Early diagnosis and prevention of pelvic and urodynamic dysfunctions in women after delivery

Cover Page

Cite item

Abstract

Background. According to various researchers, obstetric perineal injury is the most commOn complication in childbirth, the frequency of which can vary from 13 to 85%. Currently, vaginal delivery and birth trauma are recognized as the leading risk factors for the development of pelvic, urodynamic and sexual dysfunctions. Urinary and fecal incontinence, pelvic organ prolapse, sexual health disorders, chronic pelvic pain and the presence of cosmetic defects in the perineum are the reasons for a significant decrease in the quality of life of women after delivery. Recently, there has been a tendency to "rejuvenate" dysfunctions of the ligamentous apparatus and muscles of the pelvic floor, which support the pelvic organs in a normal position in women after the first birth. In the absence of timely diagnosis and treatment, anatomical changes and clinical symptoms will rapidly progress, forming persistent dysfunctions of the pelvic organs.

Aim. To evaluate pelvic and urodynamic dysfunctions in women after per vias naturales delivery with concomitant perineal trauma.

Materials and methods. A prospective cohort comparative study was conducted, which included 55 women of reproductive age after delivery per vias naturales of the fetus in cephalic presentation. The main group consisted of 30 women who had a perineal injury during childbirth, the control group included 25 women with uncomplicated straining period. All patients 3–4 months after delivery underwent a gynecological examination with perineometry, ultrasound examination of the pelvic organs, as well as a comprehensive urodynamic study.

Results. Women with a perineal injury during childbirth were significantly more likely to complain of frequent urination and urinary incontinence during physical exertion than women in the control group – 70.0% versus 40.0% and 76.7% versus 40.0% of cases respectively (p<0.05). According to the ultrasound data, the patients of the main group had a significantly more pronounced deviation of the angle α and the angle β during straining in comparison with the control group – 4.67±2.6º versus 2.65±1.1º and 11.93±7.1º versus 7.10±4.7º respectively (p<0.05). Statistically significant differences were also obtained when measuring the strength of the pelvic floor muscles in patients with perineal injury in comparison with the control group – 68.17±5.8 mmHg versus 76.80±5.3 mmHg (p<0.05). According to urofluometry, the patients of the main group showed a statistically significant decrease in the rate of average and maximum urine flow than in the women of the control group – 11.69±3.8 ml/sec versus 17.90±2.1 ml/sec and 20.61±7.0 ml/s versus 25.22±3.1 ml/s respectively (p<0.05).

Conclusion. The results obtained indicate the occurrence of urodynamic and pelvic disorders in women during the first 4 months after childbirth, complicated by perineal trauma. In women who have experienced birth trauma, such pelvic and urodynamic dysfunctions as hypermobility of the urethrovesical segment in 86% of cases, a decrease in the strength of the pelvic floor muscles in 54% of cases, and a decrease in the average urine flow rate in 25% of cases were revealed. These disorders can be diagnosed using available non-invasive instrumental examination methods, such as ultrasound, perineometry and uroflowmetry. Thus, there is a need for early detection of pelvic floor dysfunctions for the purpose of subsequent treatment after childbirth, which in turn will help prevent the progression of genital prolapse and urinary incontinence, prevent their severe forms, reduce the need for surgical interventions and preserve the quality of life of women.

Full Text

\

×

About the authors

Anna A. Mikhelson

Urals Scientific Research Institute for Maternal and Child Care

Author for correspondence.
Email: ann_lukach@list.ru
ORCID iD: 0000-0003-1709-6187

D. Sci. (Med.)

Russian Federation, Ekatеrinburg

Galina B. Malgina

Urals Scientific Research Institute for Maternal and Child Care

Email: galinamaldina@mail.ru
ORCID iD: 0000-0002-5500-6296

D. Sci. (Med.), Assoc. Prof.

Russian Federation, Ekatеrinburg

Ksenia D. Lukianova

Urals Scientific Research Institute for Maternal and Child Care

Email: k.d.lukianova@mail.ru
ORCID iD: 0000-0001-5739-2197

Graduate Student

Russian Federation, Ekatеrinburg

Mariia V. Lazukina

Urals Scientific Research Institute for Maternal and Child Care

Email: masha_balueva@mail.ru
ORCID iD: 0000-0002-0525-0856

Cand. Sci. (Med.)

