INTRODUCTION AND HYPOTHESIS: First vaginal delivery severely interferes with pelvic floor anatomy and function. This study determines maternal and pregnancy-related risk factors for pelvic floor dysfunction (PFD), including urinary incontinence (UI), urgency, anal incontinence (AI), pelvic organ prolapse (POP) and levator ani muscle (LAM) avulsion. METHODS: This is a single-centre prospective observational cohort study on healthy women in their first singleton pregnancy. All underwent clinical and 3D transperineal ultrasound examination at 6 weeks and 12 months postpartum. Objective outcomes were POP-Q and presence or absence of LAM trauma. Functional outcomes were measured by the ICIQ-SF and PISQ 12. Multivariate regression was performed to determine birth and maternal habitus-related risk factors for UI, urgency, AI, dyspareunia, LAM avulsion and ballooning. RESULTS: Nine hundred eighty-seven women were included. Risk factors for UI were maternal age per year of age (OR: 1.09; 95% CI: 1.04-1.13; p = 0.0001) and BMI before pregnancy (OR: 1.08; 95% CI: 1.04-1.13; p = 0.001); for POP stage II+ maternal age (OR: 1.08; 95% CI: 1.08-1.14; p = 0.005). Avulsion was more likely after forceps (OR: 3.22; 95% CI:1.54-8.22; p = 0.015) but less likely after epidural analgesia (OR: 0.58; 95% CI: 0.37-0.90; p = 0.015) and grade I perineal rupture (OR: 0.50; 95% CI: 0.29-0.85; p = 0.012). Ballooning was more likely at increased maternal age (OR: 1.08; 95% CI: 1.02-1.13; p = 0.005), epidural (OR: 1.64; 95% CI: 1.06-2.55; p = 0.027) and grade I perineal rupture (OR: 1.79; 95% CI: 1.10-2.90; p = 0.018). CONCLUSION: Though maternal characteristics at birth such as age or BMI increase the risk of PFD, labour and birth factors play a similarly important role. The most critical risk factor for MLA avulsion was forceps delivery, while an epidural had a protective effect.
- MeSH
- dospělí MeSH
- fekální inkontinence etiologie MeSH
- inkontinence moči etiologie MeSH
- lidé MeSH
- onemocnění dna pánevního etiologie MeSH
- parita MeSH
- porod MeSH
- prospektivní studie MeSH
- těhotenství MeSH
- vedení porodu škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
INTRODUCTION AND HYPOTHESIS: Animal models are useful for investigating the genesis of pelvic floor dysfunction and for developing novel therapies for its treatment. There is a need for an alternative large-animal model to the nonhuman primate. Therefore we studied the effects of the first vaginal delivery, ovariectomy and systemic hormonal replacement therapy (HRT) on the biomechanical and structural properties of the ovine vagina. METHODS: We examined the gross anatomical properties of nulliparous, primiparous, ovariectomized multiparous, and ovariectomized hormone-replaced multiparous sheep (six animals per group). We also harvested mid-vaginal and distal vaginal tissue to determine smooth muscle contractility and passive biomechanical properties, for morphometric assessment of the vaginal wall layers, to determine collagen and elastin content, and for immunostaining for α-smooth muscle actin and estrogen receptor-α. RESULTS: There were no regional differences in the nulliparous vagina. One year after the first vaginal delivery, stiffness and contractility of the distal vagina were decreased, whereas the elastin content increased. The mid-vagina of ovariectomized sheep was stiff, and its epithelium was thin and lacked glycogen. HRT decreased the stiffness of the mid-vagina by 45% but had no measurable effect on contractility or elastin content, and increased epithelial thickness and glycogen content. HRT also increased the epithelial thickness and glycogen content of the distal vagina. At this location, there were no changes in morphology or stiffness. CONCLUSION: In sheep, life events including delivery and ovariectomy affect the biomechanical properties of the vagina in a region-specific way. Vaginal delivery mainly affects the distal region by decreasing stiffness and contractility. HRT can reverse the increase in stiffness of the mid-vagina observed after surgical induction of menopause. These observations are in line with scanty biomechanical measurements in comparable clinical specimens.
