Establishment and validation of prediction model of new-onset pelvic organ prolapse in early postpartum period / 中华妇产科杂志

Objective:To analyze the risk factors of pelvic organ prolapse (POP) and to establish the prediction model.Methods:A study was conducted on the prevalence of POP among 2 247 parturient women at 6 weeks postpartum in Peking University People′s Hospital from December 2018 to October 2019, and relevant influencing factors were analyzed to construct a prediction model of early postpartum POP using logsitic regression, which was validated internally. Data from November 2019 to December 2019 (403 parturient women) were collected for external validation of the prediction model. In addition, the obstetrical factors affecting the occurrence of early postpartum POP in 885 primiparas with vaginal delivery (from January 2019 to November 2019) were further discussed.Results:A total of 2 247 cases were included in the modeling group, and 403 cases were included in the external validation data set. POP accounted for 24.3% (545/2 247). Age, parity, body mass index before pregnancy, vaginal delivery and newborn birth weight were negative factors for early postpartum POP (all P<0.05). The nomogram was established based on the above factors, and internal and external verification indicated that the model had a good discrimination (C-index were 0.759 and 0.760, respectively). In addition, this study found that age and newborn birth weight were the main causes of early postpartum POP in primiparas with vaginal delivery ( P=0.044, P=0.004). Conclusions:The incidence of early postpartum POP is high. The prediction model of POP constructed in this study could be used to guide clinical practice to a certain extent and give corresponding treatment suggestions to pregnant women scientifically, so as to provide theoretical support for primary prevention.

Pelvic floor function of 5143 women in early postpartum stage and analysis on the effect factors / 中华妇产科杂志

Objective To describe the situation of early stage of pelvic floor function and investigate the effect factors in postpartum women.Methods A retrospective survey was conducted,and women who did regular examination and gave birth in Peking University People's Hospital and had an annual pelvic floor examination at 6-12 weeks after delivery from Sep.2012 to Dec.2017 were interviewed.General information and pelvic floor electrical physiological indexes were collected and analyzed.Results Totally 5 143 puerpera were included in the study.The normal strength of type Ⅰ muscle was 52.40％ (2 695/5 143) and the normal strength of type Ⅱ muscle was 52.69％ (2 710/5 143).The abnormal degree of fatigue of type Ⅰ muscle was 55.84％ (2 872/5 143) and the abnormal degree of fatigue of type Ⅱ muscle was 27.34％ (1 406 / 5 143).Pelvic floor dynamic pressure was (93 + 37) cmH2O (1 cmH2O=0.098 kPa).The incidence of stress urinary incontinence (SUI) was 23.49％ (1 208/5 143) after delivery and it was as high as 57.58％ (95/165) for women who had family history of pelvic floor dysfunction.Family history of pelvic floor dysfunction was the risk factor of the fatigue index of type Ⅰ and type Ⅱ muscle (P＜0.05).The incidence of SUI was associated with vaginal delivery and age (＞30 years old) and family history of pelvic floor dysfunction (P＜0.01).Conclusions Pelvic floor electrical physiological indicators are reduced in about half of women in early postpartum stage.Age (＞30 years old) and vaginal delivery and family history of pelvic floor dysfunction are the risk factors.

Postpartum pelvic floor rehabilitation on prevention of female pelvic floor dysfunction:a multicenter prospective randomized controlled study / 中华妇产科杂志

Objective To study the postpartum pelvic floor rehabilitation on the improvement of pelvic floor electrical physiological indexes and the prevention of female pelvic floor dysfunction in China. Methods A multicenter prospective randomized controlled study was carried out. From October 2011, postpartum women in five provinces were randomly assigned into treatment group and control group. The women in treatment group received electrical stimulation and biofeedback treatment. The women in control group performed pelvic floor muscle exercise at home. When 6 months and 12 months after delivery, comparing two groups of patients with pelvic floor electrical physiological indexes and pelvic organ prolapse quantitation measurements (POP-Q), to evaluate the effect of postpartum pelvic floor rehabilitation on the prevention of pelvic floor dysfunction. Pelvic floor impact questionnaire short form (PFIQ-7) and pelvic organ prolapse/incontinence sexual questionnaire-12 (PISQ-12) were used to evaluate the influence on quality of life and sexual life. Results Until June 2013, 324 women were participated, 124 in control group, 200 in treatment group. According to the baseline results, there was statistical significance in the results of pelvic floor electrical physiological indexes between the treatment and control groups in postpartum 6 months and 12 months; the proportion above level Ⅲ of type Ⅰ and type Ⅱ muscle fibers strength in the treatment group, it was from 41.5% (83/200) and 40.5% (81/200) to 76.3% (145/190) and 79.5% (151/190) in postpartum 6 weeks and postpartum 6 months, increased to 80.6%(58/72) and 80.6%(58/72) in postpartum 12 months, improved significantly comparing with the control group (P0.05). There was no significant difference in the questionnaires in quality of life and quality of sexual life (P>0.05). Conclusion Neuromuscular electrical stimulation and biofeedback therapy in the early postpartum period could obviously improve pelvic floor electrical physiological indexes, and is beneficial to prevent the pelvic floor dysfunction.

Cognition and attitude of postpartum contraception among obstetricians in Tianjin area / 中华妇产科杂志

Objective Through analysed the questionnaire about postpartum contraception knowledge-attitude-practice (KAP) among obstetricians,to understand the postpartum contraceptive knowledge,idea,attitude and related factors among obstetricians.Methods From October 2013 toDecember 2013,209 obstetricians of 10 different levels of the hospital of Tianjin area had been enrolled in this study,and KAP questionnaire was investigated.Results The knowledge of postpartum contraception among obstetricians was seriously lack,the total correct rate was 34.8％,the lowest score was 5 points,the highest was 80 points,the average score was 34.8± 13.5,more than 60 points accounted for only 2.9％ (6/209).86.6％ (181/209) obstetricians have thought it necessary to carry out postpartum contraceptive propaganda during pregnancy,and 97.6％ (204/209) obstetricians have thought it necessary to develop postpartum contraception training.92.8％ (194/209) and 94.2％ (197/209) obstetricians always informed that pay attention to contraception before discharge and postpartum visit,specific methods were not discussed.Obstetricians obtained relevant progress of contraceptive knowledge mainly through the daily medical work (92.8％,194/209),hoped that approach postpartum contraception related knowlege through continuing education courses (77.5％,162/209),special lectures in academic conference (72.2％,151/209) and special training (67.5％,141/209).Conclusions (1) The postpartum contraception knowledge among obstetricians is seriously lack.(2) The obstetricians hold positive attitude towards the propaganda for postpartum contraceptive knowledge.(3) Postpartum contraception related education only provided before discharging and postpartum visit,and the content was simply inform that pay attention to contraception,specific methods are not discussed.(4) To explore the reason why postpartum contraception situation is not ideal,that's because insufficient attention and propaganda,obstetricians don't update the contraception knowledge,and be lack of knowledge on the efficient,long-acting reversible contraception methods,exaggerated the side effects and complications.