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Posts tagged ‘pregnancy’

Dr Arabin Cerclage pessaries for preventing preterm birth in asymptomatic singleton pregnant women

Dr Arabin Cerclage Pessary

Dr Arabin Cerclage Pessary

Vaginal progesterone, cerclage or cervical pessary for preventing preterm birth in asymptomatic singleton pregnant

women with a history of preterm birth and a sonographic short cervix.
Reference: Ultrasound Obstet Gynecol 2013; 41: 146–151 Published online 17 January 2013 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.12300
Z. ALFIREVIC*, J. OWEN†, E. CARRERAS MORATONAS‡, A. N. SHARP*, J. M. SZYCHOWSKI§
and M. GOYA‡
*Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; †Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, University of Alabama, Birmingham, AL, USA; ‡Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain; §Department of Biostatistics, University of Alabama, Birmingham, AL, USA
ABSTRACT
Objective To compare the outcome of pregnancy in cohorts of women with singleton pregnancy and history of preterm birth and sonographic short cervix managed with different treatment protocols, namely cerclage, vaginal progesterone or cervical pessary.
Methods
This was a comparison of three management protocols for women with singleton pregnancy and a high risk of preterm birth because of a prior spontaneous preterm birth before 34 weeks and a shortened cervical length detected by transvaginal ultrasound. The study included 142 women who were initially treated with cerclage (USA), 59 with vaginal progesterone (UK) and 42 with cervical pessary (Spain). Perinatal outcomes were compared between the three cohorts.
Results
There were no statistically significant differences in perinatal losses, neonatal morbidity and preterm births among the three groups, apart from a higher rate of preterm birth before 34 weeks’ gestation after treatment with vaginal progesterone in comparison with treatment with cervical pessary (32% vs 12%; relative risk (RR)=2.70; 95% CI, 1.10–6.67). When only the
subgroups of women with cervical length <25 mm, irrespective of gestational age, were compared, the difference between these two cohorts was not statistically significant (RR=2.21; 95% CI, 0.83–5.89).
Conclusion
Cerclage, vaginal progesterone and pessary appear to have similar effectiveness asmanagement strategies
in women with singleton pregnancy, previous spontaneous preterm birth and short cervix. Direct randomized comparisons of these strategies, or combinations thereof, are needed to determine optimal management.
Cerlage Dr Arabin in position

Pelvic floor dysfunction in women before their first pregnancy

Credit: Lead women’s health physiotherapist Mary O’Dwyer newsletter

A high rate of pelvic floor dysfunction (PFD) in nulliparous women with clinically significant symptoms and associated bother has been reported in a cross sectional study (part of the SCOPE study) in Ireland.

A total of 1484 women completed the validated Australian Pelvic Floor Questionnaire at 15 weeks gestation. Urinary dysfunction was present in 61%, faecal dysfunction in 41%, prolapse in 5% and sexual dysfunction in 41%. The dysfunction was perceived as bothersome by 37%.

In the urinary section, 61% of participants reported at least one primary symptom and 35% showed clinically significant symptoms. In those who reported urinary incontinence (UI), stress urinary incontinence was present in 50%, urge urinary incontinence alone in 20% and mixed urinary incontinence in 30%. The overall prevalence of UI in this study was 24%.

In the faecal dysfunction (FD) section, 41% of all women were symptomatic for primary symptoms. Within this affected group, 5.3% reported faecal incontinence, 36.8% reported flatal incontinence and 5.5% reported obstructed defecation. The authors explain the high rates of FD could be partially explained by 11% of women having a medical history of irritable bowel syndrome, celiac disease or inflammatory bowel disease.

Pelvic organ prolapse symptoms were reported by 4.8% of all women and 26% of symptomatic women commonly reported symptoms of vaginal pressure or heaviness. The authors state these results should be interpreted with caution as some bowel or bladder related symptoms might resemble prolapse.

Sexual dysfunction symptoms were reported by 41% of all women. Within this group 31% reported dyspareunia (painful intercourse), 25% reported vaginal tightness/vaginismus, 4.8% reported vaginal laxity and coital incontinence was reported by 1.2%. Regarding dyspareunia, the authors believe it is due to endometriosis, which is more prevalent in nulliparous women.

The study demonstrates that in the majority of nulliparous women with PFD, the disorder affects more than one pelvic floor compartment simultaneously. The authors stated the ‘high prevalence of PFD and multi-compartment involvement in nulliparous women could possibly suggest that congenital factors play an important role in PFD development. In order to understand the real role of childbearing in pelvic floor morbidity it is important to know the natural history of PFD by studying women before and after their first delivery.’

