Physiotherapist-led ultrasound-guided visual biofeedback prelabor training: a randomised controlled trial.

The optimal management of second stage of labor, with its passive and active phases, remains controversial. In France, delayed pushing during the active phase is recommended because of the belief that, based on older data, the fetus is at higher risk during the active phase. It is possible that uterine contractions combined with maternal pushing can lead to cord compression and reduce placental perfusion and oxygenation, which can induce acidosis and fetal heart rate abnormalities, resulting in the need for medical intervention, such as operative vaginal delivery (OVD) or episiotomy. In countries where the active phase is limited, women are encouraged to push as strongly as possible to speed delivery. However, if the active second stage of labor is prolonged, this intensive management may increase fetal hypoxia. The aim of this study was to examine the effect of moderate pushing versus intensive pushing in the second stage of labor on the risk of neonatal morbidity. This was a multicenter, randomized controlled trial at 13 French maternity units between January 2017 and May 2020. Included were nulliparous, adult women who had spontaneous or induced, uncomplicated delivery of a singleton fetus at ≥37 weeks of gestation. Excluded were women with a psychiatric condition, a disease contraindicating intensive expulsive efforts, or any uterine surgical scar, as well as those with a fetus that was small for gestational age, had congenital abnormalities, or had abnormal heart rate. Eligible women were randomized into 2 groups: the intervention group was instructed to push moderately only during the active phase of the second stage of labor, and the control group was instructed to push intensively during the same phase following French recommendations. Midwives asked the intervention group to push 2 times during each contraction and to take a break with no pushing in 1 of 5 contractions. No limit was set on pushing duration. The control group was asked to push 3 times per contraction without breaks. After 30 minutes of pushing, the midwife contacted an obstetrician to consider operative delivery. The primary outcome was a composite of neonatal acidosis, a 5-minute Apgar score <7, and/or severe neonatal trauma. Secondary neonatal outcomes were transfer to the neonatology unit or intensive care unit need for resuscitation at birth and need for hypothermia. Secondary maternal outcomes were mode of delivery, postpartum hemorrhage (PPH), and severe PPH. The trial was stopped prematurely because of difficulties obtaining an adequate sample size. Of the 3380 women initially planned, 1710 (50.6%) were included. Ultimately, the intention-to-treat analysis included 809 women in each group. The neonatal morbidity rates for the intervention group and control group were 18.9% and 20.6%, respectively (risk ratio [RR] 0.92; 95% confident interval [CI], 0.75–1.12; P = 0.38). No significant differences were observed for neonatal transfer or need for resuscitation. All but 16 women delivered vaginally. The intervention or moderate pushing group had a longer pushing duration than the control or intensive pushing group (38.8 ± 26.4 vs 28.6 ± 17.0 minutes; P < 0.001) and lower episiotomy rate (13.5% vs 17.8%; RR, 0.76; 95% CI, 0.60–0.95; P = 0.02). The rates of OVD were 21.1% in the intervention group and 24.8% in the control group (RR, 0.85; 95% CI, 0.71–1.02; P = 0.08). No significant differences were observed for PPH or severe PPH. During the active stage of labor, encouraging women to push moderately versus intensively was not associated with decreased neonatal morbidity. Although the pushing duration was longer among women instructed to push moderately, the rate of episiotomy was lower.

