Post Vaginal Delivery Research Articles

Placenta Accreta Spectrum in Unscarred Uterus: A Case Report in a Tertiary Facility

Background: Placenta accreta spectrum (PAS) is a broad term that includes placenta accreta, placenta increta, and placenta percreta. The major risk factor is a scarred uterus commonly as a result of prior cesarean delivery, myomectomy, or uterine instrumentation. We report a case of placenta increta in the absence of identifiable risk factors. Case presentation: A 22-year-old, para 2 living 2, presented with postpartum hemorrhage due to retained placenta post vaginal delivery at a gestational age of 38 weeks and 4 days, manual removal of placenta was attempted general anesthesia without success; necessitating explorative laparotomy where the placenta was found deeply invading into the myometrium. Intractable bleeding necessitated supracervical hysterectomy. Histopathological results later revealed placenta increta. Conclusion: PAS in an unscarred uterus in the absence of other identifiable risk factors is quite uncommon; however, carries high maternal morbidity and mortality. This case serves as an eye opener on the need to evaluate for radiological features of PAS during antenatal visits even in low-risk group.

Placenta accreta spectrum in unscarred uterus: A case report in a tertiary facility

Background: Placenta Accreta Spectrum (PAS) is a broad term that includes placenta accreta, placenta increta, and placenta percreta. The major risk factor is a scarred uterus commonly as a result of prior cesarean delivery, myomectomy, or uterine instrumentation. We report a case of placenta increta in the absence of identifiable risk factors. Case presentation: A 22-year-old, para 2 living 2, presented with postpartum hemorrhage due to retained placenta post vaginal delivery at a gestational age of 38 weeks and 4 days, manual removal of placenta was attempted general anesthesia without success; necessitating explorative laparotomy where the placenta was found deeply invading into the myometrium. Intractable bleeding necessitated supracervical hysterectomy. Histopathological results later revealed placenta increta. Conclusion: PAS in an unscarred uterus in the absence of other identifiable risk factors is quite uncommon; however, carries high maternal morbidity and mortality. This case serves as an eye opener on the need to evaluate for radiological features of PAS during antenatal visits even in low-risk group.

Postpartum takotsubo cardiomyopathy complicated with severe pulmonary edema and cardiogenic shock – a case report

Introduction and aim. Takotsubo cardiomyopathy (TCM) is a rare but life-threatening illness that can affect middle aged, young and pregnant women. It is a cardiac emergency and can mimic many other life threatening conditions like myocardial infarction, acute myocarditis, peripartum cardiomyopathy or dilated cardiomyopathy and is diagnosed by exclusion. Description of the case. Here we report a rare case of takotsubo cardiomyopathy in a young 28 year old female immediately post vaginal delivery of her normal full term twin pregnancy, who was otherwise a healthy female. She went on to develop complication of left ventricular heart failure and cardiogenic shock, which were successfully managed by conservative treatment leading to a full recovery. Conclusion. Takotsubo or stress cardiomyopathy is a rare entity and often a missed diagnosis, which if caught on time and treated leads to great prognosis. Our patient made a full recovery and is living a healthy life.

Postpartum hemorrhage as a result of acquired uterine arteriovenous fistula post-vaginal delivery.

A 24-year-old woman with secondary postpartum hemorrhages stemming from a Acquired uterine arteriovenous fistula (UAVF) induced after spontaneous vaginal delivery without a history of artificial removal of the placenta during childbirth. The initial diagnosis using conventional ultrasonography resulted in the suspicion of a UAVF, digital subtraction arteriography confirmed the lesion of typical UAVF. Hysteroscopy detected a false passage in the uterus. An acquired UAVF generally results from trauma, which can often be confused with retained products of conception. Pelvic DSA was promptly performed, proving the earlier suspicion of the lesion of typical UAVF over the left uterine artery. UAE of the bilateral uterine arteries was immediately carried out with microspheres for embolization, occluding active bleeders. UAVF, induced after spontaneous vaginal delivery without artificial removal of the placenta, is a rare cause of postpartum vaginal bleeding. Timely diagnosis is of utmost importance. The few published case series and single case report of UAVF may represent the tip of the iceberg. By sharing this case report, we hope our experience will add to obstetricians and gynecologists an increasing awareness that UAVFs may be more common than previously thought and more attention to UAVF in clinical work, so patients can undergone appropriate diagnostic and treatment.

