohort study included 1697 women having previous POP diagnosis or POP at the time of hysterectomy (FINHYST 2006 cohort). Follow-up was until the end of 2016. The data was derived from the Finnish National Care register linked to the cohort. Hysterectomy approaches and other demographics were compared to the risk of a prolapse diagnosis and/or surgery. Cox regression model was used to identify hazard ratios. RESULTS Following hysterectomy, a total of 280 women (16.5%) had a POP reoperation and 359 (21.2%) had an outpatient visit due to POP. Vaginal vault prolapse repair was the most common POP reoperation (n = 181, 10.7%), followed by anterior wall repair (n = 120, 7.1%). Median time to POP reoperation was 3.7 years. Hysterectomy approach did not affect reoperations or visits. Previous cesarean section and anterior repair during hysterectomy were associated with decreased risk, whereas concomitant sacrospinous fixation and uterus prolapse as the main indication led to increased risk of anterior/vault prolapse reoperations. Concomitant posterior repair decreased posterior reoperations and visits, but uterus weight over 500 g caused a fivefold increased risk of posterior prolapse visit. Residential status was associated with elevated risk of any POP reoperations and visits. CONCLUSIONS Approximately one out of five women suffering from POP ensue POP reoperation or visit after hysterectomy. These high rates are independent on hysterectomy approach, but probably indicate that hysterectomy may worsen previous pelvic floor dysfunction.
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Affiliation(s)
- Tea Kuittinen
- Women's Clinic, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290, Helsinki, Finland.
| | - Maarit Mentula
- Women's Clinic, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290, Helsinki, Finland
| | - Sari Tulokas
- Women's Clinic, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290, Helsinki, Finland
| | | | | | - Eija Tomas
- University of Tampere and Tampere University Hospital, Tampere, Finland
| | | | - Jari Sjöberg
- Women's Clinic, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290, Helsinki, Finland
| | - Päivi Härkki
- Women's Clinic, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290, Helsinki, Finland
| | - Päivi Rahkola-Soisalo
- Women's Clinic, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290, Helsinki, Finland
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Bahl R, Hotton E, Crofts J, Draycott T. Assisted vaginal birth in 21st century: current practice and new innovations. Am J Obstet Gynecol 2024; 230:S917-S931. [PMID: 38462263 DOI: 10.1016/j.ajog.2022.12.305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 03/12/2024]
Abstract
Assisted vaginal birth rates are falling globally with rising cesarean delivery rates. Cesarean delivery is not without consequence, particularly when carried out in the second stage of labor. Cesarean delivery in the second stage is not entirely protective against pelvic floor morbidity and can lead to serious complications in a subsequent pregnancy. It should be acknowledged that the likelihood of morbidity for mother and baby associated with cesarean delivery increases with advancing labor and is greater than spontaneous vaginal birth, irrespective of the method of operative birth in the second stage of labor. In this article, we argue that assisted vaginal birth is a skilled and safe option that should always be considered and be available as an option for women who need assistance in the second stage of labor. Selecting the most appropriate mode of birth at full dilatation requires accurate clinical assessment, supported decision-making, and personalized care with consideration for the woman's preferences. Achieving vaginal birth with the primary instrument is more likely with forceps than with vacuum extraction (risk ratio, 0.58; 95% confidence interval, 0.39-0.88). Midcavity forceps are associated with a greater incidence of obstetric anal sphincter injury (odds ratio, 1.83; 95% confidence interval, 1.32-2.55) but no difference in neonatal Apgar score or umbilical artery pH. The risk for adverse outcomes is minimized when the procedure is conducted by a skilled accoucheur who selects the most appropriate instrument likely to achieve vaginal birth with the primary instrument. Anticipation of potential complications and dynamic decision-making are just as important as the technique for safe instrument use. Good communication with the woman and the birthing partner is vital and there are various recommendations on how to achieve this. There have been recent developments (such as OdonAssist) in device innovation, training, and strategies for implementation at a scale that can provide opportunities for both improved outcomes and reinvigoration of an essential skill that can save mothers' and babies' lives across the world.
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Affiliation(s)
- Rachna Bahl
- Department of Obstetrics and Gynaecology, University Hospitals Bristol National Health Service Trust, Bristol, United Kingdom; Royal College of Obstetricians and Gynaecologists, London, United Kingdom.
| | | | - Joanna Crofts
- Department of Obstetrics and Gynaecology, North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Tim Draycott
- Royal College of Obstetricians and Gynaecologists, London, United Kingdom; Department of Obstetrics and Gynaecology, North Bristol National Health Service Trust, Bristol, United Kingdom
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Cadish LA, Shepherd JP, Bretschneider CE. Projecting future prolapse outcomes with induction of labor at 39 weeks: a decision analysis. Int Urogynecol J 2024; 35:311-317. [PMID: 37646803 DOI: 10.1007/s00192-023-05637-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/17/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION AND HYPOTHESIS In 2018, the ARRIVE trial (A Randomized Trial of Induction Versus Expectant Management) concluded that routine induction of labor (IOL) at 39 weeks gestation decreases cesarean delivery risk, with slightly lighter birthweight infants. We debated whether routine IOL would improve, worsen, or not change POP risk compared with expectant management (EM). METHODS We constructed a decision analysis model with a lifetime horizon where nulliparous women reaching 39 weeks underwent IOL or EM. Subsequent vaginal versus cesarean delivery varied based on prior deliveries for up to four births. Subsequent delivery prior to 39 weeks and distribution of gestational age, birthweight, and delivery mode between 24 and 39 weeks was modeled from national data. We modeled increased POP risk with increasing vaginal parity, forceps delivery, and weight of largest infant delivered vaginally, accounting for differential infant weights in each strategy. RESULTS IOL and EM have similar population-wide POP risk (15.9% and 15.7% respectively). Among women with only spontaneous vaginal deliveries that reached 39 weeks or beyond, the prevalence of POP was 20% after one delivery and 29% after four deliveries, with no difference between groups. The cesarean rate was lower with IOL (27.8% versus 29.8%). Sensitivity analysis revealed no meaningful thresholds among the variables, supporting model robustness. CONCLUSION While routine induction of labor at 39 weeks results in a meaningfully higher vaginal delivery rate, there was no increase in POP, possibly due to the protective effect of lower birthweight.
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Affiliation(s)
- Lauren A Cadish
- Urogynecology, Department of Obstetrics and Gynecology, Providence Saint John's Health Center, 2001 Santa Monica Blvd, Suite 680W, Santa Monica, CA, 90404, USA.
| | - Jonathan P Shepherd
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Hartford, CT, USA
| | - C Emi Bretschneider
- Division of Urogynecology, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
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Halle TK, Benth JŠ, Stær-Jensen J, Reimers C, Bø K, Ellström Engh M, Siafarikas F. Pelvic floor symptoms from first pregnancy up to 8 years after the first delivery: a longitudinal study. Am J Obstet Gynecol 2022; 227:613.e1-613.e15. [PMID: 35724758 DOI: 10.1016/j.ajog.2022.06.020] [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: 02/02/2022] [Revised: 05/23/2022] [Accepted: 06/08/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Despite the strong association between vaginal childbirth and pelvic floor dysfunction, genetic factors, pregnancy, advancing age, and lifestyle also play a role. The pelvic floor undergoes substantial changes during pregnancy which may contribute to pelvic floor dysfunction. On the other hand, these changes may be favorable to allow for vaginal delivery. However, there is a lack of studies assessing pelvic floor symptoms over time according to delivery mode, which includes women prior to delivery. OBJECTIVE The aim of this study was to describe urinary incontinence, vaginal symptoms, and bowel control symptoms from 21 weeks of gestation in the first pregnancy and up to 8 years after the first delivery, stratified by delivery mode. STUDY DESIGN This is a longitudinal observational cohort study. 300 nulliparous women were recruited during their first pregnancy. Pelvic floor symptoms were assessed at 21 and 37 weeks of gestation, and 6 weeks, 6 months, 12 months and 8 years after first delivery using the International Consultation on Incontinence Questionnaire (ICIQ) modules: the urinary incontinence sum score; the weighted vaginal symptom sum score; the vaginal-associated quality of life score; the bowel control sum score; and the bowel-associated quality of life sum score. Delivery mode at first delivery defined delivery groups as: normal vaginal, operative vaginal and cesarean delivery. A linear mixed model analysis was used to assess symptom scores over time and to assess the differences in symptom scores between the delivery groups. RESULTS Of the 300 women included in the study, of which 193 attended the 8-year follow-up. Pelvic floor symptoms differed in women with vaginal and cesarean delivery. The symptom scores showed a non-linear statistically significant trend. In women, who delivered vaginally, there was an increase of urinary incontinence and vaginal symptom scores already during pregnancy. In women, who later delivered by cesarean, there was a decrease of symptoms scores during pregnancy, and overall lower symptom scores compared to women with vaginal delivery until 12 months after first delivery. Pelvic floor symptoms scores increased from 12 months to 8 years after the first delivery and exceeded pregnancy levels in all delivery groups, however overall symptom scores were low. Differences between delivery groups were not statistically significant. CONCLUSION Pelvic floor symptoms differed in women with vaginal and cesarean delivery from the first pregnancy up to 8 years after the first delivery. These differences were recognizable already prior to first delivery.