Background: Gestational diabetes mellitus (GDM) is one of the risk factors for postpartum urinary incontinence. Pelvic floor muscle training (PFMT) improves pelvic floor dysfunction in puerperal women, but patient compliance is low. Mobile Health (mHealth) is a promising solution. Objective: To investigate PFMT compliance and effects on pelvic floor muscles in GDM puerperal women guided by the mobile fitness app Keep. Methods: This randomized controlled trial included puerperal women with GDM (n = 72) who were delivered at a tertiary general hospital, selected from November 2021 to April 2022 using convenience sampling, and randomly divided into control (n = 36) and experimental (n = 36) groups. The control group performed PFMT based on routine postpartum PFMT training instruction. The experimental group performed PFMT based on Keep. Both groups had a 4-week intervention period. The PFMT compliance, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Pelvic Muscle Self-efficacy Scale, and the Knowledge, Attitude, Belief, and Practice (KAP) scores of PFMT in puerperal women in the groups were compared pre- and post-intervention. Pelvic floor surface electromyographic biofeedback was used to compare the post-intervention pelvic floor muscle strength between the two groups. Results: Compared with the control group, the test group had higher post-intervention maternal PFMT compliance, pelvic floor muscle strength, pelvic floor muscle self-efficacy, and KAP scores (p < 0.05); incontinence scores were lower (p < 0.05). Pelvic floor muscles in both groups recovered better post-intervention (p < 0.05). Conclusion: The Keep app can improve PFMT adherence, urinary incontinence, KAP scores, self-efficacy, and pelvic floor muscle strength in GDM puerperal women and promote pelvic floor rehabilitation after delivery.

The role of the angle of progression in the prediction of the outcome of occiput posterior position in the second stage of labor

Influence of a pelvic floor training programme to prevent perineal trauma: A quasi-randomised controlled trial

Postpartum urinary retention (PUR) poses a risk of uterine contraction issues and postpartum vaginal bleeding. This research sought to examine the factors associated with PUR in primiparous women. This study was case-control one involving all first-time mothers in our hospital between June 2022 and June 2024. The study cohort comprised 338 mothers with PUR, whereas the control cohort included 338 mothers without PUR. By conducting univariate analysis and logistic regression analyses, we identified the independent factors contributing to PUR in primiparous women. The discriminative ability of each risk factor, individually and in combination, in predicting the occurrence of PUR amongst first-time mothers was assessed through the receiver operating characteristic (ROC) curve and the area under the curve (AUC). Univariate analysis results displayed notable variances between the observation and control groups concerning the percentage of patients receiving labour analgesia, the duration of the second stage of labour, the incidence of episiotomy, the utilization of forceps delivery, the occurrence of manual rotation of the foetal head, average self-rating anxiety scale (SAS) score, and numeric rating scale (NRS) score (p < 0.05). Logistic regression analysis unveiled that labour analgesia (OR (95% confidence interval (CI)) = 1.528 (1.070-2.317)), prolonged second stage of labour (OR (95% CI) = 1.022 (1.009-1.034)), undergoing episiotomy (OR (95% CI) = 1.609 (1.313-1.803)), using forceps delivery (OR (95% CI) = 1.499 (1.182-2.718)), and higher NRS scores (OR (95% CI) = 1.387 (1.181-2.201)) all emerged as significant independent risk factors for PUR in primiparas. ROC analysis demonstrated that the AUC for the individual and combined predictive capacities of factors for predicting PUR in primiparas were 0.583, 0.607, 0.574, 0.558, 0.571, and 0.896. The combined prediction method had notably superior efficacy compared with the individual prediction using each factor. The risk of PUR in primiparas is closely associated with the receipt of labour analgesia, a prolonged second stage of labour, episiotomy, the use of forceps delivery, and higher NRS scores. For primiparas with the above high-risk factors, early intervention during pregnancy and the perinatal period should be considered to reduce the incidence of PUR.

