1
|
Rousseau M, Asselin I, Morello R, Lecoutour X, Brouard J, Fauvet R, Pizzoferrato AC. Prevalence and factors associated with active cybersexuality among teenagers between 15 and 17 years old: a cross sectional study in Normandy, France. Arch Pediatr 2023:S0929-693X(23)00030-1. [PMID: 37147154 DOI: 10.1016/j.arcped.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/13/2022] [Accepted: 01/29/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Teenagers use the Internet to obtain and exchange information in multiple fields, including about taboo subjects such as sexuality. Our objectives were to determine the prevalence and vulnerability factors related to active cybersexuality among teenagers aged between 15 and 17 years in western Normandy. MATERIAL AND METHODS This was an observational, cross-sectional, multicenter study integrated into sexual education classes for teenagers between 15 and 17 years old. An anonymous questionnaire, designed for the study, was given at the beginning of each session. RESULTS The study had a 4-month duration and involved 1,208 teenagers. The results revealed that 66% of them engaged in cybersex, with sexting being the most widespread practice: 21% sent such sexts, 60% received such sexts, and 12% of boys shared such texts with others. Other practices, such as dedipix, dating websites, and skin parties, were more marginal, but 12% of teenagers had met someone in real life after meeting them first online. A history of experiencing violence, a lack of parental control, female gender, poor self-esteem, and consuming toxic drugs were associated with a higher risk of cybersexuality with an odds ratio (OR) of 1.63, 1.95, 2.07, 2.27, and 2.66, respectively. Number of friends on social networks >300 and daily viewing of pornography were also strongly associated with cybersexuality with an OR of 2.83 and 6.18, respectively. CONCLUSIONS This study shows that cybersex is practiced by two thirds of teens. Vulnerability factors most strongly associated with cybersexuality were female gender, poor self-esteem, consuming toxic drugs, number of friends on social networks >300, and daily viewing of pornography. Cybersexuality involves risks (social exclusion, bullying, dropout, poor self-esteem, breakdown) that are possible to prevent by highlighting this theme during sexual education classes.
Collapse
Affiliation(s)
- M Rousseau
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, Caen University Hospital, Caen, France
| | - I Asselin
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, Caen University Hospital, Caen, France
| | - R Morello
- Unit of Biostatistics and Clinical Research, Caen University Hospital, Caen, France; Caen Normandie University, Caen, France
| | - X Lecoutour
- Caen Normandie University, Caen, France; Unit of Epidemiology, Health Economics and Prevention, Caen University Hospital, Caen, France
| | - J Brouard
- Caen Normandie University, Caen, France; Department of Paediatrics, Caen University Hospital, Caen, France
| | - R Fauvet
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, Caen University Hospital, Caen, France; Caen Normandie University, Caen, France; 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), France
| | - A-C Pizzoferrato
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, Caen University Hospital, Caen, France.
| |
Collapse
|
2
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
3
|
Mouadil M, Blanchard V, Fauvet R, Dehaene A, Pizzoferrato AC. [Pelvic floor disorders: What do adolescents and young women know? A literature review]. Prog Urol 2021; 32:258-267. [PMID: 34782220 DOI: 10.1016/j.purol.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/16/2021] [Indexed: 11/27/2022]
Abstract
AIM To assess the knowledge of adolescent girls and young women on pelvic-perineal disorders (PPD). METHOD We searched on PubMed, Cochrane Library, Kinédoc and Semantic Scholar databases using the MeSH keywords: "knowledge" "awareness" "surveys" "young women" "pelvic floor" "adolescent" "teenager" "athletic injury" "urinary incontinence". The articles had to have been published within the last 15 years, written in French or English, and deal with the state of knowledge of adolescents and young women concerning the perineal sphere using questionnaires. RESULTS A total of 8 studies were included in the review, 5 cross-sectional studies and 3 intervention studies. The knowledge of adolescent girls and young women interviewed about the anatomy of the pelvic floor, its function, and risk factors for PPD was low. The majority of the participants wanted more information about the pelvic floor. Two studies that conducted an educational intervention showed a significant improvement in knowledge. CONCLUSION Knowledge of pelvic-perineal disorders and pelvic floor function is poor in adolescent girls and young women. To better assess them, it would be necessary to validate a questionnaire containing all the items about knowledge.
