Postpartum Pelvic Floor Rehabilitation Research Articles

Risk factors for postpartum stress urinary incontinence: a prospective study

PurposePostpartum stress urinary incontinence (SUI) is a common occurrence in women, and it has a profound effect on women’s health and quality of life. This study aimed to investigate the risk factors for postpartum SUI and the relative importance of each factor, including pelvic floor ultrasound measurement data and clinical data.MethodPregnant women who delivered in our hospital from March 2021 to January 2022 were selected as the study population. The clinical and anatomical Data from women with SUI and those without SUI were collected and analyzed. The clinical and anatomical risk factors associated with postpartum SUI were identified using univariate and multivariate analyses.ResultsA total of 255 participants were recruited. Logistic regression analysis indicated that age (OR:1.215, 95% CI:1.097–1.346, P < 0.001), vaginal delivery (OR:3.05, 95% CI:1.328–7.016, P < 0.009), parity (OR:3.059, 95% CI:1.506–6.216, P < 0.002), bladder neck descent (OR:4.159, 95% CI: 2.010–8.605, P < 0.001), the angle of the internal urethral orifice funnel (OR:1.133, 95% CI:1.091–1.176, P < 0.001) were important independent risk factors for postpartum SUI (all P < 0.05). The AUC was 0.883 (95% CI: 0.839–0.926) in the model.ConclusionsAge, vaginal delivery, parity, bladder neck descent and the angle of the internal urethral orifice funnel are independent risk factors for postpartum SUI. To prevent the occurrence of postpartum SUI, high-risk factors of postpartum SUI should be identified as early as possible during pregnancy and after delivery, and postpartum pelvic floor rehabilitation training should be promoted.

Comparison of the Effects of Individualized Postpartum Pelvic Floor Rehabilitation at Different Time Points in the Early Postpartum Period

Objective: To determine the clinical value of applying individualized postpartum pelvic floor rehabilitation at different time points in the early postpartum period. Methods: 184 patients admitted to the Affiliated Hospital of Jiangsu University from February 2021 to December 2022 were included in the study. Upon admission, they were divided into two groups, a conventional group (n = 46) and an intervention group (n = 138), by the random number table method. The patients in the conventional group underwent postpartum routine rehabilitation, while those in the intervention group underwent individualized postpartum pelvic floor rehabilitation. The patients in the intervention group were further divided into intervention group 1 (6–8 weeks), intervention group 2 (8–10 weeks), and intervention group 3 (10–13 weeks) according to the time of care. The rehabilitation effects were compared between the groups. Results: The pelvic floor muscle function of the patients in the intervention group was more ideal compared with those in the conventional group, and the incidence of adverse reactions was lower among patients in the intervention group; the comparison of the above indicators was statistically significant (P &lt; 0.05); however, there was no significant difference in the relevant indicators among intervention group 1, group 2, and group 3 (P &gt; 0.05). Conclusion: Although our study showed no significant difference in the effects of individualized postpartum pelvic floor rehabilitation at different time points in the early postpartum period, individualized postpartum pelvic floor rehabilitation in the early postpartum period has definite clinical value, as it improves pelvic floor muscle function and reduces the incidence of adverse reactions.

Sexually Induced Orgasm to Improve Postpartum Pelvic Floor Muscle Strength and Sexual Function in Primiparous Women After Vaginal Delivery: A Prospective Randomized Two-Arm Study

