Pelvic-Floor Dysfunction Prevention in Prepartum and Postpartum Periods

Knowledge, attitude, and practice of Chinese midwives performing in perineal massage for pregnant women in the latter stages of pregnancy

BACKGROUND

In obstetrics, perineal trauma is regarded as a serious public health issue. Perineal massage is advised for pregnant women in the later stages of pregnancy to help prevent perineal injuries during labor. This study aims to assess the knowledge, attitudes, and practices (KAP) of Chinese midwives concerning perineal massage for pregnant women in the latter stages of pregnancy.

METHODS

This cross-sectional study was conducted in China from July 2024 to September 2024, aiming to investigate the knowledge, attitudes, and practices of midwives regarding perineal massage for pregnant women in the latter stages of pregnancy. The research employed a questionnaire survey covering demographic data as well as dimensions related to knowledge, attitudes, and practices. Data were analyzed using SPSS 27.0. Descriptive statistics summarized participant characteristics, while inferential analyses included independent t-tests, one-way ANOVA, Pearson correlation (to evaluate interrelationships among knowledge, attitude, and practice scores), and multivariable logistic regression (to determine predictors of practice scores), with statistical significance set at α = 0.05.

RESULTS

A total of 446 valid questionnaires were gathered. Of these, 441 (98.88%) were female and 5 (1.12%) were male; 376 (84.30%) were from tertiary hospitals and 70 (15.70%) were from secondary hospitals. 89.01% of the sample had worked in the delivery room for more than five years. Regarding perineal massage for pregnant women in the latter stages of pregnancy, midwives received scores of 69.28 ± 12.90, 42.20 ± 4.31, and 45.25 ± 10.05 in the knowledge, attitude, and practice aspects, respectively. Multivariate logistic regression analysis outcomes indicated that practice dimension scores were influenced by knowledge (OR = 1.257, 95% CI [1.64-1.357], P < 0.001) and attitude (OR = 1.152, 95% CI [1.113-1.193], P < 0.001) scores.

CONCLUSIONS

There is an average level of midwives' knowledge, attitudes, and practices (KAP) on perineal massage for pregnant women in the later stages of pregnancy. This study recommends strengthening the knowledge and attitude dimensions of midwives in order to improve their comprehension of giving pregnant women a perineal massage in the latter stages of pregnancy. Improving these elements will also boost midwives' practical abilities, which will improve the quality of perineal massage for expectant mothers in the latter stages of pregnancy.

Women's experience and perspectives about physical therapy during pregnancy and after childbirth

Pregnancy and childbirth introduce significant physical and psychological changes, often resulting in discomforts such as back pain, pelvic pain, and post-delivery recovery challenges. Physical therapy is known to be an effective intervention, yet there is limited understanding of how women perceive and utilize it during pregnancy and the postpartum period. This study aimed to explore women's experiences and perspectives of physical therapy during pregnancy and after childbirth. A cross-sectional survey was conducted from May 2021 to May 2022, involving 298 women who were receiving or had received pregnancy and postpartum care at a medical center in southern Taiwan. Eligibility participants were aged 20 or older, understood Chinese/Mandarin, and agreed to participate. Data were collected through an online questionnaire covering demographic information, health history, symptom prevalence, physical therapy utilization, and perceptions. Descriptive statistics (means, frequencies and percentages) were used to analyze the data. Of the 298 participants, 53 (17.8 percent) utilized physical therapy during pregnancy and/or after childbirth. Ninety percent believed that pregnant and postpartum women need physical therapy, with breast massage (80.9 percent) being the most needed self-pay service. The primary barrier to utilizing was "lack of time," while the primary facilitator was "affordable self-pay costs." This study highlights the significant need for physical therapy among pregnant and postpartum women, identifying key barriers and facilitators to service utilization. These findings can guide the integration of physical therapy into maternal care pathways, improving overall health outcomes for women.

Combining pelvic floor ultrasonography with deep learning to diagnose anterior compartment organ prolapse

Background

Anterior compartment prolapse is a common pelvic organ prolapse (POP), which occurs frequently among middle-aged and elderly women and can cause urinary incontinence, perineal pain and swelling, and seriously affect their physical and mental health. At present, pelvic floor ultrasound is the primary examination method, but it is not carried out by many primary medical institutions due to the significant shortcomings of training in the early stage and the variable image quality. There has been great progress in the application of deep learning (DL) in image-based diagnosis in various clinical contexts. The main purpose of this study was to improve the speed and reliability of pelvic floor ultrasound diagnosis of POP by training neural networks to interpret ultrasound images, thereby facilitating the diagnosis and treatment of POP in primary care.

Methods

This retrospective study analyzed medical records of women with anterior compartment organ prolapse (n=1,605, mean age 45.1±12.2 years) or without (n=200, mean age 38.1±13.4 years), who were examined at West China Second University Hospital between March 2019 and September 2021. Static ultrasound images of the anterior chamber of the pelvic floor (5,281 abnormal, 535 normal) were captured at rest and at maximal Valsalva motion, and four convolutional neural network (CNN) models, AlexNet, VGG-16, ResNet-18, and ResNet-50, were trained on 80% of the images, then internally validated on the other 20%. Each model was trained in two ways: through a random initialization parameter training method and through a transfer learning method based on ImageNet pre-training. The diagnostic performance of each network was evaluated according to accuracy, precision, recall and F1-score, and the receiver operating characteristic (ROC) curve of each network in the training set and validation set was drawn and the area under the curve (AUC) was obtained.

