Pelvic floor shape variations during pregnancy and after vaginal delivery

Routzong, Megan R.; Rostaminia, Ghazaleh; Moalli, Pamela; Abramowitch, Steven D.

doi:10.1016/j.cmpb.2020.105516

Cited by 27 publications

(13 citation statements)

References 29 publications

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“…Pregnancy and childbirth are the most important independent risk factors for female pelvic floor dysfunction (24,25). During pregnancy and childbirth, the pelvic floor structure may undergo physiological and anatomical changes that may damage the structure and function of the pelvic floor to varying degrees (26).…”

Section: Discussionmentioning

confidence: 99%

Systematic review and meta-analysis of evaluation of selective cesarean section in postpartum pelvic floor function recovery under perineal ultrasound

Chen¹,

Geng²,

Zhou³

et al. 2022

Ann Palliat Med

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Background: Different delivery modes can affect the early pelvic floor function of puerpera, but there are no reports on the systematic evaluation of the effects of selective cesarean section delivery (CSD) and vaginal delivery (VD) on the pelvic floor function of puerpera.Methods: We searched for clinical controlled studies on the evaluation of pelvic floor function and performance after CSD and VD, published between 1 January 2010 and 1 August 2021, in the databases of PubMed, Embase, The Cochrane Library, and Web of Science. Literature was screened according to the inclusion and exclusion criteria. The quality of trials included in the studies was evaluated using the Cochrane Working Manual (5.3). Meta-analysis of the extracted data from the eligible articles was performed using Review Manager 5.3 software. The heterogeneity was assessed by chi-square, and P<0.05 was considered statistically significant among groups.Results: A total of 3,704 parturient women were included in 10 articles, including 1,072 cases in the CSD group and 2,632 cases in the VD group. Meta-analysis showed that pelvic floor muscle strength {mean difference (MD) [95% confidence interval (CI)]: −12.51 (−17.10 to −7.91); Z=5.34; P<0.00001} and bladder neck strength decreases in the CSD group [standardized mean difference (SMD) (95% CI): 1.01 (0.73 to 1.29); Z=7.08; P<0.00001] were higher than those in the VD group. In addition, the maximum urine flow [MD (95% CI): −6.86 (−9.32 to −4.39); Z=5.46; P<0.00001], bladder angle [MD (95% CI): −3.82 (−4.54 to −3.11); Z=10.46; P<0.00001], stress urinary incontinence (SUI) rate [relative risk (RR) (95% CI): 0.56 (0.35 to 0.88); Z=2.52; P=0.01], and pelvic floor organ prolapse rate [odds ratio (OR) (95% CI): 0.29 (0.09 to 0.89); Z=2.17; P=0.03] were lower than VD group, and the differences were significant (P<0.05). Conclusions:Selective CSD can reduce the injury of pelvic floor muscle during delivery to a certain extent, and reduce the incidence of SUI and pelvic floor organ prolapse in early puerpera; however, such impacts cannot be completely avoided.

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Section: Discussionmentioning

confidence: 99%

Systematic review and meta-analysis of evaluation of selective cesarean section in postpartum pelvic floor function recovery under perineal ultrasound

Chen¹,

Geng²,

Zhou³

et al. 2022

Ann Palliat Med

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“…Regarding urogenital problems, one possible explanation is that pregnant women may have a weak pelvic floor, as it has been studied that a higher BMI is associated with weaker pelvic floor muscles [ 30 ], and our participants had an average BMI of 25 kg/ m 2 at the 16th g.w. Moreover, lower PF levels may also exert a negative effect, especially in the later stages of pregnancy, due to the pressure of the growing fetus on the muscles of the utero muscles [ 31 ]. In fact, other factors, such as low PF levels and sleep disturbances are also significant contributors to the development of fatigue [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Association of Self-Reported Physical Fitness with Pregnancy Related Symptoms the GESTAFIT Project

