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Influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions
Murad-Regadas, Sthela Maria;Regadas, Francisco Sergio P;Rodrigues, Lusmar Veras;Furtado, Débora Couto;Gondim, Ana Cecília;Dealcanfreitas, íris Daiana;
Arquivos de Gastroenterologia , 2011, DOI: 10.1590/S0004-28032011000400009
Abstract: context: the correlation between vaginal delivery, age and pelvic floor dysfunctions involving obstructed defecation is still a matter of controversy. objectives: to determine the influence of age, mode of delivery and parity on the prevalence of posterior pelvic floor dysfunctions in women with obstructed defecation syndrome. methods: four hundred sixty-nine females with obstructed defecation syndrome were retrospectively evaluated using dynamic 3d ultrasonography to quantify posterior pelvic floor dysfunctions (rectocele grade ii or iii, rectal intussusception, paradoxical contraction/non-relaxation of the puborectalis and entero/ sigmoidocele grade iii). in addition, sphincter damage was evaluated. patients were grouped according to age (<50y x >50y) and stratified by mode of delivery and parity: group i (<50y): 218 patients, 75 nulliparous, 64 vaginal delivery and 79 only cesarean section and group ii (>50y): 251 patients, 60 nulliparous, 148 vaginal delivery and 43 only caesarean section. additionally, patients were stratified by number of vaginal deliveries: 0 - nulliparous (n = 135), 1 - vaginal (n = 46), >1 - vaginal (n = 166). results: rectocele grade ii or iii, intussusception, rectocele + intussusception and sphincter damage were more prevalent in group ii (p = 0.0432; p = 0.0028; p = 0.0178; p = 0.0001). the stratified groups (nulliparous, vaginal delivery and cesarean) did not differ significantly with regard to rectocele, intussusception or anismus in each age group. entero/sigmoidocele was more prevalent in the vaginal group <50y and in the nulliparous and vaginal groups >50y. no correlation was found between rectocele and the number of vaginal deliveries. conclusion: higher age (>50 years) was shown to influence the prevalence of significant rectocele, intussusception and sphincter damage in women. however, delivery mode and parity were not correlated with the prevalence of rectocele, intussusception and anismus in women with obstructed defecation.
Effects of pregnancy and childbirth on the pelvic floor  [cached]
Michel Naser,Valentín Manríquez,Mauricio Gómez
Medwave , 2012,
Abstract: The pelvic floor dysfunctions include urinary incontinence, pelvic organ prolapsed and anal incontinence. One in ten women will be subjected to surgery for pelvic floor dysfunction during their lifetime. In addition, between 30% and 50% will have a recurrence of these interventions. Motherhood is a factor that contributes significantly to the submission of pelvic dysfunctions. There is still no proven evidence that vaginal delivery is an absolutely crucial factor for the presence of pelvic floor dysfunction. There is extensive research on pregnancy and child birth and their effects on the pelvic floor and if some of the obstetric action scan be modified in order to protect it from potential damage.
Muscle strength measurement of pelvic floor in women by vaginal dynamometer
Parezanovi?-Ili? Katarina,Jevti? Milorad,Jeremi? Branislav,Arsenijevi? Slobodan
Srpski Arhiv za Celokupno Lekarstvo , 2009, DOI: 10.2298/sarh0910511p
Abstract: Introduction The pelvic floor is made of a mutually connected system that consists of muscles, connecting tissue and nerve components. Damage to any of these elements creates dysfunction which is exerted through stress, urinary incontinence, prolapse of genital organs and faecal incontinence. Objective The primary aim of this study was to present the possibility of objective assessment of pelvic floor muscle force in healthy and sick women using a newly designed instrument, the vaginal dynamometer, as well as to establish the correlation between the values of pelvic floor muscle force obtained by the vaginal dynamometer and digital palpation method. Methods The study included 90 female patients, age 20-58 years. One group of respondents was made of healthy women (who gave birth, and those who have not given birth), while the other one consisted of sick women (who suffered from incontinence or prolapse of genital organs, operated on or not). The pelvic floor muscle strength of every woman was measured with a newly-constructed device for measuring and monitoring of the pelvic floor muscle force in women, the vaginal dynamometer. Then it was compared with the valid clinical digital palpation (palpation with two fingers) based on the scale for measuring muscle contractions with the digital palpation - the digital pelvic assessment rating scale. The vaginal dynamometer consists of a redesigned speculum which is inserted into the vagina and a sensor for measuring the force. Results Statistically significant linear correlation was found in the values of the measured muscle force with the vaginal dynamometer and ratings produced by digital palpation (r=0.92; p<0.001). Mean value of the muscle force of the healthy women measured by the vaginal dynamometer was 1.44±0.38 daN and that value of the sick women was 0.78±0.31 daN (t=8.89 for df=88; p<0.001). Mean value of the ratings produced by digital palpation in healthy women was 4.10 (95% of trust limits 3.83- 4.37), while the value in sick women was 2.41 (95% of trust limits 2.10-4.16) (Z=-6.38; p<0.001). Conclusion The vaginal dynamometer has been presented as an attempt to overcome the limitations of the previously presented techniques for muscle force measurement. The application of the vaginal dynamometer in clinical practice makes objective and numerical assessment of pelvic floor muscle force possible, independent of the subjective assessment of the examiner. The usage of this instrument enables not only the diagnostics of women's pelvic floor muscle problem, but also the objective monitoring of rehabilitat
