scholarly journals Posterior compartment symptoms in primiparous women 1 year after non-assisted vaginal deliveries: a Swedish cohort study

2021 ◽  
Author(s):  
Emilia Rotstein ◽  
Susanne Åhlund ◽  
Helena Lindgren ◽  
Angelica Lindén Hirschberg ◽  
Ingela Rådestad ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Posterior Compartment ◽  
Perineal Tear ◽  
Perineal Tears ◽  
Vaginal Deliveries ◽  
Primiparous Women ◽  
Second Degree

Abstract Introduction and hypothesis This is a prospective cohort follow-up study based on the hypothesis that primiparous women with non-assisted vaginal deliveries and a second-degree perineal tear have more posterior compartment symptoms 1 year after delivery than those with no or first-degree tears. Methods A follow-up questionnaire, including validated questions on pelvic floor dysfunction, was completed 1 year postpartum by 410 healthy primiparas, delivered without instrumental assistance at two maternity wards in Stockholm between 2013 and 2015. Main outcome measures were posterior compartment symptoms in women with second-degree perineal tears compared with women with no or only minor tears. Results Of 410 women, 20.9% had no or only minor tears, 75.4% had a second-degree tear, and 3.7% had a more severe tear. Of women presenting with second-degree tears, 18.9% had bowel-emptying difficulties compared with 20.0% of women with minor tears. Furthermore, almost 3% of them with second-degree tears complained of faecal incontinence (FI) of formed stool, 7.2% of FI of loose stool compared with 1.2% and 3.5% respectively in women with no or only minor tears. Conclusions Symptomatic pelvic floor dysfunction is common among primiparous women within 1 year following uncomplicated vaginal delivery, and there are no significant differences between second-degree perineal tears and minor tears. These symptoms should be addressed in all women after delivery to improve pelvic floor dysfunction and quality of life.

scholarly journals Risk factors for perineal and vaginal tears in primiparous women – the prospective POPRACT-cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Markus Harry Jansson ◽  
Karin Franzén ◽  
Ayako Hiyoshi ◽  
Gunilla Tegerstedt ◽  
Hedda Dahlgren ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Pelvic Floor Dysfunction ◽  
Vacuum Extraction ◽  
Fetal Head ◽  
Perineal Tear ◽  
Perineal Tears ◽  
Independent Risk Factors ◽  
Primiparous Women ◽  
Second Degree

Abstract Background The aim of this study was to estimate the incidence of second-degree perineal tears, obstetric anal sphincter injuries (OASI), and high vaginal tears in primiparous women, and to examine how sociodemographic and pregnancy characteristics, hereditary factors, obstetric management and the delivery process are associated with the incidence of these tears. Methods All nulliparous women registering at the maternity health care in Region Örebro County, Sweden, in early pregnancy between 1 October 2014 and 1 October 2017 were invited to participate in a prospective cohort study. Data on maternal and obstetric characteristics were extracted from questionnaires completed in early and late pregnancy, from a study-specific delivery protocol, and from the obstetric record system. These data were analyzed using unadjusted and adjusted multinomial and logistic regression models. Results A total of 644 women were included in the study sample. Fetal weight exceeding 4000 g and vacuum extraction were found to be independent risk factors for both second-degree perineal tears (aOR 2.22 (95% CI: 1.17, 4.22) and 2.41 (95% CI: 1.24, 4.68) respectively) and OASI (aOR 6.02 (95% CI: 2.32, 15.6) and 3.91 (95% CI: 1.32, 11.6) respectively). Post-term delivery significantly increased the risk for second-degree perineal tear (aOR 2.44 (95% CI: 1.03, 5.77), whereas, maternal birth positions with reduced sacrum flexibility significantly decreased the risk of second-degree perineal tear (aOR 0.53 (95% CI 0.32, 0.90)). Heredity of pelvic floor dysfunction and/or connective tissue deficiency, induced labor, vacuum extraction and fetal head circumference exceeding 35 cm were independent risk factors for high vaginal tears (aOR 2.32 (95% CI 1.09, 4.97), 3.16 (95% CI 1.31, 7.62), 2.53 (95% CI: 1.07, 5.98) and 3.07 (95% CI 1.5, 6.3) respectively). Conclusion The present study corroborates previous findings of vacuum extraction and fetal weight exceeding 4000 g as risk factors of OASI. We found that vacuum extraction is a risk factor for second-degree tear, and vacuum extraction, fetal head circumference exceeding 35 cm and heredity of pelvic floor dysfunction and/or connective tissue deficiency were associated with increased risk of high vaginal tears. These findings have not been documented previously and should be confirmed by additional studies.

scholarly journals Risk factors for perineal and vaginal tears in primiparous women – the prospective POPRACT-cohort study

