Obstetric fistula: The role of physiotherapy: A report from the Physiotherapy Committee of the International Continence Society.

AIMS: To discuss the role of physiotherapy in the management of women who have suffered an obstetric fistula, referring to research findings when appropriate and available, and the experiences of clinical specialists in the field. METHODS: The experiences of physiotherapists who have worked in countries where obstetric fistula is prevalent, and the limited literature available, were considered in producing this consensus document on behalf of the ICS Physiotherapy Committee. RESULTS: The role of physiotherapy both pre- and post-fistula repair was identified, and is multi-faceted. Women may have general rehabilitation needs based on the obstructed labor itself and subsequent care. All affected women may benefit from pelvic floor muscle assessment, education and exercises to optimize the outcome of their surgery; further pelvic floor physiotherapy may be indicated for those who experience persistent genitourinary dysfunction following closure of the fistula. CONCLUSIONS: Further robust research is required to confirm the effectiveness of physiotherapy in the management of women who have suffered an obstetric fistula and the optimum development of such services. Based on the available literature and the experience of physiotherapists in the field, there was consensus within the ICS Physiotherapy Committee that patient outcomes can be improved if physiotherapy is provided as part of the multidisciplinary team. Physiotherapy should not be overlooked when fistula services are being developed.

[SHOULD EVERY WOMAN AFTER LABOR BE OFFERED PELVIC FLOOR PHYSIOTHERAPY?]

INTRODUCTION: Pelvic floor damage can occur during pregnancy, during childbirth or post-partum, and may be expressed by symptoms such as urinary incontinence, fecal and gas incontinence, sexual dysfunction, pelvic organ prolapse and chronic pelvic pain. Some of the symptoms, which manifest later in a woman's life, will go unrecognized in the immediate postpartum period. Most women do not mention their general health, unless specifically asked. Physiotherapists, who are adept with the anatomy of the musculoskeletal system and the ability to diagnose unique differences, can aid in the diagnosis and treatment of postpartum pelvic floor problems. Monitoring, pelvic floor physiotherapy and exercise can be effective both in treatment and prevention of functional disorders of the pelvic floor. In this article, we will discuss pelvic floor problems and their appearance throughout pregnancy and childbirth, and the means of treatment from the physiotherapist's perspective. We raise the question as to whether all postpartum women could benefit from a training program of pelvic floor muscles. Pelvic floor physiotherapy is included in the health basket in Israel, but is not broadly utilized. Wider use could be adopted, particularly in light of the latest research evidence.

Factors influencing postpartum women's willingness to participate in a preventive pelvic floor muscle training program: a web-based survey.

OBJECTIVE: Pregnancy and delivery are the most prominent risk factors for the onset of pelvic floor injuries and - later-on - urinary incontinence. Supervised pelvic floor muscle training during and after pregnancy is proven effective for the prevention of urinary incontinence on the short term. However, only a minority of women do participate in preventive pelvic floor muscle training programs. Our aim was to analyze willingness to participate (WTP) in an intensive preventive pelvic floor muscle training (PFMT) program and influencing factors, from the perspective of postpartum women, for participation. STUDY DESIGN: We included 169 three-month postpartum women in a web-based survey in the Netherlands. Demographic and clinical characteristics, knowledge and experience with PFMT and preconditions for actual WTP were assessed. Main outcome measures were frequencies and percentages for categorical data. Cross tabulations were used to explore the relationship between WTP and various independent categorical variables. A linear regression analysis was done to analyze which variables are associated with WTP. RESULTS: A response rate of 64% (n=169) was achieved. 31% of the women was WTP, 41% was hesitating, 12% already participated in PFMT and 15% was not interested (at all). No statistically significant association was found between WTP and risk or prognostic pelvic floor dysfunction factors. Women already having symptoms of pelvic floor dysfunction such as incontinence and pelvic organ prolapse symptoms were more WTP (p=0.010, p=0.001, respectively) as were women perceiving better general health (p<0.001). Preconditions for women to participate were program costs, and travel time not exceeding 15min. CONCLUSIONS: From the perspective of postpartum women, there is room for improvement of preventive pelvic floor management. Further research should focus on strategies to tackle major barriers and to introduce facilitators for postpartum women to participate in PFMT programs.