Reducing pelvic floor injury by induction of labor.

Introduction and hypothesisWe hypothesized that elective induction of labor (eIOL) at 39 weeks is protective of levator ani muscle injury (LAMI) and is associated with decreased pelvic symptoms at 6 weeks postpartum compared to expectant management of labor.MethodsProspective cohort pilot study of uncomplicated, primiparous women with a singleton, vertex gestation enrolled immediately post-vaginal delivery (VD). Subjects were dichotomized into two groups based on labor management: eIOL without complication defined by the ARRIVE trial versus spontaneous VD between 39 weeks0/7 and 42 weeks5/7 or no indication for IOL prior to 40 weeks5/7. The primary outcome was LAMI at 6 weeks postpartum as evidenced by any of the following ultrasound measures: (1) increased levator hiatal area (LHA) > 2500 mm2, (2) increased elasticity index (EI, > 75th quartile) or (3) levator enthesis avulsion.ResultsAnalysis represents 45/102 consented women from July 2019–October 2020 (eIOL n = 22 and spontaneous VD, n = 23). Neither maternal, clinical, sociodemographic characteristics nor pelvic symptoms differed between groups. Fewer women had LAMI as defined by the primary outcome with eIOL (n = 5, 23.8%) compared to spontaneous VD (n = 15, 65.2%), p = 0.008. Levator enthesis was more deformable (increased EI) with spontaneous VD as compared to the eIOL [10.66 (8.99) vs. 5.68 (2.93), p = 0.046]. On univariate logistic regression women undergoing spontaneous VD had unadjusted OR of 6.0 (1.6–22.5, p = 0.008) of sustaining LAMI compared to those undergoing eIOL.ConclusionsComposite measures of LAMI though not pelvic floor symptoms were markedly increased in women undergoing spontaneous VD compared to those undergoing eIOL at 39 weeks.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00192-022-05296-1.

Predictors of prolonged hospitalization after vaginal birth in Ghana: A comparative study.

Early discharge after child delivery although indispensable, but maybe precluded by several factors. The effect of these factors on prolonged length of stay (LOS) after vaginal delivery has been sparsely investigated in Ghana. This limits understanding of potential leading indicators to inform intervention efforts and optimize health care delivery. This study examined factors associated with prolonged LOS after vaginal birth in two time-separated cohorts in Ghana. We analyzed data from Ghana's demographic and health surveys in 2007 and 2017. Our comparative analysis is based on subsamples in 2007 cohort (n = 2,486) and 2017 cohort (n = 8,065). A generalized estimating equation (GEE) with logistic regression was used to examine predictors of prolonged LOS after vaginal delivery. The cluster effect was accounted for using the exchangeable working correlation. The odds ratios (OR) and 95% confidence interval were reported. We found that 62.4% (1551) of the participants in 2007 had prolonged LOS after vaginal delivery, whereas the prevalence of LOS in the 2017 cohorts was 44.9% (3617). This constitutes a 17.5% decrease over the past decade investigated. Advanced maternal age (AOR = 1.24, 95% Cl 1.01-1.54), place of delivery (AOR = 1.18, 95% Cl 1.02-1.37), child's size below average (AOR = 1.14; 95% Cl 1.03-1.25), and problems suffered during/after delivery (AOR = 1.60; 95% Cl 1.43-1.80) were significantly associated with prolonged (≥ 24 hours) length of hospitalization after vaginal delivery in 2017. However, among variables that were available in 2007, only those who sought delivery assistance from non-health professionals (AOR = 1.89, 95% CI: 1.00-3.61) were significantly associated with prolonged LOS in the 2007 cohort. Our study provides suggestive evidence of a reduction in prolonged LOS between the two-time points. Despite the reduction observed, more intervention targeting the identified predictors of LOS is urgently needed to further reduce post-vaginal delivery hospital stay. Also, given that LOS is an important indicator of medical services use, an accurate understanding of its prevalence and associated predictors are useful in assessing the efficiency of hospital management practices and the quality of care of patients in Ghana.

