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Problem Statement: Pregnancy and labor are known risk factors for pelvic floor dysfunction (PFD). Operative vaginal delivery (OVD) is one important risk factor and its impact in early PFD symptoms is controversy. The purpose of this study is to compare postpartum PFD symptoms between spontaneous vaginal delivery (SVD) and OVD.Methods: An observational prospective study (MOODS: Maternal-neonatal Outcomes in Operative-vaginal Delivery Study) was enrolled at Braga`s Hospital (tertiary center) from February to August 2018 (included all OVD (vacum, forceps and spatulas) and random SVD sample, in a 2:1 ratio). To access PFD symptoms the Pelvic Floor Distress Inventory-20 (PFDI-20) was applied 3-months, 6-months and 1-year postpartum. The questionnaire has 20 questions and is divided into three subscales: Urinary(UDI), Colorectal-Anal(CRADI) and Pelvic Organ Prolapse Distress Inventory(POPDI). The answers were converted to a numerical scale. A partial score (0-100 in each subscale) and a global score (0-300, sum of 3 subscales scores) were calculated. Women that answer at least one of the questionnaires were included.Results: Of 271 women recruited, 193 were included, 69(35.8%) had a SVD and 124(64.2%) an OVD. Thierry spatulas were used in 50% of OVD. The response rate at 3-months was 81.2% for SVD, 79.0% for OVD; at 6-months 44.0% for SVD, 43.5% for OVD; at 1-year 52.2% for SVD, 54.8% for OVD. No difference was found regarding age, body mass index, maternal/obstetric history, type of labor, perineal lacerations and birth weight. The frequency of nulliparous (p=0.001), episiotomy (p
Pelvic Floor Re-education encompasses a variety of techniques for increasing the strength of, and control over, the pelvic floor muscles. These techniques are now emerging as an effective and viable alternative to surgery in the treatment of urinary incontinence and related conditions. This volume presents a reasoned, scientific approach to the use of pelvic floor re-education. Starting with the latest theories on anatomy, pathophysiology and possible causes of pelvic floor damage, the text then describes the importance of pelvic floor evaluation in determining the type of treatment required. A number of re-education techniques are assessed including isolated muscle exercise, vaginal cones, biofeedback control and electrical stimulation. Recent research work is also reviewed which allows the reader to evaluate the different modalities advocated in the management of pelvic floor dysfunction.
​This book offers an up-to-date overview of childbirth-related pelvic floor dysfunction covering prevention, diagnosis, and management. It encompasses all relevant conditions, with particular focus on genital prolapse, urinary incontinence, and fecal incontinence. Risk factors for pelvic floor damage related to childbirth are identified, and a 3D simulation of delivery is presented. The role of various diagnostic tools, including pelvic floor ultrasonography and magnetic resonance imaging and anal sphincter electromyography, is clearly described. The importance of physiotherapy in preventing future alterations is explained, and the indications for surgery, which is reserved for more severe situations, are discussed. The book highlights the need for a multidisciplinary approach involving obstetricians, gynecologists, urologists, midwives, radiologists, physiotherapists, muscle laboratory engineers, and computer technicians.
First book devoted to the diagnosis and treatment of sexual pain in women Female Sexual Pain Disorders is a remarkable fusion of clinical and scientific knowledge that will empower women’s healthcare professionals to help their patients in overcoming this common debilitating disorder. Based on the highest level research, it provides state-of-the-art practical guidance that will help you to: Evaluate and distinguish the causes of sexual pain in women Differentiate the many forms of sexual pain Implement multidisciplinary treatments Distilling the experience of world leaders across many clinical, therapeutic and scientific disciplines, with an array of algorithms and diagnostic tools, Female Sexual Pain Disorders is your ideal companion for treating the many millions of women who suffer from this disorder worldwide. All proceeds from this book are being donated to the International Society for the Study of Women’s Sexual Health (ISSWSH).
