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Pelvic floor injury

Bertrand Gachon, Marion Desgranges, Laetitia Fradet, Arnaud Decatoire, Florian Poireault, Fabrice Pierre, Xavier Fritel, David Desseauve
INTRODUCTION AND HYPOTHESIS: Increased ligamentous laxity is associated with pelvic floor distension in pregnant women. This considered, it may also be related to the risk of obstetric anal sphincter injury (OASI). Our objective was to assess the association among increased ligamentous laxity, perineal tear severity, and OASI occurrence. METHODS: This is a prospective study. We assessed ligamentous laxity between the 36th week of pregnancy and the onset of labor, by measuring the passive extension of the nondominant index finger for a 0...
March 7, 2018: International Urogynecology Journal
Hege Hølmo Johannessen, Signe Nilssen Stafne, Ragnhild Sørum Falk, Arvid Stordahl, Arne Wibe, Siv Mørkved
INTRODUCTION AND HYPOTHESIS: Urinary (UI) and anal incontinence (AI) are common pelvic floor disorders (PFD), and postpartum women experiencing double incontinence (DI), the combination of UI and AI, tend to have more severe symptoms and a greater impact on quality of life. Our objective was to investigate the prevalence and predictors of postpartum DI and UI alone 1 year after first delivery. METHODS: In this prospective cohort study, 976 women reported the prevalence of DI and UI alone 1 year after their first delivery in one of two hospitals in Norway using the St Marks score and the ICI-Q UI SF...
March 2, 2018: International Urogynecology Journal
P Tirumanisetty, D Prichard, J G Fletcher, S Chakraborty, A R Zinsmeister, A E Bharucha
BACKGROUND: Endoanal MRI and MR defecography are used to identify anal sphincter injury and disordered defecation. However, few studies have evaluated findings in asymptomatic healthy people. The effects of BMI and parity on rectoanal motion and evacuation are unknown. METHODS: In 113 asymptomatic females (age 50 ± 17 years, Mean ± SD) without risk factors for anorectal trauma, anal sphincter appearance, anorectal motion, and pelvic organ prolapse were evaluated with MRI...
March 2, 2018: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Vita Začesta, Dace Rezeberga, Haralds Plaudis, Kristina Drusany-Staric, Corrado Cescon
INTRODUCTION AND HYPOTHESIS: Mediolateral episiotomy is one of the most frequent surgical interventions performed in obstetrics. There is conflicting evidence as to whether mediolateral episiotomy reduces the risk of obstetric anal sphincter injuries (OASI). Recent studies suggest that functional asymmetry of pelvic floor innervation exists in healthy women and is strongly associated with postpartum incontinence when the trauma occurs on the dominant side of innervation. Mediolateral episiotomy is the most common cause of perineal trauma during delivery, and the surgical incision is usually performed on the mediolateral right side...
February 26, 2018: International Urogynecology Journal
You Maria Wu, Natalia McInnes, Yvonne Leong
OBJECTIVES: Pelvic floor muscle training (PFMT) is often recommended to treat postpartum urinary incontinence (UI). However, the role of postpartum PFMT in pelvic organ prolapse (POP), sexual function, and anal incontinence (AI) remains unclear. We therefore aim to assess the efficacy of postpartum PFMT on these pelvic floor disorders. METHODS: This study is a meta-analysis consisting of randomized controlled trials (RCTs). We searched databases including CENTRAL, MEDLINE, EMBASE, CINAHL, and PEDro...
March 2018: Female Pelvic Medicine & Reconstructive Surgery
Susan A Barr, Catrina C Crisp, Amanda B White, Shazia A Malik, Kimberly Kenton
OBJECTIVE: The aims of this study are to identify screening, treatment, and referral practices of primary care physicians (PCPs) for patients with pelvic floor disorders (PFDs) and evaluate awareness of the Female Pelvic Medicine and Reconstructive Surgery (FPMRS) subspecialty. METHODS: We conducted a cross-sectional survey of PCPs using a random sample of 1005 American College of Physicians members, stratified by demographic region. Electronic survey content included awareness of FPMRS certification, comfort diagnosing and treating PFDs, and PFD referral patterns for PCPs...
March 2018: Female Pelvic Medicine & Reconstructive Surgery
Qinyi Zhu, Huimin Shu, Guiqiang Du, Zhiyuan Dai
BACKGROUND: Pelvic organ prolapse (POP) is a common disease in women. The aim of this research was to evaluate the safety, efficacy and complication of transvaginal modified sacrospinous ligament fixation with mesh using for the treatment of vaginal vault prolapse. MATERIALS AND METHODS: This was a prospective study including information from 60 symptomatic women with anterior-apical pelvic floor prolapse. The patients underwent transvaginal modified sacrospinous ligament fixation combined with anterior vaginal wall mesh between May 2014 and Sep 2015...
