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Pelvic floor function and advanced maternal age at first vaginal delivery

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DOI: 10.4236/ojog.2013.34A005    3,214 Downloads   4,847 Views   Citations

ABSTRACT

Purpose: The study aimed to show differences in temporal recovery of pelvic floor function within 6 months postpartum between women having their first delivery at an advanced age and those having their first delivery at a younger age. Methods: Seventeen women (age: 35.5 ± 3.5, BMI: 21.1 ± 3.2) were studied at about 6 weeks, 3 months, and 6 months after vaginal delivery. Urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire-Short Form. Pelvic floor function was assessed by the anteroposterior diameter of the levator hiatus using transperineal ultrasound. Women who delivered for the first time at 35 years and/or older were defined as being of advanced maternal age. Results: Nine of 17 women (52.9%) were of advanced maternal age and 5 experienced postpartum stress urinary incontinence. Four of these 5 women (80.0%) were of advanced maternal age. The anteroposterior diameter of the levator hiatus at rest was significantly greater in the advanced maternal age women than in the younger maternal age women at 3 and 6 months postpartum (p < 0.01). Among the continent women, the anteroposterior diameter of the levator hiatus at rest was significantly greater in the advanced maternal age women than in the younger maternal age women at 6 months postpartum (p = 0.004). However, among the advanced maternal age women, all parameters of the anteroposterior diameter of the levator hiatus were not significantly different between the women with and without stress urinary continence. Conclusion: Recovery of pelvic floor function following delivery may be delayed in women of advanced maternal age at first delivery because of the damage to the pelvic floor during pregnancy and vaginal delivery, resulting in increase in the incidence of stress urinary incontinence.

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Yoshida, M. , Murayama, R. , Nakata, M. , Haruna, M. , Matsuzaki, M. , Shiraishi, M. and Sanada, H. (2013) Pelvic floor function and advanced maternal age at first vaginal delivery. Open Journal of Obstetrics and Gynecology, 3, 28-34. doi: 10.4236/ojog.2013.34A005.

