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  • 1
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 107 (2000), S. 0 
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective The aims of this study were to establish prospectively the prevalence of objective bladder dysfunction before and after delivery by means of urodynamic investigations and to assess the effect of obstetric variables on bladder function.Design Prospective longitudinal study. Twin channel subtracted cystometry was performed in the standing and sitting position, with a cough stress test at the end of filling. The investigations were repeated three months postpartum.Participants Two hundred and eighty-six nulliparae with singleton pregnancies who were delivered between April 1996 and November 1997 attended for antenatal assessment after 34 weeks of gestation and 161 who returned postpartum.Setting Department of Obstetrics and Gynaecology in a London teaching hospital.Results The mean urodynamic values both in pregnancy and postpartum lower than values defined in a non-pregnant population. The prevalence of genuine stress incontinence and detrusor instability were antenatally 9% and 8%, respectively, and postpartum 5% and 7%, respectively. Obstetric and neonatal factors were not related to urodynamic variables.Conclusions Despite the reported high prevalence of urinary incontinence related to pregnancy and childbirth, neither pregnancy nor delivery resulted in any consistent effects on objective bladder function. Postpartum urodynamic measurements were not related to either obstetric or neonatal variables, but were dependent on antenatal values.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To undertake a five year follow up of a cohort of women and children delivered by forceps or vacuum extractor in a randomised controlled study.Design Follow up of a randomised controlled trial.Setting District general hospital in the West Midlands.Population Follow up questionnaires were sent to 306 of the 313 women originally recruited at the North Staffordshire Hospital to a randomised controlled study comparing forceps and vacuum extractor for assisted delivery. Two hundred and twenty-eight women responded (74.5%) and all were included in the study; forceps (n= 115) and vacuum extractor (n= 113).Main outcome measures Bowel and urinary dysfunction, child vision assessment, and child development.Results Maternal adverse symptoms at long term follow up were relatively common. Urinary incontinence of various severity was reported by 47%, bowel habit urgency was reported by 44% (98/225), and loss of bowel control ‘sometimes’ or ‘frequently’ by 20% of women (46/226). No significant differences between instruments were found in terms of either bowel or urinary dysfunction. Overall, 13% (20/158) of children were noted to have visual problems. There was no significant difference in visual function between the two groups: ventouse 11/86 (12.8%), compared with forceps 9/72 (12.5%); odds ratio 0.97,95% CI 0.38–2.50. Of the 20 children with visual problems, a family history was known in 18, and 17/18 (94%) had a positive family history for visual problems. No significant differences in child development were found between the two groups.Conclusions There is no evidence to suggest that at five years after delivery use of the ventouse or forceps has specific maternal or child benefits or side effects.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    International journal of colorectal disease 8 (1993), S. 206-209 
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé 20 malades enceintes ont été étudiées de façon prospective pour établir si la grossesse avait un effet sur la fonction et la morphologie des sphincters anaux. Une échographie endoanale, une manométrie ont été céalisées durant la grossesse et six semaines après une césarienne. L'épaisseur du puborectal, du muscle longitudinal et des sphincters anaux interne et externe a été mesurée. Il n'y avait pas de différence significative dans l'épaisseur musculaire avant ou après césarienne. La pression de repos maximale et la pression maximale d'effort n'était pas significativement changée. Aucune correlation significative n'a été trouvée entre l'épaisseur du muscle et les pressions de l'un ou de l'autre sphincter. La grossesse par elle même n'a pas d'effet sur la morphologie et la fonction sphinctérienne anale. Les modifications des fonctions sphinctériennes qui surviennent en relation avec la grossesse ou l'accouchement sont probablement dûes à des traumatismes mécaniques plutôt qu'à des modifications hormonales durant la grossesse.
    Notes: Abstract Twenty pregnant women were investigated prospectively to establish if pregnancy had any effect on the function and morphology of the anal sphincters. Anal endosonography and manometry were performed during pregnancy and 6 weeks after Caesarean section. Muscle thicknesses of the puborectalis, longitudinal muscle, internal and external anal sphincter were measured. There was no significant difference in the muscle thickness of either before and after Caesarean delivery. The maximum resting pressure and the maximum squeeze pressure were not significantly changed. No significant correlation was found between anal pressure and muscle thickness of either sphincter. Pregnancy itself does not have a significant effect on anal sphincter morphology or function. Any changes in sphincter function that occur in relation to pregnancy or delivery are likely to be due to mechanical trauma rather than hormonal changes in pregnancy.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Diseases of the colon & rectum 37 (1994), S. 1296-1299 
    ISSN: 1530-0358
    Keywords: Anal endosonography ; Anal sphincters ; Pelvic floor musculature ; vaginal endosonography ; Pelvic anatomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Although anal endosonography provides clear images of anal sphincters, the probe in the anal canal may distort epithelial structures and sphincter muscles may be compressed, producing inaccurate muscle thickness measurements. The aim of this study is to describe a new approach using vaginal endosonography to image the anal canal undistorted. METHODS: Twenty females (10 healthy volunteers and 10 with fecal incontinence) had both anal and vaginal endosonography performed. RESULTS: The undisturbed anorectum, submucosa, anal cushions, and anal sphincter muscles were clearly visualized by vaginal endosonography, and anatomy was described. Although anal and vaginal endosonographic measurements of internal sphincter muscle thickness correlated (r=0.83;P=0.01), anal endosonography consistently underestimated the thickness (2.3±0.5 vs. 3.2±1.2 mm; mean ± standard deviation). Anterior internal and external anal sphincter defects were identified accurately with both techniques. CONCLUSIONS: Vaginal endosonography is a new technique that enables accurate imaging of anal sphincters and epithelial structures at rest. In addition to making the diagnosis of anal sphincter defects, it has potential applications in the imaging of anovaginal sepsis and malignancy and possibly in understanding the pathogenesis of anal fissure and hemorrhoids.
    Type of Medium: Electronic Resource
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