Vernix caseosa peritonitis following vaginal delivery

The incidence of the acute abdomen during early postpartum is not uncommon. In this report, we highlight an extremely rare cause of acute abdomen which posed significant diagnostic and management dilemmas. In this case, the patient presented at day 5 postvaginal delivery with progressive respiratory embarrassment, mild abdominal pain, and fever. Her clinical signs, blood and laboratory parameters, and imaging (ultrasound and computed tomography scan) were however nonspecific except for worsening ascites. Laparotomy was determined as the best procedure for her in view of her polymorphonuclear cell count from an abdominal paracentesis being very high and the absence of clinical improvement even with the best intensive care support. Vernix caseosa peritonitis (VCP) was finally diagnosed based on histological examination of the “cheesy” slough extracted intraoperatively. Our case illustrates the nonspecific features of VCP which may be potentially fatal if undiagnosed early and no definitive care is provided.

Prevalence of Planned Abdominal Binder Use after Vaginal Delivery.

Pregnancy and vaginal delivery are risk factors for pelvic floor dysfunction. Abdominal binder use may increase intraabdominal pressure, affecting pelvic floor healing or function in recently traumatized postpartum pelvic floor muscle. This study assesses the prevalence of postpartum abdominal binder use, timing, and reasons for use. In this cross-sectional observational survey study, women who underwent a vaginal delivery at our institution were enrolled. Participants were excluded if they did not speak Spanish or English. Participants were recruited on the postpartum unit. Data were deidentified and analyzed as appropriate for each variable. In total, 673 surveys were completed. Seven were excluded because they had cesarean deliveries. The average age was 26 years. Median gravidity and parity were 2 and 2. In total, 549 women (82%) planned to wear an abdominal binder postpartum. In all, 335 women provided a specific time when they would start use: 240 women (71%) would start at ≤2 days postpartum, 60 women (18%) would start at 3 to 7 days postpartum, and 35 women (11%) would start after 1 week postpartum. Common reasons reported for use included appearance, support, pain, swelling, weight loss, and recommendation. Among women delivering at our institution, planned abdominal binder use postvaginal delivery is common. The reasons cited include health and desire to return to prior body shape. The effects of using an abdominal binder in the postpartum period are unknown. More research is needed to better elucidate how increased postpartum intraabdominal pressure affects healing in traumatized pelvic floor muscles.

End-to-end anal Sphincter Repair in Treatment of Post-traumatic Fecal Incontinence

AbstractThe present report describes the end-to-end technique of anal sphincter repair in a 36-year-old female patient with post-vaginal delivery fecal incontinence (FI). The patient had a history of two vaginal deliveries and the symptoms of FI were observed after the second delivery. On assessment of the severity of FI using the Wexner incontinence score, the patient had a score of 12. Endoanal ultrasonography revealed an anterior defect of the external anal sphincter extending from 11 to 3 o'clock. The patient had no previous anal surgery and did not have any medical comorbidities.The operation time was 45 minutes. No intraoperative complications were recorded. At 12 months of follow-up, the patient showed significant improvement in the continence state, with her Wexner score dropping to 4. No postoperative complications were recorded. We can conclude that end-to-end anal sphincter repair is a technically feasible operation that confers satisfactory improvement in the continence state without imposing much tension on the site of sphincter repair.

