Systematic Review of Obstetric and Neonatal Complications Associated With Female Genital Mutilation.

OBJECTIVE: To assess the prevalence of obstetric and neonatal complications in women with female genital mutilation (FGM) compared to women without FGM. DATA SOURCES: Literature searches carried out on three scientific databases (CINAHL, ScienceDirect, and PubMed). STUDY SELECTION: Selected observational studies published from 2010 to 2021 that assessed prolonged second phase of labor, vaginal outlet obstruction, emergency cesarean birth, perineal tear, instrumental births, episiotomy, and postpartum hemorrhage in women with and without FGM, as well as Apgar score and resuscitation of their newborns. RESULTS: Nine studies were selected, including case-control, cohort, and cross-sectional studies. There were associations between FGM and vaginal outlet obstruction, emergency cesarean birth, and perineal tears. CONCLUSION: For obstetric and neonatal complications other than those listed in the "Results" section, researchers' conclusions remain divided. Still, there is some evidence to support the impact of FGM on obstetric and neonatal harm, particularly in cases of FGM Types II and III.

Psychological consequences of female genital mutilation: A mixed-method systematic review.

Background: Female genital mutilation (FGM/C) defined as 'all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons' is a cultural practice having several consequences on women's health. Medical and sexual consequences have been documented, but the link between FGM/C and the development of psychological symptoms is not clearly established. The influence of contextual factors is poorly understood. Objectives: To evaluate the psychological impact of FGM/C and how victims experience it. Method: A mixed method systematic review was conducted. The inclusion criteria were observational primary studies involving women who had undergone FGM/C and had experienced psychological symptoms. Publication bias was assessed by using the Mixed Methods Appraisal Tool. A configurative strategy that involved a comparison of quantitative and qualitative data was used, followed by an analysis of causal link between FGM/C and induced psychological disorders. Results: Fourteen studies were included. Post-traumatic stress disorder (PTSD), depression, anxiety and somatisation showed a significantly higher prevalence in women who have experienced FGM/C versus non-mutilated women. Female genital mutilation type II or III were identified as predictors of disorder severity. Qualitative studies showed a significant difference in the perception of FGM/C between immigrant and non-immigrant women, as well as the multidimensional nature of the factors influencing disorders' onsets. Conclusion: Our study showed a high association of FGM/C (and its degree of severity) with psychological disorders such as PTSD, depression, anxiety and somatisation. It also illustrates contextual factors, including socio-cultural factors that may influence the intensity of these psychological disorders. Clinical implications: It is important for health professionals to be aware of the psychological consequences of FGM/C and the different factors influencing FGM/C perception. Indeed, a feeling of 'Being abnormal' can be awakened among patients because of health professionals' incorrect behaviours.

Physical activity and urinary incontinence during pregnancy and postpartum: A systematic review and meta-analysis.

To assess the association of physical activity and urinary incontinence, or its recovery, during pregnancy and postpartum. A search of publications indexed in five major electronic databases (CENTRAL, PubMed, EMBASE, CINAHL and PEDro) was performed from their respective inception dates to the 30 March 2020 with a combination of keywords to identify studies of interest. Google Scholar was used for non-indexed literature. All studies comparing physical activity with standard care in pregnant and postpartum women were selected. Two reviewers independently selected studies, assessed quality and extracted data. Odds ratios with 95% confidence intervals were calculated using fixed effects or random effects models, for low and moderate heterogeneity between studies, respectively. Seven studies (n = 12479) were included. Data of four studies could be pooled for meta-analyses; subgroup and sensitivity analyses were not possible. Physical activity, either during pregnancy or postpartum, is not associated with urinary incontinence, OR 0.90 (95% CI: 0.69-1.18) and OR 1.31 (95% CI: 0.74-2.34), respectively. Due to a lack of available data, urinary incontinence recovering could not be assessed. The available low evidence does not show that physical activity during pregnancy or postpartum is associated with urinary incontinence. Moderate physical activity should therefore be encouraged for the evidence-based benefits on other obstetrical outcomes.

Consequences of Female Genital Mutilation on Women's Sexual Health - Systematic Review and Meta-Analysis.