February 16, 2018: International Journal of Surgery
Tatiana Catanzarite, Shannon Bremner, Caitlin L Barlow, Laura Bou-Malham, Shawn O'Connor, Marianna Alperin
BACKGROUND: Maternal birth trauma to the pelvic floor muscles is thought to be consequent to mechanical demands placed on these muscles during fetal delivery that exceed muscle physiological limits. The above is consistent with studies of striated limb muscles that identify hyperelongation of sarcomeres, the functional muscle units, as the primary cause of mechanical muscle injury and resultant muscle dysfunction. However, pelvic floor muscles' mechanical response to strains have not been examined at a tissue level...
February 9, 2018: American Journal of Obstetrics and Gynecology
Nazan Karahan, Hediye Arslan, Çetin Çam
Term pregnant women were divided into oxytocin infusion and control groups. The electrical activities of pelvic floor muscles (PFM) were recorded at rest and during contractions electromyographically. The beginning and the end of each contraction were marked on the recorded electromyographic trace. A trace was regarded as 'negative' if no increase in electrical activity was observed and 'positive' if increased electrical activity was observed during the contractions. To evaluate the relative frequency of the areas of electrical activity during uterine contractions (UC) a 'positive electrical activity percentage' was used and calculated as: (total count of positive electrical activity areas)/(total count of UC) × 100...
February 12, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Francisco J Orejuela, Rajshi Gandhi, Lauren Mack, Wesley Lee, Haleh Sangi-Haghpeykar, Hans P Dietz, Susan M Ramin
INTRODUCTION AND HYPOTHESIS: The objective was to assess the safety and feasibility of using a pelvic floor dilator during active labor to prevent injuries to the levator ani muscle (LAM) and perineum. METHODS: In a prospective pilot study, a pelvic floor dilator using soft pads was introduced into the vaginal canal to gradually expand the vagina, in 30 nulliparous women and in 10 controls. The primary outcomes were adverse events related to the device. Secondary outcomes were perineal lacerations after delivery, sonographically defined levator ani injury, hiatal area dimensions, and anal sphincter disruption, all at 12-20 weeks postpartum, and maximum pelvic floor dilation, time to achieve maximum dilation, and device retention rate...
February 6, 2018: International Urogynecology Journal
Mehrnoosh Aref-Adib, Evangelia Vlachodimitropoulou, Rajvinder Khasriya, Benjamin W Lamb, Dan Selo-Ojeme
We assessed the attitudes of UK Obstetrics and Gynaecology (O&G) trainees towards a caesarean delivery for maternal request (CDMR); and identified differences in attitude towards patients requesting CDMR and preferences for their own mode of delivery. An internet survey was constructed with questions covering trainees' personal preferences towards and experience of CDMR; attitudes to CDMR; and how they might treat patients making this request. From 02/2013 to 06/2013, the survey was sent electronically via email to all UK Deaneries to be forwarded to O&G trainees...
January 27, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Emma Long, Swati Jha
PURPOSE: A common indication for elective caesarean is previous obstetric anal sphincter injury (OASI). This study aims to identify factors that influence womens' preferences regarding mode of delivery (MoD) in a subsequent pregnancy following an OASI. METHODS: 100 consecutive women who sustained an OASI completed a questionnaire when attending postnatal follow up at a perineal trauma clinic. They also completed ePAQ-PF to assess pelvic floor symptoms. Data was collated and percentages generated for each response...
December 8, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
David Sheyn, Kateena L Addae-Konaedu, Alison M Bauer, Konyinsola I Dawodu, David N Hackney, Sherif A El-Nashar
OBJECTIVE: A likely contributor to pelvic floor disorders is injury and degradation of connective tissue components such as collagen and elastin, leading to weakening of the pelvic floor. Prior studies have found similar connective tissue component changes in women with cervical insufficiency (CI). However, the connection between pelvic floor disorders and cervical insufficiency has not previously been evaluated. Our objective was to determine whether a history of cervical insufficiency is associated with an increased risk of pelvic organ prolapse and stress urinary incontinence after controlling for confounders...