The relationship between self-esteem and husband support with body image perception in post-vaginal delivery primiparous mother in independent Delima midwife practice in Denpasar

Background: Childbirth is a big, happy event for a mother. In post-partum mothers, physical changes and psychological changes can occur. It is reported that 50% to 70% of post-partum mothers experience psychological disorders, such as a mother can feel uncomfortable with body image perception changes, which result in feelings of lack of husband support. Body image perception itself can cause an effect on self-esteem. This study aimed to analyze the relationship between self-esteem and husband's support with body image perception among primiparous mothers after vaginal delivery.Methods: An observational analytic study was conducted among 30 post-vaginal delivery primiparous mothers in independent Delima midwife practice in Denpasar. Data regarding respondents’ characteristics, self-esteem, husband’s support and body image perception were obtained using the Rosenberg self-esteem questionnaire, the Revised Dyadic Adjustment Scale (R-DAS) questionnaire Multidimensional Body-Self Relations Questionnaire Appearance Scales (MBSRQ-AS). The relationship between self-esteem and husband's support with body image perception was analyzed using SPSS version 23 for Windows.Results: The average age of the respondents were 24.73 years old, and most of them were graduated from high school (50%), employed (53.3%) and have no conflict in their marriage (80%), have normal self-esteem (96.6%), didn’t get enough husband’s support (56.7%) and have positive perception regarding the evaluation of physical appearance (96.6%). We found a significant relationship between self-esteem and body image perception (p = 0.001), husband's support and body image perception (p = 0.001) and husband's support and self-esteem (p = 0.010) in post-vaginal delivery primiparous mother in independent Delima midwife practice in Denpasar.Conclusion: Self-esteem, husband's support and body image perception were essentials factors that contributed to post-partum woman mental health stability that should be understood by family and health workers to avoid psychological disorder in post-partum woman.

Spontaneous Broad Ligament Hematoma after Vaginal Delivery Requiring Hysterectomy

Background Broad ligament hematomas are rare in the setting of vaginal delivery. When they do occur, patients typically present with acute hemodynamic instability. No cases of infected broad ligament hematomas have been reported. Case A 22-year-old G2 P1011 status post vaginal delivery complicated by chorioamnionitis and pre-eclampsia presented 5 days postpartum with subjective complaints of fever, vomiting, and increased vaginal bleeding. She was treated with antibiotics and uterine evacuation was planned for presumed retained products. After dilation and curettage, the patient was transferred to our facility, as her clinical status did not improve, and was later found to have an infected broad ligament hematoma requiring hysterectomy. Conclusion Though uncommon, broad ligament hematomas should be considered in postpartum women presenting with anemia and vaginal bleeding, even without hemodynamic instability. Recent intrauterine infections may predispose to hematoma infection.

Acceptability and Complications of Postpartum Intrauterine Device Insertion in Tertiary Care Hospital in Eastern Nepal

The modern intrauterine contraceptive device (PPIUCD) is a safe, effective and long term reversible, coitus independent method of contraception with fewer side effects. The immediate postpartum insertion is considered to be an ideal time as patients need not have to return to the facility for the same. The aim of the study was to see the acceptance of PPIUCD and study its related complications. This is a hospital based prospective observational study done in a tertiary hospital at Eastern Nepal over a period of Six months from August 2019 to January 2020. All the women who delivered during the study period were counseled for family planning methods and those who opted for PPIUCD were enrolled. Data was validated and analyzed using SPSS version 17. Acceptance of PPIUCD in the study was only 6.3% despite the method being very effective, safe, long acting and reversible with fewer side effects. The main reason for declining the method being misbelief about the method and husband’s refusal. Forty percent of the acceptors were in the age group of 21-25 years and 33.6% of them were multigravida. Insertion was high in post placental vaginal delivery (61%) as compared to trans cesarean (28%). The main reason for removal was psychosocial aspects followed by pelvic pain and abnormal uterine bleeding. Few complications like UTI (4.4%), fever (4%) were noted during hospital stay and at three month follow up pelvic pain was the most common problem reported. Though the overall acceptance of PPIUCD is in rising trend but in this study it is very low. Awareness of the method, improving health education, active participation of the partner in the counseling process will definitely change the recent scenario. It should be incorporated in the government schemes like Safe Motherhood to cover the high unmet need of contraception in Nepal.

Association Between First-Trimester Bleeding and Retained Placenta Requiring Dilatation and Curettage.

