Pelvic Floor Changes Before and After Birth

描述（由申请人提供）：背景：妊娠和分娩改变骨盆底解剖结构和功能。在美国，每年有超过400万妇女分娩，其中大多数经历生殖道创伤，包括对骨盆底神经和肌肉组织的损伤。这种创伤会给新妈妈带来短期和长期的问题，包括尿失禁和肛门失禁、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。具体目标：本研究的具体目的是：1）确定有和无生殖道创伤的女性中尿失禁和肛门失禁、性主诉、解剖学变化和会阴疼痛的患病率，产前和产后，并评估骨盆底（PF）变化对母亲生活质量的影响2）比较有和无生殖道创伤的妇女PF变化3）确定可修改的第二产程护理措施是否与PF变化相关; 4）比较剖宫产但未进入第二产程的妇女与有和无生殖道创伤的阴道分娩妇女的PF变化。研究人群：来自新墨西哥州阿尔伯克基的630名由护士助产士护理的健康未经产孕妇和135名通过剖腹产分娩的妇女。研究设计：产前，妇女将从三个护士助产诊所招募。女性将完成有效的症状严重程度量表和生活质量（QOL）问卷，测量PF功能。结合盆腔器官脱垂量化系统的结构化盆腔检查将评估盆底解剖结构。出生时，将记录会阴创伤的详细地图。通过剖腹产分娩的妇女将在产后招募。在产后6周、6个月和1年，女性将完成症状严重程度和QOL测量，并接受详细的盆腔检查。在6个月时，将进行肛门内超声检查以评价肛门括约肌，经唇3D超声检查以评价提肛肌，并进行纸巾试验以记录尿失禁。所有在研究的前三年分娩的妇女将在第二年接受症状严重程度和QOL问卷调查。这项工作的意义：PF的功能和解剖学障碍影响妇女的生活，并给保健系统造成经济负担。分娩和妊娠被认为是这些疾病的原因之一，但妊娠期间和分娩后骨盆底变化的自然史尚未被描述。该项目将提供基础数据，以指导未来的决策，对劳动干预，以防止PF的变化，以及基于数据的决定，产妇要求剖宫产。

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.