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Koenig JB, Burnett LA. Understanding the Role of Obesity and Metabolism in Pelvic Floor Disorders. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:389-393. [PMID: 38564623 DOI: 10.1097/spv.0000000000001478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Jenny B Koenig
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences
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Sun ZJ, Tian Z, Xu T, Wang ZM, Zhu XH, Luo J, Cheng F, Gong L, Zhang J, Wang LH, Zhu WP, Qu XL, Lin Z, Ge WP, Wang BN, Zhu L. Pelvic floor muscle strength and influencing factors based on vaginal manometry among healthy women at different life stages: A multicentre cross-sectional study. BJOG 2024. [PMID: 38168494 DOI: 10.1111/1471-0528.17736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/03/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To assess pelvic floor muscle (PFM) strength and influencing factors among healthy women at different life stages. DESIGN Multicentre cross-sectional study. SETTING Fourteen hospitals in China. POPULATION A total of 5040 healthy women allocated to the following groups (with 1680 women per group): premenopausal nulliparous, premenopausal parous and postmenopausal. METHODS The PFM strength was evaluated by vaginal manometry. Multivariate logistic regression was used to determine the influencing factors for low PFM strength. MAIN OUTCOME MEASURES Maximum voluntary contraction pressure (MVCP). RESULTS The median MVCP values were 36, 35 and 35 cmH2 O in premenopausal nulliparous (aged 19-51 years), premenopausal parous (aged 22-61 years), and postmenopausal (aged 40-86 years) women, respectively. In the premenopausal nulliparous group, physical work (odds ratio, OR 2.05) was the risk factor for low PFM strength, which may be related to the chronic increased abdominal pressure caused by physical work. In the premenopausal parous group, the number of vaginal deliveries (OR 1.28) and diabetes (OR 2.70) were risk factors for low PFM strength, whereas sexual intercourse (<2 times per week vs. none, OR 0.55; ≥2 times per week vs. none, OR 0.56) and PFM exercise (OR 0.50) may have protective effects. In the postmenopausal group, the number of vaginal deliveries (OR 1.32) and family history of pelvic organ prolapse (POP) (OR 1.83) were risk factors for low PFM strength. CONCLUSIONS Physical work, vaginal delivery, diabetes and a family history of POP are all risk factors for low PFM strength, whereas PFM exercises and sexual life can have a protective effect. The importance of these factors varies at different stages of a woman's life.
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Affiliation(s)
- Zhi-Jing Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Zhao Tian
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Tao Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Zhong-Min Wang
- Department of Obstetrics and Gynecology, Dalian Municipal Women and Children's Medical Center (Group), Dalian, Liaoning, China
| | - Xi-Hui Zhu
- Department of Obstetrics and Gynecology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
| | - Jun Luo
- Department of Obstetrics and Gynecology, Hunan Maternal and Child Health Hospital, Changsha, Hunan, China
| | - Fang Cheng
- Department of Obstetrics and Gynecology, Huaian Maternal and Child Health Hospital, Huaian, Jiangsu, China
| | - Lin Gong
- Department of Obstetrics and Gynecology, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Guangdong, China
| | - Jie Zhang
- Department of Obstetrics and Gynecology, Maternal and Child Health Care Hospital of Qinhuangdao, Qinhuangdao, Liaoning, China
| | - Li-Hui Wang
- Department of Obstetrics and Gynecology, Women and Children's Health Care Hospital of Luohu, Shenzhen, Guangdong, China
| | - Wei-Pei Zhu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xue-Ling Qu
- Department of Obstetrics and Gynecology, Changjianglu Pelvic Floor Repair Center, Dalian Maternity and Child Healthcare Center (Group), Dalian, Liaoning, China
| | - Zhong Lin
- Department of Obstetrics and Gynecology, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, Guangxi, China
| | - Wei-Ping Ge
- Department of Obstetrics and Gynecology, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Bi-Nan Wang
- Department of Obstetrics and Gynecology, Changsha Hospital for Maternal and Child Health Care Affiliated to Hunan Normal University, Changsha, Hunan, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