BACKGROUND: Female genital mutilation (FGM) can leave a lasting mark on the lives and minds of those affected. AIM: To assess the consequences of FGM on women's sexual function in women who have undergone FGM compared to women who have not undergone FGM. METHODS: A systematic review and meta-analysis were conducted from 3 databases; inclusion and exclusion criterions were determined. Studies included adult women having undergone FGM and presenting sexual disorders assessed by the Female Sexual Function Index (FSFI). RESULTS: Of 129 studies, 5 that met the criteria were selected. The sexual function of mutilated women, based on the FSFI total score and its different domains, was compared to the sexual function of non-mutilated women. There was a significant decrease in the total FSFI scores of mutilated women compared to non-mutilated women. However, the results obtained for the different domains were not the same for all authors. The meta-analysis highlighted a high heterogeneity with inconsistency and true variance in effect size between-studies. CONCLUSION: Analysis of studies showed that there is a significant decrease in the total FSFI score, indicating that FGM of any type may cause impaired sexual functioning. But a firm conclusion on this topic is not yet achievable because the results of this analysis do not allow to conclude a cause and effect relationship of FGM on sexual function. Nzinga A-M, De Andrade Castanheira S, Herklmann J, et al. Consequences of Female Genital Mutilation on Women's Sexual Health - Systematic Review and Meta-Analysis. J Sex Med 2021;18:750-760.

Relationship between urinary incontinence and back or pelvic girdle pain: a systematic review with meta-analysis.

INTRODUCTION AND HYPOTHESIS: Many observational studies have suggested the existence of a link between urinary incontinence (UI) and lumbopelvic pain. The aim of our study is to evaluate the association between UI and back pain (BP) or pelvic girdle pain (PGP) in the adult population. METHODS: This systematic review with meta-analysis was registered in PROSPERO under the number 2019:CRD42019120047. Literature was sought in the Medline, Embase, and PEDro databases. The search was limited to English, Spanish, and French records, and was conducted from inception until November 2019. Observational studies evaluating the association between UI and BP/PGP were selected by two independent reviewers. Quality assessment was performed using the "Critical Review Form for quantitative studies" (McMaster University). RESULTS: From the 2,055 retrieved articles, 18 were selected. Both qualitative (n = 18) and quantitative analysis (n = 7) were performed. Fifteen out of 18 studies (83%) found a positive association between UI and BP or PGP for at least one type of incontinence. Pooled estimates were OR 1.61, 1.53, and 1.51 for stress, urgency, and mixed urinary incontinence respectively. A similar degree of association between women and men was found. Subjects with stress and mixed incontinence showed greater likelihoods of mild pain compared with severe pain, although severe pain was more frequently associated with urgency incontinence than mild pain. CONCLUSIONS: Our results support the association between UI and BP/PGP, which seems to be independent of gender-based differences. The strength of this association depends on pain or incontinence subtypes. Clinicians should be aware of the relationship in their clinical practice.

[Interest of mobile and internet applications in the management of stress urinary incontinence in women. A systematic review]. / Intérêt des applications mobiles et internet dans la prise en charge de l'incontinence urinaire d'effort chez la femme.

INTRODUCTION: Current recommendations for the management of stress urinary incontinence (SUI) include conservative interventions as first-line treatments. New approaches are emerging with the arrival of health applications on smartphones. The objective of this review is to evaluate the interest of mobile and Internet applications in the treatment of SUI in women. METHOD: Interventional studies evaluating the use of mobile applications or websites in the management of women with SUI were selected from PubMed, Cinalh and PEDro databases. An analysis of symptoms, quality of life and adherence was carried out, highlighting biases. RESULTS: Eight of the 85 retrieved articles were selected. These studies report an improvement in SUI symptoms, quality of life and adherence after an intervention including new technologies (LE1). This type of intervention appears to be superior to the absence of intervention: patients report an improvement in symptoms (ICIQ-SF P<0.001 ; decrease in the number of pads P=0.023, LE1) and a greater perception of improvement (P<0.001, LE1). This type of intervention seems to be more effective than those in paper format on the decrease in the number of pads (P=0.02, LE1) and the perception of improvement (P=0.03, LE1). CONCLUSION: This innovative approach seems to reduce SUI symptoms, improve the quality of life and the functionality of pelvic floor muscles with long-term results. This type of intervention may improve adherence provided that it is associated with a treatment by a therapist.

