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Xu Y, Wei L, Liu M, Jia Z, Li Y, Li F. Transvaginal posterior levatorplasty and perineoplasty for female primary stress urinary incontinence: 12-month follow-up and technical presentation. BMC Urol 2024; 24:235. [PMID: 39456007 DOI: 10.1186/s12894-024-01604-7] [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: 11/28/2023] [Accepted: 09/24/2024] [Indexed: 10/28/2024] Open
Abstract
OBJECTIVE To investigate the feasibility of transvaginal posterior levatorplasty combined with perineoplasty (TPLP) for women with primary stress urinary incontinence and demonstrate the surgical technique with step-by-step procedures. METHODS A prospective, non-randomised study was conducted using technique of TPLP to treat female primary SUI from January 2019 to December 2021. Patient follow-up was performed at 3 and 12 months posteroperatively. A series of validated questionnaires were used to evaluate the improvement of symptom severity, sexual function and quality of life. In addition, 4-D ultrasonography was used to measure the anatomic changes of pelvic structures. RESULTS A total of 47 patients were enrolled in this study with a mean age of 43.6 years. Mean operative time was 78.7 min. Median estimated intraoperative blood loss was 80.2 ml. Objective cure and subjective cure rates were 87.2% and 91.5%, respectively. Compared with baseline, scores of quality of life, symptom severity and sexual function improved after surgery. Meanwhile, mobility of the urethra and bladder neck and areas of levator hiatus were decreased after surgery. Mild coitus pain was reported in 15.4% (6/39) patients at the initial several times of intercourse after resuming sexual activity. CONCLUSIONS This study shows that transvaginal posterior levatorplasty combined with perineoplasty appears to be an effective surgical method for selected women with primary stress urinary incontinence.
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Affiliation(s)
- Yansheng Xu
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lan Wei
- Department of Ultrasonography, Beijing Erlong Road Hospital, Beijing Pelvic Floor Disease Research Center, Beijing, China
| | - Meichen Liu
- Gynecological Perineal Plastic Surgery and Gender Affirming Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da Chu Road, Shi Jing Shan District, Beijing, China
| | - Zhuomin Jia
- Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yilin Li
- Gynecological Perineal Plastic Surgery and Gender Affirming Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da Chu Road, Shi Jing Shan District, Beijing, China
| | - Fengyong Li
- Gynecological Perineal Plastic Surgery and Gender Affirming Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da Chu Road, Shi Jing Shan District, Beijing, China.
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2
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Koomson G, Mgolozeli-Mgolose S, Mshunqane N. Prevalence of urinary incontinence in postpartum women and physiotherapy interventions applied: An integrative review. Int J Gynaecol Obstet 2024. [PMID: 39429211 DOI: 10.1002/ijgo.15950] [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: 04/07/2023] [Revised: 08/21/2024] [Accepted: 09/29/2024] [Indexed: 10/22/2024]
Abstract
OBJECTIVE This integrative review identified studies that reported the prevalence of physiotherapeutic interventions for urinary incontinence among postpartum women. METHODS This is an integrative literature review study. We used the integrative literature review framework proposed by Whittemore and Knafl to search for relevant literature. SEARCH STRATEGY The search strategy for electronic databases was developed from the research question and definitions of key concepts, assisted by the librarian. Databases that were searched include Google Scholar, Medline (PubMed), CINAHL, and the Joanna Briggs Institute databases. Both qualitative and quantitative studies that met the inclusion criteria were included. We used the CASP tool to assess the quality of selected papers. DATA COLLECTION AND ANALYSIS The included articles were thematically analyzed. Thirty-six papers met the inclusion criteria for the review. Six themes emerged from the analysis: prevalence of postpartum UI; risk factors for postpartum UI; antenatal pelvic floor muscle training; conservative treatment and quality of life; experiences of postpartum women with UI; and possible coping strategies adopted by women. Most of the articles were quantitative studies (80.5%); 16.6% were qualitative and 2.7% adopted mixed methods. CONCLUSIONS Urinary incontinence is common in postpartum women. Antenatal pelvic floor muscle training is protective against postpartum UI and should be the first-line treatment option.
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Affiliation(s)
- Gifty Koomson
- Department of Physiotherapy, School of Healthcare Sciences, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Siyabulela Mgolozeli-Mgolose
- Department of Health Studies, School of Social Sciences, College of Human Sciences, University of South Africa, Pretoria, South Africa
| | - Nombeko Mshunqane
- Department of Physiotherapy, School of Healthcare Sciences, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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3
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Schuyler AQ, Koch FR, Goodier CG. Understanding Obstetrical Surgical Planning for the Pediatrician. Neoreviews 2024; 25:e497-e505. [PMID: 39085174 DOI: 10.1542/neo.25-8-e497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/15/2024] [Accepted: 04/29/2024] [Indexed: 08/02/2024]
Abstract
Cesarean deliveries are common in the United States, occurring in approximately one-third of deliveries in 2021. Given this high rate of cesarean deliveries, it is important for all clinicians caring for the pregnant person-infant dyad to be educated about cesarean deliveries. In this review, we describe the indications for cesarean delivery, the evidence-based practices of preoperative planning to ensure safe deliveries, and the clinical decision-making behind various cesarean incisions. In addition, we discuss the most common complications of cesarean deliveries for the pregnant person-infant dyad.
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Affiliation(s)
- Amelia Q Schuyler
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL
| | | | - Christopher G Goodier
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
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4
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Bergendahl S, Sandström A, Zhao H, Snowden JM, Brismar Wendel S. Pelvic floor dysfunction after intervention, compared with expectant management, in prolonged second stage of labour: A population-based questionnaire and cohort study. BJOG 2024; 131:1279-1289. [PMID: 38375535 DOI: 10.1111/1471-0528.17792] [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: 10/20/2023] [Revised: 01/20/2024] [Accepted: 02/04/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To investigate the effect of vacuum extraction (VE) or caesarean section (CS), compared with expectant management, on pelvic floor dysfunction (PFD) 1-2 years postpartum in primiparous women with a prolonged second stage of labour. DESIGN A population-based questionnaire and cohort study. SETTING Stockholm, Sweden. POPULATION A cohort of 1302 primiparous women with a second stage duration of ≥3 h, delivering from December 2017 to November 2018. METHODS The 1-year follow-up questionnaire from the Swedish National Perineal Laceration Register was distributed 12-24 months postpartum. Exposure was VE or CS at 3-4 h or 4-5 h, compared with expectant management. MAIN OUTCOME MEASURES Pelvic floor dysfunction was defined as at least weekly symptoms of urinary incontinence, pelvic organ prolapse or a Wexner score of ≥4. The risk of PFD was calculated using Poisson regression with robust variance estimation, presented as crude and adjusted relative risks (RRs and aRRs) with 95% confidence intervals (95% CIs). The implication of obstetric anal sphincter injury (OASI) on pelvic floor disorders was investigated through mediation analysis. RESULTS In total, 35.1% of women reported PFD. Compared with expectant management, the risk of PFD was increased after VE at 3-4 h (aRR 1.33, 95% CI 1.06-1.65) and 4-5 h (aRR 1.34, 95% CI 1.05-1.70), but remained unchanged after CS. The increased risk after VE was not mediated by OASI. CONCLUSIONS Pelvic floor dysfunction was common in primiparous women after a prolonged second stage, and the risk of PFD increased after VE but was unaffected by CS, compared with expectant management. If a spontaneous vaginal delivery eventually occurred, allowing an extended duration of labour did not increase the risk of PFD.
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Affiliation(s)
- Sandra Bergendahl
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
- BB Sankt Göran, Capio Sankt Göran Hospital, Stockholm, Sweden
| | - Anna Sandström
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Hongwei Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Texas University, College Station, Texas, USA
| | - Jonathan M Snowden
- School of Public Health, Oregon Health and Science University - Portland State University, Portland, Oregon, USA
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Sophia Brismar Wendel
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
- Department of Women's Health, Danderyd Hospital, Stockholm, Sweden
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5
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Ghanbari Z, Jelodarian P, Salkisari FH, Sohbati S, Eftekhar T, Hosseini RS, Nezami Z, Pesikhani MD. A 5-year evaluation of quality of life, pelvic discomfort, and sexual function following posterior pericervical repair. J Med Life 2024; 17:392-396. [PMID: 39071513 PMCID: PMC11282904 DOI: 10.25122/jml-2023-0321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/09/2023] [Indexed: 07/30/2024] Open
Abstract
The aim of this study was to evaluate the quality of life, pelvic discomfort, and sexual function of patients who underwent posterior pericervical repair or level I to III surgical procedures for pelvic organ prolapse (POP) after 5 years of follow-up. This retrospective cohort study enrolled 107 women with POP who were referred to the Imam Khomeini Hospital Complex, an academic center affiliated with the Tehran University of Medical Sciences, Tehran, Iran, from 2014 to 2021. The patients underwent transvaginal surgery using native tissue, in which the rectovaginal fascia was attached to the pericervical ring. The Pelvic Floor Distress Inventory-20 (PFDI-20) and Lower Urinary Tract Symptoms Module (ICIQ-FLUTSsex) questionnaires were completed by each patient before and 5 years after surgery. Of the 107 patients, only 78 completed the 5-year follow-up. The mean PFDI-20 scores before, 12 months, and 5 years after surgery were 141.87 ± 34.48, 100.87 ± 26.48, and 37.49 ± 56.39, respectively, indicating a significant improvement in the patients' symptoms after surgery (P < 0.001). The total mean score of ICIQ-FLUTSsex was 3.67 ± 3.63 (range, 0-10). In total, 22 (28.2%) women had an ICIQ-FLUTSsex score of 0, indicating no problems. The attachment of the rectovaginal fascia to the pericervical rings can be an effective surgical technique for correcting posterior vaginal wall prolapses, without significant morbidity. The PFDI-20 score improved significantly from before surgery to 12 months and 5 years after surgery.
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Affiliation(s)
- Zinat Ghanbari
- Department of Obstetrics and Gynecology, Pelvic Floor Fellowship, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parivash Jelodarian
- Pelvic Floor Fellowship, Department of Obstetrics and Gynecology, Fertility Infertility and Perinatology Research Center, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Hosseini Salkisari
- Pelvic Floor Fellowship, Department of Obstetrics and Gynecology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Sohbati
- Department of Obstetrics and Gynecology, Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Tahereh Eftekhar
- Department of Obstetrics and Gynecology, Pelvic Floor Fellowship, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reihane Sadat Hosseini
- Department of Obstetrics and Gynecology, Pelvic Floor Fellowship, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Nezami
- Fellowship of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Maryam Deldar Pesikhani
- Department of Obstetrics and Gynecology, Pelvic Floor Fellowship, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Özgül S, Gürşen C, Toprak Çelenay Ş, Baran E, Üzelpasacı E, Nakip G, Çinar GN, Beksaç MS, Akbayrak T. Contributory effects of individual characteristics on pelvic floor distress in women with pelvic floor dysfunctions. Physiother Theory Pract 2024; 40:625-636. [PMID: 36168816 DOI: 10.1080/09593985.2022.2127137] [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: 03/08/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To determine individual characteristics (i.e. sociodemographic and medical, obstetric and gynecological, and musculoskeletal and anthropometric parameters) for greater pelvic floor distress (PFD). METHODS A cross-sectional study was performed in 253 women with pelvic floor dysfunction. PFD was assessed using the Pelvic Floor Distress Inventory-20 (PFDI-20). The score of Urogenital Distress Inventory-6 (UDI-6) was used to perform secondary analyses. Sociodemographic, medical, and obstetric & gynecological parameters were recorded. Waist and hip circumferences and pelvic diameters were measured as anthropometric parameters. Pearson test, t-test, and linear regression analyses were conducted with a significance level of 0.05. RESULTS Education level (r = -0.23, p < .001; r = -0.24, p < .001), number of vaginal births (r = 0.15, p = .012; r = 0.12, p = .048), total vaginal birth weight (r = 0.15, p = .021; r = 0.16, p = .019), and Body Mass Index (r = 0.12, p = .043; r = 0.16, p = .007) were significantly correlated with the higher PFDI-20 and UDI-6 scores. The maternal age at the first vaginal birth (r = -0.13, p = .049) and pelvic antero-posterior diameter (r = 0.17, p = .013) were also significantly correlated with higher UDI-6 score. Linear regression analyses revealed that younger age (Beta coefficient (β) = -1.10, p = .005), greater symptom duration (β = 2.28, p = .001), the presence of chronic cough/constipation (β = 25.72, p = .001), and increased total vaginal birth weight (β = 2.38, p = .030) were associated with the greater PFDI-20 score. Increased pelvic antero-posterior diameter (β = 0.88, p = .049) was a contributory factor for the greater UDI-6 score. CONCLUSION This study showed that younger age, chronic cough/constipation, higher total vaginal birth weight, greater symptom duration, and pelvic antero-posterior diameter can be contributors of greater PFD. We suggest further longitudinal studies that better reveal the causal relationship between individual characteristics and PFD.