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Takacs P, Pákozdy K, Koroknai E, Erdődi B, Krasznai Z, Kozma B. A randomized controlled pilot trial to assess the effectiveness of a specially formulated food supplement and pelvic floor muscle training in women with stress-predominant urinary incontinence. BMC Womens Health 2023; 23:321. [PMID: 37340306 DOI: 10.1186/s12905-023-02476-z] [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: 10/18/2022] [Accepted: 06/10/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Pelvic floor muscle training (PFMT) is the first-line treatment approach for stress urinary incontinence. Creatine and leucine have been shown to improve muscle function. Our aim was to assess the effectiveness of a food supplement and PFMT in women with stress-predominant urinary incontinence. METHODS Women with stress-predominant urinary incontinence were randomized in 1:1 ratio to receive daily oral supplementation for six weeks with either a food supplement (treatment group) or placebo (control group). Both groups were instructed to perform standardized daily PFMT. The primary outcome was the Urogenital Distress Inventory Short Form (UDI-6) score. Secondary outcomes were the Incontinence Impact Questionnaire (IIQ-7) score, Patient's Global Impression of Severity (PGI-S), and Biomechanical Integrity score (BI-score) measured by Vaginal Tactile Imager. To have a power of 80% and a significance level of 5% to detect a decrease of 16 points in the UDI-6 score, a sample size of 32 was needed, with 16 patients in each arm of our trial. RESULTS Sixteen women in the control group and sixteen in the treatment group completed the trial. Between-group analysis revealed no significant differences between the control and treatment group except for mean change (delta) in vaginal squeeze pressure [(cmH2O, mean ± SD), 5 ± 12 vs. 15 ± 15, P = 0.04] and mean change (delta) in PGI-S score [(mean ± SD), -0.2 ± 0.9 vs. -0.8 ± 0.8, P = 0.04]. Within-group analysis showed that UDI-6 and IIQ-7 scores improved significantly from baseline to six weeks in the treatment group but not in the control group [UDI-6 score (mean ± SD) 45 ± 21 vs. 29 ± 21, P = 0.02; 43 ± 18 vs. 33 ± 26, P = 0.22] [IIQ-7 score (mean ± SD) 50 ± 30 vs. 30 ± 21, P = 0.01; 48 ± 23 vs.40 ± 28, P = 0.36]. PGI-S scores only improved in the treatment group from baseline to six weeks after treatment [PGI-S score (mean ± SD) 3.1 ± 0.8 vs. 2.3 ± 0.8, P = 0.0001]. BI-score, on average, improved significantly in the treatment and control group as well [SD unit, mean, from - 1.06 to -0.58, P = 0.001; from - 0.66 to -0.42, P = 0.04]. CONCLUSIONS Women with stress-predominant urinary incontinence receiving a specially formulated supplement in addition to daily PFMT for six weeks had significantly improved urinary symptoms (decrease in UDI-6 score and IIQ-7) and BI-score compared to their baseline. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05358769. 27/04/2022.
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Affiliation(s)
- Peter Takacs
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 526, Norfolk, VG, 23507-2007, USA
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Krisztina Pákozdy
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Erzsébet Koroknai
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Balázs Erdődi
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Zoárd Krasznai
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Bence Kozma
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary.
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Zhu J, Si J, Zhao L, Liu W. Association between infant birthweight and pelvic floor muscle strength: a population-based cohort study. BMC Pregnancy Childbirth 2023; 23:266. [PMID: 37076810 PMCID: PMC10114441 DOI: 10.1186/s12884-023-05511-x] [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: 09/08/2022] [Accepted: 03/09/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND To assess the relationship between infant birthweight and pelvic floor muscle (PFM) strength in China. METHODS We performed a retrospective, single-center cohort study of 1575 women delivering vaginally between January 2017 and May 2020. All participants completed pelvic floor examinations within 5-10 weeks after delivery and were evaluated for PFM strength, which was estimated by vaginal pressure. Data were collected from electronic records. We evaluated the association between infant birthweight and vaginal pressure through multivariable-adjusted linear regression analysis. We also performed subgroup analyses stratified by potential confounders. RESULTS Vaginal pressure decreased as the quartile of birthweight increased (P for trend < 0.001). Beta coefficients were -5.04 (95%CI -7.98 to -2.1), -5.53 (95%CI -8.5 to -2.57), -6.07 (95%CI -9.08 to -3.07) for birthweight quartile 2-4, respectively (P for trend < 0.001), independent of age, postpartum hemorrhage, and the number of vaginal deliveries. In addition, the results of subgroup analyses showed the same patterns across strata. CONCLUSIONS This study demonstrates that infant birthweight was associated with decreased vaginal pressure in women after vaginal delivery and could be considered a risk factor for decreased PFM strength in the population with vaginal delivery. This association may provide an extra basis for appropriate fetal weight control during pregnancy, and for earlier pelvic floor rehabilitation of postpartum women delivering babies with larger birthweight.
