Comparison of pelvic floor dysfunction in primiparous and nulliparous women and its relation to pelvic floor muscle strength

Background: The pelvic floor muscles (PFM) play an important role in supporting the pelvic and abdominal organs and controlling urinary and fecal continence, in addition to their role in the sexual function. The objective of this study was to compare pelvic floor muscle strength in primiparous 6 months after delivery and nulliparous women, to evaluate pelvic floor dysfunction (PFD) in these women and to find the association of PFD with pelvic floor muscle strength (PFMS).Methods: A total of 100 women were recruited in the cross-sectional study which included 28 nulliparous and 72 primiparous women 6 months after delivery. The assessment included general physical examination (GPE), POP-Q and assessment of pelvic floor muscle strength by modified oxford score and perineometer.Results: Endurance of PFMS measured by duration of contraction and number of contractions/min was higher in nulliparous. Mean of the duration of contraction was significantly higher in nulliparous group as compared to primipara i.e., 28.61 seconds and 23.9 seconds in nulliparous and primiparous group respectively (p=0.005). Mean of the number of contractions performed in one minute was significantly higher in nulliparous group as compared to primipara i.e., 31.04 and 19.97 in nulliparous and primiparous group respectively (p<0.0001). None of the nulliparous women had any PFD symptoms, while 4.17% of the primiparous patients had PFD in the form of bladder symptoms and 1.39% of them had PFD in the form bowel symptoms. Vaginal squeeze pressure was found to be affected by mode of delivery. It was lowest in instrumental delivery. It was 39.78±13.33 cmH20 in vaginal delivery, 51.42±12.88 cmH2O in Caesarean section and 31.67±14.36 cmH2O in instrumental delivery (p-0.039).Conclusions: Endurance of PFMS measured by duration of contraction and number of contractions/min was higher in nulliparous. Vaginal squeeze pressure was found to be affected by mode of delivery. It was lowest in instrumental delivery

Intravenous oxytocin bolus and infusion versus infusion alone on the blood loss during caesarean section

Background: PPH is one of the leading causes of maternal mortality in the world. In India >30% maternal mortality is because of PPH.Methods: 250 females posted for LSCS were randomised into 2 groups. Group A: 5U oxytocin bolus + 40U oxytocin infusion @125 ml/hour in 500 ml saline. Group B: 5 ml Saline bolus + 40 U oxytocin infusionPrimary outcome was to measure blood loss (objective and subjective). Secondary outcomes were time for uterine hardening, additional uterotonic agents, hemodynamic changes, side effects and need for blood transfusion within 24 hours of LSCS.Results: Blood loss was significantly less in Group A in objective as well as subjective assessment (p0.05). However, during the postoperative period increase in heart rate was noted in Group B (p<0.05). Vomiting was the only major side effect observed, which was higher in Group A (5.6% versus 3.2%).Conclusions: Combination of 5U oxytocin bolus followed by an infusion of 40 U oxytocin given over 4 hours routinely in ASA grade I and ASA grade II parturient significantly decreases the operative blood loss during LSCS without causing any hemodynamic variability. This regimen provides better uterine contractility, lesser need for additional utero-tonic agents and lesser requirement of blood transfusion

Pelvic floor muscle training with and without biofeedback in treatment of overactive bladder

Background: Overactive bladder (OAB) is a commonly encountered problem in gynaecological practice. It has profound effect on quality of life (QOL), affecting simple daily activities as well. Prevalence rates of OAB in Asians are 53.1%. The first line management of OAB is behaviour modification and pelvic floor muscle training (PFMT). Objective of this study was to comparative assessment of biofeedback assisted PFMT (BAPFMT) versus PFMT alone in treatment of OAB using strength of pelvic floor muscle and QOL before and after treatment.Methods: A prospective comparative randomized controlled trial was conducted to compare the effect of PFMT versus BAPFMT on OAB symptoms over period of 12 weeks. Total of 100 patients fulfilling inclusion and exclusion criteria were selected. Randomization of patients was done into two groups of 50 patients each; half of them were subjected to PFMT and other half to BAPFMT. Appropriate statistical test were applied.Results: At the end of 12 weeks of intervention, there was a significant improvement in pelvic floor muscle strength and QOL in both groups (p&lt;0.001). The improvement in pelvic floor muscle strength was more with BAPFMT; however there was no difference in improvement of QOL between the groups.Conclusions: Addition of biofeedback to PFMT may be a useful adjunct in OAB patients

