Pelvic Floor Health Index: Initial validation of a practical postpartum tool for busy clinicians.

OBJECTIVE: To design a primary care clinical tool (Pelvic Floor Health Index [PFHI]) to screen for postpartum pelvic floor disorders, as well as complete its psychometric validation. DESIGN: Prospective cohort study. SETTING: Two tertiary care obstetric centres in Vancouver, BC. PARTICIPANTS: Primiparous women older than 19 years of age who were in the immediate postpartum period. MAIN OUTCOME MEASURES: The PFHI was administered to 74 primiparous women immediately postpartum and at 2, 4, and 6 months postpartum. For evaluation of convergent and divergent construct validity, participants also completed several validated questionnaires, including the Female Sexual Functioning Index, the Pelvic Floor Distress Inventory, the 36-Item Short Form Health Survey, and the Edinburgh Postnatal Depression Scale. Fifteen women repeated their 6-month questionnaires 2 weeks later in order to determine test-retest reliability. Responsiveness was assessed by measuring the PFHI score change from baseline to 6 months postpartum. RESULTS: Pelvic Floor Health Index score was inversely correlated with subscale scores on the Pelvic Floor Distress Inventory at all time points. There were moderate correlations between PFHI score and the Female Sexual Functioning Index and 36-Item Short Form Health Survey scores at several time points. There were weak correlations with postpartum depression scores. The intraclass correlation coefficient for test-retest reliability was 0.78 (95% CI 0.47 to 0.92). The PFHI mean total score significantly improved by 1.8 (95% CI 1.0 to 2.6) at 6 months postpartum. CONCLUSION: The PFHI is a 10-item, newly validated, and psychometrically robust questionnaire that can be administered to patients in the postpartum period to screen for pelvic floor dysfunction.

Abdominal sacrohysteropexy for large iatrogenic early postpartum vesicouterine fistula.

Sacrohysteropexy is a surgical technique employed for the surgical treatment of uterine prolapse when uterine preservation is desired. Vesicouterine fistulae are rare iatrogenic complications of difficult operative childbirth, typically via caesarean section. If further childbearing is planned, uterus-sparing fistula closure in layers, with interposition grafts, has been described. To further decrease recurrence rates, temporary suspension of the uterus away from the fistula site can be achieved via sacrohysteropexy with absorbable biologic graft. The graft eventually resorbs with return of the uterus to its normal pelvic anatomic location.

Cannabis use during pregnancy and postpartum.

OBJECTIVE: To help obstetric care providers, including family physicians, nurse practitioners, midwives, and obstetricians, educate patients on the risks of cannabis use in pregnancy and postpartum and its relationship to nausea and vomiting in pregnancy. SOURCES OF INFORMATION: The Ovid MEDLINE database was searched using the MeSH terms pregnancy, cannabis, lactation, and cannabinoid hyperemesis in various combinations. The relevant articles were reviewed and further sources were found within the references of these articles. MAIN MESSAGE: In utero exposure to cannabis has been associated with long-term neurodevelopmental outcomes that persist into young adulthood. Cannabis should not be used to treat nausea and vomiting in pregnancy and its chronic use might lead to the development of cannabinoid hyperemesis syndrome. CONCLUSION: There is no known safe level of cannabis use during pregnancy or lactation. Pregnant women should be counseled regarding the risks of in utero exposure and encouraged to abstain from use in pregnancy and while breastfeeding.

Usage de cannabis durant la grossesse et le post-partum.

OBJECTIF: Aider les fournisseurs de soins obstétriques, y compris les médecins de famille, infirmières praticiennes, sages-femmes et obstétriciens, à renseigner les patientes sur les risques liés à l'usage de cannabis durant la grossesse et le post-partum, et sur son lien avec les nausées et les vomissements durant la grossesse. SOURCES D'INFORMATION: Une recherche a été effectuée dans les banques de données Ovid MEDLINE à l'aide de diverses combinaisons des mots-clés anglais pregnancy, cannabis, lactation et cannabinoid hyperemesis. Les articles pertinents ont été étudiés, et d'autres sources ont été relevées dans la liste de références de ces articles. MESSAGE PRINCIPAL: L'exposition in utero au cannabis est liée à des conséquences prolongées sur le développement neurologique, qui persistent au début de l'âge adulte. Le cannabis ne doit pas être utilisé pour traiter les nausées et les vomissements durant la grossesse, et son usage prolongé serait lié au syndrome cannabinoïde. CONCLUSION: Aucun niveau de consommation de cannabis n'est sécuritaire durant la grossesse et l'allaitement. Il faut renseigner les femmes enceintes quant aux risques liés à l'exposition in utero et les encourager à s'abstenir de consommer durant la grossesse et l'allaitement.