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Affiliation(s)
- Junyan Zhu
- Department of Gynecology and Obstetrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, China
| | - Junwen Si
- Department of Gynecology and Obstetrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, China
| | - Lu Zhao
- Department of Gynecology and Obstetrics, Jiuting Hospital, Shanghai, 201615, China
| | - Wei Liu
- Department of Gynecology and Obstetrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, China.
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Zhang J, Zhang R, Chi J, Li Y, Bai W. Pre-pregnancy body mass index has greater influence on newborn weight and perinatal outcome than weight control during pregnancy in obese women. Arch Public Health 2023; 81:5. [PMID: 36639806 PMCID: PMC9838058 DOI: 10.1186/s13690-023-01025-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The pre-pregnancy weight and gestational weight gain (GWG) are closely related to perinatal maternal and infant complications, but the relationship between pre-pregnancy weight and GWG and the pattern of interaction have not been reported. This study investigated the influence of weight control during pregnancy on the perinatal maternal and infant outcomes. METHODS A total of 835 singleton pregnant women who were hospitalized between January 2018 and December 2018 were retrospectively included in this study and divided into two groups: the diet guidance (DG) group (n = 167) and the control group (n = 668). The pre-pregnancy body mass index (BMI), GWG, and perinatal outcomes of the women and infants were determined in two groups. RESULTS The dietary modification and reasonable exercise during pregnancy effectively reduced the GWG, and even some women with pre-pregnancy obesity achieved weight loss during pregnancy. The GWG in the DG group was significantly lower than in the control group, especially in the second and third trimesters. GWG was positively related to birth weight. The birth weight in the DG group was significantly lower than in the control group when their mothers had similar GWG. In women with pre-pregnancy obesity, GWG seemed to be negatively related to birth weight. However, after adjusting the mean BMI, the pre-pregnancy BMI and GWG were positively related to the birth weight. Compared with the control group, the incidences of dystocia, postpartum hemorrhage, macrosomia, small for gestational age infants and neonatal complications significantly reduced in the DG group, and the preterm birth rate was comparable between two groups. Some women with pre-pregnancy obesity lose weight during pregnancy, but there was no premature birth or small for gestational age infant. The incidences of macrosomia, postpartum hemorrhage, dystocia, cesarean section and gestational diabetes increased significantly with the increase of pre-pregnancy BMI. CONCLUSION For women with increased pre-pregnancy BMI, strict weight control is required to reduce obesity-related complications of the mother and infant. The weight control in the second and third trimesters is especially important and most likely to prevent GWG. Compared with GWG, pre-pregnancy BMI has greater influence on the birth weight and maternal and infant complications, and may even compromise the benefits of weight control during pregnancy. Thus, weight control is recommended before pregnancy.
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Affiliation(s)
- Jin Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Obstetrics and Gynaecology, Beijing Shijitan Hospital, Capital Medical University, Haidian, Beijing, 100038 China
| | - Rui Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Obstetrics and Gynaecology, Beijing Shijitan Hospital, Capital Medical University, Haidian, Beijing, 100038 China
| | - Jingjing Chi
- grid.24696.3f0000 0004 0369 153XDepartment of Obstetrics and Gynaecology, Beijing Shijitan Hospital, Capital Medical University, Haidian, Beijing, 100038 China
| | - Ya Li
- grid.24696.3f0000 0004 0369 153XDepartment of Obstetrics and Gynaecology, Beijing Shijitan Hospital, Capital Medical University, Haidian, Beijing, 100038 China
| | - Wenpei Bai
- grid.24696.3f0000 0004 0369 153XDepartment of Obstetrics and Gynaecology, Beijing Shijitan Hospital, Capital Medical University, Haidian, Beijing, 100038 China
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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.
