Pelvic Floor Changes Before and After Birth

描述(申请人提供)：背景：妊娠和分娩改变盆底解剖和功能。在美国，每年有400多万妇女分娩，大多数人都经历过生殖道创伤，包括盆底的神经和肌肉系统受损。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病史尚不清楚。具体目的：本研究的具体目的是：1)确定有和没有生殖道损伤的妇女产前和产后尿失禁和肛门失禁、性主诉、解剖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损伤的妇女的PF变化；3)确定可改变的第二产程护理措施是否与PF变化有关；4)比较剖腹产但未进入第二产程的妇女与有或无生殖道损伤的阴道分娩妇女的PF变化。研究人群：在新墨西哥州阿尔伯克基的低风险产科服务中心，630名由助产士护理的健康未分娩孕妇和135名剖腹产妇女。研究设计：在产前，将从三个助产护士诊所招募妇女。女性将完成经过验证的症状严重程度量表和生活质量(QOL)问卷，以衡量PF功能。结合盆腔器官脱垂量化系统的结构性盆腔检查将评估盆底解剖结构。出生时，会阴创伤的详细地图将被记录下来。剖腹产的妇女将在产后被招募。在产后六周、六个月和一年后，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。术后6个月行肛门内超声检查肛门括约肌，经唇部三维超声检查肛门提肌，纸巾试验检查尿失禁。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生活质量问卷的跟踪调查。这项工作的意义：PF的功能和解剖障碍影响妇女的生活，并导致卫生保健系统的经济负担。分娩和怀孕被认为是这些疾病的原因之一，然而，怀孕期间和分娩后盆底变化的自然历史尚未被描述。该项目将提供基本数据，以指导未来关于防止PF变化的分娩干预措施的决策，以及基于数据的关于产妇要求剖腹产的决策。

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.