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Affiliation(s)
- Serap Özgül
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ceren Gürşen
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Şeyda Toprak Çelenay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Emine Baran
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hitit University, Corum, Turkey
| | - Esra Üzelpasacı
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Gülbala Nakip
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Gamze Nalan Çinar
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Mehmet Sinan Beksaç
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Türkan Akbayrak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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7
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Nohr EA, Taastrøm KA, Kjeldsen ACM, Wu C, Pedersen FH, Brown WJ, Davis DL. Parity, mode of birth, and long-term gynecological health: A follow-up study of parous and nonparous women in the Australian Longitudinal Study on Women's Health cohort. Birth 2024; 51:198-208. [PMID: 37849409 DOI: 10.1111/birt.12781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 07/11/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Although gynecological health issues are common and cause considerable distress, little is known about their causes. We examined how birth history is associated with urinary incontinence (UI), severe period pain, heavy periods, and endometriosis. METHODS We studied 7700 women in the Australian Longitudinal Study on Women's Health with an average follow-up of 10.9 years after their last birth. Surveys every third year provided information about birth history and gynecological health. Logistic regression was used to estimate how parity, mode of birth, and vaginal tears were associated with gynecological health issues. Presented results are adjusted odds ratios (OR) with 95% confidence intervals. RESULTS UI was reported by 16%, heavy periods by 31%, severe period pain by 28%, and endometriosis by 4%. Compared with women with two children, nonparous women had less UI (OR 0.35 [0.26-0.47]) but tended to have more endometriosis (OR 1.70 [0.97-2.96]). Also, women with only one child had less UI (OR 0.77 [0.61-0.98]), but more severe period pain (OR 1.24 [1.01-1.51]). Women with 4+ children had more heavy periods (OR 1.42 [1.07-1.88]). Compared with women with vaginal birth(s) only, women with only cesarean sections or vaginal birth after cesarean section had less UI (ORs 0.44 [0.34-0.58] and 0.55 [0.40-0.76]), but more endometriosis (ORs 1.91 [1.16-3.16] and 2.31 [1.25-4.28]) and heavy periods (ORs 1.21 [1.00-1.46] and 1.35 [1.06-1.72]). Vaginal tear(s) did not increase UI after accounting for parity and birth mode. CONCLUSION While women with vaginal childbirth(s) reported more urinary incontinence, they had less menstrual complaints and endometriosis.
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Affiliation(s)
- Ellen A Nohr
- Department of Clinical Research, Research Unit of Obstetrics and Gynaecology, University of Southern Denmark, Odense, Denmark
| | - Katja A Taastrøm
- Department of Clinical Research, Research Unit of Obstetrics and Gynaecology, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Cathrine M Kjeldsen
- Department of Clinical Research, Research Unit of Obstetrics and Gynaecology, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Chunsen Wu
- Department of Clinical Research, Research Unit of Obstetrics and Gynaecology, University of Southern Denmark, Odense, Denmark
| | | | - Wendy J Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, and Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Deborah L Davis
- ACT Government, Health Directorate and Faculty of Health, University of Canberra, New South Wales, Australia
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Topcu EG, McClenahan P, Pule K, Khattak H, Karsli SE, Cukelj M, Ubom AE, Algurjia E, Ozpinar K, Perez YR, Bunu R, Sanabria LS, Portilla FJR, Pumpure E, Roy P, Fogarty P. FIGO best practice guidance in surgical consent. Int J Gynaecol Obstet 2023; 163:795-812. [PMID: 37807812 DOI: 10.1002/ijgo.15174] [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] [Indexed: 10/10/2023]
Abstract
Obtaining medical consent preoperatively is one of the key steps in preparing for surgery, and is an important step in informed decision making with the patient. According to good medical practice guidelines, doctors are required to have the knowledge and skills to treat patients as well as inform them, respect their wishes, and establish trust between themselves and their patients. Valid consent includes elements of competence, disclosure, understanding, and voluntariness. Documentation of these elements is also very important. The International Federation of Gynecology and Obstetrics (FIGO) Education Communication and Advocacy Consortium (ECAC) has realized that the quality of consent varies considerably across the world and has developed simple guidelines regarding consent and procedure-specific checklists for the most common obstetric and gynecological procedures.
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Affiliation(s)
- E Goknur Topcu
- Department of Obstetrics and Gynecology, Istanbul Health and Technology University, Istanbul, Turkey
| | - Phil McClenahan
- Department of Obstetrics and Gynecology, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Koketso Pule
- Department of Obstetrics and Gynecology, Wits University, Johannesburg, South Africa
| | - Hajra Khattak
- Department of Obstetrics and Gynecology, UCL EGA Institute for Women's Health, London, UK
| | - S Eda Karsli
- Department of Obstetrics and Gynecology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Marijo Cukelj
- Department of Obstetrics and Gynecology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Akaninyene E Ubom
- Department of Obstetrics and Gynecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Esraa Algurjia
- Department of Obstetrics and Gynecology, Al-Elwya Maternity Hospital, Baghdad, Iraq
| | - Kubra Ozpinar
- Department of Obstetrics and Gynecology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Yotin Ramon Perez
- Department of Obstetrics and Gynecology, Hospital Central de las Fuerzas, Santo Domingo, Dominican Republic
| | - Rashid Bunu
- Department of Obstetrics and Gynecology, Kenyatta National Hospital, Nairobi, Kenya
| | - Leopoldo S Sanabria
- Department of Obstetrics and Gynecology, Unidad Medica de Alta Especialidad, Mexico City, Mexico
| | - Francisco J R Portilla
- Department of Obstetrics and Gynecology, Instituto Nacional de Perinatologia, Mexico City, Mexico
| | - Elizabete Pumpure
- Department of Obstetrics and Gynecology, Riga East Clinical University, Riga, Latvia
| | - Priyankur Roy
- Department of Obstetrics and Gynecology, Roy's Clinic, Siliguri, West Bengal, India
| | - Paul Fogarty
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
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9
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Wang X, Wang H, Xu P, Mao M, Feng S. Epidemiological trends and risk factors related to lower urinary tract symptoms around childbirth: a one-year prospective study. BMC Public Health 2023; 23:2134. [PMID: 37907879 PMCID: PMC10617094 DOI: 10.1186/s12889-023-17065-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/25/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) are prevalent and distressing concerns for women worldwide. The prevalence of LUTS reaches the first peak during pregnancy and postnatal period. However, less attention has been paid to LUTS around childbirth and little progress has been made in the prevention of LUTS. Understanding the epidemiological characteristics of LUTS around childbirth would inform decision making for health care providers and perinatal women in the prevention of LUTS. The study aims to investigate the epidemiological trends and associated risk factors related to LUTS around childbirth. METHODS Pregnant women were consecutively enrolled during pregnancy in the obstetrical wards of a tertiary hospital and followed up at 6-8 weeks and one year postpartum through a prospective design. Urinary incontinence was assessed with the International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence Short Form. Other symptoms were measured with questions based on definitions of the International Incontinence Society. Multiple logistic regression was used to examine the risk factors for LUTS including urinary incontinence, increased daytime frequency, nocturia and urgency. The report followed the STROBE statement. RESULTS A total of 1243 pregnant women participated in this study. The prevalence of at least one type of storage symptoms was 94%, 55% and 35% in late pregnancy, at 6-8 weeks and one year postpartum, respectively. The prevalence of urinary incontinence remained at 21% within one year postpartum. The majority of the participants suffered from mild to moderate urinary incontinence. Age, job, BMI before pregnancy, gestational diabetes mellitus, urinary tract infection history, previous history of LUTS, age at first birth and birth mode were predictors of LUTS one year postpartum. CONCLUSION LUTS were highly prevalent during pregnancy and postnatal period. The prevalence of urinary incontinence was more stable than that of other LUTS within one year postpartum. Women aged more than 35 years, engaging in manual work, with gestational diabetes mellitus, with a history of urinary tract infection and LUTS, with advanced age at first birth and vaginal delivery were more likely to suffer from LUTS postpartum. The findings provided a novel and deep insight into the epidemiological trends and related risk factors of LUTS around childbirth.
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Affiliation(s)
- Xiaojuan Wang
- School of Medicine, Zhejiang University, No.866 Yu Hang Tang Road, Hangzhou, Zhejiang Province, 310058, China
- Women's Hospital, School of Medicine, Zhejiang University, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, China
| | - Hongyan Wang
- Women's Hospital, School of Medicine, Zhejiang University, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, China
| | - Ping Xu
- School of Medicine, Zhejiang University, No.866 Yu Hang Tang Road, Hangzhou, Zhejiang Province, 310058, China
- Women's Hospital, School of Medicine, Zhejiang University, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, China
| | - Minna Mao
- School of Medicine, Zhejiang University, No.866 Yu Hang Tang Road, Hangzhou, Zhejiang Province, 310058, China
- Women's Hospital, School of Medicine, Zhejiang University, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, China
| | - Suwen Feng
- Women's Hospital, School of Medicine, Zhejiang University, No.1 Xue Shi Road, Hangzhou, Zhejiang Province, 310006, China.
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10
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Pizzoferrato AC, Briant AR, Le Grand C, Gaichies L, Fauvet R, Fauconnier A, Fritel X. Influence of prenatal urinary incontinence and mode of delivery in postnatal urinary incontinence: A systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 2023; 52:102536. [PMID: 36646318 DOI: 10.1016/j.jogoh.2023.102536] [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: 09/01/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND It is likely that the pathophysiology of urinary incontinence (UI) differs between women who are incontinent before the first delivery and those whose incontinence occurs after. In this systematic review, we aimed to assess the association between the mode of delivery and the risk of postpartum UI in primiparous women with and without prenatal UI. METHODS We searched MEDLINE, Cochrane, Web of Science, Embase and CINHAL databases. Prospective studies including primiparous women during their pregnancy with a comparison of the rate of postpartum UI in women who underwent cesarean delivery or vaginal delivery according to continence status before delivery were included. The Risk Ratio (RR) was calculated with a 95% confidence interval (95% CI) using the total number of events and patients extracted from the individual studies. A subgroup comparison analysed the potential influence of women's prenatal continence status. Heterogeneity was estimated using I² statistics. RESULTS The risk of postpartum UI was significantly higher after vaginal delivery than after cesarean section (RR 1.80, 95% CI 1.48- 2.18). According to the subgroup test, the postpartum UI risk following a vaginal delivery, compared to cesarean section, was significantly higher in the subgroup of continent women during pregnancy (RR 2.57, 95% CI 2.17-3.04) than in the subgroup of incontinent pregnant women (1.56, 95% CI 1.27-1.92). CONCLUSIONS The effect of a cesarean section in preventing postpartum UI appears controversial, particularly in women with prenatal UI.