Results

All four models, regardless of training method, achieved recognition accuracy of >91%, whereas transfer learning led to more stable and effective feature extraction. Specifically, ResNet-18 and ResNet-50 performed better than AlexNet and VGG-16. However, the four networks learned by transfer all showed fairly high AUCs, with the ResNet-18 network performing the best: it read images in 13.4 msec and provided recognition an accuracy of 93.53% along with an AUC of 0.852.

Conclusions

Combining DL with pelvic floor ultrasonography can substantially accelerate diagnosis of anterior compartment organ prolapse in women while improving accuracy.

The impact of oral postbiotics on the restoration of pelvic floor muscle function

AIM

To elucidate the efficacy and underlying mechanisms of postbiotics in ameliorating stress urinary incontinence (SUI) in a rat model.

METHODS

SUI model was established via pelvic floor injury and bilateral ovariectomy to simulate postmenopausal conditions. Following successful model induction, subjects were randomly allocated into control, model, positive drug, and experimental groups. The positive drug group received midodrine hydrochloride (20 mg/kg), while the experimental group received postbiotics (75 mg/kg) daily for 28 days. Urodynamic and abdominal leak point pressure tests were conducted on days 7, 14, 21, and 28. After 28 days, histopathology and western blot analysis for collagen I (Col I), collagen III (Col III), and elastin, as well as quantitative polymerase chain reaction for gene expression, were performed.

RESULTS

The model group showed abnormal urodynamic waveforms and lower maximum abdominal leak point pressure compared to controls. Histopathology revealed muscle fiber disarray, fiber rupture, and decreased muscle thickness. Both mRNA and protein levels of Col I, Col III, and Elastin were reduced. Midodrine improved urodynamic parameters and pathology, increasing Col I, Col III, and Elastin levels. Postbiotics also improved urodynamic parameters and pathology, with increased protein levels of Col I, Col III, and Elastin, and upregulated mRNA levels of Col I, Col III, Elastin, and transforming growth factor β1.

CONCLUSION

Postbiotics demonstrate therapeutic potential in alleviating SUI in rats by upregulating the expression of Col I, Col III, Elastin, and transforming growth factor β1 genes, enhancing collagen and elastin protein content in sphincter and pubococcygeus muscles, and consequently restoring muscle contractility and function.

Unveiling novel regulatory mechanisms of miR-5195-3p in pelvic organ prolapse pathogenesis†

Pelvic organ prolapse is a condition that significantly affects women's quality of life. The pathological mechanism of pelvic organ prolapse is not yet fully understood, and its pathogenesis is often caused by multiple factors, including the metabolic imbalance of the extracellular matrix. This study aims to investigate the role of miR-5195-3p, a microRNA, in the pathology of pelvic organ prolapse and its regulatory mechanism. Using various molecular biology techniques such as real-time reverse transcription Polymerase Chain Reaction (PCR), fluorescence in situ hybridization, immunohistochemistry, and Western blot, miR-5195-3p expression was examined in vaginal wall tissues obtained from pelvic organ prolapse patients. Results revealed an up-regulation of miR-5195-3p expression in these tissues, showing a negative correlation with the expression of extracellular matrix-related proteins. Further analysis using bioinformatics tools identified Lipoxygenase (LOX) as a potential target in pelvic organ prolapse. Dual luciferase reporter gene experiments confirmed LOX as a direct target of miR-5195-3p. Interestingly, regulating the expression of LOX also influenced the transforming growth factor β1 signaling pathway and had an impact on extracellular matrix metabolism. This finding suggests that miR-5195-3p controls extracellular matrix metabolism by targeting LOX and modulating the TGF-β1 signaling pathway. In conclusion, this study unveils the involvement of miR-5195-3p in the pathological mechanism of pelvic organ prolapse by regulating extracellular matrix metabolism through the LOX/TGF-β1 axis. These findings reveal new mechanisms in the pathogenesis of pelvic organ prolapse, providing a theoretical foundation and therapeutic targets for further research on pelvic organ prolapse treatment.

Sexual function in pregnancy and postpartum: breaking the silence

BACKGROUND

Sexual function during pregnancy and the postpartum period is a complex component of maternal and couple health, and it's deeply influenced by an intricate interplay of physiological, psychological, childbirth, and relational factors.

AIM

This review seeks to explore the nuanced dynamics of sexual function during pregnancy and the postpartum period, shedding light on both the challenges and opportunities for enhancing maternal and couple sexual well-being.

METHODS

Drawing on a combination of existing scientific literature and extensive clinical experience, this expert opinion delves into the physiological transformations, psychological adjustments, and shifts in relational dynamics that accompany pregnancy and postpartum. It sheds light on the sexual experiences of partners and underscores the necessity of a holistic understanding of sexual health in this context.

