RESUMEN
OBJECTIVE: To estimate the prevalence of flatus-only and faecal incontinence, to describe their risk factors and to analyse the association between anal incontinence and psychological distress over the first year postpartum. DESIGN: Cohort study from pregnancy to 12 months postpartum. SETTING: Two university hospital maternity wards in France. POPULATION: A total of 2002 pregnant women were recruited between 2003 and 2006. Data on anal incontinence were available for the 1632 women who comprise the sample for analysis. METHODS: Women were enrolled during pregnancy. A postal questionnaire was sent at 4 and 12 months postpartum. MAIN OUTCOME MEASURES: Anal (flatus-only and faecal) incontinence was assessed at 4 months postpartum. Mental health was assessed at 4 and 12 months postpartum by the Edinburgh Postpartum Depression Scale (EPDS) and use of antidepressant drugs as well as by self-rated mental health. RESULTS: At 4 months postpartum, the prevalence for flatus-only incontinence was 14.4% and for faecal incontinence 1.7%; multivariate analysis, restricted to women reporting no anal incontinence before the index pregnancy, showed that continuing breastfeeding at 4 months was related to a higher risk of de novo postpartum anal incontinence (OR = 2.23). Women who reported anal incontinence at 4 months were more frequently depressed (EPDS ≥10 or antidepressant use) at 12 months postpartum: 36.0% of those with faecal incontinence were depressed, 23.3% of those with flatus-only incontinence and only 14.8% of the continent women. CONCLUSION: Postnatal faecal incontinence was rare but associated with poorer maternal mental health. Postnatal screening should be encouraged, and psychological support offered. TWEETABLE ABSTRACT: Postnatal faecal incontinence was associated with depression; postnatal screening should be encouraged and psychological support offered.
Asunto(s)
Incontinencia Fecal/psicología , Distrés Psicológico , Trastornos Puerperales/psicología , Adulto , Antidepresivos/uso terapéutico , Lactancia Materna , Estudios de Cohortes , Depresión/tratamiento farmacológico , Depresión/epidemiología , Incontinencia Fecal/epidemiología , Femenino , Flatulencia/epidemiología , Flatulencia/psicología , Francia/epidemiología , Humanos , Análisis Multivariante , Trastornos Puerperales/epidemiología , Encuestas y CuestionariosRESUMEN
OBJECTIVE: The main endpoint was to perform a survey about the practices of episiotomy into a CNGOF (National College of French Obstetricians and Gynecologists) members population. METHODS: In November 2018, it was proceeded to a national survey from CNGOF members thanks to an online questionnaire. We collected prospectively: the answerer's characteristics, the rate of episiotomy and its systematics indications for spontaneous and operative delivery, the habits of the practitioners for the section and the reparation, the modalities of women's information and the data entered into the medical record. RESULTS: Three hundred and eighty nine CNGOF members answered to the survey. They were 69% to declare performing less than 10% of episiotomy in case of spontaneous vertex delivery. The most frequent systematic indication of episiotomy was the personal history of obstetric anal sphincter injury (more than 30% of answerers). Systematic episiotomy was less frequent in case of vacuum assisted operative delivery compared to forceps (OR=0.18 [0.08-0.37]) or spatulas (OR=0.28 [0.12-0.59]). Most of practitioners (94%) declared performing mediolateral episiotomies, 64% declared cutting with an equal or more than 45° angle and 50% declared using a resorbable continuous suture technique for the reparation. Half of the answerers (46%) indicated that they inform et collected women's consent before performing an episiotomy. CONCLUSIONS: Several practices, women's information, section angle and the reparation technique are subject to change by the latest 2018 CNGOF guidelines about perineal protection.