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Affiliation(s)
- A C Pizzoferrato
- Department of Obstetrics and Gynecology, La Miletrie University Hospital, Poitiers, France; Poitiers University, INSERM CIC 1402, Poitiers, France.
| | - A R Briant
- Clinical Research Department, Caen University Hospital, Caen 14000, France
| | - C Le Grand
- Department of Obstetrics and Gynecology, University Hospital center of Caen, Avenue Cpote de Nacre, 14033 Caen Cedex 9, Caen 14000, Caen
| | - L Gaichies
- Department of Obstetrics and Gynecology, University Hospital center of Caen, Avenue Cpote de Nacre, 14033 Caen Cedex 9, Caen 14000, Caen
| | - R Fauvet
- Department of Obstetrics and Gynecology, University Hospital center of Caen, Avenue Cpote de Nacre, 14033 Caen Cedex 9, Caen 14000, Caen; Caen Normandie University, Inserm U1086 "ANTICIPE", Unité de recherche Interdisciplinaire pour la Prévention et le Traitement des Cancers, Axe 2: Biologie et Thérapies Innovantes des cancers Localement Agressifs (BIOTICLA), Caen 14000, France
| | - A Fauconnier
- Department of Obstetrics and Gynaecology, Intercommunal Hospital Center of Poissy-St Germain en Laye, Poissy, France; Research unit EA7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, Versailles St-Quentin University, Montigny-le-Bretonneux, France
| | - X Fritel
- Department of Obstetrics and Gynecology, La Miletrie University Hospital, Poitiers, France; Poitiers University, INSERM CIC 1402, Poitiers, France
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11
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Xu C, Guo Y, Chi X, Chen Y, Chu L, Chen X. Establishment and validation of a simple nomogram for predicting early postpartum stress urinary incontinence among women with vaginal delivery: a retrospective study. BMC Womens Health 2023; 23:8. [PMID: 36624424 PMCID: PMC9827703 DOI: 10.1186/s12905-023-02160-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/03/2023] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a common public health issue that negatively impacts the quality of life for women worldwide, of which early detection and rehabilitation are consequently pivotal. The aim of this study is to establish a simple nomogram for identifying women at risk of postpartum SUI. METHODS A retrospective study was conducted in a tertiary specialized hospital in Shanghai, China. The study included only women with singleton, full-term, and vaginal deliveries. 2,441 women who delivered from July 2019 to November 2019 were included in the training cohort, and 610 women who delivered from January 2022 to February 2022 were included in the validation cohort. SUI was determined by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF). Univariate and multifactorial logistical regression were used to identify independent risk factors for postpartum SUI and further construct the nomogram accordingly. Based on concordance statistics (C-statistics), calibration curves, and decision curve analyses, we evaluated the performance of the nomogram in the training cohort and the validation cohort. In addition, the model was validated internally in the training cohort through cross-validation. RESULTS There were no significant statistically differences in important baseline data such as age, pre-pregnancy BMI, and parity between the training and validation cohorts. SUI was observed in 431 (17.6%) and 125 (20.5%) women in the training and validation cohorts, respectively. According to the regression analysis, age, parity, second stage of labor, infant weight, and forceps delivery were included in the nomogram. The nomogram had a C-statistic of 0.80 (95% confidence interval [CI] 0.74-0.85) for predicting SUI. C-statistics were stable in both internally cross-validated training cohort (mean 0.81) and validation cohort (0.83 [95% CI 0.79-0.87]). The nomogram's calibration curve was near the ideal diagonal line. Additionally, the model exhibited a positive net benefit from the decision curve analysis. CONCLUSION We have created a nomogram that can be utilized to quantify the risk of postpartum SUI for women with vaginal delivery. The model might contribute to predicting early postpartum SUI, thereby facilitating the management of SUI.
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Affiliation(s)
- Chuangchuang Xu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, China
- Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China
| | - Ying Guo
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, China
- Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China
| | - Xiaolei Chi
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, China
- Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China
| | - Yiyao Chen
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, China
- Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China
| | - Lei Chu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China.
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, China.
- Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China.
| | - Xinliang Chen
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China.
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, 200030, China.
- Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, 200030, China.
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Larsudd-Kåverud J, Gyhagen J, Åkervall S, Molin M, Milsom I, Wagg A, Gyhagen M. The influence of pregnancy, parity, and mode of delivery on urinary incontinence and prolapse surgery-a national register study. Am J Obstet Gynecol 2023; 228:61.e1-61.e13. [PMID: 35932880 DOI: 10.1016/j.ajog.2022.07.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/01/2022] [Accepted: 07/19/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The long-term effects of vaginal delivery, parity, and pregnancy on the pelvic floor remain uncertain and controversial issues. In comparison with studies using self-reported symptoms, surgical register data may offer a more valid means for evaluating the relative influence of these risk factors. OBJECTIVE This study used data from 3 high-quality nationwide registers, namely the Swedish National Quality Register of Gynecological Surgery, the Swedish Medical Birth Register, and the Total Population Register, to evaluate the contribution of vaginal and cesarean delivery, parity, and factors not related to childbirth to the long-term risk for reconstructive urogenital surgery. STUDY DESIGN This was a register-based linkage study among women aged ≥45 years who underwent urinary incontinence or prolapse surgery from 2010 to 2017. This surgical cohort was divided into nulliparous women, women with ≥1 cesarean deliveries only, those with ≥1 vaginal deliveries, and according to the number of births. A corresponding reference group was constructed based on women born in 1960 from the Total Population Register (n=2,309,765). The Swedish Medical Birth Register was used to determine the rate of women with cesarean and vaginal delivery and their respective parity. Absolute and relative risk were presented per 1000 women with 95% confidence intervals. Pairwise differences were analyzed with Fisher exact tests and the Mann-Whitney U test for dichotomous and continuous variables. The trend between ≥3 ordered categories of dichotomous variables was analyzed with Mantel-Haenszel statistics. RESULTS A total of 39,617 women underwent prolapse surgery and 20,488 underwent incontinence surgery. Among women with prolapse surgery, 97.8% had ≥1 vaginal delivery, 0.4% had ≥1 cesarean delivery only, and 1.9% were nullipara. Corresponding figures for those with incontinence surgery were 93.1%, 2.6%, and 4.3%, respectively. Women with vaginal deliveries were overrepresented in the prolapse surgery (relative risk, 1.23; 95% confidence interval, 1.22-1.24; P<.001) and incontinence surgery groups (relative risk, 1.17; 95% confidence interval, 1.15-1.19; P<.001). Nulliparous and cesarean delivered women were underrepresented in the prolapse surgery (relative risk, 0.14; 95% confidence interval, 0.13-0.15 and relative risk 0.055; 95% confidence interval, 0.046-0.065; all P<.001) and incontinence surgery groups (relative risk, 0.31; 95% confidence interval, 0.29-0.33 and relative risk, 0.40; 95% confidence interval, 0.36-0.43). The absolute risk for prolapse surgery was lowest after cesarean delivery (0.09 per 1000 women; 95% confidence interval, 0.08-0.11) and differed by a factor of 23 (absolute risk, 2.11 per 1000 women; 95% confidence interval, 2.09-2.13) from that after vaginal birth. The absolute risk for prolapse and incontinence surgery increased consistently with parity after vaginal births. This trend was not observed after cesarean delivery, which is on par with that of nulliparous women. The first vaginal birth contributed the highest increase in the absolute risk for pelvic organ prolapse surgery (6-fold) and stress urinary incontinence surgery (3-fold). The second vaginal birth contributed the lowest increase in the absolute risk for pelvic organ prolapse surgery (∼1/3 of the first vaginal birth) and for stress urinary incontinence surgery (∼1/10 of the first vaginal birth). CONCLUSION Surgery for urinary incontinence and prolapse was almost exclusively related to vaginal parity. The risk for prolapse surgery increased consistently with parity after vaginal births but not after cesarean delivery, whereas the risk associated with cesarean delivery was on par with that of nulliparous women. Thus, cesarean delivery seems to offer protection from the need for pelvic organ prolapse and stress urinary incontinence surgery later in life.
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Affiliation(s)
- Jennie Larsudd-Kåverud
- Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Obstetrics and Gynecology, Södra Älvsborgs Hospital, Borås, Sweden
| | - Julia Gyhagen
- Department of Obstetrics and Gynecology, Södra Älvsborgs Hospital, Borås, Sweden
| | - Sigvard Åkervall
- Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Mattias Molin
- Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Statistical Consultancy Group, Gothenburg, Sweden
| | - Ian Milsom
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adrian Wagg
- Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maria Gyhagen
- Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Geriatrics, Dalen Hospital, Stockholm, Sweden.
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13
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Sartorão Filho CI, Barbosa AMP, Calderon IDMP, Rudge MVC. Assessment of Pelvic Floor Disorders due to the Gestational Diabetes Mellitus Using Three-Dimensional Ultrasonography: A Narrative Review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:1134-1140. [PMID: 36580942 PMCID: PMC9800152 DOI: 10.1055/s-0042-1759742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Gestational diabetes mellitus (GDM)is an entity with evolving conceptual nuances that deserve full consideration. Gestational diabetes leads to complications and adverse effects on the mother's and infants' health during and after pregnancy. Women also have a higher prevalence of urinary incontinence (UI) related to the hyperglycemic status during pregnancy. However, the exact pathophysiological mechanism is still uncertain. We conducted a narrative review discussing the impact of GDM on the women's pelvic floor and performed image assessment using three-dimensional ultrasonography to evaluate and predict future UI.
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Affiliation(s)
- Carlos Izaias Sartorão Filho
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo (UNESP), Botucatu, SP, Brazil,Department of Medical School, Fundação Educacional do Município de Assis (FEMA), Assis, SP, Brazil
| | - Angélica Mércia Pascon Barbosa
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo (UNESP), Botucatu, SP, Brazil
| | - Iracema de Mattos Paranhos Calderon
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo (UNESP), Botucatu, SP, Brazil
| | - Marilza Vieira Cunha Rudge
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo (UNESP), Botucatu, SP, Brazil,Address for correspondence Marilza Vieira Cunha Rudge Distrito de Rubião Jr s/n 18.618-000, Botucatu, SPBrazil
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Mama ST, Chandra Regmi M. Pelvic Floor Disorders/Obstetric Fistula. Obstet Gynecol Clin North Am 2022; 49:735-749. [DOI: 10.1016/j.ogc.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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Karaca SY, Adıyeke M, İleri A, Vural T, Şenkaya AR, İleri H, Özeren M. Obstetric Perineal Tears in Pregnant Adolescents and the Influencing Factors. J Pediatr Adolesc Gynecol 2022; 35:323-328. [PMID: 34748916 DOI: 10.1016/j.jpag.2021.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/02/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE The incidence and risk factors of obstetric perineal tear occurrence in vaginal delivery of adolescent pregnant patients are not well established. We aimed to describe the incidence of obstetric perineal tears in adolescents and the maternal obstetric risk factors associated with this situation. DESIGN Retrospective cohort study SETTING: Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Izmir, Turkey PARTICIPANTS: Adolescent pregnant patients (≤19 years) who delivered vaginally in our institution between January 2014 and January 2021 INTERVENTIONS AND MAIN OUTCOME MEASURES: The main outcome measures were the incidence of perineal tears, the degree of perineal tears, and the risk factors associated with severe perineal tears in adolescents. Severe perineal tears include third- and fourth-degree lacerations. A third-degree tear is defined as partial or complete disruption of the anal sphincter muscles, and a fourth-degree tear is defined as lacerations involving the rectal mucosa. RESULTS A total of 3441 adolescents who had a vaginal delivery were included in the study. The rate of severe perineal tear was 5.8% (200/3441). Risk factors associated with obstetric laceration in adolescents in multivariate analysis were nulliparity (OR = 1.72; 95% CI, 1.14-2.41; P = 0.007), high birth weight (OR = 4.1; 95% CI, 2.71-6.21; P < 0.001), and labor induction (OR = 1.36; 95% CI, 1.01-1.85; P = 0.02). Spontaneous onset of labor and previous delivery reduced the risk of severe perineal tear in adolescent pregnant patients (respectively, OR = 0.68; 95% CI, 0.51-0.94; P = 0.02 and OR = 0.51; 95% CI, 0.33-0.79; P = 0.007). CONCLUSIONS In adolescents, the risk of severe perineal tear was associated with nulliparity, birth weight, and labor induction. The only possible modifiable risk factor was labor induction.
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Affiliation(s)
- Suna Yıldırım Karaca
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey; Ege University, Institute of Health Sciences, Department of Stem Cell, Izmir, Turkey
| | - Mehmet Adıyeke
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Alper İleri
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey.
| | - Tayfun Vural
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Ayşe Rabia Şenkaya
- Health Sciences University Tepecik Education and Research Hospital, Department of Obstetrics and Gynaecology, Izmir, Turkey
| | - Hande İleri
- Alsancak State Hospital, Department of Family Medicine, İzmir, Turkey
| | - Mehmet Özeren
- Ege University, Institute of Health Sciences, Department of Stem Cell, Izmir, Turkey
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Hübner M, Rothe C, Plappert C, Baeßler K. Aspects of Pelvic Floor Protection in Spontaneous Delivery - a Review. Geburtshilfe Frauenheilkd 2022; 82:400-409. [PMID: 35392067 PMCID: PMC8983111 DOI: 10.1055/a-1515-2622] [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: 01/29/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
The necessity of increasingly addressing aspects of pelvic floor protection, i.e., prevention of the most frequent female pelvic floor disorders, such as urinary incontinence, faecal incontinence and pelvic organ prolapse, is the result of the steadily improving understanding of the association of pregnancy and delivery with the prevalence of these disorders. About a quarter of all women experience one or more such symptoms during their life. Apart from age and weight, pregnancies and births play an important part. While initial discussion of pelvic floor protection often focused very rapidly on the mode of delivery and elective caesarean section as a possible protective intervention, it has become apparent in the last few decades how varied and wide-ranging the options are that can be used to protect against pelvic floor disorders. The mode of delivery as such is "only" one element among numerous other considerations and has diminished markedly in importance. Interprofessionality and interdisciplinarity undoubtedly represent an important development as resulting recommendations must always be incorporated in an overall context that considers mother and child at the same time. Considering the pelvic floor only certainly does not make sense. This review article will analyze in greater detail important pre-, intra- and postpartum aspects that in their entirety can provide insight into the various aspects of pelvic floor protection. The authors regard the following article as an additional basis for discussion on achieving a sustained reduction in the incidence and prevalence of female pelvic floor disorders.