This manual encompasses a comprehensive approach to the management of labour. Based on the simple proposition that effective uterine action is the key to normal delivery, Active Management of Labour covers all aspects of delivery for nulliparous women with vertex presentation and single foetus. This is an accessible and practical guide for obstetricians and midwives as well as anaesthetists and the auxiliary staff of maternity units. Encourages an active interest in labour by all professional staff Emphasises the importance of constant personal attention and good communication in labour Discusses in detail the need to distinguish between: - first and subsequent births - single cephalic and all other pregnancies - induction and acceleration of labour Fosters the development of a team spirit between midwife and obstetrician Demonstrates how good labour ward organisation can improve care Proves the importance of audit in ensuring quality of care Updated chapters on dystocia and caesarean section New key points summary at the end of each chapter Updated review of clinical outcomes at the National Maternity Hospital
Biomechanics of the Female Pelvic Floor, Second Edition, is the first book to specifically focus on this key part of women’s health, combining engineering and clinical expertise. This edited collection will help readers understand the risk factors for pelvic floor dysfunction, the mechanisms of childbirth related injury, and how to design intrapartum preventative strategies, optimal repair techniques, and prostheses. The authors have combined their expertise to create a thorough, comprehensive view of female pelvic floor biomechanics in order to help different disciplines discuss, research, and drive solutions to pressing problems. The book includes a common language for the design, conduct, and reporting of research studies in female PFD, and will be of interest to biomechanical and prosthetic tissue engineers and clinicians interested in female pelvic floor dysfunction, including urologists, urogynecologists, maternal fetal medicine specialists, and physical therapists. Contains contributions from leading bioengineers and clinicians, and provides a cohesive multidisciplinary view of the field Covers causes, risk factors, and optimal treatment for pelvic floor biomechanics Combines anatomy, imaging, tissue characteristics, and computational modeling development in relation to pelvic floor biomechanics
Many women with pelvic floor disorders (PFDs) suffer in silence; unaware there is a medical explanation for their symptoms. Limited research on their perspectives living with these conditions was the underlying reason for this phenomenological study. Semi-structured, in-depth interviews were conducted with at least one vaginal delivery and a PFD diagnosis by a medical professional required for all participants. Subjects' ages ranged from 29 to 57, with the mean age of 41.3 years. The four major themes that emerged were (a) pregnancy-related issues, (b) interaction with family and friends, (c) relationships with significant others, and (d) interactions with healthcare professionals. All of the women visited multiple health care specialists, with the average period being 12 years from their first symptoms to diagnosis. Participants shared they did not discuss their symptoms with friends and/or partners hoping the problems would resolve on their own. Further studies on the personal experiences of women living with PFD are essential not only for the quality of prenatal care, but to encourage more women to seek help and improve their overall quality of life.
Bridging the gap between evidence-based research and clinical practice, Physical Therapy for the Pelvic Floor has become an invaluable resource to practitioners treating patients with disorders of the pelvic floor. The second edition is now presented in a full colour, hardback format, encompassing the wealth of new research in this area which has emerged in recent years. Kari Bø and her team focus on the evidence, from basic studies (theories or rationales for treatment) and RCTs (appraisal of effectiveness) to the implications of these for clinical practice, while also covering pelvic floor dysfunction in specific groups, including men, children, elite athletes, the elderly, pregnant women and those with neurological diseases. Crucially, recommendations on how to start, continue and progress treatment are also given with detailed treatment strategies around pelvic floor muscle training, biofeedback and electrical stimulation. aligns scientific research with clinical practice detailed treatment strategies innovative practice guidelines supported by a sound evidence base colour illustrations of pelvic floor anatomy and related neuroanatomy/ neurophysiology MRIs and ultrasounds showing normal and dysfunctional pelvic floor incorporates vital new research and material uses key summary boxes throughout new edition to highlight quick reference points now in full colour throughout and a hardback format
"Pregnancy as well as delivery are both associated with pelvic floor disorders such as pelvic organ prolapse, overactive bladder syndrome and urinary incontinence. However, little is known about the relationship between voiding dysfunction and postpartum urinary retention (PUR). It is feasible that the onset of voiding problems later in life is related to the period immediately after delivery when inadequate voiding is a frequently encountered condition. In order to gain insight in the clinical consequences of inadequate voiding after delivery, identification of risk factors and management strategies, women after vaginal delivery with symptomatic and asymptomatic postpartum urinary retention were studied. First of all we observed not only that incomplete bladder emptying after vaginal delivery resolves rather quickly, but also that the currently used cut-off values do not discriminate between physiology and pathology. Additionally we concluded that an automatic scanning device is a valid non-invasive tool to identify increased post void residual bladder volume after vaginal delivery and to prevent unneeded catheterisations. Finally we found that clean intermittent catheterisation (CIC) is preferred over transurethral indwelling catheterisation (TIC) in patients with the inability to adequately empty the bladder after vaginal delivery. The results presented in this thesis could be used to create evidence based guidelines on the management of bladder emptying problems after vaginal delivery and to increase awareness of clinicians."--Samenvatting auteur.