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Wu H, Zhong X, He L, Li X, Zeng Y, Jia Y. Clinical effect and prognostic factor of electric stimulation and biofeedback therapy on postpartum pelvic organ prolapse. Rev Esc Enferm USP 2024; 58:e20230421. [PMID: 39115220 PMCID: PMC11308478 DOI: 10.1590/1980-220x-reeusp-2023-0421en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/10/2024] [Indexed: 08/11/2024] Open
Abstract
OBJECTIVE To explore the effects of electric stimulation and biofeedback therapy in patients with postpartum pelvic organ prolapse and to identify factors that can affect therapeutic efficacy outcomes. METHOD This retrospective study analysed clinical data about patients with postpartum pelvic organ prolapse. A total of 328 women with pelvic organ prolapse at 6 weeks postpartum were recruited from one tertiary hospitals in Sichuan province in China, between March 2019 and March 2022. The prognostic factors of therapeutic efficacy were analysed using logistic regression and decision tree model. RESULTS Overall, 259 women showed clinical benefits from the treatment. The logistic regression model showed that parity, pelvic floor muscle training at home, and the pelvic organ prolapse quantitation stage before treatment were independent prognostic factors. The decision tree model showed that the pelvic organ prolapse quantitation stage before treatment was the main prognostic factor, followed by parity. There was no significant difference in the area under the receiver operating characteristic curve between the two models. CONCLUSION Parity, pelvic floor muscle training at home, and the pelvic organ prolapse quantitation stage before treatment were important prognostic factors of electric stimulation and biofeedback therapy on postpartum pelvic organ prolapse.
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Affiliation(s)
- Hongjin Wu
- Chengdu Medical College, School of Nursing, Chengdu, Sichuan, China
- University of Electronic Science and Technology of China, School of Medicine, Mianyang Central Hospital, Obstetrics and Gynecology Department, Mianyang, Sichuan, China
| | - Xiaoying Zhong
- University of Electronic Science and Technology of China, School of Medicine, Mianyang Central Hospital, Obstetrics and Gynecology Department, Mianyang, Sichuan, China
| | - Linqian He
- Chengdu Medical College, School of Nursing, Chengdu, Sichuan, China
| | - Xixi Li
- Chengdu Medical College, School of Nursing, Chengdu, Sichuan, China
- University of Electronic Science and Technology of China, School of Medicine, Department of Nursing, Mianyang Central Hospital, Mianyang, Sichuan, China
| | - Yan Zeng
- University of Electronic Science and Technology of China, School of Medicine, Mianyang Central Hospital, Obstetrics and Gynecology Department, Mianyang, Sichuan, China
| | - Yuanli Jia
- University of Electronic Science and Technology of China, School of Medicine, Mianyang Central Hospital, Obstetrics and Gynecology Department, Mianyang, Sichuan, China
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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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Wu H, Zhang L, He L, Lin W, Yu B, Yu X, Lin Y. Roles and mechanisms of biomechanical-biochemical coupling in pelvic organ prolapse. Front Med (Lausanne) 2024; 11:1303044. [PMID: 38410754 PMCID: PMC10894963 DOI: 10.3389/fmed.2024.1303044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/29/2024] [Indexed: 02/28/2024] Open
Abstract
Pelvic organ prolapse (POP) is a significant contributor to hysterectomy among middle-aged and elderly women. However, there are challenges in terms of dedicated pharmaceutical solutions and targeted interventions for POP. The primary characteristics of POP include compromised mechanical properties of uterine ligaments and dysfunction within the vaginal support structure, often resulting from delivery-related injuries. Fibroblasts secrete extracellular matrix, which, along with the cytoskeleton, forms the structural foundation that ensures proper biomechanical function of the fascial system. This system is crucial for maintaining the anatomical position of each pelvic floor organ. By systematically exploring the roles and mechanisms of biomechanical-biochemical transformations in POP, we can understand the impact of forces on the injury and repair of these organs. A comprehensive analysis of the literature revealed that the extracellular matrix produced by fibroblasts, as well as their cytoskeleton, undergoes alterations in patient tissues and cellular models of POP. Additionally, various signaling pathways, including TGF-β1/Smad, Gpx1, PI3K/AKT, p38/MAPK, and Nr4a1, are implicated in the biomechanical-biochemical interplay of fibroblasts. This systematic review of the biomechanical-biochemical interplay in fibroblasts in POP not only enhances our understanding of its underlying causes but also establishes a theoretical foundation for future clinical interventions.
