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01-03-2013 | Original Article

Spontaneous pushing to prevent postpartum urinary incontinence: a randomized, controlled trial

Published in: International Urogynecology Journal | Issue 3/2013

Abstract

Introduction and hypothesis

The risk for urinary incontinence can be 2.6-fold greater in women after pregnancy and childbirth compared with their never-pregnant counterparts, with the incidence increasing with parity. We tested the hypothesis that the incidence of de novo postpartum urinary incontinence in primiparous women is reduced with the use of spontaneous pushing alone or in combination with perineal massage compared with women who experienced traditional directed pushing for second-stage management.

Methods

This was a prospective clinical trial enrolling and randomizing 249 women into a four-group design: (1) routine care with coached or directed pushing, (2) spontaneous self-directed pushing, (3) prenatal perineal massage initiated in the third trimester, and (4) the combination of spontaneous pushing plus perineal massage. Self-report of incontinence was assessed using analysis of variance (ANOVA) and covariance (ANCOVA) models in 145 remaining women at 12 months postpartum using the Leakage Index, which is sensitive to minor leakage.

Results

No statistical difference in the incidence of de novo postpartum incontinence was found based on method of pushing (spontaneous/directed) (P value = 0.57) or in combination with prenatal perineal massage (P value = 0.57). Fidelity to pushing treatment of type was assessed and between-groups crossover detected.

Conclusions

Spontaneous pushing did not reduce the incidence of postpartum incontinence experienced by women 1 year after their first birth due to high cross-over between randomization groups.

Coyne KS, Sexton CC, Irwin DE, Kopp ZS, Kelleher CJ, Milsom I (2008) The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study. Br J Urol Int 101:1388–1395CrossRef

National Institutes of Health, State of the Science Conference Report: Cesarean Delivery on Maternal Request. March 27–29, 2006. http://consensus.nih.gov/2006/cesareanstatement.htm. Accessed 15 July 2012

Schaffer JI, Bloom SL, Casey BM, McIntire DD, Nihira MA, Leveno KJ (2005) A randomized trial of the effects of coached vs. uncoached maternal pushing during the second stage of labor on postpartum pelvic floor structure and function. Am J Obstet Gynecol 192(5):1692–1696PubMedCrossRef

Kearney R, Miller J, Ashton Miller J, DeLancey JO (2006) Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol 107(1):144–148PubMedCrossRef

Viswanathan M, Hartmann K, Palmieri R, et al. (2005) The use of episiotomy in obstetrical care: a systematic review. Evidence reports/technology assessments, No. 112. Rockville,MD: Agency for Healthcare Research and Quality; 2005

Avery MD, Van Arsdale L (1987) Perineal massage: effect on incidence of episiotomy and lacerations in a nulliparous population. J Nurse Midwifery 32(3):128–134CrossRef

Hinz B (2005) Perineal massage in pregnancy. J Midwifery Womens Health 50(1):63–64PubMedCrossRef

Aasheim V, Nilsen ABV, Lukasse M, Reinar LM (2011) Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev 12:CD006672. doi:10.1002/14651858.CD006672.pub2 PubMed

Miller JM, Ashton-Miller JA, DeLancey JOL (1998) Quantification of cough-related urine loss using the paper towel test. Obstet Gynecol 91(5):705–709PubMedCrossRef

10.

Antonakos CL, Miller JM, Sampselle CM (2003) Indices for studying urinary incontinence and levator ani function in primiparous women. J Clin Nursing 12:1–8CrossRef

11.

Miller J, Kasper C, Sampselle C (1994) Review of muscle physiology with application to pelvic muscle exercise. Urol Nurs 14(3):92–97, PMID 8826155PubMed

12.

Sampselle CM, Miller JM, Luecha Y, Fischer K, Rosten L (2005) Provider support of spontaneous pushing during second stage labor. J Obstet Gynecol Neonatal Nurs 34(6):695–702PubMedCrossRef

13.

Bloom SL, Casey BM, Schaffer JI, McIntire DD, Leveno KJ (2006) A randomized trial of coached versus uncoached maternal pushing during the second stage of labor. Am J Obstet Gynecol 194:10–13PubMedCrossRef

14.

Prins M, Boxem J, Lucas C, Hutton E (2011) Effect of spontaneous pushing versus Valsalva pushing in the second stage of labour on mother and fetus: a systematic review of randomised trials. Br J Obstet Gynecol 118(6):662–670. doi:10.1111/j.1471-0528.2011.02910.x CrossRef

15.

Wai C, Antip S, Bloom S (2011) Urodynamic indices and pelvic organ prolapse quantification 3 months after vaginal delivery in primiparous women. postpartum. Int Urogynecol J 22:1293–1298. doi:10.1007/s00192-011-1438-8 PubMedCrossRef

16.

Fitzpatrick M, Harkin R, McQuillan K, O’Brien C, O’Connell PR, O’Herlihy C (2002) A randomised clinical trial comparing the effects of delayed versus immediate pushing with epidural analgesia on mode of delivery and fecal continence. Int J Obstet Gynecol (BJOG) 109(12):1359–1365CrossRef

17.

Fraser WD, Marcoux S, Krauss I, Douglas J, Goublet C, Boulvain M (2000) Multicenter, randomized, controlled trial of delayed pushing for nulliparous women in the second stage of labor with continuous epidural analgesia. Am J Obstet Gynecol 182(5):1165–1172PubMedCrossRef

18.

Simpson KR, James DC (2005) Effects of immediate versus delayed pushing during 2nd-stage labor on fetal well-being: a randomized controlled trial. Nurs Res 54(3):149–157PubMedCrossRef

19.

Parnell C, Langhoff-Roos J, Iversen R, Damgaard P (1993) Pushing method in the expulsive phase of labor: a randomized trial. Acta Obstet Gynecol Scand 72:31–35PubMedCrossRef

20.

Woldringh C, van den Wijngaart M, Albers-Heitner P, Lycklama a Nijeholt AA, Lagro-Janssen T (2007) Pelvic floor muscle training is not effective in women with UI in pregnancy: a randomized controlled trial. Int Urogynecol J Pelvic Floor Dysfunct 18(4):383–390PubMedCrossRef

21.

Hintze JL (2008) PASS 2008 User’s Guide. Number Cruncher Statistical Software, Kaysville, Utah

22.

Cohen J (1992) A power primer. Psychol Bull 112:155–159PubMedCrossRef

Title: Spontaneous pushing to prevent postpartum urinary incontinence: a randomized, controlled trial
Publication date: 01-03-2013
Published in: International Urogynecology Journal / Issue 3/2013
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-012-1884-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Spontaneous pushing to prevent postpartum urinary incontinence: a randomized, controlled trial

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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