Association of Pelvic Floor Disorders, Perceived Psychological Stress, and Military Service in U.S. Navy Servicewomen: A Cross-Sectional Survey.

IMPORTANCE: Pelvic floor disorders (PFDs) are linked to psychological stress and decreased work performance in civilian populations. Higher psychological stress is reported in female active-duty servicewomen (ADSW), which affects military readiness. OBJECTIVE: This study sought to associate PFDs, work-related challenges, and psychological stress in ADSW. STUDY DESIGN: We conducted a single-site, cross-sectional survey of ADSW seeking care in the urogynecology, family medicine, and women's health clinics between December 2018 and February 2020 using validated questionnaires to determine the prevalence of PFDs and the association with psychological stress, performance of military duties, and continued military service. RESULTS: One hundred seventy-eight U.S. Navy ADSW responded; most were seeking care for PFDs. The reported prevalence rates of PFDs were as follows: urinary incontinence, 53.7%; pelvic organ prolapse, 16.3%; fecal incontinence, 73.2%; and interstitial cystitis/bladder pain syndrome, 20.3%. Active-duty servicewomen with PFDs were more likely to have higher psychological stress scores (22.5 ± 3.7 vs 20.5 ± 4.2, P = 0.002) and body composition failures (22.0% vs 7.3%, P = 0.012), yet more strongly consider remaining on active service if they reported urinary incontinence (22.8% vs 1.8%) or interstitial cystitis/bladder pain syndrome (19.5% vs 1.8%; all P ≤ 0.001). No significant differences were noted in physical fitness failures or other military duties. CONCLUSIONS: For these U.S. Navy ADSW with PFDs, there was no significant difference in duty performance but reported psychological stress levels were higher. The presence of PFD was associated with women more strongly considering ongoing military service compared with other factors such as family, job, or career path.

Inpatient Biophysical Profiles and the Effect on Clinical Decision Making.

Objective Our primary objective was to determine whether biophysical profiles (BPP) performed on the antepartum unit result in changes in clinical decision making. Study Design A retrospective cohort chart review was performed among women who had a BPP during hospital admission. BPP status was categorized as normal (8/8 points) and abnormal (6/8 or less points). The primary outcome, clinical decision making, was the need for prolonged external fetal monitoring (defined as > 2 hours) or decision to proceed with delivery. Secondary outcomes included mode of delivery, indicated preterm delivery, birth weight, 5-minute Apgar's score <7, and neonatal intensive care unit (NICU) admission. Results Among our cohort ( n = 186), 85.5% ( n = 159) had a normal BPP. Delivery management was altered in one case (0.54%) by the BPP findings, and there were no BPPs that resulted in need for prolonged monitoring. Compared with women with normal BPP, women with abnormal BPPs were more likely to deliver at <37 weeks, to be admitted to the NICU, or have a 5-minute Apgar's score <7. Conclusion In-hospital BPPs alter clinical decision making in less than 1% of cases.