Showing papers by "Kari Bø published in 2019"

Risk factors for anatomic pelvic organ prolapse at 6 weeks postpartum: a prospective observational study

Abstract: The objective was to identify risk factors for postpartum anatomic pelvic organ prolapse (aPOP) by comparing women with and without aPOP at 6 weeks postpartum with regard to pelvic floor measurements antepartum and obstetrical characteristics. We carried out a prospective observational cohort study including nulliparous pregnant women in a Norwegian university hospital. Participants underwent clinical examinations, including pelvic organ prolapse quantification system (POP-Q) and transperineal ultrasound at gestational week 21 and at 6 weeks postpartum. Background and obstetrical information was obtained from an electronic questionnaire and from the patient’s electronic medical file respectively. Associations were estimated using logistic regression analyses. The dependent variable was aPOP, defined as POP-Q stage ≥2 at 6 weeks postpartum. Independent variables were mid-pregnancy measurements of selected POP-Q variables and levator hiatus area (LHarea), delivery route, and the presence of major levator ani muscle (LAM) injuries at 6 weeks postpartum. A larger LHarea, a more distensible LAM, a longer distance from the meatus urethra to the anus (Gh + Pb) and a more caudal position of the anterior vaginal wall (Ba) at mid-pregnancy were risk factors for aPOP at 6 weeks postpartum, whereas delivery route and the presence of major LAM injuries were not. Prelabor differences in the pelvic floor rather than obstetrical events were risk factors for aPOP at 6 weeks postpartum.

Is abdominal hypopressive technique effective in the prevention and treatment of pelvic floor dysfunction? Marketing or evidence from high-quality clinical trials?

Abstract: In the late 1940s, Arnold Kegel first described pelvic floor muscle training (PFMT) to prevent and treat pelvic floor dysfunctions such as urinary incontinence (UI) and pelvic organ prolapse (POP). Several systematic reviews and Cochrane reviews conclude that there is level 1A evidence for prevention and treatment of PFMT for UI1 and POP.2 Despite the strong evidence for PFMT for these conditions, several other exercise regimens have been proposed and advocated to manage UI and POP. Specifically for stress UI, Pilates and Paula methods, Tai Chi and other methods based on breathing exercises and correction of body posture have very limited or questionable effects based on randomised controlled trials (RCTs).3 The abdominal hypopressive technique (AHT) may be classified as a breathing exercise. It was developed in the 1980s by a physical therapist named Dr Marcel Caufriez, and is widely known and used in countries including France, Italy, Spain, Canada and countries of South America. Those in charge of …

Pelvic floor muscle knowledge and relationship with muscle strength in Brazilian women: a cross-sectional study

Abstract: There seems to be little knowledge about pelvic floor muscles (PFMs) in the general population; however, literature confirming this assertion is scarce, especially in developing countries. The present study hypothesized a low level of knowledge about PFMs in a sample of Brazilian women and a positive relationship between that knowledge and the ability to contract the PFMs, strength, and urinary continence. This was a cross-sectional study including 133 women. A questionnaire assessing knowledge about PFMs and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) were applied. Vaginal palpation and manometry were used to assess PFM condition. Pearson’s correlation coefficient was used to test the association between PFM knowledge and continuous variables, and Fisher’s exact test was used to compare the women’s PFM knowledge with the categorical variables. A low level of PFM knowledge was observed in this sample, with a mean total score of 0.48 (±0.97). Vaginal manometry peak, mean, and duration values were 39.1 cmH2O (±23.7), 25.5 cmH2O (±16.1), and 21.1 s (±20.8) respectively. The ICIQ-UI-SF mean score was 7.1 (± 6.8). There were weak correlations between PFM knowledge and age (r −0.2044/ p = 0.01), and parity (r −0.19568/p = 0.02). PFM knowledge was higher among women with higher education levels (p = 0.0012) and those who had previously performed PFM training (p <0.001). The participants showed a low level of PFM knowledge. No relationship between PFM knowledge and ability to contract or prevalence of UI was observed.