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Affiliation(s)
- Markus Hübner
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
- Medizinische Fakultät der Universität Tübingen, Tübingen, Germany
| | | | - Claudia Plappert
- Institut für Gesundheitswissenschaften, Abt. Hebammenwissenschaft, Universität Tübingen, Tübingen, Germany
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Patel UJ, Godecker AL, Giles DL, Brown HW. Updated Prevalence of Urinary Incontinence in Women: 2015-2018 National Population-Based Survey Data. Female Pelvic Med Reconstr Surg 2022; 28:181-187. [PMID: 35030139 DOI: 10.1097/spv.0000000000001127] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to update estimates of urinary incontinence (UI) prevalence and associated risk factors for adult women in the United States, using the National Health and Nutrition Examination Survey (NHANES). METHODS We used descriptive analysis of 2015-2018 NHANES weighted data for women to estimate prevalence and characterize UI types and severity. Logistic regression modeling determined adjusted associations with UI. RESULTS Complete data were available for 5,006 women. In weighted analyses, 61.8% had UI, corresponding to 78,297,094 adult U.S. women, with 32.4% of all women reporting symptoms at least monthly. Of those with UI, 37.5% had stress urinary incontinence, 22.0% had urgency urinary incontinence, 31.3% had mixed symptoms, and 9.2% had unspecified incontinence. The prevalence of moderate or more severe UI by Sandvik Severity Index was 22.1%, corresponding to 28,454,778 adult U.S. women. In multivariate models, increasing age, body mass index ≥25, prior vaginal birth, anxiety, depression, functional dependence, and non-Hispanic White ethnicity and race were associated with any and moderate UI. Urinary incontinence was not associated with diabetes, education level, prior hysterectomy, smoking status, physical activity level, or current pregnancy status. CONCLUSIONS More than 60% of community-dwelling adult women in the United States experience any UI and an increase from prior estimates (38%-49%) using NHANES data from 1999 to 2004; more than 20% experience moderate or more severe UI. Increases in UI prevalence may be related to population aging and increasing obesity prevalence. Age greater than 70 years, body mass index >40, and vaginal birth had the strongest association with UI in multivariate modeling.
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Affiliation(s)
- Ushma J Patel
- From the Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health (UW SMPH), Madison, WI
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Seeking the Truth About Primary Elective Cesarean Delivery and Pelvic Floor Disorders: A Systematic Review and Meta-Analysis. Female Pelvic Med Reconstr Surg 2022; 28:e108-e114. [PMID: 35272343 DOI: 10.1097/spv.0000000000001164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE A better understanding of the effect of elective cesarean delivery (CD) on the development of pelvic floor disorders can help obstetricians counsel pregnant women. OBJECTIVE This study aimed to perform a systematic review and meta-analysis evaluating whether primary elective CD is protective against pelvic floor disorders. STUDY DESIGN Using the MOOSE criteria, electronic databases were searched for studies that compared the prevalence of pelvic floor disorders among primiparous women. Outcomes of interest were urinary incontinence (UI), fecal incontinence (FI), anal incontinence (AI), and pelvic organ prolapse (POP). Comparisons were made between CD before the onset of labor ("Elective CD"), CD after trial of labor ("Labor CD"), and vaginal delivery (VD). Risk ratios (RRs) were computed using STATA. Between-study heterogeneity was assessed via Cochrane's homogeneity test and review of the I2 statistic. RESULTS Nineteen studies were included. The overall prevalence of UI for Elective CD was estimated at 7% (95% confidence interval [CI], 3%-13%), Labor CD at 14% (95% CI, 8%-21%), and VD at 26% (95% CI, 20%-32%). Meta-analysis demonstrated a decreased risk of UI after Elective CD compared with Labor CD (RR, 0.75; P = 0.011) or VD (RR, 0.43; P < 0.001). There was a decreased risk of FI or AI after Elective CD compared with VD, but not when compared with Labor CD. Only 2 studies examined POP, precluding meta-analysis. CONCLUSIONS Among primiparous women, Elective CD may be protective against UI when compared with Labor CD. There was not a protective effect of Elective CD against FI and AI when compared with Labor CD. More data on the effect of elective CD on POP are needed.
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Bugge C, Strachan H, Pringle S, Hagen S, Cheyne H, Wilson D. Should pregnant women know their individual risk of future pelvic floor dysfunction? A qualitative study. BMC Pregnancy Childbirth 2022; 22:161. [PMID: 35220939 PMCID: PMC8883628 DOI: 10.1186/s12884-022-04490-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study aimed to explore: • pregnant women's and healthcare professionals' perspectives on provision of individual risk scores for future Pelvic Floor Dysfunction (PFD), • the feasibility of providing this during routine maternity care, • actions women might take as a result of knowing their PFD risk. METHODS Qualitative study. SETTING UK NHS Health Board. PARTICIPANTS Pregnant women (n = 14), obstetricians (n = 6), midwives (n = 8) and physiotherapists (n = 3). A purposive sample of pregnant women and obstetric healthcare professionals were introduced to the UR-CHOICE calculator, which estimates a woman's PFD risk, and were shown examples of low, medium and high-risk women. Data were collected in 2019 by semi-structured interview and focus group and analysed using the Framework Approach. RESULTS Women's PFD knowledge was limited, meaning they were unlikely to raise PFD risk with healthcare professionals. Women believed it was important to know their individual PFD risk and that knowledge would motivate them to undertake preventative activities. Healthcare professionals believed it was important to discuss PFD risk, however limited time and concerns over increased caesarean section rates prevented this in all but high-risk women or those that expressed concerns. CONCLUSION Women want to know their PFD risk. As part of an intervention based within a pregnant woman/ maternity healthcare professional consultation, the UR-CHOICE calculator could support discussion to consider preventative PFD activities and to enable women to be more prepared should PFD occur. A randomised controlled trial is needed to test the effectiveness of an intervention which includes the UR-CHOICE calculator in reducing PFD.
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Affiliation(s)
- Carol Bugge
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK.
| | - Heather Strachan
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - Stewart Pringle
- Obstetrics and Gynaecology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research, University of Stirling, Stirling, UK
| | - Don Wilson
- University of Otago, Christchurch, New Zealand
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Wang X, Jin Y, Xu X, Wang H, Feng S. Development and validation of a predictive model for urinary incontinence postpartum: a prospective longitudinal study. Int Urogynecol J 2022; 33:1609-1615. [PMID: 35182156 DOI: 10.1007/s00192-022-05105-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence is a common and burdensome problem amongst women. Although it can be prevented, little progress has been made. Identifying individuals at risk remains the key to the prevention of urinary incontinence. METHODS Eligible women were enrolled in the obstetric wards of a tertiary maternity hospital in 2020. Urinary incontinence was measured using a well-accepted questionnaire. Logistic regression with a backward stepwise process was used for predictor selection. The discrimination and calibration of the nomogram were measured using the area under the ROC curve (AUC), Hosmer-Lemeshow test and calibration curve respectively. Bootstrapping procedure with 1000 resamples was used for internal validity. A temporal split (7:3) was made and data collected from the later period were used for temporal validation. RESULTS Seven predictors including birth mode, urinary incontinence before and during pregnancy, place of residence, feeding pattern, parity, and age at first birth remained in the final model. The AUC was 0.757 (95% CI: 0.72-0.80) and 0.759 (95% CI: 0.70-0.82) in the derivation and validation cohorts respectively. No significant differences were detected in the Hosmer-Lemeshow test and calibration curve in both cohorts. CONCLUSIONS The nomogram proved to be a convenient and reliable tool in the clinical setting for risk assessment of postpartum incontinence, which can be applied during pregnancy and the postnatal period for individual risk estimates of postpartum incontinence.
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Affiliation(s)
- Xiaojuan Wang
- Zhejiang University School of Medicine, No.866 Yu Hang Tang Road, Hangzhou, 310058, Zhejiang Province, China
| | - Ying Jin
- Women's Hospital, School of Medicine Zhejiang University, No.1 Xue Shi Road, Zhejiang Province, 310006, Hangzhou, China
| | - Xuefen Xu
- Women's Hospital, School of Medicine Zhejiang University, No.1 Xue Shi Road, Zhejiang Province, 310006, Hangzhou, China
| | - Hongyan Wang
- Women's Hospital, School of Medicine Zhejiang University, No.1 Xue Shi Road, Zhejiang Province, 310006, Hangzhou, China
| | - Suwen Feng
- Women's Hospital, School of Medicine Zhejiang University, No.1 Xue Shi Road, Zhejiang Province, 310006, Hangzhou, China.
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Ferrari A, Bonciani M, Russo E, Mannella P, Simoncini T, Vainieri M. Patient-Reported Outcome measures for pregnancy-related urinary and fecal incontinence: a prospective cohort study in a large Italian population. Int J Gynaecol Obstet 2022; 159:435-443. [PMID: 35122688 DOI: 10.1002/ijgo.14132] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/26/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate prevalence and risk factors of pregnancy-related urinary/fecal incontinence (UI/FI) in a large Italian population. METHODS This is a prospective cohort study analyzing patient-reported outcome (PRO) measures obtained from the systematic longitudinal survey on the maternity pathway of Tuscany from March 2019 to April 2021. Four questionnaires were completed by 6,023 women from the beginning of pregnancy until six months postpartum, each including two PRO measures - Wexner scale for FI and ICIQ-SF for UI -, and questions investigating sociodemographic/clinical factors. After assessing UI/FI prevalence at each time-point, we run panel regressions to explore the related risk factors. RESULTS Women reporting UI and FI were, respectively, 24.3% and 6.2% in the third trimester, and 12.6% and 4.2% six months postpartum. UI occurrence and severity were higher in highly-educated, aged > 30, and overweight/obese women. Spontaneous tears or episiotomy were risk factors for postpartum UI, while receiving cesarean-section and performing pelvic-floor-muscle-training during pregnancy were protective, mainly in specific groups. Finally, higher FI prevalence and severity emerged in overweight, aged > 40, highly-educated, non-Italian women and in those undergoing tears. CONCLUSION We employed PRO measures to investigate the epidemiology of pregnancy-related UI/FI and detect the main risk groups. Pelvic-floor-muscle-training may be recommended in women with peculiar sociodemographic/clinical features.
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Affiliation(s)
- Amerigo Ferrari
- Anna School of Advanced Studies, Institute of Management, MeS (Management and Health) Laboratory, 56127, Pisa, Italy
| | - Manila Bonciani
- Anna School of Advanced Studies, Institute of Management, MeS (Management and Health) Laboratory, 56127, Pisa, Italy
| | - Eleonora Russo
- University of Pisa, Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, 56126, Pisa, Italy
| | - Paolo Mannella
- University of Pisa, Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, 56126, Pisa, Italy
| | - Tommaso Simoncini
- University of Pisa, Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, 56126, Pisa, Italy
| | - Milena Vainieri
- Anna School of Advanced Studies, Institute of Management, MeS (Management and Health) Laboratory, 56127, Pisa, Italy
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Roman P, Spinelli V, Gauer APM, Fiório FB, Mucke AC, Azzi VJB. Prevalence and factors associated with urinary incontinence in women farmers. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Urinary incontinence (UI) is any involun-tary loss of urine, exhibiting a relationship with pelvic floor muscle weakness and overload. The physical exertion required of the woman farmer may predispose her to higher frequency of UI. Objective: To evaluate the prevalence of UI and associated factors in women farmers. Methods: Cross-sectional study, with appli-cation of an evaluation form and the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) in women aged between 25 and 50 years old. Women with urinary loss responded to the King's Health Questionnaire (KHQ). Data were collected by individual interview. The data were analyzed by absolute and relative frequency, using the Mann-Whitney test for intergroups and Spearman's Correlation Coefficient to relate the variables, considering p < 0.05. Results: Two hundred farmers were interviewed, where 52 (26%) reported involuntary urine loss. The incontinent group had a higher number of annual urinary infection (3.23 ± 1.40). Most incontinent women reported escape 1x/week or less (73.08%), in small amounts (82.69%), during stress (57.69%). Quality of life was classified as very good by 59.62%. The intensity of the work was considered strong by 25% of the incontinent women. Only 30.5% of the volunteers were able to define UI and 97.7% considered it not normal. Conclusion: The prevalence of UI was equivalent to the average of the female population in general, with urinary infection as an associated factor. The loss occurs mainly to stress, and lack of knowledge can reflect in the identification treatment.