Russian Federation, Ekatеrinburg

Evgenia V. Lugovykh

Urals Scientific Research Institute for Maternal and Child Care

Email: usovaev94@gmail.com
ORCID iD: 0000-0003-4687-6764

Grаduate Studеnt

Russian Federation, Ekatеrinburg

Anatoly N. Varaksin

Institute оf Industriаl Еcоlogy

Email: varaksinanatolij2@gmail.com
ORCID iD: 0000-0003-2689-3006

D. Sci. (Phys.-Math.), Prof.

Russian Federation, Ekaterinburg

Maria A. Lukach

Urals Scientific Research Institute for Maternal and Child Care

Email: mary.lukach13@gmail.com
ORCID iD: 0000-0001-5570-3713

Medical Resident

Russian Federation, Ekatеrinburg

Elvira A. Nesterova

Urals Scientific Research Institute for Maternal and Child Care

Email: elvira.nesterova.85@mail.ru
ORCID iD: 0000-0002-5591-6046

Cand. Sci. (Med.)

Russian Federation, Ekatеrinburg

References

  1. Жабченко И.А. Современные подходы к профилактике акушерского травматизма и его последствий. Репродуктивная медицина. 2020;2(43):50-5 [Zhabchenko IA. Modern approaches to the prevention of obstetric trauma and its consequences. Reproductive Medicine. 2020;2(43):50-5 (in Russian)]. doi: 10.37800/RM2020-1-15
  2. Кажина М.В. Акушерские проблемы тазового дна. Охрана материнства и детства. 2017;1(29):47-51 [Kazhina MV. Obstetric problems of the pelvic floor. Protection of motherhood and childhood. 2017;1(29):47-51 (in Russian)].
  3. Сойменова О.И., Бычков И.В., Бычков В.И., Фролов М.В. Проблема родового травматизма при естественном родоразрешении. Системный анализ и управление в биомедицинских системах. 2013;12(1):217-25 [Soimenova OI, Bychkov IV, Bychkov VI, Frolov MV. The problem of birth trauma in natural delivery. System analysis and control in biomedical systems. 2013;12(1):217-25 (in Russian)].
  4. Оразов М.Р., Кампос Е.С., Радзинский В.Е., Хамошина М.Б. Структура перинеальной травмы при повторных родах. Хирургическая практика. 2016;4:34-6 [Orazov MR, Campos ES, Radzinsky VE, Khamoshina MB. The structure of perineal trauma in repeated births. Surgical practice. 2016;4:34-6 (in Russian)].
  5. Токтар Л.Р., Крижановская А.Н. 31% разрывов за ширмой классификации. Ранняя диагностика интранатальных травм промежности как первый шаг к решению проблемы. Status Praesens. 2012;5(11):61-7 [Toktar LR, Krizhanovskaya AN. 31% gaps behind the classification screen. Early diagnosis of intranatal perineal injuries as the first step towards solving the problem. Status Praesens. 2012;5(11):61-7 (in Russian)].
  6. Cyr M-P, Kruger J, Wong V, et al. Morin Pelvic floor morphometry and function in women with and without puborectalis avulsion in the early postpartum period. Am J Obstet Gynecol. 2017;216(3):274. doi: 10.1016/j.ajog.2016.11.1049
  7. Ящук А.Г., Мусин И.И., Нафтулович Р.А., Камалова К.А. Современный подход к реабилитации женщин после родов через естественные родовые пути. Практическая медицина. 2017;7:31-4 [Yashchuk AG, Musin II, Naftulovich RA, Kamalova KA. A modern approach to the rehabilitation of women after childbirth through the natural birth canal. Practical medicine. 2017;7:31-4 (in Russian)].
  8. Бычков И.В., Сойменова И.В., Бычков В.И. Методика хирургического восстановления промежности у женщин при самостоятельных родах. Вестник экспериментальной и клинической хирургии. 2013;6(2):250-3 [Bychkov IV, Soimenova IV, Bychkov VI. The technique of surgical restoration of the perineum in women with independent childbirth. Bulletin of Experimental and Clinical Surgery. 2013;6(2):250-3 (in Russian)].
