Pelvic Floor Changes Before and After Birth

出生前后盆底的变化

• 批准号: 7141765
• 负责人: REBECCA GLENN ROGERS
• 金额: $ 32.73万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-12 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7141765
• 关键词: anatomy; birth; cesarean section; clinical research; fecal incontinence; female; gynecology; human subject; labor complications; longitudinal human study; outcomes research; pain; pathologic process; pelvis; postpartum; quality of life; questionnaires; sex behavior; trauma; ultrasonography; urinary incontinence; women' s health

DESCRIPTION (provided by applicant): Background: Pregnancy and childbirth alter pelvic floor anatomy and function. Over 4 million women give birth each year in the United States, and most experience genital tract trauma, including damage to the nerves and musculature of the pelvic floor. This trauma can cause short and long term problems for new mothers, including urinary and anal incontinence, sexual dysfunction, perineal pain, and pelvic floor anatomical changes. The prevalence and natural history of these disorders in healthy women is unknown. Specific Aims: The specific aims of this study are to 1) identify the prevalence of urinary and anal incontinence, sexual complaints, anatomical changes and perineal pain in women with and without genital tract trauma, prenatally and postpartum and to evaluate the effect of pelvic floor (PF) changes on maternal quality of life 2) compare PF changes in women with and without genital tract trauma 3) determine if modifiable second stage labor care measures are associated with PF changes and 4) compare PF changes in women who deliver by cesarean but do not enter the second stage of labor to women who deliver vaginally with and without genital tract trauma. Study population: Six hundred and thirty healthy nulliparous pregnant women cared for by nurse-midwives and 135 women who deliver by cesarean from the low risk obstetrical services in Albuquerque, New Mexico. Study Design: Prenatally, women will be recruited from three nurse midwifery clinics. Women will complete validated symptom severity scales and quality of life (QOL) questionnaires that measure PF function. Structured pelvic examinations incorporating the pelvic organ prolapse quantification system will evaluate pelvic floor anatomy. At birth, a detailed map of perineal trauma will be recorded. Women who deliver by cesarean will be recruited postpartum. At six weeks, six months and one year postpartum, women will complete symptom severity and QOL measures and undergo detailed pelvic exams. At 6 months, endoanal ultrasound to evaluate the anal sphincter, translabial 3 D ultrasonography to evaluate the levator ani and a paper towel test to document urinary incontinence will be performed. All women who deliver in the first three years of the study will be followed for the second year with symptom severity and QOL questionnaires. Significance of this work: Functional and anatomical disorders of the PF impact women's lives, and result in an economic burden to the health care system. Childbirth and pregnancy have been implicated as a cause of these disorders, yet the natural history of pelvic floor changes during pregnancy and following childbirth has yet to be described. This project will provide fundamental data to guide future decisions about labor interventions to prevent PF changes as well as data-based decisions regarding maternal request cesarean.

描述（由申请人提供）：背景：妊娠和分娩改变骨盆底解剖和功能。在美国，每年有超过400万妇女分娩，大多数妇女经历了生殖道创伤，包括对骨盆底的神经和肌肉的损害。这种创伤可能会给新妈妈带来短期和长期的问题，包括尿和肛门尿失禁，性功能障碍，会阴疼痛和骨盆底解剖学变化。这些疾病在健康女性中的患病率和自然史尚不清楚。具体目的：这项研究的具体目的是1）确定患有和没有生殖器性创伤的女性的尿和肛门尿失禁，性抱怨，解剖学变化和会阴疼痛的流行率，产前和产后和产后以及评估骨盆底（pf）对生命的效果的影响，以及是否概述pf的效果2）护理措施与PF变化有关，4）比较剖宫产术的妇女的PF变化，但没有进入第二阶段的劳动阶段，这些妇女与有或没有生殖器造成创伤的阴道交付的妇女。研究人群：六百三十五十个健康的零下孕妇受到护士同会妇女和135名妇女的照顾，这些妇女是由剖宫产从新墨西哥州阿尔伯克基的低风险产科服务中分娩的。研究设计：产前，将从三个护士助产士诊所招募妇女。妇女将完成测量PF功能的症状严重程度和生活质量（QOL）问卷。结合骨盆器官脱垂定量系统的结构化骨盆检查将评估骨盆底解剖结构。出生时，将记录详细的会阴创伤图。通过剖宫产分娩的妇女将被招募在产后。六周，六个月零一年的产后，妇女将完成症状严重性和QOL措施，并接受详细的骨盆检查。在6个月的时间里，将进行肛门括约肌，转换3 d超声检查以评估左旋ANI和纸巾测试以记录尿失禁。在第二年的前三年中，所有在症状严重性和QOL问卷中都将遵循所有分娩的妇女。这项工作的意义：PF的功能性和解剖疾病会影响妇女的生活，并给医疗保健系统带来经济负担。分娩和怀孕已被视为这些疾病的原因，但是怀孕期间骨盆底变化的自然历史尚未描述。该项目将提供基本数据，以指导有关劳动干预措施的未来决策，以防止PF变化以及有关母亲请求剖宫产的基于数据的决策。