OUTCOMES

The review offers an enhanced perspective on sexual function during pregnancy and postpartum and aims to contribute to a deeper and more nuanced understanding that can inform both clinical practice and future research.

RESULTS

The results highlight that pregnancy and postpartum phases influence sexual function, with fluctuations in sexual desire and activity resulting from changes in physiological, psychological, and relational factors. Women experience a decline in sexual function, particularly during the third trimester, with factors, such as hormonal changes, body image concerns, and partner dynamics shaping sexual experiences across pregnancy and postpartum stages.

CLINICAL IMPLICATIONS

A thorough understanding of sexual function throughout pregnancy and postpartum is critical for enhancing maternal and couple health and it creates pathways to more effective and compassionate care.

STRENGTHS AND LIMITATIONS

The strengths of this review include the integration of scientific literature with clinical experience to provide a holistic view of sexual function. However, the limitations are the reliance on cross-sectional studies and the scarcity of data on couple sexual functioning.

CONCLUSION

Understanding the interplay of physiological and anatomical changes, psychological factors, and partner dynamics is crucial in addressing sexual function during pregnancy and the postpartum period.

Occupational Therapy Practitioners' Perceptions of Providing Services for the Acute Postpartum Population

Occupational therapy practitioners' (OTP's) perceptions of their role in working on the acute postpartum hospital unit are unknown. The objective of this research was to determine the perspectives of OTP's enrolled in a continuing education course to gain competency in providing services to acute postpartum patients. Investigators engaged in a phenomenology consisting of semi-structured interviews with six OTP's working in acute care hospitals preparing to work on the postpartum unit. Three themes emerged from transcripts: (a) Its' Not THAT Different; (b) Willing To Try; and (c) Shifting Focus To Mom. OTPs working in hospitals identified existing skills applicable to working with acute postpartum patients, a need for additional learning to enhance competence, and a desire to focus support for the birthing person to improve maternal outcomes. Hospital onboarding and/or entry-level OTP programs should consider including education on the postpartum population. Future research should focus on program implementation on acute postpartum hospital units.

The Impact of Pelvic Floor Muscle Strengthening on the Functional State of Women Who Have Experienced OASIS After Childbirth

Background and Objectives: The primary objective of this study was to assess the impact of pelvic floor muscle (PFM) strengthening on the pelvic floor function in women who have experienced OASIS two years after delivery, and the secondary objective was to educate women about PFM strengthening and instruct them on the correct way to exercise. Methods and Materials: A prospective case-control study was conducted. The participants were divided into two groups: the case group (women who experienced OASIS) and the control group (women who did not experience perineal tears but had similar obstetric-related data to the case). Women were invited for a gynecological exam, PFM assessment, and consultation on PFM training. Women in the case group had three consultations, and women in the control group had two. Women were presented with four sets of questions about pre-pregnancy condition and questions related to UI and FI after delivery. Results were considered significant when p < 0.05. Results: OASIS were detected in 13 (0.4%) women in 2021. Risk factors for OASIS were found to be fetal macrosomia (p = 0.012), fetal occiput posterior position (p = 0.001), and epidural analgesia (p = 0.003). After one year of performing PFM strengthening exercises, some women in the study group exhibited stronger PFM contractions (p = 0.076), while others held the contracted PFM for a longer time (p = 0.133). UI affected women in the control group more often (p = 0.019). Two years after delivery, gas incontinence was mentioned significantly more frequently in the case group (p = 0.019). One year after initial consultation, gas incontinence was also more significantly common in the case group (p = 0.037). Conclusions: This study found that PFM strengthening exercises significantly improved pelvic floor function in women who experienced OASIS two years after delivery. Participants exhibited stronger PFM contractions and an increased ability to maintain these contractions. Women reported a better understanding of PFM exercises and proper techniques.

The Efficacy of Pelvic Floor Rehabilitation in the Treatment of Urinary Incontinence in Female Athletes: A Systematic Review

BACKGROUND AND OBJECTIVES

Urinary incontinence (UI) prevalence reaches the 80% rate in female athletes involved in high-impact sports. In this context, although conservative treatment represents the first therapeutic choice, there is still a lack of knowledge on the efficacy of conservative programs in young female athletes. Therefore, the aim of this study was to investigate the role of pelvic floor rehabilitation in the treatment of UI in young nulliparous female athletes. We performed a literature search using PubMed, Medline, Cochrane Library, Web of Science, and Scopus. The selection of articles was conducted using a specific search string: "[((pelvic floor dysfunction) OR (urinary incontinence) OR (dyspareunia) OR (dysuria)) AND ((sport) OR (sports)) AND ((female) OR (woman) OR (women) OR (girl)) AND ((rehabilitation) OR (rehab) OR (pelvic rehabilitation) OR (exercise))]". The review protocol was registered in PROSPERO with the ID CRD42024559990. A total of 1018 articles were found in all searches of the databases. After removing duplicates, 663 papers were reviewed in terms of title and abstract. Finally, a total of six studies were included in the present review. The results of this review show that conservative treatment with a personalised pelvic floor muscle training program (PFMTP) represents an effective treatment for UI, decreasing urine loss and improving maximum voluntary pelvic contraction; this is linked with an improvement in quality of life and sports performance, in particular when supervised by a physical therapist. Moreover, due to the reluctance of athletes to talk about UI, an educational program should be considered as part of a prevention programme in pre-season training.

