Pelvic floor dysfunction in primiparous women up to 6 months after delivery: cohort study

Oliveira, Sheyla Guimarães; Caroci-Becker, Adriana; Mendes, Edilaine de Paula Batista; Riesco, Maria Luiza Gonzalez; Oliveira, Robson da Costa; Oliveira, Sonia Maria Junqueira Vasconcellos de

doi:10.1590/0034-7167-2020-0607

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 74 (05) • 2021 • https://doi.org/10.1590/0034-7167-2020-0607 copy

Pelvic floor dysfunction in primiparous women up to 6 months after delivery: cohort study

Disfunctión del suelo pélvico en primíparas hasta 6 meses después del parto: estudio de cohort

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze pelvic floor muscular strength (PFMS), urinary (UI) and anal (AI) incontinence and dyspareunia in primiparous women up to 6 months after normal or cesarean delivery.

Methods:

this is a prospective cohort with 169 women (128 normal births, 41 cesarean sections), followed between 50-70 and 170-190 days postpartum, when PFMS was measured using perineometry, and UI and AI and dyspareunia, through interview.

Results:

PFMS, UI and dyspareunia were similar between types of delivery. The difference was significant only for the time elapsed, with improvement in the studied period (2 and 6 months postpartum). Regarding AI, there was a significant difference between 2 and 6 months postpartum, with an interaction between type of delivery and time (p=0.022).

Conclusion:

the type of delivery did not show any influence on pelvic floor dysfunctions, except for AI. For all outcomes, there was an improvement in the period studied.

Descriptors:
After Childbirth Period; Pelvic Floor; Muscle Strength; Urinary Incontinence; Dyspareunia

Variable	Type of childbirth				p value
	Normal		Caesarian
	n/mean	%/SD	n/mean	%/SD
Age (years) n=169	21.3	4.9	23.1	5.1	0.022^* * Wilcoxon-Mann-Whitney test;
< 20	59	46.2	11	26.8	0.166†
20 ˫ 25	42	32.8	16	39.0
25 ˫ 30	18	14.1	10	24.4
30 ˫ 35	6	4.7	3	7.3
35 ˫ 40	3	2.3	1	2.4
Skin color (n=169)
White	73	57.0	28	68.2	0.525†
Brown	43	33.6	9	22.0
Black	11	8.6	4	9.8
Yellow	1	0.8	-	-
Education (years) (n=169)
< 9	3	2.3	1	2.4	1.000†
9 ˫ 12	36	28.1	12	29.3
≥ 12	89	69.6	28	68.3
Occupation (n=169)
Paid	42	32.8	11	73.2	0.474^{^‡ ‡ Chi-square test} ‡ Chi-square test
Unpaid	86	67.2	30	26.8	0.474^{^‡ ‡ Chi-square test} ‡ Chi-square test
Marital status (n=150)
With partner	102	87.2	28	84.8	0.729^{^‡ ‡ Chi-square test} ‡ Chi-square test
Without partner	15	12.8	5	15.2	0.729^{^‡ ‡ Chi-square test} ‡ Chi-square test
Previous urinary incontinence (n=169)
Yes	20	15.6	11	26.8	0.108^{^‡ ‡ Chi-square test} ‡ Chi-square test
No	108	84.4	30	73.2	0.108^{^‡ ‡ Chi-square test} ‡ Chi-square test

Variable	Type of childbirth				p value^* * Mixed effects model
	Normal		Caesarian		Childbirth	Time	Childbirth x time
	n	Mean (SD)	n	Mean (SD)
Body mass index
2 months after childbirth	128	24.4 (3.6)	41	26.4 (4.2)	0.002	0.039	0.368
6 months after childbirth	74	23.9 (3.6)	25	26.1 (4.9)
Pelvic floor muscular strength
2 months after childbirth	128	23.5 (15.5)	41	23.3 (14.1)	0.682	0.002	0.457
6 months after childbirth	74	26.8 (13.7)	25	24.4 (12.4)

Variable	Type of childbirth				p value^* * Generalized mixed effects model with Firth penalty.
	Normal		Caesarian		Childbirth	Time	Childbirth x time
	n	%	n	%
Urinary incontinence
2 months after childbirth	10	7.8	4	9.8	0.997	0.005	0.613
6 months after childbirth	3	4.1	-	-
Anal incontinence
2 months after childbirth	6	4.7	-	-	0.078	0.044	0.022
6 months after childbirth	1	1.4	-	-
Dyspareunia
2 months after childbirth	45	44.5	14	43.7	0.167	0.005	0.172
6 months after childbirth	10	14.1	-	-
Resumption of sexual relations
2 months after childbirth	97	75.8	32	78.1	0.451	<0.001	0.503
6 months after childbirth	71	95.9	24	96.0

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[1] Corresponding author: Sheyla Guimarães Oliveira E-mail: sheylaenf@hotmail.com