Asunto(s)
Episiotomía/métodos , Ginecología/métodos , Encuestas de Atención de la Salud , Obstetricia/métodos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Canal Anal/lesiones , Competencia Clínica , Parto Obstétrico/métodos , Episiotomía/estadística & datos numéricos , Femenino , Francia , Humanos , Perineo/lesiones , Guías de Práctica Clínica como Asunto , EmbarazoRESUMEN
INTRODUCTION: The objective of these clinical practice guidelines was to analyse all of the interventions during pregnancy and childbirth that might prevent obstetric anal sphincter injuries (OASIS) and postnatal pelvic floor symptoms. MATERIAL AND METHODS: These guidelines were developed in accordance with the methods prescribed by the French Health Authority (HAS). RESULTS: A prenatal clinical examination of the perineum is recommended for women with a history of Crohn's disease, OASIS, genital mutilation, or perianal lesions (professional consensus). Just after delivery, a perineal examination is recommended to check for OASIS (Grade B); if there is doubt about the diagnosis, a second opinion should be requested (Grade C). In case of OASIS, the injuries (including their severity) and the technique for their repair should be described in detail (Grade C). Perineal massage during pregnancy must be encouraged among women who want it (Grade B). No intervention conducted before the start of the active phase of the second stage of labour has been shown to be effective in reducing the risk of perineal injury. The crowning of the baby's head should be manually controlled and the posterior perineum manually supported to reduce the risk of OASIS (Grade C). The performance of an episiotomy during normal deliveries is not recommended to reduce the risk of OASIS (Grade A). In instrumental deliveries, episiotomy may be indicated to avoid OASIS (Grade C). When an episiotomy is performed, a mediolateral incision is recommended (Grade B). The indication for episiotomy should be explained to the woman, and she should consent before its performance. Advising women to have a caesarean delivery for primary prevention of postnatal urinary or anal incontinence is not recommended (Grade B). During pregnancy and again in the labour room, obstetrics professionals should focus on the woman's expectations and inform her about the modes of delivery.
Asunto(s)
Canal Anal/lesiones , Parto Obstétrico/efectos adversos , Parto Obstétrico/métodos , Laceraciones/prevención & control , Perineo/lesiones , Canal Anal/patología , Canal Anal/cirugía , Episiotomía/métodos , Episiotomía/rehabilitación , Femenino , Ginecología/métodos , Ginecología/organización & administración , Ginecología/normas , Humanos , Recién Nacido , Obstetricia/métodos , Obstetricia/organización & administración , Obstetricia/normas , Parto/fisiología , Perineo/patología , Perineo/cirugía , Embarazo , Factores de Riesgo , Sociedades Médicas/normasRESUMEN
OBJECTIVE: The endpoint was to assess the interest of planned cesarean section in primary and secondary obstetrical perineal prevention. METHODS: This is a review of the literature about the impact of the mode of delivery in urinary incontinence (UI), anal incontinence (AI), pelvic organ prolapse (POP), sexual disorders de novo or prior to delivery and history of obstetric anal sphincter injuries (OASI). RESULTS: The studies about UI, AI and sexual disorders report a potential protective impact of cesarean section but with a possible selection bias and an inadequate comparability of the groups. Randomized trials do not report any protective effect of planned cesarean section for these 3 disorders. The literature about POP reports a higher risk for the women who delivered vaginally but still with a possible selection bias et there is no randomized trial for this outcome. About the secondary prevention of OASI, there is no evidence in the literature for a benefit of a systematic planned cesarean section for all women. For symptomatic women, the mode of delivery has to be discussed individually. In secondary prevention of UI, AI, POP and sexual disorders, there is no evidence in the literature for a benefit of planned cesarean section even if there is a history of surgical procedure for the disorder. CONCLUSION: Planned cesarean section is not recommended in order to prevent primary or secondary obstetrical perineal disorders except for symptomatic OASI for whom an individual discussion about the mode of delivery is recommended.