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Affiliation(s)
- Tuva Kristine Halle
- University of Oslo, Faculty of Medicine, Division Akershus University Hospital, Oslo, Norway; Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo; Health Services Research Unit, Akershus University Hospital, Norway
| | - Jette Stær-Jensen
- Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway
| | - Cathrine Reimers
- Oslo University Hospital, Department of Obstetrics and Gynecology, Oslo, Norway
| | - Kari Bø
- Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway; Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway
| | - Marie Ellström Engh
- University of Oslo, Faculty of Medicine, Division Akershus University Hospital, Oslo, Norway; Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway
| | - Franziska Siafarikas
- University of Oslo, Faculty of Medicine, Division Akershus University Hospital, Oslo, Norway; Akershus University Hospital, Department of Obstetrics and Gynecology, Lørenskog, Norway
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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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International urogynecology consultation chapter 1 committee 2: Epidemiology of pelvic organ prolapse: prevalence, incidence, natural history, and service needs. Int Urogynecol J 2022; 33:173-187. [PMID: 34977950 DOI: 10.1007/s00192-021-05018-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/15/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This narrative review describes the existing epidemiologic literature and identifies gaps regarding pelvic organ prolapse (POP) prevalence, incidence, natural history, and current and future service needs. MATERIALS AND METHODS A PubMed search identified relevant citations published in 2000 or later. Pre-specified criteria were used to screen titles, abstracts, and manuscripts, including reference sections. Study findings were summarized to define what is known, identify gaps in current knowledge, and suggest priority areas for future research. RESULTS The reported prevalence of POP varies widely (1-65%) based on whether its presence is ascertained by symptoms (1-31%), pelvic examination (10-50%), or both (20-65%). Most existing population-based surveys do not include physical examination data. White women from higher income countries are overrepresented in the existing literature. Incidence and natural history data are limited and consist mainly of cohorts that follow women after pregnancy or menopause. Given global increases in aging populations in well-resourced countries, the need for POP treatment is anticipated to increase in the coming decades. In lower and middle income countries (LMICs) where demographic trends are different, there is a dearth of information about anticipated POP service needs. CONCLUSION Future POP incidence, prevalence, and natural history studies should include non-white women from LMICs and should combine pelvic examination data with validated patient-reported outcome measures when feasible. Anticipated future service needs differ globally, with a greater demand for POP treatment services in well-resourced settings where aging populations are prevalent.
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Effects of Oxytocin for Induction and Augmentation of Labor on Pelvic Floor Symptoms and Support in the Postpartum Period. Female Pelvic Med Reconstr Surg 2021; 27:289-296. [PMID: 32097161 DOI: 10.1097/spv.0000000000000848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The aim of the study was to determine whether oxytocin for induction or augmentation of labor impacts the incidence or persistence of pelvic floor symptoms and support 5 to 10 weeks after first vaginal delivery. METHODS Participants in this prospective cohort study were nulliparous women 18 years or older that delivered vaginally at 37 weeks gestation or more and completed the Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ) and the Pelvic Organ Prolapse Quantification examination in third trimester and 5 to 10 weeks postpartum. We compared the incidence and persistence of symptomatic EPIQ domains and worse vaginal support (maximal vaginal descent ≥0 cm) between women who received oxytocin with those that did not (with or without prostaglandin or mechanical methods in both groups). We performed modified binomial regression to calculate adjusted relative risks of each outcome with 95% confidence intervals. RESULTS The mean (SD) age of the 722 participants was 28.3 (5.2) years; 20% were Hispanic. There were no significant differences according to oxytocin exposure in either incidence or persistence of symptomatic EPIQ domains or worse vaginal support. We found similar results in sensitivity analyses comparing women who received oxytocin as the sole pharmacologic agent to women who received no pharmacologic agent. After adjusting for demographic and obstetric factors associated with incidence and persistence of symptoms and support, oxytocin exposure continued to have no effect. CONCLUSIONS Oxytocin during labor does not significantly increase the risks for the incidence or persistence of pelvic floor symptoms or worse vaginal support in the early postpartum period, although power for less frequent outcomes was limited.
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Cattani L, Neefs L, Verbakel JY, Bosteels J, Deprest J. Obstetric risk factors for anorectal dysfunction after delivery: a systematic review and meta-analysis. Int Urogynecol J 2021; 32:2325-2336. [PMID: 33787952 DOI: 10.1007/s00192-021-04723-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/04/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pregnancy and childbirth are considered risk factors for pelvic floor dysfunction, including anorectal dysfunction. We aimed to assess the effect of obstetric events on anal incontinence and constipation after delivery. METHODS We systematically reviewed the literature by searching MEDLINE, Embase and CENTRAL. We included studies in women after childbirth examining the association between obstetric events and anorectal dysfunction assessed through validated questionnaires. We selected eligible studies and clustered the data according to the type of dysfunction, obstetric event and interval from delivery. We assessed risk of bias using the Newcastle Ottawa Scale and we performed a random-effects meta-analysis and reported the results as odds ratios (ORs) with their 95% confidence intervals. Heterogeneity across studies was assessed using I2 statistics. RESULTS Anal sphincter injury (OR: 2.44 [1.92-3.09]) and operative delivery were risk factors for anal incontinence (forceps-OR :1.35 [1.12-1.63]; vacuum-OR: 1.17 [1.04-1.31]). Spontaneous vaginal delivery increased the risk of anal incontinence compared with caesarean section (OR: 1.27 [1.07-1.50]). Maternal obesity (OR:1.48 [1.28-1.72]) and advanced maternal age (OR: 1.56 [1.30-1.88]) were risk factors for anal incontinence. The evidence on incontinence is of low certainty owing to the observational nature of the studies. No evidence was retrieved regarding constipation after delivery because of a lack of standardised validated assessment tools. CONCLUSIONS Besides anal sphincter injury, forceps delivery, maternal obesity and advanced age were associated with higher odds of anal incontinence, whereas caesarean section is protective. We could not identify obstetric risk factors for postpartum constipation, as few prospective studies addressed this question and none used a standardised validated questionnaire.
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Affiliation(s)
- Laura Cattani
- Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium
| | - Liesbeth Neefs
- Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium
| | - Jan Y Verbakel
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jan Bosteels
- Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Obstetrics and Gynaecology Unit, Imelda Hospital, Bonheiden, Belgium.,CEBAM, The Centre for Evidence-based Medicine, Cochrane Belgium, Academic Centre for General Practice, Leuven, Belgium
| | - Jan Deprest
- Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Department of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium. .,Research Department of Maternal Fetal Medicine, Institute for Women's Health, University College London, London, UK.
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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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Kuhlmann PK, Patel DN, Chen A, Houman J, Weinberger J, Wood Thum LN, Anger JT, Eilber KS. Economic evaluation of elective cesarean versus vaginal delivery on cost of future pelvic floor disorders in the United States. Neurourol Urodyn 2020; 40:451-460. [PMID: 33232551 DOI: 10.1002/nau.24582] [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] [Received: 07/03/2020] [Revised: 10/12/2020] [Accepted: 11/04/2020] [Indexed: 12/22/2022]
Abstract
AIM To analyze the cost impact of cesarean versus vaginal delivery in the United States on the development of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). METHODS We compared average cost of delivery method to the lifetime risk and cost of pelvic floor disorders (PFDs) in women < 65 years. Costs of maternal care, obtained from the MarketScan® database, included those incurred at delivery and 3 months post-partum. Future costs of PFDs included those incurred after delivery up to 65 years. Previously reported data on the prevalence of POP and SUI following cesarean and vaginal delivery was used to calculate attributable risk. An incremental cost of illness model was used to estimate costs for SUI. Direct surgical and ambulatory care costs were used to determine cost of POP. RESULTS Average estimated cost was $7089 for vaginal delivery and $9905 for cesarean delivery. The absolute risks for SUI and POP were estimated as 7% and 5%, respectively, following cesarean delivery, and 13% and 14%, respectively, following vaginal delivery. For SUI, average direct cost was $5642, indirect cost was $4208, and personal cost was $750. Average direct cost of POP surgery was $4658, and nonsurgical cost was $2220. The potential savings for reduced prevalence of SUI and POP in women who underwent cesarean delivery is estimated at $1255, but they incur an additional $2816 maternal care cost over vaginal delivery. CONCLUSIONS Although elective cesarean is associated with reduced prevalence of PFDs, the increased initial cost of cesarean delivery does not offset future cost savings.
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Affiliation(s)
- Paige K Kuhlmann
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Devin N Patel
- Department of Urology, University of California San Diego, San Diego, California, USA
| | - Andrew Chen
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Justin Houman
- Tower Urology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - James Weinberger
- Department of Urology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | | | - Jennifer T Anger
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Karyn S Eilber
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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11
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Johannessen HH, Frøshaug BE, Lysåker PJG, Salvesen KÅ, Lukasse M, Mørkved S, Stafne SN. Regular antenatal exercise including pelvic floor muscle training reduces urinary incontinence 3 months postpartum-Follow up of a randomized controlled trial. Acta Obstet Gynecol Scand 2020; 100:294-301. [PMID: 32996139 DOI: 10.1111/aogs.14010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Urinary incontinence is a frequently reported condition among women with pregnancy and delivery as established risk factors. The aims of this study were to evaluate the effect of an antenatal exercise program including pelvic floor muscle training on postpartum urinary incontinence, and to explore factors associated with urinary incontinence three months postpartum. MATERIAL AND METHODS This is a short-term follow-up and secondary analysis of a randomized controlled trial conducted at two Norwegian University Hospitals including healthy, pregnant women aged >18 years with a singleton live fetus. Women in the exercise group received a 12-week standardized exercise program including pelvic floor muscle training, with once weekly group exercise classes led by a physiotherapist and twice weekly home exercise sessions. The controls received standard antenatal care. Data were obtained from questionnaires answered in pregnancy weeks 18-22, and three months postpartum. Urinary incontinence prevalence in the exercise and control groups was compared, and multivariable logistic regression analyses were applied. Urinary incontinence prevalence three months postpartum was assessed by the Sandvik severity index. RESULTS Among the 722 (84%) women who responded three months postpartum, significantly fewer women in the exercise group (29%) reported urinary incontinence compared with the standard antenatal care group (38%, P = .01). Among women who were incontinent at baseline, 44% and 59% (P = .014) were incontinent at three months postpartum in the exercise and control groups, respectively. Urinary incontinence three months postpartum was associated with age (OR 1.1, 95% CI 1.0-1.1), experiencing urinary incontinence in late pregnancy (OR 3.6, 95% CI 2.3-5.9), birthweight ≥4000 g (OR 1.8, 95% CI 1.2-2.8), and obstetric anal sphincter injuries (OR 2.6, 95% CI 1.1-6.1). Cesarean section significantly reduced the risk of urinary incontinence three months postpartum compared with spontaneous vaginal delivery (OR 0.2, 95% CI 0.1-0.5). CONCLUSIONS A moderate-intensity exercise program including pelvic floor muscle training reduced prevalence of urinary incontinence 3 months postpartum in women who were incontinent at baseline.
