Der Einfluss von Schwangerschaft und Geburt auf Veränderungen des Beckenbodens : Eine prospektive longitudinale Beobachtungsstudie

Der Einfluss von Schwangerschaft und Geburt auf Veränderungen des Beckenbodens: Eine prospektive longitudinale Beobachtungsstudie Ziele: Erfassung von Veränderungen des Beckenbodens während und nach der Schwangerschaft bei Erstgebärenden hinsichtlich des Auftretens von Beckenbodenfunktionsstörungen sowie des Einflusses auf die Lebensqualität der Frauen. Methoden: In einer Kohorte von Erstgebärenden mit einer komplikationslosen Einlingsschwangerschaft, die sich in der Universitätsklinik des Saarlandes zwecks Geburtsplanung vorstellten, wurden POP-Q Untersuchungen und translabiale 2D/3D-Ultraschalluntersuchungen in Ruhe und unter Valsalva im dritten Trimenon und 3 Monate nach der Entbindung durchgeführt. Im Anschluss erfolgte eine Offline-Analyse, um die Position des Blasenhalses, den retrovesikalen Winkel sowie die Dimensionen des Hiatus urogenitalis in Ruhe und unter Valsalva zu messen. Des Weiteren wurde die Levator ani Muskulatur auf das Vorhandensein einer möglichen Avulsion geprüft. Die Ergebnisse wurden hinsichtlich prä- und peripartaler Faktoren analysiert. Zwei individualisierte, detaillierte Fragebögen wurden 3 Monate und 12 Monate nach der Entbindung ausgehändigt, um potenzielle Inkontinenzsymptome, die Lebensqualität und das Verhalten der Probandinnen nach der Entbindung zu bestimmen. Ergebnisse: Es wurden 56 Probandinnen rekrutiert, von denen 45 (80,4 %) die Studie abschlossen. Das Durchschnittsalter lag bei 31 Jahren. 17 Frauen (37,8 %) entbanden spontan, 17 Frauen (37,8 %) erhielten eine Sectio caesarea und 11 Frauen (24,4 %) wurden durch eine Vakuumextraktion entbunden. Während der Schwangerschaft bestand bei 12 Frauen (26,7 %) eine Harninkontinenz. 3 Monate und 12 Monate nach der Entbindung gaben 7 bzw. 5 Frauen eine Harninkontinenz an, 3 bzw. 2 Frauen eine Analinkontinenz und 7 bzw. 1 Frau eine kombinierte Inkontinenz. Beschwerden beim Geschlechtsverkehr, wie beispielsweise eine Dyspareunie oder ein Fremdkörpergefühl in der Vagina, bestanden bei 19 Probandinnen (42 %) 3 Monate nach der Entbindung und bei 11 Probandinnen (24 %) ein Jahr nach der Entbindung. In der POP-Q Testung wurde bei 4 Frauen in der Schwangerschaft eine Zystozele I° festgestellt. 3 Monate post partum bestand bei 7 Probandinnen eine Zystozele I°, bei 3 Probandinnen eine Rektozele I° und bei 5 Probandinnen ein Descensus uteri I°. Eine Bindegewebsschwäche, wie zum Beispiel das Vorhandensein von Cellulite oder Striae (p=0,0483), und ein hohes fetales Geburtsgewicht (p=0,0384) wurden in einer multivarianten Regressionsanalyse als signifikante Risikofaktoren für das Auftreten von Beckenbodenfunktionsstörungen identifiziert. In unserer Studie wurde kein signifikanter Zusammenhang zwischen dem Auftreten von Beckenbodenbeschwerden und dem Geburtsmodus festgestellt. Dennoch zeigten 64 % der Frauen, die per Vakuumextraktion entbunden wurden, postpartale Inkontinenzsymptome. Beim Vergleich des Ultraschalls im dritten Trimenon mit dem 3 Monate post partum stieg die Mobilität des Blasenhalses unter Valsalva signifikant von 2 mm auf 10 mm an. Der retrovesikale Winkel verringerte sich von 132,6 ± 9,74° auf 128,3 ± 15,6°. Diese Veränderung war jedoch nicht signifikant. Die Hiatusfläche nahm unter Valsalva von 13,37 cm² auf 14,53 cm² zu, was jedoch nur nach Spontanpartus eine Signifikanz aufwies. 3 Monate nach der Entbindung wurde eine Avulsion des Musculus levator ani bei 2 Probandinnen nach Vakuumextraktion festgestellt, ein Ballooning (Fläche des Hiatus urogenitalis ≥ 25 cm²) wurde bei 2 Frauen nach Spontanpartus detektiert. 93 % der Frauen engagierten eine Hebamme im Wochenbett und 56 % der Probandinnen besuchten einen Rückbildungskurs. Frauen mit Inkontinenzsymptomen nutzen in nur 35 % der Fälle spezialisierte Behandlungsstrategien wie Elektrostimulation oder Physiotherapie. Schlussfolgerungen: Bindegewebsschwäche und ein hohes fetales Geburtsgewicht werden als signifikante Risikofaktoren für das Auftreten von Beckenbodenfunktionsstörungen identifiziert. Der Geburtsmodus ist kein signifikanter Risikofaktor für das Auftreten von Störungen des Beckenbodens. Dennoch gibt es Hinweise, dass insbesondere die Vakuumgeburt zu Veränderungen des Beckenbodens und damit langfristig zu Beckenbodenfunktionsstörungen führen kann. Die Daten weisen auf eine mögliche Regression der initialen