To investigate the effectiveness of supervised remote rehabilitation programs comprising novel methods of pelvic floor muscle (PFM) training for women with urinary incontinence (UI). A systematic review and meta-analysis including randomized controlled trials (RCTs), involving novel supervised PFM rehabilitation programs as intervention groups (e.g., mobile applications programs, web-based programs, vaginal devices) versus more traditional PFM exercise groups (acting as control); both sets of groups being offered remotely. Data have been searched and retrieved from the electronic databases of Medline, PUBMED, and PEDro using relevant key words and MeSH terms. All included study data were handled as reported in the Cochrane Handbook for Systematic Reviews of Interventions and the evaluation of their quality was undertaken utilizing the Cochrane risk-of-bias tool 2 (RoB2) for RCTs. The included RCTs, involved adult women with stress UI (SUI) or mixed urinary incontinence, where SUI were the most predominant symptoms. Exclusion criteria involved pregnant women or up to 6-month postpartum, systemic diseases and malignancies, major gynecological surgeries or gynecological problems, neurological dysfunction or mental impairments. The searched outcomes included subjective and objective improvements of SUI and exercise adherence in PFM exercises. Meta-analysis was conducted and included studies pulled by the same outcome measure. The systematic review included 8 RCTs with 977 participants. Novel rehabilitation programs included mobile applications (1 study), web-based programs (1 study) and vaginal devices (6 studies) versus more traditional remote PFM training, involving home-based PFM exercise programs (8 studies). Estimated quality with Cochrane's RoB2, presented the 80% of the included studies as "some concerns" and the 20% as "high risk." Meta-analysis included 3 studies with no heterogeneity (I2 = 0) across them. Weak-evidenced results presented home PFM training equally effective with novel PFM training methods (mean difference: 0.13, 95% confidence interval: -0.47, 0.73), with small total effect size (0.43). Novel PFM rehabilitation programs presented as effective (but not superior) to traditional ones in women with SUI, both offered remotely. However, individual parameters of novel remote rehabilitation including supervision by the health professional, remains in question and larger RCTs are required. Connection between devices and applications in combination with real-time synchronous communication between patient and clinician during treatment is challenged for further research across novel rehabilitation programs.

Can postpartum pelvic floor muscle training reduce urinary and anal incontinence?: An assessor-blinded randomized controlled trial

Urinary incontinence is a common health problem that carries with it a significant burden. Nearly twice as many men suffer from this problem than women, and studies have demonstrated that help-seeking behavior is more challenging for men. This information sheet is based on a systematic review and focuses on the best-available evidence regarding educational interventions to raise men's awareness of bladder and bowel health. It also provides recommendations for practice.

Aim: To explore the effect of different electrical stimulation intensities combined with pelvic floor muscle training on postpartum pelvic floor dysfunction. Methods: 720 patients with pelvic floor dysfunction diagnosed following vaginal delivery were randomly divided into intervention and control groups. The control group was treated with conventional electrical stimulation combined with pelvic floor muscle training. Patients in the intervention group were treated with electrical stimulation of increasing intensity. The electrophysiological indices of pelvic floor function, SUI incidence, ICI-Q-SF, POP-Q, PFIQ-7 and PISQ-12 scores were compared between the two groups. Results: Following treatment, patients in the intervention group had significantly higher pelvic floor muscle type I, type II muscle strengths, slow muscle average myoelectric values, fast muscle maximum myoelectric values, front resting average myoelectric values, rear resting average myoelectric values, and vaginal resting pressure, compared to the control group. There was no difference in the Bp, D, GH, PB and TVL measurements between the two groups. SUI, ICI-Q-SF and PISQ-12 scores were significantly lower in the intervention group, but there was no difference in the PFIQ-7 score. Conclusion: Use of higher intensity electric stimulation combined with pelvic floor muscle training appears to improve the electrophysiological indices of pelvic floor function and POP-Q parameters, as well as reducing the severity and incidence of urinary incontinence and improving sexual function.

To compare the efficacy of pelvic floor muscle exercises (PFME) with and without electromyographic biofeedback (BF) in increasing muscle strength, improving myoelectric activity, and improving pre-contraction and quality of life in postmenopausal women with stress urinary incontinence. Randomized controlled trial of 49 postmenopausal women with stress urinary incontinence. Participants were allocated across three groups: control, PFME alone, and PFME + BF. Forty-five women completed the study (14 control, 15 PFME, 16 PFME + BF; mean age 58.26 years). Outcome assessment was carried out using digital palpation (modified Oxford grading scale), electromyography, and the International Consultation Incontinence Questionnaire-Short Form (ICIQ-SF) quality of life instrument. The treatment protocol consisted of eight twice-weekly, 20-min one-on-one sessions. Controls were assessed only at baseline and after 1 month. The PFME and PFME + BF groups exhibited significant increases in muscle strength (Oxford scale) (P < 0.0001), precontraction while coughing (P < 0.0001), maximum voluntary contraction, duration of endurance contraction, and ICIQ-SF scores (P < 0.0001). PFME + BF was associated with significantly superior improvement of muscle strength, precontraction while coughing, maximum voluntary contraction, and duration of endurance contraction as compared to PFME alone (P < 0.05). This preliminary study suggests that pelvic floor muscle training, with and without biofeedback, is associated with increased muscle strength, myoelectric activity, precontraction of pelvic floor muscles, and improved quality of life in postmenopausal women with stress urinary incontinence.