Uterine prolapse in pregnancy: a case report and literature review

Uterine prolapse complicating pregnancy is extremely rare. However, in some cases, serious complications may appear such as miscarriage, preterm labor, infection, fetal demise, and maternal death. Management is essentially conservative but surgical intervention is always possible. We report a case of uterine prolapse in a young 24-year-old parturient, para 4, gravida 4 at 36 weeks of gestation. She was presented to the obstetric emergency, with uterine contraction and rupture of the amniotic sac. She successfully gave birth to a male baby weighing 2600 g by assisted vaginal delivery. We opted for conservative treatment and there were no fetal or maternal complications. A pessary was placed at the postpartum. Early diagnosis and good monitoring during pregnancy are essential to avoid complications; improve the prognosis of pregnancy and increase women´s chances to benefit from the advantages of conservative treatment.

Women's use of Swedish health care during the postpartum period in relation to maternal country of birth-A population-based study

INTRODUCTION

Migrant women are a heterogenous group with both higher and lower risk for pregnancy complications and adverse birth outcomes compared with women in the receiving countries. This study aimed to investigate women's use of Swedish healthcare postpartum, in terms of hospital stay >48 h, readmission to hospital, and specialized out-patient clinic visits, in relation to maternal country of birth.

MATERIAL AND METHODS

A population-based register study including 278 219 primiparous and 367 776 multiparous women in Sweden (2014-2019) using data from Swedish Pregnancy Register, National Patient Register and Statistics Sweden. Multivariable logistic regression analyses were used to estimate associations between maternal country of birth and outcomes, adjusting for year of birth, maternal age, education, pre-gestational hypertension and diabetes, and healthcare region, presented as crude and adjusted odds ratios (aOR) with 95% confidence interval (CI) with Swedish-born women as reference.

RESULTS

Subgroups of migrant women had higher odds of postpartum hospital stays > 48 h, particularly women from Eritrea (primiparous aOR 2.80, CI 2.49-3.15; multiparous aOR 2.78, CI 2.59-2.98), Somalia (primiparous aOR 2.61, CI 2.34-2.92; multiparous aOR 1.87, CI 1.79-1.97), and India (primiparous aOR 2.52, CI 2.14-2.97; multiparous aOR 2.61, CI 2.33-2.93), compared to Swedish-born women. Primiparous women from Afghanistan (aOR 1.32, CI 1.08-1.6), Iraq (aOR 1.30, CI 1.16-1.46), and Iran (aOR 1.23, CI 1.04-1.45) had slightly higher odds of hospital readmission, along with multiparous women from India (aOR 1.34, CI 1.02-1.76) and Somalia (aOR 1.24, CI 1.11-1.38). Specialized out-patient clinic visits were most common in primiparous women from Somalia (aOR 1.47, CI 1.35-1.59), Iran (aOR 1.31, CI 1.22-1.42) and Afghanistan (aOR 1.31, CI 1.18-1.46), and in multiparous women from Iran (aOR 1.30, CI 1.20-1.41) and Iraq (aOR 1.15, CI 1.11-1.20), however less common in women from some other countries.

CONCLUSIONS

The use of Swedish health care during the postpartum period varied among women, depending on their country of birth. Women from certain countries had particularly high odds of postpartum hospital stays exceeding 48 h, compared to Swedish-born women, regardless of parity and pre-gestational medical disorders. Further studies are needed to determine whether the individual needs of migrant women are being met during the postpartum period or not.

Pelvic Floor Muscle Training Interventions in Female Athletes: A Systematic Review and Meta-analysis

CONTEXT

Athletes are almost 3 times more at risk of experiencing urinary incontinence (UI) than sedentary women, with prevalence rates varying from 10.9% in low-impact sports such as cycling to 80% when engaging in high-impact sports such as trampoline gymnastics. To treat UI, pelvic floor muscle (PFM) training (PFMT) is recommended as a first line of treatment.

OBJECTIVE

The aim of the present study was to perform a meta-analysis of the available literature on the efficacy of PFMT interventions in young, nulliparous female athletes.

DATA SOURCES

A literature research was conducted using PubMed, Sport Discus, and Web of Science.

STUDY SELECTION

The inclusion criteria were studies with PFMT intervention in female athletes or recreationally active women. Interventions could be carried out for treatment or prevention of pelvic floor dysfunctions.

STUDY DESIGN

Systematic review with meta-analysis.

LEVEL OF EVIDENCE

Level 5.

DATA EXTRACTION

A descriptive analysis of the articles included in the systematic review was carried out. Meta-analyses could be performed on 6 of the included articles, evaluating the maximal voluntary contraction (MVC) of the PFMs, the amount of urinary leakage (AUL), and the vaginal resting pressure (VRP). Random-effects model and standardized mean differences (SMD) ± 95% CI were reported.

