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International Urogynecology Journal Mar 2021To evaluate the evidence for pathologies underlying stress urinary incontinence (SUI) in women. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION AND HYPOTHESIS
To evaluate the evidence for pathologies underlying stress urinary incontinence (SUI) in women.
METHODS
For the data sources, a structured search of the peer-reviewed literature (English language; 1960-April 2020) was conducted using predefined key terms in PubMed and Embase. Google Scholar was also searched. Peer-reviewed manuscripts that reported on anatomical, physiological or functional differences between females with signs and/or symptoms consistent with SUI and a concurrently recruited control group of continent females without any substantive urogynecological symptoms. Of 4629 publications screened, 84 met the inclusion criteria and were retained, among which 24 were included in meta-analyses.
RESULTS
Selection bias was moderate to high; < 25% of studies controlled for major confounding variables for SUI (e.g., age, BMI and parity). There was a lack of standardization of methods among studies, and several measurement issues were identified. Results were synthesized qualitatively, and, where possible, random-effects meta-analyses were conducted. Deficits in urethral and bladder neck structure and support, neuromuscular and mechanical function of the striated urethral sphincter (SUS) and levator ani muscles all appear to be associated with SUI. Meta-analyses showed that observed bladder neck dilation and lower functional urethral length, bladder neck support and maximum urethral closure pressures are strong characteristic signs of SUI.
CONCLUSION
The pathology of SUI is multifactorial, with strong evidence pointing to bladder neck and urethral incompetence. While there is also evidence of impaired urethral support and levator ani function, standardized approaches to measurement are needed to generate higher levels of evidence.
Topics: Female; Humans; Parity; Pelvic Floor; Pregnancy; Urethra; Urinary Bladder; Urinary Incontinence, Stress
PubMed: 33416968
DOI: 10.1007/s00192-020-04622-9 -
Journal of Atherosclerosis and... Feb 2023
Topics: Pregnancy; Female; Humans; Parity; Cardiovascular Diseases; Risk Factors
PubMed: 35599001
DOI: 10.5551/jat.ED203 -
International Urogynecology Journal Dec 2022The objective was to test the hypotheses that a linear relationship exists between age and levator bowl volume (LBV); and that age, parity, and prolapse are...
INTRODUCTION AND HYPOTHESIS
The objective was to test the hypotheses that a linear relationship exists between age and levator bowl volume (LBV); and that age, parity, and prolapse are independently associated with LBV.
METHODS
We conducted a secondary analysis of data from nulliparous women, parous controls, and prolapse (Pelvic Organ Prolapse Quantification (POP-Q) Ba ≥ 1 cm) cases from each of three age groups: young (≤40), mid-age (50-60), and older (≥70). LBV was measured using MRI at rest and Valsalva as the 3D space contained above the levator ani muscles and below the sacrococcygeal junction-to-inferior pubic point reference plane. Linear regression models were used to examine the effects of age, parity, prolapse, and their interactions (age*parity and age*prolapse) on LBV.
RESULTS
Each group consisted of 9-12 women. LBV increased with age in a nonlinear fashion. For nulliparous women, the median value increased 4.7% per decade from the young to mid-age group and 84% per decade from the mid-age to older group; for parous controls, the corresponding increases were 38% and -0.5%; and for women with prolapse, they were 46% and 11%. Age and prolapse status (both p<0.001) were found to be significant independent predictors of LBV. Interactions between age*prolapse (p=0.003) and age*parity (p=0.045) were also independently associated with LBV.
CONCLUSIONS
Parity and prolapse influence how age affects LBV. In nulliparous women, age had little effect on LBV until after mid-age. For women with prolapse, LBV increased at a much earlier age, with the biggest difference occurring between young and mid-age women.
Topics: Humans; Female; Pregnancy; Parity; Pelvic Floor; Pelvic Organ Prolapse; Magnetic Resonance Imaging; Ultrasonography
PubMed: 35503121
DOI: 10.1007/s00192-022-05203-8 -
Ugeskrift For Laeger Nov 2023Rusty pipe syndrome (RPS) is a benign, self-limiting condition characterized by bloody milk secretion, and is primarily seen among primiparous women. This case report...
