Risk factors for stress urinary incontinence following vaginal and caesarean delivery

Abstract   Background: Most of the stress urinary incontinence (SUI) occurs after first delivery and related to the mode of delivery. Objective: To determine the factors that affects the incidence of stress urinary incontinence post partum Methods: Women experienced with stress urinary incontinence 3 months after birth vaginally or section caesarean were enrolled in the present cross sectional study. The strength of the pelvic floor muscle measured with perineometer. All of women were assessed for SUI using Sandvix Severity Index (SSI) dan The three incontinence question (3IQ) questionnaire. A person chi-square test was used to analysis with p value <0.05 was considered significant. Results: Eighty-four women with stress urinary incontinence  (SUI) after vaginal delivery or caesarean section enrolled in the study. There was a significant difference between mode of delivery and SUI following delivery (p<0.05). Perineal tear (grade 1-2), BMI, newborn weight and circumference significantly affect the SUI after vaginal or caesarean section. Perineal tear increase SUI after delivery 7-fold compared to other factors (OR=7.367; 95% CI=1.815-29.904). Conclusion : SUI after delivery affected by Mode of delivery, pelvic muscle floor weakness, perineal tear, BMI, newborn weight and head circumference.   Keywords: stress urinary incontinence, mode of delivery     Abstrak   Latar belakang: Sebagian besar kasus stress inkontinensia urin terjadi setelah partus pertama kali dan berhubungan dengan metode persalinan. Tujuan: Untuk mengetahui faktor-faktor yang mempengaruhi terjadinya stress inkontinensia urin post partum Metode: Wanita yang mengalami stres inkontinensia urin 3 bulan postpartum normal atau seksio dilibatkan dalam penelitian cross sectional ini. Kekuatan otot dasar panggul diukur dengan perineometer. Penilaian SUI dilakuakn dengan menggunakan kuesioner Sandvix Severity Index (SSI) dan The three incontinence question (3IQ). Data dianalisis dengan uji Chi-square dengan tingkat kemaknaan p<0,05. Hasil: Delapan puluh empat wanita dengan SIU postpartum per vaginam atau operasi caesar dilibatkan dalam penelitian ini. Terdapat perbedaan signifikan antara cara persalinan dan SIU setelah postpartum (p<0,05). Ruptur perineum (grade 1-2), IMT, berat bayi lahir dan lingkar kepala secara signifikan mempengaruhi SIU postpartum. Ruptur perineum meningkatkan SUI postpartum 7 kali lipat dibandingkan dengan faktor-faktor lainnya (OR = 7,367; 95% CI = 1,815-29,904). Kesimpulan: SIU postpartum dipengaruhi oleh cara persalinan, kelemahan dasar otot panggul, robekan perineum, IMT, berat bayi lahir dan lingkar kepala.   Kata kunci : stress inkontinensia urin, metode persalina

Perineal Massage during Second Stage of Labor to the Perineal Laceration Degree in Primigravida

Objective: To determine the effect of perineal massage during second stage of labor on the perineal laceration degree in primigravida. Methods: The design of this study was non randomized controlled trial by conducting massage training of the perineum to 20 obstetrics and gynecology residents. All residents had passed the normal delivery care training. Primigravida who met the inclusion criteria were included in this study. We assessed the degree of perineal laceration in this study. Data were analyzed using Chi square test in SPSS. Results: We obtained 103 subjects for massage group and 79 subjects for control group. There was a significant association between massage group and the incidence of intact perineum. In the massage group, most of perineal lacerations were first degree of laceration (52.4%); whereas, in the control group, most of them were second degree of laceration (77.2%). Statistical analysis showed a significant association between perineal massage and decreased of perineal laceration degree (

Effect of Postpartum Pelvic Floor Muscles Training in Pelvic Floor Muscles Strength on Postpartum Women with Stress Urinary Incontinence