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Affiliation(s)
- Hege H Johannessen
- Department of Health and Welfare, Østfold University College, Fredrikstad, Norway.,Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Sarpsborg, Norway
| | - Betina E Frøshaug
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.,Department of Obstetrics and Gynecology, Østfold Hospital Trust, Sarpsborg, Norway
| | - Pernille J G Lysåker
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Kjell Å Salvesen
- Department of Obstetrics and Gynecology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mirjam Lukasse
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Siv Mørkved
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Signe N Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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12
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Xue K, Palmer MH, Zhou F. Prevalence and associated factors of urinary incontinence in women living in China: a literature review. BMC Urol 2020; 20:159. [PMID: 33054777 PMCID: PMC7559450 DOI: 10.1186/s12894-020-00735-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/05/2020] [Indexed: 12/15/2022] Open
Abstract
Background This review of studies on urinary incontinence (UI) was focused primarily on UI prevalence rates and associated factors across the adult lifecourse of Chinese women. UI is a urologic symptom that can have a significant impact on women's physical and mental health and quality of life. In addition, women with UI may experience socioeconomic burdens due to UI’s effect on their ability to work and function in society. Although researchers from many countries have reported prevalence rates and associated factors for UI, little is known about the prevalence of UI in China’s large female population. Language may act as a barrier to the inclusion of published studies in English-language journals. To overcome this barrier and to add to the global knowledge base about UI in women, the authors reviewed and discussed findings from epidemiological studies published in China and in Chinese language. Methods The authors retrieved research studies from the Wanfang database using the following search terms: "Subject: (Female) × Subject: (Urinary incontinence) × Subject: (Prevalence) × Date: 2013 to 2019". Searches employed the China National Knowledge Infrastructure Database, VIP Database for Chinese Technical Periodicals and China Biology Medicine Database. The authors also used PubMed to search English-language studies published in Chinese journals on UI in Chinese women. Results This literature review includes 48 articles published between January 2013 and December 2019. The overall UI prevalence rates reported in adult Chinese women ranged from 8.7 to 69.8%, representing 43–349 million women, respectively. For women aged 17–40 years, 41–59 years, and 60 years and older, prevalence rates ranged from 2.6–30.0, 8.7–47.7, to 16.9–61.6%, respectively. Significant associated factors for overall UI included age, body mass index, constipation, parity, and menopause. Despite the 17–40 age range being peak reproductive years, the literature revealed little focus on UI prevalence rates. For women aged 41–59 years, the main associated factors included those related to pregnancy and gynecologic diseases. For women 60 years and older, chronic diseases represented most of the associated factors. Conclusions About 43–349 million Chinese women may experience UI. Many of the identified associated factors could be mitigated to reduce UI incidence and prevalence rates. Little is known about the prevalence rates and associated factors for UI among young (aged 17–40) Chinese women. Future research should investigate UI in young women to improve bladder health across their lifecourse.
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Affiliation(s)
- Kaikai Xue
- School of Nursing, Xuzhou Medical University, Xuzhou, China.,School of Nursing and Midwifery, Jiangsu College of Nursing, Huai'an, China
| | - Mary H Palmer
- School of Nursing, University of North Carolina at Chapel Hill, CB 7460, Chapel Hill, USA
| | - Fang Zhou
- School of Nursing, Xuzhou Medical University, Xuzhou, China.
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13
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Wesnes SL, Seim E. Birthweight and urinary incontinence after childbirth: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol X 2020; 8:100115. [PMID: 32954252 PMCID: PMC7486687 DOI: 10.1016/j.eurox.2020.100115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 11/30/2022] Open
Abstract
Birthweight and urinary incontinence after childbirth: a systematic review and meta-analysis Stian Langeland WESNES, Elin SEIM MD Urinary incontinence (UI) is common after childbirth. Many cohort and cross-sectional studies have reported data on birthweight, but results have not been pooled. It is unclear how birthweight affects UI after childbirth. The objective is to review the effect of birthweight on UI after childbirth through meta-analyses. Searches were performed in Medline, Embase, Svemed+, ClinicalTrials.gov, Cochrane, and Cinahl in August 2016. Additional reference checking was performed. Included articles evaluated birthweight as a possible risk factor for maternal UI. We included articles that were presented in Norwegian, Danish, Swedish, or English. Two independent reviewers extracted the data and analysed it using Review Manager 5.3 software. Available data from included studies on birthweight (≥4000 g and ≥3500 g, respectively) and UI were combined in meta-analyses. PRISMA and MOOSE guidelines were used. Eighteen studies (N = 30 070) reported data on birthweight >4000 g vs <4000 g. Birthweight>4000 g compared to weight <4000 g was associated with a significantly increased OR of any UI (OR 1.49, 95% CI 1.24 - 1.80). Five studies (N = 15 066) reported data on birthweight >3500 g vs <3500 g. Birthweight>3500 g was also associated with a significantly increased OR of UI (OR 1.26, 95% CI 1.15 - 1.37). High birthweight appears to increase OR of UI after childbirth. Preventative strategies should be targeted towards women at particular risk.
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Affiliation(s)
- Stian Langeland Wesnes
- Corresponding author at: Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018, Bergen, Norway.
| | - Elin Seim
- Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Norway
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14
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Johannessen HH, Mørkved S, Stordahl A, Wibe A, Falk RS. Evolution and risk factors of anal incontinence during the first 6 years after first delivery: a prospective cohort study. BJOG 2020; 127:1499-1506. [DOI: 10.1111/1471-0528.16322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 12/19/2022]
Affiliation(s)
- HH Johannessen
- Department of Physical Medicine and Rehabilitation Østfold Hospital Trust Sarpsborg Norway
- Department of Health and Welfare Østfold University College Fredrikstad Norway
| | - S Mørkved
- Department of Public Health and Nursing Norwegian University of Science and Technology Trondheim Norway
| | - A Stordahl
- Department of Physical Medicine and Rehabilitation Østfold Hospital Trust Sarpsborg Norway
| | - A Wibe
- Department of Clinical and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway
- Department of Surgery St. Olavs Hospital Trondheim University Hospital Trondheim Norway
| | - RS Falk
- Oslo Centre of Biostatistics and Epidemiology Oslo University Hospital Oslo Norway
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15
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Author Response: No. 381-Assisted Vaginal Birth. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:407-408.e1. [PMID: 32303294 DOI: 10.1016/j.jogc.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Mathew S, Guzmán Rojas RA, Salvesen KA, Volløyhaug I. Levator ani muscle injury and risk for urinary and fecal incontinence in parous women from a normal population, a cross‐sectional study. Neurourol Urodyn 2019; 38:2296-2302. [DOI: 10.1002/nau.24138] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/27/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Seema Mathew
- Department of Gynecology and ObstetricsSt. Olavs University Hospital Trondheim Norway
- Department of Clinical and Molecular MedicineNorwegian University of Science and Technology Trondheim Norway
| | - Rodrigo A. Guzmán Rojas
- Departamento de Ginecología y Obstetricia, Facultad de MedicinaClínica Alemana‐Universidad del Desarrollo Santiago Chile
- Departamento de Ginecología y ObstetriciaHospital Clínico de la Universidad de Chile Santiago Chile
| | - Kjell A. Salvesen
- Department of Gynecology and ObstetricsSt. Olavs University Hospital Trondheim Norway
- Department of Clinical and Molecular MedicineNorwegian University of Science and Technology Trondheim Norway
| | - Ingrid Volløyhaug
- Department of Gynecology and ObstetricsSt. Olavs University Hospital Trondheim Norway
- Department of Clinical and Molecular MedicineNorwegian University of Science and Technology Trondheim Norway
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17
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Grodzinsky A, Florio K, Spertus JA, Daming T, Schmidt L, Lee J, Rader V, Nelson L, Gray R, White D, Swearingen K, Magalski A. Maternal Mortality in the United States and the HOPE Registry. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:42. [DOI: 10.1007/s11936-019-0745-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Nelson RL, Go C, Darwish R, Gao J, Parikh R, Kang C, Mahajan A, Habeeb L, Zalavadiya P, Patnam M. Cesarean delivery to prevent anal incontinence: a systematic review and meta-analysis. Tech Coloproctol 2019; 23:809-820. [PMID: 31273486 DOI: 10.1007/s10151-019-02029-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cesarean delivery (CD), is increasingly recommended as a mode of delivery that prevents the anal incontinence (AI) that arises in some women after vaginal delivery (VD). The assessment of the efficacy of CD in this regard was the subject of this systematic review. METHODS Searches were conducted in Medline, EMBASE and the Cochrane Library. Both randomized (RCTs) and non-randomized trials (NRTs) comparing the risk of sustained fecal and/or flatus incontinence after VD or CD were sought from 1966 to 1 January, 2019. Studies were eligible if they assessed AI more than 6 months after birth, and had statistical adjustment for at least one of the three major confounders for AI: age, maternal weight or parity. In addition, each study was required to contain more than 250 participants, more than 50 CDs and more than 25 cases of AI. Data after screening and selection were abstracted and entered into Revman for meta-analysis. Analyses were done for combined fecal and flatus incontinence (comAI), fecal incontinence (FI), gas incontinence (GI), CD before or during labor, time trend of incontinence after delivery, assessment of both statistical and clinical heterogeneity, parity and late incident AI. RESULTS Out of the 2526 titles and abstracts found, 24 eligible studies were analyzed, 23 NRTs and one RCT. These included women with 29,597 VDs and women with 6821 CDs. Among the primary outcomes, VD was found not to be a significant predictor of postpartum comAI compared to CD in 6 studies, incorporating 18,951 deliveries (OR = 0.74; 0.54-1.02). VD was also not a significant predictor of FI in 14 studies, incorporating 29,367 deliveries, (OR = 0.89; 0.76-1.05). VD was not a significant predictor of GI in six studies, incorporating 6724 deliveries (OR = 0.96; 0.79-1.18). The strength of the grading of recommendations, assessment, development and evaluations (GRADE) evidence for each of these was low for comAI and moderate for FI and GI (upgrade for lack of expected effect). Time trend FI showed incontinence at 3 months often resolved at 1 year. Other secondary analyses assessing parity, delayed incidence of FI, clinical and statistical heterogeneity, spontaneous VD only, late risk of incidence of AI, and CD in or prior to labor all had similar results as in the primary outcomes. CONCLUSIONS There are three components of pelvic floor dysfunction that are thought to be caused by VD and hopefully prevented by CD: AI, urinary incontinence and pelvic floor prolapse. Of these, AI was not found to be reliably prevented by CD in this review.