BackgroundPostpartum pelvic floor dysfunction is known to affect the quality of life of women and the methods to treat it are more complex with majority requiring training under supervision. AimTo compare the efficacy of sexually induced orgasm along with Kegels exercises versus Kegels exercises alone as a treatment method to enhance postpartum pelvic floor muscle strength and sexual function in primiparous women undergoing uncomplicated vaginal deliveries. MethodsThe prospective randomized two-arm study was conducted on sexually active primiparous women who had undergone uncomplicated vaginal deliveries. Those with risk factors for female sexual dysfunction and pelvic floor muscle dysfunction were excluded. Participants in Group 1 were advised daily Kegel's exercises, whereas, those in Group 2 were advised to initiate self-initiated/partnered sexual activity-induced orgasms along with daily Kegel's exercises. Their pelvic floor muscle strength on voluntary contraction, ability to relax pelvic floor voluntarily, and sexual function (using FSFI-6) were assessed monthly for 6 months and the analysis was done using G* Power software (© 2021 Heinrich-Heine-Universität Düsseldorf, Germany). Main Outcome MeasurePostpartum pelvic floor strength and sexual function in 2 groups of women under study. ResultsThe study period was from January 2020 to December 2020. The Group 1 had 26 participants (mean age 29.69 ± 2.2 years) and Group 2 had 29 participants (mean age 30.07 ± 2.57 years). The sexual function as well as ability to relax pelvic floor were significantly better in Group 2 compared to Group 1 at each monthly intervals whereas strength of pelvic floor muscles during voluntary contraction was significantly higher in Group 2 compared to Group 1 at the end of 6 months and it was statistically significant at a P value of .05. Clinical ImplicationsNovel method of using naturally occurring sexually induced orgasms for postpartum pelvic floor rehabilitation can revolutionize postpartum pelvic floor training in women, as it can be practiced at home with ease, along with easily performable Kegel's exercises. Strengths and LimitationsUse of prospective randomization and minimization of confounding factors is the strength of the study. The small sample size is the limitation of the study. ConclusionsPostpartum pelvic floor muscle strength and sexual function in primiparous women who have undergone uncomplicated vaginal deliveries can be significantly improved with the addition of sexually induced orgasm as a therapeutic tool along with physical exercises such as Kegels exercises in these women.Bhat GS, Shastry A. Sexually Induced Orgasm to Improve Postpartum Pelvic Floor Muscle Strength and Sexual Function in Primiparous Women After Vaginal Delivery: A Prospective Randomized Two-Arm Study. J Sex Med 2022;19:1634–1643.

Evaluation of Factors Affecting the Reduction in Postpartum Pelvic Floor Muscle Tension and The Therapeutic Effect

Purpose: This study investigated the risk factors associated with reductions in postpartum pel-vic floor muscle tension and evaluated improvements in pelvic floor muscle tension with electrical stimulation combined with biofeedback technology and Kegel exercis-es. Methods: We conducted a case-control study of 170 women with postpartum follow-up at Ningbo Li Huili Hospital from April 2019 to May 2020. According to the Oxford modified scale assessment(MOS), 94 and 76 women were included in the abnormal pelvic floor muscle tension group and control group, respectively. The two groups were trained by pelvic floor training. The changes in pelvic floor muscle tension before and after treatment in the two groups were analyzed to evaluate the effect of postpartum pelvic floor rehabilitation training. Results: The EMG value of the fast muscle contraction stage was negatively correlated with age and neonatal weight (P &lt;0.05). The EMG values of slow muscle contraction and endurance were negatively correlated with weight gain during pregnancy but posi-tively correlated with age and BMI at delivery (P &lt;0.05). The muscle tension of the abnormal muscle tension group was significantly improved and significantly higher than that of the control group (P &lt;0.05) after the two groups received the intervention. Conclusion: The factors affecting postpartum pelvic floor muscle tension include age, delivery times, BMI at delivery and neonatal weight. Electrical stimulation combined with the biofeedback technique and Kegel exercises in the early postpartum period are effec-tive means to reduce the incidence of Pelvic floor disorders.

The Effects of Yoga Exercise on Pelvic Floor Rehabilitation of Postpartum Women.

Rehabilitation of the pelvic floor after delivery is very important for women. Pelvic floor rehabilitation can speed up the recovery of the postpartum vagina and pelvic floor muscle tension and elasticity and have a good effect on the prevention and treatment of postpartum vaginal prolapse and relaxation, urinary incontinence and other pelvic floor disorders. Thus, this article focuses on yoga exercise to explore its impact on postpartum pelvic floor rehabilitation. This article uses electrical stimulation and the treatment of pelvic floor muscles combined with the posture recognition algorithm, the yoga rehabilitation training program that has the best effect on the parturient is obtained, and the yoga myoelectric stimulation combined method and the traditional myoelectric stimulation method are designed for comparison experiments. The experimental results show that the parturients who have undergone the combined method of yoga myoelectric stimulation, in the resting state, contraction state, and Valsalva state, the position of the bladder meridian, the position of the uterus, and the position of the rectal ampulla of the parturient have a significant recovery compared those who have undergone the traditional electromyography treatment. In addition, the average area of hiatus in the pelvic floor ultrasound examination in the control group 42 days postpartum was 12.2605 cm2, while the average area of the hiatus in the pelvic floor ultrasound examination in the experimental group 42 days postpartum was 10.788 cm2; the average area of hiatus in the pelvic floor ultrasound examination in the control group at 3 months postpartum was 11.4805 cm2, and the average area of hiatus in the pelvic floor ultrasound examination in the experimental group at 3 months postpartum was 8.9475 cm2. To sum up, yoga had a very significant improvement on the physical indicators and mental health of postpartum women.