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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
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Grimes CL, Clare CA, Meriwether KV, Geynisman-Tan J, Lozo S, Antosh DD, Brown HW, LeBrun EEW, Raman SV, Iglesia CB, Keltz J, Kim-Fine S, Brennand EA, Rogers R. Reporting Race and Ethnicity In Research Presented at the Society of Gynecologic Surgeons' Annual Meeting. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cara L. Grimes
- Departments of Obstetrics and Gynecology and Urology, New York Medical College, Valhalla, New York, USA
| | - Camille A. Clare
- Department of Obstetrics and Gynecology, State University of New York-Downstate Health Sciences University, Brooklyn, New York, USA
| | - Kate V. Meriwether
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Julia Geynisman-Tan
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
| | - Svjetlana Lozo
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York, USA
| | - Danielle D. Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Medical Center, Houston, Texas, USA
| | - Heidi W. Brown
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Emily E. Weber LeBrun
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Sonali V. Raman
- Department of Women's Health, Female Pelvic Medicine and Reconstructive Surgery, St. Elizabeth Healthcare, Fort Thomas, Kentucky, USA
| | - Cheryl B. Iglesia
- Department of Obstetrics and Gynecology, MedStar Health and Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Julia Keltz
- Departments of Obstetrics and Gynecology and Urology, New York Medical College, Valhalla, New York, USA
| | - Shunaha Kim-Fine
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Erin A. Brennand
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rebecca Rogers
- Department of Obstetrics and Gynecology, Albany Medical College, Albany, New York, USA
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Parkinson LA, Karjalainen PK, Mukherjee S, Papageorgiou AW, Kulkarni M, Arkwright JW, Young N, Werkmeister JA, Davies‐Tuck M, Gargett CE, Rosamilia A. Vaginal pressure sensor measurement during maximal voluntary pelvic floor contraction correlates with vaginal birth and pelvic organ prolapse—A pilot study. Neurourol Urodyn 2022; 41:592-600. [DOI: 10.1002/nau.24882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/02/2021] [Accepted: 12/19/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Luke A. Parkinson
- Parkki Pty Ltd Kensington Park South Australia Australia
- College of Science and Engineering Flinders University Bedford Park South Australia Australia
| | | | - Shayanti Mukherjee
- The Ritchie Centre Hudson Institute of Medical Research Clayton Victoria Australia
- Department of Obstetrics and Gynaecology Monash University Clayton Victoria Australia
| | - Anthony W. Papageorgiou
- College of Science and Engineering Flinders University Bedford Park South Australia Australia
| | - Mugdha Kulkarni
- Pelvic Floor Unit Monash Health Moorabbin Victoria Australia
| | - John W. Arkwright
- College of Science and Engineering Flinders University Bedford Park South Australia Australia
- Arkwright Technologies Pty. Ltd. Hawthorndene South Australia Australia
| | - Natharnia Young
- Pelvic Floor Unit Monash Health Moorabbin Victoria Australia
| | - Jerome A. Werkmeister
- The Ritchie Centre Hudson Institute of Medical Research Clayton Victoria Australia
- Department of Obstetrics and Gynaecology Monash University Clayton Victoria Australia
| | - Miranda Davies‐Tuck
- The Ritchie Centre Hudson Institute of Medical Research Clayton Victoria Australia
| | - Caroline E. Gargett
- The Ritchie Centre Hudson Institute of Medical Research Clayton Victoria Australia
- Department of Obstetrics and Gynaecology Monash University Clayton Victoria Australia
| | - Anna Rosamilia
- Pelvic Floor Unit Monash Health Moorabbin Victoria Australia
- The Ritchie Centre Hudson Institute of Medical Research Clayton Victoria Australia
- Department of Obstetrics and Gynaecology Monash University Clayton Victoria Australia
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Randomized controlled trial for improved recovery of the pelvic floor after vaginal delivery with a specially formulated postpartum supplement. Obstet Gynecol Sci 2020; 63:305-314. [PMID: 32489975 PMCID: PMC7231945 DOI: 10.5468/ogs.2020.63.3.305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/07/2019] [Accepted: 11/26/2019] [Indexed: 11/12/2022] Open
Abstract
