European Journal of Obstetrics & Gynecology and Reproductive Biology
Pelvic floor assessment after delivery: how should women be selected?
Introduction
Childbirth and vaginal delivery in particular are commonly considered to be the major aetiological factors for pelvic floor dysfunctions (PFDs), specifically urinary incontinence (UI), anal incontinence (AI) and pelvic organ prolapse (POP). PFDs after delivery are estimated to occur in up to 46% of puerperal women [1]. While only a small minority of women experience severe injury, the effect of PFDs on the quality of life of young, active women is disastrous and cannot be ignored by caregivers. Furthermore, the occurrence of obstetric pelvic floor trauma has to be considered in the medium to long term as an important predisposing factor for significant morbidity later in life [2]. The importance of monitoring PFDs after delivery is also reinforced by the availability of effective preventable measures as demonstrated by a recent Cochrane collaboration review on the effectiveness of physiotherapy in the treatment of UI after delivery [3].
Identifying strategies for selecting women who are at risk for PFDs after delivery is increasingly acknowledged as a critical issue [4]. Scenarios range from the adoption of an extensive to a selective approach on the basis of well-known risk factors (RFs). Therefore, health system decision-makers require precise data to develop feasible and effective programs. Unfortunately, the picture is far from clear. The literature is still controversial regarding the identification of RFs. This controversy reflects both methodological issues as well as substantial differences related to the different settings and populations included in these studies [5]. Good quality data from different countries are therefore of paramount importance. However, the health-seeking behaviours of new mothers, particularly as they relate to PFDs, has not been sufficiently investigated [6], [7].
We designed a study to test patient adherence to an offer for an extensive pelvic floor assessment 3 months after delivery in an Italian tertiary obstetric referral centre. We also aimed to investigate the prevalence of PFDs at 3 months after delivery and their related RFs to develop a customized model for hypothetical restrictive selection criteria. The identification of an efficient model to select patients for pelvic floor assessment after delivery is a critical point in daily clinical practice in an era of limited resources.
Section snippets
Materials and methods
This prospective observational study was approved by the Milano Area C—Ethics Review Committee (reference no. 319-052015). The study included all women who were ≥32 weeks gestational age when they delivered at Buzzi Children’s Hospital, a tertiary referral maternity hospital in Milan, Italy, between July and December 2014. At admission, while obtaining a patient history, each woman was questioned about the presence of PFDs before or during her pregnancy. Before discharge from the hospital, the
Results
Among the 1606 eligible women who delivered during the study period, 313 (19.5%) were not included in the analysis: 44 (14.1%) refused to participate in the study, 74 (23.6%) were not enrolled due to linguistic difficulties, 41 (13.1%) were not enrolled due to logistic and/or neonatal/maternal complications and 154 (49.2%) had missing data. A total of 1293 women signed the consent form and were scheduled for the postnatal PFC at 3 months after delivery; 685 women (53.0%) attended the 3-month
Comment
The impact of pregnancy and delivery on pelvic floor function is an increasingly popular topic among both women and clinicians. Nevertheless, the actual burden of PFDs after delivery is quite complex and difficult to determine.
According to the epidemiological data, detectable PFDs soon after delivery are estimated to occur in approximately 1/3 of all deliveries [1], [4]. The results of our study are consistent with previously published articles, indicating a prevalence of 34.7% at the time of
Funding
No specific funding was dedicated to this study.
Acknowledgement
We are particularly grateful to the midwives, nurses and medical staff of our unit for their support.
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