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Affiliation(s)
- Priscila Roman
- Universidade do Oeste de Santa Catarina (UNOESC), Brazil
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Roman P, Spinelli V, Gauer APM, Fiório FB, Mucke AC, Azzi VJB. Prevalência e fatores associados à incontinência urinária em agricultoras. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35606.0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Introdução: Incontinência urinária (IU) é qualquer perda involuntária de urina, apresentando relação com sobrecarga e fraqueza da musculatura do assoalho pélvico. O esforço físico exigido da mulher agricultora pode predispor à maior frequência de IU. Objetivo: Avaliar a prevalência e fatores associados à IU em mulheres agricultoras. Métodos: Estudo de corte transversal, com aplicação de ficha de avaliação e do International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) em mulheres com idade entre 25 e 50 anos. As mulheres com perda urinária responderam ao King’s Health Questionnaire (KHQ). A coleta de dados foi por entrevista individual. Os dados foram analisados por frequência absoluta e relativa, sendo empregado o teste de Mann-Whitney para intergrupos e o coeficiente de correlação de Spearman para relacionar as variáveis, considerando p < 0,05. Resultados: Duzentas mulheres agricultoras foram entrevistadas, das quais 52 (26%) referiram perda involuntária de urina. O grupo incontinente apresentou maior número de infecção urinária anual (3,23 ± 1,40). A maior parte das mulheres incontinentes referiram escape 1x/semana ou menos (73,08%), em pequena quantidade (82,69%) e durante o esforço (57,69%). A qualidade de vida foi classificada como muito boa por 59,62%. A intensidade do trabalho foi considerada forte por 25% das mulheres incontinentes. Apenas 30,5% das voluntárias souberam definir IU a e 97,7% consideram não ser normal. Conclusão: A prevalência de IU foi equivalente à média da população feminina em geral, tendo a infecção urinária como fator associado. A perda ocorre principalmente por conta de esforços e a falta de conhecimento pode dificultar a identificação e procura por tratamento.
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Affiliation(s)
- Priscila Roman
- Universidade do Oeste de Santa Catarina (UNOESC), Brazil
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24
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Chang SR, Lin WA, Lin HH, Lee CN, Chang TC, Lin MI. Cumulative incidence of urinary incontinence and associated factors during pregnancy and after childbirth: a cohort study. Int Urogynecol J 2021; 33:1451-1461. [PMID: 34783862 DOI: 10.1007/s00192-021-05011-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study examined the associated factors (i.e., obstetric and maternal-newborn factors) related to cumulative incidence of urinary incontinence and changes in urinary incontinence during pregnancy and the first year postpartum. METHODS This prospective, longitudinal, within-subject study included 501 women who completed the Incontinence Questionnaire-Urinary Incontinence Short Form during pre-pregnancy, early pregnancy, mid-pregnancy, and late pregnancy and at five time points during the first year postpartum. Data were analyzed by multivariate logistic regression, McNemar's and analysis of variance (ANOVA) tests. RESULTS According to the multivariate analysis, the gestational week and number of previous vaginal deliveries increased the risk of cumulative incidence of urinary incontinence (CIUI) during pregnancy (both p < 0.05). Full-time employment, higher body mass index, vaginal delivery and UI during early pregnancy and mid-pregnancy increased the risk of CIUI during the first year postpartum (all p < 0.05). CIUI tended to increase throughout the entire pregnancy (p < 0.001) and decrease from 3 to 5 days to 6 months postpartum (p = 0.028). The prevalence rates of UI at all postpartum visits were lower than those during late pregnancy (p < 0.001-0.009) but higher than those during pre-pregnancy (p < 0.001). CONCLUSIONS The results identified the change patterns in UI and the risk factors associated with CIUI during the entire pregnancy (i.e., gestational age and number of previous vaginal deliveries) and the first year postpartum (i.e., full-time work, higher body mass index, vaginal delivery and UI during early and mid-pregnancy). Appropriate counseling should be provided to women preparing for pregnancy and during the prenatal and postpartum periods.
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Affiliation(s)
- Shiow-Ru Chang
- Department of Nursing, College of Medicine, National Taiwan University and National Taiwan University Hospital, No. 1, Section 1, Jen-Ai Road, 100, Taipei, Taiwan.
| | - Wei-An Lin
- Department of Occupational Medicine, Ten-Chan General Hospital, Taoyuang, Taiwan
| | - Ho-Hsiung Lin
- Department of Obstetrics and Gynecology, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Nan Lee
- Department of Obstetrics and Gynecology, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Ting-Chen Chang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-I Lin
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Time course for urethral neuromuscular reestablishment and its facilitated recovery by transcutaneous neuromodulation after simulated birth trauma in rats. Sci Rep 2021; 11:21591. [PMID: 34732833 PMCID: PMC8566552 DOI: 10.1038/s41598-021-01200-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/25/2021] [Indexed: 11/08/2022] Open
Abstract
The aims of the study were to determine the time-course of urinary incontinence recovery after vaginal distension (VD), elucidate the mechanisms of injury from VD leading to external urethral sphincter (EUS) dysfunction, and assess if transcutaneous electrical stimulation (TENS) of the dorsal nerve of the clitoris facilitates recovery of urinary continence after VD. Rats underwent 4-h VD, 4-h sham VD (SH-VD), VD plus 1-h DNC TENS, and VD plus 1-h sham TENS (SH-TENS). TENS or SH-TENS were applied immediately and at days 2 and 4 post-VD. Micturition behavior, urethral histochemistry and histology, EUS and nerve electrophysiology, and cystometrograms were evaluated. VD induced urine leakage and significantly disrupted EUS fibers and nerve-conduction (VD vs SH-VD group;p < 0.01). Urine leakage disappeared 13 days post-VD (p < 0.001). Structural and functional recovery of EUS neuromuscular circuitry started by day 6 post-VD, but did not fully recover by day 11 post-VD (p > 0.05). TENS significantly decreased the frequency of urine leakage post-VD (days 5–7;p < 0.01). We conclude that rat urinary continence after VD requires 2 weeks to recover, although urethra structure is not fully recovered. TENS facilitated urinary continence recovery after VD. Additional studies are necessary to assess if TENS could be used in postpartum women.
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Natural history of urinary incontinence from first childbirth to 30-months postpartum. Arch Gynecol Obstet 2021; 304:713-724. [PMID: 34175975 DOI: 10.1007/s00404-021-06134-3] [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: 03/08/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The objectives of this study were to determine the incidence of UI in a large cohort of primiparous women before and during pregnancy and over the course of 30-months postpartum, and to identify risk factors for UI during and after pregnancy. METHODS Nulliparous women aged 18-35 years with singleton pregnancies were interviewed in their third trimester and asked about urinary incontinence before and during pregnancy (n = 3001). After delivery these women were interviewed at 1, 6, 12, 18, 24 and 30-months postpartum and asked about urinary incontinence occurring in the month prior to each interview. Multivariable logistic regression models identified risk factors for UI during pregnancy and during the follow-up period. RESULTS Overall, 4% reported having urinary incontinence before pregnancy and 36.8% during pregnancy. The strongest predictor of urinary incontinence during pregnancy was urinary incontinence before pregnancy (adjusted OR 13.11, 95% CI 7.43-23.13). Among the women with no subsequent pregnancies, the rate of urinary incontinence increased from 12.5% at 6-months postpartum to 27.4% at 30-months postpartum, 52.1% reported UI at one or more postpartum data collection stages, and the strongest predictors of postpartum UI were UI before pregnancy (adjusted OR 3.95 (95% CI 1.60-9.75) and during pregnancy (adjusted OR 4.36, 95% CI 3.24-5.87). CONCLUSION Our findings suggest that primiparous women who report UI before and during pregnancy should be monitored for the continuation or worsening of UI over the course of the first 2-3 years postpartum, and treatment options discussed.
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Schrey-Petersen S, Tauscher A, Dathan-Stumpf A, Stepan H. Diseases and complications of the puerperium. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:arztebl.m2021.0168. [PMID: 33972015 PMCID: PMC8381608 DOI: 10.3238/arztebl.m2021.0168] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 02/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND In terms of maternal morbidity and mortality, the puerperium is just as significant as pregnancy and childbirth. Nearly half of all maternal deaths occur in the time after delivery. METHODS This review is based on pertinent articles in English and German from the years 2000- 2020 that were retrieved by a selective search in MEDLINE and EMBASE, as well as on the available guidelines in English and German and on German-language textbooks of obstetrics. RESULTS The most common and severe complications are, in the post-placental phase, bleeding and disturbances of uterine involution; in the first seven days after delivery, infection (e.g., endomyometritis, which occurs after 1.6% [0.9; 2.5] of all births) and hypertension-related conditions. Thromboembolism, incontinence and disorders of the pelvic floor, mental disease, and endocrine disturbances can arise at any time during the puerperium. In an Australian study, the incidence of embolism was 0.45 per 1000 births, with 61.3% arising exclusively after delivery. CONCLUSION Basic familiarity with the most common and severe diseases in the puerperium is important for non-gynecologists as well, among other things because highly acute, lifethreatening complications can arise that demand urgent intervention.
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Affiliation(s)
| | - Anne Tauscher
- Division of Obstretics, University of Leipzig Medical Center
| | | | - Holger Stepan
- Division of Obstretics, University of Leipzig Medical Center
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Gao J, Liu X, Zuo Y, Li X. Risk factors of postpartum stress urinary incontinence in primiparas: What should we care. Medicine (Baltimore) 2021; 100:e25796. [PMID: 34011042 PMCID: PMC8137028 DOI: 10.1097/md.0000000000025796] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/14/2021] [Indexed: 01/05/2023] Open
Abstract
Stress urinary incontinence (SUI) is a common clinical postpartum complication. It is necessary to explore the risk factors of postpartum SUI in primiparas to provide evidence support for preventing and reducing the occurrence of SUI.Primiparas who were delivered in our hospital from March 2019 to October 2020 were identified, the personal information and related treatment details of SUI and no-SUI primiparas were collected and analyzed. Logistic regression analyses were conducted to identify the risk factors of postpartum SUI in primiparas.A total of 612 primiparas were included, the incidence of SUI in primiparas was 32.03%. There were significant differences in the body mass index (BMI) before pregnancy, diabetes, abortion, delivery method, newborn's weight, epidural anesthesia, and duration of second stage of labor (all P < .05) between SUI and no-SUI group, and there were no significant differences in the age, BMI at admission, hypertension and hyperlipidemia SUI and no-SUI group (all P > .05). Logistic regression analyses indicated that BMI before pregnancy ≥24 kg/m2 (odds ratio [OR]: 2.109, 95% confidence interval [CI]: 1.042-4.394), diabetes (OR: 2.250, 95% CI: 1.891-3.544), abortion history (OR: 3.909, 95% CI: 1.187-5.739), vaginal delivery (OR: 2.262, 95% CI: 1.042-4.011), newborn's weight ≥3 kg (OR: 1.613, 95% CI: 1.095-2.316), epidural anesthesia (OR: 2.015, 95% CI: 1.226-3.372), and duration of second stage of labor ≥90 minutes (OR: 1.726, 95% CI: 1.084-2.147) were the risk factors of postpartum SUI in primiparas (all P < .05).The clinical incidence of SUI in primiparas is relatively high. In clinical practice, medical staff should conduct individualized early screening for those risk factors, and take prevention measures to reduce the occurrence of SUI.
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Nishibayashi M, Okagaki R. Ultrasonographic evaluation of pelvic floor structure at antepartum and postpartum periods using three-dimensional transperineal ultrasound. J Med Ultrason (2001) 2021; 48:345-351. [PMID: 33963946 DOI: 10.1007/s10396-021-01100-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the changes in the pelvic floor structure caused by pregnancy and delivery. METHODS A total of 141 nulliparous women were examined with three-dimensional transperineal ultrasound (3D-TPU) at the 24th and 34th weeks of gestation, 5th day postpartum, and 1 month postpartum. Puborectalis muscle trauma was diagnosed and the area of levator hiatus (ALH) was measured. RESULTS One hundred and five normal vaginal deliveries, 19 vacuum/forceps deliveries, and 17 cesarean deliveries were included. In the normal delivery group, the rate of puborectalis muscle trauma was low and showed no significant change between the 24th and 34th weeks of gestation (12.5% vs. 17.2%, p = 0.42). The rate of trauma significantly increased to 70.2% at the 5th day postpartum (p < 0.001). There was no significant difference between the rates at the 5th day postpartum and 1 month postpartum (73.7%, p = 0.60). The same trend was found in the vacuum/forceps group. In the cesarean section group, no significant change was observed throughout pregnancy and postpartum periods. In the normal delivery group, ALH significantly increased between the 24th and 34th week (14.1 ± 2.6 cm2 vs. 14.6 ± 3.4 cm2, p = 0.007). ALH markedly increased to 20.9 ± 4.8 cm2 at the 5th day postpartum (p < 0.001). ALH at 1 month postpartum decreased to 17.0 ± 4.3 cm2 (p < 0.001), but did not return to the value at the 24th week (p < 0.001). CONCLUSIONS Vaginal childbirth results in enlargement of the levator hiatus. Pelvic floor muscles in pregnant women are affected not only by mechanical damage associated with delivery but also by physiologic changes during pregnancy. The effects of pregnancy and delivery on pelvic floor muscles may persist after delivery.