- MeSH
- aktiny metabolismus MeSH
- alfa receptor estrogenů metabolismus MeSH
- biomechanika MeSH
- elastin metabolismus MeSH
- epitel metabolismus patologie MeSH
- glykogen metabolismus MeSH
- hladké svalstvo patofyziologie MeSH
- hormonální substituční terapie MeSH
- kolagen metabolismus MeSH
- modely nemocí na zvířatech MeSH
- onemocnění dna pánevního etiologie MeSH
- ovarektomie škodlivé účinky MeSH
- ovce MeSH
- parita MeSH
- porod * MeSH
- svalová kontrakce MeSH
- vagina patologie patofyziologie MeSH
- zvířata MeSH
- Check Tag
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
This protocol describes mesh insertion into the rectovaginal septum in sheep using a single vaginal incision technique, with and without the trocar-guided insertion of anchoring arms. Parous sheep underwent the dissection of the rectovaginal septum, followed by the insertion of an implant with or without four anchoring arms, both designed to fit the ovine anatomy. The anchoring arms were put in place using a trocar and an "outside-in" technique. The cranial arms were passed through the obturator, gracilis, and adductor magnus muscles. The caudal arms were fixed near the sacrotuberous ligament, through the coccygeus muscles. This technique allows for the mimicking of surgical procedures performed in women suffering from pelvic organ prolapse. The anatomical spaces and elements are easily identified. The most critical part of the procedure is the insertion of the cranial trocar, which can easily penetrate the peritoneal cavity or the surrounding pelvic organs. This can be avoided by a more extensive retroperitoneal dissection and by guiding the trocar more laterally. This approach is designed only for experimental testing of novel implants in large animal models, as trocar-guided insertion is currently not used clinically.
Cíl studie: Využití ovce jako experimentálního modelu, při studiu vlivu těhotenství, porodu a urogynekologických operačních výkonů na orgány pánevního dna. Typ studie: Přehledový článek. Název a sídlo pracoviště: Ústav pro péči o matku a dítě, 3. LF UK, Praha. Metodika: Přehled recentní literatury publikované na téma změny biomechanických vlastností a histologické skladby poševní stěny v průběhu gestace a implantace experimentálních materiálů včetně výuky operačních výkonů na ovčím modelu. Výsledky a závěry: Ovce, ač kvadrupední živočich, má morfologicky srovnatelné pánevní dno a pochvu s člověkem. Stejně jako u žen vykazuje mechanické a biochemické změny v průběhu gestace a postpartálně. Je možné ji využít k testování materiálů pro transvaginální urogynekologickou operativu, kterou lze doplnit o simultánní implantaci do břišní stěny. Vzhledem k velikosti modelu je možné provádět celou řadu biomechanických, biochemických a histologických testů, které mohou obohatit naše znalosti o patologických i fyziologických procesech vyvolaných hormonálními změnami či operacemi. Ovce se jeví vhodným velkým zvířecím modelem pro studium vlivu životních milníků pánevních orgánů a je praktická z hlediska vaginální operativy.
Objective: A short literature review of ewe as an experimental model in research of effects of pregnancy, delivery and urogynecological surgical procedures on the pelvic floor. Design: Literature overview. Setting: Institute for the Care of Mother and Child, Third Faculty of Medicine, Prague. Methods: This is an overview of recent literature on experiments using ewes as a model for biomechanical and morphological changes of the vagina induced by pregnancy, delivery and transvaginal graft implantation. Results and conclusion: The ovine pelvic floor and vagina have comparable morphology to human. It’s biomechanical and biochemical properties get changed during the pregnancy and postpartum similarly to clinical findings. Sheep could be used for testing of urogynaecological implants vaginally and simultaneously implanted in the abdominal wall to provide better understanding of anatomical environment differences. The size of the ovine vagina gives the opportunity to perform comprehensive biomechanical, histological and biochemical testing. Experiments and observation may improve our understanding of pathology and physiology of vaginal wall changes induced by hormones, prolapse or surgery.
- MeSH
- experimenty na zvířatech MeSH
- gynekologické chirurgické výkony MeSH
- ovce domácí * MeSH
- pánevní dno * zranění MeSH
- porod * MeSH
- prolaps pánevních orgánů chirurgie terapie MeSH
- rizikové faktory MeSH
- stresová inkontinence moči chirurgie terapie MeSH
- suburetrální pásky využití MeSH
- těhotenství MeSH
- urologické chirurgické výkony MeSH
- vagina zranění MeSH
- zvířata MeSH
- Check Tag
- těhotenství MeSH
- zvířata MeSH
- Publikační typ
- přehledy MeSH
- Klíčová slova
- kongenitální diafragmatická hernie, prenatální diagnostika,
- MeSH
- brániční hernie terapie ultrasonografie MeSH
- echokardiografie trojrozměrná MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- novorozenec MeSH
- prenatální péče MeSH
- těhotenství MeSH
- ultrasonografie prenatální MeSH
- vrozená brániční kýla MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
