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Sunday, March 13, 2016

The effect of antenatal pelvic floor muscle training on labor and delivery outcomes" a systematic review with meta-analysis. Du Y, et al. Int Urogynecol J (2015) 26:1415-1427.

Beth Shelly
Pelvic PT Distance Journal Club March 2016

Background

·         Many studies have shown PFM exercise during pregnancy can prevent and decrease UI

·         Study by Aran showed reduced PFM strength associated with prolonged first stage of labor

·         That study also postulated a strong PFM might limit decent or rotation of the fetal head

·         Other believe PFM exercises produce flexible, well controlled muscles that can facilitate labor

Study

·         12 RCT (one quasi RCT) involving a total of 2,243 European and Chinese nulliparous women

·         excluded vaginal weights, electrical stimulation, and biofeedback

·         Five outcomes evaluated

o   Length of first stage of labor

o   Length of second stage of labor

o   Episiotomy

o   Instrument deliver - forceps or vacuum

o   Perineal laceration

·         Parameters of PFM training varied - 3 trials ensured proper technique, see page 1421

Results

·         First stage of labor - PFM exercises significantly decreased by 28.33 min on average (only Chinese studies measured this)

·         Second stage of labor - PFM exercises significantly decreased by 10.41 min on average

o   Secondary analysis was done is several ways

o   Statically sig only in Chinese studies

o   No difference for BMI, age or baby wt

·         Episiotomy - no sig diff

·         Instrument deliver - forceps or vacuum  - no sig diff

·         Perineal laceration - no sig diff

Conclusion

·         Antenatal PFM training does not negatively affect birth

·         Training may result in improved muscle control and flexibility which may contribute to the descent or rotation of fetal head

·         Also may be related to a positive attitude toward childbirth

Limitations

·         Several discussed including variety of training schedules

·         Ethnicity differences also discussed

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