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Affiliation(s)
- Manabu Nishibayashi
- Department of Obstetrics and Gynecology, Nerima-Hikarigaoka Hospital, Japan Association for Development of Community Medicine, 2-11-1 Hikarigaoka, Nerima-ku, Tokyo, 1790072, Japan.
| | - Ryugo Okagaki
- Department of Obstetrics and Gynecology, Saitama Medical University, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama, 3500495, Japan
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Jelovsek JE. Clinical prediction is at the heart of preventing birth trauma and pelvic floor disorders for individual women. Int Urogynecol J 2021; 32:1971-1976. [PMID: 33864475 DOI: 10.1007/s00192-021-04797-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/09/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of this article is to understand that the majority of studies investigating the role of risk factors for maternal birth trauma and pelvic floor disorders are designed using causal inferential statistical methods and have not been designed to investigate the more useful goal of clinical prediction. METHODS A review of the literature was conducted to describe notable causal and predictive associations between risk factors and maternal birth trauma outcomes. Examples were obtained to illustrate and contrast differences in clinical usefulness between causal and predictive models. RESULTS Effects of pregnancy and childbirth on the risk of maternal birth trauma outcomes and subsequent pelvic floor disorders are an area of profound investigation. Numerous observational studies provide evidence that pregnancy and childbirth play a causal role in the increasing prevalence of these outcomes, and clinicians must rely on this observational evidence to guide decisions about preventing maternal birth trauma and pelvic floor disorders. However, there are important differences between the design and evaluation of models for a predictive context including: study design goals, inclusion or exclusion of candidate risk factors, model evaluation and the additional need to assess model error. CONCLUSION This article contrasts how causal and predictive modeling approaches are different and argues that indiscriminately modeling risk factors for birth trauma and pelvic floor disorder outcomes is costly to women.
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Affiliation(s)
- John Eric Jelovsek
- Department of Obstetrics & Gynecology, Duke University School of Medicine, DUMC 3084, Durham, NC, 27710, USA.
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Monti M, Fischetti M, DI Pinto A, Santangelo G, Giannini A, D'Oria O, Golia D'Augè T, Carbone F, Perniola G, DI Donato V, Palaia I, Muzii L, Benedetti Panici P. Update on surgical treatment of female stress urinary incontinence. Minerva Obstet Gynecol 2021; 73:140-144. [PMID: 33103408 DOI: 10.23736/s2724-606x.20.04658-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Urinary incontinence is a common condition that negatively impacts quality of life of millions of women. It is a result of a synergy between the structures of pelvic floor in particular levator ani muscle and pelvic connective tissues. Urinary incontinence, increasing with age, is associated with considerable personal and societal expenditure. EVIDENCE ACQUISITION Systematic data search performed using PubMed/Medline database up to August 20, 2020. Focus was only for English language publications of original studies on urinary incontinence and in particular stress urinary incontinence. EVIDENCE SYNTHESIS Given the basis of published evidence and the consensus of European experts, this study provides an updated overview on clinical applications and surgical procedures of urinary incontinence. CONCLUSIONS Urinary incontinence is an underestimated health problem. Many surgical options exist for women with stress urinary incontinence. Nevertheless, new strategies need to be evaluated in order to improve quality of life of patients.
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Affiliation(s)
- Marco Monti
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Margherita Fischetti
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Anna DI Pinto
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy -
| | - Giusi Santangelo
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Andrea Giannini
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Ottavia D'Oria
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Tullio Golia D'Augè
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Fabiana Carbone
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Violante DI Donato
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
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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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Evaluating the Prevalence of Pelvic Floor Disorders in Women in Nonmetropolitan Communities. Female Pelvic Med Reconstr Surg 2021; 27:e295-e300. [PMID: 33497070 DOI: 10.1097/spv.0000000000000908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Prevalence rates of pelvic floor disorders in women in nonmetropolitan communities compared with metropolitan communities are unknown. We hypothesize that the rates are higher in women in nonmetropolitan communities. METHODS We accessed the health survey data from the NHANES (National Health and Nutrition Examination Survey) from 2009 to 2010 divided by geocodes into nonmetropolitan (<50,000 inhabitants) and metropolitan communities (>50,000). Responses were analyzed for the following conditions: urinary incontinence and nocturia, bowel urgency and anal incontinence, and symptomatic vaginal bulge. Age-adjusted prevalence rates were estimated using logistic regression. RESULTS The 2009-2010 NHANES survey was completed nationwide by 302 women in nonmetropolitan communities and 2201 women in metropolitan communities. Overall, prevalence rates of PFDs did not significantly differ between groups. Prevalence rates of urinary incontinence and nocturia at least weekly were similar between metropolitan and nonmetropolitan groups (16.2% vs 14.6%, P = 0.47), with stress incontinence being more common than urgency and other types of incontinence (40% vs 23% and 8%). Women in metropolitan communities reported more bowel urgency than women in nonmetropolitan communities (33.3% vs 26.8%, P = 0.02); however, prevalence rates between both groups are similar with regards to anal incontinence at least once a month or more (9.2% vs 9.0%, P = 0.76). Prolapse symptoms were also not significantly different between the groups (2.4% in both). There was an increase in prevalence in each of the pelvic floor disorder symptoms with age. CONCLUSIONS Pelvic floor disorders are prevalent and increase with age in women in nonmetropolitan communities at rates similar to women in metropolitan communities.
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Chen Z, Wang X, Jin Y, Feng S. Knowledge, attitude and practice of pelvic floor dysfunction among obstetrical healthcare workers in China: A cross-sectional study. J Gynecol Obstet Hum Reprod 2021; 50:102068. [PMID: 33484932 DOI: 10.1016/j.jogoh.2021.102068] [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: 08/10/2020] [Revised: 01/02/2021] [Accepted: 01/14/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Many women experience pelvic floor dysfunction (PFD) during the perinatal period. Knowledge of PFD among women is poor, which may reflect inadequate provision of information by healthcare workers. The aim of this study was to explore obstetrical healthcare workers' knowledge, attitude, and practice regarding PFD. MATERIAL AND METHODS This study had a cross-sectional design. We developed a 65-question survey to explore obstetrical healthcare workers' knowledge, attitude, and practice regarding PFD. An electronic version of the questionnaire was distributed to healthcare workers from 31 provinces in the People's Republic of China by convenience sampling in July and August 2019. This research complied with the guidelines of the Strengthening of the Reporting of Observational Studies in Epidemiology checklist. RESULTS In total, 1545 valid questionnaires were collected. The mean scores for the knowledge, attitude, and practice of obstetrical healthcare workers were 23.67 ± 4.70 out of 30, 31.91 ± 6.68 out of 40, and 47.88 ± 9.17 out of 65, respectively. Approximately 50 % of the respondents reported providing practical pelvic floor muscle training (PFMT) guidance and evaluation of its correct performance only "sometimes" or even "never". Nearly 30 % of respondents denied asking patients about PFD-related symptoms. Respondents' PFD-related practice were affected not only by their knowledge and attitude but also by their age, treatment or nursing experience of PFD, own PFD history and that of relatives or friends, and the PFD-related departmental setup of their hospital (P < 0.001). CONCLUSION Most obstetrical healthcare workers have knowledge of PFD and hold a positive attitude but fail to routinely provide PFD counseling and mentoring to patients. Many factors affect the respondents' PFD-related practice.
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Affiliation(s)
- Zhengfei Chen
- Zhejiang University School of Medicine Women's Hospital, No.1 Xueshi Road, Hangzhou 310006, Zhejiang Province, China.
| | - Xiaojuan Wang
- Zhejiang University School of Medicine Women's Hospital, No.1 Xueshi Road, Hangzhou 310006, Zhejiang Province, China.
| | - Ying Jin
- Zhejiang University School of Medicine Women's Hospital, No.1 Xueshi Road, Hangzhou 310006, Zhejiang Province, China.
| | - Suwen Feng
- Zhejiang University School of Medicine Women's Hospital, No.1 Xueshi Road, Hangzhou 310006, Zhejiang Province, China.
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Baud D, Sichitiu J, Lombardi V, De Rham M, Meyer S, Vial Y, Achtari C. Comparison of pelvic floor dysfunction 6 years after uncomplicated vaginal versus elective cesarean deliveries: a cross-sectional study. Sci Rep 2020; 10:21509. [PMID: 33299112 PMCID: PMC7726103 DOI: 10.1038/s41598-020-78625-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 11/27/2020] [Indexed: 12/16/2022] Open
Abstract
Clinicians and patients have traditionally believed that elective cesarean section may protect against certain previously ineluctable consequences of labor, including a plethora of urinary, anorectal and sexual dysfunctions. We aimed to evaluate fecal, urinary and sexual symptoms 6 years postpartum, comparing uncomplicated vaginal delivery and elective cesarean delivery, and to assess their impact on quality of life. We conducted a cross-sectional study to compare perineal functional symptomatology between women having singleton elective cesarean deliveries (eCS) and singleton uncomplicated vaginal deliveries (uVD). Women who delivered 6 years before this study were chosen randomly from our hospital database. This database includes demographic, labor, and delivery information, as well as data regarding maternal and neonatal outcomes, all of which is collected at the time of delivery by the obstetrician. Four validated self-administrated questionnaires were sent by post to the participants: the short forms of the Urogenital Distress Inventory, Incontinence Impact Questionnaire, Wexner fecal incontinence scale, and Female Sexual Function Index. Current socio-demographic details, physical characteristics, obstetrical history and mode of delivery at subsequent births were also registered using a self-reported questionnaire. A total of 309 women with uVD and 208 with eCS returned postal questionnaires. The response rate was 49%. Socio-demographic characteristics and fecal incontinence were similar between groups. After eCS, women reported significantly less urgency urinary incontinence (adjusted Relative Risk 0.55; 95% confidence interval 0.34-0.88) and stress incontinence (adjusted Relative Risk 0.53; 95% confidence interval 0.35-0.80) than after uVD. No difference in total Incontinence Impact Questionnaire score was found between both modes of delivery. Lower abdominal or genital pain (adjusted Relative Risk 1.58; 95% confidence interval 1.01-2.49) and pain related to sexual activity (adjusted Relative Risk 2.50; 95% confidence interval 1.19-5.26) were significantly more frequent after eCS than uVD. Six years postpartum, uVD is associated with urinary incontinence, while eCS is associated with sexual and urination pain.
