Are there differences in short-term pelvic floor muscle function after cesarean section or vaginal delivery in primiparous women? A systematic review with meta-analysis.

INTRODUCTION AND HYPOTHESIS: The literature presents controversial results regarding the role of delivery mode in pelvic floor muscle (PFM) function after birth. Some studies showed a greater impairment of PFM function after vaginal delivery compared with cesarean section, while others have not identified a significant difference between these two modes of delivery. This study aimed to investigate whether there was a difference in short-term PFM function after childbirth in primiparous women who underwent cesarean section compared with those who underwent vaginal delivery. METHODS: Up to December 2018, the PubMed-MEDLINE, CINAHL, Embase, Bireme, Scopus, Web of Science, and Science Direct databases were searched. Two independent reviewers performed the selection process based on titles, abstracts, and full-text reading. Observational studies comparing PFM function after cesarean section versus vaginal delivery in primiparous women were included. PRISMA guidelines and Cochrane recommendations were followed. Methodological quality of the primary studies was assessed through the checklist proposed by the Joanna Briggs Institute for cross-sectional studies. Random effects meta-analysis was performed to synthesize evidence regarding PFM strength in primiparous woman after vaginal delivery compared with cesarean section. The GRADE approach was applied to classify the quality of the evidence. RESULTS: Eleven studies met the inclusion criteria and were included in this review. A total of 1726 primiparous women were analyzed after childbirth. Five studies were included in the meta-analysis. No difference in PFM strength after childbirth was identified when cesarean section was compared with vaginal delivery [standardized mean difference (SMD): -0.15, 95% confidence interval (CI): -0.85 to 0.56]. Differences in PFM strength were identified when patients who underwent cesarean section were compared with those with an episiotomy or instrumented vaginal delivery (SMD: -12.51, CI 95%: -24.57 to -0.44), favoring the cesarean section group. In both cases, the quality of evidence was classified as very low because of the observational design of the included studies and population heterogeneity. CONCLUSION: There was no difference in short-term PFM strength after childbirth between primiparous women who underwent cesarean section or vaginal delivery, as assessed through vaginal manometry. However, we identified reduced PFM strength in women who underwent an episiotomy or instrumented vaginal delivery compared with those who underwent cesarean section. Nevertheless, this conclusion should be cautiously considered as the observational design of the primary studies and possible heterogeneity among the primiparous women included in the studies contributed to reducing the quality of the evidence synthesized. Future primary studies with longitudinal designs and long-term follow-up periods are needed to strengthen the quality of evidence and provide more conclusive evidence to guide clinical practice.

Influence of short-term training on the distal adjustments of reaching in preterm infants

OBJECT: The purpose of the study was to investigate the influence of short-term training on distal adjustments of reaching in preterm infants with low birth weight and compare them with full-term infants METHODS: Sixteen infants at the onset of reaching were equally allocated to a: preterm group (<34 weeks of gestational age) with a low birth weight (<2.5kg), and control group (full-term infants). The infants were submitted to two assessments carried out on a single day: pre-training (2 minutes) and post-training (2 minutes). The preterm group received one training session under a serial practice condition and the control group received one session of social training. It was used the repeated-measures analysis of variance, with Bonferroni adjustments RESULTS: The preterm infants presented more reaches with semi-open and oblique hand compared with the full-term infants and the short-term training increased more reaches and reaches with dorsal hand CONCLUSION: We conclude that the preterm infants presented more reaches with semi-open and oblique hand compared with the full-term infants and that the short-term training was effective in providing more reaches, observed in the increase in the number of hand contacts with the object.(AU)

OBJETIVO: O objetivo do estudo foi investigar a influência do treino de curta duração nos ajustes distais do alcance em lactentes pré-termo e baixo peso ao nascimento, e compará-los com lactentes a termo MÉTODOS: Dezesseis lactentes na emergência do alcance foram igualmente alocados em: grupo pré-termo (< 34 semanas de idade gestacional), e baixo peso ao nascimento (< 2,5 kg), e grupo controle (lactentes a termo). Os lactentes foram submetidos a duas avaliações realizadas em um único dia: pré-treino (2 minutos) e pós-treino (2 minutos). O grupo pré-termo recebeu uma sessão de treino (prática variada seriada) e o grupo controle recebeu uma sessão de treino social. Foi utilizada a análise de medidas repetidas de variância, com ajustes de Bonferroni RESULTADOS: Os lactentes pré-termo apresentaram mais alcances com mão semi-aberta e oblíqua em comparação com os lactentes a termo. O treino de curta duração aumentou a frequência de alcances CONCLUSÃO: Conclui-se que os lactentes pré-termo apresentaram mais alcances com mão semi-aberta e oblíqua em relação aos lactentes a termo e que o treino de curta duração foi efetivo na emergência do alcance, observando o aumento do número de contatos da mão do lactente com o objeto.(AU)

Influence of short-term training on the distal adjustments of reaching in preterm infants

OBJECT: The purpose of the study was to investigate the influence of short-term training on distal adjustments of reaching in preterm infants with low birth weight and compare them with full-term infants METHODS: Sixteen infants at the onset of reaching were equally allocated to a: preterm group (<34 weeks of gestational age) with a low birth weight (<2.5kg), and control group (full-term infants). The infants were submitted to two assessments carried out on a single day: pre-training (2 minutes) and post-training (2 minutes). The preterm group received one training session under a serial practice condition and the control group received one session of social training. It was used the repeated-measures analysis of variance, with Bonferroni adjustments RESULTS: The preterm infants presented more reaches with semi-open and oblique hand compared with the full-term infants and the short-term training increased more reaches and reaches with dorsal hand CONCLUSION: We conclude that the preterm infants presented more reaches with semi-open and oblique hand compared with the full-term infants and that the short-term training was effective in providing more reaches, observed in the increase in the number of hand contacts with the object...

OBJETIVO: O objetivo do estudo foi investigar a influência do treino de curta duração nos ajustes distais do alcance em lactentes pré-termo e baixo peso ao nascimento, e compará-los com lactentes a termo MÉTODOS: Dezesseis lactentes na emergência do alcance foram igualmente alocados em: grupo pré-termo (< 34 semanas de idade gestacional), e baixo peso ao nascimento (< 2,5 kg), e grupo controle (lactentes a termo). Os lactentes foram submetidos a duas avaliações realizadas em um único dia: pré-treino (2 minutos) e pós-treino (2 minutos). O grupo pré-termo recebeu uma sessão de treino (prática variada seriada) e o grupo controle recebeu uma sessão de treino social. Foi utilizada a análise de medidas repetidas de variância, com ajustes de Bonferroni RESULTADOS: Os lactentes pré-termo apresentaram mais alcances com mão semi-aberta e oblíqua em comparação com os lactentes a termo. O treino de curta duração aumentou a frequência de alcances CONCLUSÃO: Conclui-se que os lactentes pré-termo apresentaram mais alcances com mão semi-aberta e oblíqua em relação aos lactentes a termo e que o treino de curta duração foi efetivo na emergência do alcance, observando o aumento do número de contatos da mão do lactente com o objeto...