Effect of Delivery and Episiotomy on the Emergence of Urinary Incontinence in Women: Review of Literature

Episiotomy is obstetric procedure during which the incision extends the vestibule of the vagina during the second stage of labor. Episiotomy was extensively spread with gradual increase of rates in the first half of the 20th century and was performed medio-laterally in all nulliparous women with the idea to protect fetal head from trauma and pelvic floor from injuries. However, reports claiming that episiotomy had no such benefits were published. It was shown that routine medio-lateral episiotomy did not protect against the appearance of urinary incontinence after vaginal delivery, while the risk of anal incontinence could be increased. The role of episiotomy in development of pelvic floor dysfunction remains quite unclear. Due to the mentioned reason, restricted episiotomy approach should be accepted. The origin of stress incontinence during pregnancy is controversial and not definitely scientifically proven. Pregnancy per se and older age at first delivery may have impact on the onset of pelvic floor dysfunction. Urinary incontinence in pregnancy increases the risk of later urinary incontinence, both postpartum and later in life. Vaginal delivery is just one of the potential risk factors for development of urinary incontinence. Mechanical pressure by fetus on the pelvic floor structures, limited denervation of the pelvic floor and soft tissue damage during delivery are some of explanations for the onset of stress urinary incontinence. On the other hand, cesarean delivery might not be protective against emergence of urinary incontinence. Further research in this field is needed.

Correlation of psychological symptoms with cortisol and CRP levels in pregnant women with metabolic syndrome.

BACKGROUND: In pregnancy occurs series of physiological, organic and psychological changes in the female organism. Particularly are significant hormonal and metabolic changes. Elevated cortisol levels are reduced by linking the transport of globulin (transcortin). Triglycerides were increased 50% and other lipids from 20 to 30%. The values of CRP were slightly elevated in the third trimester of pregnancy (10-15 mg/L). To investigate the association of psychological symptoms with the level of cortisol and CRP in women with metabolic syndrome. SUBJECTS AND METHODS: From 1646 pregnant women cross-sectional, prospective study included 180 pregnant women divided into three groups by applying the inclusion and exclusion criteria. Research methods are laboratory and clinical tests and questionnaires. Every pregnant woman have been made complete laboratory findings and determined cortisol in 8 and 17 hours using the chemiluminescent immunoassay method. All pregnant women filled in several questionnaires: socio-demographic, obstetrical-gynecological, standardized psychometric questionnaire (SCL 90-R), a questionnaire syndrome of depression according to ICD 10 and Beck self depression scale. The study was conducted from August 2011 to mid-November 2012. RESULTS: From the total of 1646 hospitalized pregnant women, 176 pregnant women had a BMI>30 and 120 of them were tested, but 60 had criteria for MS. The concentration of morning and afternoon cortisol is increased in pregnant women with the metabolic syndrome Obese pregnant women have a statistically higher level and morning and afternoon cortisol levels than women with normal body weight and without the metabolic syndrome, but these differences are smaller than in the case of pregnant women with the metabolic syndrome. CRP is significantly higher in women with metabolic syndrome. CRP concentration is significantly higher in obese pregnant women compared to pregnant women with normal weight and without the metabolic syndrome, but it is lower than in pregnant women with the metabolic syndrome. The incidence of psychological symptoms as somatization, obsessive-compulsive symptoms, depression, anxiety, phobia, and nonspecific symptoms is statistically increased in pregnant women with elevated morning cortisol, but in women with elevated afternoon cortisol also occurring aggressiveness and paranoia. In pregnant women with elevated CRP is statistically higher incidence of psychological symptoms such as somatization, obsessive-compulsive symptoms, depression, anxiety, and nonspecific symptoms. CONCLUSION: There is a statistically significantly higher levels of cortisol and C-reactive protein in obese pregnant women and pregnant women with the criteria of MS. Morning cortisol has a specific predictive value for the diagnosis of MS, but the values of CRP are changing in numerous physiological and pathological conditions and cannot be taken as a predictive factor in the diagnosis of MS. Pregnant women with MS and elevated morning and evening levels of cortisol and CRP shows a statistically significant higher number of complications in pregnancy and psychological symptoms.

Efficacy of sling procedures for treatment of female stress urinary incontinence.

The aim of this study was to determine the efficacy and surgical outcome of the sling procedures in stress incontinent women in comparison to conventional anterior colporrhaphy. Total of 56 patients with stress urinary incontinence (SUI) were treated with sling procedure between November 2011 and March 2013, 39/56 (69.6%) with suprapubic arc (SPARC) and 17/56 (30.4%) with MiniArc method. During the same period total of 49 patients with SUI were treated with traditional anterior colporrhaphy according to Bagovid method as the control group. All patients were prospectively clinically assessed over aperiod of 3, 6 and l2 months after surgery. The objective cure rate after the follow-up was 92.9% (52/56) in observed group of patients and 79.6% (39/49) in control group and improvement was occurred in rest of 5.4% (3/56) and 18.4% (9/49), respectively (p < 0.05). The overall complications rate was significantly lower in the observed group of patients than in the control group, 12.5% (7/56) vs. 28.6% (14/49), (p < 0.05). In the sling group was postoperatively noticed slightly higher rate of urinary incontinence, but in the colporrhaphy group was emphasized rate of urinary retention. Only one from the each group of patients failed the surgical procedure and required additional correction for SUI. The mean operating time for SPARC and MiniArc procedure was 19 +/- 7 and 9 +/- 5 minutes, respectively (p < 0.0001). Mean duration of hospitalization was significantly shorter in the sling group of patients (2.6 +/- 1.0, range 2-7) days than in the control group of (9.6 +/- 1.8, range 6-18), (p < 0.001 < 0.0001). According to presented results, sling is a highly effective method in patients with SUI with low incidence of perioperative complications, promising long-term results and high patient's satisfaction.