Collapse
Affiliation(s)
- M Mouadil
- Département de gynécologie-obstétrique, hôpital universitaire de Caen Normandie, Caen, France.
| | - V Blanchard
- Cabinet de rééducation périnéale, Chanceaux-Sur-Choisille, France
| | - R Fauvet
- Département de gynécologie-obstétrique, hôpital universitaire de Caen Normandie, Caen, France; Université de Caen Normandie, 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, France
| | - A Dehaene
- Cabinet de rééducation périnéale, Maisons-Lafitte, France
| | - A-C Pizzoferrato
- Département de gynécologie-obstétrique, hôpital universitaire de Caen Normandie, Caen, France
| |
Collapse
|
4
|
Fritel X, de Tayrac R, de Keizer J, Campagne-Loiseau S, Cosson M, Ferry P, Deffieux X, Lucot JP, Wagner L, Debodinance P, Saussine C, Pizzoferrato AC, Carlier-Guérin C, Thubert T, Panel L, Bosset PO, Nkounkou E, Ramanah R, Boisramé T, Charles T, Raiffort C, Charvériat A, Ragot S, Fauconnier A. Serious complications and recurrences after pelvic organ prolapse surgery for 2309 women in the VIGI-MESH registry. BJOG 2021; 129:656-663. [PMID: 34541781 DOI: 10.1111/1471-0528.16892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the incidence of serious complications and reoperations for recurrence after surgery for pelvic organ prolapse (POP) and compare the three most common types of repair. DESIGN Prospective cohort study using a registry. SETTING Nineteen French surgical centres. POPULATION A total of 2309 women participated between 2017 and 2019. METHODS A multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. MAIN OUTCOME MEASURES Serious complications and subsequent reoperations for POP recurrence. RESULTS The median follow-up time was 17.6 months. Surgeries were native tissue vaginal repairs (n = 504), transvaginal mesh placements (n = 692) and laparoscopic sacropexies with mesh (n = 1113). Serious complications occurred among 52 women (2.3%), and reoperation for POP recurrence was required for 32 women (1.4%). At 1 year the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair, 3.9% for transvaginal mesh and 2.2% for sacropexy, and the rates for reoperation for recurrence of POP were 1.5, 0.7 and 1.1%, respectively. Compared with native tissue vaginal repair, the risk of serious complications was higher in the transvaginal mesh group (weighted hazard ratio, wHR 3.84, 95% CI 2.43-6.08) and the sacropexy group (wHR 2.48, 95% CI 1.45-4.23), whereas the risk of reoperation for prolapse recurrence was lower in both the transvaginal mesh (wHR 0.22, 95% CI 0.13-0.39) and sacropexy (wHR 0.29, 95% CI 0.18-0.47) groups. CONCLUSIONS Our results suggest that native tissue vaginal repairs have the lowest risk of serious complications but the highest risk of reoperation for recurrence. These results are useful for informing women and for shared decision making. TWEETABLE ABSTRACT Laparoscopic sacropexy had fewer serious complications than transvaginal mesh and fewer reoperations for recurrence than vaginal repair.
Collapse
Affiliation(s)
- X Fritel
- Service de Gynécologie, CHU de Poitiers, Poitiers, France.,Université de Poitiers, INSERM CIC 1402, Poitiers, France
| | - R de Tayrac
- Service de Gynécologie, CHU Carémeau, Nîmes, France
| | - J de Keizer
- Université de Poitiers, INSERM CIC 1402, Poitiers, France
| | | | - M Cosson
- Service de Gynécologie, CHU de Lille, Lille, France
| | - P Ferry
- Service de Gynécologie, CH de La Rochelle, La Rochelle, France
| | - X Deffieux
- Service de Gynécologie, APHP Antoine-Béclère, Clamart, France
| | - J-P Lucot
- Service de Gynécologie, Hôpital Saint-Vincent-de-Paul, Lille, France
| | - L Wagner
- Service d'Urologie, CHU Carémeau, Nîmes, France
| | - P Debodinance
- Service de Gynécologie, CH de Dunkerque, Dunkerque, France
| | - C Saussine
- Service d'Urologie, CHU de Strasbourg, Strasbourg, France