Objective: To evaluate the effect of pelvic floor training (Kegelexercise) on pelvic floor muscle strength in postpartum womenwith SUI.Methods: Thirty-five birth vaginally postpartum women with SUIwere experimentally enrolled. After four weeks of postpartumobservation, the diagnosis of SUI confirmed, and all of these womenwere asked to complete the International Consultation onIncontinence Questionnaire-Sort Form (ICIQ-SF) questionnaire.The strength of the pelvic floor muscle measured with perineometerevery once in 3 weeks for 12 weeks of Kegel exercise. SUI severityassessed with ICIQ-SF after completing the Kegel exercise. A pairedt-test was used to compare measurement results between ICIQ-SFquestionnaire and perineometer and multiple linear regressionmodels was used for multivariate analysis. A p value of less than 0.05was taken to be statistically significant.Results: Findings show a significant difference between clinicalvariables (parity, neonates birth weight, perineal tear grade, BMI)and the improvement of pelvic floor muscles before and afterperformed the Kegel exercise (all p&lt;0.05). The pelvic floormuscles strength significantly improved (p=0.000) after Kegelexercise both in ICIQ-SF questionnaire and perineometermeasurement.Conclusion: Pelvic muscles floor training or Kegel exercise improvepelvic muscles floor strength in postpartum women with SUI.[Indones J Obstet Gynecol 2018; 6-2: 114-118]Keywords: pelvic muscles floor training, postpartum, stress urinaryincontinenc

Lidocaine Prilocaine Cream versus LidocaineHCL Injection for Pain Relief during Second Degree of Perineal Tear Suturing after Vaginal Delivery: A Comparative Study

Abstract Objective : To compare the effectiveness of topically applied lidocaine-prilocaine cream with lidocaine-HCl injection in the reduction of pain during second degree of perineal tear suturing after vaginal delivery. Methods : One hundred and twenty-four of women with second degree of perineal tear after vaginal delivery were enrolled in this randomized clinical trial. Women were assigned randomly to have either application of lidocaine-prilocaine cream (n=62) or local injection of lidocaine-HCl (n=62) for anesthetic during perineal suturing. Pain measured with viasual analog scale (VAS) for the first 5 minutes during the perineal suturing. Statistical analysis was performed by comparative analytic numerical unpaired with independent t test between the two groups and significance was assessed at p<0.05. Data were presented as mean ± standard deviation (SD). Results : There was no significantly different of pain score between lidocaine-prilocaine cream and lidocaine-HCl injection group (5.66±1.07 vs 5.56±1.5; p=0.473). Conclusion : Application of lidocaine-prolicaine cream as effective as injection of lidocaine for reducing pain during second degree of perineal tear suturing after vaginal delivery. Keywords : Lidocaine-prilocaine cream, lidocaine-HCl injection, pain, perineal suturing, vaginal delivery     Abstrak Tujuan: Untuk membandingkan efektivitas antara lidokain-prilokain topikal dan lidokain-HCl injeksi dalam mengurangi nyeri selama penjahitan luka perineum tingkat dua setelah persalinan normal. Metode: Seratus dua puluh empat perempuan dengan robekan perineum tingkat dua postpartum pervaginam mengikuti uji coba klinis secara acak ini. Enam puluh dua perempuan (n=62) menggunakan lidokain-prilokain topikal dan 62 perempuan lainnya (n=62) menggunakan injeksi lokal lidokain-HCl untuk anestesi selama penjahitan perineum. Nyeri diukur dengan visual analog scale (VAS) untuk 5 menit pertama selama penjahitan perineum. Analisis statistik dilakukan dengan uji numerik komparatif tidak berpasangan dengan uji t independen antara kedua kelompok dengan tingkat kemaknaan p<0,05. Data disajikan sebagai rerata ± standar deviasi (SD). Hasil: Tidak terdapat perbedaan signifikan skor nyeri antara kelompok  lidokain-prilokain topikal dan kelompok injeksi lidokain-HCl (5,66 ± 1,07 vs 5,56 ± 1,5; p = 0,473). Kesimpulan : Efektifitas lidokain-prolikain topikal untuk mengurangi nyeri sama dengan injeksi lidokain-HCl selama penjahitan robekan perineum tingkat dua postpartum pervaginam. Kata kunci : Lidokain-prolikain topical, lidokain-HCl injeksi, nyeri, penjahitan perineum, persalinan norma

