Risk of postpartum urinary incontinence associated with pregnancy and mode of delivery

AIM: The aim was to estimate the postpartum urinary incontinence (PP UI) impact of precursory UI during pregnancy (PR UI) and delivery performed by cesarean section (CS) vs. vaginal childbirth (VC). METHODS: Among the members of two population samples, in total 8610 women aged 20-59 years, 1232 had their first childbirth and 642 their second childbirth within 13-120 months prior to responding to a questionnaire that included information on PR UI occurrence, mode of delivery and PP UI occurrence. RESULTS: CS was applied in 12.2% of first childbirths, and 87.8% thus delivered vaginally; PR UI during the pregnancy leading to the first childbirth was reported by 15.6%, and a total of 26.3% reported PP UI. An increased PP UI occurrence was reported following VC (28.3% vs. 12.0% in women undergoing CS, p < 0.001) and after PR UI (first childbirth, 66.7% vs. 18.8% in women not reporting PR UI, p < 0.0001). Among cases of PP UI following the first childbirth, 56.1% and 69.5% of cases could be attributed to PR UI and VC, respectively. CONCLUSIONS: The highest PP UI risks were found among women complaining of PR UI, which manifested itself as a crucial, independent precursor of PP UI. Because of the high frequency of VC, more than seven out of 10 cases of UI following the first childbirth, however, seemed to be attributable to VC. The present data did not lend significant support to the assumption that the PP UI risk is also lowered after a subsequent delivery by CS.     

Bilateral postpartum vulvar edema associated with maternal death

Reported is a maternal death associated with bilateral postpartum vulvar edema. Data are reviewed for this patient and four other patients who were previously reported to have had a syndrome of unilateral postpartum vulvar edema associated with maternal death. Overall, an 80% mortality rate has been observed.     

Effect of delivery mode on postpartum neonatal body temperatures

Objective: It is known that general and local anesthesia practices disrupt the delicate balance of thermoregulation center which is already sensitive to very tiny differences of temperatures in a normal subject. We aimed to evaluate and compare the rectal temperatures of newborns born with normal vaginal delivery and cesarean section.

Methods: We performed a prospective study of 106 term newborn – 40 born with normal vaginal delivery (group 1) and 66 born with cesarean section [51 spinal anesthesia (group 2), 15 general anesthesia (group 3)]. Only term babies were included in the study. Babies of eclamptic, pre-eclamptic and diabetic mothers and babies with chronic systemic diseases were excluded. Pregnants who underwent elective cesarean section were included in the study. Adolescent pregnants, pregnants with increased risks and pregnants with complicated operations were excluded. Mothers’ temperatures were measured before and after the interventions. Rectal temperatures of the babies were measured immediately after birth.

Results: Environmental temperature was maintained at 22–24?°C. Pre-operative mother temperatures were 36.31?±?0.30?°C in group 1, 36.36?±?0.26?°C in group 2 and 36.39?±?0.19?°C in group 3 (p?=?0.414). Post-operative mother temperatures were 36.39?±?0.27?°C in group 1, 36.29?±?0.31?°C in group 2 and 36.25?±?0.28?°C in group 3 (p?=?0.215). Rectal temperatures of the babies born with normal vaginal delivery were significantly higher than the others. It was lowest in the general anesthesia group (37.5?±?0.6?°C, 37.2?±?0.2?°C and 36.8?±?0.4?°C in group 1, 2 and 3, respectively). The temperature differences between groups were statistically significant p?<?0.001).

Conclusions: In conclusion, it is worthy to note that temperatures of the newborns can differ according to the delivery mode. Physicians and health professionals that take care of the newborns should be aware of this difference.     

Hospital readmission for postpartum endometritis

This study identified risk factors associated with readmission for postpartum endometritis.

The study group consisted of 109 mothers (Group I) who were discharged after delivery and readmitted with endometritis. Control groups consisted of women who had endometritis immediately after delivery but who did not require readmission (Group II, n = 109), and women who had no intrapartum or puerperal infection and also were not readmitted (Group III, n = 109). Subjects in Groups II and III were matched to an index study subject for date of delivery and maternal age, race, and parity; and women in Groups I and III were also matched for route of delivery. Groups were compared in terms of demographic characteristics, intrapartum course, and clinical presentation. The data were analyzed with the t-test, χ₂, and multiple logistic regression analyses, and a P value >. 05 was considered significant.