Vaginal Delivery after Pelvic Fracture Fixation with a Subcutaneous Anterior Fixator with Review of Literature of Delivery Mode in Pelvic Injuries  [PDF]
Anil Sethi, Rahul Vaidya, Sarah Schneider, Jennifer Fleming, Bryant W. Oliphant
Open Journal of Obstetrics and Gynecology (OJOG) , 2014, DOI: 10.4236/ojog.2014.414117
Abstract: Background: The cesarean section rate following a pelvic fracture is more than double the standard norms. This results from residual deformity and a lack of knowledge among obstetricians regarding the ability to deliver vaginally after a pelvic fracture. Aim: To present a case of pelvic fracture that delivered vaginally indicating vaginal delivery is possible even after pelvic fractures that are stabilized surgically with minimal or no residual displacement. Case presentation: We present a patient that delivered vaginally following internal fixation of an unstable pelvic fracture with a retained orthopedic implant that spanned the lower abdomen with a metallic bar. We also discuss the role of cesarean section in patients with pelvic fractures. Conclusion: Women with pelvic fractures may possibly deliver vaginally however decision regarding mode of delivery in such patients should be on a case by case basis.
What harm does a second delivery to the pelvic floor?
K Jundt, I Scheer, V von Bodungen, F Krumbachner, K Friese, UM Peschers
European Journal of Medical Research , 2010, DOI: 10.1186/2047-783x-15-8-362
Abstract: A questionnaire evaluating symptoms of urinary and anal incontinence was used in nulliparous women before and 27 months after childbirth. Furthermore these symptoms were correlated with functional changes of the pelvic floor based on a careful gynecologic examination as well as perineal and endoanal ultrasound.112 nulliparous women were included, 49 women returned for follow-up on average 27 months (SD 4.4 months) after the first delivery. 39 women (group A) had just one delivery, 10 women (group B - 10/49) had had a second delivery. Apart from levator ani muscle strength, no significant difference between pelvic floor function of group A vs group B was demonstrable. Furthermore, we could show no significant difference for symptoms of urinary (11 (28.2%) vs. 5 (50.0%)) and anal incontinence (14 (35.9%) vs. 4 (40.0%)) between both groups. However, we found a lasting increase of stress urinary and anal incontinence as well as overactive bladder symptoms after one or more deliveries. The position of the bladder neck at rest was lower in both groups compared to the position before the first delivery and bladder neck mobility increased after one or more deliveries.Our study shows several statistically significant changes of the pelvic floor function even on average 27 months after delivery, but a subsequent delivery did not compromise the pelvic floor any further.Urinary and fecal incontinence as well as genital prolapse in women are problems that frequently occur after childbirth.Women with the onset of stress urinary incontinence during their first pregnancy or puerperal period have an increased risk of long-lasting symptoms. Viktrup and co-workers showed that twelve years after their first delivery the prevalence of stress urinary incontinence is 42% (102 of 241) and that the prevalence of SUI among women with onset during their first pregnancy (56%) and among women with onset shortly after delivery (78%) is significantly higher compared to those without initial sympt
Urethral and vaginal infections, age of patients and state of the pelvic floor in the aetiology of the irritative symptoms of the lower urinary tract in women
Vecchioli Scaldazza,Carlo; Morosetti,Carolina;
Archivos Espa?oles de Urología (Ed. impresa) , 2006, DOI: 10.4321/S0004-06142006000500020
Abstract: objectives: the aim of this study was to evaluate the importance of a) urethral and/or vaginal infections caused by common germs or mycoplasmas, chlamydia, candida; b) age of patients; c) pelvic floor disorders in the development of irritative urinary symptoms in women. methods: 77 consecutive abacteriuric symptomatic female patients were compared with 55 asymptomatic women. a detailed micturition history and a genitourinary physical examination were performed. urine samples as well as vaginal and urethral swabs were taken for cultures. results: no statistical difference was found between the two groups regarding both urethral and/or vaginal infections and pelvic floor disorders. whereas a significant statistical difference was found in the age of the patients. in the symptomatic group the women were older than in the asymptomatic group. conclusions: the results of this study confirm that ageing is a very important cause in the development of the lower urinary tract symptoms in women.
Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence
Castro, Rodrigo A.;Arruda, Raquel M.;Zanetti, Miriam R. D.;Santos, Patricia D.;Sartori, Marair G. F.;Gir?o, Manoel J. B. C.;
Clinics , 2008, DOI: 10.1590/S1807-59322008000400009
Abstract: purpose: to compare the effectiveness of pelvic floor exercises, electrical stimulation, vaginal cones, and no active treatment in women with urodynamic stress urinary incontinence. patients and methods: one hundred eighteen subjects were randomly selected to recieve pelvic floor exercises (n=31), es (n=30), vaginal cones (n=27), or no treatment (untreated control) (n=30). women were evaluated before and after completion of six months of treatment by the pad test, quality of life questionnaire (i-qol), urodynamic test, voiding diary, and subjective response. results: in the objective evaluation, we observed a statistically significant reduction in the pad test (p=0.003), in the number of stress urinary episodes (p<0.001), and a significant improvement in the quality of life (p<0.001) in subjects who used pelvic floor exercises, electrical stimulation, and vaginal cones compared to the control group. no significant difference was found between groups in the urodynamic parameters. in the subjective evaluation, 58%, 55%, and 54% of women who had used pelvic floor exercises, electrical stimulation, and vaginal cones, respectively, reported being satisfied after treatment. in the control group, only 21% patients were satisfied with the treatment. conclusion: based on this study, pelvic floor exercises, electrical stimulation, and vaginal cones are equally effective treatments and are far superior to no treatment in women with urodynamic stress urinary incontinence.
Comparison of pelvic floor muscle strength evaluations in nulliparous and primiparous women: a prospective study
Gameiro, M?nica Orsi;Sousa, Vanessa Oliveira;Gameiro, Luiz Felipe;Muchailh, Rosana Carneiro;Padovani, Carlos Roberto;Amaro, Jo?o Luiz;
Clinics , 2011, DOI: 10.1590/S1807-59322011000800014
Abstract: objective: this study aimed to compare the pelvic floor muscle strength of nulliparous and primiparous women. methods: a total of 100 women were prospectively distributed into two groups: group 1 (g1) (n = 50) included healthy nulliparous women, and group 2 (g2) (n = 50) included healthy primiparous women. pelvic floor muscle strength was subjectively evaluated using transvaginal digital palpation. pelvic floor muscle strength was objectively assessed using a portable perineometer. all of the parameters were evaluated simultaneously in g1 and were evaluated in g2 during the 20th and 36th weeks of pregnancy and 45 days after delivery. results: in g2, 14 women were excluded because they left the study before the follow-up evaluation. the median age was 23 years in g1 and 22 years in g2; there was no significant difference between the groups. the average body mass index was 21.7 kg/m2 in g1 and 25.0 kg/m2 in g2; there was a significant difference between the groups (p = 0.0004). in g2, transvaginal digital palpation evaluation showed significant impairments of pelvic floor muscle strength at the 36th week of pregnancy (p = 0.0006) and 45 days after vaginal delivery (p = 0.0001) compared to g1. objective evaluations of pelvic floor muscle strength in g2 revealed a significant decrease 45 days after vaginal delivery compared to nulliparous patients. conclusion: pregnancy and vaginal delivery may cause weakness of the pelvic floor muscles.
O fortalecimento do assoalho pélvico com cones vaginais: programa de atendimento domiciliar = Strengthening of pelvic floor muscles using vaginal cones: a home care program  [cached]
Dreher, Daniela Z. et al.