RESULTS

The meta-analysis showed that PFMT produced a significant increase in MVC (SMD, 0.60; 95% CI, 0.11 to 1.08; P = 0.02) and a significant reduction of AUL (SMD, -1.13; 95% CI, -1.84 to -0.41; P < 0.01) in female athletes. No effects were shown in VRP (SMD, -0.05; 95% CI, -1.27 to 1.17; P = 0.93).

CONCLUSION

PFMT is shown to be effective in increasing PFM strength and reducing urine leakage in female athletes, being a powerful tool to prevent and treat pelvic floor dysfunction in this population.

Antenatal Perineal Training for Injuries Prevention: Follow Up after Puerperium

Background and Objectives: This retrospective analysis investigated the impact of preparation of the pelvic floor for childbirth with stretching balloons and perineal massage on the risk of pelvic floor injuries. Materials and Methods: We analyzed 150 primiparous women who accessed private clinics in Padua (Italy) in the period 2019-2023 regarding the rate of perineal trauma and postpartum dysfunction across three groups: the balloon stretching group (BSG, N = 50, 33.3%), the perineal massage group (PMG, N = 39, 26.0%), and the control group (CG, 61, 40.7%). Results: Prenatal perineal training had a significant impact on reducing the rate of perineal injury and episiotomy (27.5% in BSG vs. 48.7% in PMG and 68.3% in CG, p = 0.008, respectively, 9.8% vs. 26% and 40%, p = 0.046) and the duration of the second stage of labor (BSG and PMG had a shorter duration compared to CG with a mean difference of -0.97892 h, p < 0.001, respectively, -0.63372 h, p = 0.002). Patients who carry out the preparation with the stretching balloon are less likely to develop urinary and anal incontinence and pain during intercourse. Specifically, the rate of urinary incontinence in BSG stands at around 23.5% compared to 43.6% in PMG (p = 0.345) and 55% in CG (p = 0.034). Dyspareunia in BSG was detected in 11.8% of cases compared to 35.5% in PMG (p = 0.035) and 61.7% in CG (p < 0.01). Symptomatology inherent to the posterior compartment was reported in 9.8% of cases in BSG vs. 23.11% in PMG (p = 0.085) and 33.3% in CG (p = 0.03%). Conclusions: Stretching balloons and perineal massage can be chosen as tools to prevent and reduce the rates of obstetric trauma during childbirth and to reduce the use of episiotomies as well as protect against the development of dysfunctions of the pelvic floor.

The effect of postpartum nursing guidance on early pelvic floor dysfunction recovery in women of advanced maternal age: a randomized controlled trial

Objective

This study aimed to investigate the efficacy of postpartum nursing guidance in the treatment of early pelvic floor dysfunction (PFD) in women of advanced maternal age.

Methods

A total of 146 patients of advanced maternal age admitted to our hospital between January and December 2021 were enrolled in this study and randomly divided into two groups: the control group and the experimental group, with 73 patients in each group. Parturients in the control group received routine pelvic floor rehabilitation treatment, whereas those in the experimental group were given individualized postpartum nursing guidance alongside routine pelvic floor rehabilitation treatment. The recovery of pelvic floor muscle (PFM) strength, the incidence of PFD diseases and nursing satisfaction were compared between the two groups after 3 months of treatment.

Results

The enhancement of PFM strength in the experimental group significantly surpassed that in the control group. Furthermore, the experimental group exhibited a notably lower overall occurrence of PFD and significantly greater maternal satisfaction compared with the control group, and the difference was statistically significant (p < 0.05).

Conclusion

Combining postpartum nursing guidance with pelvic floor rehabilitation for women of advanced maternal age represents a treatment regimen deserving of clinical endorsement, as it offers numerous advantages, including substantial improvement in PFM strength, decreased incidence of PFD and enhanced patient satisfaction.

Curative effect of hydrogen peroxide combined with silver ion disinfection on pelvic floor dysfunction

BACKGROUND

Pelvic floor dysfunction (PFD) is related to muscle fiber tearing during childbirth, negatively impacting postpartum quality of life of parturient. Appropriate and effective intervention is necessary to promote PFD recovery.

AIM

To analyze the use of hydrogen peroxide and silver ion disinfection for vaginal electrodes in conjunction with comprehensive rehabilitation therapy for postpartum women with PFD.

METHODS

A total of 59 women with PFD who were admitted to the hospital from May 2019 to July 2022 were divided into two groups: Control group (n = 27) received comprehensive rehabilitation therapy and observation group (n = 32) received intervention with pelvic floor biostimulation feedback instrument in addition to comprehensive rehabilitation therapy. The vaginal electrodes were disinfected with hydrogen peroxide and silver ion before treatment. Intervention for both groups was started 6 weeks postpartum, and rehabilitation lasted for 3 months. Pelvic floor muscle voltage, pelvic floor muscle strength, vaginal muscle voltage, vaginal muscle tone, pelvic floor function, quality of life, and incidence of postpartum PFD were compared between the two groups.

