Posterior compartment symptoms in primiparous women 1 year after non-assisted vaginal deliveries: a Swedish cohort study

Rotstein, Emilia; Åhlund, Susanne; Lindgren, Helena; Hirschberg, Angelica Lindén; Rådestad, Ingela; Tegerstedt, Gunilla

doi:10.1007/s00192-021-04700-6

Cited by 9 publications

(18 citation statements)

References 38 publications

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“…An insufficient sample size for this rare outcome might explain why the association did not reach significance in our study. The lack of association between obstructed defecation and severity of perineal or vaginal tear is in line with a previous study by Rotstein et al 7 …”

Section: Discussionsupporting

confidence: 92%

“…Pelvic organ prolapse, including rectocele and symptoms of vaginal bulging, is more common in women with a history of previous vaginal delivery 4,5 . Rectocele is associated with obstructed defecation, 6 and a similar association has been hypothesized between obstetric perineal tears and obstructed defecation 7 . However, attempts to demonstrate this latter association have failed 7 …”

Section: Introductionmentioning

confidence: 99%

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Fecal incontinence and associated pelvic floor dysfunction during and one year after the first pregnancy

Jansson

Franzén

Tegerstedt

et al. 2023

Acta Obstet Gynecol Scand

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Introduction: Obstetric anal sphincter injury is an important risk factor for postpartum fecal incontinence but few studies have reported fecal incontinence occurring, even during pregnancy. The first objective of this study was to examine the prevalence of fecal incontinence, obstructed defecation and vaginal bulging early and late in pregnancy and postpartum. The second objective was to assess the association between symptoms in pregnancy, delivery characteristics, and bowel and vaginal bulging symptoms at 1 year postpartum. Material and methods: This prospective cohort study was conducted betweenOctober 2014 and October 2017, including 898 nulliparous women enrolled with the maternity healthcare service in Örebro County, Sweden. The women responded to questionnaires regarding pelvic floor dysfunction in early and late pregnancy and at 8 weeks and 1 year postpartum. The data were analyzed using random effect logistic models estimating odds ratios (ORs) and generalized linear models estimating relative risks, with 95% confidence intervals (CIs).Results: At 1 year postpartum, the prevalence of fecal incontinence, obstructed defecation and vaginal bulging was 6% (40/694), 28% (197/699) and 8% (56/695), respectively. Among women with vaginal delivery, the risk of fecal incontinence and vaginal bulging increased significantly both in late pregnancy, with ORs of 3.4 (95% CI 1.5-7.7) and 3.6 (95% CI 1.6-8.1), respectively, and at 1 year postpartum, with ORs of 5.0 (95% CI 2.1-11.5) and 8.3 (95% CI 3.8-18.1), respectively, compared with early pregnancy. Among all women, factors associated with increased prevalence of fecal incontinence 1 year postpartum were fecal incontinence during pregnancy (adjusted relative risk [aRR] 7.4; 95% CI 4.1-13.3), obstructed defecation during pregnancy (aRR 2.0; 95% CI 1.1-3.9) and concurrent obstructed defecation (aRR 2.4; 95% CI 1.3-4.5). Conclusions:This prospective study shows an increased risk of fecal incontinence by late pregnancy, suggesting that the pregnancy itself may be involved in the

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Fecal incontinence and associated pelvic floor dysfunction during and one year after the first pregnancy

Jansson

Franzén

Tegerstedt

et al. 2023

Acta Obstet Gynecol Scand

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“…As the case‐load midwives also work at the labor ward, they may also influence the professional culture at the unit, especially among the midwives. Both the labor wards of Linköping and Karolinska Huddinge have Pelvic Floor Centres with a research focus on pelvic floor dysfunction, 28,29 which may have influenced their attitudes on this subscale. Additionally, it is interesting to note that Linköping, the organization with the lowest CS rate since more than a decade, 11 was not less fearful of the consequences of vaginal birth than the other labor wards.…”

Section: Discussionmentioning

confidence: 99%

“…with a research focus on pelvic floor dysfunction, 28,29 which may have influenced their attitudes on this subscale. Additionally, it is interesting to note that Linköping, the organization with the lowest CS rate since more than a decade, 11 was not less fearful of the consequences of vaginal birth than the other labor wards.…”

Section: Ta B L E 3 (Continued)mentioning

confidence: 99%

The effect of organizational belonging and profession on cliniciansʼ attitudes toward supporting vaginal birth and interprofessional teamwork—a cross‐sectional study

