The maternal pelvic floor and labor outcome

Youssef, A.; Brunelli, Elena; Pilu, G.; Dietz, Hans Peter

doi:10.1016/j.ajogmf.2021.100452

Cited by 16 publications

(14 citation statements)

References 64 publications

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“…Indicators or MCH outcomes can be compared within different regions of China or with other countries. Otherwise, since the system tries to cover the whole MCH care process for patients, long-term follow-up studies on sequela after delivery (eg, pelvic floor dysfunction after vaginal delivery [ 43 ] or uterus rupture after cesarean delivery [ 44 ]) or rehabilitation therapy effects on children with birth defects [ 45 ] are feasible. Thanks to large-scale data, techniques, such as big data, provide the basic foundation to build models to predict maternal outcomes.…”

Section: Discussionmentioning

confidence: 99%

Provincial Maternal and Child Information System in Inner Mongolia, China: Descriptive Implementation Study

Yan,

Xing,

Chen

et al. 2024

JMIR Pediatr Parent

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Background After the implementation of 2- and 3-child policies, the rising proportion of high-age and high-risk pregnancies put enormous pressure on maternal and child health (MCH) services for China. This populous nation with an increasing population flow imperatively required the support of large-scale information systems for management. Municipal MCH information systems were commonly applied in developed cities of eastern provinces in China. However, implementation of provincial MCH information systems in relatively low-income areas is lacking. In 2020, the implementation of a regional maternal and child information system (RMCIS) in Inner Mongolia filled this gap. Objective This paper aimed to demonstrate the construction process and evaluate the implementation effect of an RMCIS in improving the regional MCH in Inner Mongolia. Methods We conducted a descriptive study for the implementation of an RMCIS in Inner Mongolia. Based on the role analysis and information reporting process, the system architecture design had 10 modules, supporting basic health care services, special case management, health support, and administration and supervision. Five-color management was applied for pregnancy risk stratification. We collected data on the construction cost, key characteristics of patients, and use count of the main services from January 1, 2020, to October 31, 2022, in Inner Mongolia. Descriptive analysis was used to demonstrate the implementation effects of the RMCIS. Results The construction and implementation of the RMCIS cost CNY 8 million (US $1.1 million), with a duration of 13 months. Between 2020 and 2022, the system recorded 221,772 registered pregnant women, with a 44.75% early pregnancy registry rate and 147,264 newborns, covering 278 hospitals and 225 community health care centers in 12 cities. Five-color management of high-risk pregnancies resulted in 76,975 (45.45%) pregnancies stratified as yellow (general risk), 36,627 (21.63%) as orange (relatively high risk), 156 (0.09%) as red (high risk), and 3888 (2.30%) as purple (infectious disease). A scarred uterus (n=28,159, 36.58%), BMI≥28 (n=14,164, 38.67%), aggressive placenta praevia (n=32, 20.51%), and viral hepatitis (n=1787, 45.96%) were the top factors of high-risk pregnancies (yellow, orange, red, and purple). In addition, 132,079 pregnancies, including 65,018 (49.23%) high-risk pregnancies, were registered in 2022 compared to 32,466 pregnancies, including 21,849 (67.30%) high-risk pregnancies, registered in 2020. Conclusions The implementation of an RMCIS in Inner Mongolia achieved the provincial MCH data interconnection for basic services and obtained both social and economic benefits, which could provide valuable experience to medical administration departments, practitioners, and medical informatics constructors worldwide.

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Section: Discussionmentioning

confidence: 99%

Provincial Maternal and Child Information System in Inner Mongolia, China: Descriptive Implementation Study

Yan,

Xing,

Chen

et al. 2024

JMIR Pediatr Parent

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“…Second, visual feedback predominantly emphasizes pushing the fetal head downward in the birth canal, but there is mounting evidence indicating that the pelvic floor plays a pivotal role in the success of vaginal delivery. Both smaller dimensions of the levator ani muscle (LAM) hiatus and failure to relax the LAM (LAM coactivation) as assessed on transperineal ultrasound in nulliparous women before the onset of labor have been linked consistently to adverse labor outcomes, such as a prolonged second stage of labor and operative delivery [4][5][6][7][8] . These findings imply that pelvic floor relaxation should be considered as a crucial aspect of effective pushing and provide a tool to identify women who may benefit from coaching due to improper pushing.…”

Section: Time To Focus On the Role Of The Pelvic Floor In Vaginal Del...mentioning

confidence: 99%

Time to focus on the role of the pelvic floor in vaginal delivery

Youssef,

Nedu,

Dapoto

et al. 2024

Ultrasound in Obstet & Gyne

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“…Smaller hiatal dimensions and failure to increase them though proper relaxation were found in women with deep infiltration endometriosis [19][20][21][22][23] . In obstetrics, various LAM hiatal dimensions are associated with labor outcomes [3][4][5][6][7] . The anteroposterior diameter of the LAM hiatus can be measured using the simple two-dimensional (2D)-TPUS technique 4,5,24 .…”