Clinical Analysis of Curative Effect of Postpartum Pelvic Floor Rehabilitation

Clinical Analysis of Curative Effect of Postpartum Pelvic Floor Rehabilitation

Discussion on the Improvement of Postpartum Pelvic Floor Rehabilitation Nursing Method on Pelvic Floor Dysfunction of Vaginal Delivery Parturients

Discussion on the Improvement of Postpartum Pelvic Floor Rehabilitation Nursing Method on Pelvic Floor Dysfunction of Vaginal Delivery Parturients

Effect of Postpartum Pelvic Floor Rehabilitation Nursing Strategy in Preventing Pelvic Floor Dysfunction during Vaginal Delivery

Effect of Postpartum Pelvic Floor Rehabilitation Nursing Strategy in Preventing Pelvic Floor Dysfunction during Vaginal Delivery

Effect of Different Delivery Modes on Pelvic Floor Function and Effect of Postpartum Pelvic Floor Rehabilitation

Effect of Different Delivery Modes on Pelvic Floor Function and Effect of Postpartum Pelvic Floor Rehabilitation

Effect of Nursing Intervention on Postpartum Psychological Status and Pelvic Floor Rehabilitation Nursing Compliance of Primiparas

Effect of Nursing Intervention on Postpartum Psychological Status and Pelvic Floor Rehabilitation Nursing Compliance of Primiparas

Analysis of Prevention Effect and Safety of Postpartum Pelvic Floor Rehabilitation Nursing for Female Pelvic Floor Dysfunction

Analysis of Prevention Effect and Safety of Postpartum Pelvic Floor Rehabilitation Nursing for Female Pelvic Floor Dysfunction

Effect of postpartum pelvic floor rehabilitation nursing on patients' compliance.

Effect of postpartum pelvic floor rehabilitation nursing on patients' compliance.

The Value of Postpartum Pelvic Floor Rehabilitation Nursing to Prevent Pelvic Floor Dysfunction

Female pelvic floor dysfunctions are the most common diseases after pregnancy. Vaginal relaxation, stress urinary incontinence (SUI), and pelvic organ prolapse (POP), decreased sexual activity, and mental depression and other clinical symptoms, are the most normal results of childbirth which leading to cause various problems for the mother. We aim to explore the clinical situation and effect of postpartum pelvic floor rehabilitation nursing for patients with postpartum pelvic floor dysfunction. In this study, 100 patients with postpartum pelvic floor dysfunction randomly selected from January 2018 to December 2019. They were randomly divided into two groups for nursing care, including control group and observation group. The control group received routine care, and the observation group received postpartum pelvic floor rehabilitation care. We carry out comparison of the clinical nursing effects of the two groups. After analysis and statistics, the total clinical effectiveness (94.0%) and nursing satisfaction (92.0%) of the observation group were significantly higher than those of the control group (80.0%, 72.0%), and the differences between the groups were significant (P<0.05). In conclusion, implementing pelvic floor rehabilitation nursing for patients with postpartum pelvic floor dysfunction can better promote the rehabilitation of patients' pelvic floor function, improve clinical effects and nursing satisfaction.