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Affiliation(s)
- Huaye Wu
- Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Ling Zhang
- Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Li He
- Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Wenyi Lin
- Department of Medical Pathology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Bo Yu
- Department of Medical Pathology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xia Yu
- Department of Clinical Laboratory, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yonghong Lin
- Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
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Addisu D, Mekie M, Belachew YY, Degu A, Gebeyehu NA. The prevalence of pelvic organ prolapse and associated factors in Ethiopia: a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1193069. [PMID: 37476611 PMCID: PMC10354282 DOI: 10.3389/fmed.2023.1193069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/13/2023] [Indexed: 07/22/2023] Open
Abstract
Background Pelvic organ prolapse (POP) affects millions of women globally, with resource-limited countries, such as Ethiopia, carrying the highest burden. Previously, the prevalence of POP was estimated using seven studies. However, this study lacks generalization because of the limited number of studies and low geographical representation. In total, 12 additional primary studies were conducted after this review, and their reported prevalence was significantly variable across the studies. In addition, different new factors were reported in the primary studies. Therefore, this study aimed to update the pooled prevalence of POP and its associated factors in Ethiopia. Methods This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Articles that were published between 2000 and 2023 were searched using the African Journal of Online, ScienceDirect, DOAJ, PubMed, and Google Scholar. The quality of the studies was evaluated using the modified Newcastle-Ottawa quality assessment tool. The data were extracted using Microsoft Excel and analyzed by Stata version 11. A random effect model was used to investigate the pooled prevalence of POP and its associated factors. The I2 test and Egger's regression test were used to detect the presence of heterogeneity and publication bias across studies, respectively. Result A total of 21 studies met the inclusion criteria and represented the data of 14,575 women. The pooled prevalence of POP was found to be 22.70%. History of home delivery (pooled odds ratio (OR) =2.93, 95% CI =1.46, 5.91), prolonged labor (OR = 4.63, 95% CI = 2.56, 8.38), history of perineal tear (OR = 4.83, 95% CI = 2.31, 10.11), instrumental delivery (OR =3.70, 95% CI =2.01, 6.81), grand multipara (OR = 5.42, 95% CI = 4.06, 7.23), family history of POP (OR = 3.30, 95% CI = 2.07, 5.25), and carrying heavy objects (OR = 3.23, 95% CI = 2.22, 4.70) were significantly associated with POP. Conclusion The pooled prevalence of POP was high in Ethiopia. The Ministry of Health and clinicians should emphasize counseling on modifiable risk factors and develop further prevention strategies.
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Affiliation(s)
- Dagne Addisu
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Maru Mekie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yismaw Yimam Belachew
- Department of Obstetrics and Gynecology, College of Health Sciences, School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Alemu Degu
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Atnafu Gebeyehu
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
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Zhang W, Ge J, Qu Z, Wu W, Lei H, Pan H, Chen H. Evaluation for causal effects of socioeconomic traits on risk of female genital prolapse (FGP): a multivariable Mendelian randomization analysis. BMC Med Genomics 2023; 16:125. [PMID: 37296408 PMCID: PMC10251634 DOI: 10.1186/s12920-023-01560-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Although observational studies have established some socioeconomic traits to be independent risk factors for pelvic organ prolapse (POP), they can not infer causality since they are easily biased by confounding factors and reverse causality. Moreover, it remains ambiguous which one or several of socioeconomic traits play predominant roles in the associations with POP risk. Mendelian randomization (MR) overcomes these biases and can even determine one or several socioeconomic traits predominantly accounting for the associations. OBJECTIVE We conducted a multivariable Mendelian randomization (MVMR) analysis to disentangle whether one or more of five categories of socioeconomic traits, "age at which full-time education completed (abbreviated as "EA")", "job involving heavy manual or physical work ("heavy work")", "average total household income before tax (income)", "Townsend deprivation index at recruitment (TDI)", and "leisure/social activities" exerted independent and predominant effects on POP risk. METHODS We first screened single-nucleotide polymorphisms (SNPs) as proxies for five individual socioeconomic traits and female genital prolapse (FGP, approximate surrogate for POP due to no GWASs for POP) to conduct Univariable Mendelian randomization (UVMR) analyses to estimate causal associations of five socioeconomic traits with FGP risk using IVW method as major analysis. Additionally, we conducted heterogeneity, pleiotropy, and sensitivity analysis to assess the robustness of our results. Then, we harvested a combination of SNPs as an integrated proxy for the five socioeconomic traits to perform a MVMR analysis based on IVW MVMR model. RESULTS UVMR analyses based on IVW method identified causal effect of EA (OR 0.759, 95%CI 0.629-0.916, p = 0.004), but denied that of the other five traits on FGP risk (all p > 0.05). Heterogeneity analyses, pleiotropy analyses, "leave-one-out" sensitivity analyses and MR-PRESSO adjustments did not detect heterogeneity, pleiotropic effects, or result fluctuation by outlying SNPs in the effect estimates of six socioeconomic traits on FGP risk (all p > 0.05). Further, MVMR analyses determined a predominant role of EA playing in the associations of socioeconomic traits with FGP risk based on both MVMR Model 1 (OR 0.842, 95%CI 0.744-0.953, p = 0.006) and Model 2 (OR 0.857, 95%CI 0.759-0.967, p = 0.012). CONCLUSION Our UVMR and MVMR analyses provided genetic evidence that one socioeconomic trait, lower educational attainment, is associated with risk of female genital prolapse, and even independently and predominantly accounts for the associations of socioeconomic traits with risk of female genital prolapse.