Early subchorionic hemorrhage may lead to a disruption in the placental-uterine matrix, which may result in an adherence of the placenta to the endometrium. We evaluated the effect of a first-trimester bleed on the need for a post-vaginal delivery dilatation and curettage (D&C) for removal of retained placenta. We conducted a case-control study at a tertiary care centre between 2012 and 2016. Patients identified through medical records as having required a post-vaginal delivery D&C for retained placenta were considered cases and were matched 1:5 with patients delivering vaginally within 1 week who did not require a D&C. History of first-trimester bleeding and subchorionic hemorrhage were identified through chart review. Conditional logistic regression analyses estimated the effect of a first-trimester bleed on the requirement for D&C for retained placenta. Models were adjusted for maternal age and previous uterine surgery. There were 68 cases of retained placenta requiring D&C, for an estimated 3 in 1000 deliveries. Patients requiring D&C were slightly older than controls but were otherwise comparable with respect to baseline demographic characteristics. In adjusted analyses, patients who required a postpartum D&C were more likely than controls to have had a first-trimester bleed at 11.8% and 0.6%, respectively (OR 25.3; 95% CI 4.7-135.4, P < 0.001). Postpartum D&C for retained placenta was associated with postpartum hemorrhage, need for blood transfusion, and manual removal of placenta. First-trimester bleeding should be considered a high-risk determinant for post-vaginal delivery D&C for retained placenta and for severe postpartum hemorrhage.

Bimanual examination for clot evacuation: a retrospective cohort study of women with postpartum haemorrhage after vaginal delivery

BackgroundBimanual clot evacuation (BCE) is a simple clinical manoeuvre that may reduce need for surgical intervention in the management of severe postpartum haemorrhage (PPH). We sought to determine whether performing BCE in cases of severe PPH after vaginal birth reduces the need for surgical intervention.MethodsA retrospective chart review of women who delivered vaginally with a severe PPH between January 1, 2011 and December 31, 2014 in a single tertiary women’s hospital in Sydney, Australia was conducted. Severe PPH was classified as a blood loss ≥1000mls. The need for surgical management (including operating theatre uterine exploration or evacuation, intrauterine balloon tamponade, repair of significant trauma, uterine or internal iliac artery ligation, B-Lynch suture insertion or hysterectomy) was the primary outcome measure, as expressed by need for operating theatre utilisation.ResultsFrom a cohort of 438, 149 women (34.0%) had BCE, of whom 29 (19.5%) required surgical management compared to 103 of 289 women with no BCE (35.6%); an odds ratio (OR) of 0.38 for BCE (confidence interval 0.20–0.72; p = 0.003). Early BCE (< 1 h of delivery) was associated with a further reduction in surgery (OR 0.24; confidence interval 0.08–0.70; p = 0.009) compared to late BCE (> 1 h of delivery). There was no reduction in estimated blood loss (p = 0.86) or blood transfusion (p = 0.71) with BCE.ConclusionOur study suggests BCE reduces theatre utilisation in the context of severe PPH following vaginal delivery. Prospective trials are needed to determine whether BCE should be endorsed as a treatment modality for PPH post-vaginal delivery.

Effect of Perineal Massage on Perineal Traumas for Nulliparous Women during Labor

Background: Short and long-term morbidity in women is associated with perineal trauma, mainly caused by subsequent vaginal delivery. Interventions that increase the likelihood of intact perineum are therefore needed. Purpose: This study aimed to evaluate the effect of perineal massage on perineal traumas for nulliparous women during labor. Methods: This Comparative quasi experimental design was conducted in the labor unit at Suez Canal University Hospital. A purposive sample of 74 laboring women in the labor unit. Three tools were used for data collection, interviewing questionnaire for assessing demographic characteristics. Observational checklist and visual Analogue Scale (RAS). Results: The incidence of perineal trauma was significantly lower for women who received perineal massage during labor than those who did not (54.05% in the massage group had intact perineum compared to 29.73% in the control group). The perineal pain score among women in the massage group is also lower than in the control group at the end of labor and the fourth stage of labor. Conclusions: This study concluded that perineum massage performed in the active phase of labor is safe, increases the occurrence of an intact perineum, decreased the risk of episiotomy and severe perineal trauma. As well as perineal pain, which improves the quality of life in women post vaginal delivery. Implications for Practice: Awareness program for healthy nulliparous women regarding the benefits of perineal massage by their health care providers.