Asunto(s)
Cesárea , Parto Obstétrico/métodos , Laceraciones/prevención & control , Obstetricia/métodos , Perineo/lesiones , Canal Anal/lesiones , Parto Obstétrico/efectos adversos , Incontinencia Fecal/etiología , Incontinencia Fecal/prevención & control , Femenino , Francia , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Prolapso de Órgano Pélvico/prevención & control , Embarazo , Factores de Riesgo , Incontinencia Urinaria/etiología , Incontinencia Urinaria/prevención & controlRESUMEN
INTRODUCTION: The objective of these clinical practice guidelines was to analyse all of the interventions during pregnancy and childbirth that might prevent obstetric anal sphincter injuries (OASIS) and postnatal pelvic floor symptoms. MATERIAL AND METHODS: These guidelines were developed in accordance with the methods prescribed by the French Health Authority (HAS). RESULTS: A prenatal clinical examination of the perineum is recommended for women with a history of Crohn's disease, OASIS, genital mutilation, or perianal lesions (professional consensus). Just after delivery, a perineal examination is recommended to check for OASIS (Grade B); if there is doubt about the diagnosis, a second opinion should be requested (GradeC). In case of OASIS, the injuries (including their severity) and the technique for their repair should be described in detail (GradeC). Perineal massage during pregnancy must be encouraged among women who want it (Grade B). No intervention conducted before the start of the active phase of the second stage of labour has been shown to be effective in reducing the risk of perineal injury. The crowning of the baby's head should be manually controlled and the posterior perineum manually supported to reduce the risk of OASIS (GradeC). The performance of an episiotomy during normal deliveries is not recommended to reduce the risk of OASIS (Grade A). In instrumental deliveries, episiotomy may be indicated to avoid OASIS (GradeC). When an episiotomy is performed, a mediolateral incision is recommended (Grade B). The indication for episiotomy should be explained to the woman, and she should consent before its performance. Advising women to have a caesarean delivery for primary prevention of postnatal urinary or anal incontinence is not recommended (Grade B). During pregnancy and again in the labour room, obstetrics professionals should focus on the woman's expectations and inform her about the modes of delivery.
Asunto(s)
Obstetricia/métodos , Perineo/lesiones , Canal Anal/lesiones , Cesárea , Parto Obstétrico/efectos adversos , Parto Obstétrico/métodos , Episiotomía/métodos , Incontinencia Fecal/etiología , Incontinencia Fecal/prevención & control , Femenino , Francia , Humanos , Trabajo de Parto , Laceraciones/prevención & control , Complicaciones del Trabajo de Parto , Embarazo , Factores de RiesgoRESUMEN
Our main objectives were to identify risk factors, methods for early diagnosis, and prevention of obstetric anal sphincter injuries (OASIs), using a literature review. The main risk factors for OASIs are nulliparity, instrumental delivery, posterior presentation, median episiotomy, prolonged second phase of labor and fetal macrosomia. Asian origin, short ano-vulvar distance, ligamentous hyperlaxity, lack of expulsion control, non-visualization of the perineum or maneuvers for shoulder dystocia also appear to be risk factors. There is a risk of under-diagnosis of OASIs in the labor ward. Experience of the accoucheur is a protective factor. Secondary prevention is based on the training of birth professionals in recognition and repair of OASIs. Primary prevention of OASIs is based on training in the maneuvers of the second phase of labor; if possible, instrumental extractions should be avoided. Mediolateral episiotomy may have a preventive role in high-risk OASIs deliveries. A robust predictive model is still lacking to allow a selective use of episiotomy.
Asunto(s)
Canal Anal/lesiones , Incontinencia Fecal/etiología , Parto Obstétrico/instrumentación , Parto Obstétrico/métodos , Distocia , Episiotomía/efectos adversos , Episiotomía/métodos , Incontinencia Fecal/epidemiología , Incontinencia Fecal/prevención & control , Femenino , Macrosomía Fetal/complicaciones , Humanos , Segundo Periodo del Trabajo de Parto , Complicaciones del Trabajo de Parto , Paridad , Embarazo , Factores de Riesgo , HombroRESUMEN
BACKGROUND: An overview of labor based only on epidemiological data cannot identify or explain the mechanisms involved in childbirth. Data about the position that women should take in giving birth are discordant. None of the studies of birth positions adequately define or describe them or their biomechanical impact (pelvic orientation, position of the back). The measurement of the effect of one position relative to that of another requires precise definitions of each position and of their maternal biomechanical consequences, as well as safe measurement methods. METHODOLOGY: We have developed a system to analyze the position of labor by quantifying the posture of the woman's body parts (including thighs, trunk, and pelvis), using an optoelectronic motion capture device (Vicon™, Oxford Metrics) widely used in human movement analysis and a system for measuring the lumbar curve (Epionics spine system). A specific body model has also been created to conduct this biomechanical analysis, which is based on external markers. With this methodology and model, it should be possible to define: (1) the hip joint angles (flexion/extension, abduction/adduction, internal/external rotation); (2) the ante/retroversion of the pelvis; (3) the lumbar curve. DISCUSSION: This methodology could become a reference for assessing delivery postures, one that makes it possible to describe the relation between the postures used in the delivery room and their impact on the pelvis and the spine in an integrated and comprehensive model. TRIAL REGISTRATION: No. Eudract 2013-A01203-42.