Adaptation of independent midwives to the COVID-19 pandemic: A national descriptive survey

Objective: The main objective of this survey was to identify how independent midwives, mainly working in primary care, adapted their practices at the beginning of the COVID-19 pandemic in France. Our assumption was that this practice adaptation would vary according to both geographical area (timing of pandemic effect) and whether they practiced alone or in a group. DesignWe conducted an online national survey of independent midwives in France from March 16–23, 2020. SettingAll districts in mainland France and the overseas territories. ParticipantsRespondents from the population of all independent midwives working in France. Measurements and findingsThe primary outcome measure was the proportion of midwives reporting that they had adapted their practices to the context of the COVID-19 pandemic, and the rank, in order of frequency, of the postponed or cancelled activities. Results: Of the 1517 midwives who responded, i.e., 20.3% of the independent midwives in France, 90.6% reported adapting one or more of their practices . The main adjustment was the postponement or cancellation of consultations deemed non-essential, listed in descending order: postpartum pelvic floor rehabilitation (n = 1270, 83.7%), birth preparation (n = 1188, 78.3%), non-emergency preventive gynaecology consultation (n = 976, 64.3%), early prenatal interview (n = 170, 11.2%), and postnatal follow-up (n = 158, 10.4%). Key conclusionsWithout guidelines, each midwife had to decide individually if and how to adapt her practice. Postpartum pelvic floor rehabilitation and birth preparation have been strongly affected. The results of this national survey indicate that a large majority of midwives have adapted their practices, independently of the local course of the pandemic, and that this reduction of contacts with women raises questions in this period of anxiety about intermediate-term adaptations to guarantee the continuity and safety of care. Implications for practiceThis study's results can be used to develop tools to handle cancelled consultations. Video, also called virtual, visits and coordination between independent practitioners and hospitals are probably the major challenges in the current context.

Opinion survey on postpartum pelvic floor rehabilitation among Ivorian practitioners

Introductioncette étude visait à rapporter l´expérience des prestataires de soins dans les maternités d´Abidjan en matière de rééducation périnéale en évaluant leur niveau de connaissance et leurs attitudes pratiques.Méthodesune enquête a été menée auprès des obstétriciens et sages-femmes exerçant dans une maternité d´Abidjan depuis au moins deux ans. Les informations ont été recueillies sur un questionnaire à questions directes, ouvertes et semi-ouvertes.Résultatscent vingt praticiens ont été sélectionnés dont 66 sages-femmes et 54 obstétriciens. Un total de 79,6% des obstétriciens et 37,9% des sages-femmes officiaient dans un centre hospitalier universitaire. L´indice de connaissance des sages-femmes était bon ou moyen dans 25% (intervalle interquartile [IIQ] 16,8-48,3). Tandis que les obstétriciens avaient un niveau de connaissances bon ou moyen dans 65% (IIQ 41,1-48,3). La majorité des prestataires convoquaient les femmes dans le post partum, mais seulement 7 soignants sur dix contrôlaient le périnée et deux obstétriciens sur dix proposaient une rééducation périnéale.Conclusionle faible niveau de connaissances des sages-femmes et obstétriciens ivoiriens sur la rééducation périnéale du post-partum et le manque de pratique suggèrent la nécessité d´une mise à niveau perpétuelle de ceux-ci à travers des formations continues.

Comparison of the effects of early pelvic floor muscle rehabilitation on postpartum pelvic floor rehabilitation and sexual function in different delivery methods

Objective To observe the effect of early pelvic floor muscle rehabilitation on postpartum pelvic floor rehabilitation and sexual function in different delivery methods. Methods Ninety-three parturient women who admitted to the Department of Obstetrics and Gynecology in Taizhou Hospital from January 2018 to December 2018 were divided into cesarean section group (53 cases) and vaginal delivery group (40 cases) according to the mode of delivery.Early pelvic floor muscle rehabilitation was performed in both two groups.Maternal pelvic floor rehabilitation was assessed by pelvic floor muscle pressure and muscle fiber contraction, and maternal sexual function was assessed by sexual function status score. Results Before treatment, the sustained systolic blood pressure of type Ⅰ muscle fibers[(28.14±3.03)cmH2O vs.(27.66±3.14)cmH2O], the duration of type Ⅰ muscle fibers[(9.54±1.04)s vs.(9.66±1.00)s], the rapid systolic blood pressure of type Ⅱ muscle fibers[(48.14±3.03)cmH2O vs.(47.66±3.14)cmH2O], and the contraction of type Ⅱ muscle fibers[(2.54±1.04) vs.(2.66±1.00)] had no statistically significant differences between the two groups (t=0.401, 0.312, 2.401, 0.324, all P>0.05). After treatment, the sustained systolic blood pressure of type Ⅰ muscle fibers, duration of type Ⅰ muscle fibers, rapid systolic blood pressure of type Ⅱ muscle fibers, and the contraction of type Ⅱ muscle fibers had statistically significant differences between the two groups (t=10.642, 10.214, 10.672, 10.254, all P 0.05). After intervention, both two indicators were elevated, and the differences were statistically significant compared with before treatment (t=12.093, 14.152, all P 0.05). Conclusion Early pelvic floor rehabilitation is beneficial to the recovery of pelvic floor and sexual function. Key words: Pelvic floor; Hospitals, convalescent; Cesarean section; Natural childbirth

Hypopressive technique versus pelvic floor muscle training for postpartum pelvic floor rehabilitation: A prospective cohort study.