Section: Introductionmentioning

confidence: 99%

Feasibility and reproducibility of new technique for measurement of transverse diameter of levator ani muscle hiatus using two‐dimensional transperineal ultrasound in nulliparous women with term pregnancy

Youssef,

Del Magno,

Nedu

et al. 2024

Ultrasound in Obstet & Gyne

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ObjectivesThe aim of the present study was twofold; firstly to develop and describe the technique for measurement of the transverse diameter of the levator ani muscle hiatus (TD) in the coronal view using 2D transperineal ultrasound (TPUS) in nulliparous women at term of pregnancy. Secondly, we aimed to assess the feasibility and reproducibility of 2D TPUS assessment of TD, in addition to the inter‐method agreement between 2D TPUS and the 3D measurement of TD on the axial plane, the latter considered as the gold standard in nulliparous women at term of pregnancy.MethodsFor the aim of the study, we recruited a group of nulliparous women at term of pregnancy before the onset of labor. The study was conducted in two phases: phase 1 involved developing and describing the 2D TPUS technique for measuring TD, while phase 2 focused on assessing the technique's feasibility, reproducibility, and inter‐method agreement.In phase 1, we enrolled 30 women. Each woman underwent the acquisition of a 3D TPUS volume, which was analyzed using the multiplanar mode to identify the appearance of the lateral borders of the levator ani muscle at the level of the plane of minimal hiatal dimensions in the coronal plane. These borders were used as landmarks for TD measurement. Additionally, we measured the distance between the line indicating TD and the center of the urethra in the axial view.Phase 2 involved recruiting 100 women. Each woman underwent the acquisition of three 2D TPUS clips in the coronal plane, each encompassing a sweep of the entire levator hiatus, and a 3D volume, all obtained during rest. On the 2D clips, TD was measured twice by one operator and once by another operator. TD was measured once in the 3D volume in the axial plane, considered the gold standard. Each operator was blinded to all other measurements during their assessments. We analyzed intraobserver, interobserver, and intermethod (2D vs. 3D) reproducibility. Bland‐Altman analysis was conducted, and Levene's W0 and Student t‐tests were performed to explore clinical factors that might contribute to systematic differences.ResultsIn phase 1, we successfully identified the landmarks denoting the lateral borders of TD in the coronal view. These appeared as two symmetrical hypoechoic indentations located at the inner border of the hyperechoic structure of the levator ani muscle, at the point of maximum distance between the two sides of the levator ani muscle. Additionally, the distance between the urethra and the plane where TD was measured using 3D TPUS in the axial plane had a median of 4 mm and varied from 0 to 9 mm. This enabled us to describe the method for assessing TD in the coronal plane through the use of 2D TPUS.In phase 2, TD was successfully measured in all 2D and 3D acquisitions from the entire group of 100 women. The analyses for intraobserver, interobserver reproducibility, and intermethod comparison (2D vs. 3D) revealed almost perfect agreement in TD measurements using 2D TPUS, with Intraclass Correlation Coefficients (ICCs) of 0.95 (95% CI, 0.92 to 0.96), 0.87 (95% CI, 0.78 to 0.92), and 0.85 (95% CI, 0.78 to 0.90), respectively. The average differences between measurements were 0.1 mm for intraobserver, 1.0 mm for interobserver, and 0.2 mm for intermethod repeatability. No systematic differences were observed in any of the measurement sets, except in the inter‐operator analysis, although the difference was clinically insignificant (38.2 vs. 37.1 mm, P= 0.01). None of the examined clinical factors (maternal body mass index and maternal age) exhibited a statistically significant impact on intraobserver, interobserver, or intermethod reliability.ConclusionsUtilizing our described technique to measure the transverse diameter of the levator hiatus in the coronal view using 2D TPUS is not only feasible but also highly reproducible and accurate in nulliparous women at term of pregnancy. Moreover, it yields measurements that are comparable to those obtained in the reconstructed axial plane generated by 3D TPUS.This article is protected by copyright. All rights reserved.

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The maternal pelvic floor and labor outcome

Cited by 16 publications

References 64 publications

Provincial Maternal and Child Information System in Inner Mongolia, China: Descriptive Implementation Study

Provincial Maternal and Child Information System in Inner Mongolia, China: Descriptive Implementation Study

Time to focus on the role of the pelvic floor in vaginal delivery

Feasibility and reproducibility of new technique for measurement of transverse diameter of levator ani muscle hiatus using two‐dimensional transperineal ultrasound in nulliparous women with term pregnancy

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