| | | | - C Carlier-Guérin
- Service de Gynécologie, CH de Châtellerault, Châtellerault, France
| | - T Thubert
- Service de Gynécologie, CHU de Nantes, Nantes, France
| | - L Panel
- Service de Gynécologie, Clinique Beau-Soleil, Montpellier, France
| | - P-O Bosset
- Service d'Urologie, Hôpital Foch, Suresnes, France
| | - E Nkounkou
- Service de Gynécologie, CH de Béthune, Béthune, France
| | - R Ramanah
- Université de Franche-Comté, CHU de Besançon, Besançon, France
| | - T Boisramé
- Service de Gynécologie, CHU de Strasbourg, Strasbourg, France
| | - T Charles
- Service d'Urologie, CHU de Poitiers, Poitiers, France
| | - C Raiffort
- Service de Gynécologie, Groupe Hospitalier Diaconesses-Croix-Saint-Simon, Paris, France
| | - A Charvériat
- Service de Gynécologie, CHU de Poitiers, Poitiers, France
| | - S Ragot
- Université de Poitiers, INSERM CIC 1402, Poitiers, France
| | - A Fauconnier
- Service de Gynécologie, CHI Poissy-Saint-Germain, Poissy, France
| |
Collapse
|
5
|
Berujon E, Blanchard V, Fauvet R, Nyangoh-Timoh K, Pizzoferrato AC. [Benefits of group pelvic floor education sessions: satisfaction and improvement of women's knowledge]. Prog Urol 2021; 31:1201-1208. [PMID: 34417091 DOI: 10.1016/j.purol.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/11/2021] [Accepted: 07/25/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Pelvic floor dysfunctions are an important health-care issue however there are no primary prevention programs for perineal health. This study aims to evaluate the impact of perineal education group sessions on women's urinary and digestive behaviors and their satisfaction with these sessions. MATERIAL Perineal education sessions were proposed to women working in a gynecology department. Each session covered perineal physiology and anatomy, urinary and digestive physiology as well as risk situations for the pelvic floor. At the beginning and end of the sessions, participants completed a questionnaire on their knowledge about the pelvic floor and questions concerning their satisfaction were asked at the end of the session. A 2-month questionnaire assessed changes in urinary and digestive habits as well as the dissemination of information. RESULTS One hundred and sixty-three women, average age 38, participated in these sessions; 107 responded at 2 months. The education sessions significantly improved pelvic floor fonctions knowledge. After the sessions, 81.3% of women reported changing their urinary habits and 60.7% their defecatory habits. Participants found the sessions very useful (rating 9.7/10), all participants recommended these sessions to a friend and the dissemination of the information was important. CONCLUSION Perineal education sessions improve women's knowledge and limit risky behaviors for the pelvic floor. The satisfaction of women who received information is important and the dissemination of information strong. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- E Berujon
- Service de gynécologie-obstétrique, CHU de Caen Normandie, avenue Côte de Nacre, 14033 Caen cedex 9, France
| | - V Blanchard
- Cabinet de rééducation périnéale, Chanceaux-Sur-Choisille, France
| | - R Fauvet
- Service de gynécologie-obstétrique, CHU de Caen Normandie, avenue Côte de Nacre, 14033 Caen cedex 9, France; Unité de Recherche Interdisciplinaire pour la Prévention et le Traitement des Cancers, Axe 2 : biologie et Thérapies Innovantes des Cancers Localement Agressifs (BioTICLA), Université de Caen Normandie, Inserm U1086 « ANTICIPE », 3, avenue général Harris BP 45026, 14076 Caen cedex 5, France
| | - K Nyangoh-Timoh
- Laboratoire d'Anatomie, hôpital universitaire de Rennes 1, université de Rennes, Rennes, France
| | - A-C Pizzoferrato
- Service de gynécologie-obstétrique, CHU de Caen Normandie, avenue Côte de Nacre, 14033 Caen cedex 9, France.