Abdominal hypopressive technique (AHT) is gaining popularity as an alternative to pelvic floor muscle training (PFMT) during postpartum. Although, there is no solid evidence for its recommendation. We conducted a prospective observational cohort study in a university hospital with 105 primiparae who performed a two-month PFMT or AHT program. The aim was to compare the effectiveness of both treatments in terms of morphofunctional changes in 3D transperineal ultrasound, manometry, dynamometry, and differences in urinary incontinence symptoms (ICIQ-IU-SF) and satisfaction. The average change in levator ani muscle was 1.2 mm higher in AHT group vs PFMT (95% confidence interval [CI], -2.2 to -0.2; P = .017). No statistically significant differences were shown in maximal strength changes between groups. After AHT, basal tone change was 63.0 g/cm2 higher than PFMT (95% CI, -129 to 2.9; P = .06). A statistically significant reduction in ICIQ-IU-SF was observed after both treatments [(PFMT, -0.8 points; 95% CI, -1.4 to -0.1; P = .015), (AHT, -0.7 points; 95% CI, -1.3 to -0.1; P = .018]. AHT showed a higher median satisfaction score than PFMT (P = .004). This preliminary study is the first that analyses the effect of AHT vs PFMT during postpartum. The results suggest a higher improve for AHT in levator muscle thickness and satisfaction compared to PFMT. These must be considered with caution due to the limitations of the study. Further randomized clinical trials about both techniques during postpartum are required.

Application of soft skills nursing model of nurses on maternal postpartum pelvic floor rehabilitation

Objective To explore the application effect of soft skills nursing model on maternal postpartum pelvic floor rehabilitation. Methods A total of 516 cases of maternal postpartum pelvic floor rehabilitation in Department of Obstetrics in Peking Union Medical College Hospital from December 2014 to March 2017 were selected using purpose sampling method. Patients were divided into the control group and the observation group according to the random number table method, 258 cases respectively. Patients in the control group were treated with routine nursing intervention, while patients in the observation group received additional nursing on the basis of soft skills nursing intervention model. The treatment compliance, anxiety and satisfaction rate of patients were compared between two groups. Results At 3 months after the intervention, the treatment compliance rates of patients were 54.7% in the control group and 82.6% in the observation group; there was statistically significant difference between two groups (χ2=4.287, P<0.05) . The satisfaction rates were 69.4% in the control group and 89.9% in the observation group; statistically significant difference was observed between two groups (χ2=4.792, P<0.05) . The SAS score of observation group was (26.18±5.11) , which was significantly lower than control group (32.56±5.34) (t=2.315, P<0.05) . Conclusions Nursing model of soft skills can effectively improve the treatment compliance and nursing satisfaction of women druing maternal postpartum pelvic floor rehabilitation, and release their anxiety. Key words: Rehabilitation; Pelvic floor; Nurses' soft skills; Treatment compliance; Satisfaction rate

Postpartum practice: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF)

