Protecting the pelvic floor: obstetric management to prevent incontinence and pelvic organ prolapse

Handa, Victoria L.; Harris, Toni; Ostergard, Donald R.

doi:10.1016/0029-7844(96)00151-2

Cited by 222 publications

(85 citation statements)

References 28 publications

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“…Some studies suggested that only vaginal deliveries are at risk of the condition, but this finding is not consistent [19, 22, 23, 24, 25]. The pathomechanism leading to urinary incontinence following pregnancy involve damage to the pelvic connective tissue and nerves [18]. Vaginal delivery may result in significant pelvic floor tissue stretching and pudendal nerve damage.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Urinary Incontinence in Both Sexes

Schmidbauer

Temml²,

Schatzl

et al. 2001

European Urology

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Section: Discussionmentioning

confidence: 99%

“…There is consensus that obstetric traumas are associated with a higher risk for urinary incontinence [12, 18, 19]. Most studies report a higher frequency of urinary incontinence in parous than in nulliparous women [2, 4, 13, 19, 20, 21].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Urinary Incontinence in Both Sexes

Schmidbauer

Temml²,

Schatzl

et al. 2001

European Urology

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“…Estas forças distendem o assoalho pélvico, resultando em alterações anatômicas e funcionais nos músculos, nervos e tecidos conectivos. Danos à inervação do elevador do ânus e dos músculos esfincterianos têm sido associados à diminuição da força muscular depois do parto 3,4 .…”

Section: Abstract | Introduction: Pregnancy and Deliveryunclassified

Avaliação Da Função Sexual Em Primíparas Após Parto Vaginal E Nuligestas

Macêdo

Carvalho²,

Medeiros³

et al. 2017

RPF

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Introdução: a gestação e o parto podem prejudicar a função dos músculos do assoalho pélvico (MAP) e influenciar na função sexual após o parto Objetivo: avaliar a função sexual em primíparas pós-parto vaginal e em nuligestas. Materiais e Métodos: estudo transversal descritivo, aprovado pelo Comitê de Ética em Pesquisa da UEPB (CAAE44775015.1.0000.5175) realizado com 36 mulheres, faixa etária de 18 a 35 anos, sendo primíparas pós-parto vaginal com episiotomia (n=12), sem episiotomia (n=12) e mulheres nuligestas (n=12). Foram verificadas características biológicas, sociodemográficas e avaliada a função sexual através do Female Sexual Function Index (FSFI). As primíparas responderam ao questionário três meses após o parto e o mesmo questionário foi respondido pelas nuligestas. Resultados: as mulheres com episiotomia, sem episiotomia e nuligestas apresentaram média de 21,41±4,56; 20,16±4,60 e 26,3±4,16 anos de idade, média de 14,66±2,42; 14,81±2,44 e 18,83±1,80 anos estudados, e frequência de dispareunia de 66,66% (n=8); 50%(n=6) e 0%(n=0), respectivamente. Em relação à função sexual, ao comparar os três grupos da pesquisa, foi encontrado um menor escore de desejo nas primíparas com episiotomia e o grupo sem episiotomia apresentou menos excitação, menos lubrificação, menos orgasmos e uma pior satisfação sexual, quando comparado aos outros grupos. Quanto a variável dor as primíparas com episiotomia apresentaram os piores escores. Conclusão: no grupo de primíparas com episiotomia, foi encontrada maior frequência de dispareunia, índices mais baixos de desejo e as primíparas sem episiotomia apresentaram menos excitação, menos lubrificação, menos orgasmos e uma pior satisfação sexual.

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“…Difficult vaginal childbirth has been implicated as the primary etiologic factor leading to pelvic floor disorders such as anal incontinence, urinary incontinence, and pelvic organ prolapse in the mother [2] as well as permanent brachial plexus injuries in the newborn [3]. Delivery via C-section (especially when the C-sections are performed in the absence of labor) tends to protect against such devastating maternal and neonatal injuries [4,5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Methods A decision analytic model was developed to compare the cost-effectiveness of two policies for managing the delivery of primigravid patients: (1) current standard of care (i.e., spontaneous labor followed by either vaginal delivery or C-section as indicated) and (2) ultrasound at 39 weeks gestation followed by elective C-section for those women with estimated fetal weights of ‡4500 g. Consideration of those two policies for all primigravidas represented the two main branches of our decision tree. Diabetics and nondiabetics were considered independently.…”

Section: Introductionmentioning

confidence: 99%

Elective cesarean section to prevent anal incontinence and brachial plexus injuries associated with macrosomia?a decision analysis

et al. 2004

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Our aim was to determine the cost-effectiveness of a policy of elective C-section for macrosomic infants to prevent maternal anal incontinence, urinary incontinence, and newborn brachial plexus injuries. We used a decision analytic model to compare the standard of care with a policy whereby all primigravid patients in the United States would undergo an ultrasound at 39 weeks gestation, followed by an elective C-section for any fetus estimated at > or =4500 g. The following clinical consequences were considered crucial to the analysis: brachial plexus injury to the newborn; maternal anal and urinary incontinence; emergency hysterectomy; hemorrhage requiring blood transfusion; and maternal mortality. Our outcome measures included (1) number of brachial plexus injuries or cases of incontinence averted, (2) incremental monetary cost per 100,000 deliveries, (3) expected quality of life of the mother and her child, and (4) "quality-adjusted life years" (QALY) associated with the two policies. For every 100,000 deliveries, the policy of elective C-section resulted in 16.6 fewer permanent brachial plexus injuries, 185.7 fewer cases of anal incontinence, and cost savings of $3,211,000. Therefore, this policy would prevent one case of anal incontinence for every 539 elective C-sections performed. The expected quality of life associated with the elective C-section policy was also greater (quality of life score 0.923 vs 0.917 on a scale from 0.0 to 1.0 and 53.6 QALY vs 53.2). A policy whereby primigravid patients in the United States have a 39 week ultrasound-estimated fetal weight followed by C-section for any fetuses > or =4500 g appears cost effective. However, the monetary costs in our analysis were sensitive to the probability estimates of urinary incontinence following C-section and vaginal delivery and the cost estimates for urinary incontinence, vaginal delivery, and C-section.

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Protecting the pelvic floor: obstetric management to prevent incontinence and pelvic organ prolapse

Cited by 222 publications

References 28 publications

Risk Factors for Urinary Incontinence in Both Sexes

Risk Factors for Urinary Incontinence in Both Sexes

Avaliação Da Função Sexual Em Primíparas Após Parto Vaginal E Nuligestas

Elective cesarean section to prevent anal incontinence and brachial plexus injuries associated with macrosomia?a decision analysis

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