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Wu X, Zheng X, Yi X, Fan B. Association of the second birth mode of delivery and interval with maternal pelvic floor changes: a prospective cohort study. BMC Pregnancy Childbirth 2024; 24:178. [PMID: 38454330 PMCID: PMC10918865 DOI: 10.1186/s12884-024-06366-6] [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: 06/27/2023] [Accepted: 02/23/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND This study aimed to explore the association of the second birth delivery mode and interval with maternal pelvic floor changes. METHODS This prospective cohort study included women who had a first delivery and were in weeks 36-41 of a subsequent pregnancy at Panzhihua Central Hospital between July 2017 and June 2018. The primary outcomes of the study were the hiatus area at 6 months postpartum and bladder neck (mm) at rest and during a maximum Valsalva maneuver. RESULTS There were 112 women with vaginal delivery and 182 with Cesarean section. The hiatus area and hiatus circumference decreased at all time points (all P < 0.001). The women with Cesarean section had a smaller hiatus area and circumference (P < 0.001 and P < 0.001). The hiatus diameters decreased with time in both groups (all P < 0.001) and were smaller after Cesarean section (both P < 0.001). The bladder neck at maximum Valsalva increased with time (all P < 0.001) without significant differences between the two groups. Finally, the proportion of patients with POP-Q stage 0/I increased with time in both groups (all P < 0.001), with the proportions being higher in the Cesarean group (P = 0.002). The birth interval was negatively correlated with the hiatus area (B=-0.17, 95%CI: -0.25, -0.08, P < 0.001) and positively correlated with the bladder neck at rest (B = 0.22, 95%CI: 0.08, 0.35, P = 0.001) and at maximum Valsalva (B = 0.85, 95%CI: 0.65, 1.05, P < 0.001). CONCLUSIONS In conclusion, the mode of delivery at the second birth could influence the hiatus area and circumference and bladder neck size. The birth interval was negatively correlated with the hiatus area and positively correlated with the bladder neck at rest and at maximum Valsalva.
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Affiliation(s)
- Xiaoli Wu
- Department of Ultrasonography, Panzhihua Central Hospital, No.34 Yikang Street, Panzhihua, Sichuan, 617067, China.
| | - Xiu Zheng
- Department of Ultrasonography, Panzhihua Central Hospital, No.34 Yikang Street, Panzhihua, Sichuan, 617067, China
| | - Xiaohong Yi
- Department of Ultrasonography, Panzhihua Central Hospital, No.34 Yikang Street, Panzhihua, Sichuan, 617067, China
| | - Bolin Fan
- Department of Ultrasonography, Panzhihua Central Hospital, No.34 Yikang Street, Panzhihua, Sichuan, 617067, China
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Maes N, Lakerveld T, Dekelver D, Jacquemyn Y, Neels H. Relationship between urethral motion profile and parity assessed by translabial ultrasound imaging. Arch Gynecol Obstet 2023; 307:1833-1838. [PMID: 36795144 PMCID: PMC9933794 DOI: 10.1007/s00404-022-06897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 12/18/2022] [Indexed: 02/17/2023]
Abstract
PURPOSE This study aims to describe the differences in the urethral motion profile (UMP) of primiparous and multiparous women immediately postpartum. METHODS This prospective study recruited 65 women (29 primiparous, 36 multiparous) one-seven days postpartum. The patients underwent a standardised interview and two-dimensional translabial ultrasound (TLUS). To evaluate the UMP, the urethra was manually traced and divided into five segments with six equidistant points. The mobility vector (MV) for each point was calculated as [Formula: see text]. A Shapiro-Wilk test was conducted to test normality. An independent t-test and a Mann-Whitney test were conducted to express differences between the groups. The Pearson correlation coefficient was used to determine the relationships among MVs, parity and confounders. Finally, a univariate generalised linear regression analysis was performed. RESULTS MV1-MV4 were found to be normally distributed. A significant difference for all MVs, except for MV5, was demonstrated between parity groups (MV1: t = 3.88 (p < .001), MV2: t = 3.82 (p < .001), MV3: t = 2.65 (p = .012), MV4: t = 2.54 (p = .015), MV6: U = 150.00 (exact sig. two tailed = .012)). A strong-to-very strong mutual correlation was observed between MV1 to MV4. The univariate generalised linear regression showed that parity can predict up to 26% of urethral mobility. CONCLUSION This study shows that multiparous women have significantly higher urethral mobility compared to primiparous women in the first week postpartum, with the most significant effect observed in the proximal urethra.