The authors believe the strength of this study is the large number of nulliparous women with extensive, detailed demographic characteristics and medical history of the participants. The study can be considered representative of an entire population from a statistical point of view. The main limitation of this study is that the women were not clinically examined to verify the questionnaires findings. As women completed the questionnaire in early pregnancy, they cannot rule out the potential for confusion or recall bias, as questions related only to pre-pregnancy status.

Due to the high prevalence of PDF in pregnant nulliparous women, the authors say that a comprehensive approach to investigating this group is needed to determine their history of PFD. Postpartum follow up will detect the role of pre-pregnancy PFD in the structure of postpartum pathology and determine the women who could be at a higher risk of severe postpartum PFD.

Reference:

Durnea CM, Khashan AS, Kenny LC, Tabirca SS, O’Reilly BA. An insight in pelvic floor status in nulliparous women. Int Urogyn Journal. Vol 25: 3, 337-345. March 2014.

ImageMary O’Dwyer has written many wonderful books in a language every lay person can relate to. Her books ‘speak to you’ Hold it sister and hold it mama are available at all bookstores and on line at www.incostress.com

Medical professionals contact info@incostress.com for reduced prices on books.

 

PFILATES TRAINING COURSE COMING TO THE UNITED KINGDOM

Pfilates– A combination of pelvic floor exercise AND Pilates!

 One-Day Workshop

 Date: Saturday 28 or Sunday 29 September 2013

 

Venue: Springhealth Leisure, 81 Belsize Park Gardens, Belsize Park, London NW3 4NJ

 

Price: £197 – EARLY BIRD PRICE ENDS 31 JULY 2013!!!

Then £237 if paid thereafter

 

Book your space NOW – www.clairemockridge.com/pfilates

controls urge and stress incontinence. Gets you back into the shape you need

controls urge and stress incontinence. Gets you back into the shape you need

 Who is Pfilates suitable for?

Pfilates is suitable for:

  • Fitness Instructors
  • Personal Trainers
  • Pilates Teachers
  • Ante/Postnatal Specialists
  • Chiropractors
  • Physiotherapists
  • Osteopaths
  • And, ANYONE with an interest in pelvic floor health!

You do NOT need to have a Pilates qualification to attend, and on completion of the Workshop, you’ll receive certification as a Pfilates Instructor.

The Pfilates method can be used 1-2-1 with clients who require specialist attention, and also lends itself well to instruction in small groups.  Pfilates is particularly popular with groups of postnatal women.

Who created Pfilates?

Founder of Pfilates program

Founder of Pfilates program

The PFilates program was created by Urogynecologist Dr. Bruce Crawford to help women and men improve pelvic floor fitness.

Pfilates includes a series of exercise routines to assist clients improve pelvic floor strength, in a progressive pelvic floor fitness training program.

In 2008, Dr. Crawford studied 120 mat Pilates, Yoga, and personal training movements using and from this pool of data, a series of movements were selected that provide excellent passive engagement of the pelvic floor by using various co-contractors including the Transversus abdominis, lower extremity adductors, and Gluteals.

The result?  We achieve much greater motor-unit recruitment per contraction than the “traditional  Kegel”.

The Pfilates program exploits principals of plyometric training and overflow to achieve optimal pelvic floor performance.

Book your space NOW here: www.clairemockridge.com/pfilates

Contact Claire for Pfilates training

Contact Claire for Pfilates training

Date: Saturday 28 or Sunday 29 September 2013

Venue: Springhealth Leisure, 81 Belsize Park Gardens, Belsize Park, London NW3 4NJ

Price: £197 – EARLY BIRD PRICE ENDS 31 JULY 2013!!!

Then £237 if paid thereafter

For more details, your UK contacts are:

– Sarah Rosenfield

www.sarahpilates.com

– Tel: 07767 404748

– Claire Mockridge

www.clairemockridge.com

– Tel: 07747 656550

 

Order your Pfilates kits or Pfilates DVDs from www.incoshop.co.uk  64 min Pfilates DVDs an incredible £9.99

Pre and Post natal massage therapy

Especially for mothers –
Healthy and comfortable pregnancy

The antenatal weeks are probably one of the most exciting periods in any woman’s life. The mother to be will experience great happiness and possibly even a little anticipation. It is a time of varying emotions and physical changes too, when the mother experiences a whole new awareness of her body as it prepares itself for the birth of her baby.