| |
Collapse
|
6
|
Martin-Lasnel M, Nyangoh-Timoh K, Fauvet R, Pizzoferrato AC. [The use of pessaries for treatment of pelvic organ prolapse: A survey from gynecologists and urologists residents]. ACTA ACUST UNITED AC 2021; 49:763-766. [PMID: 33774264 DOI: 10.1016/j.gofs.2021.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pelvic organ prolapse (POP) is a common condition responsible for symptoms that significantly affect the quality of life in women. Despite its effectiveness, low cost and minor side effects, the pessary is little used in France. The objective of our study was to assess the knowledge, training and practices of residents regarding pessaries. MATERIAL AND METHODS This survey was conducted among residents in obstetrics gynecology, medical gynecology and urology in France between March and September 2020. RESULTS During the study period, 328 interns responded to the questionnaires. The majority of residents (52.1%) reported never having attended a consultation specializing in pelvicperineology. Only 31.7% felt comfortable having a pessary inserted. According to them, the pessary was indicated in 3 main situations: in case of contraindication to surgery (80%), while awaiting surgery (79%) and in women over 70 years old (62%). The pessary could be offered to all women for only 46.9% of them. Almost 53% of residents reported ignoring the main complications of pessaries and 83.5% felt they needed further training on the subject. CONCLUSION Interns seem to be generally aware of the use of the pessary. Their knowledge of the indications, complications or even monitoring leads us to believe that it is essential to promote their training so that the pessary becomes an integral part of the first-line therapeutic arsenal in the event of POPs.
Collapse
Affiliation(s)
- M Martin-Lasnel
- Département de gynécologie-obstétrique, hôpital universitaire de Caen Normandie, Caen, France.
| | - K Nyangoh-Timoh
- Inserm, LTSI-UMR 1099, département of obstetrics and gynecology, Rennes Hospital, Rennes, University 1, Rennes, France
| | - R Fauvet
- Département de gynécologie-obstétrique, hôpital universitaire de Caen Normandie, Caen, France; Université Caen Normandie, 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), 14000 Caen, France
| | - A-C Pizzoferrato
- Département de gynécologie-obstétrique, hôpital universitaire de Caen Normandie, Caen, France
| |
Collapse
|
7
|
Blanchard V, Nyangoh Timoh K, Bruyère F, Fritel X, Pizzoferrato AC. [Benefits of pelvic floor education in perineal re-education in women]. Prog Urol 2020; 30:190-197. [PMID: 32067907 DOI: 10.1016/j.purol.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 12/15/2022]
Abstract
AIM Evaluate the impact of pelvic floor education on the symptoms of female patients referred for pelvic floor muscle training (PFMT). METHODS Forty female patients suffering from pelvic floor disorders and referred to independent practice for PFME between February and May 2019 answered a survey on symptoms and quality of life before PFME, after four sessions of pelvic floor education and at the end of PFME. The ICIQ-SF, USP, Contilife, PDFI 20, Kess, and Wexner scores were used to evaluate the results. The protocol consisted in four initial sessions of pelvic floor education including information on each field of perineology ; the fifth session was dedicated to visual feedback using a mirror ; the following five sessions were tailored according to the care objectives established based on the initial assessment. RESULTS The scores were significantly improved after the four initial sessions of pelvic floor education. The improvement was significant at the end of the re-education program. The PFDI-20 score dropped from 66,9 to 20,9 (P=0,002), the ICIQ-SF score from 8,4 to 1,5 (P<10-3), the Wexner score from 7,4 to 5,1 (P<10-3) and the Kess score from 14,2 to 8,7 (P=0,05). CONCLUSION The results showed that female patients undergoing perineal re-education including pelvic floor education sessions show a significant improvement in their symptoms already immediately after the pelvic floor education sessions.
Collapse
Affiliation(s)
- V Blanchard
- Cabinet de rééducation périnéale, Chanceaux-Sur-Choisille, France
| | - K Nyangoh Timoh
- Université de Rennes, Laboratoire d'Anatomie, Hôpital Universitaire de Rennes 1, Rennes, France
| | - F Bruyère
- Université François Rabelais de Tours, PRES Centre Val-de-Loire, Tours, France
| | - X Fritel
- Université de Poitiers, Inserm CIC1402, Hôpital Universitaire de Poitiers, Poitiers, France
| | - A C Pizzoferrato
- Département de Gynécologie-Obstétrique, Hôpital Universitaire de Caen Normandie, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
| |
Collapse
|
8
|
Pizzoferrato AC, Ducarme G, Jacquetin B, Fritel X. [Perineal Prevention and Protection in Obstetrics: CNGOF Guidelines for Clinical Practice - Introduction, Objectives, Methods, Definitions, Organization and Limits]. ACTA ACUST UNITED AC 2018; 46:889-892. [PMID: 30392992 DOI: 10.1016/j.gofs.2018.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 10/27/2022]
Affiliation(s)
- A C Pizzoferrato
- Service de gynécologie-obstétrique, CHU Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - G Ducarme
- Service de gynécologie-obstétrique, centre hospitalier départemental Vendée, boulevard Stéphane-Moreau, 85000 La-Roche-sur-Yon, France