Objectives: The present systematic review focused on the prevention or treatment of three main types of pelvic floor dysfunctions (PFDs) specifically pelvic organ prolapse (POP), urinary incontinence (UI), and fecal incontinence (FI) using physiotherapy and pelvic floor muscle exercises (PFMEs). With regard to the breadth of the problem, there is not much evidence grounded on the best management. The main purpose of this systematic review was to evaluate the effects of physiotherapy and PFMEs on the prevention and treatment of pregnancy-related PFDs; namely, POP, FI, and UI. Therefore, this review incorporated studies comparing the use of physiotherapy and PFMEs with every other existing interventions. Methods: This systematic review and meta-analysis was conducted on randomized-controlled-trial (RCT) articles and quasi-RCT designs through a search in the studies published with no time limits until December 2017 in the databases of PubMed (Medline), Web of Science, Scopus, Embase, Cochrane Library, and ProQuest. The meta-analysis was also applied for data synthesis. Moreover, heterogeneity was assessed using Cochran’s Q test and I2 index. Results: A total number of 26 RCTs were examined in this review in which the outcome variables were related to POP, UI, and FI prevalence; POP, UI, and FI severity, as well as pelvic floor muscle (PFM) strength and endurance. In most articles, UI prevalence or severity in intervention groups had significantly improved compared with those in controls. The number of studies examining POP and FI was also relatively low. In two studies, FI severity or prevalence in intervention groups had significantly enhanced in comparison with those in control groups; however, FI prevalence in two articles had been reported lower in intervention groups than that in control groups although no significant difference had been observed. There was also no significant improvement in intervention groups in two other studies in this respect. Besides, three articles had not reported traces of improvement in POP, as well as a significant difference between intervention and control groups. Nevertheless, two studies had found a significant improvement in POP in this regard. Based on meta-analysis results for the variable of PFM strength, Cochran’s Q test (P&lt;0.001) and I2 index (90.02) indicated heterogeneity between studies; so, a random-effect meta-analysis was applied to estimate overall effect sizes. The overall mean differences following intervention between the study groups were also equal to 6.94, with a 95% CI (1.36 to 12.52). Conclusions: It was concluded that physiotherapy and PFMEs might have effects on pregnancy-related UI, but they had not consistently reduced FI severity or prevalence and failed to constantly improve POP.