Do female elite athletes experience more complicated childbirth than non-athletes? A case–control study

Abstract: Objective Previous studies have suggested that female athletes might be at higher risk of experiencing complications such as caesarean sections and perineal tears during labour than non-athletes. Our aim was to study delivery outcomes, including emergency caesarean section rates, length of the first and second stages of labour and severe perineal tears, in first-time pregnant elite athletes compared with non-athletes. Methods This is a retrospective case–control study comparing birth outcomes of primiparous female elite athletes engaging in high-impact and low-impact sports compared with non-athletic controls. The athletes had prior to birth competed at a national team level or equivalent. Participant characteristics and frequency of training for at least 3 years before a first pregnancy were collected via a self-administered questionnaire. Information on delivery outcome was retrieved from the Icelandic Medical Birth Registry. Results In total, 248 participated, 118 controls, 41 low-impact and 89 high-impact elite athletes. No significant differences were found between the groups with regard to incidence of emergency caesarean section or length of the first and second stages of labour. The incidence of third-degree to fourth-degree perineal tears was significantly higher (23.7%) among low-impact athletes than in the high-impact group (5.1%, p=0.01), but no significant differences were seen when the athletes were compared with the controls (12%; p=0.09 for low-impact and p=0.12 for high-impact athletes). Conclusion Participation in competitive sports at the elite level was not related to adverse delivery outcome, including length of labour, the need for caesarean section during delivery and severe perineal tears.

Is there any association between abdominal strength training before and during pregnancy and delivery outcome? The Norwegian Mother and Child Cohort Study.

Abstract: Background Abdominal strength training before and during pregnancy has been recommended to enhance normal vaginal birth by enabling increased force needed for active pushing However, to date there is little research addressing this hypothesis Objective To investigate whether nulliparous pregnant women reporting regular abdominal strength training prior to and at two time points during pregnancy have reduced risk of cesarean section, instrumental assisted vaginal delivery and third- and fourth-degree perineal tears Methods Analysis of 36 124 nulliparous pregnant women participating in the Norwegian Mother and Child Cohort Study during the period 1999–2009 who responded to questions regards the main exposure; regular abdominal strength training Data on delivery outcomes were retrieved from the Medical Birth Registry of Norway Logistic regression analyses were used to evaluate the association between exposure and outcome before pregnancy and at gestational weeks 17 and 30 Results Amongst participants, 669% reported doing abdominal strength training exercises before pregnancy, declining to 312% at gestational week 30 The adjusted odds ratios were 097 (95% CI 079–119) for acute cesarean section, among those training with the same frequency before and during pregnancy compared to those that never trained The results were similar for instrumental assisted vaginal delivery and third- and fourth-degree perineal tear Conclusion There was no association between the report of regular abdominal strength training before and during pregnancy and delivery outcomes in this prospective population-based cohort

Specific Musculoskeletal Adaptations in Pregnancy: Pelvic Floor, Pelvic Girdle, and Low Back Pain: Implications for Physical Activity and Exercise

Abstract: Pregnancy and childbirth bring along several changes to a woman’s body, especially to the musculoskeletal system. Pregnancy represents a window of opportunity for the adoption of an active and healthy lifestyle, but it is also a risk period for musculoskeletal disorders, impairments, and other discomforts. This chapter addresses the evidence-based knowledge on the most prevalent pelvic floor muscle dysfunction (urinary incontinence), diastasis recti abdominis, pregnancy-related low back pain, and/or pelvic girdle pain, since these factors are reported to have a negative effect on daily activities. The chapter also provides recommendations for treatment of such disorders and guidance on how to recover functional capacity.

Does low and heavy load resistance training affect musculoskeletal pain in overweight and obese women? Secondary analysis of a randomized controlled trial.