RESULTS

Before comprehensive rehabilitation treatment, basic data and pelvic floor function were not significantly different between the two groups. After treatment, the observation group showed significant improvements in the maximum voltage and average voltage of pelvic floor muscles, contraction time of type I and type II fibers, pelvic floor muscle strength, vaginal muscle tone, vaginal muscle voltage, and quality of life (GQOLI-74 reports), compared with the control group. The observation group had lower scores on the pelvic floor distress inventory (PFDI-20) and a lower incidence of postpartum PFD, indicating the effectiveness of the pelvic floor biostimulation feedback instrument in promoting the recovery of maternal pelvic floor function.

CONCLUSION

The combination of the pelvic floor biostimulation feedback instrument and comprehensive rehabilitation nursing can improve pelvic floor muscle strength, promote the recovery of vaginal muscle tone, and improve pelvic floor function and quality of life. The use of hydrogen peroxide and silver ion disinfectant demonstrated favorable antibacterial efficacy and is worthy of clinical application.

Clinical effect and prognostic factor of electric stimulation and biofeedback therapy on postpartum pelvic organ prolapse

OBJECTIVE

To explore the effects of electric stimulation and biofeedback therapy in patients with postpartum pelvic organ prolapse and to identify factors that can affect therapeutic efficacy outcomes.

METHOD

This retrospective study analysed clinical data about patients with postpartum pelvic organ prolapse. A total of 328 women with pelvic organ prolapse at 6 weeks postpartum were recruited from one tertiary hospitals in Sichuan province in China, between March 2019 and March 2022. The prognostic factors of therapeutic efficacy were analysed using logistic regression and decision tree model.

RESULTS

Overall, 259 women showed clinical benefits from the treatment. The logistic regression model showed that parity, pelvic floor muscle training at home, and the pelvic organ prolapse quantitation stage before treatment were independent prognostic factors. The decision tree model showed that the pelvic organ prolapse quantitation stage before treatment was the main prognostic factor, followed by parity. There was no significant difference in the area under the receiver operating characteristic curve between the two models.

CONCLUSION

Parity, pelvic floor muscle training at home, and the pelvic organ prolapse quantitation stage before treatment were important prognostic factors of electric stimulation and biofeedback therapy on postpartum pelvic organ prolapse.

Exosomes isolated from TNF-α-treated bone marrow mesenchymal stem cells ameliorate pelvic floor dysfunction in rats

Exosomes derived from bone marrow-derived mesenchymal stem cells (BMSCs) can alleviate the symptoms of pelvic floor dysfunction (PFD) in rats. However, the potential therapeutical effects of exosomes derived from BMSCs treated with tumour necrosis factor (TNF)-α on the symptoms of PFD in rats are unknown. Exosomes extracted from BMSCs treated with or without TNF-α were applied to treat PFD rats. Our findings revealed a significant elevation in interleukin (IL)-6 and TNF-α, and matrix metalloproteinase-2 (MMP2) levels in the vaginal wall tissues of patients with pelvic organ prolapse (POP) compared with the control group. Daily administration of exosomes derived from BMSCs, treated either with or without TNF-α (referred to as Exo and TNF-Exo), resulted in increased void volume and bladder void pressure, along with reduced peak bladder pressure and leak point pressure in PFD rats. Notably, TNF-Exo treatment demonstrated superior efficacy in restoring void volume, bladder void pressure and the mentioned parameters compared with Exo treatment. Importantly, TNF-Exo exhibited greater potency than Exo in restoring the levels of multiple proteins (Elastin, Collagen I, Collagen III, IL-6, TNF-α and MMP2) in the anterior vaginal walls of PFD rats. The application of exosomes derived from TNF-α-treated BMSCs holds promise as a novel therapeutic approach for treating PFD.

The Effect of Pelvic Floor Rehabilitation on Low Anterior Resection Syndrome After Colorectal Cancer Treatment

Purpose

Low anterior resection (LAR) is the preferred surgical treatment of rectosigmoid or rectal cancers. However, it is often associated with bowel dysfunction, which is termed low anterior resection syndrome (LARS). Daily bowel dysfunction symptoms have a detrimental effect on quality of life (QOL). Pelvic floor rehabilitation (PFR) can improve pelvic floor function and QOL among patients with LARS. This quality improvement (QI) project seeks to assess the prevalence of LARS and develop and incorporate PFR for the treatment and prevention of LARS.

Methods

A convenience sample of 20 patients met project inclusion. Thirteen patients participated. Individuals were categorized by diagnostic risk: low risk, high risk, and established. The intervention included 1-hour PFR sessions with the physical therapist (PT) and 5 minutes of daily self-led pelvic floor muscle exercises. Outcomes questionnaires included the LARS Score and Fecal Incontinence Quality of Life (FIQOL) Scale. Data were collected both pre- and post-colorectal cancer treatment.

Results

The overall prevalence of LARS was 76.9%, which was significantly higher than the retrospective cohort comparison rate of 21.8% (p < .001). The prevalence of major LARS was 89%, 83%, and 50% at the initial, second, and third sessions, respectively, representing a 44% relative decrease. Embarrassment was significantly affected among individuals with major LARS, although ongoing PFR facilitated improvement.