Symptomatik im postpartalen Verlauf hin. Im Vergleich zur Schwangerschaft besteht nach der Entbindung unabhängig vom Geburtsmodus eine Zunahme der Blasenhalsmobilität. Präventive Behandlungsstrategien werden nur unzureichend genutzt, obwohl ihre Wirksamkeit erwiesen ist.The impact of pregnancy and childbirth on pelvic floor changes: A prospective longitudinal observational study Objectives: To assess changes in the pelvic floor during and after pregnancy in primiparous women with regard to the occurrence of pelvic floor dysfunction and the influence on women's quality of life. Methods: In a cohort of primigravidae with singleton pregnancy without complications, who presented to Saarland University Hospital for birth planning, POP-Q examinations and 2D/3D translabial ultrasound examinations were performed at rest and during Valsalva in the third trimester and 3 months after delivery. Subsequently, an offline analysis was performed to measure the position of the bladder neck, the retrovesical angle and the dimensions of the urogenital hiatus at rest and during Valsalva maneuver. Furthermore, the levator ani muscles were checked for the presence of a possible avulsion. The results were analyzed regarding prepartum and peripartum factors. 3 months and 12 months after delivery individualized, detailed questionnaires were handed out to determine potential incontinence symptoms, quality of life and behavior of the participants in the postpartum period. Results: 56 women were recruited, of whom 45 (80.4 %) completed the study. The mean age was 31 years. 17 participants (37.8 %) had a vaginal delivery, 17 participants (37.8 %) a Cesarean section and 11 participants (24.4 %) a vacuum extraction delivery. During pregnancy urinary incontinence was present in 12 women (26.7 %). At 3 months and 12 months after delivery 7 respectively 5 women reported urinary incontinence, 3 respectively 2 women reported anal incontinence and 7 respectively 1 woman reported combined incontinence. Discomfort during sexual intercourse, such as dyspareunia or a foreign body sensation in the vagina, was reported by 19 participants (42 %) 3 months after delivery and by 11 participants (24 %) one year after delivery. In POP-Q testing 4 women were found to have a cystocele I° during pregnancy. 3 months postpartum 7 participants had a cystocele I°, 3 participants had a rectocele I° and 5 participants had a descensus uteri I°. In a multivariat regression analysis connective tissue weakness, such as the presence of cellulite or striae (p=0.0483), and high fetal birth weight (p=0.0384) were identified as significant risk factors for the occurrence of pelvic floor dysfunction. In our study no significant association was found between the occurrence of pelvic floor disorders and delivery mode, although 64 % of women, who delivered by vacuum extraction, showed incontinence symptoms. Ultrasonography detected a significant increase in bladder neck mobility during Valsalva maneuver from 2 mm in pregnancy to 10 mm postpartum, which was independent of the delivery mode. Comparing pregnancy and 3 months postpartum the retrovesical angle decreased from 132.6 ± 9.74° to 128.3 ± 15.6°, which was not significant. Hiatal area increased during Valsalva from 13.37 cm² to 14.53 cm², but this was significant only after vaginal delivery. 3 months after delivery avulsion of the levator ani muscle was detected in 2 participants with vacuum extraction and ballooning (area of urogenital hiatus ≥ 25 cm²) was detected in 2 women after vaginal delivery. 93 % of women engaged a midwife and 56 % visited pelvic floor recovery courses postpartum. Women with incontinence symptoms used specialized treatment strategies such as electrostimulation or physiotherapy in 35 %. Conclusions: Significant risk factors for the occurence of pelvic floor disorders are connective tissue weakness and high fetal birth weight. Delivery mode is not a risk factor for the occurrence of pelvic floor disorders. Nevertheless, there is evidence that vacuum birth in particular can lead to changes in the pelvic floor and thus to pelvic floor dysfunction in the long term. The data indicate a possible regression of the initial symptoms in the postpartum period. Comparing pregnancy to after childbirth there is an increase in the bladder neck mobility regardless of the delivery mode. Although the effectiveness of preventive treatment strategies has been proven, they are insufficiently used