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Affiliation(s)
- R L Nelson
- Epidemiology/Biometry Division, University of Illinois School of Public Health, Chicago, IL, USA.
| | - C Go
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - R Darwish
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - J Gao
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - R Parikh
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - C Kang
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - A Mahajan
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - L Habeeb
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - P Zalavadiya
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - M Patnam
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
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19
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Apostolopoulos NV, Alexandraki KI, Gorry A, Coker A. The early benefits of Laparoscopic Sacrocolpopexy. J Gynecol Obstet Hum Reprod 2019; 48:799-804. [PMID: 31276843 DOI: 10.1016/j.jogoh.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 06/22/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Prospective evaluation of the 6 months functional and clinical outcome of 27 patients treated with Laparoscopic Sacrocolpopexy (LSC). METHODS Pelvic organ prolapse was assessed by Baden-Walker system along with a validated quality of life questionnaire preoperatively and at 6 months postoperatively to assess vaginal, urinary, bowel and sexual symptoms. RESULTS At a mean 6 months follow-up, 96% of the symptomatic women had successful vaginal vault support with no recurrence of prolapse symptoms. Successful anatomical outcome (any prolapse ≤ stage 1) was found in 89%. Regarding the urinary functional symptoms, significant improvement was reported in the voiding function, painful symptoms and the relevant quality of life. Stress urinary incontinence resolved in 67% without concomitant continence surgery; 4% from the stress incontinence was de novo. Bowel symptoms were common, both pre- and postoperatively; 40% from the postoperative bowel symptoms was de novo. Sexually active women reported significant improvement in sexual function; there was one case of de novo dyspareunia. CONCLUSION LSC is an effective treatment for vault prolapse as soon as in the 6-months follow-up. The outcome for anterior and posterior support is less predictable. The pelvic organ vaginal, urinary and sexual functional symptoms improve. The effects on bowel function are less clear. Long-term prospective studies are required to establish the duration of the benefits.
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Affiliation(s)
| | | | - Anwen Gorry
- Department of Obstetrics and Gynaecology, Queen's Hospital, Rom Valley Way, Romford, RM70AG, UK
| | - Adeyemi Coker
- Department of Obstetrics and Gynaecology, Queen's Hospital, Rom Valley Way, Romford, RM70AG, UK
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20
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Draycott TJ, Di Renzo GC. The role of operative vaginal birth in the 21st century and a way forward. BJOG 2019; 124 Suppl 4:5-6. [PMID: 28940871 DOI: 10.1111/1471-0528.14791] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2017] [Indexed: 11/26/2022]
Abstract
Effective devices and effective, validated training can improve operative vaginal birth outcomes for women and their babies. TWEETABLE ABSTRACT Effective devices and effective, validated training can improve operative vaginal birth outcomes for women and their babies.
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Affiliation(s)
- T J Draycott
- Department of Obstetrics & Gynaecology, North Bristol NHS Trust, Bristol, UK.,School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - G C Di Renzo
- Department of Obstetrics & Gynaecology, University of Perugia, Perugia, Italy
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21
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Association between delivery mode and pelvic organ prolapse: A meta-analysis of observational studies. Eur J Obstet Gynecol Reprod Biol 2019; 235:19-25. [DOI: 10.1016/j.ejogrb.2019.01.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/23/2018] [Accepted: 01/23/2019] [Indexed: 11/23/2022]
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22
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Lin S, Atan IK, Dietz HP, Herbison P, Wilson PD. Delivery mode, levator avulsion and obstetric anal sphincter injury: A cross-sectional study 20 years after childbirth. Aust N Z J Obstet Gynaecol 2019; 59:590-596. [PMID: 30793279 DOI: 10.1111/ajo.12948] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/02/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Levator ani muscle (LAM) and anal sphincter injuries are common after vaginal birth and are associated with pelvic organ prolapse and anal incontinence. AIMS Our objective was to investigate long-term association between delivery mode, LAM avulsion and obstetric anal sphincter injuries (OASIS) in women at least 20 years after their first birth. METHODS All women recruited at 'index birth' of the Dunedin (New Zealand) arm of ProLong (PROlapse and incontinence LONG-term research) Study, were invited to have translabial and transperineal ultrasound assessment of LAM and anal sphincters. Post-processing analysis of imaging data was performed blinded against delivery data. Statistical analysis was performed using the χ2 test and results are expressed as odds ratios (OR). RESULTS Of the initial 1250 participants, 196 women returned for examination. Mean age was 50.8 years with a mean body mass index of 27.6 and median parity was three. They were seen on average 23 years after their first delivery. Four data sets were unavailable and one declined ultrasound assessment, leaving 191 for analysis. LAM avulsion was diagnosed in 29 (15.2%), and 24 women (12.6%) had significant anal sphincter defect. LAM avulsion was associated with forceps delivery (OR 2.45, 95% CI 1.04-5.80, P = 0.041). Forceps conveyed a greater risk of OASIS (21%) compared to a spontaneous vaginal delivery (11%) but did not reach statistical significance. CONCLUSIONS Forceps delivery is associated with long-term injurious effect on pelvic floor structures. Discussions of the long-term negative impact of pelvic floor structures and their functions are necessary to achieve an informed consent toward an operative vaginal delivery.
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Affiliation(s)
- Sylvia Lin
- Women's Health Waikato DHB, Hamilton, New Zealand.,Department of Obstetrics & Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ixora Kamisan Atan
- Department of Obstetrics, Gynaecology & Neonatology, Sydney Medical School Nepean, The University of Sydney, Sydney, New South Wales, Australia.,Department of Obstetrics & Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hans Peter Dietz
- Department of Obstetrics, Gynaecology & Neonatology, Sydney Medical School Nepean, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Herbison
- Department of Preventive and Social Medicine Dunedin School of Medicine University of Otago, Dunedin, New Zealand
| | - Peter Donald Wilson
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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O'Brien S, Jordan S, Siassakos D. The role of manual rotation in avoiding and managing OVD. Best Pract Res Clin Obstet Gynaecol 2018; 56:69-80. [PMID: 30670334 DOI: 10.1016/j.bpobgyn.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/08/2018] [Accepted: 12/03/2018] [Indexed: 11/16/2022]
Abstract
Manual rotation (MR) is the most common technique used by accoucheurs who wish to correct malposition of the foetal head to either avoid or facilitate an operative vaginal delivery (OVD). MR can be performed using either a whole-hand or a digital approach. MR should be formally taught and trainees should be assessed for competence, and later, performance should ideally be tracked with statistical control charts. There is paucity of robust evidence evaluating MR relative to the other methods of rotational OVD: rotational forceps (RF) and rotational ventouse (RV). Furthermore, there is little evidence concerning long-term maternal outcomes of rotational OVD. A prospective randomised trial of MR versus either RF or RV is clearly needed, along with a core outcome set for OVD to facilitate comprehensive evaluation programmes that focus on aspects pertaining to women.
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Affiliation(s)
- Stephen O'Brien
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Dept of Women's Health, The Chilterns, Southmead Hospital, Bristol, BS10 5NB, UK. stephen.o'
| | - Sharon Jordan
- Dept of Women's Health, The Chilterns, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Dimitrios Siassakos
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Dept of Women's Health, The Chilterns, Southmead Hospital, Bristol, BS10 5NB, UK.
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24
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Urinary Incontinence and Surgery for Obesity and Weight-Related Diseases: Are There Predictors of Improvement? Obes Surg 2018; 29:109-113. [PMID: 30178155 DOI: 10.1007/s11695-018-3482-7] [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: 10/28/2022]
Abstract
PURPOSE The aim of this study was to evaluate changes in urinary incontinence (UI) before and after surgery for obesity in female patients and to identify factors related to the remission of symptoms. MATERIALS AND METHODS This was a prospective cohort study with female patients over 18 years old who underwent surgery for obesity and weight-related diseases between June 2016 and September 2017. Urinary symptoms and quality of life related to UI were assessed based on a structured interview and the results of the validated questionnaires. RESULTS Two hundred twenty-one patients were assessed pre-operatively, and 118 (53.3%) reported UI. Eighty-eight patients (74.6%) completed the pre- and postoperative questionnaires. After 6 to 12 months, patients were revaluated, and 50 (56.8%) were considered to be in remission of urinary symptoms. Women who had only a cesarean birth had a 117% increase in the probability of achieving remission of UI compared with women who had both vaginal and cesarean deliveries, and patients with an additional point in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score at the beginning had a 4% lower probability of having remission of symptoms. CONCLUSIONS Improvement in UI may be an important outcome of surgery for obesity and weight-related diseases. In this study, previous cesarean section was only associated with the highest rate of remission of symptoms, and patients with higher scores in the ICIQ-UI-SF had a lower probability of remission.
