Postpartum urinary incontinence and birth outcomes as a result of the pushing technique: a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: Directed pushing while using the Valsalva maneuver is shown to lead to bladder neck descent, especially in women with urinary incontinence (UI). There is insufficient evidence about the benefits or adverse effects between the pushing technique during the second stage of labor and urinary incontinence postpartum. The objective of this study was to evaluate the effects of the pushing technique for women during labor on postpartum UI and birth outcomes. METHODS: Scientific databases were searched for studies relating to postpartum urinary incontinence and birth outcomes when the pushing technique was used from 1986 until 2020. RCTs that assessed healthy primiparas who used the pushing technique in the second stage of labor were included. In accordance with Cochrane Handbook guidelines, risk of bias was assessed and meta-analyzed. Certainty of evidence was assessed using the GRADE approach. RESULTS: Seventeen RCTs (4606 primiparas) were included. The change in UI scores from baseline to postpartum was significantly lower as a result of spontaneous pushing (two studies; 867 primiparas; standardized mean difference: SMD -0.18, 95% CI -0.31 to -0.04). Although women were in the recumbent position during the second stage, directed pushing group showed a significantly shorter labor by 21.39 min compared with the spontaneous pushing group: there was no significant difference in the duration of the second stage of labor between groups. CONCLUSIONS: Primiparas who were in the upright position and who experienced spontaneous pushing during the second stage of labor could reduce their UI score from baseline to postpartum.

Effectiveness of a Spousal Support Program in Improving the Quality of Life of Male Patients Undergoing Infertility Treatment: A Pilot Study.

BACKGROUND: There are various causes of male infertility. Infertile men usually have a low quality of life (QoL) and a high level of stress compared with men without infertility problems. The present study aimed to examine the effects of a spousal support program to enhance the QoL of male patients undergoing infertility treatment. METHODS: The present quasi-experimental study (pretest-posttest) was conducted among 38 infertile couples in Tokyo (Japan) during April-August 2018. The levels of QoL, distress, and spousal support were measured using self-administered valid and reliable questionnaires. The paired t test was used to analyze pre- and post-intervention data with SPSS software (version 23.0). P<0.05 was considered statistically significant. RESULTS: There were significant differences between the pre-test and post-test scores for the relational and emotional sub-scales of QoL. The paired t test results showed that the post-test emotional sub-scale (66.9±16.9) was significantly higher than the pre-test emotional sub-scale (58.5±13.5; t (30)=2.2, P=0.04). Similarly, the post-test relational sub-scale (71.2±21.6) was significantly higher than its pre-test score (60.8±13.7; t (30)=2.3, P=0.03). The majority of the participants 23 (74.2%) expressed satisfaction with the program. CONCLUSION: The spousal support program was well-received and significantly improved part of the QoL of men who were infertile due to various causes.

Quality-of-life predictors for men undergoing infertility treatment in Japan.

AIM: To dentify the predictors of the quality of life (QOL) of infertile men who are undergoing infertility treatments in Japan and to create a QOL prediction model, with the main variables aimed at providing more adequate support to male patients. METHODS: This cross-sectional study used the quantitative data that were collected from 321 returned self-report questionnaires that had been distributed to the men of 411 couples who were undergoing fertility treatment. The following four scales were used to measure the main outcomes: FertiQoL, psychological distress, spousal support, and workplace support. The data were analyzed by descriptive statistics, multiple regression analyses, and structural equation modeling. RESULTS: The number of returned questionnaires was 321 (78.1%). The QOL that was measured by FertiQoL was significantly lower in those men who were diagnosed with male factor infertility than in the other male patients. The two significant predictors of QOL were: spousal support and the infertility period. The structural equation modeling revealed that the same factors were related to QOL. CONCLUSIONS: Male factor infertility, less spousal support, and a longer period of infertility were associated with a poorer QOL of those men who were undergoing infertility treatment. These results suggest that focusing on infertility causes, the length of the infertility period, and the couples' partnership during treatment is needed to provide full support to men who have been diagnosed with infertility.