PREVALENCE OF PELVIC FLOOR DYSFUNCTIONS IN PRIMIPAROUS 12 TO 24 MONTHS AFTER VAGINAL DELIVERY
M. PEREIRA1, M. MONTEIRO 2, Z. S. REIS 3, E. M. FIGUEIREDO 4, M. C. CRUZ 1, M. MEINBERG 1;
1Department of Obstetrics and Gynaecology, Univ.e Federal de Minas Gerais, Belo Horizonte, Brazil, 2FEDERAL Univ. OF MINAS GERAIS, BELO HORIZONTE, Brazil, 3Univ.e Federal de Minas Gerais, Belo Horizonte, Brazil, 4UNIVERSIDADE FEDERAL DE MINAS GERAIS, BELO HORIZONTE, Brazil.
Introduction: Pelvic floor dysfunction may appear following delivery. The main postpartum disorders are urinary incontinence, anal incontinence, perineal pain and sexual dysfunction1. Approximately 31% of women, who have vaginal birth, develop urinary incontinence and 4,3% anal incontinence2.
Objective: The aim of this study is assessing, prospectively, the prevalence of the pelvic floor dysfunction in primiparous twelve to twenty-four month after vaginal birth.
Methods: This is an observational study with prospective analysis. We include randomly all vaginal birth of primiparous women that occurred between January 2013 and December 2015. The present study was approved by the Research Ethics Committee of the Federal University of Minas Gerais in accordance with the Code of Ethics of the Declaration of Helsinki and informed, written consent was obtained accordingly. Clinical and obstetric data of interest were obtained from the clinical database of the Hospital das Clinicas, Federal University of Minas Gerais, SISMater. We included birth information such as diabetes, gemelar birth, prematurity, anesthesia, lithotomy position, episiotomy, shoulder dystocia, occurrence of perineal laceration, oxytocin use, forceps, birthweight, gestational age, duration of active phase and maternal age. Active phase was calculated by subtracting the time of birth from the initial registration time in the partogram. Women with perineal laceration were assessed and classified as no laceration, mild laceration (grade I and II) and severe laceration (grade III and IV). All participants answered the following questionnaires: ICIQ-SF (The International Consultation of Incontinence Questionnaire - Short Form), Wexner Scale and FSFI (Female Sexual Function Index). All categorical variables were evaluated according to their absolute and relative frequency (percentage). For the categorical variables, the Pearson Chi-Square Test (X2) and Fisher's Exact Test were used. The Odds Ratio was calculated to determine the prognostic values of the exposure factors in relation to the chosen outcomes. In all statistical calculations the level of significance was 0.05 and confidence level was 0.95. Statistical analysis was performed using statistical software SPSS version 21.0.
Results: The present study selected 773 primiparous women from the database that delivered vaginally from January 2013 to December 2015. Of these, 624 were contacted by telephone to participate in the study and 149 were not found or did not answer the phone calls. Only 76 women accepted to participate of the study. Both Diabetes and Gemelar Birth represented only 2.7% of the women studied. Prematurity was found in 9.3% of the cases and Shoulder Dystocia was not found in any of the cases studies. Anesthesia was used in 33 women and restrictive episiotomy was performed in 44, representing respectively 44 and 58.7%. Perineal laceration occurred in 66 primiparous. Of these, 12 presented first degree perineal laceration, 47 second degree and seven third degree perineal laceration. Fourth degree laceration was not found in any women assessed. Oxytocin in the first and second stage of the labor was used in 26.7% and forceps was performed in only 11 participants. The mean maternal age of the primiparous was 25.8 years and the gestational age was 38.25 weeks. The prevalence of urinary incontinence was found in 32.8% of the participants assessed. The same percentage of women presented anal incontinence. Sexual dysfunction occurred in 56.7% of women studied. The use of oxytocin and forceps delivery were statistically significant when associated with urinary incontinence representing (P= 0,016) and (P=0,034) respectively. Labor anesthesia was statistically significant when associated with sexual dysfunction representing (P=0,029). This finding seems to find no correlation with the clinical findings related to sexual dysfunction. Anal incontinence were not statistically significant for any risk factors evaluated.
Conclusions: The prevalence of anal incontinence was greater than expected and no risk factor was found. Sexual dysfunction occurred in 56.7% and labor anesthesia showed association in our study, but we could not find direct clinical correlation with the finding itself. These findings were greater than expected in primiparous. Will be necessary a functional and anatomical evaluation of these cases since we did not find factors of obstetric risks for their occurrence.
References: 1. Practice Bulletin No. 165 Summary: Prevention and Management of Obstetric Lacerations at Vaginal Delivery (vol 128, pg 226, 2016). Obstetrics and Gynecology. 2016 Aug;128(2):411-.2. Monteiro MVD, Pereira GMV, Aguiar RAP, Azevedo RL, Correia MD, Reis ZSN. Risk factors for severe obstetric perineal lacerations. International Urogynecology Journal. 2016 Jan;27(1):61-7.