Conclusion

PFR is a valuable adjunct therapy for LARS, with continued sessions decreasing the overall prevalence among the cohort. Major LARS negatively impacts QOL measures early on in treatment but improves with continued PFR.

Polypropylene composite mesh modified by polyurethane gel with ROS scavenging and anti-inflammatory effects for pelvic floor repair

Development of an inflammation modulating polypropylene (PP) mesh in pelvic floor repair is an urgent clinical need. This is because PP mesh for pelvic floor repair can cause a series of complications related to foreign body reactions (FBR) in postoperative period. Therefore, we successfully prepared PP composite mesh that can scavenge reactive oxygen species (ROS) and inhibit inflammation to moderate FBR by a simple method. First, a pregel layer was formed on PP mesh by dip coating. Among them, polyurethane with polythioketal (PTK) is an excellent ROS scavenger, and dopamine methacrylamide (DMA) improves the stability of the coating and synergistically scavenges ROS. Then, a composite mesh (optimal PU50-PP) was obtained by photopolymerization. The results showed that the polyurethane gel layer was able to scavenge more than 90% of free radicals and about 75% of intracellular ROS. In vitro, PU50-PP mesh significantly scavenged ROS and resisted macrophage adhesion. After implantation in the posterior vaginal wall of rats, PU50-PP eliminated 53% of ROS, inhibited inflammation (decreased IL-6, increased IL-10), and dramatically reduced collagen deposition by about 64%, compared to PP mesh. Thus, the composite PP mesh with ROS scavenging and anti-inflammatory properties provides a promising approach for mitigating FBR.

Efficacy of perineal massage during the second stage of labor for the prevention of perineal injury: A systematic review and meta-analysis

BACKGROUND

Numerous interventions to reduce perineal trauma during childbirth have been studied in recent years, including perineal massage.

OBJECTIVE

To determine the efficacy of perineal massage during the second stage of labor to prevent perineal damage.

SEARCH STRATEGY

Systematic search in PubMed, Pedro, Scopus, Web of Science, ScienceDirect, BioMed, SpringerLink, EBSCOhost, CINAHL, and MEDLINE with the terms Massage, Second labor stage, Obstetric delivery, and Parturition.

SELECTION CRITERIA

The articles must have been published in the last 10 years; the perineal massage was administered to the study sample; and the experimental design consisted of randomized controlled trial.

DATA COLLECTION AND ANALYSIS

Tables were used to describe both the studies' characteristics and the extracted data. The PEDro and Jadad scales were used to assess the quality of studies.

MAIN RESULTS

Of the 1172 total results identified, nine were selected. Seven studies were included in the meta-analysis and indicated a statistically significant decreased number of episiotomies in perineal massage.

CONCLUSIONS

Massage during the second stage of labor appears to be effective in preventing episiotomies and reducing the duration of the second stage of labor. However, it does not appear to be effective in reducing the incidence and severity of perineal tears.

Reflections on abortion rights: From policy to medicine

On June 24, 2022, the US Supreme Court overturned Roe v. Wade, which marked a further restriction on women's abortion rights in the US. It has sparked a wide range of societal reactions around the world. Women in different countries enjoy diverse abortion rights due to conditions in their respective nations and cultures. Abortion protects women's rights to a certain extent, and especially in the event of unintended pregnancy. An inappropriate abortion ban will affect women's health and lives and all aspects of medicine, including the lives of doctors, patient access, and the development of medical technology. This review provides a gynecologist's perspective on the impact of abortion policies on women's health and the medical system. This review also attempts to determine the reason for the government's abortion ban.

The effectiveness of eHealth interventions on female pelvic floor dysfunction: a systematic review and meta-analysis

INTRODUCTION AND HYPOTHESIS

eHealth interventions represent a promising novel strategy in pelvic floor management for women. Nevertheless, the effectiveness of eHealth interventions among women with or at risk of pelvic floor dysfunction (PFD) has not been adequately discussed to date. This study aimed to determine the effectiveness of eHealth interventions in preventing and treating PFD among women.

METHODS

Eleven electronic databases were searched for randomized controlled trials (RCTs) from inception until August 28, 2021.

RESULTS

Twenty-four RCTs were included in this meta-analysis that included 3691 women. The meta-analysis showed that eHealth interventions were not only vital for preventing PFD (pregnant women: pooled OR = 0.25, 95% CI: 0.14 to 0.45, p < 0.001; postnatal women: pooled OR = 0.19, 95% CI: 0.06 to 0.60, p = 0.005), but also for reducing the severity of PFD (pooled SMD = -0.63, 95% CI: -1.20 to -0.06, p = 0.031). In addition, compared with traditional care, eHealth interventions showed significant positive effects on several outcome indicators, including quality of life (pooled SMD = 0.49, 95% CI: 0.19 to 0.80, p = 0.002), pelvic floor type I muscle strength (pooled OR = 1.92, 95% CI: 1.30 to 2.82, p = 0.001), pelvic floor type II muscle strength (pooled OR = 2.04, 95% CI: 1.38 to 3.01, p < 0.001), sexual function (pooled SMD = 0.51, 95% CI: 0.29 to 0.73, p < 0.001), satisfaction (pooled OR = 3.93, 95% CI: 2.73 to 5.66, p < 0.001), and self-efficacy (pooled SMD = 2.62, 95% CI: 2.12 to 3.13, p < 0.001).

