Background: Pregnancy and childbirth alter pelvic floor anatomy and function. Over 4 million women give birth each year in the United States, and most experience genital tract trauma, including damage to the nerves and musculature of the pelvic floor. This trauma can cause short and long term problems for new mothers, including urinary and anal incontinence, sexual dysfunction, perineal pain, and pelvic floor anatomical changes. The prevalence and natural history of these disorders in healthy women is unknown.
Specific Aims :
The specific aims of this study are to 1) identify the prevalence of urinary and anal incontinence, sexual complaints, anatomical changes and perineal pain in women with and without genital tract trauma, prenatally and postpartum and to evaluate the effect of pelvic floor (PF) changes on maternal quality of life 2) compare PF changes in women with and without genital tract trauma 3) determine if modifiable second stage labor care measures are associated with PF changes and 4) compare PF changes in women who deliver by cesarean but do not enter the second stage of labor to women who deliver vaginally with and without genital tract trauma. Study population: Six hundred and thirty healthy nulliparous pregnant women cared for by nurse-midwives and 135 women who deliver by cesarean from the low risk obstetrical services in Albuquerque, New Mexico. Study Design: Prenatally, women will be recruited from three nurse midwifery clinics. Women will complete validated symptom severity scales and quality of life (QOL) questionnaires that measure PF function. Structured pelvic examinations incorporating the pelvic organ prolapse quantification system will evaluate pelvic floor anatomy. At birth, a detailed map of perineal trauma will be recorded. Women who deliver by cesarean will be recruited postpartum. At six weeks, six months and one year postpartum, women will complete symptom severity and QOL measures and undergo detailed pelvic exams. At 6 months, endoanal ultrasound to evaluate the anal sphincter, translabial 3 D ultrasonography to evaluate the levator ani and a paper towel test to document urinary incontinence will be performed. All women who deliver in the first three years of the study will be followed for the second year with symptom severity and QOL questionnaires. Significance of this work: Functional and anatomical disorders of the PF impact women's lives, and result in an economic burden to the health care system. Childbirth and pregnancy have been implicated as a cause of these disorders, yet the natural history of pelvic floor changes during pregnancy and following childbirth has yet to be described. This project will provide fundamental data to guide future decisions about labor interventions to prevent PF changes as well as data-based decisions regarding maternal request cesarean.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD049819-04
Application #
7666822
Study Section
Urologic and Kidney Development and Genitourinary Diseases Study Section (UKGD)
Program Officer
Parrott, Estella C
Project Start
2006-09-12
Project End
2011-06-30
Budget Start
2009-07-01
Budget End
2010-06-30
Support Year
4
Fiscal Year
2009
Total Cost
$354,813
Indirect Cost
Name
University of New Mexico
Department
Obstetrics & Gynecology
Type
Schools of Medicine
DUNS #
868853094
City
Albuquerque
State
NM
Country
United States
Zip Code
87131
Rogers, Rebecca G; Ninivaggio, Cara; Gallagher, Kelly et al. (2017) Pelvic floor symptoms and quality of life changes during first pregnancy: a prospective cohort study. Int Urogynecol J 28:1701-1707
Singh, Rameet H; Montoya, Maria; Espey, Eve et al. (2017) Nitrous oxide versus oral sedation for pain management of first-trimester surgical abortion - a randomized study. Contraception 96:118-123
Leeman, Lawrence; Rogers, Rebecca; Borders, Noelle et al. (2016) The Effect of Perineal Lacerations on Pelvic Floor Function and Anatomy at 6 Months Postpartum in a Prospective Cohort of Nulliparous Women. Birth 43:293-302
Meriwether, Kate V; Rogers, Rebecca G; Dunivan, Gena C et al. (2016) Perineal body stretch during labor does not predict perineal laceration, postpartum incontinence, or postpartum sexual function: a cohort study. Int Urogynecol J 27:1193-200
Meriwether, Kate V; Hall, Rebecca J; Leeman, Lawrence M et al. (2015) The relationship of 3-D translabial ultrasound anal sphincter complex measurements to postpartum anal and fecal incontinence. Int Urogynecol J 26:1191-9
Meriwether, Kate V; Hall, Rebecca J; Leeman, Lawrence M et al. (2015) Anal sphincter complex: 2D and 3D endoanal and translabial ultrasound measurement variation in normal postpartum measurements. Int Urogynecol J 26:511-7
Gallagher, Kelly; Migliaccio, Laura; Rogers, Rebecca G et al. (2014) Impact of nulliparous women's body mass index or excessive weight gain in pregnancy on genital tract trauma at birth. J Midwifery Womens Health 59:54-9
Komorowski, Leanne K; Leeman, Lawrence M; Fullilove, Anne M et al. (2014) Does a large infant head or a short perineal body increase the risk of obstetrical perineal trauma? Birth 41:147-52
Meriwether, Kate V; Hall, Rebecca J; Leeman, Lawrence M et al. (2014) Postpartum translabial 2D and 3D ultrasound measurements of the anal sphincter complex in primiparous women delivering by vaginal birth versus Cesarean delivery. Int Urogynecol J 25:329-36
Singh, Rameet H; Rogers, Rebecca G; Leeman, Lawrence et al. (2014) Postpartum contraceptive choices among ethnically diverse women in New Mexico. Contraception 89:512-5

Showing the most recent 10 out of 19 publications