Support for mothers and their families after life-threatening illness in pregnancy and childbirth: a qualitative study in primary care.

BACKGROUND: One in 100 women who give birth in the UK develop life-threatening illnesses during childbirth. Without urgent medical attention these illnesses could lead to the mother's death. Little is known about how the experience of severe illness in childbirth affects the mother, baby, and family. AIM: As part of the UK National Maternal Near-miss Surveillance Programme, this study explored the experiences of women and their partners of life-threatening illnesses in childbirth, to identify the long-term impact on women and their families. DESIGN AND SETTING: Qualitative study based on semi-structured narrative interviews. Interviews were conducted in patients' homes in England and Scotland from 2010 to 2014. METHOD: An in-depth interview study was conducted with 36 women and 11 partners. A maximum variation sample was sought and interviews transcribed for thematic analysis with constant comparison. RESULTS: Women's birth-related illnesses often had long-lasting effects on their mental as well as physical health, including anxiety, panic attacks, and post-traumatic stress disorder. In some cases the partner's mental health was also affected. Women often described feeling isolated. Their experiences can have a profound impact on their relationships, family life, career, and future fertility. While some women described receiving good support from their GP, others felt there was little support available for them or their families after discharge from hospital. CONCLUSION: A near-miss event can have long-lasting and major effects on women and their families. Support in primary care, including watchful waiting for mental health impacts, can play a valuable role in helping these families come to terms with their emergency experience. The findings highlight the importance of communication between primary and secondary care.

Explaining daily functioning in young adults with obstetric brachial plexus lesion.

PURPOSE: To study the influence of obstetric brachial plexus lesion (OBPL) on arm-hand function and daily functioning in adults, and to investigate the relationship of arm-hand function and pain to daily functioning. METHOD: Adults with unilateral OBPL who consulted the brachial plexus team at the VU University Medical Center in the past were invited to participate. Daily functioning was measured with the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and the SF36, pain with VAS Pain Scales and arm-hand function with the Nine Hole Peg Test (9-HP-test) and the Action Research Arm Test (ARAT). Scores of the affected arm were compared to those of the non-affected arm or norm values for healthy controls. RESULTS: Twenty-seven persons (mean age 22, SD 4.2 years), of whom 10 men, participated. The ARAT and 9-HP-test scores for the affected arm were significantly worse than those for the non-affected arm. Moderate to severe pain in the affected arm, the non-affected arm or the back was reported by 50% of the participants. The DASH general, sports/music and SF36 physical functioning scores were significantly worse than norm values. The ARAT/9-HP-test and daily functioning showed little association. Low to moderate associations were found between pain and daily functioning. CONCLUSIONS: Many young adults with OBPL experience limitations in daily functioning. Pain, rather than arm-hand function, seems to explain these limitations. Implications for Rehabilitation Obstetric brachial plexus lesion (OBPL) is caused by traction to the brachial plexus during labour, resulting in denervation of the muscles of the arm and shoulder girdle. Adults with OBPL are hardly seen in rehabilitation medicine. This study shows that many young adults with OBPL experience limitations in daily functioning. Pain, rather than arm-hand function, seems to explain these limitations. Fifty percent of the participants complained about moderate or severe pain, which was located in the affected arm, the back and the non-affected arm. There seems an age-related increase in pain prevalence. Persons who had undergone plexus surgery had a significantly worse arm-hand function, but comparable scores on daily functioning scales compared to persons without plexus surgery. When limitations in daily functioning or pain occur, referral to a rehabilitation physician is indicated.