Postpartum stress urinary incontinence (PSUI) commonly impairs quality of life in postpartum women. Pelvic floor muscle training (PFMT), as a primary foundational treatment, faces challenges such as inadequate adherence and significant individual differences in efficacy. Electrical stimulation (ES) and magnetic stimulation (MS), as passive pelvic floor rehabilitation techniques, are often used in conjunction with PFMT in clinical settings. However, there is a lack of systematic retrospective cohort study evidence comparing the efficacy, safety, and adherence of these three methods. Compare the effects of the three intervention strategies: PFMT, PFMT combined with ES, and PFMT combined with MS, on the recovery of pelvic floor function and the improvement of clinical symptoms in patients with PSUI. This retrospective study enrolled patients with PSUI who received systematic treatment at our hospital's plastic surgery department between June 2020 and June 2025. Patients were divided based on their treatment regimens: PF (receiving PFMT guidance), ES (receiving PFMT combined with outpatient ES therapy), and MS (receiving PFMT combined with outpatient MS therapy). A total of 102 patients (n = 34) were ultimately included. All patients received a 12-week course of systematic rehabilitation treatment. Primary indicators were objective measures: the amount of urine leakage during a 1-hour pad test, pelvic floor muscle strength (modified Oxford grading), and urodynamic parameters (maximum urethral closure pressure [MUCP], abdominal pressure leak point pressure [LPP]). Secondary indicators included the overall clinical response rate, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scores, Incontinence Quality of Life Questionnaire (I-QOL) scores, and the incidence of adverse events. Baseline characteristics were balanced among the three groups (P > 0.05). After 12 weeks of treatment, the urine leakage volume in all three groups decreased compared to the baseline (P < 0.001). Specifically, the urine leakage volume after MS and ES treatments was lower than after PF treatment (P < 0.01). In terms of pelvic floor muscle strength, both MS and ES treatments resulted in higher Oxford grades compared to PF (P < 0.001). Regarding urodynamic parameters, both MS and ES treatments showed higher MUCP and LPP values than PF (P < 0.001) with MS higher than ES (P < 0.05). In terms of clinical overall effectiveness, PF had a rate of 73.5% (25/34), ES had a rate of 91.2% (31/34), and MS had a rate of 94.1% (32/34). Both ES and MS had higher rates compared to PF (P < 0.05). Both MS and ES showed lower ICIQ-SF scores (P < 0.01) and higher I-QOL scores (P < 0.001) than PF. Moreover, MS had higher I-QOL scores than ES (P = 0.008). In this non-randomized study, PFMT combined with ES or MS was associated with greater improvements than PFMT alone, and MS showed more favorable urodynamic and quality-of-life changes. Causal superiority cannot be determined.

Background: Normal vaginal delivery is associated with a significant risk of perineal trauma and associated complications. This can be avoided by engaging in prenatal pelvic floor exercises, yoga, and perineal massage. Exercise and perineal massage significantly improve maternal and neonatal outcomes and reduce postpartum complications. Aims and Objectives: To study the impact of prenatal perineal massage and pelvic floor relaxing exercises on obstetric outcome, incidence of episiotomy, mode of delivery, duration of labor, and postpartum complications in women of both groups. Materials and Methods: This prospective randomized controlled trial study was conducted in a tertiary care hospital in Northern India. 200 primigravida antenatal women with uncomplicated singleton pregnancy at the period of gestation ≥32 weeks who attended the antenatal outpatient department, Post Graduate Institute Memory Scale were included in the study and were divided into two groups: Group A (performing perineal massage and pelvic floor exercises) and Group B (receiving routine antenatal care). Patients were followed till 6 days postpartum and data were collected regarding fetomaternal outcomes. Results: From Group A, 80% of participants had spontaneous onset of labor as compared to 64% in Group B (P=0.012). In the present study, the mean duration of the first stage of labor was 232.84±29.88 min and 245.39±26.13 min, respectively, which was significantly reduced in Group A (P&lt;0.004). Similarly, the duration of the second stage of labor was significantly reduced in Group A, 44.2±10.73 min in Group A, and 58.02±20.81 min in Group B (P&lt;0.001). A significant reduction was seen in the need for episiotomy and postpartum complications in Group A, (P&lt;0.0001) and (P=0.003), respectively. Conclusion: The findings of this study suggest that engaging in perineal exercises and massage has contributed to shortening the duration of labor with a significant reduction in rates of episiotomy and 2nd perineal tear, hence leading to less number postpartum complications such as infection and episiotomy gaping.