Phase transformations and local deformation mechanisms - A case study on Cu 20 m.% Sn

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Urogynecology in obstetrics: impact of pregnancy and delivery on pelvic floor disorders, a prospective longitudinal observational pilot study

Purpose To assess changes in the pelvic floor anatomy that cause pelvic floor disorders (PFDs) in primigravidae during and after pregnancy and to evaluate their impact on women’s quality of life (QoL). Methods POP-Q and translabial ultrasound examination was performed in the third trimester and 3 months after delivery in a cohort of primigravidae with singleton pregnancy delivering in a tertiary center. Results were analyzed regarding mode of delivery and other pre- and peripartal factors. Two individualized detailed questionnaires were distributed at 3 months and at 12 months after childbirth to determinate QoL. Results We recruited 45 women, of whom 17 delivered vaginally (VD), 11 received a vacuum extraction delivery (VE) and 17 a Cesarean section in labor (CS). When comparing third-trimester sonography to 3 months after delivery, bladder neck mobility increased significantly in each delivery group and hiatal area increased significantly in the VD group. A LAM avulsion was found in two women after VE. Connective tissue weakness (p = 0.0483) and fetal weight at birth (p = 0.0384) were identified as significant risk factors for the occurrence of PFDs in a multivariant regression analysis. Urinary incontinence was most common with 15% and 11% of cases at 3, respectively, 12 months after delivery. 42% of women reported discomfort during sexual intercourse, 3 months after delivery and 24% 12 months postpartum. Although 93% of women engage a midwife after delivery, only 56% participated in pelvic floor muscle training. Conclusion Connective tissue weakness and high fetal weight at birth are important risk factors for the occurrence of PFDs. Nevertheless, more parturients should participate in postpartal care services to prevent future PFDs

Uncovering the (un-)occupied electronic structure of a buried hybrid interface

The energy level alignment at organic/inorganic (o/i) semiconductor interfaces is crucial for any light-emitting or -harvesting functionality. Essential is the access to both occupied and unoccupied electronic states directly at the interface, which is often deeply buried underneath thick organic films and challenging to characterize. We use several complementary experimental techniques to determine the electronic structure of p -quinquephenyl pyridine (5P-Py) adsorbed on ZnO(1 0   −1 0). The parent anchoring group, pyridine, significantly lowers the work function by up to 2.9 eV and causes an occupied in-gap state (IGS) directly below the Fermi level EF. Adsorption of upright-standing 5P-Py also leads to a strong work function reduction of up to 2.1 eV and to a similar IGS. The latter is then used as an initial state for the transient population of three normally unoccupied molecular levels through optical excitation and, due to its localization right at the o/i interface, provides interfacial sensitivity, even for thick 5P-Py films. We observe two final states above the vacuum level and one bound state at around 2 eV above EF, which we attribute to the 5P-Py LUMO. By the separate study of anchoring group and organic dye combined with the exploitation of the occupied IGS for selective interfacial photoexcitation, this work provides a new pathway for characterizing the electronic structure at buried o/i interfaces.Deutsche Forschungsgemeinschafthttps://doi.org/10.13039/501100001659Peer Reviewe

Tropical Pacific climate response to obliquity forcing in the Pleistocene

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95532/1/palo1247.pd

Digital support of narrative writing skills for students with special educational needs. A systematic review