Upright kneeling position during second stage of labor: a pilot study

Background: Women delivering in upright position have shorter labour due to efficient and stronger contractions with faster descent of foetal head. The present study aimed to find out effect of upright kneeling position in the second stage of labour on maternal and foetal outcome and assess patients’ satisfaction.Methods: The study was carried out in a tertiary care hospital of North India from October 2012 to February 2014. Low risk women admitted in early labour were divided into two groups, women delivering in kneeling position and in supine position. The outcome measures studied were, duration of second stage of labour, mode of delivery, 2nd degree perineal tears, Apgar scores at 5 minutes, NICU admission rate and patient satisfaction.Results: The mean duration of second stage of labour in kneeling group was shorter by 14.901 minutes. The rate of vaginal delivery was comparable for both primigravidas and multigravida in kneeling and supine groups, RR: 2.275, 95% CI (0.7872-6.5831) and RR: 1.633, 95% CI (0.393-6.775). Primigravidas had more 2nd degree perineal tears in kneeling group as compared to supine, RR 4.191, 95% CI (1.54 to 11.41). No difference in Apgar scores >7 at 5 minutes was observed in both groups, however, significantly lesser babies in kneeling group were admitted in NICU, RR 0.246, 95% CI (0.079 to 0.761). There was no difference on comparing satisfaction scores of primigravidas and multigravida in both supine and kneeling position.Conclusions: Kneeling position reduces the duration of second stage of labour and NICU admissions

Strenuous physical activity, exercise, and pelvic organ prolapse : a narrative scoping review

Introduction and hypothesis High-intensity physical activity and exercise have been listed as possible risk factors for pelvic organ prolapse (POP). The aim of the present study is to conduct a literature review on the prevalence and incidence of POP in women who engage in regular physical activity. In addition, we review the effects of a single exercise or a single session of exercise on pelvic floor support. Finally, the effect of exercises on POP in the early postpartum period is reviewed. Methods This is a narrative scoping review. We searched PubMed and Ovid Medline, the Physiotherapy Evidence Database (PEDro), and the Cochrane Database of Systematic Reviews up to May 2022 with the following MeSH terms: “physical activity” AND “exercise” AND “pelvic floor” AND “pelvic organ prolapse”. Results Eight prevalence studies were retrieved. Prevalence rates of symptomatic POP varied between 0 (small study within different sports) and 23% (Olympic weightlifters and power lifters). Parity was the only factor associated with POP in most studies. Three studies evaluated the pelvic floor after a single exercise or one session of exercise and found increased vaginal descent or increased POP symptoms. One prospective cohort study reported the development of POP after 6 weeks of military parashot training, and one randomized trial reported increased POP symptoms after transverse abdominal training. There is scant knowledge on exercise and POP in the postpartum period. Conclusions Prevalence of POP in sports varies widely. Experimental and prospective studies indicate that strenuous exercise increased POP symptoms and reduced pelvic floor support

Are hypopressive and other exercise programs efective for the treatment of pelvic organ prolapse?

Introduction and hypothesis Pelvic floor muscle training (PFMT) is effective for the treatment of pelvic organ prolapse (POP), but other exercise programs have also been promoted and used. The aim of this review was to evaluate the effect of hypopressive and other exercise programs besides PFMT for POP. Methods A literature search was conducted on Ovid Medline, EMBASE, CINAHL, Cochrane, PEDro, and Scopus databases from January 1996 to 30 December 2021. Only randomized controlled trials (RCTs) were included. The keywords were combinations of “pelvic organ prolapse” or “urogenital prolapse,” and “exercise therapy,” “hypopressive exercise,” “Kegel,” “pelvic floor muscle training,” “pelvic floor muscle exercises,” “Pilates,” “treatment,” “yoga,” “Tai Chi.” Methodological quality was assessed using the PEDro rating scale (0–10). Results Seven RCTs containing hypopressive exercise, yoga or breathing and hip muscle exercises in an inverted position were retrieved and analyzed. PEDro score ranged from 4 to 7. There was no additional effect of adding hypopressive exercise to PFMT, and PFMT was more effective than hypopressive exercise alone. The studies that included the term “yoga” included regular PFMT and thus can be classified as PFMT. Hip exercises in an inverted position added to PFMT vs PFMT alone showed better improvement in some secondary outcomes but not in the primary outcome, POP stage. Conclusions There are few RCTs assessing the effects of other exercise programs besides PFMT in the treatment of POP. To date, there is no evidence that other exercise programs are more effective than PFMT for POP

Randomized Comparison of Isosorbide Mononitrate and PGE2 Gel for Cervical Ripening at Term including High Risk Pregnancy

Aims. Prostaglandin E2 is the most commonly used drug for cervical ripening prior to labour induction. However, there are concerns regarding uterine tachysystole and nonreassuring fetal heart (N-RFH). Isosorbide mononitrate (IMN) has been used successfully for cervical ripening. The present study was conducted to compare the two drugs for cervical ripening at term in hospital. Methods. Two hundred women with term pregnancies referred for induction of labour with Bishop score less than 6 were randomly allocated to receive either 40 mg IMN tablet vaginally (n=100) or 0.5 mg PGE2 gel intracervically (n=100). Adverse effects, progress, and outcomes of labour were assessed. Results. PGE2 group had significantly higher postripening mean Bishop score, shorter time from start of medication to vaginal delivery (13.37 ± 10.67 hours versus 30.78 ± 17.29 hours), and shorter labour-delivery interval compared to IMN group (4.53 ± 3.97 hours versus 7.34 ± 5.51 hours). However, PGE2 group also had significantly higher incidence of uterine tachysystole (15%) and N-RFH (11%) compared to none in IMN group, as well as higher caesarean section rate (27% versus 17%). Conclusions. Cervical ripening with IMN was less effective than PGE2 but resulted in fewer adverse effects and was safer especially in high risk pregnancies

