1
|
Min L, Xudong D, Qiubo L, Pingping L, Yuhan L, Guifang Z, Tianzi G, Qing F, Chunxue Y, Yaxin L. Two year follow-up and comparison of pelvic floor muscle electromyography after first vaginal delivery with and without episiotomy and its correlation with urinary incontinence: A prospective cohort study. Acta Obstet Gynecol Scand 2022; 102:200-208. [PMID: 36448197 PMCID: PMC9889321 DOI: 10.1111/aogs.14487] [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] [Received: 07/17/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Few prospective studies have revealed the long-term neuromuscular alterations of pelvic floor after vaginal delivery. The aim of this study was to evaluate the impact of episiotomy on the electrical activity of pelvic floor muscle 2 years following vaginal delivery, and explore the relation between surface electromyography (sEMG) amplitudes and urinary incontinence. MATERIAL AND METHODS A total of 427 primiparous women with full-term singleton vaginal delivery were included in the cohort and 362 with no further births within the 2 year follow-up completed observations. Of these, 200 underwent episiotomy and 162 underwent nonepisiotomy. Clinical demographic characteristics, vaginal EMG variables and urinary incontinence-specific questionnaire scores were collected at 6 weeks, 6, 12 and 24 months after childbirth, respectively. Primary outcomes were the comparison of sEMG values between the episiotomy and nonepisiotomy groups throughout 2 years. Secondary outcomes were the correlation between sEMG of both groups and the incidence and severity of urinary incontinence. Spearman's correlation analysis, Kruskal-Wallis test and ANOVA with Bonferroni correction were used to analyze the variables. RESULTS Amplitude of maximal fast and endurance contractions on sEMG in the episiotomy group was significantly lower than the nonepisiotomy counterpart. Such difference of sEMG persisted for a long period after birth: endurance contraction, 33.12 ± 8.92 vs 35.085 ± 9.98, p < 0.01 at 24 months, and fast contraction, 36.53 ± 8.87 vs 39.05 ± 9.98, p = 0.01 at 12-month. Although there was no significant difference in incidence and severity of urinary incontinence between both groups, a negative correlation existed between EMG values of muscle contraction and urinary incontinence symptoms throughout. CONCLUSIONS Primiparous women delivered with episiotomy demonstrated lower contractile sEMG activity of pelvic floor muscle in the long term. The lower sEMG values of fast contraction were associated with urinary incontinence symptoms.
Collapse
Affiliation(s)
- Li Min
- Department of Gynecology and ObstetricsBeijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina,The First People's Hospital of Yunnan ProvinceAffiliated Hospital of Kunming University of Science and TechnologyKunmingChina
| | - Dong Xudong
- Department of Obstetrics, The First People's Hospital of Yunnan ProvinceAffiliated Hospital of Kunming University of Science and TechnologyKunmingChina
| | - Lyu Qiubo
- Department of Gynecology and ObstetricsBeijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
| | - Li Pingping
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing HospitalBeijingChina
| | - Lyu Yuhan
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing HospitalBeijingChina
| | - Zhang Guifang
- Department of Epidemiology, The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
| | - Gai Tianzi
- Department of Gynecology and ObstetricsBeijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
| | - Feng Qing
- Department of Gynecology and ObstetricsBeijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
| | - Yang Chunxue
- Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing HospitalBeijingChina
| | - Liang Yaxin
- The Key Laboratory of Geriatrics, Beijing Institute of GeriatricsBeijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingChina
| |
Collapse
|
2
|
Zhu H, Zhang D, Gao L, Liu H, Di Y, Xie B, Jiao W, Sun X. Effect of Pelvic Floor Workout on Pelvic Floor Muscle Function Recovery of Postpartum Women: Protocol for a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191711073. [PMID: 36078788 PMCID: PMC9517758 DOI: 10.3390/ijerph191711073] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 05/15/2023]
Abstract
BACKGROUND There is a risk of pelvic floor dysfunction (PFD) from baby delivery. Many clinical guidelines recommend pelvic floor muscle training (PFMT) as the conservative treatment for PFD because pelvic floor muscles (PFMs) play a crucial role in development of PFD. However, there is disagreement about the method and intensity of PFM training and the relevant measurements. To pilot the study in PFM training, we designed a Pelvic Floor Workout (PEFLOW) for women to train their pelvic through entire body exercises, and we planned a trial to evaluate its effectiveness through comparing the outcomes from a group of postpartum women who perform PELFLOW at home under professional guidance online with the control group. METHODS/DESIGN The randomized controlled trial was projected to be conducted from November 2021 to March 2023. A total of 260 postpartum women would be recruited from the obstetrics departments of the study hospital and women would be eligible for participation randomized into experimental or control groups (EG/CG) if their PFM strength are scaled by less than Modified Oxford grading Scale (MOS) to be less than grade 3. Women in EG would perform a 12-week PEFLOW online under the supervision and guidance of a physiotherapist, while women in CG would have no interventions. Assessments would be conducted at enrollment, post intervention (for EG) or 18th to 24th week postpartum (for CG), and 1 year postpartum. Assessment would be performed in terms of pelvic floor symptoms, including MOS, cough stress test, urinary leakage symptoms, pelvic organ prolapse quantitation (POP-Q), and vaginal relaxation, clinic examinations including Pelvic floor electrophysiological test, Pelvic floor ultrasound and Spine X-ray, overall body test including trunk endurance test, handgrip test, body composition test, and questionnaires including International Physical Activity Questionnaire Score-Short Form(IPAQ-SF), Pelvic Floor Distress Inventory Questionnaire-20 (PFDI-20), Pelvic Floor Impact Questionnaire-7 (PFIQ-7), the 6-item Female Sexual Function Index (FSFI-6), and the Pittsburgh Sleep Quality Index (PSQI). Primary analysis will be performed to test our main hypothesis that PEFLOW is effective with respect to strengthen PFM strength. DISCUSSION This trial will demonstrate that pelvic floor-care is accessible to most women and clinical practice on PFD may change relevantly should this study find that Online PEFLOW approach is effective to improve PFMs. TRIAL REGISTRATION ClinicalTrials.gov, NCT05218239.
Collapse
Affiliation(s)
- Hongmei Zhu
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China
- Department of Sports medicine and rehabilitation, Beijing Sports University, No.48, Xin Xi Road, Hai Dian District, Beijing 100084, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
| | - Di Zhang
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
| | - Lei Gao
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
| | - Huixin Liu
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
| | - Yonghui Di
- Department of Sports medicine and rehabilitation, Beijing Sports University, No.48, Xin Xi Road, Hai Dian District, Beijing 100084, China
| | - Bing Xie
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
| | - Wei Jiao
- Department of Sports medicine and rehabilitation, Beijing Sports University, No.48, Xin Xi Road, Hai Dian District, Beijing 100084, China
- Correspondence: (W.J.); (X.S.)
| | - Xiuli Sun
- Department of Obstetrics and Gynecology, Peking University People’s Hospital, No. 11, Xi-Zhi-Men South Street, Xi Cheng District, Beijing 100044, China
- The Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
- Correspondence: (W.J.); (X.S.)
| |
Collapse
|