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Affiliation(s)
- Wei Zhang
- Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430023, Hubei Province, People's Republic of China
| | - Jing Ge
- Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430023, Hubei Province, People's Republic of China
| | - Zhaohui Qu
- Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430023, Hubei Province, People's Republic of China
| | - Wenjuan Wu
- Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430023, Hubei Province, People's Republic of China
| | - Hua Lei
- Department of Tuberculosis, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong, University of Science and Technology, Wuhan, 430023, Hubei Province, People's Republic of China
| | - Huiling Pan
- Department of Tuberculosis, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong, University of Science and Technology, Wuhan, 430023, Hubei Province, People's Republic of China
| | - Honggu Chen
- Department of Orthopedics, the Affiliated Hospital of Jiangsu University, Zhenjiang, 212000, Jiangsu Province, People's Republic of China.
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Vereeck S, Pacquée S, Jacquemyn Y, Neels H, De Wachter S, Weeg N, Dietz HP. Does Cystocele Type Vary Between Vaginally Parous and Nulliparous Women? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:809-813. [PMID: 35766234 DOI: 10.1002/jum.16046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To evaluate whether cystocele type varies with vaginal parity. METHODS Retrospective analysis of 464 vaginally nulliparous women seen at 2 urogynecology units between November 2006 and November 2019. A control group consisted of 871 vaginally parous women seen between July 2017 and November 2019. Patients underwent a standardized interview, POPQ, urodynamic testing, and translabial ultrasound. On imaging, significant cystocele was defined as bladder descent to ≥10 mm below symphysis pubis. Volume datasets were analyzed offline and blinded against clinical data. RESULTS Of 5266 women seen during the inclusion period, 464 were vaginally nulliparous. Three were excluded due to missing data, leaving 461. A control group of 871 parous women was generated from patients seen during the last 2.5 years of the inclusion period. Vaginally nulliparous women were presented at a younger age compared to vaginally parous women (P < .001). Symptoms of prolapse were reported in 104 (22%) nulliparae and 489 (56%) parous women (P < .0001). Vaginally parous women demonstrated more bladder descent (P < .0001) and more cystocele (418/871 versus 43/461, P < .0001), with a higher proportion of type III cystocele (cystocele with intact retrovesical angle) (20/43 versus 273/ 418, P < .0001). Cystourethrocele (Green type II) was more common in nulliparae and cystocele type III in parous women (P = .015). On multivariate analysis, these differences in proportions remained significant (P = .049). CONCLUSIONS Nulliparity was associated with a higher proportion of Green type II cystoceles. Green type III cystocele was more common in vaginally parous women, suggesting that the latter may be more likely to be due to childbirth-related pelvic floor trauma.