ObjectiveTo make evidence-based recommendations for the postpartum management of women and their newborns, regardless of the mode of delivery. Material and methodsSystematic review of articles from the PubMed database and the Cochrane Library and of recommendations from the French and foreign societies or colleges of obstetricians. ResultsBecause breast-feeding is associated with reductions in neonatal, infantile, and childhood morbidity (lower frequency of cardiovascular, infectious, and atopic diseases and infantile obesity) (LE2) and improved cognitive development in children (LE2), exclusive and extended breastfeeding is recommended (grade B) for at least 4–6 months (professional consensus). Pharmacological treatments for inhibition of lactation should not be given routinely to women who do not wish to breastfeed (professional consensus). Because of potentially serious adverse effects, bromocriptine is contraindicated in inhibiting lactation (professional consensus). For women aware of the risks of pharmacological treatments to inhibit lactation but choose to take them, lisuride and cabergoline are the preferred drugs (professional consensus). Regardless of the mode of delivery, only women with bleeding or symptoms of anemia should be tested for it (professional consensus). Immediate postoperative monitoring after cesarean delivery should be performed in the postanesthesia care unit (PACU). An analgesic multimodal protocol for analgesia, preferring oral administration, should be developed by the medical team and be available for all staff (professional consensus) (grade B). Thromboprophylaxis with compression stockings should begin the morning of all cesarean deliveries and maintained for at least 7 postoperative days (professional consensus) with or without the addition of LMWH, depending on the presence and severity (major or minor) of additional risk factors. It is recommended that women be informed of the dangers of closely spaced pregnancies (LE3), that effective contraception begin no later than 21 days post partum for women who do not want such a pregnancy (grade B), and that it be prescribed at the maternity ward (professional consensus). In view of the postpartum risk of venous thromboembolism, use of combination hormonal contraception is not recommended before six weeks post partum (grade B).Pelvic floor rehabilitation in asymptomatic women to prevent urinary or anal incontinence in the medium or long term is not recommended (professional consensus). Rehabilitation using pelvic floor muscle contraction exercises is recommended to treat persistent urinary incontinence at 3 months post partum (grade A), regardless of the type of incontinence. Postpartum pelvic floor rehabilitation is recommended to treat anal incontinence (grade C), but not to treat or prevent prolapse (grade C) or dyspareunia (grade C). The months following the birth are a period of transition and of psychological changes for all parents (LE2) and are still more difficult for those with psychosocial risk factors (LE2). Situations of evident psychological difficulties can have a significant effect on the child's psychological and emotional development (LE3). Among these difficulties, postpartum depression is most common, but the risk of all mental disorders is generally higher in the perinatal period (LE3). ConclusionThe postpartum period presents clinicians with a unique and privileged opportunity to address the physical, psychological, social, and somatic health of women and babies.

Postpartum pelvic floor rehabilitation on prevention of female pelvic floor dysfunction: a multicenter prospective randomized controlled study

To study the postpartum pelvic floor rehabilitation on the improvement of pelvic floor electrical physiological indexes and the prevention of female pelvic floor dysfunction in China. A multicenter prospective randomized controlled study was carried out. From October 2011, postpartum women in five provinces were randomly assigned into treatment group and control group. The women in treatment group received electrical stimulation and biofeedback treatment. The women in control group performed pelvic floor muscle exercise at home. When 6 months and 12 months after delivery, comparing two groups of patients with pelvic floor electrical physiological indexes and pelvic organ prolapse quantitation measurements (POP-Q), to evaluate the effect of postpartum pelvic floor rehabilitation on the prevention of pelvic floor dysfunction. Pelvic floor impact questionnaire short form (PFIQ-7) and pelvic organ prolapse/incontinence sexual questionnaire-12 (PISQ-12) were used to evaluate the influence on quality of life and sexual life. Until June 2013, 324 women were participated, 124 in control group, 200 in treatment group. According to the baseline results, there was statistical significance in the results of pelvic floor electrical physiological indexes between the treatment and control groups in postpartum 6 months and 12 months; the proportion above level III of type I and type II muscle fibers strength in the treatment group, it was from 41.5% (83/200) and 40.5% (81/200) to 76.3% (145/190) and 79.5% (151/190) in postpartum 6 weeks and postpartum 6 months, increased to 80.6% (58/72) and 80.6% (58/72) in postpartum 12 months, improved significantly comparing with the control group (P < 0.01). According to Point Aa, treatment group and control group in the postpartum 6 weeks was (-2.2 ± 0.7) versus (-2.4 ± 0.6) cm, in postpartum 12 months (- 2.5 ± 1.1) versus (- 2.7 ± 0.6) cm, the improvement in treatment group was statistically significant (P < 0.01). And the other points were not significantly different (P > 0.05). There was no significant difference in the questionnaires in quality of life and quality of sexual life (P > 0.05). Neuromuscular electrical stimulation and biofeedback therapy in the early postpartum period could obviously improve pelvic floor electrical physiological indexes, and is beneficial to prevent the pelvic floor dysfunction.