Center of plantar pressure during gait in pregnancy-related pelvic girdle pain and the effect of pelvic belts.

PURPOSE: Many pregnant women suffer from pelvic girdle pain (PGP) during pregnancy. Etiologies are multifactorial and affect the joint stability of the sacroiliac joint. Pelvic belts could restore stability and reduce pain during gait. The center of pressure (COP) is a reliable parameter to assess gait and balance. The objectives of this study were to analyze the COP during gait in pregnant women with PGP, to evaluate the effect of pelvic belts and to compare two types of belts on COP parameters. MATERIALS AND METHODS: 46 pregnant women with PGP, 58 healthy pregnant women and 23 non-pregnant women participated in the study. The motor task consisted of three gait trials at different velocities on an electronic walkway. Two pelvic belts for pregnant women were used. An analysis of variance was performed to determine the effects of the progression of the pregnancy, gait speed, presence of pregnancy and occurrence of pain on the COP parameters. RESULTS: Compared to the control group, pregnant women with PGP had a higher stance time, but COP displacement and velocity were lower. The COP parameters varied between pregnant women with and without pelvic girdle pain, the use of a belt during pregnancy decreased the walking velocity. No difference was found according to the type of belt. CONCLUSIONS: Differences in COP parameters during gait between pregnant women with or without PGP were minimal. Pelvic girdle pain did not affect the center of pres- sure. Wearing a belt during pregnancy modified the center of pressure velocity during gait in pregnant women with PGP.

Pregnancy and pelvic girdle pain: Analysis of pelvic belt on pain.

AIMS AND OBJECTIVES: To analyse pain and functional capacity in women with pelvic girdle pain and to evaluate the effect of pelvic belt on these parameters. Two types of belts were to compare. BACKGROUND: Pelvic girdle pain is very common during pregnancy. To prevent and relieve pelvic pain, women can use a set of techniques and tools such as a pelvic belt. While scientific evidence is lacking, commercial industries suggest the effectiveness of pelvic belts. DESIGN: Randomised control trial. METHODS: Forty-six pregnant women with pelvic girdle pain were evaluated. Pain analysis included a quantitative and a qualitative assessment. A daily activities questionnaire was used for functional capacity evaluation. Women were tested at two times during the pregnancy for a longitudinal evaluation, and they used one of the two belt models during their pregnancy. RESULTS: Pelvic pain started between the 14th-21st week of pregnancy. Pain intensity was 60 ± 20 mm. Daily activities could increase pain. The use of belts reduced pain. The intensity of pain decreased by 20 mm on a visual analogue scale. The daily activities were also easier. However, all these conclusions are valid only if pregnant women used belts regularly on short periods. CONCLUSIONS: The belts appear to be interesting tools to reduce pelvic pain and improve comfort of pregnant women. This effect might be explained by an analgesic effect with proprioceptive and biomechanical effect. The different types of belts could have differential effects on global, sacroiliac joint and back pain during pregnancy, but this hypothesis requires confirmation. RELEVANCE TO CLINICAL PRACTICE: Relevant for patient: to use an easy and validated tool. Relevant for clinical practice: to suggest a tool scientifically validated for patient. Relevant to economic issues: belts decrease pelvic pain and increase comfort of pregnant women. Sick leave could decrease.

Pregnancy and Pelvic Girdle PainAnalysis of Center of Pressure During Gait.

BACKGROUND: A woman's body undergoes many changes during pregnancy, and it adapts by developing compensatory strategies, which can be sources of pain. We sought to analyze the effects of pregnancy and pelvic girdle pain (PGP) on center of pressure (COP) parameters during gait at different speeds. METHODS: Sixty-one healthy pregnant women, 66 women with PGP between 18 and 27 weeks of pregnancy, and 22 healthy nonpregnant women walked at different velocities (slow, preferential, and fast) on a walkway with built-in pressure sensors. An analysis of variance was performed to determine the effects of gait speed and group on COP parameters. RESULTS: In healthy pregnant women and women with PGP, COP parameters were significantly modified compared with those in nonpregnant women (P < .01). Support time was increased regardless of gait speed, and anteroposterior COP displacement was significantly decreased for women with PGP compared with healthy pregnant women. In addition, mediolateral COP displacement was significantly decreased in pregnant women compared with nongravid women. CONCLUSIONS: Gait speed influenced COP displacement and velocity parameters, and gait velocity potentiated the effect of pregnancy on the different parameters. Pelvic girdle pain had an influence on COP anteroposterior length only. With COP parameters being only slightly modified by PGP, the gait of pregnant women with PGP was similar to that of healthy pregnant women but differed from that of nonpregnant women.