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25
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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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26
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Volløyhaug I, Rojas RG, Mørkved S, Salvesen KÅ. Comparison of transperineal ultrasound with POP-Q for assessing symptoms of prolapse. Int Urogynecol J 2018; 30:595-602. [PMID: 30069728 DOI: 10.1007/s00192-018-3722-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Our aim was to study any correlation between pelvic organ prolapse quantification (POP-Q) and ultrasound measurement of prolapse in women from a normal population and to identify the method with a stronger association with prolapse symptoms. METHODS A cross-sectional study of 590 parous women responding to the Pelvic Floor Distress Inventory was carried out. They were examined using POP-Q and transperineal ultrasound, and correlation was tested using Spearman's rank test. Numerical measurements and significant prolapse (POP-Q ≥ 2 in any compartment or bladder ≥10 mm, cervix ≥0 mm or rectal ampulla ≥15 mm below the symphysis on ultrasound) were compared in symptomatic and asymptomatic women (Mann-Whitney U and Chi-squared tests). RESULTS A total of 256 women had POP-Q ≥ 2 and 209 had significant prolapse on ultrasound. The correlation (rs) between POP-Q and ultrasound was 0.69 (anterior compartment), 0.53 (middle), and 0.39 (posterior), p < 0.01. Women with a "vaginal bulge" (n = 68) had greater descent on POP-Q and ultrasound in the anterior and middle compartments than asymptomatic women, p < 0.01. For women with a symptomatic bulge, the odds ratio was 3.8 (95% CI 2.2-6.7) for POP-Q ≥ grade 2 and 2.4 (95% CI 1.4-3.9) for prolapse on ultrasound. A sensation of heaviness (n = 90) and incomplete bladder emptying (n = 4) were more weakly associated with ultrasound (p = 0.03 and 0.04), and splinting (n = 137) was associated with POP-Q Bp, p = 0.02. CONCLUSION POP-Q and ultrasound measurement of prolapse had moderate to strong correlation in the anterior and middle compartments and weak correlation in the posterior compartment. Both methods were strongly associated with the symptom "vaginal bulge," but POP-Q had a stronger association than ultrasound.
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Affiliation(s)
- Ingrid Volløyhaug
- Department of Obstetrics and Gynecology, Trondheim University Hospital, Trondheim, Norway. .,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, PO Box 8905, Medisinsk teknisk forskningssenter, 7491, Trondheim, Norway.
| | - Rodrigo Guzmán Rojas
- Departamento de Ginecología y Obstetricia, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.,Departamento de Ginecología y Obstetricia, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Siv Mørkved
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Research Department, Trondheim University Hospital, Trondheim, Norway
| | - Kjell Åsmund Salvesen
- Department of Obstetrics and Gynecology, Trondheim University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, PO Box 8905, Medisinsk teknisk forskningssenter, 7491, Trondheim, Norway
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Colla C, Paiva LL, Ferla L, Trento MJB, de Vargas IMP, Dos Santos BA, Ferreira CF, Ramos JGL. Pelvic floor dysfunction in the immediate puerperium, and 1 and 3 months after vaginal or cesarean delivery. Int J Gynaecol Obstet 2018; 143:94-100. [PMID: 29876920 DOI: 10.1002/ijgo.12561] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/15/2018] [Accepted: 06/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify and assess postpartum pelvic floor dysfunction (PFD) between vaginal delivery, elective cesarean delivery (ECD), and intrapartum cesarean delivery (ICD). METHODS The present prospective observational study included women aged at least 18 years with no history of pelvic surgery or lower urinary tract malformation, and who had not undergone pelvic floor muscle (PFM) training in the preceding 12 months, who underwent delivery at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil between August 1, 2016, and May 31, 2017. Participants were assessed at 48 hours (phase 1), 1 month (phase 2), and 3 months (phase 3) after delivery. Assessments included the International Consultation on Incontinence Questionnaire, Short Form (ICIQ-SF); the Jorge-Wexner anal incontinence scale; a self-rated visual analog scale for pelvic pain; the pelvic organ prolapse quantification (POP-Q) system; and a PFM perineometer. RESULTS A total of 227 women were assessed in phase 1 (141 vaginal deliveries; 28 ICDs; and 58 ECDs), 79 in phase 2, and 41 in phase 3. The ICIQ-SF, Jorge-Wexner scale, visual analog scale, and perineometer measurements did not identify significant differences in relation to the type of delivery (P>0.05). CONCLUSION The type of delivery was not associated with differences in the short-term development of postpartum PFD.
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Affiliation(s)
- Cássia Colla
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luciana L Paiva
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Physical Therapy Course, School of Physical Education, Physical Therapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lia Ferla
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria J B Trento
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Isadora M P de Vargas
- Physical Therapy Course, School of Physical Education, Physical Therapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bianca A Dos Santos
- Physical Therapy Course, School of Physical Education, Physical Therapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Charles F Ferreira
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - José G L Ramos
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Guzmán Rojas RA, Salvesen KÅ, Volløyhaug I. Anal sphincter defects and fecal incontinence 15-24 years after first delivery: a cross-sectional study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:677-683. [PMID: 28782264 DOI: 10.1002/uog.18827] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/22/2017] [Accepted: 07/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To establish the prevalence of external (EAS) and internal (IAS) anal sphincter defects present 15-24 years after childbirth according to mode of delivery, and their association with development of fecal incontinence (FI). The study additionally aimed to compare the proportion of women with obstetric anal sphincter injuries (OASIS) reported at delivery with the proportion of women with sphincter defect detected on ultrasound 15-24 years later. METHODS This was a cross-sectional study including 563 women who delivered their first child between 1990 and 1997. Women responded to a validated questionnaire (Pelvic Floor Distress Inventory) in 2013-2014, from which the proportion of women with FI was recorded. Information about OASIS was obtained from the National Birth Registry. Study participants underwent four-dimensional transperineal ultrasound examination. Defect of EAS or IAS of ≥ 30° in at least four of six slices on tomographic ultrasound was considered a significant defect and was recorded. Four study groups were defined based on mode of delivery of the first child. Women who had delivered only by Cesarean section (CS) constituted the CS group. Women in the normal vaginal delivery (NVD) group had NVD of their first child and subsequent deliveries could be NVD or CS. The forceps delivery (FD) group included women who had FD, NVD or CS after FD of their first born. The vacuum delivery (VD) group included women who had VD, NVD or CS after VD of their first born. Multiple logistic regression was used to calculate adjusted odds ratios (aORs) for comparison of prevalence of an EAS defect following different modes of delivery and to test its association with FI. Fisher's exact test was used to calculate crude odds ratios (ORs) for IAS defects. RESULTS Defects of EAS and IAS were found after NVD (n = 201) in 10% and 1% of cases, respectively, after FD (n = 144) in 32% and 7% of cases and after VD (n = 120) in 15% and 4% of cases. No defects were found after CS (n = 98). FD was associated with increased risk of EAS defect compared with NVD (aOR = 3.6; 95% CI, 2.0-6.6) and VD (aOR = 3.0; 95% CI, 1.6-5.6) and with increased risk of IAS defect compared with NVD (OR = 7.4; 95% CI, 1.5-70.5). The difference between VD and NVD was not significant for EAS or IAS. FI was reported in 18% of women with an EAS defect, in 29% with an IAS defect and in 8% without a sphincter defect. EAS and IAS defects were associated with increased risk of FI (aOR = 2.5 (95% CI, 1.3-4.9) and OR = 4.2 (95% CI, 1.1-13.5), respectively). Of the ultrasonographic sphincter defects, 80% were not reported as OASIS at first or subsequent deliveries. CONCLUSIONS Anal sphincter defects visualized on transperineal ultrasound 15-24 years after first delivery were associated with FD and development of FI. Ultrasound revealed a high proportion of sphincter defects that were not recorded as OASIS at delivery. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R A Guzmán Rojas
- Departamento de Ginecología y Obstetricia, Facultad de Medicina, Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
- Departamento de Ginecología y Obstetricia, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - K Å Salvesen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynaecology, Trondheim University Hospital, Trondheim, Norway
| | - I Volløyhaug
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynaecology, Trondheim University Hospital, Trondheim, Norway
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It is the first birth that does the damage: a cross-sectional study 20 years after delivery. Int Urogynecol J 2018; 29:1637-1643. [DOI: 10.1007/s00192-018-3616-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 02/26/2018] [Indexed: 12/31/2022]
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30
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van Meegdenburg MM, Trzpis M, Broens PMA. Fecal incontinence and parity in the Dutch population: A cross-sectional analysis. United European Gastroenterol J 2018; 6:781-790. [PMID: 30083341 PMCID: PMC6068786 DOI: 10.1177/2050640618760386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/25/2018] [Indexed: 12/15/2022] Open
Abstract
Background It is assumed that pregnancy and childbirth increase the risk of developing
fecal incontinence (FI). Objective We investigated the incidence of FI in groups of nulliparous and parous
women. Methods Retrospectively, we studied a cross-section of the Dutch female population
(N = 680) who completed the Groningen Defecation &
Fecal Continence questionnaire. We also analyzed a subgroup of healthy women
(n = 572) and a subgroup of women with comorbidities
(n = 108). Results The prevalence of FI and the Vaizey and Wexner scores did not differ
significantly between nulliparous and parous women. Parous women were 1.6
times more likely to experience fecal urgency than nulliparous women (95%
CI, 1.0–2.6, p = 0.042). Regression analyses showed that
parity, mode of delivery, duration of second stage of labor, obstetrical
laceration or episiotomy, and birth weight seem not to be associated with
the likelihood of FI. Conclusions Pregnancy and childbirth seem not to be associated with the prevalence and
severity of FI in the Dutch population. Vacuum and forceps deliveries,
however, might result in a higher prevalence of FI. Although the duration of
being able to control bowels after urge sensation is comparable between
nulliparous and parous women, parous women experience fecal urgency more
often.