Rusty pipe syndrome (RPS) is a benign, self-limiting condition characterized by bloody milk secretion, and is primarily seen among primiparous women. This case report highlights the clinical presentation of a 31-year-old primiparous woman with bloody milk secretion from gestational week 31. This persisted throughout pregnancy until seven days after birth. RPS should be considered in pregnant women with painless bilateral bloody milk secretion during pregnancy and/or the early days post-partum. The milk can safely be provided to the infant, and RPS is not an indication for formula feeding.
Topics: Infant; Female; Pregnancy; Humans; Adult; Animals; Breast Feeding; Lactation; Milk; Postpartum Period; Syndrome; Parity
PubMed: 38018741
DOI: No ID Found -
Journal of Alzheimer's Disease : JAD 2023Race/ethnicity is associated with differences in reproductive history and cognition individually, yet it remains an understudied factor in the relationship between...
BACKGROUND
Race/ethnicity is associated with differences in reproductive history and cognition individually, yet it remains an understudied factor in the relationship between parity and later-life cognition.
OBJECTIVE
To evaluate if the association between parity and cognition differs between racial/ethnic groups.
METHODS
Participants included 778 older, postmenopausal women from the Health and Nutrition Examination Survey (Latina: n = 178, Non-Latino Black [NLB]: n = 169, Non-Latino White [NLW]: n = 431) who self-reported at least one birth. Cognitive outcomes included working memory, learning memory, and verbal fluency. Covariates included age, education, cardiovascular and other reproductive health factors, adult socioeconomic status (SES) and depressive symptoms. We fit a series of linear models to examine a) whether parity was associated with cognitive functioning, b) if this association varied by race/ethnicity through parity by race/ethnicity interactions, and c) individual parity with cognition associations stratified by race/ethnicity.
RESULTS
In the full sample, parity was significantly negatively associated with Digit Symbol Substitution Test (DSST) performance (b = -0.70, p = 0.024) but not Animal Fluency or word-list learning and memory. Tests of race/ethnicity-by-parity interactions were not statistically significant (ps > 0.05). However, stratified analyses by race/ethnicity showed a differential effect of parity on DSST performance, such that parity was significantly negatively associated with DSST performance (b = -1.66, p = 0.007) among Latinas but not in NLWs (b = -0.16, p = 0.74) or NLBs (b = -0.81, p = 0.191).
CONCLUSION
Among Latina, but not NLB or NLW women, greater parity was associated with worse processing speed/executive functioning later in life. Further research is needed to understand the mechanisms driving racial/ethnic differences.
Topics: Female; Humans; Cognition; Ethnicity; Hispanic or Latino; Parity; Racial Groups; Aged; Postmenopause; Black or African American; White; Cognition Disorders
PubMed: 37393496
DOI: 10.3233/JAD-221210 -
International Urogynecology Journal Jan 2022Test the hypotheses that (1) cardinal ligament (CL) straightening and lengthening occur with parity and prolapse, (2) CL straightening occurs before lengthening, and (3)...
INTRODUCTION AND HYPOTHESIS
Test the hypotheses that (1) cardinal ligament (CL) straightening and lengthening occur with parity and prolapse, (2) CL straightening occurs before lengthening, and (3) CL length is correlated with level III measures.
METHODS
We performed a secondary analysis of MRIs from women in three groups: (1) nulliparous with normal support, (2) parous with normal support, and (3) uterine prolapse (POP-Q point C > - 4 and Ba > 1 cm). The 3D stress MRI images at rest and maximal Valsalva were analyzed. CLs were traced from their origin to cervico-vaginal insertions. Curvature ratio was calculated as curved length/straight length. Level III measures included urogenital hiatus (UGH), levator hiatus (LH), and levator bowl volume (LBV), and their correlations with CL length were calculated.