Pregnancy-related changes in center of pressure during gait.

PURPOSE: Physical and hormonal modifications occuring during the pregnancy, can lead to an increase in postural instability and to a higher risk of falls during gait. The first objective was to describe the center of pressure (COP) during late pregnancy at different gait velocity. Comparison of nulliparous women with postpartum women were conducted in order to investigate the effects of pregnancy. The second objective was to analyse COP variability between pregnant and non-pregnant women in order to investigate the effects of pregnancy on gait variability. METHODS: Fifty-eight pregnant women in the last four months of pregnancy, nine postpartum women and twenty-three healthy non-pregnant women performed gait trials at three different speeds: preferred, slow and fast. RESULTS: In the last four months of pregnancy gait velocity decreased. During the pregnancy, gait velocity decreased by 22%, stopover time increased by 6-12%, COP excursion XY decreased by 5% and COP velocity decreased by 16% and 20% along the anteroposterior and transverse axes, respectively. After delivery, gait velocity increased by 3% but remained a lower compared to non-pregnant women (-12%). Intra-individual variability was greater for non-pregnant than pregnant women. CONCLUSIONS: COP parameters were influenced by pregnancy. This suggests that pregnant women establish very specific and individual strategies with the aim of maintaining stability during gait.

Plantar Pressure During Gait in Pregnant Women.

BACKGROUND: During pregnancy, physical and hormonal modifications occur. Morphologic alterations of the feet are found. These observations can induce alterations in plantar pressure. This study sought to investigate plantar pressures during gait in the last 4 months of pregnancy and in the postpartum period. A comparison with nulliparous women was conducted to investigate plantar pressure modifications during pregnancy. METHODS: Fifty-eight women in the last 4 months of pregnancy, nine postpartum women, and 23 healthy nonpregnant women (control group) performed gait trials on an electronic walkway at preferred speeds. The results for the three groups were compared using analysis of variance. RESULTS: During pregnancy, peak pressure and contact area decreased for the forefoot and rearfoot. These parameters increased significantly for the midfoot. The gait strategy seemed to be lateralization of gait with an increased contact area of the lateral midfoot and both reduced pressure and a later peak time on the medial forefoot. In the postpartum group, footprint parameters were modified compared with the pregnant group, indicating a trend toward partial return to control values, although differences persisted between the postpartum and control groups. CONCLUSIONS: Pregnant women had altered plantar pressures during gait. These findings could define a specific pattern of gait footprints in late pregnancy because plantar pressures had characteristics that could maintain a stable and safe gait.

Temporal and spatial parameters of gait during pregnancy.

PURPOSE: The objective of this study was to describe spatial and temporal parameters during gait in pregnant women, and to compare it with women in post-partum and with a control group. METHODS: To investigate alteration in natural locomotion, we used an electronic walkway (GAITRite system). Fifty-eight pregnant women (four last months of pregnancy), nine post-partum women and twenty-three healthy nulligravidae women participated in this study. The women performed the motor task at three different speeds: preferred, fast and slow. Spatial and temporal parameters for pregnant and non-pregnant were compared. RESULTS: In pregnant women, gait speed, step length and cadence were reduced. Consequently, cycle time was longer. The gait cycle was modified by an increase of stance phase and a decrease of swing phase. As a result, an increase of double support and a decrease of single support phases were observed. Step width increased by 15%. CONCLUSIONS: The pattern of gait displayed significant modifications during pregnancy as compared to nulliparous women. These changes favour a more stable and safe gait. After childbirth, women kept some characteristics of gait in pregnancy during 8 months.