References

[1] Kinchen, K.S., Burgio, K., Diokno, A.C., Fultz, N.H., Bump, R. and Obenchain, R. (2003) Factors associated with women’s decisions to seek treatment for urinary incontinence. Journal of Women’s Health, 12, 687-698. doi:10.1089/154099903322404339
[2] Tennstedt, S.L., Fitzgerald, M.P., Nager, C.W., Xu, Y., Zimmern, P., Kraus, S., et al. (2007) Quality of life in women with stress urinary incontinence. International Urogynecology Journal, 18, 543-549. doi:10.1007/s00192-006-0188-5
[3] Schytt, E., Lindmark, G. and Waldenstrom, U. (2004) Symptoms of stress incontinence 1 year after childbirth: Prevalence and predictors in a national swedish sample. Acta Obstetricia et Gynecologica Scandinavica, 83, 928-936.
[4] Glazener, C.M., Herbison, G.P., MacArthur, C., Lancashire, R., McGee, M.A., Grant, A.M., et al. (2006) New postnatal urinary incontinence: Obstetric and other risk factors in primiparae. BJOG: An International Journal of Obstetrics & Gynaecology, 113, 208-217. doi:10.1111/j.1471-0528.2005.00840.x
[5] Baydock, S.A., Flood, C., Schulz, J.A., MacDonald, D., Esau, D., Jones, S., et al. (2009) Prevalence and risk factors for urinary and fecal incontinence four months after vaginal delivery. Journal of Obstetrics and Gynaecology Canada, 31, 36-41.
[6] Fritel, X., Fauconnier, A., Levet, C. and Benifla, J.L. (2004) Stress urinary incontinence 4 years after the first delivery: A retrospective cohort survey. Acta Obstetricia et Gynecologica Scandinavica, 83, 941-945.
[7] MacArthur, C., Glazener, C.M., Wilson, P.D., Lancashire, R.J., Herbison, G.P. and Grant, A.M. (2006) Persistent urinary incontinence and delivery mode history: A sixyear longitudinal study. BJOG: An International Journal of Obstetrics & Gynaecology, 113, 218-224. doi:10.1111/j.1471-0528.2005.00818.x
[8] Wesnes, S.L., Hunskaar, S., Bo, K. and Rortveit, G. (2009) The effect of urinary incontinence status during pregnancy and delivery mode on incontinence postpartum. A cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 116, 700-707. doi:10.1111/j.1471-0528.2008.02107.x
[9] Foldspang, A., Hvidman, L., Mommsen, S. and Nielsen, J.B. (2004) Risk of postpartum urinary incontinence associated with pregnancy and mode of delivery. Acta Obstetricia et Gynecologica Scandinavica, 83, 923-927.
[10] Rortveit, G., Daltveit, A.K., Hannestad, Y.S., Hunskaar, S. (Norwegian EPINCONT Study) (2003) Urinary incontinence after vaginal delivery or cesarean section. The New England Journal of Medicine, 348, 900-907. doi:10.1056/NEJMoa021788
[11] El-Hefnawy, A.S. and Wadie, B.S. (2011) Severe stress urinary incontinence: Objective analysis of risk factors. Maturitas, 68, 374-377. doi:10.1016/j.maturitas.2011.01.005
[12] Groutz, A., Rimon, E., Peled, S., Gold, R., Pauzner, D., Lessing, J.B., et al. (2004) Cesarean section: Does it really prevent the development of postpartum stress urinary incontinence? A prospective study of 363 women one year after their first delivery. Neurourology & Urodynamics, 23, 2-6. doi:10.1002/nau.10166
[13] Hijaz, A., Sadeghi, Z., Byrne, L., Hou, J.C. and Daneshgari, F. (2012) Advanced maternal age as a risk factor for stress urinary incontinence: A review of the literature. International Urogynecology Journal, 23, 395-401. doi:10.1007/s00192-011-1562-5
[14] Dietz, H.P. and Wilson, P.D. (2005) Childbirth and pelvic floor trauma. Best Practice & Research Clinical Obstetrics & Gynaecology, 19, 913-924. doi:10.1016/j.bpobgyn.2005.08.009
[15] Ministry of Health, Labour and Welfare. (2010) Nationality in specified report of vital statistics. http://www.mhlw.go.jp/english/index.html
[16] DeLancey, J.O., Kearney, R., Chou, Q., Speights, S. and Binno, S. (2003) The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstetrics & Gynecology, 101, 46-53. doi:10.1016/S0029-7844(02)02465-1
[17] Kearney, R., Miller, J.M., Ashton-Miller, J.A. and DeLancey, J.O. (2006) Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstetrics & Gynecology, 107, 144-149. doi:10.1097/01.AOG.0000194063.63206.1c
[18] Whittaker, J.L., Thompson, J.A., Teyhen, D.S. and Hodges, P. (2007) Rehabilitative ultrasound imaging of pelvic floor muscle function. Journal of Orthopaedic & Sports Physical Therapy, 37, 487-498.
[19] Dietz, H.P., Shek, C. and Clarke, B. (2005) Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound in Obstetrics & Gynecology, 25, 580-585. doi:10.1002/uog.1899
[20] Huang, W.C., Yang, S.H. and Yang, J.M. (2006) Anatomical and functional significance of urogenital hiatus in primary urodynamic stress incontinence. Ultrasound in Obstetrics & Gynecology, 27, 71-77. doi:10.1002/uog.2649
[21] Weinstein, M.M., Jung, S.A., Pretorius, D.H., Nager, C.W., den Boer, D.J. and Mittal, R.K. (2007) The reliability of puborectalis muscle measurements with 3-dimensional ultrasound imaging. American Journal of Obstetrics & Gynecology, 197, 68.e1-e6.
[22] Braekken, I.H., Majida, M., Ellstrom-Engh, M., Dietz, H.P., Umek, W. and Bo, K. (2008) Test-retest and intra-observer repeatability of two-, threeand four-dimensional perineal ultrasound of pelvic floor muscle anatomy and function. International Urogynecology Journal, 19, 227-235. doi:10.1007/s00192-007-0408-7
[23] Kruger, J.A., Heap, S.W., Murphy, B.A. and Dietz, H.P. (2008) Pelvic floor function in nulliparous women using three-dimensional ultrasound and magnetic resonance imaging. Obstetrics & Gynecology, 111, 631-638.
[24] Yoshida, M., Murayama, R., Haruna, M., Matsuzaki, M., Yoshimura, K., Murashima, S., et al. (2012) Longitudinal comparison study of pelvic floor function between women with and without stress urinary incontinence after vaginal delivery. Journal of Medical Ultrasonics, 40, 125-131. doi:10.1007/s10396-012-0396-1
[25] Gotoh, M., Homma, Y., Funahashi, Y., Matsukawa, Y. and Kato, M. (2009) Psychometric validation of the Japanese version of the international consultation on incontinence questionnaire-short form. International Journal of Urology, 16, 303-306. doi:10.1111/j.1442-2042.2008.02237.x
[26] Main, D.M., Main, E.K. and Moore II, D.H. (2000) The relationship between maternal age and uterine dysfunction: A continuous effect throughout reproductive life. American Journal of Obstetrics & Gynecology, 182, 1312-1320. doi:10.1067/mob.2000.106249
[27] Wang, Y., Tanbo, T., Abyholm, T. and Henriksen, T. (2011) The impact of advanced maternal age and parity on obstetric and perinatal outcomes in singleton gestations. Archives of Gynecology & Obstetrics, 284, 31-37. doi:10.1007/s00404-010-1587-x
[28] DeLancey, J.O., Miller, J.M., Kearney, R., Howard, D., Reddy, P., Umek, W., et al. (2007) Vaginal birth and de novo stress incontinence: Relative contributions of urethral dysfunction and mobility. Obstetrics & Gynecology, 110, 354-362. doi:10.1097/01.AOG.0000270120.60522.55

  
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