RESULTS
Ten women were included in each group. Compared to the nulliparous group, CL length was 18% longer in parous controls (p = .04) and 59% longer with prolapse (p < .01) at rest, while at Valsalva, CL length was 10% longer in parous controls (p = .21) and 49% longer with prolapse (p < .01). Curvature ratios showed 18% more straightening in women with prolapse compared to parous controls (p < .01). Curved CL length and level III measures were moderately to strongly correlated: UGH (rest: R = 0.68, p < .01; Valsalva: R =0.80, p < .01), LH (rest: R = 0.60, p < .01; Valsalva: R = 0.78, p < .01), and LBV (rest: R = 0.71, p < .01; Valsalva: R =0.89, p < .01).
CONCLUSION
Our findings suggest that the CLs undergo three times as much lengthening with prolapse as with parity; however, straightening only occurs with prolapse. Strong correlations exist between level I and level III support.
Topics: Female; Humans; Ligaments; Parity; Pelvic Floor; Pelvic Organ Prolapse; Pregnancy; Valsalva Maneuver
PubMed: 34028573
DOI: 10.1007/s00192-021-04824-9 -
Frontiers in Neuroendocrinology Apr 2020Risk and resilience in brain health and disease can be influenced by a variety of factors. While there is a growing appreciation to consider sex as one of these factors,... (Review)
Review
Risk and resilience in brain health and disease can be influenced by a variety of factors. While there is a growing appreciation to consider sex as one of these factors, far less attention has been paid to sex-specific variables that may differentially impact females such as pregnancy and reproductive history. In this review, we focus on nervous system disorders which show a female bias and for which there is data from basic research and clinical studies pointing to modification in disease risk and progression during pregnancy, postpartum and/or as a result of parity: multiple sclerosis (MS), depression, stroke, and Alzheimer's disease (AD). In doing so, we join others (Shors, 2016; Galea et al., 2018a) in aiming to illustrate the importance of looking beyond sex in neuroscience research.
Topics: Alzheimer Disease; Animals; Central Nervous System; Depression, Postpartum; Female; Humans; Multiple Sclerosis; Nervous System Diseases; Parity; Postpartum Period; Pregnancy; Pregnancy Complications; Risk Factors; Sex Characteristics; Sex Factors; Stroke
PubMed: 31987814
DOI: 10.1016/j.yfrne.2020.100820 -
PloS One 2022To examine how (a) parity and (b) mode of birth were associated with later Quality of Life (QOL) in young adult women, with a mean follow-up of 11.0 years.
OBJECTIVE
To examine how (a) parity and (b) mode of birth were associated with later Quality of Life (QOL) in young adult women, with a mean follow-up of 11.0 years.
DESIGN
Prospective cohort study.
SETTING
Australia.
R SAMPLE
A total of 7770 women participating in the 1973-1978 cohort of the Longitudinal Study of Women's Health.
METHODS
Linear regression models were used to estimate (1) prospective associations between parity and mode of birth with eight subscale and two summary scores of the SF36, assessed after a mean follow-up of 11 years., and (2) differences between SF36 scores at follow up for women in different parity and mode of birth categories.
MAIN OUTCOME MEASURE
Quality of Life as measured by the SF36.
RESULTS
Women experiencing no births (parity 0) and one birth (parity 1) had lower scores on all the physical health measures, and on some mental health measures, than women who had 2 births (parity 2) (all p<0.05).
CONCLUSIONS
Parity and mode of birth may have long-term implications for women's physical and mental health. Both childless and women with only one child had poorer physical and mental health than their peers with two children. Women with only caesarean section(s) also had poorer health than women who had vaginal birth/s.
Topics: Cesarean Section; Child; Delivery, Obstetric; Female; Humans; Longitudinal Studies; Parity; Pregnancy; Prospective Studies; Quality of Life; Young Adult
PubMed: 36084030
DOI: 10.1371/journal.pone.0273366 -
International Urogynecology Journal Jun 2023High-intensity physical activity and exercise have been listed as possible risk factors for pelvic organ prolapse (POP). The aim of the present study is to conduct a... (Review)
Review
INTRODUCTION AND HYPOTHESIS
High-intensity physical activity and exercise have been listed as possible risk factors for pelvic organ prolapse (POP). The aim of the present study is to conduct a literature review on the prevalence and incidence of POP in women who engage in regular physical activity. In addition, we review the effects of a single exercise or a single session of exercise on pelvic floor support. Finally, the effect of exercises on POP in the early postpartum period is reviewed.