Perineal Body Length and Pelvic Organ Prolapse in Menopausal Women: Panjang Perineal Body dan Prolaps Organ Panggul pada Wanita Menopause

Abstract Objective: To determine the correlation between the perineal body length and the pelvic organ prolapse (POP) in menopausal women. Methods: The total vaginal length (TVL), genital hiatus (GH), and perineal body (PB) length as the POP-Q component were measured at 60 menopausal women enrolled in a cross-sectional study. Results: Menopausal women with POP have the shorter perineal body (63.3%; &lt;3 cm) compared with menopausal women without POP (36.7%; ≥3 cm). The mean length of the perineal body in menopausal women who suffer POP 2.81 ± 0.26 cm while in women without POP is 3.23±0.17 cm. POP risk was 25 times in menopausal women with a perineal body length &lt;3 cm compared with longer perineal body (p = 0.01; OR = 25.4; 95% CI 3.1-209.1).Conclusion: Perineal body length is a risk factor for pelvic organ prolapse in menopausal women.Keywords: perineal body, prolapse, pelvic organ prolapsed Abstrak Tujuan: Menentukan korelasi panjang perineal body dengan kejadian prolaps organ panggul (POP) pada perempuan menopause. Metode: Pengukuran komponen POP-Q meliputi total vaginal length (TVL), genital hiatus (GH), dan panjang perineal body (PB) dilakukan pada 60 perempuan menopause yang dilibatkan dalam penelitian potong lintang. Hasil: &nbsp;&nbsp; Perempuan menopause dengan POP memiliki perineal body yang lebih pendek (63,3%; &lt;3 cm) dibandingkan dengan perempuan menopause tanpa POP (36,7%; ≥3 cm). Panjang rata-rata perineal body pada perempuan menopasue yang menderita POP 2,81 ± 0,26 cm sedangkan pada perempuan tanpa POP adalah 3,23 ± 0,17 cm. Risiko POP 25 kali pada perempuan menopause dengan panjang perineal body &lt;3 cm dibandingkan dengan tubuh perineum yang lebih panjang (p = 0,01; OR = 25,4; 95% CI 3,1-209,1). Kesimpulan: Panjang perineal body merupakan faktor risiko prolaps organ panggul pada perempuan menopause. Kata kunci : perineal body, prolapsed, prolaps organ panggu

The 45o Mediolateral Episiotomy: Does it Reduce to the Incidence of Extended Laceration Incidence and Postlabour Pain? Episiotomi Mediolateral 45 Derajat terhadap Kejadian Perluasan Cedera dan Nyeri Pascasalin pada Primigravida

Abstract Objective: To see the relation between 45 and 60 degrees mediolateral episiotomy to extended laceration incidence and post labor pain in primigravida.Method: The research used simple randomization design which was conducted in the Department of Obstetrics and Gynecology, Teaching Hospital, Faculty of Medicine, Universitas Hasanuddin from April 2018 to September 2018. There were 80 samples for the 45 degrees mediolateral episiotomy group and 80 samples for the 60 degrees group.Result: After the Chi-Square correlation test has been carried out, the research result indicates that there is higher incidence in 60 degrees mediolateral episiotomy group in extended perineal laceration (p=0.002), and Fisher Exact test shows that post labor pain (p=0.000) higher in the same group compared to the 45 degrees group.Conclusion: Mediolateral episiotomy 45 degrees has lower extended perineal laceration and post labor pain compared to the 60 degrees group.Key Words: episiotomy, mediolateral 45, mediolateral 60, perineal laceration, postlabor pain, primigravida &nbsp; Abstrak Tujuan: mengetahui hubungan episiotomi mediolateral 45 dan 60 derajat terhadap kejadian perluasan cedera dan nyeri pasca salin pada primigravida.Metode: simple randomization. Penelitian dilaksanakan di Rumah Sakit Pendidikan Departemen Obstetri dan Ginekologi Fakultas Kedokteran Universitas Hasanuddin periode April 2018–September 2018. Total sampel yang diperoleh adalah 80 untuk kelompok 45 derajat dan 80 sampel untuk kelompok 60 derajat.Hasil: setelah dilakukan uji hubungan dengan Chi Square terdapat hubungan yang signifikan pada episiotomi 60 derajat dengan kejadian perluasan cedera (p=0.002) dan uji Fisher menyatakan hubungan bermakna nyeri pasca salin pada kelompok yang sama (p=0,000) dibandingkan episiotomi 45 derajat. Episiotomi mediolateral 45 derajat memiliki luaran lebih sedikit menyebabkan kejadian perluasan cedera dan nyeri pasca salin dibandingkan episiotomi 60 derajat.Kata kunci: episiotomi, mediolateral 45, mediolateral 60, ruptur perineum, nyeri pasca salin, primigravid

