Pelvic floor assessment after delivery: how should women be selected?
OBJECTIVE
Pelvic floor dysfunction after delivery is quite common. New mothers deserve to receive targeted care for pelvic floor dysfunction, but how should women who are at risk be identified and selected for treatment? This study investigated risk factors and puerperal health-seeking behaviours to develop a restrictive patient selection model for postpartum pelvic floor dysfunction assessment.


METHODS
This prospective observational study involved women who were at ≥32 weeks gestational age when they delivered in a tertiary referral maternity hospital in Milan, Italy, between July and December 2014. Eligible women were scheduled for a 3-month postnatal pelvic floor clinic. The adherence rate to the pelvic floor clinic and the prevalence of pelvic floor dysfunctions at 3 months postpartum were recorded. Univariable and logistic multivariable analyses were performed to select risk factors for pelvic floor dysfunctions. Risk factors were then tested for sensitivity and specificity for 3-month postpartum pelvic floor dysfunctions.


RESULTS
Of 1606 eligible women, 1293 (80.5%) were included in the analysis; 685 puerperal women (53.0%) adhered to the 3-month postnatal pelvic floor clinic; pelvic floor dysfunctions were detected in 238 women (34.7%). Four elements emerged as risk factors: symptoms before pregnancy (OR 1.72, 95% CI 1.15-2.56; p=0.008), symptoms during pregnancy (OR 2.13, 95% CI 1.49-3.06; p<0.0001), vacuum extractor use (OR 1.62, 95% CI 1.04-2.54; p=0.034), and severe perineal tears (OR 19.45, 95% CI 2.42-156.15; p=0.005). The combined sensitivity and specificity for the 4 risk factors were 82% and 39%, respectively.


CONCLUSIONS
Internal risk factors analysis offers the potential to efficiently restrict patient selection for follow-up.
Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy. Electronic address: marcosoligo@fastwebnet.it.
Marco
M
Soligo
Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy.
Stefania
S
Livio
Medical Physics Department, ASST, Monza, Italy.
Elena
E
De Ponti
Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy.
Ileana
I
Scebba
Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy.
Federica
F
Carpentieri
Department of Obstetrics and Gynaecology, Del Ponte Hospital, University of Insubria, Varese, Italy.
Maurizio
M
Serati
Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy.
Enrico
E
Ferrazzi
D000328:Adult; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005081:Exercise Therapy; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D007558:Italy; D010349:Patient Compliance; D018579:Patient Selection; D017773:Pelvic Floor / Q000503:physiopathology; D059952:Pelvic Floor Disorders / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D011181:Postnatal Care / Q000379:methods*; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology / Q000628:therapy
Adherence; Anal incontinence; Delivery; Pelvic floor dysfunction; Postpartum; Urinary incontinence