2020 ◽  
Author(s):  
Markus Harry Jansson ◽  
Karin Franzén ◽  
Ayako Hiyoshi ◽  
Gunilla Tegerstedt ◽  
Hedda Dahlgren ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Pelvic Floor Dysfunction ◽  
Vacuum Extraction ◽  
Fetal Head ◽  
Perineal Tear ◽  
Perineal Tears ◽  
Independent Risk Factors ◽  
Primiparous Women ◽  
Second Degree

Abstract BackgroundThe aim of this study was to estimate the incidence of second-degree perineal tears, obstetric anal sphincter injuries (OASI), and high vaginal tears in primiparous women, and to examine how sociodemographic and pregnancy characteristics, hereditary factors, obstetric management and the delivery process are associated with the incidence of these tears.MethodsAll nulliparous women registering at the maternity health care in Region Örebro County, Sweden, in early pregnancy between 1 October 2014 and 1 October 2017 were invited to participate in a prospective cohort study. Data on maternal and obstetric characteristics were extracted from questionnaires completed in early and late pregnancy, from a study-specific delivery protocol, and from the obstetric record system. These data were analyzed using unadjusted and adjusted multinomial and logistic regression models.ResultsA total of 644 women were included in the study sample. Fetal weight exceeding 4000 g and vacuum extraction were found to be independent risk factors for both second-degree perineal tears (aOR 2.22 (95% CI: 1.17, 4.22) and 2.41 (95% CI: 1.24, 4.68) respectively) and OASI (aOR 6.02 (95% CI: 2.32, 15.6) and 3.91 (95% CI: 1.32, 11.6) respectively). Post-term delivery significantly increased the risk for second-degree perineal tear (aOR 2.44 (95% CI: 1.03, 5.77), whereas, maternal birth positions with reduced sacrum flexibility significantly decreased the risk of second-degree perineal tear (aOR 0.53 (95% CI 0.32, 0.90)). Heredity of pelvic floor dysfunction and/or connective tissue deficiency, induced labor, vacuum extraction and fetal head circumference exceeding 35 cm were independent risk factors for high vaginal tears (aOR 2.32 (95% CI 1.09, 4.97), 3.16 (95% CI 1.31, 7.62), 2.53 (95% CI: 1.07, 5.98) and 3.07 (95% CI 1.5, 6.3) respectively).ConclusionThe present study corroborates previous findings of vacuum extraction and fetal weight exceeding 4000 g as risk factors of OASI. We found that vacuum extraction is a risk factor for second-degree tear, and vacuum extraction, fetal head circumference exceeding 35 cm and heredity of pelvic floor dysfunction and/or connective tissue deficiency were associated with increased risk of high vaginal tears. These findings have not been documented previously and should be confirmed by additional studies.

scholarly journals Risk factors for perineal and vaginal tears in primiparous women – the prospective POPRACT-cohort study

2020 ◽  
Author(s):  
Markus Harry Jansson ◽  
Karin Franzén ◽  
Ayako Hiyoshi ◽  
Gunilla Tegerstedt ◽  
Hedda Dahlgren ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Pelvic Floor Dysfunction ◽  
Vacuum Extraction ◽  
Fetal Head ◽  
Perineal Tear ◽  
Perineal Tears ◽  
Independent Risk Factors ◽  
Primiparous Women ◽  
Second Degree

Abstract Background The aim of this study was to estimate the incidence of second-degree perineal tears, obstetric anal sphincter injuries (OASI), and high vaginal tears in primiparous women, and to examine how sociodemographic and pregnancy characteristics, hereditary factors, obstetric management and the delivery process are associated with the incidence of these tears.Methods All nulliparous women registering at the maternity health care in Region Örebro County, Sweden, in early pregnancy between 1 October 2014 and 1 October 2017 were invited to participate in a prospective cohort study. Data on maternal and obstetric characteristics were extracted from questionnaires completed in early and late pregnancy, from a study-specific delivery protocol, and from the obstetric record system. These data were analyzed using unadjusted and adjusted multinomial and logistic regression models.Results A total of 644 women were included in the study sample. Fetal weight exceeding 4000 g and vacuum extraction were found to be independent risk factors for both second-degree perineal tears (aOR 2.22 (95% CI: 1.17, 4.22) and 2.41 (95% CI: 1.24, 4.68) respectively) and OASI (aOR 6.02 (95% CI: 2.32, 15.6) and 3.91 (95% CI: 1.32, 11.6) respectively). Post-term delivery significantly increased the risk for second-degree perineal tear (aOR 2.44 (95% CI: 1.03, 5.77), whereas, maternal birth positions with reduced sacrum flexibility significantly decreased the risk of second-degree perineal tear (aOR 0.53 (95% CI 0.32, 0.90)). Heredity of pelvic floor dysfunction and/or connective tissue deficiency, induced labor, vacuum extraction and fetal head circumference exceeding 35 cm were independent risk factors for high vaginal tears (aOR 2.32 (95% CI 1.09, 4.97), 3.16 (95% CI 1.31, 7.62), 2.53 (95% CI: 1.07, 5.98) and 3.07 (95% CI 1.5, 6.3) respectively).Conclusion The present study corroborates previous findings of vacuum extraction and fetal weight exceeding 4000 g as risk factors of OASI. We found that vacuum extraction is a risk factor for second-degree tear, and vacuum extraction, fetal head circumference exceeding 35 cm and heredity of pelvic floor dysfunction and/or connective tissue deficiency were associated with increased risk of high vaginal tears. These findings have not been documented previously and should be confirmed by additional studies.