Objective To improve pelvic floor recovery after vaginal delivery with daily supplementation of a specially formulated postpartum recovery supplement. Methods Within 48 hours of vaginal delivery, primipara women were randomized in a 1:1 ratio to receive daily oral supplementation for 6 weeks with either a combination of regular prenatal vitamin (PNV), leucine (4 g/day), zinc (30 mg/day) and omega-3 fatty acid (900 mg/day) (treatment group), or only a PNV daily (control group). Co-primary outcomes were vaginal squeeze pressure as measured by perineometer and levator muscle injury as measured by transperineal 3-dimensional tomographic ultrasound at 6 weeks postpartum. Results Twenty-six women in the control group and 27 in the treatment group completed the trial. Weak pelvic floor muscle strength was significantly less frequent in the treatment group compared to the control group at 6 weeks after delivery (28% vs. 58%, P=0.03). Both right and left-sided levator-urethra gap was significantly larger in the control group compared to the treatment group indicating more levator injury being present in the control group at 6 weeks after delivery. Anterior vaginal wall prolapse at or beyond the hymenal ring was significantly more common in the control group compared to the treatment group (19% vs. 0%, P=0.02). Significantly more women reported bothersome bulge symptoms in the control group compared to the treatment group at 6 weeks postpartum (19% vs. 0%, P=0.02). Conclusion Postpartum women who received a specially formulated postpartum recovery supplement had improved recovery of the pelvic floor after vaginal delivery.
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Pelvic organ prolapse as a function of levator ani avulsion, hiatus size, and strength. Am J Obstet Gynecol 2019; 221:41.e1-41.e7. [PMID: 30885773 DOI: 10.1016/j.ajog.2019.03.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/22/2019] [Accepted: 03/11/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Obstetrical levator ani muscle avulsion is detected after 10%-30% of vaginal deliveries and is associated with pelvic organ prolapse later in life. However, the mechanism by which levator avulsion may contribute to prolapse is unknown. OBJECTIVES This study investigated the extent by which size of the levator hiatus and pelvic muscle weakness may explain the association between levator avulsion and pelvic organ prolapse. STUDY DESIGN This was a supplementary study of a longitudinal cohort of parous women enrolled 5-10 years after first delivery and assessed annually for prolapse (defined as descent beyond the hymen) for up to 9 annual visits. For this substudy, vaginally parous participants were assessed for levator avulsion using 3-dimensional transperineal ultrasound. Ultrasound was performed at a median interval of 11 years from delivery. Ultrasound volumes also were used to measure levator hiatus area with Valsalva. Pelvic muscle strength was measured with perineometry. Women with and without pelvic organ prolapse were compared for levator avulsion, levator hiatus area, and pelvic muscle strength, using multivariable logistic regression yielding a measure of mediation. Bootstrap methods were used to calculate the confidence interval corresponding to the measure of mediation by hiatus area and pelvic muscle strength. RESULTS Prolapse was identified in 109 of 429 (25%) and was significantly associated with levator avulsion (odds ratio, 4.17; 95% confidence interval, 2.28-7.31). Prolapse also was associated with levator hiatus area (odds ratio, 1.52 per 5 cm2; 95% confidence interval, 1.34-1.73) and inversely with muscle strength (odds ratio, 0.87 per 5 cm H2O; 95% confidence interval, 0.81-0.94). In a multivariable logistic model including levator avulsion, levator hiatus area, and strength, the association between levator avulsion and prolapse was substantially attenuated and indeed was no longer statistically significant (odds ratio, 1.75; 95% confidence interval, 0.91-3.39). Hiatus area and strength mediated 61% (95% confidence interval, 34%-106%) of the association between avulsion and prolapse. Furthermore, since the 95% confidence interval for this estimate contained 100%, it cannot be ruled out that the 2 markers fully mediate the effect of avulsion on prolapse. CONCLUSIONS The strong association between pelvic organ prolapse and levator avulsion can be explained to a large extent by a larger levator hiatus and weaker pelvic muscles after levator avulsion.
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