Body image and pelvic floor dysfunction in pregnancy and postpartum: A prospective one-year follow-up cohort study.

OBJECTIVE: To determine the prevalence of pelvic floor dysfunction (PFD) among pregnant women, their clustering and their association with body image disturbance (BID) up to 1 year postpartum. DESIGN: Monocentric prospective cohort study. SETTING: University Hospitals Leuven. POPULATION: Pregnant women attending for pregnancy care, first assessed prior to 14 weeks of gestation and agreeing to follow-up until 1 year postpartum. METHODS: Standardised questionnaires reporting on PFD and BID at 12-14 and 28-32 weeks of gestation, and again at 6-8 weeks and 1 year postpartum. We calculated the prevalence of PFD, how the cases clustered and how the cases correlated with BID using a linear mixed-model analysis. A minimum of 174 women with complete follow-up were required. MAIN OUTCOME MEASURES: The questionnaires used were the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF), St. Mark's Incontinence Score (SMIS), Patient Assessment of Constipation Symptoms (PAC-SYM), Pelvic Organ Prolapse Distress Inventory (POPDI), Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA Revised (PISQ-IR) and the Body Image Disturbance Questionnaire (BIDQ). RESULTS: Out of 208 women, 92.8% reported one or multiple symptoms of PFD at 28-32 weeks of gestation, dropping to 73.6% by 1 year postpartum. The most common symptoms were constipation (65.3% at 28-32 weeks of gestation and 42.8% at 1 year postpartum) and urinary incontinence (56.8% at 28-32 weeks of gestation and 35.1% at 1 year postpartum). After correcting for body mass index, parity and mode of delivery, the severity of BID was associated with the ICIQ-UI SF score (ß = 0.016, range 0.007-0.024), the PAC-SYM score (ß = 0.006, range 0.002-0.011) and the POPDI score (ß = 0.009, range 0.005-0.012), but not with the SMIS score (ß = 0.015, range -0.001 to 0.031) or the PISQ-IR score, in sexually active women. CONCLUSIONS: Urinary incontinence, constipation and symptoms of prolapse have a measurable impact on BID.

Validity, reliability and responsiveness of a Dutch version of the prolapse quality-of-life (P-QoL) questionnaire.

INTRODUCTION AND HYPOTHESIS: We aimed to test validity, reliability and responsiveness of a Dutch version of a prolapse quality-of-life questionnaire (P-QoL). METHODS: P-QoL was translated into Dutch and adjusted by a panel of five experts. The scores of the final version were compared between symptomatic (n = 160) and asymptomatic (n = 80) patients and with findings on vaginal examination (pelvic organ prolapse quantification (POP-Q)). In terms of reliability, Cronbach's alpha was calculated, and a test-retest (n = 20) was performed. Responsiveness to treatment was assessed by comparing pre- and postoperative scores in 45 patients. RESULTS: Total scores for each P-QoL domain were different between symptomatic and asymptomatic women (p < 0.001). Severity according to P-QoL correlated well with POP-Q findings. Cronbach's alphas showed internal consistency within the domains. Test-retest reliability was high. Pre- and postoperative scores for each domain were significantly different (p < 0.001). CONCLUSION: The Dutch version of P-QoL is valid, reliable and responsive to assess quality-of-life and symptoms in Dutch-speaking patients with urogenital prolapse.

Relationship between follicle number and (multiple) live birth rate after controlled ovarian hyperstimulation and intrauterine insemination.

OBJECTIVES: The goal of this study was to determine the relationship between the number of mature ovarian follicles and the (multiple) live birth rate after controlled ovarian hyperstimulation and intrauterine insemination. STUDY DESIGN: A total of 2463 intrauterine insemination cycles performed during a natural cycle (n = 118), or after controlled ovarian hyperstimulation with either clomiphene citrate (n = 663) or with gonadotrophins (n = 1682) were reviewed to assess the impact of the type of stimulation and the number of follicles 14 mm or larger on the (multiple) live birth rate per cycle. RESULTS: The live birth rate after intrauterine insemination was significantly higher (P = .02) after stimulation with gonadotrophins (13%) than after clomiphene cirate (8%) if only 1 follicle 14 mm or larger was present. If 2 or more follicles were present, there was no statistically significant difference between both stimulation methods. CONCLUSION: Treatment of intrauterine insemination with gonadotrophin is effective with an acceptable (multiple) live birth rate when 1 or 2 follicles 14 mm or larger are present.