Investigating antenatal pelvic floor training using a vaginal balloon device in Czech women
A vaginal balloon device for antenatal pelvic floor training may reduce the incidence of negative outcomes from vaginal birth on women's pelvic health. This study's aims were to investigate the effect of antenatal vaginal training on birth-induced levator ani muscle avulsion and to analyse the relationship between use of a balloon device for training and the duration of the second stage of labour, incidence of episiotomy and birth-induced perineal trauma.
In this prospective cohort intervention study, 123 nulliparous women were divided into two groups: 64 training with the device antenatally (intervention) and 59 women receiving normal antenatal care (control). Clinical data were collected 10 weeks after birth and differences in the incidence of levator ani muscle avulsion, episiotomy, perineal tears and other birth injuries, as well as the duration of the second stage of labour, were assessed using two-tailed tests.
Training with the device was not associated with a reduction in the incidence of levator ani muscle avulsions (P=0.82), and the device did not shorten the duration of the second stage of labour (P=0.63). However, it was associated with a reduction in the frequency of episiotomies (cases: 34% vs controls: 59%; P=0.007). There was no significant difference in the incidence of perineal tears (P=1.00) or other birth injuries (P=0.50). An obstetric anal sphincter injury occurred in only one case, in a woman in the control group.
The use of an antenatal training device in nulliparous women with cephalic vaginal birth at term is not associated with better pelvic health outcomes. However, it may reduce the frequency of episiotomies.
Vaginal birth is an established risk factor for pelvic floor trauma (Švabík, 2009; Kamisan Atan et al, 2016). This trauma may include avulsion of the levator ani muscle from the inferior pubic ramus (macrotrauma) or irreversible levator ani muscle overdistension (microtrauma) (Kamisan Atan et al, 2016).
Pelvic floor trauma is most frequently caused by overdistension during the second stage of labour, primarily affecting the pubococcygeus muscle (Lien et al, 2004; Švabík, 2009). The incidence of levator ani muscle avulsion ranges from 10–35% (van Delft et al, 2014; Kamisan Atan et al, 2016) and the use of forceps significantly increases this risk (Friedman et al, 2019). Additionally, levator ani muscle avulsion is associated with obstetric anal sphincter injury, prolonged second stage of labour (van Delft et al, 2014) and the application of pressure on the uterine fundus during the second stage of labour, also known as the Kristeller maneuvre (Youssef et al, 2019).
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