Women in Groups I and III delivered vaginally more often than mothers in Group II. In addition, mothers in Groups I and III had similar postpartum courses, no evidence of infection on discharge after delivery, and a similar period from delivery until postpartum discharge. Although women in Group I were more likely to have spontaneous rupture of membranes, a shorter latent period, and have fewer bilateral tubal ligations than mothers in Group II, multivariate analysis identified route of delivery as the only significant maternal variable associated with postpartum endometritis requiring readmission. Women who were readmitted for endometritis usually delivered vaginally, and the occurrence of late-onset postpartum endometritis was unrelated to the length of stay following delivery.     

Women's attitudes regarding mode of delivery and cesarean delivery on maternal request

Objective.?To explore women's attitudes and beliefs regarding cesarean delivery and cesarean delivery on maternal request (CDMR).

Study design.?Anonymous questionnaires assessing patient demographics, knowledge, and attitudes about CDMR were distributed at the time of routine mid-trimester ultrasound appointment.

Results.?Eight hundred thirty three out of 3929 (21.2%) potential participants completed the questionnaire. About 81.7% of participants indicated that they believed that vaginal delivery was a safer alternative for the mother and 72.8% believed that it was safer for the fetus. While only 6.1% of women thought that CDMR was ‘a good idea’, most believed that women should have the right to choose their mode of delivery and that the option should be offered to everyone (85.9% and 79.6%, respectively). Socioeconomic and demographic variables did not significantly influence the participants' responses.

Conclusion.?Majority of women believe that vaginal delivery is safer for the mother and baby and would prefer to have a vaginal delivery if given the option.     

Antenatal pelvic organ mobility is associated with delivery mode

OBJECTIVE: Relaxation of pelvic ligaments may facilitate parturition in certain animal species. Biomechanical properties of pelvic connective tissue may also influence progress of labour in the human female. This study was designed to test whether peripheral joint mobility or pelvic organ mobility as measures of connective tissue biomechanical properties are associated with progress in labour and delivery mode. DESIGN: Prospective clinical observational study. SETTING: Tertiary obstetric service. SAMPLE: 200 nulliparous women recruited in antenatal clinic. METHODS: Translabial ultrasound was used to obtain data on third trimester pelvic organ mobility. Upper limb joint mobility was assessed clinically. MAIN OUTCOME MEASURES: Gestational length, length of first and second stage of labour, delivery mode. RESULTS: Pelvic organ mobility was significantly associated with total length of second stage (P = 0.034 to P = 0.002). This was mainly due to the length of passive, not active second stage. There also was a statistically significant association between delivery mode and pelvic organ descent (P = 0.007 to P = 0.001), with the lowest mobility seen in women who required a Caesarean section in second stage. Joint mobility did not correlate with delivery data. CONCLUSION: Third trimester pelvic organ mobility is associated with duration of second stage and delivery mode.     

不同分娩方式对产后早期盆底功能的影响

目的探讨不同分娩方式对产后早期盆底功能的影响。方法随机抽取2007年7~10月在广州医学院第一附属医院分娩的产妇43例,根据不同分娩方式分为选择性剖宫产组(21例)和阴道顺产组(22例)。分别于产后6~8周及12~14周行POP-Q评分、尿垫试验、超声检测残余尿以及会阴超声检查,比较两组产妇压力性尿失禁(SUI)、盆腔器官脱垂(POP)的发生率及膀胱颈移动度情况。结果产后6~8周和产后12~14周随访时,SUI发生率依次为选择性剖宫产组4.76%(1/21),0(0/14);顺产组27.27%(6/22),28.57%(4/14),两组比较差异均无统计学意义(P>0.05)。产后6~8周和产后12~14周随访时,POP发生率依次为选择性剖宫产组38.10%(8/21),35.71%(5/14),较顺产组72.72%(16/22),78.57%(11/14)低,差异均有统计学意义(P<0.05)。产后6~8周会阴超声结果显示:选择性剖宫产组与顺产组膀胱颈角度[(81.48±7.96)°对(93.82±15.37)°]及膀胱颈旋转角度[(15.71±8.01)°对(27.72±11.14)°]比较,差异有统计学意义(P<0.05)。产后12~14周选择性剖宫产组与顺产组膀胱颈角度[(79.93±8.19)°对(89.93±13.92)°]及膀胱颈旋转角度[(13.79±4.98)°对(23.07±12.17)°]比较,差异有统计学意义(P<0.05)。结论剖宫产可降低产后早期POP的发生率,并可减少发生SUI的风险。     

Factors associated with the course of maternal fatigue across the early postpartum period

