Comparison of caesarean section and vaginal delivery for pelvic floor function of parturients: a meta-analysis

Yang, Xiao-Jing; Sun, Yun

doi:10.1016/j.ejogrb.2019.02.003

Cited by 23 publications

(20 citation statements)

References 13 publications

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Section: Discussionmentioning

confidence: 99%

“…[5] However, even without reducing access to medically indicated CS, decreasing the overall rate of CS may lead to increased morbidity and associated cost increases for at least some types of health problems, such as pelvic floor function problems. [24] Incremental cost estimates require data on the total population of women in each region, as well as the expected number and order of children that will be born to women within that cohort. We used census data on the total number of women aged 18 years in Ireland and England/Wales in 2016, and adjusted for the background mortality rate and rate of multiple pregnancies to avoid overestimating the number of hospital birth episodes.…”

Section: Limitationsmentioning

confidence: 99%

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Economic implications of reducing caesarean section rates – Analysis of two health systems

et al. 2020

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Caesarean section (CS) rates throughout Europe have risen significantly over the last two decades. As well as being an important clinical issue, these changes in mode of birth may have substantial resource implications. Policy initiatives to curb this rise have had to contend with the multiplier effect of women who had a CS for their first birth having a greater likelihood of requiring one during subsequent births, thus making it difficult to decrease CS rates in the short term. Our study examines the long-term resource implications of reducing CS rates among first-time mothers, as well as improving rates of vaginal birth after caesarean section (VBAC), among an annual cohort of women over the course of their most active childbearing years (18 to 44 years) in two public health systems in Europe. We found that the economic benefit of improvements in these two outcomes is considerable, with the net present value of the savings associated with a five-percentage-point change in nulliparous CS rates and VBAC rates being €1.1million and £9.8million per annual cohort of 18-yearolds in Ireland and England/Wales, respectively. Reductions in CS rates among first-time mothers are associated with a greater payoff than comparable increases in VBAC rates. The net present value of achieving CS rates comparable to those currently observed in the best performing Scandinavian countries was €3.5M and £23.0M per annual cohort in Ireland and England/Wales, respectively.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Economic implications of reducing caesarean section rates – Analysis of two health systems

et al. 2020

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“…For many years, studies have been published indicating that normal vaginal delivery does not weaken the pelvic floor if evaluated independently of parity (13,14). However, in a recently published meta-analysis, in which 9 studies and 4491 patients were involved, cesarean section was proposed to protect the pelvic floor, and statistically, significant improvement was observed in the cesarean group in all components of pelvic floor disorders (15). In the current study, it was observed that the type of delivery did not weaken the pelvic floor.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Decreased Pelvic Floor Muscle Strength: Which is More Effective?

Demir

Comba

2020

Gynecol Obstet Reprod Med

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Objective: The aim of this study was to assess whether cigarette smoking weakens the pelvic floor and to determine its effective impact relative to other factors.Study Design: Between September 2017 and September 2018, 250 patients admitted to an outpatient gynecology clinic were examined by a single physician and their anamnesis was taken. As a result of the examination, the pelvic floor muscle strength was evaluated according to the Modified Oxford Scale and the patients evaluated as 1/5 and 2/5 were grouped as having weak muscle strength and the rest were grouped as having high muscle strength. The intention was then to compare these two groups. The SPSS 21.0 for Windows program was used to perform statistical evaluations. Comparative analysis was performed with regression analysis.Results: 250 women participated in the study. 4 patients had muscle strength of 1/5; while 40 patients had muscle strength of 2/5 (17.6%). Patients with muscle strength of 1/5 and 2/5 were grouped as weak muscle strength. Advanced age, increased parity, smoking, and obesity are risk factors for a decrease in pelvic floor muscle strength (p < 0.05). Binary logistic regression analysis was performed to determine which of these factors has the greatest impact on pelvic floor muscle strength. Smoking has a 7-fold effect on decreased muscle strength (OR: 7.925) and obesity has a 5-fold impact (OR: 5.374).Conclusion: Although the mechanism of the effect of cigarette smoking on the pelvic floor is not known, it should be remembered that this effect has an adverse impact together with other factors which also have proven detrimental effects.

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“…Em uma revisão sistemática com metanálise, Yang e Sun 26 descreveram que o parto cesáreo é o modo de parto preferido para as gestantes em termos de função do assoalho pélvico. Porém, a indicação de parto cesáreo deve levar em consideração outros riscos para a saúde da mãe e do feto como complicações cirúrgicas, cardiovasculares e infecções etc.…”

Section: Discussionunclassified

“…Porém, a indicação de parto cesáreo deve levar em consideração outros riscos para a saúde da mãe e do feto como complicações cirúrgicas, cardiovasculares e infecções etc. [25][26][27] Por isso, a cesariana deve ser discutida com a paciente apenas se houver um risco aumentado de perda funcional do trabalho de parto, e não apenas para os propósitos de evitar danos no assoalho pélvico e possível comprometimento da IU pós-parto. 27 No entanto, mulheres que não exercitam o assoalho pélvico, durante a gravidez, estão mais propensas a desenvolver algum tipo de DAP, principalmente a IU.…”

Section: Discussionunclassified

Existe preparação dos músculos do assoalho pélvico na assistência pré-natal? uma avaliação de mulheres acompanhadas em uma unidade básica de saúde

Rodrigues¹,

Oliveira²,

Carneiro³

et al. 2020

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Introdução: A fisioterapia como forma de tratamento dos MAP na gravidez é uma alternativa eficaz na redução dos índices de DAP, porém, não existe garantia no Brasil de que a gestante será informada a respeito da necessidade de realizar uma avaliação do assoalho pélvico e da importância de exercitá-los. Objetivo: Observar se a puérpera recebeu orientação durante o pré-natal para exercitar os músculos do assoalho pélvico. Metodologia: Foi utilizado o Questionário de Experiência e Satisfação com o Parto modificado para a coleta de dados com mulheres entre 18 a 40 anos no Centro Saúde Escola do Marco (CSE – MARCO), localizado na cidade de Belém-PA no período de Janeiro a Abril de 2017. Resultados: 199 puérperas participaram da pesquisa. O parto normal foi o mais incentivado, realizado e desejado. A maioria das entrevistadas não conhecia os músculos do assoalho pélvico e não receberam orientação para a preparação dos mesmos. 61,31% não apresentaram perda de urina e 85,43% não apresentaram perda de fezes. Conclusão: A maioria das mulheres não recebeu orientação para preparar os MAP para o parto durante o pré-natal e apenas uma minoria tinha conhecimento sobre o que é o assoalho pélvico.

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Comparison of caesarean section and vaginal delivery for pelvic floor function of parturients: a meta-analysis

Cited by 23 publications

References 13 publications

Economic implications of reducing caesarean section rates – Analysis of two health systems

Economic implications of reducing caesarean section rates – Analysis of two health systems

Risk Factors for Decreased Pelvic Floor Muscle Strength: Which is More Effective?

Existe preparação dos músculos do assoalho pélvico na assistência pré-natal? uma avaliação de mulheres acompanhadas em uma unidade básica de saúde

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