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Affiliation(s)
- Sascha Vereeck
- Department of Gynaecology, Antwerp University Hospital, Edegem, Belgium
- University of Antwerp, ASTARC, Antwerp, Belgium
| | - Stefaan Pacquée
- Department of Obstetrics, Gynaecology & Neonatology, University of Sydney, Sydney, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, 2747, Australia
| | - Yves Jacquemyn
- Department of Gynaecology, Antwerp University Hospital, Edegem, Belgium
- University of Antwerp, ASTARC, Antwerp, Belgium
| | - Hedwig Neels
- Department of Gynaecology, Antwerp University Hospital, Edegem, Belgium
- University of Antwerp, ASTARC, Antwerp, Belgium
| | - Stefan De Wachter
- University of Antwerp, ASTARC, Antwerp, Belgium
- Department of Urology, Antwerp University Hospital, Edegem, Belgium
| | - Natalie Weeg
- Department of Obstetrics, Gynaecology & Neonatology, University of Sydney, Sydney, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, 2747, Australia
| | - Hans Peter Dietz
- Department of Obstetrics, Gynaecology & Neonatology, University of Sydney, Sydney, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, 2747, Australia
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Vargas BAM, García AEV, Mendoza RLA, Sarmiento CAG, Vargas EHL. Management of pelvic organ prolapse during pregnancy: Case report. Case Rep Womens Health 2022; 35:e00421. [PMID: 35607457 PMCID: PMC9123191 DOI: 10.1016/j.crwh.2022.e00421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/25/2022] Open
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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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Lakovschek I, Trutnovsky G, Obermayer‐Pietsch B, Gold D. Longitudinal Study of Pelvic Floor Characteristics Before, During, and After Pregnancy in Nulliparous Women. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:147-155. [PMID: 33682186 PMCID: PMC9291937 DOI: 10.1002/jum.15689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate the changes in the pelvic floor before, during, and after pregnancy in the same collective of nulliparous women. METHODS In a prospective observational pilot study between April 2015 and June 2019 in nulliparous women with planned pregnancy, we used the pelvic organ prolapse quantification (POP-Q) system; a 2-dimensional (2D) sonography to investigate the bladder neck, cervix, and anorectal junction positions; and a 3D/4D sonography to measure the hiatus of the levator ani muscle (LH area) during Valsalva maneuver. Five visits were planned: 1 before, 3 during, and 1 visit after pregnancy. RESULTS Twenty-four women participated in the study. We achieved a minimum of 2 visit measurements from 10 women who became pregnant. The LH area decreased during the first trimester and then increased until the third trimester. Postpartum, the LH area reached the prepregnancy state. We observed changes in the bladder neck mobility, bladder neck position, cervix, and anorectal junction from the first trimester. Postpartum, the bladder neck mobility was higher, and the position of the bladder neck and anorectal junction was lower than before pregnancy. We observed no remarkable changes in the POP-Q state during pregnancy. CONCLUSION This was the first study to investigate pelvic floor characteristics in the same collective before, during, and after pregnancy. We observed pelvic floor changes from the prepregnancy state to the first trimester to postpartum. The study results need to be confirmed in a larger study.
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Affiliation(s)
| | - Gerda Trutnovsky
- Department of Obstetrics and GynecologyMedical University of GrazGrazAustria
| | - Barbara Obermayer‐Pietsch
- Department of Internal Medicine, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Daniela Gold
- Department of Obstetrics and GynecologyMedical University of GrazGrazAustria
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Influence of a Virtual Exercise Program throughout Pregnancy during the COVID-19 Pandemic on Perineal Tears and Episiotomy Rates: A Randomized Clinical Trial. J Clin Med 2021; 10:jcm10225250. [PMID: 34830530 PMCID: PMC8621123 DOI: 10.3390/jcm10225250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022] Open
Abstract
The complications associated with COVID-19 confinement (impossibility of grouping, reduced mobility, distance between people, etc.) influence the lifestyle of pregnant women with important associated complications regarding pregnancy outcomes. Therefore, perineal traumas are the most common obstetric complications during childbirth. The aim of the present study was to examine the influence of a supervised virtual exercise program throughout pregnancy on perineal injury and episiotomy rates during childbirth. A randomized clinical trial design (NCT04563065) was used. Data were collected from 98 pregnant women without obstetric contraindications who attended their prenatal medical consultations. Women were randomly assigned to the intervention (IG, N = 48) or the control group (CG, N = 50). A virtual and supervised exercise program was conducted from 8-10 to 38-39 weeks of pregnancy. Significant differences were found between the study groups in the percentage of episiotomies, showing a lower episiotomy rate in the IG (N = 9/12%) compared to the CG (N = 18/38%) (χ2 (3) = 4.665; p = 0.031) and tears (IG, N = 25/52% vs. CG, N = 36/73%) (χ2 (3) = 4.559; p = 0.033). A virtual program of supervised exercise throughout pregnancy during the current COVID-19 pandemic may help reduce rates of episiotomy and perineal tears during delivery in healthy pregnant women.
