Does the impact of subsequent incontinence risk factors depend on continence status during the first pregnancy or the postpartum period 12 years before? A cohort study in 232 primiparous women

2008 ◽  
Vol 199 (1) ◽  
pp. 73.e1-73.e4 ◽  
Author(s):  
Lars Viktrup ◽  
Guri Rortveit ◽  
Gunnar Lose
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Postpartum Period ◽  
Continence Status ◽  
The Impact ◽  
Primiparous Women

scholarly journals Relation between body composition and severe diarrhea in patients treated with preoperative chemoradiation with capecitabine for rectal cancer: a single-centre cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
J. M. van Rees ◽  
W. Hartman ◽  
J. J. M. E. Nuyttens ◽  
E. Oomen-de Hoop ◽  
J. L. A. van Vugt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Body Composition ◽  
Logistic Regression ◽  
Cohort Study ◽  
Preoperative Chemoradiation ◽  
Regression Analyses ◽  
Single Centre ◽  
Severe Diarrhea ◽  
The Impact

Abstract Background Chemoradiation with capecitabine followed by surgery is standard care for locally advanced rectal cancer (LARC). Severe diarrhea is considered a dose-limiting toxicity of adding capecitabine to radiation therapy. The aim of this study was to describe the risk factors and the impact of body composition on severe diarrhea in patients with LARC during preoperative chemoradiation with capecitabine. Methods A single centre retrospective cohort study was conducted in a tertiary referral centre. All patients treated with preoperative chemoradiation with capecitabine for LARC from 2009 to 2015 were included. Patients with locally recurrent rectal cancer who received chemoradiation for the first time were included as well. Logistic regression analyses were performed to identify risk factors for severe diarrhea. Results A total of 746 patients were included. Median age was 64 years (interquartile range 57–71) and 477 patients (64%) were male. All patients received a radiation dosage of 25 × 2 Gy during a period of five weeks with either concomitant capecitabine administered on radiation days or continuously during radiotherapy. In this cohort 70 patients (9%) developed severe diarrhea. In multivariable logistic regression analyses female sex (OR: 4.42, 95% CI 2.54–7.91) and age ≥ 65 (OR: 3.25, 95% CI 1.85–5.87) were the only risk factors for severe diarrhea. Conclusions Female patients and patients aged sixty-five or older had an increased risk of developing severe diarrhea during preoperative chemoradiation therapy with capecitabine. No relation was found between body composition and severe diarrhea.

scholarly journals Impact of Covid-19 on attendances for a 1st episode of reduced fetal movements: A retrospective observational study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253796
Author(s):  
Laia Marques-Fernandez ◽  
Swati Sharma ◽  
Una Mannu ◽  
Hsu Phern Chong
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Fold Increase ◽  
Stillbirth Rate ◽  
Hospital Records ◽  
Reduced Fetal Movements ◽  
Fetal Movements ◽  
Provision Of Care ◽  
The Impact ◽  
Primiparous Women

Background Prior studies have demonstrated an increased stillbirth rate. It was suggested that the COVID-19 pandemic may have impacted on attendances for reduced fetal movements. Thus, we sought to ascertain the impact of the pandemic on attendances for reduced fetal movements (RFM) in our unit, ultrasound provision for reduced fetal movements, and the stillbirth rate. Methods This was a single site retrospective cohort study involving all women complaining of a 1st episode of reduced fetal movements between 01/03/2020-30/04/2020 (COVID) to 01/03/2019-30/04/2019 (Pre-COVID). Data were retrieved from computerised hospital records and statistical analyses were performed using GraphPad Prism and SPSS. Results 22% (179/810) of women presented with a 1st episode of reduced fetal movements Pre-COVID compared to 18% (145/803) during COVID (p = 0.047). Primiparous women were significantly over-represented in this population with a 1.4-fold increase in attendances during COVID (67% vs 48%, p = 0.0005). Neither the total stillbirth rate nor the stillbirth rate amongst women who presented with reduced fetal movements changed during COVID. Ultrasound provision was not impacted by COVID with 95% of the scans performed according to local guidelines, compared to Pre-COVID (74%, p = 0.0001). Conclusions There is a significant decrease in 1st attendances for reduced fetal movements during COVID-19 pandemic. Primiparous women were 1.4 times more likely to attend with RFM. Women should be reassured that COVID-19 has not resulted in a decreased provision of care for RFM, and has not impacted on the stillbirth rate.