Parálisis braquial obstétrica en el contexto de la rehabilitación física temprana / Obstetric brachial plexus palsy in the context of early physical rehabilitation

En la actualidad el sistema de salud cubano promueve el estudio prenatal y el seguimiento del embarazo; a pesar de esto la parálisis braquial obstétrica continúa siendo una consecuencia desafortunada tras un parto difícil y constituye uno de los traumatismos obstétricos más frecuentes. Su tratamiento ha sido tradicionalmente conservador, basado en el seguimiento multidisciplinario y consultas a los distintos especialistas para tratar las secuelas. Luego de realizar una amplia revisión bibliográfica, en este artículo se exponen la etiología, anatomía, fisiopatología, tipos de lesiones, pronóstico y evolución, secuelas, instrumentos de evaluación, tratamientos existentes y ejercicios para la parálisis braquial obstétrica(AU)

Cuban health system currently promotes prenatal testing and monitoring of pregnancy; nevertheless obstetric brachial plexus palsy remains an unfortunate consequence of a difficult delivery and is one of the most common birth trauma. Traditionally, its treatment has been conservative, based on multidisciplinary monitoring and consultations with various specialists to deal with the consequences. After conducting an extensive literature review, we discussed in this paper the etiology, anatomy, pathophysiology, types of injuries, prognosis and outcome, consequences, assessment tools, existing treatments and series of exercises for obstetric brachial plexus palsy(AU)

Case report: Physiotherapy strategies for a woman with symphysis pubis diastasis occurring during labour.

This case report demonstrates a therapeutic exercise program as a noninvasive functional treatment for symphysis pubis diastasis (SPD) and reports its results. A 32-year-old primigravida with SPD during labour received a specific functional exercise program, which consisted of abdominal stabilization and strengthening of the pelvic floor muscles, hip adductors, and extensors; training for bed mobility; and walking training with suitable aids. The program was performed for 1-hour per session, twice a day, for 2 weeks. Before the intervention, the patient was totally dependent on others for performing her daily activities owing to severe pain in the pelvic region. After the 2-week intervention, however, the interpubic distance was reduced by 36% (from 22 mm to 14 mm), and pain and functional disability were remarkably improved. Moreover, the patient could walk independently for 30 m with a pelvic corset. Our results suggest that a systematically designed functional rehabilitation program may be beneficial in the functional recovery of patients suffering from SPD related to pregnancy.

On the mediating effects of pregnancy and birth stress events on the relation between lateral preferences and cognitive functioning in healthy school-aged children.

If the pathological left-handedness theory is valid, left-handed people who also experienced pregnancy and birth stress events (PBSEs) would especially be expected to deviate from the cognitive norm (rather than left-handers in general). This hypothesis was tested in a large sample of healthy children (aged 6.6-15.9 years). Multiple cognitive abilities were assessed, including verbal fluency and working memory. Children with a left lateral preference who also experienced a PBSE did not deviate from the cognitive norm. Age was positively associated with all cognitive measures, and mean level of parental education strongly affected verbal fluency functioning.

[The basis of rehabilitation and treatment in acute period of perinatal cerebral pathology].

We have examined 89 newborns with perinatal CNS lesions due to critical states at birth. Disturbances of vital functions of the organism developed as a result of severe posthypoxia states at birth that exert a significant effect on patient's quality of life in the following age periods, including the formation of "rough" polyorganic injuries, have been studied. Therefore, the adequate treatment of post-critical states in the neonatal period demands understanding of pathogenetic mechanisms of their development that has formed the basis for using peptide drugs with neuroprotective effect, in particular, cortexin.

Unassisted pelvic floor exercises for postnatal women: a systematic review.

AIM: This paper is a report of a systematic review on unassisted pelvic floor exercises for postnatal stress incontinence to identify effective interventions and highlight areas for further research. BACKGROUND: Stress incontinence is a common and embarrassing problem. Childbirth is a major cause and problems can be persistent for some. However women are often reluctant to seek help. METHOD: We conducted a systematic literature search in December 2006 using the CINAHL, Medline and Cochrane Library databases, hand-searching of selected textbooks, checking reference lists and contacting experts. There were no date restrictions. The review included randomized controlled trials, published in English, of unassisted pelvic floor exercises in postnatal women. Two reviewers independently extracted data and assessed study quality. Main outcomes were reduction in symptoms of incontinence, patient satisfaction and quality of life. RESULTS: Four randomized controlled trials met the inclusion criteria. Interventions ranged from written information to structured exercise classes, while usual care varied from a leaflet to group sessions with a midwife. Three out of four studies demonstrated short-term improvement in incontinence symptoms, which was statistically significant in two. However, at later follow-up there was no longer a statistically significant effect on continence. All trials found that women in the intervention group were more likely to do the exercises. CONCLUSION: We found few trials, quality was variable, and comparisons were difficult because of variations in interventions and outcomes measured. Further high quality evaluations are needed, using standardized interventions and outcome measures, patient-relevant outcomes such as quality of life, and follow-up periods that enable evaluation of long-term effectiveness.