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Delara R, Yi J, Girardo M, Wasson M. Perioperative Outcomes of Total Vaginal Hysterectomy in Women with Prior Cesarean Delivery. J Minim Invasive Gynecol 2020; 27:1603-1609. [DOI: 10.1016/j.jmig.2020.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/22/2020] [Accepted: 02/29/2020] [Indexed: 11/29/2022]
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Mao YJ, Zheng ZJ, Xu JH, Xu J, Zhang XL. Pelvic floor biometry in asymptomatic primiparous women compared with nulliparous women: a single-center study in Southern China. J Int Med Res 2020; 48:300060520920393. [PMID: 32351146 PMCID: PMC7221480 DOI: 10.1177/0300060520920393] [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] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to investigate pelvic floor biometry of asymptomatic primiparous women compared with nulliparous women by using four-dimensional transperineal ultrasound (4D TPUS). METHODS From July 2015 to February 2017, 722 women were enrolled and divided into the nulliparous group (n = 292), the vaginal delivery group (n = 272), and the elective cesarean section group (n = 158). The ultrasound parameters of 4D TPUS were compared among the groups. RESULTS The vaginal delivery group had a significantly greater bladder neck descent (η2 = 0.04), retrovesical angles on Valsalva maneuver (η2 = 0.01), urethral rotation (η2 = 0.01), levator hiatus area on Valsalva maneuver (η2 = 0.02), urethral inclination angle (η2 = 0.02), and funneling of the proximal urethra (η2 = 0.11) than the other two groups. Comparison of the two modes of delivery (vaginal delivery and cesarean section) also showed significant differences in the above-mentioned ultrasound parameters. CONCLUSION There are significant differences in pelvic floor biometry between asymptomatic primiparous women and nulliparous women, as well as between women with vaginal delivery and those with elective cesarean section.
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Affiliation(s)
- Yong-Jiang Mao
- Department of Ultrasonography, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhi-Juan Zheng
- Department of Ultrasonography, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jie-Hua Xu
- Department of Ultrasonography, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jing Xu
- Department of Ultrasonography, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xin-Ling Zhang
- Department of Ultrasonography, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Mirskaya M, Lindgren EC, Carlsson IM. Online reported women's experiences of symptomatic pelvic organ prolapse after vaginal birth. BMC WOMENS HEALTH 2019; 19:129. [PMID: 31664987 PMCID: PMC6819438 DOI: 10.1186/s12905-019-0830-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/17/2019] [Indexed: 11/13/2022]
Abstract
Background Pelvic organ prolapse (POP) is a major public health problem with a relative high lifetime risk of surgery. The main risk factor for developing POP is vaginal birth. Many women become symptomatic later in life and most of the existing research on symptomatic pelvic organ prolapse (sPOP) predominantly concentrates on the effects of the condition on postmenopausal women. However bothersome symptoms of POP can be reported as early as in women’s 20s and may occur shortly after vaginal birth. Limited studies provide an insight into daily life of fertile women with sPOP. Thus, we aimed to explore fertile women’s experiences of symptomatic pelvic organ (sPOP) after vaginal birth. Methods An inductive, text-driven approach was taken by selecting thread posts from an internet forum written by 33 Swedish fertile women who had experienced sPOP after vaginal birth. Results The overarching theme “being irreparably damaged” was identified as representing an experience of being disabled by sPOP after vaginal birth. The fertile women experienced that their lives were ruined because of physical and psychological limitations caused by this unexpected, unfamiliar and unexplained condition. Living with sPOP impinged on sexual health, restricted daily and sports activities and affected the women’s ability to fulfill everyday parental duties. This in turn compromised women’s psychological health. In addition, the negligence of healthcare professionals who tended to trivialize and normalize the symptoms led to the belief that there were no sustainable treatments and that women would have to live with bothersome symptoms of POP for rest of their lives. Conclusions This study found that sPOP had a significant negative impact on fertile women’s lives. The women indicated that they had not had the opportunity to voice their concerns and had not been taken seriously by healthcare professionals. It is of the utmost importance to acknowledge this problem and develop guidelines for prevention and management of sPOP to improve the quality of life for women.