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Affiliation(s)
- Nelli Maes
- Faculty of Medicine and Health Sciences, Antwerp University (UA), Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Thirza Lakerveld
- Faculty of Medicine and Health Sciences, Antwerp University (UA), Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Dyo Dekelver
- Faculty of Medicine and Health Sciences, Antwerp University (UA), Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Yves Jacquemyn
- Department of Gynaecology and Obstetrics, ASTARC and Global Health Institute GHI Antwerp University (UA), 2610, Wilrijk, Belgium
| | - Hedwig Neels
- Department of Gynaecology and Obstetrics, ASTARC and MOVANT Antwerp University (UA), 2610, Wilrijk, Belgium
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Shao XH, Kong DJ, Zhang LW, Wang LL, Wang SM, Yu LJ, Dong XQ. Ultrasound analysis of the effect of second delivery on pelvic floor function in Chinese women. J OBSTET GYNAECOL 2021; 42:261-267. [PMID: 34078229 DOI: 10.1080/01443615.2021.1907554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In our study, patients who had a second delivery were categorised into the following 4 groups. Pelvic floor ultrasound data were compared during the 6th week after the second delivery. The incidence of cystoceles was highest in group A and lowest in group D. In addition, groups A and B had a higher rate of rectoceles or perineum descent. Similarly, the areas of the levator hiatus were higher in Groups A and B during Valsalva manoeuvres. The area of the levator hiatus from the resting state to the Valsalva manoeuvre effect had the greatest change in Group A. A comparison of the PR thickening rates among the four groups did not reveal significant differences. All second delivery methods can cause varying degrees of pelvic organ prolapse and decreased pelvic floor function; however, vaginal delivery as the second delivery mode may have a more significant effect in Chinese women.Impact StatementWhat is already known on this subject? Different modes of delivery have significantly different effects on female pelvic floor function. Pregnancy beyond 35 weeks of gestation has an effect on female pelvic floor function, irrespective of the mode of delivery.What do the results of this study add? This study analysed the impact of different delivery modes on Chinese female pelvic floor function. Parous women who underwent different modes of second delivery all demonstrated different degrees of pelvic organ prolapse, as well as pelvic floor function decline.What are the implications of these findings for clinical practice and/or further research? Our study will provide basic research of Chinese female pelvic floor function after a second delivery, which will be of clinical significance around the world, as well as in China. China will keep promoting further delivery as the aging population is increasing. If the developing countries want to promote the second delivery around the women, they have basic research and data to instruct the females.
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Affiliation(s)
- Xiao-Hui Shao
- PET/CT Center, Harbin Medical University Cancer Hospital, Heilongjiang Province, Harbin, P. R. China.,Department of Ultrasonography, The Fourth Hospital of Harbin Medical University, Heilongjiang Province, Harbin, P. R. China
| | - De-Jiao Kong
- Department of Ultrasonography, The Fourth Hospital of Harbin Medical University, Heilongjiang Province, Harbin, P. R. China
| | - Li-Wei Zhang
- Department of Ultrasonography, The Fourth Hospital of Harbin Medical University, Heilongjiang Province, Harbin, P. R. China
| | - Lu-Lu Wang
- Department of Ultrasonography, The Fourth Hospital of Harbin Medical University, Heilongjiang Province, Harbin, P. R. China
| | - Si-Ming Wang
- Department of Ultrasonography, The Fourth Hospital of Harbin Medical University, Heilongjiang Province, Harbin, P. R. China
| | - Li-Juan Yu
- PET/CT Center, Harbin Medical University Cancer Hospital, Heilongjiang Province, Harbin, P. R. China.,Nuclear Medicine Department, Hainan Cancer Hospital, Hainan Province, Haikou, P. R. China
| | - Xiao-Qiu Dong
- Department of Ultrasonography, The Fourth Hospital of Harbin Medical University, Heilongjiang Province, Harbin, P. R. China
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The effect of parity on the function of pelvic floor musculature in the long term: cross-sectional study. Obstet Gynecol Sci 2020; 63:577-585. [PMID: 32933227 PMCID: PMC7494773 DOI: 10.5468/ogs.19236] [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: 12/26/2019] [Accepted: 04/12/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Parity is associated with an increased risk of pelvic floor muscle dysfunction. The aim of this study was to evaluate the long-term effects of parity on this musculature. Methods This cross-sectional study was completed at the Department of Physical Therapy, Federal University of São Carlos, Brazil. In total, 143 women participated in the study and were classified into three groups according to parity: nulliparae, primiparae, and secundiparae women. All parous participants had last given birth between 1 and 6 years prior. Pelvic floor muscle function was assessed through unidigital vaginal palpation using the PERFECT scheme, with the contraction grade classified according to the Modified Oxford Scale and through manometry. Results There was no difference in scores on the Modified Oxford Scale (the means and standard deviations were 2.5±0.8 in nulliparae women, 2.3±0.9 in primiparae women, and 2.2±0.9 in secundiparae women; P=0.482) and manometry findings (the means and standard deviations were 42.3±22.7 in nulliparae women, 35.0±21.8 in primiparae women, and 33.2±20.0 in secundiparae women; P=0.144) among the assessed groups. Conclusion Parity had no effect, regardless of mode of birth, on the function of pelvic floor muscles and the presence of urinary symptoms, such as long-term urinary incontinence after birth.