The primary objective of this review was to determine, from the available evidence, the effectiveness of an antenatal and/or a post-natal program of pelvic floor muscle exercises (PFME) compared with usual care on preventing, reducing or resolving the incidence and severity of stress incontinence, urge incontinence or mixed stress and urge urinary incontinence following childbirth. Secondary objectives were included to examine the effectiveness of a PFME program on pelvic floor muscle strength and on encouraging adherence to an exercising program.Randomised controlled trials and non-randomised controlled trials were included in the review if, in relation to urinary incontinence, and/or adherence to a PFME program, and/or pelvic floor muscle strength, the following had been explored:Usual care is commonly used to describe the care women normally receive from health professionals in the antenatal and/or post-natal period. In some cases usual care includes a standard information package given to all women attending the health service and in others it is advice about performing PFME.Participants included women who experienced a spontaneous onset of labour and who subsequently delivered at more than 20 weeks gestation either vaginally, both spontaneous and assisted, or by non-elective caesarean section.1 Pelvic floor muscle exercises.2 PFME instruction and a PFME program's components, such as educational materials, feedback (including biofeedback, e.g. information about strength of pelvic floor muscle contractions by various means) and number of PFME.In studies that included a subgroup treated with one of these interventions, the results of the subgroup were excluded from the review's analysis.Outcomes that were of interest: SEARCH STRATEGY: All major electronic sources of information relevant to the topic (e.g. PubMed, CINAHL and the Cochrane Library) were searched to identify published and unpublished studies and previous work in the field. Printed journals were hand-searched and reference lists checked for potentially useful research. The review included any studies undertaken between 1981 and 2003. The search did not attempt to locate unpublished research before 1991.An independent Review Panel carried out quality assessment of studies. Two members of the panel, using quality assessment checklists developed for the review, reviewed each study. Disagreements between reviewers were resolved through discussion or a third reviewer examining a study.A data extraction tool was developed to extract data relating to participant characteristics, study methods, interventions and outcomes. Two reviewers independently extracted the required data.Randomised controlled trials included in the review were pooled in several meta-analyses using RevMan software program. Heterogeneity between studies was determined to ensure that they were sufficiently similar to allow for the pooling of their results. Non-randomised controlled trials were discussed in narrative comparisons.Six randomised controlled trials met the inclusion criteria for the primary objective of the systematic review. The results of this review indicate that antenatal PFME and post-natal PFME are effective in resolving or reducing urinary incontinence following childbirth. There was insufficient evidence to conclude that PFME can prevent urinary incontinence in post-partum women. In most of these studies women were selected randomly and therefore included women without urinary incontinence and women with urinary incontinence. Two randomised controlled trials selected their sample on the criteria of existing post-partum urinary incontinence. A subgroup analysis of these studies showed that post-natal PFME also have a significant effect on reducing or resolving urinary incontinence in women with existing post-partum urinary incontinence.Seven randomised controlled trials and three non-randomised controlled trials met the inclusion criteria for the secondary objectives of the review. Findings of the studies included in the review suggest a PFME program will improve the frequency with which women perform PFME. Two studies found that women receiving the intervention (a PFME program) and who were performing PFME regularly in the month before data collection were significantly less likely to have any incontinence. The review's results support previous findings showing there is little evidence that a high-intensity PFME program is more effective than a low-intensity PFME regimen of exercising. No conclusions about the effectiveness of feedback to a woman about pelvic floor muscle strength, for example, perineometer measures, as part of a PFME program can be reached.The mixed results of this review mean that no conclusions can be reached about the effectiveness of a PFME program, antenatal or post-natal, on improving pelvic floor muscle strength.A number of studies reported a high percentage of women lost to follow-up and the data collected in most of the studies relied on self-reports relating to urinary incontinence and/or frequency of exercising. These factors may have affected the overall results of the review. However, wherever possible, tests for heterogeneity were carried out to determine if studies should be combined in meta-analyses and in other cases the results' limitations are acknowledged.In terms of the effectiveness of PFME programs, the results of this review indicate that urinary incontinence following childbirth can be improved by performing PFME and that any form of a specific PFME program appears to improve exercising frequency. However, the value of individual components of PFME programs, such as take-home materials, reminder telephone calls and feedback of exercising effectiveness, is less clear.

The effect of maternal oxygen administration during the second stage of labor on umbilical cord blood gas values: A randomized controlled prospective trial