Abstract: Background Overweight and obesity are associated with musculoskeletal pain, particularly in the female population. However, regular resistance training may positively affect these complaints. Objective The present study aimed to investigate between group differences in musculoskeletal pain in previously inactive women, allocated to three different resistance-training modalities available in health- and fitness clubs. Methods This is secondary analysis from a single-blinded randomized controlled trial, including healthy women (aged 18–65) with a BMI (kg/m2) ≥25. The participants were allocated to 12 weeks (3 times/weekly) of either BodyPump (high-repetition low-load group session) (n = 24), heavy load resistance training with a personal trainer (n = 28), non-supervised heavy load resistance training (n = 19) or non-exercising controls (n = 21). Primary outcome was self-reported musculoskeletal pain in ten different body parts, measured with the Standardized Nordic Pain Questionnaire, at baseline and post-test. In addition, the study included sub-analyses of the participants when they were divided into high (≥28 of 36 sessions, n = 38) and low (≤27 of 36 sessions, n = 22) exercise adherence. Results The analysis revealed no between group differences in musculoskeletal pain in any of the ten body parts. The results did not change when the participants were divided into high versus low adherence. Conclusions Twelve weeks of BodyPump, heavy load resistance training with a personal trainer and non-supervised heavy load resistance training did not show any effect on self-reported musculoskeletal pain in overweight women. Clinical Trial registration number: NCT01993953 . ( https://clinicaltrials.gov/ct2/show/NCT01993953 ).

Therapeutic Exercise Regarding Musculoskeletal Health of the Pregnant Exerciser and Athlete

Abstract: Physical activity during pregnancy is recommended and has been shown to benefit most women. However, some modification to exercise routines may be necessary due to normal anatomic and physiologic changes and fetal requirements. Therefore, knowledge about the systemic changes of pregnancy should be taken into account when counseling women who wish to exercise through their pregnancy and should be complemented by the knowledge about the potential effect of exercise (therapeutic exercise) for prevention and resolution of some common pregnancy-related musculoskeletal conditions. Therapeutic exercise is the systematic and planned performance of exercises which aims to improve and restore physical function.

RE: Pelvic Floor Dysfunction in Female Athletes

Abstract: To date, there is level 1 evidence and grade A recommendation for pelvic floor muscle training alone to be the first-line treatment for urinary incontinence and pelvic organ prolapse in the general female population (3). Pelvic floor muscle training during pregnancy may also decrease the risk of urinary incontinence in late pregnancy (62% less) and 3–6 months postpartum (29% less) (9). However, there is currently no strong evidence in support for hypopressive training techniques in treatment or prevention of pelvic floor dysfunctions. Only 3 studies (2 experimental studies and one randomized controlled trial) were found and described in recent literature reviews (5,8). Effects on symptoms of pelvic organ prolapse were studied in one additional randomized controlled trial (7). In these studies, hypopressive training techniques were added to pelvic floor muscle training contractions/programs. No additional effects were found on pelvic floor muscle function and levator hiatus area in the experimental studies or pelvic floor muscle strength, crosssectional area, and pelvic organ prolapse symptoms in the randomized controlled trials.

Prevalence, risk factors and bother of urinary incontinence in nulliparous, young, high level rhythmic gymnasts. a cross-sectional study.

Abstract: 3. Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23(4):322-330. References Among the 107 enrolled in the study (80.5% response rate), all answered the questionnaire and fulfilled the clinical examination. Mean age was 14.5 (SD 1.6) years, mean BMI was 18.9 (SD 2.2) with 47 gymnasts (43.9%) having a BMI ≤18. Mean age when starting with rhythmic gymnastics was 7.5 years old (SD 1.9), and mean number of years as a competing gymnast was 4.3 (SD 1.5) years. Mean hours of exercise per week was 15.7(SD 7.8). Fifty rhythmic gymnasts were classified as hypermobile, 37 (34.6%) had not reached menarche age, and 10 (9.3%) reported former or present disordered eating.