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

2020 ◽  
Author(s):  
Markus Harry Jansson ◽  
Karin Franzén ◽  
Ayako Hiyoshi ◽  
Gunilla Tegerstedt ◽  
Hedda Dahlgren ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Prospective Cohort ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Vacuum Extraction ◽  
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, 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 (adjusted odds ratio 2.26 (95% CI: 1.22, 4.19) and 3.28 (95% CI: 1.73, 6.21) respectively) and OASI (adjusted odds ratio 5.93 (95% CI: 2.29, 15.33) and 4.31 (95% CI: 1.49, 12.5) respectively), whereas age above 25 years only increased the risk of second-degree perineal tears (adjusted odds ratio 1.94 (95% CI: 1.10, 3.43)). Heredity of pelvic floor dysfunction and/or connective tissue deficiency, induced labor, and fetal head circumference exceeding 35 cm were independent risk factors for high vaginal tears (adjusted odds ratio 2.33 (95% CI: 1.09, 5.00), 3.64 (95% CI: 1.54, 8.59) and 2.86 (95% CI: 1.43, 5.75) respectively).ConclusionsThis prospective study showed that fetal weight exceeding 4000 g and vacuum extraction are independent risk factors for both second-degree perineal tears and OASI in primiparous women. Risk factors for high vaginal tears were heredity of pelvic floor dysfunction and/or connective tissue deficiency, induced labor, and fetal head circumference > 35 cm. These tears have been found to be common among primiparous women, and merit more attention.Brief summary: This prospective cohort study showed that fetal birthweight exceeding 4000 g and vacuum extraction increased the risk of second-degree tear and anal sphincter injury.

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 Sexual function in primiparous women: a prospective study

2022 ◽  
Author(s):  
Hedda Dahlgren ◽  
Markus H. Jansson ◽  
Karin Franzén ◽  
Ayako Hiyoshi ◽  
Kerstin Nilsson
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Sexual Function ◽  
Sexual Activity ◽  
Early Pregnancy ◽  
Significant Risk ◽  
Nulliparous Women ◽  
And Function ◽  
The Impact ◽  
Primiparous Women

Abstract Introduction and hypothesis The aim of this prospective study was to examine the impact of sociodemographic, pregnancy and obstetric characteristics on sexual function 12 months postpartum in primiparous women. We hypothesized that sexual function would decrease after childbirth. Methods Between 1 October 2014 and 1 October 2017, all nulliparous women in early pregnancy registering for maternity health care in Region Örebro County, Sweden, were invited to participate in this prospective study. A total of 958 women were included. Sexual activity and function were measured at early pregnancy, 8 weeks postpartum and 12 months postpartum using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). The associations between sociodemographic, pregnancy and obstetric characteristics and sexual activity and function from early pregnancy to 12 months postpartum were examined using linear and logistic models based on generalized estimating equations. Results We found that the prevalence of sexually active women decreased from 98.0% in early pregnancy to 66.7% at 8 weeks postpartum, but increased to 90.0% at 12 months postpartum. Age ≥ 35 years, second-degree perineal tear and current breastfeeding were statistically significant risk factors for sexual inactivity at 12 months postpartum. Poor self-reported health in early pregnancy was statistically significantly associated with decreased sexual function at 12 months postpartum. Conclusions A majority of women resumed sexual activity at 8 weeks postpartum and most women at 12 months postpartum; the decrease in sexual function at 12 months postpartum was small and few risk factors were observed.

scholarly journals Fatality and risk features for prognosis in COVID-19 according to the care approach – a retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248869
Author(s):  
Mariano Andrés ◽  
Jose-Manuel Leon-Ramirez ◽  
Oscar Moreno-Perez ◽  
José Sánchez-Payá ◽  
Ignacio Gayá ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Troponin T ◽  
Invasive Mechanical Ventilation ◽  
Academic Center ◽  
Care Approach ◽  
Independent Risk Factors ◽  
The Impact

Introduction This study analyzed the impact of a categorized approach, based on patients’ prognosis, on major outcomes and explanators in patients hospitalized for COVID-19 pneumonia in an academic center in Spain. Methods Retrospective cohort study (March 3 to May 2, 2020). Patients were categorized according to the followed clinical management, as maximum care or limited therapeutic effort (LTE). Main outcomes were all-cause mortality and need for invasive mechanical ventilation (IMV). Baseline factors associated with outcomes were analyzed by multiple logistic regression, estimating odds ratios (OR; 95%CI). Results Thirty-hundred and six patients were hospitalized, median age 65.0 years, 57.8% males, 53.3% Charlson index ≥3. The overall all-cause fatality rate was 15.0% (n = 46). Maximum care was provided in 238 (77.8%), IMV was used in 38 patients (16.0%), and 5.5% died. LTE was decided in 68 patients (22.2%), none received IMV and fatality was 48.5%. Independent risk factors of mortality under maximum care were lymphocytes <790/mm3, troponin T >15ng/L and hypotension. Advanced age, lymphocytes <790/mm3 and BNP >240pg/mL independently associated with IMV requirement. Conclusion Overall fatality in the cohort was 15% but markedly varied regarding the decided approach (maximum care versus LTE), translating into nine-fold higher mortality and different risk factors.

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