January 2018: Maturitas
Krešimir Živković, Nikica Živković, Tomislav Župić, Damir Hodžić, Vjekoslav Mandić, Slavko Orešković
Episiotomy is obstetric procedure during which the incision extends the vestibule of the vagina during the second stage of labor. Episiotomy was extensively spread with gradual increase of rates in the first half of the 20th century and was performed medio-laterally in all nulliparous women with the idea to protect fetal head from trauma and pelvic floor from injuries. However, reports claiming that episiotomy had no such benefits were published. It was shown that routine medio-lateral episiotomy did not protect against the appearance of urinary incontinence after vaginal delivery, while the risk of anal incontinence could be increased...
December 2016: Acta Clinica Croatica
Amanda Williams, Beverly Gonzalez, Colleen Fitzgerald, Cynthia Brincat
OBJECTIVES: The aim of the study was o determine whether variations exist between races/ethnicities in perineal laceration at first vaginal delivery. METHODS: We assessed first vaginal deliveries greater than 35 weeks gestation, for a four-year period, in our diverse urban healthcare system. Predictor variable was race/ethnicity with outcome variable of none, first-, second-, third-, or fourth-degree perineal laceration. Race and ethnicity were self-reported and combined into one variable to facilitate analysis...
November 7, 2017: Female Pelvic Medicine & Reconstructive Surgery
L Ramage, C Yen, S Qiu, C Simillis, C Kontovounisios, E Tan, P Tekkis
Introduction This study aimed to ascertain whether missed obstetric anal sphincter injury at delivery had worse functional and quality of life outcomes than primary repair immediately following delivery. Materials and methods Two to one propensity matching was undertaken of patients presenting to a tertiary pelvic floor unit with ultrasound evidence of missed obstetric anal sphincter injury within 24 months of delivery with patients who underwent primary repair at the time of delivery by parity, grade of injury and time to assessment...
September 15, 2017: Annals of the Royal College of Surgeons of England
Krystel Nyangoh Timoh, David Moszkowicz, Mazen Zaitouna, Cedric Lebacle, Jelena Martinovic, Djibril Diallo, Maud Creze, Vincent Lavoue, Emile Darai, Gérard Benoit, Thomas Bessede
BACKGROUND: Injury to the levator ani muscle or pelvic nerves during pregnancy and vaginal delivery is responsible for pelvic floor dysfunction. OBJECTIVE: We sought to demonstrate the presence of smooth muscular cell areas within the levator ani muscle and describe their localization and innervation. STUDY DESIGN: Five female human fetuses were studied after approval from the French Biomedicine Agency. Specimens were serially sectioned and stained by Masson trichrome and immunostained for striated and smooth muscle, as well as for somatic, adrenergic, cholinergic, and nitriergic nerve fibers...
January 2018: American Journal of Obstetrics and Gynecology
Camille S Calderwood, Amy Thurmond, Amanda Holland, Blake Osmundsen, W Thomas Gregory
OBJECTIVE: The aim of this study was to compare the detection of levator ani defects (LAD) between 3-dimensional (3D) ultrasound (US) and 3D magnetic resonance imaging (MRI). METHODS: This is a secondary analysis of the Pelvic Floor Nerve Injury Following Childbirth Study. Nulliparous women underwent a standardized protocol of pelvic floor evaluations between January 2008 and December 2013, prior to pregnancy (V1) and at 2 points postpartum: 6 weeks (V2) and 6 months (V3)...
September 26, 2017: Female Pelvic Medicine & Reconstructive Surgery
Melissa H Mendez, Stephanie J Sexton, Aaron C Lentz
INTRODUCTION: Urinary leakage during sexual activity is a prevalent and often distressing condition that is under-addressed despite having a range of reasonable treatment options. AIM: To review the available literature on prevalence, pathophysiology, and treatment of urinary leakage during sexual activities. METHODS: A literature review was performed through PubMed from 1996 to 2017 regarding urinary leakage during sexual activities for men and women including foreplay incontinence, coital incontinence, and climacturia...
September 20, 2017: Sexual Medicine Reviews
Giuseppe Campagna, Giovanni Panico, Andrea Morciano, Pierre Gadonneix, Vincent Delmas, Mauro Cervigni, Alfredo Ercoli, Giovanni Scambia
INTRODUCTION: The present study aim to compare the anatomic landmarks of two pelvic floor repair systems, in order to identify the potential neurovascular lesions related to different mesh fixation techniques. METHODS: Abdominal and perineal dissections of 10 fresh cadavers after prolapse surgery using transobturator/transgluteal versus single incision techniques. Neuro-vascular structures of obturator region and perineum were isolated. Distances between needles and anatomical structures were measured...
September 18, 2017: Neurourology and Urodynamics
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