| | - B Jacquetin
- Pôle Femme-Enfant, CHU Estaing, 1, place Lucie-Aubrac, 63001 Clermont-Ferrand, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| |
Collapse
|
9
|
Ducarme G, Pizzoferrato AC, de Tayrac R, Schantz C, Thubert T, Le Ray C, Riethmuller D, Verspyck E, Gachon B, Pierre F, Artzner F, Jacquetin B, Fritel X. [Perineal prevention and protection in obstetrics: CNGOF Clinical Practice Guidelines (short version)]. ACTA ACUST UNITED AC 2018; 46:893-899. [PMID: 30391283 DOI: 10.1016/j.gofs.2018.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The objective of these clinical practice guidelines was to analyse all of the interventions during pregnancy and childbirth that might prevent obstetric anal sphincter injuries (OASIS) and postnatal pelvic floor symptoms. MATERIAL AND METHODS These guidelines were developed in accordance with the methods prescribed by the French Health Authority (HAS). RESULTS A prenatal clinical examination of the perineum is recommended for women with a history of Crohn's disease, OASIS, genital mutilation, or perianal lesions (professional consensus). Just after delivery, a perineal examination is recommended to check for OASIS (Grade B); if there is doubt about the diagnosis, a second opinion should be requested (GradeC). In case of OASIS, the injuries (including their severity) and the technique for their repair should be described in detail (GradeC). Perineal massage during pregnancy must be encouraged among women who want it (Grade B). No intervention conducted before the start of the active phase of the second stage of labour has been shown to be effective in reducing the risk of perineal injury. The crowning of the baby's head should be manually controlled and the posterior perineum manually supported to reduce the risk of OASIS (GradeC). The performance of an episiotomy during normal deliveries is not recommended to reduce the risk of OASIS (Grade A). In instrumental deliveries, episiotomy may be indicated to avoid OASIS (GradeC). When an episiotomy is performed, a mediolateral incision is recommended (Grade B). The indication for episiotomy should be explained to the woman, and she should consent before its performance. Advising women to have a caesarean delivery for primary prevention of postnatal urinary or anal incontinence is not recommended (Grade B). During pregnancy and again in the labour room, obstetrics professionals should focus on the woman's expectations and inform her about the modes of delivery.
Collapse
Affiliation(s)
- G Ducarme
- Service de gynécologie-obstétrique, centre hospitalier départemental Vendée, boulevard Stéphane-Moreau, 85000 La Roche-sur-Yon, France.
| | - A C Pizzoferrato
- Service de gynécologie-obstétrique, CHU Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - R de Tayrac
- Service de gynécologie-obstétrique, CHU Carémeau, place du Pr-Debré, 30900 Nîmes, France
| | - C Schantz
- Centre population et développement (Ceped), institut de la recherche et du développement (IRD), université Paris Descartes, Inserm, Commission scientifique du Collège national des sages-femmes (CNSF), 75000 Paris, France
| | - T Thubert
- Service de gynécologie-obstétrique, CHU Hôtel-Dieu, hôpitaux de Nantes, université de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; GMC-UPMC 01, GREEN (Groupe de recherche clinique en neurourologie), 4, rue de la Chine, 75020 Paris, France
| | - C Le Ray
- Maternité Port-Royal, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 123, boulevard de Port-Royal, 75014 Paris, France; Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - D Riethmuller
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - E Verspyck
- Service de gynécologie-obstétrique, CHU Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - B Gachon
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - F Pierre
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - F Artzner
- Collectif inter-associatif autour de la naissance (CIANE), 40, rue de Chanzy, 75011 Paris, France
| | - B Jacquetin
- Pôle Femme-Enfant, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| |
Collapse
|
10
|
Pizzoferrato AC, Fritel X. [Preoperative functional explorations of genital prolapse (urodynamics, dynamic MRI)]. ACTA ACUST UNITED AC 2018; 46:593-597. [PMID: 29997048 DOI: 10.1016/j.gofs.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Indexed: 11/28/2022]
Abstract
The evaluation of genital prolapse is essentially clinical; however imaging tests such as dynamic MRI or urodynamic explorations may be useful in complex cases, especially before surgical management. Dynamic MRI allows morphological and dynamic analysis of pelvic floor and levator ani function. It can also detect post-obstetric injuries, although the long-term significance of these injuries remains to be discovered. Quantification of the severity of prolapse is possible with MRI; however, the correlation of these measures with clinical examination seems poor. Its interest lies mainly in the qualitative assessment of the three stages of prolapse and the detection of elytroceles, which can be difficult to clinical examination. Urodynamics provides useful information on vesico-sphincteric function, but none of these parameters seems to be decisive in the management of prolapse.