  9. Радзинский В.Е. Перинеология: болезни женской промежности в акушерско-гинекологических, сексологических, урологических, проктологических аспектах. М.: Медицинское информационное агентство, 2006 [Radzinsky VE. Perineologiia: bolezni zhenskoi promezhnosti v akushersko-ginekologicheskikh, seksologicheskikh, urologicheskikh, proktologicheskikh aspektakh. Moscow: Meditsinskoe informatsionnoe agentstvo, 2006 (in Russian)].
  10. Harvey M. Pelvic floor exercises during and after pregnancy: a systematic review of their role in preventing pelvic floor dysfunction. J Obstet Gynaecol Can. 2003;25(6):487-98. doi: 10.1016/s1701-2163(16)30310-3
  11. Осипова Н.А., Ниаури Д.А., Зиятдинова Г.М. Нарушение мочеиспускания при беременности и после родов. Журнал акушерства и женских болезней. 2017;66:59-60 [Osipova NA, Niauri DA, Ziyatdinova GM. Urination disorders during pregnancy and after childbirth. Journal of Obstetrics and Women's Diseases. 2017;66:59-60 (in Russian)].
  12. Петров С.Б., Безменко А.А., Куренников А.В., Беженарь В.Ф. Недержание мочи. Урологическая гинекология. СПб.: Фолиант, 2006, с. 147-232 [Petrov SB, Bezmenko AA, Kurennikov AV, Bezhenar' VF. Nederzhanie mochi. Urologicheskaya ginekologiya. Saint Petersburg: Foliant, 2006, р. 147-232 (in Russian)].
  13. Brown S, Gartland D, Perlen S, et al. Consultation about urinary and faecal incontinence in the year after childbirth: a cohort study. BJOG. 2015;122(7):954-62. doi: 10.1111/1471-0528.12963
  14. Балан В.Е., Ковалева Л.А. Проблемы нарушения мочеиспускания в разные периоды женщины. Эффективная фармакотерапия. 2013;36:32-8 [Balan VE, Kovaleva LA. Problems of urination disorders in different periods of a woman. Еffective pharmacotherapy. 2013;36:32-8 (in Russian)].
  15. Cardozo L, Staskin D. Pregnancy and childbirth. Textbook of female Urology and Urogynaecology. UK, 2002, p. 977-94.
  16. Bani D. Relaxin: a pleiotropic hormone. Gen Pharmacol. 1997;28(1):13-22. doi: 10.1016/s0306-3623(96)00171-1
  17. Weber AM, Richter HE. Pelvic organ prolapse. Obstet Gynecol. 2005;106(3):615-34. doi: 10.1097/01.AOG.0000175832.13266.bb
  18. Lien KC, Mooney B, DeLancey JO, Ashton-Miller JA. Levator ani muscule stretch induced by simulated vaginal birth. Obstet Gynecol. 2004;103(1):31-40. doi: 10.1097/01.AOG.0000109207.22354.65
  19. Радзинский В.Е., Дурандин Ю.М., Голикова Т.П., и др. Травмы промежности в родах. Клинический анализ структуры, причин и отдаленных последствий. Вестник Российского университета дружбы народов. Медицина. 2012;1:91-5 [Radzinsky VE, Durandin YuM, Golikova TP, et al. Perineal trauma during childbirth. Clinical analysis of the structure, causes and long-term effects. Bulletin of the Peoples' Friendship University of Russia. Medicine. 2012;1:91-5 (in Russian)].

Supplementary files

Supplementary Files
Action
1. Fig. 1 Urodynamic disorders in women after natural delivery.

Download (105KB)
2. Fig. 2. Psychological problems associated with urodynamic disorders in women.

Download (105KB)
3. Fig. 3 Perineometry results.

Download (102KB)
4. Fig. 4. Evaluation of uroflowmetry.

Download (92KB)
5. Fig. 5. Mean and maximum urine flow according to uroflowmetry (mL/s).

Download (137KB)

Copyright (c) 2022 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС77-63961 от 18.12.2015.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies