Double incontinence in a cohort of nulliparous pregnant women

Espuña‐Pons, Montserrat; Solans‐Domènech, Maite; Sánchez, Emília

doi:10.1002/nau.22249

Cited by 25 publications

(14 citation statements)

References 28 publications

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“…Furthermore, through Epi-no, it is also possible to evaluate the real need for episiotomy and prevent its indiscriminate use, thereby protecting the patient from complications such as perineal pain in the immediate postoperative period and dyspareunia in the late puerperium. In addition, studies have shown that episiotomy does not protect women from the risk of urinary and fecal incontinence [22, 23]. …”

Section: Discussionmentioning

confidence: 99%

Distensibility and Strength of the Pelvic Floor Muscles of Women in the Third Trimester of Pregnancy

Petricelli

Resende

Elito

et al. 2014

BioMed Research International

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Objective. The objective of this study was to compare the role of the pelvic floor muscles between nulliparous and multiparous women in the third trimester of pregnancy, by analyzing the relationship between electrical activity (surface electromyography—EMG), vaginal palpation (modified Oxford scale), and perineal distensibility (Epi-no). Methods. This was an observational cross-sectional study on a sample of 60 healthy pregnant women with no cervical dilation, single fetus, gestational age between 35 and 40 weeks, and maternal age ranging from 15 to 40 years. The methods used were bidigital palpation (modified Oxford scale, graded 0–5), surface EMG (electrical activity during maximal voluntary contraction), and perineal distensibility (Epi-no device). The Pearson correlation coefficient (r) was used to analyze the Epi-no values and the surface EMG findings. The Kruskal-Wallis test was used to compare the median values from surface EMG and Epi-no, using the modified Oxford scale scores. Results. Among the 60 patients included in this study, 30 were nulliparous and 30 multiparous. The average maternal age and gestational age were 26.06 (±5.58) and 36.56 (±1.23), respectively. It was observed that nulliparous women had both higher perineal muscle strength (2.53 ± 0.57 versus 2.06 ± 0.64; P = 0.005) and higher electrical activity (45.35 ± 12.24 μV versus 35.79 ± 11.66 μV; P = 0.003), while among the multiparous women, distensibility was higher (19.39 ± 1.92 versus 18.05 ± 2.14; P = 0.013). We observed that there was no correlation between perineal distensibility and electrical activity during maximal voluntary contraction (r = − 0.193; P = 0.140). However, we found a positive relationship between vaginal palpation and surface electromyography (P = 0.008), but none between Epi-no values (P = 0.785). Conclusion. The electrical activity and muscle strength of the pelvic floor muscles of the multiparous women were damaged, in relation to the nulliparous women, while the perineal distensibility was lower in the latter group. There was a positive relationship between surface EMG and the modified Oxford scale.

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Section: Discussionmentioning

confidence: 99%

Distensibility and Strength of the Pelvic Floor Muscles of Women in the Third Trimester of Pregnancy

Petricelli

Resende

Elito

et al. 2014

BioMed Research International

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“…This discrepancy highlights the importance for more research on this topic to define precise guidelines for this common procedure. Furthermore, some previous studies reported that episiotomy use was additionally associated with higher rates of obstetric complications, comprising advanced perineal tears, postpartum haemorrhage, pain and urinary and anal sphincter incontinence [9][10][11][12]. Despite higher failure rates than when the conventional vacuum is used, the Kiwi omnicup is nowadays the most commonly used vacuum device at our department [13][14][15].…”

Section: Introductionmentioning

confidence: 96%

Management of the Perineum during Delivery with the Kiwi Omnicup: Effects of Mediolateral Episiotomy on Anal Sphincter Tears in Nulliparous Women