Relación entre factores de riesgo y necesidad de reanimación en la sala de partos / Relationship between risk factors and need for delivery room resuscitation

Objetivo: Estudio retrospectivo del modo de reanimación realizada en sala de partos y su relación con diferentes factores de riesgo, de todos los recién nacidos (RN) que precisaron reanimación, nacidos de enero a diciembre de 2004 en el Hospital Clínico Universitario (HCU) de Valladolid. Resultados: De los 1.364 RN en el período de estudio, 96 (7,03%) precisaron ventilación con presión positiva. De estos en el 6,89% mediante bolsa y mascarilla, y en el 0,73% mediante intubación traqueal. El líquido amniótico meconial y la prematuridad extrema fueron los factores con riesgo más alto de necesitar intubación traqueal en paritorio. Los niños nacidos mediante cesárea urgente o los procedentes de un parto vaginal mediante ventosa precisaron reanimación en el 14,12 y el 12% respectivamente La ventosa fue el parto vaginal instrumental con mayor riesgo. En un 20% de los RN que precisaron reanimación no se encontró ningún factor de riesgo, si bien todos respondieron a la ventilación con bolsa y mascarilla. En 6 niños el test de Apgar al minuto fue = 4 ó = 7. Conclusión: Los recién nacidos con riesgo bajo o moderado que precisaron ventilación con presión positiva al nacimiento respondieron adecuadamente a la ventilación con bolsa y mascarilla. La prematuridad extrema y el líquido amniótico meconial fueron los factores de riesgo en los que con mayor frecuencia fue necesaria la intubación endotraqueal. Conocer el impacto sobre el feto de los diferentes factores de riesgo ayuda a optimizar la asistencia al recién nacido en sala de partos (AU)

Objetive: Retrospective study of the resuscitation practice at birth and the relationship with level of risk of different risk factors, of babies who required resuscitation at birth, born between january and december 2004 at HCU of Valladolid. Results: 1,364 infants were born in our hospital in 2004, of these 96 needed positive pressure ventilation. The proportion of babies receiving bag and mask ventilation was 6,89%, and intubation was undertaken in 0.73%. Infants with meconium-stained fluid and very preterm infants had a high risk of traqueal intubation. Infants born by emergency C-section and vacuum delivery need resuscitation in 14,12% and 12% respectively. Vacuum delivery was the instrumental delivery with high risk than others. In 6 infants the Apgar test was = 4 ó = 7. Conclusion: The bag and mask ventilation was an useful method in resuscitation of infants with low or moderate levels of risk factors. In very preterm infants or in cases of meconium-stained fluid there were a high incidence of traqueal intubation Assignment of level of risk in a delivery, provides a safe means to take care of the newborn in the delivery room in the best conditions (AU)

Analise dos casos de paralisia braquial obstetrica nos prontuarios do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto - USP / Survey based on medical records about the cases of obstetric brachial paralysis of Ribeirao Preto Medicine University Clinic Hospital - USP

A paralisia braquial obstetrica e uma lesao do plexo braquial que ocorre durante o parto. O tratamento e conservador na maioria dos casos e o acompanhamento fisioterapico e essencial. O objetivo deste trabalho foi realizar uma analise dos casos acompanhados...

Prevalence and persistence of health problems after childbirth: associations with parity and method of birth.

