Pelvic Floor Changes Before and After Birth

出生前后盆底的变化

• 批准号: 8090033
• 负责人: REBECCA GLENN ROGERS
• 金额: $ 15.69万
• 依托单位: UNIVERSITY OF NEW MEXICO HEALTH SCIS CTR
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8090033
• 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; 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; Woman; Work; experience; fetal; indexing; interdisciplinary collaboration; levator ani muscle; muscle strength; novel; prenatal; prevent; programs; rectal; reproductive; response; sphincter ani muscle structure; urinary

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 associatedwith 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.

背景：怀孕和分娩骨盆底解剖结构和功能。超过400万妇女给予 每年在美国出生，大多数人都会经历生殖道的创伤，包括损害 骨盆底的神经和肌肉。这种创伤可能导致新的短期问题 母亲，包括尿和肛门尿失禁，性功能障碍，会阴疼痛和骨盆底 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）确定尿和肛门的患病率 有或没有生殖器的女性的尿失禁，性投诉，解剖学变化和会周围的疼痛 造口创伤，产前和产后，并评估骨盆底（PF）对母体的影响 生活质量2）比较患有和没有生殖器造成创伤的女性的PF变化3）确定是否是否 可修改的第二阶段劳动护理措施与PF变化有关，4）比较PF变化 在剖宫产但不进入第二阶段的妇女中 阴道有或没有生殖道创伤。研究人群：六百三十健康的无效 由护士中间妇女和135名剖宫产从低风险中分娩的孕妇和135名妇女 新墨西哥州阿尔伯克基的产科服务。研究设计：产前，将从中招募妇女 三个护士助产士诊所。妇女将完成经过验证的症状严重程度和生活质量 （QOL）测量PF函数的问卷。结合骨盆结构的结构化骨盆检查 器官脱垂定量系统将评估骨盆底解剖结构。出生时，会阴的详细地图 创伤将被记录。通过剖宫产分娩的妇女将被招募在产后。六个星期，六个 产后月和一年，妇女将完成症状严重程度和质量验证措施并接受 详细的骨盆检查。在6个月时，内侧超声检查以评估肛门括约肌3 d 评估左右ANI和纸巾测试以记录尿失禁的超声检查 执行。在研究的前三年中，所有分娩的妇女都将在第二年进行 症状严重程度和QOL问卷。这项工作的意义：功能和解剖学 PF的疾病会影响妇女的生活，并给医疗保健系统带来经济负担。 分娩和怀孕已被牵涉到这些疾病的原因，但是 怀孕期间和分娩后骨盆底的变化尚未描述。这个项目将 提供基本数据，以指导未来有关劳动干预措施的决策，以防止PF变化 作为有关剖腹产的基于数据的决策。