Asunto(s)
Parto/fisiología , Posicionamiento del Paciente/métodos , Postura/fisiología , Femenino , Articulación de la Cadera/fisiología , Humanos , Movimiento/fisiología , Embarazo , Rango del Movimiento Articular/fisiología , Proyectos de Investigación , RotaciónRESUMEN
OBJECTIVE: To assess the frequency of labor and birth positions in 2015, and identify factors associated with choosing and changing position during labor. METHODS: Multicenter prospective study during five weeks in 2015. We collected the distribution of the observed positions during the first and second stage of labor. Then we considered the main birth position as the one used for the longest duration. Factors associated to the main birth position as well as to the changes of position during labor were studied using univariate analysis and the role of each factor was analyzed using multilevel logistic regression. RESULTS: Among women who delivered, 86.1% did so in gynecological position. There was a center effect for the position during the expulsive phase, which was not related to legal status or level of perinatal care. After adjustment, a labor duration shorter than 2hours was associated to dorsal decubitus during labor (OR=2.1 95%CI [1.01-4.3]). Prematurity and labor duration less than 2hours decreased the occurrence of changes in position during labor: OR=0.05 95%CI [0.01-0.2] and OR=0.2 95%CI [0.1-0.3]. Epidural analgesia was associated to change in birth position during labor: (OR=2.1 95%CI [1.2-3.8]). During the expulsive phase, primiparity and labor duration less than 2hours were associated to dorsal decubitus position (OR=3.6 95%CI [1.2-10.8]). CONCLUSION: Women still mostly deliver in gynecological position in 2015. A systematic collection of birth positions on the partograph, with an acute definition of these positions, could allow an evaluation of the benefits/disadvantages of the different positions currently available.
Asunto(s)
Parto Obstétrico/métodos , Segundo Periodo del Trabajo de Parto , Parto , Postura , Adulto , Analgesia Epidural , Femenino , Humanos , Paridad , Embarazo , Complicaciones del Embarazo , Nacimiento Prematuro , Estudios Prospectivos , Factores de TiempoRESUMEN
INTRODUCTION: The role of pregnancy in pelvic floor disorders occurrence remains poorly known. It might exist a link between changes in ligamentous laxity and changes in pelvic organ mobility during this period. Our objective was to conduct a non-systematic review of literature about changes in pelvic organ mobility as well as in ligamentous laxity during pregnancy and postpartum. METHODS: From the PubMed, Medline, Cochrane Library and Web of Science database we have selected works which pertains clinical assessment of pelvic organ mobility (pelvic organ prolapse quantification), ultrasound assessment of levator hiatus and urethral mobility, ligamentous laxity assessment during pregnancy and postpartum. RESULTS: Clinical assessments performed in these works show an increase of pelvic organ mobility and perineal distension during pregnancy followed by a recovery phase during postpartum. Pelvic floor imaging shows an increase of levator hiatus area and urethral mobility during pregnancy then a recovery phase in postpartum. Different authors also report an increase of ligamentous laxity (upper and lower limbs) during pregnancy followed by a decrease phase in postpartum. CONCLUSION: Pelvic organ mobility, ligamentous laxity, levator hiatus and urethral mobility change in a similarly way during pregnancy (increase of mobility or distension) and postpartum (recovery). LEVEL OF EVIDENCE: 3.