Perbandingan Inkontinensia Urin Ibu Hamil Aterm Primigravida dan Multigravida Berdasarkan QUID (Questionnaire for Urinary Incontinence Diagnosis) dan Faktor Risiko yang Berpengaruh

Tujuan: Penelitian ini bertujuan untuk menganalisis inkontinensia urin pada ibu hamil primigravida dan multigravida aterm berdasarkan kuisioner Questionnaire for Urinary Incontinence Diagnosis (QUID) dan faktor risiko yang berpengaruh. Metode : Penelitian ini menggunakan metode case control  analitik observasional untuk melihat pengaruh faktor risiko terhadap inkontinensia urin pada primigravida dan multigravida dan kemudian dilanjutkan dengan metoda survei secara cross-sectional untuk melihat perbandingan inkontinensia urin pada primigravida dan multigravidaHasil: Faktor risiko yang berhubungan dengan kejadian inkontinensia urin adalah ibu dengan adanya riwayat inkontinensia sebelum kehamilan (p=0,003), pendidikan (p=0,032), kategori pekerjaan (p=0,012), dan umur (0,003). Dari analisis regresi logistik menunjukkan faktor yang paling berpengaruh adalah Inkontinensia sebelum kehamilan dengan Risk ratio (RR) 15,750. Tidak didapatkan adanya hubungan bermakna antara paritas  primigravida dan multigravida terhadap jenis inkontinensia urin (P=0,671).Kesimpulan: Pada Primigravida faktor risiko yang mempunyai hubungan terhadap terjadinya inkontiensia urin adalah Indeks Massa Tubuh dan Taksiran berat janin. Pada Multigravida faktor risiko yang mempunyai hubungan terhadap terjadinya inkontiensia urin adalah Indeks Massa Tubuh dan riwayat inkontinensia sebelum kehamilan. Tidak  ada  hubungan bermakna antara paritas  primigravida dan multigravida terhadap jenis inkontinensia urin.Comparison of Urinary Incontinence in Primigravida and Multigravida Pregnant Women Based on QUID (Questionnaire for Urinary Incontinence Diagnosis) and Influential Risk FactorsAbstractObjective: This study aims to analyze urinary incontinence in primigravida and multigravida term pregnant women based on the Questionnaire for Urinary Incontinence Diagnosis (QUID) questionnaire and the risk factors that influence it.Method: This study used an observational analytical case control method to see the effect of risk factors on urinary incontinence in primigravida and multigravida and then continued with a cross-sectional survey method to compare urinary incontinence in primigravida and multigravida.Results: Risk factors associated with the incidence of urinary incontinence are mothers with a history of incontinence before pregnancy (p=0.003), education (p=0.032), occupational categories (p=0.012), and age (0.003). Logistic regression analysis showed the most influential factor was pre-pregnancy incontinence with RR 15,750. There was no meaningful association between primigravida parity and multigravida to the type of urinary incontinence (P 0.671).Conclusion: In Primigravida, the risk factors that have an association with urine inconsistency are body mass index and fetal weight estimate. In Multigravida risk factors that have an association with the occurrence of urine inconsistencies are body mass index and history of incontinence before pregnancy. There is no meaningful relationship between primigravida parity and multigravida to this type of urinary incontinence.Key words: Urinary incontinence, Primigravida, Multigravida, Hamil aterm, QUID, cough tes