Johnson

Elvander

Johansson

et al. 2023

Acta Obstet Gynecol Scand

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Introduction The aim of this study was to investigate the effect of organizational belonging and profession on clinicians' attitudes toward supporting vaginal birth and interprofessional teamwork in Swedish maternity care. Material and methods The study used a cross‐sectional design, with a web‐based survey sent to midwives, physicians and nurse assistants at five labor wards in Sweden. The survey consisted of two validated scales: the Swedish version of the Labor Culture Survey (S‐LCS), measuring attitudes toward supporting vaginal birth, and the Assessment of Collaborative Environments (ACE‐15), measuring attitudes toward interprofessional teamwork. Two‐way ANOVA was conducted to assess the main effect of and interaction effect between organizational belonging and profession for the different subscales of the S‐LCS and the ACE‐15, together with Tukey's honest significant difference post‐hoc analysis and partial eta squared to determine effect size. The relation between the subscales was assessed using the Pearson's correlation analysis. Results A total of 539 midwives, physicians and nurse assistants completed the survey. Organizational belonging significantly influenced attitudes toward supporting vaginal birth and interprofessional teamwork, with the largest effect for Positive team culture (F = 38.88, effect size = 0.25, p < 0.001). The effect of profession was strongest for the subscale Best practices (F = 59.43, effect size = 0.20, p < 0.001), with midwives being more supportive of strategies proposed to support vaginal birth than physicians and nurse assistants. A significant interaction effect was found for four of the subscales of the S‐LCS, with the strongest effect for items reflecting the Unpredictability of vaginal birth (F = 4.49, effect size = 0.07, p < 0.001). Labor ward culture (unit microculture) specifically related to supporting vaginal birth was strongly correlated to interprofessional teamwork (r = 0.598, p < 0.001). Conclusions In the current study, both organizational belonging and profession influenced attitudes toward supporting vaginal birth and interprofessional teamwork. Positive team culture was positively correlated to an organizational culture supportive of vaginal birth. Interventions to support vaginal births should include efforts to strengthen teamwork between professions, as well as considering women's values, preferences and informed choices.

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“…It has previously been assumed that women with severe perineal tears have the highest risk of morbidity compared to women with a first-or second-degree perineal tear, thus, research has focused on long-term consequences for women after third-or fourth-degree tears [3]. Regardless of severity of the perineal tear, studies indicate that women can experience symptoms of PFD, such as a feeling of wide vagina, bowel emptying difficulties, dyspareunia, and perineal pain many years after vaginal birth [4][5][6]. This may possibly be due to a deficient perineum causing a loss of support of the pelvic floor.…”

Section: Introductionmentioning

confidence: 99%

Development and initial validation of a Swedish inventory to screen for symptoms of deficient perineum in women after vaginal childbirth: ‘Karolinska Symptoms After Perineal Tear Inventory’

Rotstein

Rosen

Karlström

et al. 2022

BMC Pregnancy Childbirth

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Background Perineal tears are common after vaginal birth and may result in pelvic floor symptoms. However, there is no validated questionnaire that addresses long-term symptoms in women with a deficient perineum after vaginal birth. Thus, the objective of this study was to develop and psychometrically evaluate a clinical screening inventory that estimates subjective symptoms in women with a deficient perineum more than one year after vaginal delivery. Material and methods The development and psychometric evaluation employed both qualitative and quantitative methods. Qualitative strategies involved content validity and Think Aloud protocol for generation of items. The psychometric evaluation employed principal component analysis to reduce the number of items. The inventory was completed by women with persistent symptoms after perineal tears (N = 170). Results were compared to those of primiparous women giving birth by caesarean section (N = 54) and nulliparous women (N = 338). Results A preliminary 41-item inventory was developed, and the psychometric evaluation resulted in a final 11-item inventory. Women with confirmed deficient perineum after perineal trauma scored significantly higher on the symptoms inventory than women in control groups. A cut-off value of ≥ 8 could distinguish patients from controls with high sensitivity (100%) and specificity (87–91%). Conclusions The Karolinska Symptoms After Perineal Tear Inventory, is a psychometrically valid 11-item patient-reported outcome measure for symptoms of deficient perineum more than one year after vaginal birth. More research is needed to validate the inventory in various patient populations as well as its use in pelvic floor interventions. The inventory has the potential to improve patient counseling and care in the future.

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Posterior compartment symptoms in primiparous women 1 year after non-assisted vaginal deliveries: a Swedish cohort study

Cited by 9 publications

References 38 publications

Fecal incontinence and associated pelvic floor dysfunction during and one year after the first pregnancy

Fecal incontinence and associated pelvic floor dysfunction during and one year after the first pregnancy

The effect of organizational belonging and profession on cliniciansʼ attitudes toward supporting vaginal birth and interprofessional teamwork—a cross‐sectional study

Development and initial validation of a Swedish inventory to screen for symptoms of deficient perineum in women after vaginal childbirth: ‘Karolinska Symptoms After Perineal Tear Inventory’

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