Defining “normal recovery” of pelvic floor function and appearance in a high-risk vaginal delivery cohort

Fairchild, Pamela S.; Low, Lisa Kane; Kowalk, Katherine; Kolenic, Giselle; DeLancey, John O.L.; Fenner, Dee E.

doi:10.1007/s00192-019-04152-z

Cited by 15 publications

(12 citation statements)

References 23 publications

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“…Among the three regions of LA, the PVM is the portion under the highest stress and is most vulnerable to stress-related injuries 15,16 . Although most injuries are subclinical, and the vast majority of women recover function and appearance similar to their prenatal status 17 , these women have a higher risk of developing pelvic oor dysfunction in the future with the degeneration of pelvic muscles and ligaments 18,19 . PB, a wedge shaped bromuscular structure located in the midline of the perinium between the posterior fourchette and anus, is essential for maintaining the integrity of the pelvic oor by providing attachments to muscles and fascia 20 .…”

Section: Discussionmentioning

confidence: 99%

Transvaginal Posterior Levatorplasty and Perineoplasty for female Primary Stress Urinary Incontinence: 12-month follow-up and technical presentation

Wei²,

Liu

et al. 2023

Preprint

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The levator ani (LA) plays key roles in maintaining continence during sudden increase of intraabodominal pressure. To date, there has been no reports on the treatment of female stress urinary incontinence (SUI) by repairing the LA. We aimed to investigate the feasibility of transvaginal posterior levatorplasty combined with perineoplasty (TPLP) for women with primary stress urinary incontinence and demonstrate the surgical technique with step-by-step procedures. A total of 47 patients were prospectively enrolled in this study with a mean age of 43.6 years. Mean operative time was 78.7minites. Median estimated intraoperative blood loss was 80.2 ml. Objective cure and subjective cure rates were 87.2% and 91.5%, respectively. Compared with baseline, scores of quality of life，symptom severity and sexual function improved after surgery. Meanwhile, mobility of the urethra and bladder neck and areas of levator hiatus were decreased after surgery. There was no major adverse event, except mild coitus pain was reported in 15.4% (6/39) patients at the initial several times of intercourse after resuming sexual activity. In conclusions，this study shows that TPLP appears to be an effective surgical method for selected women with primary stress urinary incontinence.

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Section: Discussionmentioning

confidence: 99%

Transvaginal Posterior Levatorplasty and Perineoplasty for female Primary Stress Urinary Incontinence: 12-month follow-up and technical presentation

Wei²,

Liu

et al. 2023

Preprint

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“…Our outcomes were designed to capture injury at the enthesis (increased deformation, avulsion) and stretch (LHA). Additionally, evolving measures of injury that assess voluntary muscle function are still highly subjective and dependent on subject effort [28][29][30]. Although, continued study to define their value in detecting injury is critical.…”

Section: Discussionmentioning

confidence: 99%

Reducing pelvic floor injury by induction of labor

et al. 2022

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Introduction and hypothesis We hypothesized that elective induction of labor (eIOL) at 39 weeks is protective of levator ani muscle injury (LAMI) and is associated with decreased pelvic symptoms at 6 weeks postpartum compared to expectant management of labor. Methods Prospective cohort pilot study of uncomplicated, primiparous women with a singleton, vertex gestation enrolled immediately post-vaginal delivery (VD). Subjects were dichotomized into two groups based on labor management: eIOL without complication defined by the ARRIVE trial versus spontaneous VD between 39 weeks 0/7 and 42 weeks 5/7 or no indication for IOL prior to 40 weeks 5/7 . The primary outcome was LAMI at 6 weeks postpartum as evidenced by any of the following ultrasound measures: (1) increased levator hiatal area (LHA) > 2500 mm 2 , (2) increased elasticity index (EI, > 75th quartile) or (3) levator enthesis avulsion. Results Analysis represents 45/102 consented women from July 2019–October 2020 (eIOL n = 22 and spontaneous VD, n = 23). Neither maternal, clinical, sociodemographic characteristics nor pelvic symptoms differed between groups. Fewer women had LAMI as defined by the primary outcome with eIOL ( n = 5, 23.8%) compared to spontaneous VD ( n = 15, 65.2%), p = 0.008. Levator enthesis was more deformable (increased EI) with spontaneous VD as compared to the eIOL [10.66 (8.99) vs. 5.68 (2.93), p = 0.046]. On univariate logistic regression women undergoing spontaneous VD had unadjusted OR of 6.0 (1.6–22.5, p = 0.008) of sustaining LAMI compared to those undergoing eIOL. Conclusions Composite measures of LAMI though not pelvic floor symptoms were markedly increased in women undergoing spontaneous VD compared to those undergoing eIOL at 39 weeks. Supplementary Information The online version contains supplementary material available at 10.1007/s00192-022-05296-1.

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“…Dyspareunia and perineal pain are well-known sequelae after vaginal delivery [1,2]. However, the contribution of postpartum vaginal atrophy to these issues is largely unknown.…”

Section: Introductionmentioning

confidence: 99%

A pilot randomized controlled trial of vaginal estrogen on postpartum atrophy, perineal pain, and sexual function

et al. 2022

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Introduction and hypothesis Vulvovaginal symptoms following perineal laceration may be worsened by atrophy related to decreased estrogen. Our objective was to evaluate the effect of local estrogen therapy in this setting. Methods We conducted a single-center, pilot, randomized, placebo-controlled trial of local estradiol in primiparous women with a second-degree or greater perineal laceration following a term vaginal delivery. Participants were randomized to twice weekly estradiol or placebo cream from delivery through 3 months postpartum. The primary outcome was a validated measure of vulvovaginal symptoms at 12 weeks postpartum. Secondary outcomes included measures of perineal pain, quality of life, sexual function, ease of use, likelihood of continued use, and adverse events. Results We planned to enroll 70 women; however, due to human subjects research restrictions related to the COVID-19 pandemic, enrollment was stopped early. A total of 59 women were randomized, 31 to the estradiol group and 28 to the placebo group. Nearly all participants (95%) were followed through 12 weeks with suggestion of marginal improvement in Vulvar Assessment Scale scores [-0.10; 90% CI = (-0.20, 0.01)] in those randomized to estradiol compared to placebo. Local estradiol was not associated with improvement in other measures, and only one non-serious adverse event was observed. Conclusions In primiparous women with a perineal laceration, use of local estradiol showed minimal clinical benefit in vulvovaginal atrophy and related symptoms but appears to be acceptable and safe for postpartum use. Larger adequately powered trials enrolling a diverse group of postpartum women are needed to affirm these findings. Supplementary Information The online version contains supplementary material available at 10.1007/s00192-022-05149-x.

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Defining “normal recovery” of pelvic floor function and appearance in a high-risk vaginal delivery cohort

Cited by 15 publications

References 23 publications

Transvaginal Posterior Levatorplasty and Perineoplasty for female Primary Stress Urinary Incontinence: 12-month follow-up and technical presentation

Transvaginal Posterior Levatorplasty and Perineoplasty for female Primary Stress Urinary Incontinence: 12-month follow-up and technical presentation

Reducing pelvic floor injury by induction of labor

A pilot randomized controlled trial of vaginal estrogen on postpartum atrophy, perineal pain, and sexual function

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