Defining "normal recovery" of pelvic floor function and appearance in a high-risk vaginal delivery cohort.

Childbirth pelvic floor trauma leads to pelvic floor disorders. Identification of significant injuries would facilitate intervention for recovery. Our objectives were to identify differences in pelvic floor appearance and function following delivery and patterns of normal recovery in women sustaining high-risk labor events. We completed a prospective cohort study comparing women undergoing vaginal births involving risk factors for pelvic floor injury with women undergoing cesareans. Data were collected on multidimensional factors including levator ani muscle (LA) tears. Descriptive and bivariate statistics were used to compare the groups. We identified potential markers of pelvic floor injury based on effect size. Eighty-two women post-vaginal delivery and 30 women post-cesarean enrolled. The vaginal group had decreased perineal body length between early postpartum, 6weeks (p < 0.001), and 6months (p = 0.001). POP-Q points did not change between any time point (all p > 0.05). Measures of strength improved between each time point (all p < 0.002). When compared with cesarean delivery, women post-vaginal birth had longer genital hiatus and lower anterior and posterior vaginal walls (all p < 0.05). Based on theoretical considerations and effect sizes, those with Bp ≥0cm, Kegel force ≤1.50N, and/or an LA tear on imaging were considered to have significant pelvic floor injury. Using this definition, at 6weeks, 27 (46.4%) women were classified as injured. At 6months, 13 (29.6%) remained injured. We propose that pelvic floor muscle strength, posterior vaginal wall support, and imaging consistent with LA tear are potential indicators of abnormal or prolonged recovery in this cohort with high-risk labor events.

Safety of salpingectomy at time of delivery

Objective The most common methods of sterilization during cesarean delivery rely on excision of a mid-segment of the fallopian tube. Contemporary data suggest ovarian cancers may originate in the fimbriae of the fallopian tube; therefore, a strategy of prophylactic salpingectomy (SL) has been adopted during gynecologic surgery. The purpose of this study was to evaluate the safety of SL compared to traditional mid-segment excision at time of cesarean and after vaginal delivery through change in perioperative hemoglobin (Hgb). Study design We retrospectively evaluated patients undergoing sterilization concurrent with cesarean delivery or in the post-vaginal delivery period between 1 January 2015 and 31 December 2017 in the Mayo Clinic Health System; a community-based practice. In order to test for non-inferiority, 30 patients in each arm (tubal ligation (TL) and SL) were required to detect a pre- and post-operative Hgb difference of 0.5 mg/dL between groups with a power of 80%. Exclusion criteria included: age <18 years, BMI >50 kg/m2, endometriosis, other concurrent surgical procedures, bleeding disorders, postpartum hemorrhage due to atony, trial of labor after cesarean (TOLAC), and the presence of ovarian masses. Results One hundred fifty-two patients met inclusion criteria. There was no evidence of inferiority in either the post-vaginal delivery or the cesarean groups with a mean difference in pre- and post-op Hgb of 0.18 mg/dL (p = .99) post-cesarean and 0.04 mg/dL post-vaginal delivery with less reduction in Hgb from SL. The mean length of the procedure was 10.0 and 9.9 min (p = .005) longer for SL procedures amongst cesarean and postpartum procedures, respectively. Subgroup analyses did not demonstrate differences in blood loss between different techniques. Clamp-cut-tie techniques took longer than all other procedures in both groups. Conclusion This study provides evidence that the practice of salpingectomy at the time of cesarean and post-vaginal delivery may be safe and should form the basis of prospective trials.

Multidetector CT appearance of the pelvis after vaginal delivery: normal appearances and abnormal acute findings.

