Pelvic floor dysfunction after vaginal delivery: MOODS-a prospective study

Correlation Between Delivery Type and Pelvic Floor Dysfunction: A Case-Control Study

Background

Mode of delivery is associated with pelvic floor dysfunction (PFD). Therefore, this study aimed to investigate the relationship between delivery type and PFD six-month after delivery.

Materials and Methods

This case-control study included primigravida females who had a normal vaginal delivery with episiotomy (VDE) or uncomplicated cesarean section. All participants underwent an evaluation to check the strength and endurance of the pelvic floor muscles (PFM), intravaginal pressure measurement, electromyographic activity recording of the PFM, and Pelvic Floor Distress Inventory-20 (PFDI-20) questionnaire.

Results

In total, 260 patients were enrolled in our study and divided equally into two groups: uncomplicated cesarean delivery and VDE. Our findings showed significant differences in PFM dysfunction, electrical activity, strength, endurance, and vaginal pressure between the two groups. Patients who underwent an uncomplicated cesarean delivery had better outcomes.

Conclusion

Our study demonstrated that the severity of PFD in women who underwent uncomplicated cesarean section was lower than that in women who underwent VDE. VDE may cause PFM injury.

Common maternal health problems and their correlates in early post-partum mothers

BACKGROUND

Mothers experience a wide range of maternal health problems after childbirth, which in turn, affect their well-being and ability to care for their newborn. These problems may be influenced by factors such as mode of delivery or socio-economic status.

OBJECTIVE

This study aims to investigate the prevalence of common maternal health problems and their correlates in a public primary healthcare institution in Singapore.

DESIGN

This was a cross-sectional study, based on a self-administered questionnaire.

METHODS

A total of 373 mothers (mean age 31.9 years) who accompanied their infants for their 4- to 8-week development assessments at a public primary care clinic in Singapore completed a self-administered questionnaire from June 2021 to December 2021. The questionnaire assessed demographic factors, mode of delivery, number of children, number of individuals providing significant help, and the frequency of common physical and mental maternal health problems using a 5-point Likert-type scale.

RESULTS

The five most common maternal health problems were fatigue (77.7%), lower back pain (59.3%), Caesarean wound pain (54.3%), upper back pain (53.0%) and vaginal pain (41.2%). The prevalence of depression and anxiety was 22.0% and 11.3%, respectively. With respect to the symptoms' correlates, pain on passing urine was more frequent after assisted vaginal deliveries than all other forms of deliveries (all pairwise p < 0.01), and pain on passing motion was more frequent in vaginal deliveries than in Caesarean deliveries (all pairwise p < 0.05). Mothers having a larger number of children more frequently experienced headaches (β = 0.17, SE = 0.05, p = 0.002) and less frequently experienced breastfeeding difficulties (β = -0.28, SE = 0.08, p < 0.001).

CONCLUSION

Mothers experienced a high prevalence of maternal health problems in multiple domains during the first 8 weeks after childbirth. Mode of delivery and number of children were associated with increased prevalence of certain problems. Mothers' physical and mental well-being should be investigated early after delivery and addressed with adequate treatments and resources.

Diagnostic value of combined pelvic floor ultrasound parameters for pelvic floor dysfunction and risk factors

OBJECTIVE

To investigate the diagnostic value of pelvic floor ultrasound parameters in combination for pelvic floor dysfunction (PFD), and to explore the risk factors.

METHODS

Forty PFD patients treated from April2019to December 2020(case group) and another 40 healthy women (control group) were enrolled. Their clinical data were collected, and both groups received three-dimensional (3D) ultrasound of the pelvic floor. The diagnostic value of pelvic floor ultrasound parameters for PFD was assessed by receiver operating characteristic (ROC) curves. The risk factors of PFD were evaluated by multivariate logistic regression analysis.

RESULTS

The area under the ROC curve (AUC), sensitivity, and specificity of the parameters in combination for predicting PFD were 0.851 [95% confidence interval (CI): 0.743-0.959], 0.901, and 0.812, respectively, indicating acceptable accuracy. Results of logistic regression analysis revealed that spontaneous delivery, lateral episiotomy/laceration, and large bladder neck rotation angle, posterior urethrovesical angle (PUA), bladder neck tilt angle, bladder neck distance (BND), levator hiatus area (LHA) (at anal contraction), R-LHA and V-LHA were risk factors for PFD (p < 0.05), while physical exercise was a protective factor (p < 0.05). ROC curve analysis revealed that the AUC, sensitivity, and specificity of the forest map model were 0.822 (95% CI: 0.759-0.885), 0.942, and 0.601, respectively, indicating acceptable accuracy of the model. Internal data validation of the model demonstrated consistence of the predicted occurrence of PFD with the actual one.

CONCLUSIONS

Spontaneous delivery, lateral episiotomy/laceration, and large bladder neck rotation angle, PUA, bladder neck tilt angle, BND, LHA (at anal contraction), R-LHA and V-LHA were risk factors for PFD.

Association of cesarean delivery timing with pelvic floor muscle function and urine incontinence: A propensity score-matched study

Pelvic floor dysfunction is a common gynecological disease that adversely affects women's quality of life and mental health. Delivery is considered a significant independent risk factor for pelvic floor dysfunction. Surface electromyography (sEMG) values for the pelvic floor muscles (PFM) have been shown to differ according to different delivery modes. This study aimed to compare sEMG results between intrapartum and antepartum cesarean delivery (CD), 42-60 days after delivery. Data of women who underwent CD at the International Peace Maternity and Child Health Hospital were collected from September 2021 to December 2021. Myotrac Infiniti System was used to measure the electromyographic activity of PFM after 42-60 days of parturition. Propensity score matching (1:1) was applied to achieve a balance in baseline data between the two groups (intrapartum and antepartum CD). A total of 200 paired cases were selected for statistical analysis. In the propensity score-matched analysis, there were no statistically significant differences in PFM sEMG between women with antepartum or intrapartum CD (p > 0.05 for all). We observed similar results with postpartum urinary incontinence (24 [12.0] vs. 21 [10.5]; adjusted odds ratio (aOR), 1.12 [95% confidence interval (CI) 0.60-2.12]; p = 0.717) and stress urinary incontinence (12 [6.0] vs. 14 [7.0]; aOR, 0.80 [95% CI 0.35-1.80]; p = 0.596) as outcomes. After excluding participants with intrapartum CD when the cervix was dilated <6 cm, all sEMG of PFM had a comparable level of risk in both the antepartum and intrapartum CD groups. There were no significant differences in sEMG of the PFM and the incidence of urinary incontinence between patients undergoing intrapartum or antepartum CD. Excluding women who underwent intrapartum CD when the cervix was dilated to <6 cm produced little change in results. Thus, different opportunities for CD may not impact the sEMG of the PFM and the incidence of urinary incontinence.