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Affiliation(s)
- David Baud
- Materno-Fetal and Obstetric Research Unit, Woman-Mother-Child Department, University Hospital of Lausanne, CHUV, 1011, Lausanne, Switzerland.
| | - Joanna Sichitiu
- Materno-Fetal and Obstetric Research Unit, Woman-Mother-Child Department, University Hospital of Lausanne, CHUV, 1011, Lausanne, Switzerland
| | - Valeria Lombardi
- Materno-Fetal and Obstetric Research Unit, Woman-Mother-Child Department, University Hospital of Lausanne, CHUV, 1011, Lausanne, Switzerland
| | - Maud De Rham
- Materno-Fetal and Obstetric Research Unit, Woman-Mother-Child Department, University Hospital of Lausanne, CHUV, 1011, Lausanne, Switzerland
| | - Sylvain Meyer
- Materno-Fetal and Obstetric Research Unit, Woman-Mother-Child Department, University Hospital of Lausanne, CHUV, 1011, Lausanne, Switzerland
| | - Yvan Vial
- Materno-Fetal and Obstetric Research Unit, Woman-Mother-Child Department, University Hospital of Lausanne, CHUV, 1011, Lausanne, Switzerland
| | - Chahin Achtari
- Materno-Fetal and Obstetric Research Unit, Woman-Mother-Child Department, University Hospital of Lausanne, CHUV, 1011, Lausanne, Switzerland
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Alalfy M, Osman OM, Salama S, Lasheen Y, Soliman M, Fikry M, Ramadan M, Alaa D, Elshemy S, Abdella R. Evaluation of the Cesarean Scar Niche In Women With Secondary Infertility Undergoing ICSI Using 2D Sonohysterography Versus 3D Sonohysterography and Setting a Standard Criteria; Alalfy Simple Rules for Scar Assessment by Ultrasound To Prevent Health Problems for Women. Int J Womens Health 2020; 12:965-974. [PMID: 33177887 PMCID: PMC7650036 DOI: 10.2147/ijwh.s267691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022] Open
Abstract
Background Many expressions were used to define the defect that is seen by ultrasound after cesarean section (CS) namely scar defect, niche, isthmocele, uterine pouch or diverticula. Objective To compare the accuracy of 2 dimensional sonohysterography (2D SHG) to 3 dimensional sonohysterography (3D SHG) in evaluating cesarean section uterine scar depth (D), base width (BW), width (W) and residual myometrial thickness (RMT) in women with secondary infertility and establishment of a standard criteria; Alalfy simple rules for scar assessment. Patients and Methods This was an observational cross-sectional comparative study that was conducted on women who presented with secondary infertility and were candidates for intracytoplasmic sperm injection (ICSI) and giving a history of a previous cesarean section. Assessment of uterine scar in each woman was performed using 2D transvaginal ultrasound with sonohysterography (SHG) followed by 3D transvaginal with SHG with evaluation of niche depth, width, RMT, niche BW and RMT/depth ratio. The study was conducted at Algezeera hospital, Egypt. Results The present study revealed that 3D ultrasound with SHG is superior in evaluation of the RMT and niche width prior to ICSI providing better characterization of the scar niche. Conclusion Scar niche should be assessed by a combined integrated 2D SHG and 3D SHG scan with the specific geometrical and anatomical considerations, Alalfy simple rules for scar niche assessment that involvemeasurement of niche depth, (Base width) BW, width, RMT and RMT/depth ratio in sagittal plane, RMT in coronal plane / niche width in coronal plane ratio (ratio less than 1 denotes scar weakness with more liability for dehiscence). Trial Registration Clinical Trials.gov Id NCT04076904.
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Affiliation(s)
- Mahmoud Alalfy
- Reproductive Health and Family Planning Department, National Research Centre, Dokki, Cairo, Egypt
| | - Omneya M Osman
- Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, Egypt
| | - Sameh Salama
- Reproductive Health and Family Planning Department, National Research Centre, Dokki, Cairo, Egypt
| | - Yossra Lasheen
- Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, Egypt
| | - Mahmoud Soliman
- Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, Egypt
| | - Mohamed Fikry
- Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, Egypt
| | - Mohamed Ramadan
- Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, Egypt
| | - Doaaa Alaa
- Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, Egypt
| | - Shaimaa Elshemy
- Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, Egypt
| | - Rana Abdella
- Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, Egypt
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Hage-Fransen MAH, Wiezer M, Otto A, Wieffer-Platvoet MS, Slotman MH, Nijhuis-van der Sanden MWG, Pool-Goudzwaard AL. Pregnancy- and obstetric-related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2020; 100:373-382. [PMID: 33064839 DOI: 10.1111/aogs.14027] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 09/05/2020] [Accepted: 10/08/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Risk factors for pelvic floor disorders are often related to pregnancy and delivery. Consistent evidence is needed to develop prevention strategies targeting risk factors. The objective of this study is to identify which pregnancy- and/or obstetric-related risk factors can predict urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life by means of a systematic review and meta-analysis. MATERIAL AND METHODS Systematic review Prospero number: CRD42019131758. Literature searches of PubMed, EMBASE, CINAHL, and Cochrane Library were conducted according to PRISMA guidelines (April 2020). Prospective cohort studies describing more than two pregnancy- and/or obstetric-related risk factors on urinary incontinence, fecal incontinence (including flatal incontinence), or pelvic organ prolapse were eligible. Risk of bias was assessed (using Quality In Prognosis Studies [QUIPS]). Studies with high risk of bias were excluded. Data were extracted and checked for accuracy with the CHARMS checklist. Sub-groups were used to distinguish between a short- and long-term follow-up period: <18 months (shortterm) and >18 months (long-term) postpartum. Odds ratios were calculated from reported prevalence rates. Log odds ratios were calculated using SPSS v.24. Variables were pooled using RevMan5. RESULTS Data were extracted from nineteen studies for urinary incontinence, nine for fecal incontinence, and two for pelvic organ prolapse. Multivariate analysis was not possible because of the heterogeneity of the population and outcome measures. Pooled univariate risk factors for urinary incontinence were: urinary incontinence during pregnancy, instrumental vaginal delivery, episiotomy, tears, and constipation. Pooled univariate risk factors for fecal incontinence were: fecal incontinence during pregnancy, maternal age over 35 years, prenatal body mass index over 30 kg/m2 , instrumental vaginal delivery, a spontaneous vaginal delivery, oxytocin augmentation, and when the weight of the newborn was more than 4000 g. Both studies for pelvic organ prolapse had a short-term follow-up period and cesarean section was the only risk factor that could be pooled. CONCLUSIONS Pregnancy- and obstetric-related risk factors predicting pelvic floor disorders postpartum are multifactorial and differ between pelvic floor disorders. The strongest risk factor for incontinence later in life was incontinence during pregnancy. Better quality research with long-term follow up is needed on this topic.
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Affiliation(s)
| | - Maaike Wiezer
- Physical Therapy Practice Fysi-Unique, Amersfoort, the Netherlands
| | - Amy Otto
- Faculty of Behavior Human Movement Sciences, Amsterdam Movement Sciences, VU University Amsterdam, Amsterdam, the Netherlands
| | | | | | | | - Annelies L Pool-Goudzwaard
- Faculty of Behavior Human Movement Sciences, Amsterdam Movement Sciences, VU University Amsterdam, Amsterdam, the Netherlands.,Somt University of Physiotherapy, Amersfoort, the Netherlands
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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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Wang Y, Li H, Wang J, Hao Q, Tu Y, Chen Y, Qiu M, Peng W, Liu Y, Zhu T. A network meta-analysis protocol of conservative interventions for urinary incontinence in postpartum women. Medicine (Baltimore) 2020; 99:e21772. [PMID: 32872075 PMCID: PMC7437778 DOI: 10.1097/md.0000000000021772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Postpartum urinary incontinence (PPUI) is a common urological condition in women after childbirth. Due to the side effects of surgical and pharmacological therapies, the patients and physicians alike express a strong preference for conservative approaches on PPUI, such as pelvic floor muscle training, biofeedback, electrical stimulation, bladder training, vaginal cones and acupuncture. Application of these conservative approaches should be guided by high quality evidence, yet their comparative effectiveness has not been well documented. Therefore, the network meta-analysis aims to compare, rank and summarize all available studies to determine which conservative intervention is more effective for PPUI. METHODS In this present study, qualified English and Chinese studies will be searched in PubMed, Scopus, EMBASE, The Cochrane Library, Web of Science, VIP Database, Wanfang Database, Chinese Biomedical Literature Database and China National Knowledge Infrastructure. All eligible randomized controlled trails (RCTs) of conservative interventions for PPUI will be included. R software 3.61 (R Foundation for Statistical Computing, Vienna, Austria) will be applied to synthesize data and conduct network meta-analysis. I statistic and Z test will be used to assess heterogeneity and inconsistency, respectively. RESULTS Ethical approval is not required for this existed literature based meta-analysis. The findings of this research will be disseminated through a recognized journal. CONCLUSION The findings of this study will provide ranking evidence for clinicians and patients to choose a more appropriate conservative therapy on PPUI. TRIAL REGISTRATION NUMBER PROSPERO CRD42020168042.
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Affiliation(s)
- Yang Wang
- School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine
- Department of Rehabilitation, Shuangliu Maternal and Child Health Care Hospital
| | - Hui Li
- School of Medicine, Chengdu University
| | - Jun Wang
- School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine
| | - Qinghong Hao
- School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine
| | - Yang Tu
- School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine
| | - Yalin Chen
- School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine
| | - Mimi Qiu
- School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine
| | - Wei Peng
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Yunlu Liu
- Institute of Laboratory Animal Sciences
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Tianmin Zhu
- School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine
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Andrade BFD, Katz L, Rangel AEDO, Guendler JDA. Assessment on the measurement properties of the Brazilian Portuguese language version of the International Consultation on Incontinence Questionnaire Female Sexual Matters Associated with Lower Urinary Tract Symptoms Module (ICIQ-FLUTSsex). REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2020. [DOI: 10.1590/1806-93042020000200013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to assess internal consistency and reliability in providing a Portuguese version of the International Consultation on Incontinence Questionnaire Female Sexual Matters Associated with Lower Urinary Tract Symptoms Module (ICIQ-FLUTSsex). Methods: a validation study was conducted by applying questionnaires for 56 women over 18 years old with active sexual life and presenting urinary incontinence, excluding those who had urinary infection in the past 6 months. Three questionnaires were used, one for personal identification; the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the ICIQ-FLUTSsex. SPSS software was used for data analysis. Cronbach's alpha was used to verify reliability of the items on the questionnaires and Kappa coefficient was used to assess the agreement between the questionnaires applied in the test-retest. Results: the median age was 49.1 years old, mostly were mixed colored skin and married, with a high prevalence of mixed urinary incontinence. Cronbach's alpha score was 0.80, which was considered good. Kappa value was moderate, ranging from 0.36 to 0.76. Conclusion: internal consistency was considered good and reliability moderate. The Portuguese version of ICIQ-FLUTSsex was proven to be valid to use on women with urinary incontinence, contributing for clinical practice, as it provides as a quick tool for research on sexual dysfunction.
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Affiliation(s)
| | - Leila Katz
- Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
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Sawaqed F, Al Kharabsheh A, Tout M, Zaidan M, Khashram H, AlShunaigat N. Prevalence of stress urinary incontinence and its impact on quality of life among women in Jordan: a correlational study. J Int Med Res 2020; 48:300060520925651. [PMID: 32459115 PMCID: PMC7273785 DOI: 10.1177/0300060520925651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective The study investigated the prevalence and impact of stress urinary
incontinence (SUI) among women in Jordan. Methods A correlational study was conducted to evaluate 500 Jordanian women aged
>20 years. Women with symptoms of dementia, delirium, neurodegenerative
changes and osteodegenerative changes were excluded. Data were collected
using self-administered questionnaires (Arabic version of the Urogenital
Distress Inventory-6 and Incontinence Impact Questionnaire (IIQ-7) short
forms). Results A total of 200 (40%) women reported SUI; 47% reported mild symptoms, 37%
reported moderate symptoms and 16% reported severe symptoms. There were
positive correlations between SUI prevalence and number of pregnancies, age
and obesity. SUI had a substantial impact on all aspects of quality of life
(QoL), as assessed by the IIQ-7. Conclusions A moderate prevalence of SUI was reported. There was a significant
association between development of SUI and age, higher body mass index and
number of pregnancies. Because SUI is highly prevalent and has a major
effect on QoL, healthcare professionals should inquire about this condition
and refer patients to related specialties for treatment.
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Affiliation(s)
- Fadi Sawaqed
- Department of Special Surgery, Faculty of Medicine, Mu'tah University, Karak, Jordan
| | - Ahlam Al Kharabsheh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mu'tah University, Karak, Jordan
| | - Mohammad Tout
- Faculty of Medicine, Mu'tah University, Karak, Jordan
| | | | | | - Nadeem AlShunaigat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Rantell A, Veit-Rubin N, Giarenis I, Khullar V, Abrams P, Cardozo L. Recommendations and future research initiative to optimize bladder management in pregnancy and childbirth International Consultation on Incontinence - Research society 2018. Neurourol Urodyn 2020; 38 Suppl 5:S104-S110. [PMID: 31821638 DOI: 10.1002/nau.24053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/19/2019] [Accepted: 05/19/2019] [Indexed: 11/05/2022]
Abstract
With increasing birth rates globally, obstetric bladder care and long term pelvic floor dysfunction continues to be a issue. This paper aims to provide an overview of the concerns in the antenatal, intrapartum an post partum periods and presents recommendation for the research requirements necessary and education to challenge current practice.