Thyroid peroxidase antibody positivity among euthyroid pregnant women and its association with foeto-maternal outcome

Background: Thyroid peroxidase antibody (TPO-Ab) positivity is associated with increased risk of adverse pregnancy outcomes. The present study was planned to find out the prevalence of TPO-Ab and its association with adverse foeto-maternal outcome in euthyroid pregnant women.Methods: A total of 510 euthyroid pregnant women with &lt;20 weeks gestation were recruited from antenatal clinic. Serum TPO-Ab testing was done and women were divided into 2 groups. The study group comprised of TPO-Ab positive women and control group comprised of age and parity matched TPO-Ab negative women, double in number to that of the study group. Repeat Serum TSH was done at term/delivery and women were followed till delivery for foeto-maternal outcome.Results: The prevalence of TPO-Ab positivity in euthyroid pregnant women was 11.3%. A significant number of women in the study group developed hypothyroidism at term/delivery, 18.61% vs 7.61%, respectively, p=0.02. None of the women in the study or control group developed gestational diabetes or placental abruption, or had babies with NND or RDS. There was one IUD in the study group, rest of the maternal and foetal outcomes studied were not statistically significant between two the groups. The caesarean section rates in both groups was not statistically different, however, there were more caesarean sections done for foetal distress in the study group, p=0.04.Conclusions: Thyroid peroxidase positivity is present in 11.3% of euthyroid women and is associated with an increased risk of developing hypothyroidism during pregnancy. It is not associated with adverse foeto-maternal outcome

Thyroid peroxidase antibody positivity among euthyroid pregnant women and its association with foeto-maternal outcome

Background: Thyroid peroxidase antibody (TPO-Ab) positivity is associated with increased risk of adverse pregnancy outcomes. The present study was planned to find out the prevalence of TPO-Ab and its association with adverse foeto-maternal outcome in euthyroid pregnant women.Methods: A total of 510 euthyroid pregnant women with &lt;20 weeks gestation were recruited from antenatal clinic. Serum TPO-Ab testing was done and women were divided into 2 groups. The study group comprised of TPO-Ab positive women and control group comprised of age and parity matched TPO-Ab negative women, double in number to that of the study group. Repeat Serum TSH was done at term/delivery and women were followed till delivery for foeto-maternal outcome.Results: The prevalence of TPO-Ab positivity in euthyroid pregnant women was 11.3%. A significant number of women in the study group developed hypothyroidism at term/delivery, 18.61% vs 7.61%, respectively, p=0.02. None of the women in the study or control group developed gestational diabetes or placental abruption, or had babies with NND or RDS. There was one IUD in the study group, rest of the maternal and foetal outcomes studied were not statistically significant between two the groups. The caesarean section rates in both groups was not statistically different, however, there were more caesarean sections done for foetal distress in the study group, p=0.04.Conclusions: Thyroid peroxidase positivity is present in 11.3% of euthyroid women and is associated with an increased risk of developing hypothyroidism during pregnancy. It is not associated with adverse foeto-maternal outcome

Heart Rate Variability and Cardiovascular Reflex Tests for Assessment of Autonomic Functions in Preeclampsia

Alterations in the autonomic cardiovascular control have been implicated to play an important etiologic role in preeclampsia. The present study was designed to evaluate autonomic functions in preeclamptic pregnant women and compare the values with normotensive pregnant and healthy nonpregnant controls. Assessment of autonomic functions was done by cardiovascular reflex tests and by analysis of heart rate variability (HRV). Cardiovascular reflex tests included deep breathing test (DBT) and lying to standing test (LST). HRV was analyzed in both time and frequency domain for quantifying the tone of autonomic nervous system to the heart. The time domain measures included standard deviation of normal R-R intervals (SDNN) and square root of mean squared differences of successive R-R intervals (RMSSD). In the frequency domain we measured total power (TP), high frequency (HF) power, low frequency (LF) power, and LF/HF ratio. Cardiovascular reflex tests showed a significant parasympathetic deficit in preeclamptic women. Among parameters of HRV, preeclamptic group had lower values of SDNN, RMSSD, TP, HF, and LF (ms2) and higher value of LF in normalised units along with high LF/HF ratio compared to normotensive pregnant and nonpregnant controls. Furthermore, normotensive pregnant women had lower values of SDNN, TP, and LF component in both absolute power and normalised units compared to nonpregnant females. The results confirm that normal pregnancy is associated with autonomic disturbances which get exaggerated in the state of preeclampsia