scholarly journals Pelvic floor dysfunction one year after first childbirth in relation to perineal tear severity

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Malin Huber ◽  
Ellen Malers ◽  
Katarina Tunón
Keyword(s):  
Risk Factor ◽  
Cesarean Section ◽  
Pelvic Floor ◽  
Stress Incontinence ◽  
Daily Life ◽  
Pelvic Floor Dysfunction ◽  
Perineal Tear ◽  
Fourth Degree ◽  
One Year ◽  
Second Degree

AbstractThe aims of this study were to evaluate pelvic floor dysfunction symptoms one year after delivery and investigate whether adverse functional outcomes after childbirth were related to the degree of perineal injury. A prospective cohort of 776 primiparas were included. Self-reported pelvic floor function data were obtained using a web-based questionnaire. Women with no/first-degree injuries, second-degree injuries, third-/fourth-degree injuries (obstetric anal sphincter injury, OASI) and cesarean section were compared. A total of 511 women (66%) responded. Second-degree tears were a risk factor for stress incontinence (aOR 2.6 (95% CI 1.3–5.1)). Cesarean section was protective against stress incontinence (aOR 0.2 (95% CI 0.1–0.9)). OASI was a risk factor for urge incontinence (aOR 4.8 (95% CI 1.6–15)), prolapse (aOR 7.7 (95% CI 2.1–29)) and pelvic pain (OR 3.3 (95% CI 1.1–10)). Dyspareunia was reported by 38% of women, 63% of women in the OASI group (aOR 3.1 (95% CI 1.1–9.0)). Women with OASI reported that the injury affected daily life (OR 18 (95% CI 5.1–59)). Pelvic floor dysfunction is common after childbirth, even in women with moderate injury. Women with OASI had significantly higher risks of symptoms of prolapse, urge urinary incontinence, pain, dyspareunia and impacts on daily life.

The role of prepregnancy pelvic floor dysfunction in postnatal pelvic morbidity in primiparous women

2014 ◽  
Vol 25 (10) ◽  
pp. 1363-1374 ◽  
Author(s):  
C. M. Durnea ◽  
A. S. Khashan ◽  
L. C. Kenny ◽  
S. S. Tabirca ◽  
B. A. O’Reilly
Keyword(s):  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Primiparous Women

scholarly journals MRI comparative study of levator ani muscle changes in nulliparous and multiparous females

2019 ◽  
Vol 50 (1) ◽  
Author(s):  
Heba Azzam ◽  
Manal Halim ◽  
Hany El-Assaly ◽  
Aya Heiba
Keyword(s):  
Pelvic Floor ◽  
Treatment Plan ◽  
Pelvic Floor Dysfunction ◽  
Levator Ani ◽  
Control Group ◽  
Puborectalis Muscle ◽  
Levator Ani Muscle ◽  
Vaginal Deliveries ◽  
Significant Difference ◽  
Muscle Changes

Abstract Background Pelvic floor dysfunction is known to be among the principal factors influencing public health, regarding frequency, cost and effect on women’s quality of life. Radiographic assessment of the pelvic floor function and anatomy plays a vital role in the recognition of pelvic floor defects. The aim of this study is to detect the postpartum-related levator ani muscle changes thus defining the relationship between the vaginal deliveries and the etiology of pelvic floor dysfunction in order to provide guidelines to decrease the incidence of pelvic floor injuries during parturition and guide the treatment plan. Results There was a significant difference in the puborectalis muscle thickness between the case and control groups in the right puborectalis (P value ≤ 0.001) and in the left puborectalis (P value (≤ 0.001) as well as significant midpoint thickness (P value = 0.03) with 46.2% puborectalis muscle injury in the case group compared with none in the control group. Conclusion Pelvic floor MRI is highly recommended as it is a contrast-free modality that allows for both anatomical and functional analysis. Its incorporation in the routine postpartum assessment will allow early detection of abnormalities even in asymptomatic cases thus ensuring proper management and preventing the development of pelvic floor dysfunction predisposed to by repeated vaginal deliveries.

Quality of life and pelvic floor dysfunction symptoms after hysterectomy with or without pelvic organ prolapse

2014 ◽  
Vol 182 ◽  
pp. 16-21 ◽  
Author(s):  
Niina Humalajärvi ◽  
Pauliina Aukee ◽  
Matti V. Kairaluoma ◽  
Beata Stach-Lempinen ◽  
Harri Sintonen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ
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