BACKGROUND: Awareness about the extent of maternal physical and emotional health problems after childbirth is increasing, but few longitudinal studies examining their duration have been published. The aim of this study was to describe changes in the prevalence of maternal health problems in the 6 months after birth and their association with parity and method of birth. METHODS: A population-based, cohort study was conducted in the Australian Capital Territory (ACT), Australia. The study population, comprising women who gave birth to a live baby from March to October 1997, completed 4 questionnaires on the fourth postpartum day, and at 8, 16, and 24 weeks postpartum. Outcome measures were self-reported health problems during each of the three 8-week postpartum periods up to 24 weeks. RESULTS: A total of 1295 women participated, and 1193 (92) completed the study. Health problems showing resolution between 8 and 24 weeks postpartum were exhaustion/extreme tiredness (60-49), backache (53-45), bowel problems (37-17), lack of sleep/baby crying (30-15), hemorrhoids (30-13), perineal pain (22-4), excessive/prolonged bleeding (20-2), urinary incontinence (19-11), mastitis (15-3), and other urinary problems (5-3). No significant changes occurred in the prevalence of frequent headaches or migraines, sexual problems, or depression over the 6 months. Adjusting for method of birth, primiparas were more likely than multiparas to report perineal pain and sexual problems. Compared with unassisted vaginal births, women who had cesarean sections reported more exhaustion, lack of sleep, and bowel problems; reported less perineal pain and urinary incontinence in the first 8 weeks; and were more likely to be readmitted to hospital within 8 weeks of the birth. Women with forceps or vacuum extraction reported more perineal pain and sexual problems than those with unassisted vaginal births after adjusting for parity, perineal trauma, and length of labor. CONCLUSIONS: Health problems commonly occurred after childbirth with some resolution over the 6 months postpartum. Some important differences in prevalence of health problems were evident when parity and method of birth were considered.

[The influence of the proper preparation of the female patients with missed labor syndrome on the diminishing of the complications after its termination]. / Wplyw wlasciwego przygotowania pacjentek z zespolem ciazy obumarlej na zminimalizowanie powiklan po jej rozwiazaniu.

During the period of 6 and half years the cases of 175 patients with missed labour were analysed in Gynaecology--Obstetric Ward of the City Hospital in Tarnów. Laboratory and clinical being--well of a pregnant woman with missed labour syndrome does not exclude the possibility of complications among the patients who have not been prepared. The introduced method made it possible to eliminate such complications as deaths, hemorrhages, clotting disturbances and infections. The period of hospitalization has become evidently shorter.

Management of faecal incontinence following obstetric injury.

BACKGROUND: Faecal incontinence is common in women and the major aetiological factor is childbirth. Increasing numbers of women with faecal incontinence are presenting to surgical clinics. METHODS: A literature review was performed on Medline database for English language publications an obstetric injury. The incidence, presentation, assessment and treatment of faecal incontinence following obstetric injury were evaluated. RESULTS AND CONCLUSIONS: Third-degree tear occurs in association with less than 1 per cent of vaginal deliveries, but occult sphincter injury occurs at one-third of deliveries and may be significant in later life. Incontinence may result from sphincter damage or nerve injury, or both. Risk factors for these injuries can be identified. Clinical evaluation, anorectal physiology and endoanal ultrasonography allow accurate planning of subsequent surgery. Overlapping anterior anal sphincter repair provides symptomatic control of continence in 80 per cent of patients. Repair of an acute anal sphincter injury after a third-degree tear is controversial and a defined policy should be agreed between obstetric and colorectal teams.

Social work practice with childbirth-injured women in Nigeria.

Nigerian social workers in health care settings have been actively involved in the treatment of women in northern Nigeria who suffer from childbirth injury during obstructed labor. The patient population studied suffers from vesicovaginal fistula (VVF), a debilitating and chronic condition whereby a woman leaks urine uncontrollably and experiences grave social consequences. Crisis intervention, social rehabilitation, fighting stigma, and discharge planning similar to the American professional model were functions of the social workers in addressing the needs of this patient population. Implications for practice and the universality of social work skills are discussed.

[Quality of life in paraplegia--experience from gynecologic management of paraplegic patients]. / Fragen zur Lebensqualität nach Querschnittlähmung--Erfahrungen bei der gynäkologischen Betreuung von Paraplegikerinnen.

Gynaecological care is considered a necessary component in the rehabilitative management of paraplegic women, giving rise to a range of issues involving the quality of life of paraplegic patients. Partnership, marital problems, as well as sexual coping certainly play an essential role in this respect.