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Affiliation(s)
- Maxime M van Meegdenburg
- Department of Surgery, Anorectal
Physiology Laboratory, University of Groningen, University Medical Center Groningen,
Groningen, the Netherlands
- M.M. van Meegdenburg, Anorectal Physiology
Laboratory, University of Groningen, University Medical Center Groningen, P.O.
Box 30.001, 9700 RB Groningen, the Netherlands.
| | - Monika Trzpis
- Department of Surgery, Anorectal
Physiology Laboratory, University of Groningen, University Medical Center Groningen,
Groningen, the Netherlands
| | - Paul MA Broens
- Department of Surgery, Anorectal
Physiology Laboratory, University of Groningen, University Medical Center Groningen,
Groningen, the Netherlands
- Department of Surgery, Division of
Pediatric Surgery, University of Groningen, University Medical Center Groningen,
Groningen, the Netherlands
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31
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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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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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Leo CA, Maeda Y, Collins B, Thomas GP, Hodgkinson JD, Murphy J, Vaizey CJ. Current practice of continence advisors in managing faecal incontinence in the United Kingdom: results of an online survey. Colorectal Dis 2017; 19:O339-O344. [PMID: 28736932 DOI: 10.1111/codi.13823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/06/2017] [Indexed: 02/08/2023]
Abstract
AIM To investigate the current practice of continence advisors in the United Kingdom. METHOD Continence advisors were contacted by email or letter to participate in a survey. The survey contained 27 questions which addressed the practice of each continence advisor, their knowledge of continence management and the adequacy of their training. RESULTS Two hundred and twenty-six out of a total of 448 continence advisors (50.4%), responded. One hundred and seventy (76.9%) advisors treated both faecal and urinary incontinence, 51 (23.1%) treated urinary incontinence. Thirty-six advisors (16.1%) were lone workers and 130 (58.6%) had more than 10 years' experience. The majority of the advisors (75.6%) performed a digital rectal examination as part of their assessment. Regarding the management of faecal incontinence, 148 prescribed suppositories, 127 offered enemas and 147 advised on rectal irrigation. Most of the advisors taught pelvic floor exercises (n = 207) and urge resistance techniques (n = 188). One hundred and fifty-nine (87.4%) prescribed the Peristeen Coloplast® anal plug and 78 (47.6%) prescribed the Renew® anal insert. Eighty-nine advisors (42.6%) felt they had not been adequately trained to provide a bowel continence service. CONCLUSION The majority of continence advisors in the UK manage faecal incontinence. They are able to initiate a broad range of conservative treatment options; however, almost half of the advisors who answered the survey felt inadequately trained and may be better supported by further training.
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Affiliation(s)
- C A Leo
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Harrow, UK.,Imperial College London, London, UK
| | - Y Maeda
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Harrow, UK.,Imperial College London, London, UK
| | - B Collins
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Harrow, UK
| | - G P Thomas
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Harrow, UK
| | - J D Hodgkinson
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Harrow, UK.,Imperial College London, London, UK
| | - J Murphy
- Imperial College London, London, UK
| | - C J Vaizey
- Sir Alan Parks Physiology Unit, St Mark's Hospital, Harrow, UK
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Bø K, Artal R, Barakat R, Brown WJ, Davies GAL, Dooley M, Evenson KR, Haakstad LAH, Kayser B, Kinnunen TI, Larsén K, Mottola MF, Nygaard I, van Poppel M, Stuge B, Khan KM. Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC Expert Group Meeting, Lausanne. Part 3-exercise in the postpartum period. Br J Sports Med 2017. [PMID: 28642221 DOI: 10.1136/bjsports-2017-097964] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Kari Bø
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Raul Artal
- Department of Obstetrics, Gynecology and Women's Health, Saint Louis University, St Louis, Missouri, USA
| | - Ruben Barakat
- Facultad de Ciencias de la Actividad Física y del Deporte - INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - Wendy J Brown
- Centre for Research on Exercise Physical Activity and Health, School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia
| | - Gregory A L Davies
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Queen's University, Kingston, Canada
| | - Michael Dooley
- Department of Sport Gynaecology, Poundbury Clinic, Dorchester, UK.,Poundbury Clinic, King Edward VII Hospital, London, UK
| | - Kelly R Evenson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lene A H Haakstad
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Bengt Kayser
- Faculty of Biology and Medicine, Institute of Sport Science, University of Lausanne, Lausanne, Switzerland
| | - Tarja I Kinnunen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Karin Larsén
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Michelle F Mottola
- R Samuel McLaughlin Foundation-Exercise and Pregnancy Lab, The University of Western Ontario, London, Canada
| | - Ingrid Nygaard
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA
| | | | - Britt Stuge
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Karim M Khan
- Department of Family Practice and School of Kinesiology, Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada
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Silveira RK, Domingie S, Kirzin S, de Melo Filho DA, Portier G. Comparative study of safety and efficacy of synthetic surgical glue for mesh fixation in ventral rectopexy. Surg Endosc 2017; 31:4016-4024. [DOI: 10.1007/s00464-017-5439-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/30/2017] [Indexed: 01/05/2023]
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Huser M, Janku P, Hudecek R, Zbozinkova Z, Bursa M, Unzeitig V, Ventruba P. Pelvic floor dysfunction after vaginal and cesarean delivery among singleton primiparas. Int J Gynaecol Obstet 2017; 137:170-173. [PMID: 28171703 DOI: 10.1002/ijgo.12116] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/09/2016] [Accepted: 02/03/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare the prevalence of pelvic floor dysfunction symptoms, including pelvic organ prolapse (POP), urinary incontinence (UI), and fecal incontinence (FI) among primiparous women after vaginal and cesarean delivery. METHODS In a prospective cohort study at a University hospital in the Czech Republic, singleton primiparas with cephalic presentation who delivered at term were enrolled between 2002 and 2007. In 2013, 5-10 years after delivery, women who had not delivered again completed an internet-based survey about current symptoms of POP, UI, and FI, which were evaluated using validated questionnaires. The relative risk (RR) of POP, UI, and FI symptoms was calculated. RESULTS Complete questionnaire data were obtained from 641 women who delivered vaginally and 224 who delivered by cesarean. The mean UI score (ICIQ-SF) was 2.3 ± 3.6 in the vaginal group and 1.0 ± 2.7 in the cesarean group (P=0.005). The mean POP scores (POPDI-6) were 2.2 ± 2.3 and 2.1 ± 2.0, respectively (P=0.944). The mean Wexner scores to evaluate FI were 1.3 ± 1.7 and 1.0 ± 1.5, respectively (P=0.220). The RR of pelvic floor dysfunction after vaginal delivery was highest for women with UI symptoms (RR 1.15, 95% confidence interval 0.92-1.42). CONCLUSION Significant differences in the occurrence of symptoms of UI were observed after vaginal delivery as compared with cesarean delivery. ClinicalTrials.gov: NCT02661867.
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Affiliation(s)
- Martin Huser
- Department of Obstetrics and Gynecology, Brno University Hospital and Masaryk University Medical School, Brno, Czech Republic
| | - Petr Janku
- Department of Obstetrics and Gynecology, Brno University Hospital and Masaryk University Medical School, Brno, Czech Republic
| | - Robert Hudecek
- Department of Obstetrics and Gynecology, Brno University Hospital and Masaryk University Medical School, Brno, Czech Republic
| | - Zuzana Zbozinkova
- Institute of Biostatistics and Analyses, Masaryk University Medical School, Brno, Czech Republic
| | - Miroslav Bursa
- Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University, Prague, Czech Republic
| | - Vit Unzeitig
- Department of Obstetrics and Gynecology, University Hospital Ostrava and University of Ostrava Medical School, Ostrava, Czech Republic
| | - Pavel Ventruba
- Department of Obstetrics and Gynecology, Brno University Hospital and Masaryk University Medical School, Brno, Czech Republic
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Ng K, Cheung RYK, Lee LL, Chung TKH, Chan SSC. An observational follow-up study on pelvic floor disorders to 3–5 years after delivery. Int Urogynecol J 2017; 28:1393-1399. [DOI: 10.1007/s00192-017-3281-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/19/2017] [Indexed: 10/20/2022]
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Is levator hiatus distension associated with peripheral ligamentous laxity during pregnancy? Int Urogynecol J 2017; 28:1223-1231. [PMID: 28083713 DOI: 10.1007/s00192-016-3252-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/20/2016] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The impact of pregnancy on pelvic floor disorders remains poorly understood. During pregnancy, an increase in ligamentous laxity and pelvic organ mobility is often reported. Our main objective was to investigate a possible association between peripheral ligamentous laxity and levator hiatus (LH) distension during pregnancy. METHODS This was a prospective longitudinal study of 26 pregnant women followed up from the first to the third trimester. We collected the following information: occurrence of pelvic organ prolapse (POP) symptoms (score higher than 0 for the POP section of the Pelvic Floor Distress Inventory 20 questions score), 4D perineal ultrasound scan results with LH distension assessment and measurement of metacarpophalangeal joint mobility (MCP laxity). The association between MCP laxity and LH distension was estimated by mixed multilevel linear regression. The associations between MCP laxity and categorical parameters were estimated in a multivariate analysis using a generalized estimating equation model. RESULTS MCP laxity and LH distension were correlated with a correlation coefficient of 0.26 (p = 0.02), and 6.8% of the LH distension variance was explained by MCP laxity. In the multivariate analysis, MCP laxity was associated with POP symptoms with an odds ratio at 1.05 (95% CI 1.01-1.11) for an increase of 1° in MCP laxity. CONCLUSION LH distension and peripheral ligamentous laxity are significantly associated during pregnancy. However, the relationship is weak, and the results need to be confirmed in larger populations and with more specific techniques such as elastography to directly assess the elastic properties of the pelvic floor muscles.
