Pelvic Floor Changes Before and After Birth

出生前后盆底的变化

• 批准号: 7458036
• 负责人: REBECCA GLENN ROGERS
• 金额: $ 34.5万
• 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/7458036
• 关键词: Address; Admission activity; Affect; Anatomy; Birth; Caring; Child; Childbirth; Clinic; Clinical Research; Coughing; Data; Databases; Disease; Economic Burden; Ensure; Episiotomy; Event; Exercise; Fecal Incontinence; Future; Genital system; Goals; Head; Healthcare Systems; Hospitals; Incidence; Incontinence; Injury; Intervention; Laceration; Length; Life; Mails; Maps; Measures; Methods; Midwifery; Mothers; Natural History; Nerve; New Mexico; Nurse Midwives; Nurses; Organ; Pain; Paper; Pelvic Examination; Pelvic Floor Disorders; Pelvic Floor Muscle; Pelvic floor dysfunction; Pelvic floor structure; Pelvis; Population; Population Study; Positioning Attribute; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Prevalence; Prevention; Psychometrics; Ptosis; Quality of life; Questionnaires; Rate; Recruitment Activity; Reporting; Research; Research Design; Research Personnel; Rest; Risk; Risk Factors; Sampling; Second Labor Stage; Secondary to; Services; Severities; Sexual Dysfunction; Specificity; Staging; Structure; Surveys; Symptoms; System; Techniques; Testing; Time; Trauma; Ultrasonography; United States; Urinary Incontinence; Uterine Contraction; Vagina; Vaginal Birth after Cesarean; Vaginal delivery procedure; Week; Woman; Work; experience; fetal; indexing; interdisciplinary collaboration; levator ani muscle; muscle strength; novel; prenatal; prevent; programs; rectal; reproductive; response; sphincter ani muscle structure; urinary

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：怀孕和分娩改变盆底解剖结构和功能。美国每年有超过 400 万女性分娩，大多数女性都会经历生殖道创伤，包括盆底神经和肌肉组织受损。这种创伤可能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、会阴疼痛和盆底解剖变化。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：本研究的具体目的是 1) 确定有或没有生殖道创伤的女性在产前和产后尿失禁、肛门失禁、性主诉、解剖学变化和会阴疼痛的患病率，并评估盆底 (PF) 变化对产妇生活质量的影响 2) 比较有和没有生殖道创伤的女性 PF 变化 3) 确定是否可以修改第二产程 护理措施与 PF 变化相关，4) 比较剖腹产但未进入第二产程的妇女与阴道分娩且无生殖道创伤的妇女的 PF 变化。研究人群：630 名由护士兼助产士照顾的健康未产孕妇和 135 名来自新墨西哥州阿尔伯克基低风险产科服务机构剖腹产的妇女。研究设计：产前，将从三个护士助产诊所招募妇女。女性将完成经过验证的症状严重程度量表和衡量 PF 功能的生活质量 (QOL) 问卷。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，会记录会阴创伤的详细地图。剖腹产分娩的妇女将在产后被招募。在产后六周、六个月和一年时，女性将完成症状严重程度和生活质量测量，并接受详细的骨盆检查。 6 个月时，将进行肛内超声检查以评估肛门括约肌、经阴唇 3D 超声检查以评估提肛肌以及纸巾测试以记录尿失禁。所有在研究前三年分娩的女性都将在第二年接受症状严重程度和生活质量调查问卷的跟踪。这项工作的意义：PF 的功能和解剖疾病影响女性的生活，并给医疗保健系统带来经济负担。分娩和怀孕被认为是这些疾病的原因，但怀孕期间和分娩后盆底变化的自然史尚未得到描述。该项目将提供基础数据来指导未来有关分娩干预措施的决策，以防止 PF 变化，以及有关产妇请求剖腹产的基于数据的决策。