Scientia Medica , 2009,
Abstract: Objetivos: avaliar a eficiência de um programa de fisioterapia domiciliar com cones vaginais para o fortalecimento da musculatura do assoalho pélvico, na resolu o da incontinência urinária de esfor o. Relato do caso: foi selecionada para o estudo uma voluntária com 60 anos de idade, com história de única gesta o, com parto vaginal, apresentando queixa e diagnóstico de incontinência urinária de esfor o. Para avalia o pré e pós-interven o utilizaram-se como instrumentos: anamnese, avalia o da qualidade de vida, avalia o físico-funcional e exame de urodinamica. A interven o fisioterapêutica foi realizada através de um protocolo de exercícios terapêuticos com cones vaginais durante oito semanas, com frequência de três vezes semanais em duas sess es diárias. Na avalia o inicial foi realizada a manobra de Valsalva com 300 ml de volume intra-vesical, ocorrendo discreta perda urinária com a press o de perda ao esfor o de 94 cmH2O, indicando incontinência urinária de esfor o de grau leve. Na reavalia o n o se observou perda urinária com press o vesical de até 117 cmH2O para o mesmo volume, expressando melhora considerável da continência urinária. Conclus es: o programa de exercícios terapêuticos com cones vaginais a domicílio mostrou-se efetivo na resolu o da incontinência urinária de esfor o. Descritores: incontinência urinária por estresse/terapia, modalidades de fisioterapia; períneo; soalho pélvico; cinesiologia aplicada; feminino; genitália feminina. Aims: to evaluate the efficiency of a home care physiotherapy program using vaginal cones for the pelvic floor muscles strength to approach the treatment of stress urinary incontinence. Case description: A female volunteer, 60 years-old, with history of a single pregnancy and vaginal delivery, presenting complaints and diagnosis of stress urinary incontinence, was selected for the study. The evaluation instruments of pre and post-intervention were anamnesis, evaluation of quality of life, semiological evaluation and urodynamics examination. It was applied a therapeutical exercise protocol using vaginal cones, three times a week, two times a day. Valsalva maneuver presenting intra- vesical volume of 300 ml was the initial evaluation. Mild urinary incontinence with Valsalva leak-point pressure of 94 cmH2O denoted a mild stress urinary incontinence. During reevaluation, urinary loss was not observed with vesical pressure, until 117 cmH2O for the same volume, showing a considerable reduction in urinary incontinence. Conclusions: A home care program of therapeutical exercises using vaginal cones presented
Feto-maternal Outcomes in Cesarean Section Compared to Vaginal Delivery in Eclamptic Patients in a Tertiary Level Hospital  [cached]
Sheuly Begum,Ferdousi Islam,Arifa Akter Jahan
Journal of Enam Medical College , 2013, DOI: http://dx.doi.org/10.3329/jemc.v3i2.16128
Abstract: Background: Over half-a-million women die each year from pregnancy-related causes, and 99 percent of these occur in developing countries. In Bangladesh though maternal mortality rate (MMR) declined significantly around 40% in the past decade, still eclampsia accounts for 20% of maternal deaths. Eclampsia is uniquely a disease of pregnancy, and the only cure is delivery regardless of gestational age. A rational therapy for general management of hypertension and convulsion has been established in Bangladesh by the Eclampsia Working Group. But controversy still exists regarding obstetric management. Objective: To evaluate the feto-maternal outcome in cesarean section compared to vaginal delivery in eclamptic patients. Materials and Methods: This prospective cohort study was conducted in the department of Obstretics & Gynecology, Dhaka Medical College & Hospital (DMCH), from January to December 2011. A total 100 eclamptic women with term pregnancy and live fetus were purposively included in the study (Group I, 50 patients with vaginal delivery and Group II, 50 with cesarean section). Results: Out of these 100 patients 56% were aged ≤20 years, 71% were primigravida and 77% were from low socioeconomic status. Sixteen percent patients from vaginal delivery group and 18% from cesarean section group had no antenatal care. The mean gestational age was about 38 weeks in two groups. No significant difference was found between the two groups regarding blood pressure, proteinuria, consciousness level and convulsion. Recurrence of convulsion occurred in 30% patients of vaginal delivery group compared to 6% in cesarean section group. Maternal complications such as postpartum hemorrhage, cerebrovascular accident, renal failure, obstetric shock and abruptio placenta were higher among vaginal delivery group patients (46%) than cesarean section patients (16%). Maternal mortality was 6% in the vaginal delivery group and none in the cesarean section group. Regarding fetal outcome, stillbirth was 20% after vaginal delivery and 6% after cesarean section, the result was statistically significant. Birth asphyxia was less in the cesarean section group (23.4%) than in vaginal delivery group (60%) and this was statistically significant. Conclusions: The result of the present study shows a better feto- maternal outcome in the cesarean section group than in the vaginal delivery group.
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