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Volløyhaug I, Mørkved S, Salvesen Ø, Salvesen KÅ. Assessment of pelvic floor muscle contraction with palpation, perineometry and transperineal ultrasound: a cross-sectional study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:768-73. [PMID: 26300128 DOI: 10.1002/uog.15731] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/24/2015] [Accepted: 08/19/2015] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To study the correlation between palpation, perineometry and transperineal ultrasound for assessment of pelvic floor muscle contraction and to define a contraction scale for ultrasound measurements. METHODS This was a cross-sectional study of 608 women examined with palpation of pelvic floor muscle contraction, using the Modified Oxford Scale, and measurement of the vaginal squeeze pressure with a vaginal balloon connected to a fiber-optic microtip transducer (perineometry). Transperineal ultrasound was used for measurements of levator hiatal area and anteroposterior (AP) diameter in the plane of minimal hiatal dimensions, at rest and on contraction. The pelvic floor muscle contraction was expressed as the percentage difference between values at rest and on contraction. Spearman's rank was used to test for correlation between the different methods of assessment. RESULTS Significant correlations were found between all assessment methods (P < 0.001). Palpation correlated with perineometry (rs = 0.74) and with proportional change in hiatal area (rs = 0.67) and AP diameter (rs = 0.69) on ultrasound. Perineometry correlated with proportional change in hiatal area (rs = 0.60) and AP diameter (rs = 0.66) on ultrasound. We defined a contraction scale based on the proportional change in AP diameter. In this population, a change in AP diameter of < 7% corresponded to absence of contractions, 7-18% corresponded to weak contractions, 18-35% corresponded to normal contractions and > 35% corresponded to strong contractions. CONCLUSIONS We found moderate to strong correlation between ultrasound measurements, palpation and perineometry for assessing pelvic floor muscle contraction. The proportional change in levator hiatal AP diameter was the ultrasound measurement with strongest correlation to palpation and perineometry and formed the basis for the contraction scale for ultrasound measurements. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- I Volløyhaug
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, Trondheim University Hospital, Trondheim, Norway
| | - S Mørkved
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
- Clinical Service, Trondheim University Hospital, Trondheim, Norway
| | - Ø Salvesen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Å Salvesen
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
- National Center for Fetal Medicine, Trondheim University Hospital, Trondheim, Norway
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40
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Akter F, Gartoulla P, Oldroyd J, Islam RM. Prevalence of, and risk factors for, symptomatic pelvic organ prolapse in Rural Bangladesh: a cross-sectional survey study. Int Urogynecol J 2016; 27:1753-1759. [PMID: 27230406 DOI: 10.1007/s00192-016-3038-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/02/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The prevalence of symptomatic pelvic organ prolapse (POP), diagnosed by a pre-tested structured questionnaire, is unknown in Bangladesh. We investigated the prevalence of, and risk factors for, symptomatic POP in women in rural Bangladesh, recruited from the community. METHODS A cross-sectional survey of 787 women aged over 15 years was conducted in four villages in one district in rural Bangladesh. The prevalence of symptomatic POP and the risk factors associated with the condition was investigated, using Chi-squared and multivariate logistic regression. RESULTS The prevalence of symptomatic POP was 15.6 %. The mean age of participants was 40.1 (±9.0) years. Women aged 35-44 years (odds ratio [OR] 1.96, 95 % confidence interval [CI] 1.03-3.73) and ≥45 years (OR 2.95, 95 % CI 1.62-5.38) were more likely to have POP compared with women aged ≤35 years. Having POP was positively associated with women having ≥5 children (OR 4.34, 95 % CI 1.39-13.58), having chronic obstructive pulmonary disease (COPD; OR 2.07, 95 % CI 1.02-4.21), and women having constipation (OR 3.54, 95 % CI 1.87-6.72). Women whose husband had >5 years of schooling were less likely to have POP (OR 0.37, 95 % CI 0.19-0.73) compared with women whose husband had no schooling. CONCLUSIONS Symptomatic POP affects a substantial proportion of women in rural Bangladesh and increases with age. Parity, COPD, constipation and husband's education are associated with POP, all of which have the potential to be modified. Thus, interventions targeting these risk factors to prevent the condition are urgently needed in Bangladesh.
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Affiliation(s)
| | - Pragya Gartoulla
- Sunaulo Parivar Nepal implementing partner of Marie Stopes International, Kathmandu, Nepal
| | - John Oldroyd
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
| | - Rakibul M Islam
- Department of Population Sciences, University of Dhaka, Third Floor, Arts Faculty Building, Dhaka, 1000, Bangladesh.
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Oliveira DA, Parente MPL, Calvo B, Mascarenhas T, Jorge RMN. A biomechanical analysis on the impact of episiotomy during childbirth. Biomech Model Mechanobiol 2016; 15:1523-1534. [PMID: 27002616 DOI: 10.1007/s10237-016-0781-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
Episiotomy is still a controversy issue among physicians, despite the enormous growth of clinical research. Therefore, the potential of numerical modeling of anatomical structures to simulate biomechanical processes was exploited to realize quantitatively the real effects of the episiotomy and its consequences on the pelvic floor muscle. As such, a numerical model was used composed of pelvic floor muscles, a surface delimiting the anterior region, and a fetus body. A normal vaginal delivery without and with different episiotomies was simulated with the fetus in vertex presentation and occipitoanterior position. According to our numerical results, a mediolateral episiotomy has a protective effect, reducing the stress on the muscles, and the force required to delivery successfully up to 52.2 %. The intervention also has benefits on muscle injury, reducing the damage to a small zone. This study demonstrates the feasibility of using a computational modeling approach to study parturition, namely the capability to isolate and evaluate the mechanical significance of a single feature. It must, however, be taken into account that the numerical model does not assess problems that may occur as blood loss, infections and others, so it is necessary to examine whether the benefits of an intervention outweigh the risks.
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Affiliation(s)
- Dulce A Oliveira
- INEGI, LAETA, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465, Porto, Portugal.
| | - Marco P L Parente
- INEGI, LAETA, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465, Porto, Portugal
| | - Begoña Calvo
- Aragón Institute of Engineering Research, University of Saragossa, Calle María de Luna 3, 50018, Saragossa, Spain.,Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Teresa Mascarenhas
- Department of Gynecology and Obstetrics, Centro Hospitalar de São João-EPE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Renato M Natal Jorge
- INEGI, LAETA, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465, Porto, Portugal
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Lenzen-Schulte M. Where Are the Advantages Mentioned? DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:191. [PMID: 27118667 DOI: 10.3238/arztebl.2016.0191a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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43
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Tähtinen RM, Cartwright R, Tsui JF, Aaltonen RL, Aoki Y, Cárdenas JL, El Dib R, Joronen KM, Al Juaid S, Kalantan S, Kochana M, Kopec M, Lopes LC, Mirza E, Oksjoki SM, Pesonen JS, Valpas A, Wang L, Zhang Y, Heels-Ansdell D, Guyatt GH, Tikkinen KAO. Long-term Impact of Mode of Delivery on Stress Urinary Incontinence and Urgency Urinary Incontinence: A Systematic Review and Meta-analysis. Eur Urol 2016; 70:148-158. [PMID: 26874810 PMCID: PMC5009182 DOI: 10.1016/j.eururo.2016.01.037] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/24/2016] [Indexed: 02/05/2023]
Abstract
Context Stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) are associated with physical and psychological morbidity, and large societal costs. The long-term effects of delivery modes on each kind of incontinence remain uncertain. Objective To investigate the long-term impact of delivery mode on SUI and UUI. Evidence acquisition We searched Medline, Scopus, CINAHL, and relevant major conference abstracts up to October 31, 2014, including any observational study with adjusted analyses or any randomized trial addressing the association between delivery mode and SUI or UUI ≥1 yr after delivery. Two reviewers extracted data, including incidence/prevalence of SUI and UUI by delivery modes, and assessed risk of bias. Evidence synthesis Pooled estimates from 15 eligible studies demonstrated an increased risk of SUI after vaginal delivery versus cesarean section (adjusted odds ratio [aOR]: 1.85; 95% confidence interval [CI], 1.56–2.19; I2 = 57%; risk difference: 8.2%). Metaregression demonstrated a larger effect of vaginal delivery among younger women (p = 0.005). Four studies suggested no difference in the risk of SUI between spontaneous vaginal and instrumental delivery (aOR: 1.11; 95% CI, 0.84–1.45; I2 = 50%). Eight studies suggested an elevated risk of UUI after vaginal delivery versus cesarean section (aOR: 1.30; 95% CI, 1.02–1.65; I2 = 37%; risk difference: 2.6%). Conclusions Compared with cesarean section, vaginal delivery is associated with an almost twofold increase in the risk of long-term SUI, with an absolute increase of 8%, and an effect that is largest in younger women. There is also an increased risk of UUI, with an absolute increase of approximately 3%. Patient summary In this systematic review we looked for the long-term effects of childbirth on urinary leakage. We found that vaginal delivery is associated with an almost twofold increase in the risk of developing leakage with exertion, compared with cesarean section, with a smaller effect on leakage in association with urgency.