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Affiliation(s)
- Maria Mirskaya
- Department of Health and Welfare, Halmstad University, SE-823, SE-301 18, Halmstad, Sweden.
| | - Eva-Carin Lindgren
- Department of Health and Welfare, Halmstad University, SE-823, SE-301 18, Halmstad, Sweden
| | - Ing-Marie Carlsson
- Department of Health and Welfare, Halmstad University, SE-823, SE-301 18, Halmstad, Sweden
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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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15
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Avcıbay Vurgeç B, Kızılkaya Beji N. İleri evre pelvik organ proplapsusu olan kadınlarda yaşam kalitesi ve cinsel yaşam. CUKUROVA MEDICAL JOURNAL 2018. [DOI: 10.17826/cumj.427253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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16
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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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17
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Sanozidis A, Mikos T, Assimakopoulos E, Athanasiadis A, Tantanassis T, Tarlatzis BC, Papameletiou V. Changes in levator hiatus dimensions during pregnancy and after delivery in nulliparas: a prospective cohort study using 3D transperineal ultrasound. J Matern Fetal Neonatal Med 2017; 31:1505-1512. [DOI: 10.1080/14767058.2017.1319926] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A. Sanozidis
- 1st Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital Thessaloniki, Greece
| | - T. Mikos
- 1st Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital Thessaloniki, Greece
| | - E. Assimakopoulos
- 2nd Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, Hippokration General Hospital Thessaloniki, Greece
| | - A. Athanasiadis
- 1st Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital Thessaloniki, Greece
| | - T. Tantanassis
- 2nd Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, Hippokration General Hospital Thessaloniki, Greece
| | - B. C. Tarlatzis
- 1st Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital Thessaloniki, Greece
| | - V. Papameletiou
- 1st Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital Thessaloniki, Greece
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18
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Castro-Pardiñas M, Torres-Lacomba M, Navarro-Brazález B. Muscle function of the pelvic floor in healthy, puerperal women with pelvic floor dysfunction. Actas Urol Esp 2017; 41:249-257. [PMID: 28094073 DOI: 10.1016/j.acuro.2016.11.007] [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: 09/21/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To understand the function of the pelvic floor muscles (PFM) at different ages in healthy women and in puerperal women with pelvic floor dysfunctions (PFD) and to ascertain whether there are differences among them. MATERIAL AND METHODS A descriptive cross-sectional study was conducted between June 2014 and September 2016 and included 177 women, 70 of whom had no symptoms of PFD, 53 primiparous mothers in late postpartum and 54 with PFD. The function of the PFM was measured through vaginal palpation (quality of the contraction); manometry (force); dynamometer (tone, strength, and response to stretching), and surface electromyography (neuromuscular activity and resistance). RESULTS The healthy women showed superior values for PFM tone, maximum strength, neuromuscular activity and resistance than the puerperal mothers and the women with PFD (P<.01). The puerperal women and those with PFD showed similar functional PFM values (P>.05). The muscle function of the healthy women did not vary significantly with age, except in the case of tone, which was lower in the women older than 46 years (P=.004). CONCLUSIONS Age and births decrease the baseline tone of the PFM in healthy women. Therefore, lower strength, resistance and neuromuscular activity appear to be the main difference between the PFM of women with PFD and the PFM of healthy women.
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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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20
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Leeman L, Rogers R, Borders N, Teaf D, Qualls C. The Effect of Perineal Lacerations on Pelvic Floor Function and Anatomy at 6 Months Postpartum in a Prospective Cohort of Nulliparous Women. Birth 2016; 43:293-302. [PMID: 27797099 PMCID: PMC5125543 DOI: 10.1111/birt.12258] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the effect of perineal lacerations on pelvic floor outcomes, including urinary and anal incontinence, sexual function, and perineal pain in a nulliparous cohort with low incidence of episiotomy. METHODS Nulliparous women were prospectively recruited from a midwifery practice. Pelvic floor symptoms were assessed with validated questionnaires, physical examination, and objective measures in pregnancy and 6 months postpartum. Two trauma groups were compared, those with an intact perineum or only 1st degree lacerations and those with second-, third-, or fourth-degree lacerations. RESULTS Four hundred and forty-eight women had vaginal deliveries. One hundred and fifty-one sustained second-degree or deeper perineal trauma and 297 had an intact perineum or minor trauma. Three hundred and thirty-six (74.8%) presented for 6-month follow-up. Perineal trauma was not associated with urinary or fecal incontinence, decreased sexual activity, perineal pain, or pelvic organ prolapse. Women with trauma had similar rates of sexual activity; however, they had slightly lower sexual function scores (27.3 vs 29.1). Objective measures of pelvic floor strength, rectal tone, urinary incontinence, and perineal anatomy were equivalent. The subgroup of women with deeper (> 2 centimeter) perineal trauma demonstrated increased likelihood of perineal pain (15.5% vs 6.2%) and weaker pelvic floor muscle strength (61.0% vs 44.3%) compared with women with more superficial trauma. CONCLUSION Women having second-degree lacerations are not at increased risk for pelvic floor dysfunction other than increased pain, and slightly lower sexual function scores at 6 months postpartum.