Marín-Jiménez

Borges-Cósic

Ocón‐Hernández

et al. 2021

IJERPH

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We explored the association of physical fitness (PF) with pregnancy-related symptoms, at the 16th and 34th gestational weeks (g.w.). The International Fitness Scale and the Pregnancy Symptoms Inventory were employed to assess self-reported PF and pregnancy-related symptoms, respectively. At the 16th g.w. greater self-reported overall PF was associated with lower incidence of urinary frequency (p = 0.020); greater overall PF, cardiorespiratory fitness (CRF), muscular strength and speed-agility were associated with lower incidence of tiredness-fatigue (all, p < 0.05); greater overall PF and speed-agility were associated with lower incidence of poor sleep (both, p < 0.05); greater CRF and flexibility were associated with lower limitations by tiredness-fatigue (both, p < 0.05); and greater flexibility was associated with lower limitations by poor sleep (p = 0.021). At the 34th g.w. greater self-reported overall PF, CRF and muscular strength were associated with lower incidence of tiredness-fatigue (all, p < 0.05); greater CRF was associated with lower incidence of poor sleep (p = 0.019); and, greater flexibility was associated with lower incidence of increased vaginal discharge (p = 0.023). Adequate levels of PF, especially CRF, may help women to cope with the most endorsed pregnancy-related symptoms and its limitations, especially tiredness-fatigue and poor sleep.

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“…Different authors have reported morphological changes in the female pelvic floor with ageing [55][56][57], including a significant transition of PFM shape from V-like to U-like. Alterations in PFM shape or morphology have also been found in the case of parity [58,59]. The differences between the spectral content of both healthy groups could thus be due to a modification of the spatial filtering of their sEMG signals due to changes in the volume conductor effects [20].…”

Section: Discussionmentioning

confidence: 94%

“…Because of the lack of volunteers, we finally decided to compare the PFM activity of patients with that of women who met at least one of two requirements: (1) over 35 years old, (2) parous. Although aging, pregnancy and delivery are associated with significant changes in the pelvic floor's anatomy and functionality [58,59,62], these variations are different in the three physiological processes. A higher number of healthy women with different demographic and obstetric characteristics should be recruited to form more specific groups and individually assess the impact of each of these conditions on PFM activity.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Pelvic Floor Activity in Healthy Subjects and with Chronic Pelvic Pain: Diagnostic Potential of Surface Electromyography

Albaladejo-Belmonte

Tarazona-Motes

Nohales-Alfonso

et al. 2021

Sensors

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Chronic pelvic pain (CPP) is a highly disabling disorder in women usually associated with hypertonic dysfunction of the pelvic floor musculature (PFM). The literature on the subject is not conclusive about the diagnostic potential of surface electromyography (sEMG), which could be due to poor signal characterization. In this study, we characterized the PFM activity of three groups of 24 subjects each: CPP patients with deep dyspareunia associated with a myofascial syndrome (CPP group), healthy women over 35 and/or parous (>35/P group, i.e., CPP counterparts) and under 35 and nulliparous (<35&NP). sEMG signals of the right and left PFM were recorded during contractions and relaxations. The signals were characterized by their root mean square (RMS), median frequency (MDF), Dimitrov index (DI), sample entropy (SampEn), and cross-correlation (CC). The PFM activity showed a higher power (>RMS), a predominance of low-frequency components (<MDF, >DI), greater complexity (>SampEn) and lower synchronization on the same side (<CC) in CPP patients, with more significant differences in the >35/P group. The same trend in differences was found between healthy women (<35&NP vs. >35/P) associated with aging and parity. These results show that sEMG can reveal alterations in PFM electrophysiology and provide clinicians with objective information for CPP diagnosis.

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Pelvic floor shape variations during pregnancy and after vaginal delivery

Cited by 27 publications

References 29 publications

Systematic review and meta-analysis of evaluation of selective cesarean section in postpartum pelvic floor function recovery under perineal ultrasound

Systematic review and meta-analysis of evaluation of selective cesarean section in postpartum pelvic floor function recovery under perineal ultrasound

Association of Self-Reported Physical Fitness with Pregnancy Related Symptoms the GESTAFIT Project

Characterization of Pelvic Floor Activity in Healthy Subjects and with Chronic Pelvic Pain: Diagnostic Potential of Surface Electromyography

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