URINARY INCONTINENCE PREVENTION--REDUCING BIRTHING RISK

预防尿失禁——降低分娩风险

• 批准号: 2258050
• 负责人: CAROLYN M SAMPSELLE
• 金额: $ 26.08万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 1995
• 资助国家: 美国
• 起止时间: 1995-06-01 至 1999-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2258050
• 关键词: birth; disease /disorder proneness /risk; female; human subject; muscle contraction; muscle strength; pelvis; postpartum; posture; prognosis; urinary incontinence

DESCRIPTION: (Adapted from applicants abstract) Despite the fact that vaginal birth is a recognized factor in the etiology of urinary incontinence (UI) across the life span, the impact of birthing events on urinary continence mechanisms is not well understood. An experimental pre-posttest design will be used with one experimental and one control group to prospectively study the effect of maternal pushing during second stage of labor on the function of the urinary continence mechanisms. The independent variable to be manipulated is type of maternal pushing: non-directed, spontaneous pushing (experimental group) and directed, sustained pushing (control group). Women will be assigned using a blocked randomization procedure to maintain provider balance between certified nurse-midwives (CNM) and obstetricians (MD). The experimental group will attend a class which the research-base for non- directed, spontaneous pushing as a protective strategy in decreasing the risk of UI will be presented. In addition, both the experimental and control groups will receive information on the benefits and techniques of pelvic muscle exercise (PME) as developed in the Principal Investigator's earlier work. The investigators have shown that PME improves postpartum pelvic muscle strength and urethral support. Thus, it is important that this strategy be incorporated into the proposed care of both groups so that PME influences do not confound the analysis of pushing type effects. A trained nurse observer will attend all births to document the expulsive phase of birth. Data on maternal birthing position, use of operative procedures, duration of second stage of labor, infant presentation and position, infant weight, and cord blood pH will also be obtained. The outcome variable of postpartum perineal and perivaginal tissue integrity will be assessed by a trained observer. Baseline data on the function of the urinary continence mechanisms will be collected at 20 weeks gestation. Specifically, women will provide information about UI symptoms and the investigators will conduct procedures to assess pelvic muscle strength and function (via clinical measures and computer-based gynecologic speculum), urine leak point pressure (via manometer), and urethral support (via ultrasound). Repeated measures will occur at 35 weeks gestation, 6 weeks postpartum, 6 months postpartum, and 12 months postpartum. This research will provide much needed data about specific childbirth-related mechanisms of UI. While the focus of the study is at the time of childbirth, the knowledge gained will benefit women throughout their post-childbearing years.

描述：(改编自申请者摘要)尽管 阴道分娩是尿路疾病病因中公认的因素 生命周期中的大小便失禁(UI)，分娩的影响 有关尿失禁机制的事件还不是很清楚。一个 实验前后测设计将使用一个实验和一个 一个对照组，前瞻性地研究母亲推搡的影响 第二产程对尿失禁功能的影响 机制。要处理的自变量的类型为 母性推力：非定向、自发推力(实验性 组)和定向、持续推力(对照组)。女人 将使用分组随机化程序分配以维持 注册护士-助产士(CNM)和提供者之间的平衡 产科医生(MD)。试验组将上一节课 这是非定向的、自发的推送的研究基础 提出了降低尿失禁风险的防护策略。 此外，试验组和控制组都将收到 关于骨盆肌肉锻炼的益处和技巧的信息 (PME)，如首席调查员早期工作中所发展的。这个 研究人员表明，PME可以改善产后盆腔肌肉 力量和对尿路的支持。因此，重要的是这一点 将战略纳入两个群体的拟议护理中，以便 PME影响不会混淆推进型效应的分析。 一名训练有素的护士观察员将在所有分娩过程中记录 分娩的驱逐期。关于产妇分娩位置的数据，使用 手术程序、第二产程持续时间、婴儿 体位、婴儿体重和脐带血酸碱度 也可以获得。产后会阴和产后并发症的结局变量 阴道周围组织的完整性将由训练有素的观察者进行评估。 有关尿失禁机制功能的基线数据 将在怀孕20周时收集。具体地说，女性将 提供有关尿失禁症状的信息，调查人员将 实施评估骨盆肌肉力量和功能的程序(通过 临床措施和计算机妇科镜检)、尿漏 点压(通过压力计)和尿路支撑(通过超声波)。 重复措施将发生在妊娠35周，产后6周， 产后6个月，产后12个月。这项研究将 提供急需的有关特定分娩相关的数据 用户界面的机制。虽然研究的重点是在 分娩，所获得的知识将使妇女在整个 生育后的几年。