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Jundt K, Peschers U, Kentenich H. The investigation and treatment of female pelvic floor dysfunction. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:564-74. [PMID: 26356560 PMCID: PMC4570968 DOI: 10.3238/arztebl.2015.0564] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 07/09/2015] [Accepted: 07/09/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND 25% of all women report involuntary loss of urine, and 7% may require treatment. METHODS This review is based on a selection of pertinent literature, including guidelines and Cochrane reviews. RESULTS The assessment of pelvic floor dysfunction in women begins with a basic evaluation that is followed by special diagnostic tests if indicated. The physician taking the clinical history should inquire about the patient's behavior, personality, social and other stressors, and eating and drinking habits, as well as any mental disorders that may be present, including anxiety disorders, depression, somatization disorders, and disorders of adaptation. Conservative treatment consists mainly of lifestyle changes, physiotherapy, and medication. Stress incontinence is most commonly treated with pelvic floor exercises, with a documented success rate of 56.1% vs. 6% without such treatment (relative risk 8.38, 95% confidence interval 3.67-19.07). If incontinence persists, surgery may be indicated ( implantation of suburethral tension-free slings, or colposuspension). Feedback and biofeedback training can be used to treat an overactive bladder. If these techniques and drug therapy are unsuccessful, botulinum toxin injections can be considered. CONCLUSION Well-validated treatments for pelvic floor dysfunction are available. Psychosomatic factors must be taken into account and can have a major effect on treatment outcomes.
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Affiliation(s)
- Katharina Jundt
- Private practice for gynecology at Pasinger Bahnhof, München
- PD Dr. Jundt and Prof. Dr. Kentenich have equally contributed to the article
| | - Ursula Peschers
- Pelvic Floor Center München, Surgical Hospital München-Bogenhausen
- PD Dr. Jundt and Prof. Dr. Kentenich have equally contributed to the article
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Priddis H, Dahlen HG, Schmied V, Sneddon A, Kettle C, Brown C, Thornton C. Risk of recurrence, subsequent mode of birth and morbidity for women who experienced severe perineal trauma in a first birth in New South Wales between 2000-2008: a population based data linkage study. BMC Pregnancy Childbirth 2013; 13:89. [PMID: 23565655 PMCID: PMC3635942 DOI: 10.1186/1471-2393-13-89] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 04/03/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Severe perineal trauma occurs in 0.5-10% of vaginal births and can result in significant morbidity including pain, dyspareunia and faecal incontinence. The aim of this study is to determine the risk of recurrence, subsequent mode of birth and morbidity for women who experienced severe perineal trauma during their first birth in New South Wales (NSW) between 2000 - 2008. METHOD All singleton births recorded in the NSW Midwives Data Collection between 2000-2008 (n=510,006) linked to Admitted Patient Data were analysed. Determination of morbidity was based upon readmission to hospital within a 12 month time period following birth for a surgical procedure falling within four categories: 1. Vaginal repair, 2. Fistula repair, 3. Faecal and urinary incontinence repair, and 4. Rectal/anal repair. Women who experienced severe perineal trauma during their first birth were compared to women who did not. RESULTS 2,784 (1.6%) primiparous women experienced severe perineal trauma during this period. Primiparous women experiencing severe perineal trauma were less likely to have a subsequent birth (56% vs 53%) compared to those not who did not (OR 0.9; CI 0.81-0.99), however there was no difference in the subsequent rate of elective caesarean section (OR 1.2; 0.95-1.54), vaginal birth (including instrumental birth) (OR 1.0; CI 0.81-1.17) or normal vaginal birth (excluding instrumental birth) (OR 1.0; CI 0.85-1.17). Women were no more likely to have a severe perineal tear in the second birth if they experienced this in the first (OR 0.9; CI 0.67-1.34). Women who had a severe perineal tear in their first birth were significantly more likely to have an 'associated surgical procedure' within the ≤12 months following birth (vaginal repair following primary repair, rectal/anal repair following primary repair, fistula repair and urinary/faecal incontinence repair) (OR 7.6; CI 6.21-9.22). Women who gave birth in a private hospital compared to a public hospital were more likely to have an 'associated surgical procedure' in the 12 months following the birth (OR 1.8; CI 1.54-1.97), regardless of parity, birth type and perineal status. CONCLUSION Primiparous women who experience severe perineal trauma are less likely to have a subsequent baby, more likely to have a related surgical procedure in the 12 months following the birth and no more likely to have an operative birth or another severe perineal tear in a subsequent birth. Women giving birth in a private hospital are more likely to have an associated surgical procedure in the 12 months following birth.
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Affiliation(s)
- Holly Priddis
- School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith South DC, NSW, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith South DC, NSW, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith South DC, NSW, Australia
| | - Annie Sneddon
- The Gold Coast Health Services District, Griffith University, 108 Nerang Street, Southport, QLD, 4215, Australia
| | - Christine Kettle
- Faculty of Health, Staffordshire University, Blackheath Lane, Beaconside, Stafford, ST18 0AD, UK
| | - Chris Brown
- NHMRC Clinical Trials Centre, Locked Bag 77, Camperdown, NSW, 1450, Australia
| | - Charlene Thornton
- School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith South DC, NSW, Australia
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