Pelvic floor changes in the first term pregnancy and postpartum period

Wu, Enboa; Kuehl, Thomas J.; Gendron, Jilene M.; White, Wendy; Yandell, Paul M.

doi:10.1007/s00192-020-04456-5

Cited by 13 publications

(14 citation statements)

References 25 publications

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“…Previous studies that examined pelvic floor symptoms in pregnancy and the postpartum period have shown a trend toward decreasing PFDI-20 scores by 3 months postpartum. 12 Urinary symptom scores tend to be higher in pregnancy, with colorectal-anal scores tending to be higher in the postpartum period. 13 We saw similar trends with urinary scores being higher during pregnancy than postpartum.…”

Section: Discussionmentioning

confidence: 97%

Educating Women About Pelvic Floor Disorders During Pregnancy From the First to the “Fourth Trimester”: A Randomized Clinical Trial

Rutledge,

Spiers,

Vardeman

et al. 2023

UROGC

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Importance Pregnancy and childbirth are risk factors for developing pelvic floor disorders (PFDs), and this continues postpartum (“fourth trimester”). Knowledge of PFDs among women of childbearing age is lacking and presents an opportunity for education. Objectives The aim of this study was to compare the increase in knowledge of PFDs in patients who received written handouts versus interactive workshops as measured by the Prolapse and Incontinence Knowledge Questionnaire (PIKQ). Study Design This was a randomized clinical trial of pregnant patients 18 years or older. Patients either received written handouts only or received handouts and attended an interactive workshop. Handouts were created in collaboration with communication specialists focusing on risk factors and prevention strategies. The primary outcome was the change in PIKQ score. Secondary outcomes were Pelvic Floor Distress Inventory score and postpartum phone interviews of workshop group participants. Questionnaires were assessed at recruitment and 6 weeks postpartum. The nonparametric Wilcoxon test compared continuous variables, and the Fisher exact test compared categorical variables. Results One hundred twenty patients were randomized. Demographics were similar between groups. Median PIKQ score change showed no difference between groups (P = 0.37). Pelvic Floor Distress Inventory-20 scores were similar between groups at baseline (P = 0.78) and postpartum (P = 0.82). Quantile regression showed posteducation PIKQ scores were significantly higher in the workshop (21.00 vs 17.00; P = 0.011) and written (21.00 vs 17.00; P < 0.001) groups. Phone interviews showed consistent themes: (1) greater awareness of PFDs, (2) more likely to discuss PFDs, and (3) relief that PFDs are treatable. Fifty-nine percent of patients preferred learning through workshops compared with the handouts. Conclusions Both groups showed improvement in knowledge of PFDs. Well-written, illustrated handouts were effective in increasing patient knowledge of PFDs.

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Section: Discussionmentioning

confidence: 97%

Educating Women About Pelvic Floor Disorders During Pregnancy From the First to the “Fourth Trimester”: A Randomized Clinical Trial

Rutledge,

Spiers,

Vardeman

et al. 2023

UROGC

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“…Women in our study returned to third-trimester level of pelvic floor function at 6 months. However, there is a deterioration in pelvic floor function throughout pregnancy, translating into more symptoms as the pregnancy progresses [ 13 , 16 ]. Molecular changes, under the influence of steroid hormones, prepare the female body for the birthing process and dysfunctional pathways may lead to a predisposition for pelvic floor disorders [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Studies investigating pelvic floor changes during the third trimester of pregnancy or the 1st year postpartum show that women experience an increase in urinary incontinence, colorectal symptoms and prolapse symptoms at this time [ 13 – 16 ]. However, further data are needed to quantify pelvic floor changes in the third trimester and first few months postpartum, and to differentiate healing milestones in women who sustain OASIS versus minimal perineal trauma.…”

Section: Introductionmentioning

confidence: 99%

Pelvic floor healing milestones after obstetric anal sphincter injury: a prospective case control feasibility study

et al. 2022

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Introduction and hypothesis Severe perineal tears can predict bothersome pelvic floor disorders later in life. We have a poor understanding of pelvic floor changes during the third trimester and the first few postpartum months. We aimed to compare women with severe perineal trauma during childbirth with women who experienced minimal trauma, for condition-specific quality of life, sexual function, mental health and overall quality of life in the first 6 months postpartum. Methods We recruited primiparous women with third- or fourth-degree tears (obstetric anal sphincter injuries, OASIS) and age-matched controls with no tears or first-degree tears in the immediate postpartum period. Participants completed validated questionnaires at baseline, 2, 4 and 6 months postpartum. Mixed effects linear regression or quantile regression adjusted for baseline score were used to compare the groups as appropriate. Results A total of 74 women completed at least one questionnaire (35 OASIS, 39 controls). Both groups had similar demographics. Women with OASIS tended to have worse Pelvic Floor Distress Index-40 scores at month 2; median scores were similar in the two groups by month 6. They also had significantly lower Female Sexual Function Index scores (mean difference: −6.1; 95% CI: −11.9, −0.2, p =0.043) at month 2. There were no mental health group differences and quality of life improved over time, mainly in the OASIS group. Six-month participant attrition rate was 52%. Conclusions Women with OASIS encounter specific pelvic floor challenges during the first 6 months postpartum. Although our recruitment rate was high, the attrition rate was also high, demonstrating challenges with retention of postpartum women into longitudinal research.

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“…17 Animals in the control group demonstrated descent of pelvic structures and bladder similar to those subsequently reported in primiparous women undergoing their first vaginal delivery. 55,56 However, animals undergoing scheduled C-section prior to the onset of labor did not show these changes. 17 Thus, there is the potential that such an intervention might reduce the impact of childbirth on human pelvic floor disorders.…”

Section: Popmentioning

confidence: 93%

Female squirrel monkeys as models for research on women’s pelvic floor disorders

et al. 2021

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Animal models enable research on biological phenomena with controlled interventions not possible or ethical in patients. Among species used as experimental models, squirrel monkeys ( Saimiri genus) are phylogenetically related to humans and are relatively easily managed in captivity. Quadrupedal locomotion of squirrel monkeys resembles most other quadrupedal primates in that they utilize a diagonal sequence/diagonal couplets gait when walking on small branches. However, to assume a bipedal locomotion, the human pelvis has undergone evolutionary changes. Therefore, the pelvic bone morphology is not that similar between the female squirrel monkey and woman, but pelvic floor support structures and impacts of fetal size and malpresentation are similar. Thus, this review explores the pelvic floor support structural characteristics of female squirrel monkeys, especially in relation to childbirth to demonstrate similarities to humans.

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Pelvic floor changes in the first term pregnancy and postpartum period

Cited by 13 publications

References 25 publications

Educating Women About Pelvic Floor Disorders During Pregnancy From the First to the “Fourth Trimester”: A Randomized Clinical Trial

Educating Women About Pelvic Floor Disorders During Pregnancy From the First to the “Fourth Trimester”: A Randomized Clinical Trial

Pelvic floor healing milestones after obstetric anal sphincter injury: a prospective case control feasibility study

Female squirrel monkeys as models for research on women’s pelvic floor disorders

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