The main goal of this study to compare self-training postpartum and training with a specialist support (physiotherapist and physical medicine and rehabilitation doctor) effect on pelvic floor dysfunction prevention and treatment in postpartum period.
Hypothesis: The implementation of postpartum rehabilitation helps to alleviate existing symptoms of pelvic floor dysfunction and prevents pelvic floor dysfunction.
Study goals:
* To objectively evaluate changes in pelvic organ position and pelvic floor muscle function in postpartum period, before and after specialised rehabilitation program * To objectively evaluate pelvic floor symptoms and their influence on woman life quality * To compare data (changes in pelvic floor muscle coordination and strength, pelvic organ position and changes in life quality according to validated questionnaires)
Study participants will:
* Get an examination by obstetrician-gynaecologist, physical medicine and rehabilitation doctor and physiotherapist in 6 to 10 weeks postpartum period. * One group of participants will attend physiotherapy, biofeedback and electro stimulation procedures with a guidance of a specialist. * Other group of participants gets a recommendations and instructions of training and self-trains at home. To remind of training and help record training time "squeezy" app (an application designed for a mobile device) will be offered. * All groups of participants will be asked to fill life quality related questionnaires: (ICIQ-UI SF: International Consultation on Incontinence Questionnaire; P-QoL: Prolapse Quality-of-Life Questionnaire; PISQ-IR: Pelvic Organ Prolapse/ Urinary Incontinence Sexual Questionnaire IUGA revised; FSFI: female sexual function index; MOS-SF36 Medical Outcomes Study Short Form-36).
18 years or older
This pregnancy was singleton
No contraindications for physical activity
No connective tissue disorders (for example Ehlers-Danlos syndrome)
Younger than 18 years
Twins or triplet pregnancy
Contraindications for physical activity
Connective tissue disorders
Parallel
Rehabilitation postpartum
Behavioral* 4 Times biofeedback training * 10 times physiotherapy with specialist * 10 times transcutaneal electrostimulation (TENS)
Self-training
Behavioral* training at home after physiotherapist instructions * using an app to record training frequency, length
Improvement in pelvic floor dysfunction symptoms
Self-reported improvement of symptoms (for example: pain, urinary incontinence, fecal incontinence, vaginal "laxity")
Change in PFM contraction force and strength according to the Modified Oxford Scale
Individual change in Oxford scores (0-5), bigger number means stronger contraction.
Change in POP-Q scale
changes in POP-Q scales (especially in gh - genital hiatus, pb - perineal body, measured by centimeters, bigger number in gh means wider genital hiatus -worse outcome; smaller number in pb means thin perineal body - worse outcome)
Change in life quality questionnaires ICIQ-UI SF
Quality of Life (QoL) and clinical outcome questionnaires: \* ICIQ-UI SF (International Consultation on Incontinence Questionnaire Short Form); scores 1-21, higher the number - worse outcome
Factors potentially influencing the effectiveness of the rehabilitation program: mean age
Age in years Advanced age is a risk factor for PFD
Other participant and birth related factors which may have influence on pelvic floor: BMI
BMI (kg/m\^2) Higher BMI is a risk factor for PFD
Other participant and birth related factors which may have influence on pelvic floor: number of births
Number of births (after 22 gestational weeks) Higher number of births is a risk factor for PFD
Other participant and birth related factors which may have influence on pelvic floor: mode of delivery
Mode of delivery: natural, vacuum, forceps, c - section Vacuum or forceps assisted delivery is related to higher PFD rates compared to c - section or natural
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Vilnius University
Lead sponsor
Vilnius University Hospital Santaros Klinikos
Collaborator
Vilnius Maternity Hospital
Collaborator