During the next 40 weeks or so she will experience weight gain around the abdomen which will put a strain on her back, hips, knees and even her balance as her centre of gravity changes. Massage can help to alleviate some of these associated problems but when combined with a particular focus on her posture and a simple exercise programme the effects become much more holistic and the results are marked. Lower back, upper back, shoulders, hips, groin, knees and ankles can all be made to feel much more comfortable and even sleepless nights can become a thing of the past. Swollen hands and feet are also alleviated by the effects of the massage and exercise programme. For more information click here..

www.incostress.com are giving away Hold It Sister books. Ideal for pre and post natal mothers who want self help for the pelvic floor. Offer lasts until 31 June 2012 when you put in code JUNHIS

Amazing therapy. Ideal for mum and baby

A perfect pelvic floor needs your help

Mary O’Dwyer is a lead womens health physiotherapist in Australia. She travels worldwide holding workshops for women and physiotherapists.  For more details go to www.holditsister.com

Mary has written a number of amazing easy to read books which puts you back in the control of your own body. Hold It Sister and Hold It Mama are just 2 of the self help books women are now turning to. It’s not just women in need that are reading Hold It Mama and Hold It Sister, no even the healthcare professionals are using her books as reference books to help thier patients.

More educational information about the pelvic floor and incontinence can be found on www.incostress.com

Incontinence and pelvic organ prolapse affects millions of women and destroys their quality of life. Find the right non surgical solution for you in Mary’s books.

Following some very simple controlled exercises can help prevent, incontinence, prolapse of the pelvic organs.

Hold It Mama shows how you can have an easy childbirth. Help with postpartum how to avoid postpartum depression.

Mary’s books are available at all major book stores.

Note to medical professionals. Please contact  Richard Demery-Kane for your copies and further information about medical conferences.

Blackwell Exhibitions

183 Euston Road

London

NW1 2BE

Tel: 0207 611 2160

Healthy and comfortable pregnacy-just with you in mind

Especially for mothers –
Healthy and comfortable pregnancy

The antenatal weeks are probably one of the most exciting periods in any woman’s life. The mother to be will experience great happiness and possibly even a little anticipation. It is a time of varying emotions and physical changes too, when the mother experiences a whole new awareness of her body as it prepares itself for the birth of her baby.

During the next 40 weeks or so she will experience weight gain around the abdomen which will put a strain on her back, hips, knees and even her balance as her centre of gravity changes. Massage can help to alleviate some of these associated problems but when combined with a particular focus on her posture and a simple exercise programme the effects become much more holistic and the results are marked.

Lower back, upper back, shoulders, hips, groin, knees and ankles can all be made to feel much more comfortable and even sleepless nights can become a thing of the past. Swollen hands and feet are also alleviated by the effects of the massage and exercise programme.

Read more about Martins work here

Amazing therapy. Ideal for mum and baby

Tell me doc what exactly is the Pelvis?

Tell me doc what exactly is the Pelvis?

The pelvis is made up of 6 bones: 2 ilium bones, 2 ischium bones and 2 pubic bones

The pelvis is the structure of bones and ligaments which make the pelvic girdle. The pelvic girdle is formed by the two hip bones and the curved triangular shaped sacrum.

The hip bones are held together in front by a joint called the pubic symphysis. The rear part of the hip bones are attached to the sacrum which as two sacroiliac joints.

The hips

Each hip bone contains a deep, spherical cup shape socket (acetabulum) (try saying that after a few wines!) The ball part of the thigh bone (the femur) fits snugly into this, allowing easy movement of the ‘ball and socket’ joints.

The Scaroiliac joints are two semi-rigid ligamentous junctions, at the back, holding the two outer bones of the pelvic to the side surfaces of the sacrum.

The coccyx or tailbone is made up of four small vertebrae which are fused together and joined to the curved sacrum. Normally there is very little movement at the sacroiliac joints, however during pregnancy the strong ligaments which hold the joints together are able to support the extra weight and growth of the baby to aid an easier childbirth.

Male and female pelvises are different. The female pelvis is relatively wider and shallower than the male and the lower opening is shaped to accommodate the baby’s head to pass. The lower part of the sacrum is also more flexible in the female pelvis.

Recommended reading:

Hold It Sister by lead womens health physiotherapist Mary O’Dwyer

Pelvic Organ Prolapse by Sherrie Palm

NEWS FLASH

MARY O’Dwyer author of Hold It Sister and Hold It Mama is a lead physiotherapist specialising in womens healthcare. Mary will be giving 10 minute talks about the pelvic floor at Blackwell’s Bookstore in London. Make a date to see her and get a signed copy of Hold It Sister at Guys Blackwell’s Bookstore on 9th May. For more information contact either Guys Hospital Blackwell Bookstore or contact us via www.incostress.com

 

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