METHODS
This is a narrative scoping review. We searched PubMed and Ovid Medline, the Physiotherapy Evidence Database (PEDro), and the Cochrane Database of Systematic Reviews up to May 2022 with the following MeSH terms: "physical activity" AND "exercise" AND "pelvic floor" AND "pelvic organ prolapse".
RESULTS
Eight prevalence studies were retrieved. Prevalence rates of symptomatic POP varied between 0 (small study within different sports) and 23% (Olympic weightlifters and power lifters). Parity was the only factor associated with POP in most studies. Three studies evaluated the pelvic floor after a single exercise or one session of exercise and found increased vaginal descent or increased POP symptoms. One prospective cohort study reported the development of POP after 6 weeks of military parashot training, and one randomized trial reported increased POP symptoms after transverse abdominal training. There is scant knowledge on exercise and POP in the postpartum period.
CONCLUSIONS
Prevalence of POP in sports varies widely. Experimental and prospective studies indicate that strenuous exercise increased POP symptoms and reduced pelvic floor support.
Topics: Pregnancy; Female; Humans; Prospective Studies; Systematic Reviews as Topic; Exercise Therapy; Parity; Pelvic Organ Prolapse
PubMed: 36692525
DOI: 10.1007/s00192-023-05450-3 -
Journal of Dairy Science Mar 2022Nonambulatory dairy cattle pose a complex problem due to the challenges associated with prevention, appropriate treatment and management, and arriving at an accurate... (Review)
Review
Nonambulatory dairy cattle pose a complex problem due to the challenges associated with prevention, appropriate treatment and management, and arriving at an accurate prognosis. There is a breadth of literature regarding this topic, of which there is currently no formal synthesis. The objective of this scoping review was to describe and characterize the literature investigating risk factors, sequela, preventions, treatments, and prognostic factors for nonambulatory conditions in dairy cattle, with the intent of qualitatively synthesizing knowledge of the topic and identifying gaps in the literature. A literature search was conducted in 6 databases and 2 conference proceeding archives, which returned 7,568 unique articles. Initial screening of abstracts resulted in 1,544 articles reviewed at the full-text stage, of which 379 were included for data extraction. Over 75% of the included literature was published after 1980, and the most common countries in which these studies took place were the United States (n = 72), Canada (18), Sweden (17), and Germany (17). Common eligibility criteria used for inclusion were geographic region (97) and parity (92). Of the 379 studies included in this review, 144 were randomized controlled trials and 235 were observational studies. The majority of the controlled trials assessed prevention of nonambulatory conditions (116), most commonly through supplementation of vitamin D (27) and calcium (25) or the provision of anionic salts (22). Of the 28 studies focusing on treatment of nonambulatory conditions, 26 focused on calcium administration. Becoming nonambulatory was evaluated as an outcome in 165 of the observational studies. Frequently measured risk factors for becoming nonambulatory included hematological variables, such as blood calcium (73), phosphorus (53) and magnesium (42), and other factors such as parity (35) and breed (22). Recovery from a nonambulatory condition was the outcome in 31 of the observational studies, with commonly measured prognostic indicators being calcium (9), phosphorus (9), and duration of recumbency (7). Nonambulatory disorders were measured as risk factors in 53 of the observational studies, with the most commonly assessed outcomes including disorders of the transition period (11), and death or euthanasia (11). The most common terms used to describe nonambulatory conditions were "milk fever" (199) and "parturient paresis" (147). These terms were only further defined with explicit symptomatic criteria in 193 of the 379 studies in this review. Recumbency was the most commonly used of these criteria (144), followed by inability to rise (55). Potential gaps in the literature concerning nonambulatory dairy cattle that were identified in the present review included investigation of prognostic indicators for recovery from nonambulatory conditions that are applicable on farm, treatment alternatives to calcium administration, and guidance regarding the appropriate usage of terms meant to categorize nonambulatory dairy cattle.
Topics: Animals; Cattle; Cattle Diseases; Female; Hypocalcemia; Magnesium; Parity; Parturient Paresis; Pregnancy
PubMed: 34955243
DOI: 10.3168/jds.2021-21046