Rojas RG, Wong V, Shek KL, Dietz HP. Int Urogynecol J
2014;25:375-380.
Beth Shelly PT, DPT, WCS, BCB PMD
May 7, 2014 Pelvic PT Distance Journal Club
Method - 433 primips, Blinded
measurements before and after delivery
·
Questionnaires
·
MMT by Oxford
scale
·
4D translabial US
(specifics on page 377)
Macrotrauma = levator
avulsion
·
15% of parous
women
·
Defined as
puborectalis insertion of all three central segments of US were abnormal.
Microtrauma = overdistention
of levator hiatus
·
21% of vaginal deliveries
·
Defined as
increase of over 20% in hiatus during valsalva comparing pre to post delivery
·
May be related to
o
Over stretching
of connective tissue
o
Overstretching of
PFM
o
Changes in
resting tone, baseline cortical activation
o
Changes in
neuromuscular pathways
Results
·
All postpartum
women (table 3 page 377)
o
Decrease in all
US measurements
o
No change on MMT
o
MMT was
associated with delivery mode
·
Comparing
avulsion to no avulsion (table 4 page 378)
o
Only sig measure
was MMT
·
Comparing
microtrauma to no microtrauma (excluding avulsion) (table 5 page 378)
o
Only sig measure
was MMT
Conclusion - although US does
show changes in PFM postpartum, MMT was more sensitive in measuring contractive
function in women with avulsion and hiatal over distention
Post partum women
with and without major levator ani defect.
·
6 weeks post partum 175 randomized to PFM
training or usual care. · Both groups were trained on PFM contraction.
· Treatment group did weekly PFM training classes for 4 months and was encouraged to do PFM exercises at home.
· Control group only received one instruction.
No effect of PFMT for UI in either women with or without
major levator ani defect. There were some small difference in group outcomes
favoring the PFM training group but they
did not reach statistical sig. No
difference in PFM strength, endurance, or vaginal resting pressure. Presence of defect did not change effect
of training.
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