Collapse
Affiliation(s)
- A C Pizzoferrato
- Service de gynécologie-obstétrique, CHU de Caen, avenue Côte-de-Nacre, 14000 Caen, France.
| | - X Fritel
- Faculté de médecine et pharmacie, université de Poitiers, CIC1402, CESP, France
| |
Collapse
|
11
|
Rejano-Campo M, Desvergée A, Pizzoferrato AC. [Relationship between perineal characteristics and symptoms and pelvic girdle pain: A literature review]. Prog Urol 2018; 28:193-208. [PMID: 29307482 DOI: 10.1016/j.purol.2017.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 12/04/2017] [Accepted: 12/12/2017] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Pelvic girdle pain (PGP) is characterized by the presence of pain in the posterior pelvic area, distally and laterally to the fifth lumbar vertebra, and/or at the pubic symphysis. PGP is a very common pain condition in women, especially during pregnancy and postpartum. After delivery, pain prevalence decreases to 7 % in the first three months. The current literature describes an association between pelvic girdle pain and different perineal characteristics and symptoms. OBJECTIVES A better understanding of perineal structures influence on PGP could assist towards the management of this condition. The aim of this review is to describe the peer-reviewed literature about perineal function in patients with PGP. METHODS A bibliographic search on PubMed was conducted. The key words used were: pelvic girdle pain, pregnacy-related low back pain, lumbopelvic pain, posterior pelvic pain, peripartum pelvic pain, pelvic girdle relaxation, pelvic joint instability, peripartum pelvic pain, sacroiliac joint pain, sacroiliac joint dysfunction, sacroiliac-joint related pelvic pain and pelvic floor. Two hundred and twenty-one (221) articles were identified. Out of them, a total of nine articles were selected. The level of evidence was determined using Oxford's scale. RESULTS Patients with PGP showed increased activity of the pelvic floor muscles (P=0.05) (LE3), decreased urogenital hiatus area (PGP 12.4 cm2±2.7, control 13.7 cm2±2.8, P=0.015) (LE3), shorter endurance time (PGP 17.8 s; control 54.0 s, P=0.00) (LE3), significantly later onset time during affected side leg elevation (PGP 25ms, control -129ms, P=0.01) (LE3), levator ani and obturator internus tenderness (PGP 25/26; control 5/25, P<0.001) (LE3) and a higher prevalence of vesico-sphincteric disorders compared to asymptomatic subjects (LE3). CONCLUSION This review confirms that subjects suffering PGP present particular perineal characteristics regarding morphology and biomechanics. It would be interesting to develop clinical research concerning pelvic floor release effect in PGP.
Collapse
Affiliation(s)
- M Rejano-Campo
- Service de médecine physique et de réadaptation, CHU de Caen, CHU de Caen Normandie, 14000 Caen, France.
| | - A Desvergée
- Service de médecine physique et de réadaptation, CHU de Caen, CHU de Caen Normandie, 14000 Caen, France
| | - A C Pizzoferrato
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, CHU de Caen Normandie, 14000 Caen, France
| |
Collapse
|
12
|
Pizzoferrato AC, Samie M, Rousseau A, Rozenberg P, Fauconnier A, Bader G. [Severe post-obstetric perineal tears: Medium-term consequences on women's quality of life]. Prog Urol 2015; 25:530-5. [PMID: 26032455 DOI: 10.1016/j.purol.2015.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/31/2015] [Accepted: 04/14/2015] [Indexed: 12/15/2022]
Abstract
AIMS To assess the prevalence of anal (AI) and urinary (UI) incontinence at medium term after 3rd and 4th degree anal sphincter tears and their impact on sexuality and women's quality of life. MATERIAL It is a case-control, single center study. Sixty-eight primiparous women delivered with severe anal sphincter tear (exposed group) were compared to 136 women without (control group). Questionnaires on anal and urinary incontinence, sexual function and quality of life, using validated scores, were sent between two and five years after the first delivery. Maternal and obstetric data were collected retrospectively on the medical files. RESULTS The answer rate was 22.5% (46/204) of which 30.9% (21/68) in the exposed group and 18.4% (25/136) in the unexposed group. In case of severe anal sphincter tear, 57.1% of women reported an AI vs 48% in the control group (P=0.76). The rate of AI for liquid stool was significantly higher in the exposed group (P=0.05). Patients with severe perineal tears reported a greater impact of symptoms on their quality of life but the difference with the control group was not significant. CONCLUSIONS The severity of symptoms related to anal sphincter tears is common and underestimated. Preventive measures must be improved in order to maintain women's quality of life. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- A-C Pizzoferrato
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303 Poissy, France.