Vaginal delivery is the most commonly performed delivery in the world and accounts for nearly two-thirds of all deliveries in the United States. It is a secure method but may be associated with some acute complications, especially in the immediate postpartum days, which can potentially be fatal for the mother. The most frequent acute complications are hemorrhages/hematomas, uterine rupture, endometritis, retained product of conception (RPOC), ovarian thrombosis and HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count). A first evaluation of the clinical status of the patients is executed by the clinicians who, depending on their experience, perform ultrasonography by themselves and eventually may request further radiologic exams in doubtful cases. Radiologists may play an important role recognizing early postpartum complications and differentiating them from physiologic postoperative findings. In this setting, the use of multidetector computed tomography (MDCT) is important for diagnosis of suspected postpartum complications. The aim of this article is to review the normal and abnormal post vaginal delivery MDCT aspects in order to help the clinical management by preventing misdiagnoses and tailoring the best medical treatments.

Knowledge, Attitudes and Practices of Obstetricians for Postpartum Pain Control in the United States [33L

INTRODUCTION: Postpartum pain is one of the most common morbidities in the postpartum period. Absence of clinical practice guidelines to treat postpartum pain combined with the ongoing opioid prescriptions epidemic has impacted the physicians' practices. The objective was to study the knowledge, attitudes and practices of obstetricians in regards to postpartum pain control across the United States. METHODS: This nation-wide cross-sectional study was conducted electronically from 3/2018 to 5/2018. Participants included obstetrics-gynecology or family medicine-trained obstetricians practicing in academic institutions. Survey included 34 questions and response rate was 35% (648/1878). Institutional review board approval was obtained for this study. RESULTS: Respondents' characteristics included mean age 46.2 (±11.0) years, females 422 (66%) and Caucasians 483 (75%). Regarding knowledge about guidelines, 153 (24%) were familiar with postpartum pain management and 351 (54%) were familiar with chronic pain management guidelines. Regarding the most common source of pain post-vaginal delivery, 87 (13%) correctly cited perineal pain, while post-cesarean delivery, 333 (51%) correctly cited incisional pain. Regarding pain level, 474 (72%) felt there is mild pain post-vaginal delivery, while 506 (78%) felt there is moderate pain post-cesarean delivery. Regarding opioids for treating postpartum pain, 367 (57%) felt that it should be considered only if the pain is unresolved, while 195 (30%) felt it is unnecessary most of the times. The national attention to opioids prescription epidemic has moderately to severely impacted practices of 230 (36%) respondents. CONCLUSION: This study provides unique obstetricians' perspectives around postpartum pain management that can help develop clinical practice guidelines for treating this common morbidity.

Role of Radiofrequency (Votiva, InMode) in Pelvic Floor Restoration.

Postpartum pelvic floor disorders are estimated to impact 24% of women in the United States. This study describes the use of a radiofrequency device (Votiva, InMode) for postpartum pelvic floor restoration using an electrostimulator to objectively measure treatment effect. A retrospective evaluation was conducted between April 2017 and May 2018 of consecutive patients undergoing vaginal radiofrequency treatment. Inclusion criteria were patients at least 6 weeks postvaginal delivery with symptoms of pelvic floor dysfunction. Resting pelvic floor muscle tone and maximal pelvic floor contraction were measured. Fifty women were included in the study with an average age of 32 (29-40) years old, average of 2.6 pregnancies, and 1.8 vaginal deliveries. Two patients were lost to follow-up and excluded. Three complete radiofrequency treatments were performed in 31/50 patients, whereas 19 patients received 1-2 treatments. There were no adverse events from the radiofrequency treatment. No changes were found in resting pelvic muscle tone after Votiva treatment [Wilks' lambda = 0.98, F (1, 45) = 0.86, P = 0.36]. The quantity of treatments seemed to impact mean values of maximal pelvic floor contraction [F (1, 45) = 105.14, P < 0.001]. On the patient questionnaire, patients felt subjective improvement correlated to number of treatments. Radiofrequency is safe for the treatment of pelvic floor dysfunction. This study showed no changes in resting pelvic muscle tone but an improvement in maximal pelvic floor contraction. A prospective randomized study is being conducted to further evaluate the efficacy of this technology.