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Affiliation(s)
- Riikka M Tähtinen
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland; Department of Obstetrics and Gynecology, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Rufus Cartwright
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK; Department of Urogynecology, Imperial College London, London, UK
| | - Johnson F Tsui
- Department of Urology, North Shore-LIJ Lenox Hill Hospital, New York, NY, USA; Institute for Bladder and Prostate Research, New York, NY, USA
| | - Riikka L Aaltonen
- Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland
| | - Yoshitaka Aoki
- Department of Urology, University of Fukui Faculty of Medical Sciences, Fukui, Japan
| | - Jovita L Cárdenas
- Department of Clinical Practice Guidelines, National Center for Health Technology Excellence, México, Mexico
| | - Regina El Dib
- Department of Anesthesiology, Botucatu Medical School, São Paulo State University, São Paulo, Brazil
| | - Kirsi M Joronen
- Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland
| | - Sumayyah Al Juaid
- Department of Obstetrics and Gynecology, King Saud bin Abdulaziz University for Health Sciences, and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Sabreen Kalantan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Michal Kochana
- Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Malgorzata Kopec
- Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Luciane C Lopes
- Pharmaceutical Science Master Courde, University of Sorocaba, São Paulo, Brazil; School of Pharmaceutical Sciences, Department of Drugs and Medications, Paulista State University, São Paulo, Brazil
| | - Enaya Mirza
- Department of Obstetrics and Gynecology, St. Mary's Hospital, London, UK
| | - Sanna M Oksjoki
- Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland
| | - Jori S Pesonen
- Department of Urology, Päijät-Häme Central Hospital, Lahti, Finland
| | - Antti Valpas
- Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland
| | - Li Wang
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Canada; Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yuqing Zhang
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Diane Heels-Ansdell
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Gordon H Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kari A O Tikkinen
- Departments of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Long-term effects of vacuum extraction on pelvic floor function: a cohort study in primipara. Int Urogynecol J 2015; 27:1051-6. [DOI: 10.1007/s00192-015-2928-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
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45
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Grob ATM, Withagen MIJ, van de Waarsenburg MK, Schweitzer KJ, van der Vaart CH. Changes in the mean echogenicity and area of the puborectalis muscle during pregnancy and postpartum. Int Urogynecol J 2015; 27:895-901. [PMID: 26676911 PMCID: PMC4879173 DOI: 10.1007/s00192-015-2905-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/16/2015] [Indexed: 11/20/2022]
Abstract
Introduction and hypothesis Three-dimensional (3D) and four-dimensional (4D) volume transperineal ultrasound imaging is increasingly used to assess changes in the dimensions of the pelvic floor during pregnancy and after delivery. Little is known with regard to the area of the puborectalis muscle and its structural changes. Echogenicity measurement, a parameter that provides information on the structure of muscles, is increasingly used in orthopaedics and neuromuscular disease evaluation. This study is aimed at assessing the changes in the mean echogenicity of the puborectalis muscle (MEP) and the puborectalis muscle area (PMA) during first pregnancy and after childbirth. Methods The MEP and PMA of 254 women during first pregnancy were measured at 12 and 36 weeks’ gestation and 6 months postpartum. To determine the effect of child-birth on MEP and PMA, the results at 6 months postpartum were separately analysed for vaginal deliveries, operative vaginal deliveries (ventouse) and caesarean section deliveries. Mean differences in MEP and PMA were analysed using ANOVA statistics. Results The MEP at 6 months postpartum was, independent of manoeuvre, significantly (p < 0.001) lower than MEP values during pregnancy. After caesarean delivery, the PMA was significantly smaller at maximum pelvic floor contraction than PMA after vaginal delivery (p = 0.003) or operative vaginal delivery (p = 0.002). Conclusion Our study indicates that structural changes in the puborectalis muscle during and after pregnancy, as measured by MEP, occur and can be analysed. In addition, the mode of delivery affects the area of the puborectalis during contraction after delivery. For true volume analysis, as part of an assessment of contractility of the puborectalis muscle we will need 3D volume analysis.
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Affiliation(s)
- Anique T M Grob
- Department of Reproductive Medicine and Gynecology, University Medical Center, PO box 85500, 3508 GA, Utrecht, Netherlands. .,MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands.
| | - Mariella I J Withagen
- Department of Reproductive Medicine and Gynecology, University Medical Center, PO box 85500, 3508 GA, Utrecht, Netherlands
| | - Maria K van de Waarsenburg
- Department of Reproductive Medicine and Gynecology, University Medical Center, PO box 85500, 3508 GA, Utrecht, Netherlands
| | - Karlijn J Schweitzer
- Department of Reproductive Medicine and Gynecology, University Medical Center, PO box 85500, 3508 GA, Utrecht, Netherlands
| | - Carl H van der Vaart
- Department of Reproductive Medicine and Gynecology, University Medical Center, PO box 85500, 3508 GA, Utrecht, Netherlands
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Georgiou C, Raja M, Ye W, Grosu L, Jaffar H, Neale E, Mahran M. Re: Pelvic organ prolapse and incontinence 15-23 years after first delivery: a cross-sectional study. BJOG 2015; 122:1714-5. [PMID: 26498307 DOI: 10.1111/1471-0528.13587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - Malar Raja
- Department of Obstetrics and Gynaecology, Bedford Hospital, Bedford, UK
| | - Weiyu Ye
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Liliana Grosu
- Department of Obstetrics and Gynaecology, Bedford Hospital, Bedford, UK
| | - Hamna Jaffar
- Department of Obstetrics and Gynaecology, Bedford Hospital, Bedford, UK
| | - Ed Neale
- Department of Obstetrics and Gynaecology, Bedford Hospital, Bedford, UK
| | - Montasser Mahran
- Department of Obstetrics and Gynaecology, Bedford Hospital, Bedford, UK
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Volløyhaug I, Mørkved S, Salvesen KÅ. Authors' reply re: Pelvic organ prolapse and incontinence 15-23 years after first delivery: a cross-sectional study. BJOG 2015; 122:1715. [PMID: 26498309 DOI: 10.1111/1471-0528.13588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2015] [Indexed: 11/27/2022]
Affiliation(s)
- I Volløyhaug
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynaecology, Trondheim University Hospital, Trondheim, Norway
| | - S Mørkved
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Å Salvesen
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.,National Center for Fetal Medicine, Trondheim University Hospital, Trondheim, Norway
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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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Volløyhaug I, Mørkved S, Salvesen Ø, Salvesen KÅ. Forceps delivery is associated with increased risk of pelvic organ prolapse and muscle trauma: a cross-sectional study 16-24 years after first delivery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:487-495. [PMID: 25920322 DOI: 10.1002/uog.14891] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/16/2015] [Accepted: 04/24/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To study possible associations between mode of delivery and pelvic organ prolapse (POP) and pelvic floor muscle trauma 16-24 years after first delivery and, in particular, to identify differences between forceps and vacuum delivery. METHODS This was a cross-sectional study including 608 women who delivered their first child in 1990-1997 and were examined with POP quantification (POP-Q) and pelvic floor ultrasound in 2013-2014. Outcome measures were POP ≥ Stage 2 or previous prolapse surgery, levator avulsion and levator hiatal area on Valsalva. Univariable and multivariable logistic regression analyses and ANCOVA were applied to identify outcome variables associated with mode of delivery. RESULTS Comparing forceps to vacuum delivery, the adjusted odds ratios (aOR) were 1.72 (95% CI, 1.06-2.79; P = 0.03) for POP ≥ Stage 2 or previous prolapse surgery and 4.16 (95% CI, 2.28-7.59; P < 0.01) for levator avulsion. Hiatal area on Valsalva was larger, with adjusted mean difference (aMD) of 4.75 cm(2) (95% CI, 2.46-7.03; P < 0.01). Comparing forceps with normal vaginal delivery, the adjusted odds ratio (aOR) was 1.74 (95% CI, 1.12-2.68; P = 0.01) for POP ≥ Stage 2 or surgery and 4.35 (95% CI, 2.56-7.40; P < 0.01) for levator avulsion; hiatal area on Valsalva was larger, with an aMD of 3.84 cm(2) (95% CI, 1.78-5.90; P < 0.01). Comparing Cesarean delivery with normal vaginal delivery, aOR was 0.06 (95% CI, 0.02-0.14; P < 0.01) for POP ≥ Stage 2 or surgery and crude OR was 0.00 (95% CI, 0.00-0.30; P < 0.01) for levator avulsion; hiatal area on Valsalva was smaller, with an aMD of -8.35 cm(2) (95% CI, -10.87 to -5.84; P < 0.01). No differences were found between vacuum and normal vaginal delivery. CONCLUSIONS We found that mode of delivery was associated with POP and pelvic floor muscle trauma in women from a general population, 16-24 years after their first delivery. Forceps was associated with significantly more POP, levator avulsion and larger hiatal areas than were vacuum and normal vaginal deliveries. There were no statistically significant differences between vacuum and normal vaginal deliveries. Cesarean delivery was associated with significantly less POP and pelvic floor muscle trauma than were normal or operative vaginal delivery.
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Affiliation(s)
- I Volløyhaug
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, Trondheim University Hospital, Trondheim, Norway
| | - S Mørkved
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
- Clinical Service, Trondheim University Hospital, Trondheim, Norway
| | - Ø Salvesen
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Å Salvesen
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
- National Center for Fetal Medicine, Trondheim University Hospital, Trondheim, Norway
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Volløyhaug I, Mørkved S, Salvesen KÅ. Association between pelvic floor muscle trauma and pelvic organ prolapse 20 years after delivery. Int Urogynecol J 2015. [DOI: 10.1007/s00192-015-2784-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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