| | - M Samie
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303 Poissy, France
| | - A Rousseau
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303 Poissy, France
| | - P Rozenberg
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303 Poissy, France
| | - A Fauconnier
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303 Poissy, France
| | - G Bader
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303 Poissy, France
| |
Collapse
|
13
|
Abstract
Pelvic organ prolapse is a common pelvic floor disorder in postmenopausal women. The literature is quite poor concerning the management of prolapse during pregnancy in young women. We report the case of a 39-year-old multiparous woman referred for the treatment of an exteriorized uterine prolapse at 13 weeks of gestation. The management of cervical prolapse depends on its stage, its evolution and on gestational age. It combines local antiseptics, rest and manual reintegration or reduction of the prolapsus using a pessary to prevent ulceration of the cervix. In case of stage IV (POP-Q) uterine prolapse, vaginal delivery may be compromised. No recommendation is actually available about route of delivery in case of exteriorized uterine prolapse. It should be clearly discussed regarding the potential risk of cesarean section for dystocia. Surgical repair of the prolapse will be discussed after childbirth according to functional impairment and women's desire for pregnancy.
Collapse
Affiliation(s)
- A-C Pizzoferrato
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, Poissy, France.
| | | | | | | |
Collapse
|
14
|
Pizzoferrato AC, Legendre G, Demaria F, Benifla JL. [Cervical pregnancy: a rare case of reimplantation after abortion. A case report]. J Gynecol Obstet Biol Reprod (Paris) 2012; 41:587-90. [PMID: 22921158 DOI: 10.1016/j.jgyn.2012.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/24/2012] [Accepted: 07/13/2012] [Indexed: 11/26/2022]
Abstract
Cervical pregnancy is a rare form of ectopic pregnancy defined by the implantation of the blastocyst in the cervical canal. Most of the cervical pregnancies have been reported in patients with a history of vacuum curettage or caesarean section. The authors report a case of cervical pregnancy occurred after a failure of medical abortion. A literature review discusses the possibility of a cervical secondary implantation and describes the management of such pregnancies.
Collapse
Affiliation(s)
- A C Pizzoferrato
- Service de gynécologie-obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303 Poissy, France.
| | | | | | | |
Collapse
|
15
|
Pizzoferrato AC, Fauconnier A, Bader G. [Value of ultrasonographic measurement of bladder neck mobility in the management of female stress urinary incontinence]. Gynecol Obstet Fertil 2010; 39:42-8. [PMID: 21185762 DOI: 10.1016/j.gyobfe.2010.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 09/20/2010] [Indexed: 10/18/2022]
Abstract
Transvaginal ultrasound is the first line imaging investigation in gynaecology. It was thus introduced for the exploration of female stress urinary incontinence at the beginning of the 1980s. Various techniques and parameters of ultrasound examination have been used for the assessment of bladder neck mobility. The aim of this literature review was to suggest the adequate ultrasound technique to study bladder neck mobility. We reviewed articles indexed in MEDLINE dealing with urogenital ultrasound and published between 1998 and 2008. The bladder-symphysis distance measured by transperineal ultrasound is a reliable and reproductive tool to study female stress urinary incontinence. Despite a lack of standardization of Valsalva manoeuvre, normal bladder neck mobility is estimated between 15 and 20 mm. Furthermore, in case of complications from stress urinary incontinence surgery, ultrasound is considered as the first line imaging test. Perineal ultrasound is an interesting investigation for preoperative assessment of stress urinary incontinence or in case of surgery failure or complications. This suggests the need for wider diffusion of this technique in urogynecology teams.
Collapse
Affiliation(s)
- A-C Pizzoferrato
- Université Versailles/St-Quentin, CHI de Poissy/Saint-Germain-en-Laye, France
| | | | | |
Collapse
|