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Affiliation(s)
- Angie Rantell
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Ilias Giarenis
- Department of Urogynaecology, Norfolk and Norwich Hospital, Norwich, UK
| | - Vik Khullar
- Department of Urogynaecology, Imperial College London, London, UK
| | - Paul Abrams
- Department of Urology, Bristol Urological Institute, Bristol, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
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Åkervall S, Al-Mukhtar Othman J, Molin M, Gyhagen M. Symptomatic pelvic organ prolapse in middle-aged women: a national matched cohort study on the influence of childbirth. Am J Obstet Gynecol 2020; 222:356.e1-356.e14. [PMID: 31639370 DOI: 10.1016/j.ajog.2019.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/03/2019] [Accepted: 10/13/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND The relative impact of age, pregnancy, and vaginal delivery on symptomatic pelvic organ prolapse is still an unresolved issue that involves the controversial question about the protective effect of cesarean section. OBJECTIVE The purpose of this study was to compare the age-related prevalence of symptomatic genital prolapse in nulliparous, vaginal- and cesarean-delivered women aged 40-64 years. STUDY DESIGN This Swedish, nationwide matched cohort study involved 14,335 women. Three restricted, randomly selected source cohorts of women (nulliparous women unexposed to childbirth [n = 9136], 1-para cesarean delivered women, exposed to 1 pregnancy [n = 1412], and 1-para women exposed to 1 pregnancy followed by vaginal delivery [n = 3787]) were retrieved from the Swedish Medical Birth Register and Statistics Sweden and surveyed in 2008 and 2014. The surveys used a postal and Internet-based questionnaire containing validated questions for pelvic floor disorders. Symptomatic prolapse was defined by the question, "Do you have a sensation of tissue protrusion (a vaginal bulge) from your vagina?" In this study the symptom frequencies, sometimes and often, were defined as a positive response. Parous women were all assessed 20 years postnatally. One-to-one matching with an age interval for pairing of 3 years and 3 units of body mass index (kilograms per square meter) was used in women aged 40-64 years. The procedure succeeded in 2635 of 2640 women (99.8%), resulting in an adequate distribution of age and body mass index (kilograms per square meter) between matched groups. For comparison between groups, a Fisher exact test was used for categorical variables and the Mann-Whitney U test for continuous variables. Trend between matched groups was analyzed with Mantel-Haenszel statistics. Estimated, age-related values of symptomatic prolapse were obtained by logistic regression analysis. RESULTS In nulliparous and cesarean-delivered women, the prevalence of symptomatic prolapse was relatively similar and below 5% across ages 40-64 years. In contrast, in women after vaginal delivery, there was an accelerating increase in the prevalence of symptomatic genital prolapse up to 65 years of age. Estimated probability from the regression model increased 4-fold, from 3.8% at 40 years to 13.4% at 64 years of age. The observed induction period associated with 1 vaginal delivery seemed to be at least 20 years among women giving birth in their early 20s. At age 64 years, the estimated probability of symptomatic prolapse was 12 times higher after vaginal delivery compared with cesarean deliery (13.4% [95% confidence interval, 9.4-18.9] vs 1.1% [95% confidence interval, 0.4-2.5], P < .0001). The calculated reduction of symptomatic prolapse by cesarean delivery at 64 years of age was thus 92%. CONCLUSION In this national matched cohort study, the interaction between vaginal delivery and aging was the most important factor for the occurrence of symptomatic prolapse. Because the effect of aging can be modified only to a small extent, preventive strategies for genital prolapse should focus on how to avoid the adverse events related to a vaginal delivery.
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Thangarajah F, Hartmann-Wobbe J, Ratiu D, Pahmeyer C, Radosa JC, Mallmann P, Ludwig S. The Onset of Urinary Incontinence in Different Subgroups and its Relation to Menopausal Status: A Hospital-based Study. In Vivo 2020; 34:923-928. [PMID: 32111805 DOI: 10.21873/invivo.11859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Numerous risk factors have been reported to influence the development of urinary incontinence (UI). In this study, we took a closer look on the different forms of UI and tried to identify differences in regard to potential risk factors. Of special interest was the onset of UI symptoms and its relation to menopausal status. PATIENTS AND METHODS This was a hospital-based analysis of patients who presented with urinary incontinence in the outpatient ward of a tertiary hospital. The diagnosis of urinary incontinence was based on the subjective complaints of patients. Data concerning menopausal status, hormone replacement therapy, prior hysterectomy were assessed. RESULTS The mean age was 53.8 years in the SUI group, 62.7 years in the MUI group and 66.1 years in the UUI group, respectively (p<0.001). The proportion of patients with UUI was higher in the postmenopausal group, whereas the proportion of SUI was higher in the premenopausal group (p<0.001). The mean age in which complaints occurred was significantly lower in the SUI group (45.4 years) compared to the MUI (51.0 years) and UUI groups (54.7 years) (p<0.001). There was no correlation between menopausal status and onset of urinary incontinence (p=0.143). CONCLUSION Additional anamnestic information help further characterize the different types of urinary incontinence that can lead to an optimization of treatment options. Younger age and premenopausal status were accompanied by milder forms of UI while menopausal status itself had no influence on the onset of UI symptoms indicating that age-related changes may lead to different types of incontinence.
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Affiliation(s)
- Fabinshy Thangarajah
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Jessica Hartmann-Wobbe
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Dominik Ratiu
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Caroline Pahmeyer
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Julia Caroline Radosa
- Clinic for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, Homburg, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Sebastian Ludwig
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
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Gachon B, De Tayrac R, Schmitz T, Mahmood T, Nizard J, Fritel X. Should we advise women that pre-labor caesarean section prevents pelvic floor dysfunction? Eur J Obstet Gynecol Reprod Biol 2020; 244:31-34. [DOI: 10.1016/j.ejogrb.2019.10.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/30/2019] [Accepted: 10/22/2019] [Indexed: 01/04/2023]
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Pelvic floor muscles after birth: Do unstable shoes have an effect on pelvic floor activity and can this be measured reliably? – A feasibility study / Der Beckenboden nach der Geburt: Verändern instabile Schuhe die Aktivität und kann diese reliabel gemessen werden? – Eine Machbarkeitsstudie. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2019. [DOI: 10.2478/ijhp-2019-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background
Women often suffer from urinary incontinence after childbirth. Pelvic floor muscle training is an evidenced-based intervention to prevent urinary incontinence and improve its symptoms
Aim
The primary purpose of this study was to determine if there is a change in the activation of the pelvic floor muscles with different extrinsic parameters (barefoot versus unstable shoe). Second, we wanted to define variables that can be measured reliably and correlated with pelvic floor activity.
Methods
Data of 15 women who were 8 weeks to 6 months postpartum were analyzed. Two conditions (“barefoot” and “kyBoot”) were tested, with each participant performing three different tasks: walking, standing with an active pelvic floor, and standing with a passive pelvic floor. Three-dimensional kinematics of the body were recorded. Activity of the abdominal, back, and gluteal muscles was measured using surface electromyography (EMG). The activity of the pelvic floor was recorded using a vaginal electrode. Maximum pelvic floor activity was compared for each condition, and correlations among pelvic floor activity, kinematic variables, and skeletal muscle activity were determined.
Results
The maximum activity of the pelvic floor while walking was significantly higher when participants were barefoot than when they were wearing kyBoot shoes. For the standing trials, no significant differences between the conditions were detected. No surrogate marker was found to measure the pelvic floor activity.
Conclusion
With regard to the pelvic floor musculature, no recommendation is possible in favor of or against wearing unstable shoes. Technical developments are necessary to provide solutions to reliably measure the pelvic floor activity.
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Gyhagen M, Åkervall S, Molin M, Milsom I. The effect of childbirth on urinary incontinence: a matched cohort study in women aged 40-64 years. Am J Obstet Gynecol 2019; 221:322.e1-322.e17. [PMID: 31121136 DOI: 10.1016/j.ajog.2019.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/04/2019] [Accepted: 05/14/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The relative impact of age, pregnancy and vaginal delivery on urinary incontinence is still an unresolved issue that involves the controversial question about the protective effect of cesarean delivery. OBJECTIVE The purpose of this study was to estimate and compare the effect size of 1 pregnancy, 1 vaginal delivery, and the derived protective effect of cesarean delivery for different aspects of urinary incontinence in women 40-64 years old, all 20 years after birth. STUDY DESIGN This Swedish nationwide matched cohort study involved 14,335 women. Data from 3 restricted, randomly selected, source cohorts of (1) nulliparous women who were unexposed to childbirth (n=9136), (2) primiparous women who had experienced cesarean delivery and who had been exposed to 1 pregnancy (n=1412), and (3) primiparous women who had been exposed to 1 pregnancy followed by vaginal delivery (n=3787) were retrieved from The Swedish Medical Birth Register and Statistics Sweden and surveyed in 2008 and 2014, respectively. Parous women were all assessed 20 years postnatally. One-to-one matching with an interval for pairing of 3 years and 3 body mass index units was used in women 40-64 years old with information about body mass index (kilograms/square meters) and urinary incontinence. The procedure succeeded in 2630 of 2635 women (99.8%) and resulted in an adequate distribution of age and body mass index between groups. The surveys used a postal- and an internet-based questionnaire with validated questions for various aspects of urinary incontinence. Fisher's exact test and the Mann-Whitney U test were used for comparisons between matched groups; trend was analyzed with Mantel-Haenszel statistics. Predicted, age-related values of different aspects of urinary incontinence were obtained by logistic regression analysis. RESULTS Pregnancy increased the prevalence of urinary incontinence from 20.1-30.1% (odds ratio, 1.71; 95% confidence interval, 1.43-2.05; P<.0001]. Urinary incontinence increased further after vaginal delivery to 43.0% (odds ratio, 1.75; 95% confidence interval, 1.49-2.05; P<.0001); "moderate" and "severe" urinary incontinence increased from 12.7-19.5% (odds ratio, 1.67; 95% confidence interval, 1.35-2.07; P <.0001). There was a parallel increase in urinary incontinence from 40-65 years of age in nulliparous and vaginally and cesarean delivered women. Cesarean delivery, compared with vaginal delivery, was associated with a 30.0% reduction of urinary incontinence (P<.0001) and a 35-52% reduction of more severe grades of urinary incontinence (P<.0001) and was unaffected by age. CONCLUSION Both pregnancy and vaginal delivery incurred an increased risk of urinary incontinence in the long term. The age-related gap for urinary incontinence between nulliparous and primiparous women who were delivered by vaginal delivery or cesarean delivery was constant between parallel trajectories that spanned ages from 40-64 years. The calculated protective effect of cesarean delivery was unaltered and significant during the same age interval.
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Affiliation(s)
- Maria Gyhagen
- Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Obstetrics and Gynecology, Södra Älvsborgs Hospital, Borås, Sweden.
| | - Sigvard Åkervall
- Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Mattias Molin
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ian Milsom
- Statistical Consultancy Group, Gothenburg, Sweden
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Gommesen D, Nohr EA, Drue HC, Qvist N, Rasch V. Obstetric perineal tears: risk factors, wound infection and dehiscence: a prospective cohort study. Arch Gynecol Obstet 2019; 300:67-77. [PMID: 31004221 DOI: 10.1007/s00404-019-05165-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/12/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess risk factors for perineal tears, wound infection and dehiscence among primiparous women. METHODS A prospective cohort study at four Danish hospitals (Odense, Esbjerg, Aarhus and Kolding) among 603 primiparous women sampled in three groups: 203 with none/labia/1st degree, 200 with 2nd degree, and 200 with 3rd/4th degree tears included between July 2015 and January 2018. Baseline data were obtained and a clinical examination of perineal wound healing was performed 11-21 days postpartum. Main outcome measurements were as follows: degree of perineal tear, 1st to 4th, analyzed with a case-control approach, infection (purulent drainage or wound abscess), and wound dehiscence (a gap between wound edges > 0.5 cm). RESULTS Instrumental delivery and birthweight > 4000 g increased the risk of 3rd/4th degree tears (adjusted Odds Ratio [aOR] 13.7, 95% confidence interval [CI] 5.48-34.1 and aOR 3.27, 95% CI 1.52-7.04, respectively). BMI > 35 kg/m2 increased the risk of wound infection and dehiscence (aOR 7.66, 95% CI 2.13-27.5 and aOR 3.46, 95% CI 1.10-10.9, respectively). Episiotomy tripled the risk of infection (aOR 2.97, 95% CI 1.05-8.41). Treatment with antibiotics during delivery and postpartum seemed to decrease the risk of dehiscence (aOR 0.32, 95% CI 0.15-0.70). CONCLUSIONS Instrumental delivery and high birth weight increased the risk of perineal tears. Severe obesity and episiotomy increased the risk of perineal wound complications. More focus on these women may be warranted postpartum. The use of prophylactic antibiotics among women in high risk of wound complications should be further investigated in interventional studies.
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Affiliation(s)
- Ditte Gommesen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Department of Gynaecology and Obstetrics, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - Ellen Aagaard Nohr
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
| | - Henrik Christian Drue
- Department of Radiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
| | - Niels Qvist
- Department of Gastroenterological Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
| | - Vibeke Rasch
- Department of Gynaecology and Obstetrics, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
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