Cesarean and vaginal birth: cohort study of the impact on pelvic floor disorders

剖腹产和阴道分娩：对盆底疾病影响的队列研究

基本信息

批准号：
9253417
负责人：
VICTORIA Lynn HANDA
金额：
$ 58.35万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-07-13 至 2019-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9253417
关键词：
Adult Affect Age Anatomy Award Biological Biology Birth Bladder Control Cesarean section Childbirth Cohort Studies Computer Simulation Data Discipline of obstetrics Disease Disease Progression Epidemiology Episiotomy Event Exercise Fecal Incontinence Female Forcep Foundations Functional disorder Funding Future Goals Health Heterogeneity High Prevalence Incidence Laceration Lead Life Link Longevity Longitudinal cohort Measures Mediating Modeling Muscle Muscle Weakness Natural History Nulliparity Operative Surgical Procedures Participant Pathway interactions Pelvic Floor Disorders Pelvis Physical Examination Physical therapy Play Population Prevention Prevention strategy Prevention trial Process Ptosis Public Health Quality of life Questionnaires Recruitment Activity Research Risk Risk Factors Role Science Severities Severity of illness Symptoms Testing Therapeutic Intervention Time Translational Research Urinary Incontinence Vacuum Vagina Vaginal Birth after Cesarean Vaginal delivery procedure Woman analytical method base burden of illness cohort common treatment epidemiology study follow-up in vivo interest lifetime risk middle age models and simulation muscle strength new therapeutic target novel outcome forecast pelvic organ prolapse predictive modeling prospective public health relevance tool translational study

项目摘要

DESCRIPTION (provided by applicant): Despite the very high prevalence of female pelvic floor disorders (urinary incontinence, fecal incontinence, and pelvic organ prolapse), the biological mechanisms underlying these disorders are uncertain. Epidemiologic studies suggest that childbirth plays an essential role. The long-term research goals of this team are to identify specific obstetrical events associated with pelvic floor disorders and to investigate the biologica mechanisms underlying these associations. In the first period of this award, pelvic floor disorders were shown to be significantly increased after vaginal versus cesarean birth at a single point in time, 5-10 years after first childbirth. Also, pelvic muscle strength was found to e significantly poorer after vaginal versus cesarean birth. Recognizing the critical influence of obstetrical events on the biological pathways leading to pelvic floor disorders, the goals of this proposal are to describe changes over time in pelvic floor disorders and to investigate the extent to which these changes are affected by childbirth and by pelvic muscle weakness. The specific aims of the current application are: AIM 1: to investigate the effect of obstetrical exposures on the incidence and progression of pelvic floor disorders and AIM 2: to investigate the effect of pelvic muscle weakness on the progression of pelvic floor disorders. These aims will be accomplished via annual surveillance of an established cohort of >1300 parous women (plus additional participants recruited annually). Using data from validated questionnaires and physical examinations, the severity of pelvic floor disorders will be measured annually. The exposures of interest will include obstetrical events (vaginal versus cesarean birth, forceps delivery, episiotomy and perineal laceration) and pelvic muscle strength (measured in this cohort at the end of the first funding cycle, using a validated tool). Analysis will focus on factos associated with disease progression over time as well as the prognosis for women with mild pelvic floor disorders. Novel aspects of this research include the focus on measures of disease severity over time, analytical methods that consider heterogeneity of effect, and the opportunity to prospectively examine the impact of pelvic muscle weakness. The proposed research is significant because it will provide critical information about the natural history of pelvic floor disorders and identify the most important obstetrical antecedents. Thus, the findings will identify women at greatest risk for pelvic floor disorders and will serve as a foundation for prevention trials. Also, pelvic muscle weakness may prove to be a novel target for therapeutic intervention. Finally, results are expected to advance science by guiding future translational research on pathophysiology of pelvic floor disorders. Given the high prevalence of pelvic floor disorders and the high incidence of surgical treatment for these conditions, prevention is critical to reduce the public health burden of pelvic floor disorders among U.S. women.

描述（由申请人提供）：尽管雌性骨盆底疾病的患病率很高（尿失禁，粪便失禁和骨盆器官脱垂），但这些疾病的生物学机制仍不确定。流行病学研究表明，分娩起着至关重要的作用。该团队的长期研究目标是确定与骨盆底疾病相关的特定产科事件，并研究这些关联的生物学机制。在该奖项的第一阶段，在第一次分娩后5 - 10年的单个时间点，阴道和剖宫产出生后，骨盆底疾病被证明显着增加。同样，在阴道与剖宫产后发现骨盆肌力量明显较差。认识到产科事件对导致骨盆底疾病的生物学途径的关键影响，该提案的目标是描述骨盆底疾病中随着时间的变化，并研究这些变化受到分娩和骨盆肌肉无力影响的程度。当前应用的具体目的是：目标1：研究产科暴露对骨盆底疾病的发病率和进展的影响，目标2：研究骨盆肌肉无力对骨盆底疾病进展的影响。这些目标将通过年度监视，对> 1300名帕斯妇女的既定队列（加上每年招募的其他参与者）来实现。使用经过验证的问卷和身体检查的数据，每年将测量骨盆底疾病的严重性。感兴趣的暴露将包括产科事件（阴道与剖宫产，镊子分娩，e术和会阴裂缝）和骨盆肌肉强度（使用经过验证的工具在第一个融资周期结束时在该队列中进行测量）。分析将集中于随着时间的流逝而与疾病进展相关的事实以及对骨盆底疾病的女性的预后。这项研究的新方面包括关注疾病严重程度随时间的措施，考虑异质性的分析方法以及前瞻性地检查骨盆肌肉无力影响的机会。拟议的研究之所以重要，是因为它将提供有关骨盆底疾病自然史的关键信息，并确定最重要的产科前因。因此，发现将确定骨盆底疾病风险最大的妇女将成为预防试验的基础。同样，骨盆肌肉无力可能被证明是治疗干预的新型靶标。最后，结果有望通过指导骨盆底疾病病理生理的未来翻译研究来推进科学。鉴于骨盆底部疾病的高患病率和这些疾病的外科手术治疗的高发病率，预防对于减少美国妇女中骨盆底疾病的公共卫生负担。