CONCLUSIONS

eHealth interventions are an effective emerging treatment and preventive modality for female PFD. Higher quality, larger scale, and strictly designed RCTs are warranted to evaluate the effectiveness of eHealth interventions on female pelvic floor management.

Analysis of the Structural Characteristics and Psychometric Properties of the Pelvic Floor Bother Questionnaire (PFBQ): A Systematic Review

BACKGROUND

The Pelvic Floor Bother Questionnaire is a validated and reliable questionnaire that studies the presence and degree of pelvic floor discomfort, providing a global vision of pelvic floor dysfunction. This questionnaire assesses urinary stress incontinence, urinary urgency, urinary frequency, urge urinary incontinence, pelvic organ prolapses, dysuria, dyspareunia, defecatory dysfunction, fecal incontinence, and the disability it causes to the respondent.

AIM

The aim of the present study was to analyze the structural characteristics and psychometric properties of the different versions of the pelvic floor bother questionnaire, as well as the methodological quality, the quality of evidence, and the criteria used for good measurement properties.

METHODS

A systematic review was carried out in different databases, such as PubMed, SCOPUS, Web of Science, Dialnet, ScienceDirect, and CINAHL, on studies adapting and validating the pelvic floor bother questionnaire in other languages. The data were analyzed taking into account the guidelines of the preferred reporting item statement for systematic reviews and meta-analyses (PRISMA) and following the COSMIN guidelines, considering articles published up to 28 February 2022, and registered in the PROSPERO database.

RESULTS

Initially, a total of 443 studies were found, from which a total of four studies were analyzed with regard to structural characteristics and psychometric properties, such as reliability, internal consistency, construct validity, and criterion validity.

CONCLUSIONS

The different versions of the questionnaires show basic structural characteristics and psychometric properties for the evaluation of patients with pelvic floor dysfunctions. Most of the analyzed versions present criteria for good measurement properties qualified as sufficient, inadequate-adequate methodological quality, and low-moderate quality of evidence.

Faecal incontinence in adults

Faecal incontinence, which is defined by the unintentional loss of solid or liquid stool, has a worldwide prevalence of ≤7% in community-dwelling adults and can markedly impair quality of life. Nonetheless, many patients might not volunteer the symptom owing to embarrassment. Bowel disturbances, particularly diarrhoea, anal sphincter trauma (obstetrical injury or previous surgery), rectal urgency and burden of chronic illness are the main risk factors for faecal incontinence; others include neurological disorders, inflammatory bowel disease and pelvic floor anatomical disturbances. Faecal incontinence is classified by its type (urge, passive or combined), aetiology (anorectal disturbance, bowel symptoms or both) and severity, which is derived from the frequency, volume, consistency and nature (urge or passive) of stool leakage. Guided by the clinical features, diagnostic tests and therapies are implemented stepwise. When simple measures (for example, bowel modifiers such as fibre supplements, laxatives and anti-diarrhoeal agents) fail, anorectal manometry and other tests (endoanal imaging, defecography, rectal compliance and sensation, and anal neurophysiological tests) are performed as necessary. Non-surgical options (diet and lifestyle modification, behavioural measures, including biofeedback therapy, pharmacotherapy for constipation or diarrhoea, and anal or vaginal barrier devices) are often effective, especially in patients with mild faecal incontinence. Thereafter, perianal bulking agents, sacral neuromodulation and other surgeries may be considered when necessary.

Prevalence and impact of urinary symptoms on quality of life during the last month of pregnancy

Abstract Introduction Adaptations of the maternal organism can adversely affect the lower urinary tract, leading to urinary symptoms with impact in quality of life (QoL). Objective To determine the prevalence of urinary symptoms and the impact of urinary incontinence (UI) on QoL during the last month of pregnancy. Methods Retrospective cross-sectional study, envolving 96 women in the immediate postpartum period personally interviewed about urinary symptoms and QoL during their last four weeks of gestation. Women were divided into two groups according to the number of pregnancies: G1 = 1 pregnancy (n = 41) and G2 = ≥ 2 pregnancies (n = 55). Those who reported the presence of stress urinary incontinence (SUI) and/or urge incontinence (UUI) were also administered the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Results The most common symptoms were nocturia (90.6%), urgency (82.3%), urinary frequency (71.9%) feeling of incomplete emptying (62.5%) and SUI and/or UUI (53.1%) with no differences between groups. Only the complaint of SUI in cough was significantly higher in G2 (p = 0.04). There was no difference on QoL between groups based on ICIQ-SF scores among those with UI (53.1%), however G1 reported serious impact and G2 very serious impact. Conclusion Almost all women reported some type of urinary symptom and the most prevalent were nocturia, urgency, pollakiuria, feeling of incomplete emptying and SUI and/or UUI. SUI was more prevalent among women with two or more pregnancies and during cough were significantly higher. Regardless of the number of pregnancies, the presence any type of UI had a negative impact on QoL.