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Affiliation(s)
- Lawrence Leeman
- Departments of Family and Community Medicine, and Obstetrics and Gynecology at the University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Rebecca Rogers
- Department of Obstetrics and Gynecology at the University of New Mexico School of Medicine, Albuquerque, NM, USA
| | | | - Dusty Teaf
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Clifford Qualls
- Clinical and Translational Research Center, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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21
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Trutnovsky G, Kamisan Atan I, Ulrich D, Martin A, Dietz HP. Levator ani trauma and pelvic organ prolapse - a comparison of three translabial ultrasound scoring systems. Acta Obstet Gynecol Scand 2016; 95:1411-1417. [DOI: 10.1111/aogs.13018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/01/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Gerda Trutnovsky
- Department of Obstetrics and Gynecology; Sydney Medical School Nepean; University of Sydney; Sydney NSW Australia
- Department of Obstetrics and Gynecology; Medical University of Graz; Graz Austria
| | - Ixora Kamisan Atan
- Department of Obstetrics and Gynecology; Sydney Medical School Nepean; University of Sydney; Sydney NSW Australia
- Department of Obstetrics and Gynecology; University Kebangsaan Malaysia Medical Centre; Kuala Lumpur Malaysia
| | - Daniela Ulrich
- Department of Obstetrics and Gynecology; Medical University of Graz; Graz Austria
| | - Andrew Martin
- NHMRC Clinical Trial Centre; University of Sydney; Sydney NSW Australia
| | - Hans P. Dietz
- Department of Obstetrics and Gynecology; Sydney Medical School Nepean; University of Sydney; Sydney NSW Australia
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22
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Löfling L, Bröms G, Bahmanyar S, Kieler H. Maternal and infant characteristics: differences and similarities between the Nordic countries and the US. Clin Epidemiol 2016; 8:285-94. [PMID: 27536160 PMCID: PMC4976813 DOI: 10.2147/clep.s106126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Data from the Nordic health care registers have been of great value in perinatal epidemiological research. It has been assumed that findings from the Nordic population (Denmark, Finland, Iceland, Norway, and Sweden) are applicable to other populations as well, including the population of the US. Objective To describe and compare maternal and infant characteristics between the Nordic and the American populations as recorded in the official statistics. Materials and methods This population-based study included data on all females who gave birth and their infants in the Nordic countries and the US. The data were obtained from the US National Center for Health Statistics and the official statistics data for the Nordic countries. The data from all six countries included births from 2006 to 2010. Results The mean maternal age at delivery was lower in the US than in the Nordic countries (27.5 vs 30.3 years). Cesarean sections (32.2% vs 17.9%), low birth weight (8.2% vs 4.8%), and preterm birth (12.3% vs 5.9%) were more common in the US than in the Nordic countries. Smoking during early pregnancy was slightly less common in the US compared with Nordic countries (9.8% vs 11.2%). Restricting the data from the US to females with a university degree, characteristics such as age at delivery, birth weight, and preterm deliveries were more in alignment with the Nordic data. Conclusion There are differences in some key maternal and neonatal characteristics between the Nordic countries and the US. However, some characteristics are related to socioeconomic status, suggesting that the Nordic data seem to be applicable to the part of the population in the US with a higher socioeconomic status.
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Affiliation(s)
- Lukas Löfling
- Department of Medicine, Solna Centre for Pharmacoepidemiology (CPE), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Gabriella Bröms
- Department of Medicine, Solna Centre for Pharmacoepidemiology (CPE), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Shahram Bahmanyar
- Department of Medicine, Solna Centre for Pharmacoepidemiology (CPE), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Helle Kieler
- Department of Medicine, Solna Centre for Pharmacoepidemiology (CPE), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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