Kimberger¹,

Käfer²,

Husslein³

et al. 2017

Gynecol Obstet Invest

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Aim: The main objective of this study was to evaluate the association of mediolateral episiotomy with severe perineal trauma during Kiwi omnicup vacuum delivery. Methods: This retrospective study analyzed all Kiwi omnicup vacuum deliveries between 2010 and 2015 in nulliparous women. Secondary outcomes of interest included frequency of genital tract trauma, outcome of Kiwi extraction and influence on neonatal parameters. Results: A total of 572 nulliparous women who were delivered with the aid of vacuum were analyzed. Successful completion of birth was achieved in 549/572 (96%) resulting in a failure rate of 4%. Out of 572 women, 372 (65%) underwent the Kiwi vacuum delivery system in conjunction with episiotomy. Third- or fourth-degree perineal tears occurred in 38 out of the 572 (6.6%) women and the rate of severe perineal trauma was statistically and significantly lower in women who delivered with the aid of the Kiwi vacuum in conjunction with episiotomy (p = 0.0001). Besides, perineal tears of all degrees, vaginal tears and labial trauma were significantly less common in the Kiwi vacuum delivery system when combined with mediolateral episiotomy (p = 0.0001, p = 0.006, and p = 0.0001, respectively). Conclusion: Our data showed that the performance of a mediolateral episiotomy was associated with a decreased risk of severe perineal tears as well as vaginal and labial trauma in Kiwi omnicup vacuum deliveries.

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“…8,9 Moreover, this procedure can be related to a higher, rather than lower, incidence of advanced perineal tears. 10,11 Thus, the objective of our study was to perform a metaanalysis of the existing literature examining the effectiveness of episiotomy in the prevention of advanced perineal tears, and other maternal and neonatal complications, at the time of vacuum delivery.…”

Section: Introductionmentioning

confidence: 99%

Morbidity associated with episiotomy in vacuum delivery: a systematic review and meta‐analysis

Sagi‐Dain

Sagi

2015

BJOG

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Background The role of episiotomy in vacuum deliveries is controversial.Objectives To perform a meta-analysis of the literature examining this subject.Search strategy The search was conducted in four databases.Selection criteria Two investigators independently selected original research examining the effects of episiotomy on any neonatal and maternal outcomes during vacuum delivery.Data collection and analysis The effect estimates were presented as odds ratios (ORs) with 95% confidence intervals (95% CIs).Main results Fifteen articles were included, encompassing a total of 350 764 vacuum deliveries. A non-significant relationship was shown between mediolateral episiotomy and obstetric anal sphincter injuries (OASIS) in nulliparous women (OR 0.68, 95% CI 0.43-1.07; six studies), whereas an increased risk was demonstrated in parous women (OR 1.27, 95% CI 1.05-1.53; two reports). A higher risk of OASIS with median episiotomy use was shown in nulliparous (OR 5.11,; two studies) as well as in parous (OR 89.4, 95% CI 11.8-677.1; one study) women. Lateral episiotomy was related to lower OASIS risk in nullipara (OR 0.59, 95% CI 0.49-0.70; single paper). Mediolateral episiotomy was linked to increased rates of postpartum haemorrhage (OR 1.82, 95% CI 1.16-2.86) and analgesia use (OR 2.10, 95% CI 1.39-3.17; two reports). Overall, the quality of evidence was rated as low to very low.Author's conclusions Mediolateral and median episiotomy in parous woman may increase the rate of OASIS at vacuum delivery, whereas lateral episiotomy in nulliparous women could be associated with a decreased risk of OASIS. The suboptimal quality of the available evidence necessitates high-quality welldesigned randomised trials.Keywords Episiotomy, obstetric anal sphincter injury, vacuum extraction delivery.Tweetable abstract Episiotomy in vacuum delivery does not appear to be of benefit, and might even increase maternal morbidity.

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Double incontinence in a cohort of nulliparous pregnant women

Abstract: Symptoms of double incontinence are prevalent during first pregnancy; age and other intrinsic factors may favor the occurrence of double incontinence throughout gestation, while instrumental delivery and episiotomy increase the risk of double incontinence in the postpartum period.

Cited by 25 publications

References 28 publications

Distensibility and Strength of the Pelvic Floor Muscles of Women in the Third Trimester of Pregnancy

Distensibility and Strength of the Pelvic Floor Muscles of Women in the Third Trimester of Pregnancy

Management of the Perineum during Delivery with the Kiwi Omnicup: Effects of Mediolateral Episiotomy on Anal Sphincter Tears in Nulliparous Women

Morbidity associated with episiotomy in vacuum delivery: a systematic review and meta‐analysis

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