Background: Relatively little is known about the course and persistence of fatigue across the postpartum period, despite the potentially adverse effects fatigue has on maternal daily functioning, well-being, parenting behaviour and parent–child interactions. Objective: Using multi-wave data over a 4-month period in the postpartum, the present study sought to: (a) examine the course of maternal fatigue, and (b) identify a range of potentially modifiable individual and contextual factors associated with the course of fatigue over this time. Methods: Seventy mothers of infants aged between 0 and 7 months participated in the current study. To measure change over time and predictors of fatigue, latent growth curve analysis was used. Results: The results indicated that maternal fatigue at approximately three months postpartum was moderate to high, with little or no change in fatigue severity over time. Higher fatigue scores at three months postpartum were also significantly associated with younger maternal age, higher socioeconomic disadvantage, low self-efficacy to engage in health behaviours and poor sleep quality. Older maternal age and poor sleep quality were associated with stability of fatigue over time. Conclusions: Findings underscore the importance of identifying and supporting women experiencing high levels of fatigue in the first seven months postpartum. Additionally, findings highlight potential risk factors for initial and persistent fatigue, possibly allowing the identification of women who might be more vulnerable to fatigue. Implications for future research and practice are discussed.     

产妇精神因素对分娩方式及产后出血的影响(附120例临床分析)

目的　观察产妇精神状态（ 焦虑与抑郁） 与分娩方式、产后出血间的关系。方法　１２０ 例健康初产妇以汉密顿焦虑量表（ＨＡＳ） 和抑郁量表（ＨＤＳ） 评定精神状态,所有产妇以产科常规进行分娩而不进行干预,观察其分娩方式及产后出血状况;按分娩方式不同分为剖宫产组、钳产组及顺产组;按产后出血不同分产后出血组及无产后出血组。结果　１２０ 例产妇焦虑发生率３５ ％ ,抑郁发生率２８．３ ％ ,焦虑并抑郁发生率１６．７ ％ 。剖宫产组、钳产组的焦虑评分及抑郁评分明显高于顺产组,而剖宫产组、钳产组间则无显著差异;产后出血组焦虑及抑郁评分亦明显高于无产后出血组。结论　焦虑状态与抑郁状态是增加助产率及产后出血的一个可能因素     

Prenatal maternal stress is associated with delivery analgesia and unplanned cesareans

We tested the hypothesis that women with greater prenatal maternal stress (PNMS) would be more likely to receive intravenous opiates and epidural for delivery, and thereby increase the likelihood of unplanned cesarean delivery. PNMS was assessed during early, mid, and late pregnancy using psychometrically sound instruments in structured interviews with women receiving prenatal care at a public university clinic. Medical records were abstracted for analgesia during delivery, fetal heart tracing (FHT) abnormalities, and method of delivery. Only subjects attempting vaginal delivery (N = 298) were included. Using structural equation modeling, a PNMS variable was constructed from five indicators: pregnancy-specific distress, number of prenatal stressful life events, distress from life events, state anxiety, and perceived stress. After controlling for medical predictors of analgesia receipt and surgical delivery, women with higher PNMS were more likely to receive analgesia, and those who received analgesia were more likely to deliver surgically. Analgesia was also associated with FHT abnormalities, which in turn was associated with surgical delivery (all p's < 0.05). Women who received both an epidural and meperidine were most likely to have a cesarean delivery; 29% of this group delivered surgically. Results indicate that PNMS contributes to higher likelihood of unplanned cesarean delivery through its association with delivery analgesia.     

Prenatal maternal stress is associated with delivery analgesia and unplanned cesareans

We tested the hypothesis that women with greater prenatal maternal stress (PNMS) would be more likely to receive intravenous opiates and epidural for delivery, and thereby increase the likelihood of unplanned cesarean delivery. PNMS was assessed during early, mid, and late pregnancy using psychometrically sound instruments in structured interviews with women receiving prenatal care at a public university clinic. Medical records were abstracted for analgesia during delivery, fetal heart tracing (FHT) abnormalities, and method of delivery. Only subjects attempting vaginal delivery (N = 298) were included. Using structural equation modeling, a PNMS variable was constructed from five indicators: pregnancy-specific distress, number of prenatal stressful life events, distress from life events, state anxiety, and perceived stress. After controlling for medical predictors of analgesia receipt and surgical delivery, women with higher PNMS were more likely to receive analgesia, and those who received analgesia were more likely to deliver surgically. Analgesia was also associated with FHT abnormalities, which in turn was associated with surgical delivery (all p's < 0.05). Women who received both an epidural and meperidine were most likely to have a cesarean delivery; 29% of this group delivered surgically. Results indicate that PNMS contributes to higher likelihood of unplanned cesarean delivery through its association with delivery analgesia.