Die Fähigkeit, Gedanken schriftlich festzuhalten, ist für gesellschaftliche Teilhabe unabdingbar. Viele Schülerinnen und Schüler erwerben diese Kompetenz jedoch nicht in ausreichendem Maße und benötigen deswegen eine zusätzliche spezifische Förderung. Vor dem Hintergrund einer zunehmenden Bedeutung der Digitalisierung im Bildungsbereich stellt sich die Frage, welche wissenschaftlichen Erkenntnisse bezüglich digitaler Schreibinterventionen bei Schülerinnen und Schülern mit unterschiedlichen diagnostizierten Unterstützungsbedarfen existieren. Das vorliegende systematische Literatur-Review gibt einen Überblick über den gegenwärtigen internationalen Forschungsstand. Insgesamt wurden 40 Zeitschriftenartikel und 11 Dissertationen in die Beurteilung einbezogen. Es zeigt sich, dass digitale Förderung unabhängig vom Förderbedarf, vom Alter und von der Schulform dazu beitragen kann, die narrative Schreibkompetenz zu verbessern. Eine Zuordnung der genutzten digitalen Elemente anhand des SAMR-Modells (Puentedura, 2006) gibt einen Hinweis darauf, dass diese hauptsächlich die analogen Elemente ersetzen und erweitern und weniger der Umgestaltung der Aufgaben zuzuordnen sind. Trotz der Vielzahl an einschlägigen empirischen Arbeiten ist die Datenbasis im Hinblick auf hochwertige Studien allerdings noch zu gering, um verlässliche und allgemeingültige Aussagen über die Wirkungen treffen zu können. (DIPF/Orig.)The ability to capture thoughts in a written form is essential for social participation. However, many students develop this skill insufficiently and therefore require additional specific support. Digitalization in education is gaining in importance. The question therefore arises which scientific findings exist regarding digital writing interventions for students with different diagnosed educational needs. This systematic literature review provides an overview of the current state of international research. A total of 40 journal articles and 11 dissertations were included in the review. It is found that digital support is able to improve narrative writing skills regardless of diagnosed educational need, age, and school type. A categorization of the digital elements used based on the SAMR model (Puentedura, 2006) indicates that they mainly substitute and augment the analog elements and are less associated with modification and redefinition. However, despite the large amount of relevant empirical works, the data base in terms of high-quality studies is still too small to draw reliable and generalizable conclusions about the effects. (DIPF/Orig.

Sea surface temperature pattern reconstructions in the Arabian Sea

Author Posting. © American Geophysical Union, 2006. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Paleoceanography 21 (2006): PA1014, doi:10.1029/2005PA001162.Sea surface temperature (SST) and seawater δ18O (δ18Ow) were reconstructed in a suite of sediment cores from throughout the Arabian Sea for four distinct time intervals (0 ka, 8 ka, 15 ka, and 20 ka) with the aim of understanding the history of the Indian Monsoon and the climate of the Arabian Sea region. This was accomplished through the use of paired Mg/Ca and δ18O measurements of the planktonic foraminifer Globigerinoides ruber. By analyzing basin-wide changes and changes in cross-basinal gradients, we assess both monsoonal and regional-scale climate changes. SST was colder than present for the majority of sites within all three paleotime slices. Furthermore, both the Indian Monsoon and the regional Arabian Sea mean climate have varied substantially over the past 20 kyr. The 20 ka and 15 ka time slices exhibit average negative temperature anomalies of 2.5°–3.5°C attributable, in part, to the influences of glacial atmospheric CO2 concentrations and large continental ice sheets. The elimination of the cross-basinal SST gradient during these two time slices likely reflects a decrease in summer monsoon and an increase in winter monsoon strength. Changes in δ18Ow that are smaller than the δ18O signal due to global ice volume reflect decreased evaporation and increased winter monsoon mixing. SSTs throughout the Arabian Sea were still cooler than present by an average of 1.4°C in the 8 ka time slice. These cool SSTs, along with lower δ18Ow throughout the basin, are attributed to stronger than modern summer and winter monsoons and increased runoff and precipitation. The results of this study underscore the importance of taking a spatial approach to the reconstruction of processes such as monsoon upwelling.Analyses were funded by a SGER grant from the NSF (OCE03–34598). Funding was also provided by a Schlanger Ocean Drilling Program Fellowship (to K.A.D.) and NSF Grant OCE02–20776 (to D.W.O.). 1

Monsoon hydrography and productivity changes in the East China Sea during the past 100,000 years : Okinawa Trough evidence (MD012404)

Author Posting. © American Geophysical Union, 2009. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Paleoceanography 24 (2009): PA3208, doi:10.1029/2007PA001577.We analyzed the high-resolution foraminifer isotope records, total organic carbon (TOC), and opal content from an Okinawa Trough core MD012404 in order to estimate the monsoon hydrography and productivity changes in the East China Sea (ECS) of the tropical western Pacific over the past 100,000 years. The variability shown in the records on orbital time scales indicates that high TOC intervals coincide with the increases of boreal May–September insolation driven by precession cycles (∼21 ka), implying a strong connection to the variations in monsoons. We also observed possibly nearly synchronous, millennial-scale changes of the ECS surface hydrography (mainly driven by salinity changes but also by temperature effects) and productivity coincident with monsoon events in the Hulu/Dongge stalagmite isotope records. We found that increased freshening and high productivity correlate with high monsoon intensity in interstadials. This study suggests that the millennial-scale changes in monsoon hydrography and productivity in the ECS are remarkable and persistent features over the past 100,000 years.Y.Y.’s work was partly supported by Global Environmental Research Fund (RF-081) and JSPS Kakenhi (21674003)