Kuang-Ho Chen

Comparison of the effects of episiotomy and no episiotomy on pain, urinary incontinence, and sexual function 3 months postpartum: A prospective follow-up study

BACKGROUND The episiotomy rate has declined worldwide but remains high in several countries such as Taiwan. The effects of episiotomy on womens health should be a constant concern. Few data are available on the effect of episiotomy by validated measures. OBJECTIVE The present study examined the effect of episiotomy on pain, urinary incontinence, and sexual function up to 3 months postpartum. DESIGN, SETTING AND PARTICIPANTS A prospective follow-up study of 243 women who completed the Taiwanese versions of the Short Form McGill Pain Questionnaire, International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form, Female Sexual Function Index, and a demographic questionnaire after vaginal delivery in a Taiwanese medical center. METHODS Differences between those who did and did not have an episiotomy were tested using ANCOVA, adjusting for age, parity, newborn weight, and vacuum delivery. The reliability and validity of the measuring instruments were assessed using Cronbachs α coefficient and factor analysis. RESULTS Women who delivered without an episiotomy had significantly lower perineal pain scores at weeks 1, 2 and 6 postpartum compared to women who had an episiotomy (p=0.0065, 0.0391, 0.0497, respectively). Women in the no-episiotomy group had significantly lower non-localized pain scores at week 2 postpartum compared to women in the episiotomy group (p=0.0438). The mean urinary incontinence score was significantly higher in the episiotomy group 3 months postpartum (p=0.0293). No significant difference in sexual function score was found between groups. CONCLUSIONS The results indicate that episiotomy increased pain at weeks 1, 2 and 6 postpartum, and urinary incontinence at 3 months postpartum. Awareness of the relationship between episiotomy and womens health will help health care professionals develop policy and promote the application of restrictive episiotomy.

Comparison of Overall Sexual Function, Sexual Intercourse/Activity, Sexual Satisfaction, and Sexual Desire During the Three Trimesters of Pregnancy and Assessment of Their Determinants

INTRODUCTION Pregnancy affects womens sexual function. However, few reports have addressed this phenomenon. AIM To examine overall sexual function and three dimensions of the Taiwan version of the Female Sexual Function Index and to assess their determinants during the three trimesters of pregnancy. METHODS Cross-sectional investigation of 663 pregnant women using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, the Body Image Scale for Pregnant Women, and demographics questions. MAIN OUTCOME MEASURES Urinary incontinence, body image, obstetrical history, demographics, and other factors potentially influencing overall sexual function, intercourse/activity, satisfaction, and desire during pregnancy. RESULTS Mean scores for overall sexual function, intercourse/activity, and satisfaction differed significantly among the three trimesters (P = or <0.02), whereas mean scores for sexual desire did not. Mean scores for overall sexual function and intercourse were significantly lower during the third trimester than during the first trimester (P < 0.001) or second trimester (P < 0.001). Mean score for satisfaction was significantly higher during the third trimester than during the first trimester (P = 0.01). Significant effects included the following: (i) the discomfort and infertility experiences on overall sexual function and on intercourse, the interaction between body image and artificial abortion on satisfaction, spontaneous abortion on desire during the first trimester; (ii) the full-time work and infertility experiences on overall sexual function and on intercourse, the interactions between body image and medical condition on desire during the second trimester; and (iii) the interaction between gestational age and HoLou ethnicity on overall sexual function, the interaction between body image and discomfort on overall sexual function and on intercourse, the interactions between body image and infertility experiences and gravidity on satisfaction, urinary incontinence on desire during the third trimester. CONCLUSIONS Results demonstrated that biopsychosocial and cultural factors affected Female Sexual Function Index (FSFIT) scores throughout pregnancy.

Age at menarche of three-generation families in Taiwan.

Background: Menarche is a critical transition and biological event for women. Age at menarche is an important variable for womens health and appears to be decreasing from generation to generation. Aim: This study describes the distributions of recalled age at menarche of women in three-generation families, examines generational differences, and evaluates the effects of birth mothers’ and birth grandmothers’ recalled age at menarche on their daughters. Subjects and methods: This cross-sectional investigation was performed on 214 post-adolescent girls from central Taiwan and their birth mothers and grandmothers. The descriptive analysis, analyses of mixed effect models, and multiple linear regression analyses were employed to examine the relationships of age at menarche for three generations within families. Results: The distribution of age at menarche moved significantly earlier over the three generations. The mean ages at menarche were 15.16 ± 1.75, 14.50 ± 1.50, and 13.00 ± 1.26 years for grandmothers, mothers, and daughters, respectively. Four factors for the daughters’ age at menarche (adjusted for age at the time of the study and geographical location) were identified. The first three were reinforcing effects. These were the product of the mothers’ and grandmothers’ ages at menarche, the product of the mothers’ geographical locations and ages at menarche, and the product of the grandmothers’ ethnicity and ages at menarche. The fourth factor was the grandmothers’ ethnicity. Conclusion: The results showed a significant decrease in the onset age of menstruation over three generations, with a positive effect on age at menarche from mothers to daughters and from grandmothers to granddaughters.

Sexual Function in Women 3 Days and 6 Weeks After Childbirth: A Prospective Longitudinal Study Using the Taiwan Version of the Female Sexual Function Index

INTRODUCTION Childbirth impacts sexual function in women, but few reports have addressed sexual function shortly after childbirth. AIM Using the Taiwan version of the Female Sexual Function Index (FSFIT), this study aimed to describe womens sexual function and to examine differences between groups in sexual function shortly after delivery. METHODS A prospective longitudinal investigation was performed in women who completed the FSFIT, a numeric analog scale, the Taiwan version of the Center for Epidemiologic Studies Depression Scale (CES-D), and a demographic questionnaire in a Taiwanese medical center at 3 days and 6 weeks postpartum. MAIN OUTCOME MEASURES Using a general linear model, differences were tested between groups, including those defined by delivery mode, type of feeding, depression score, pain score, and birth history. RESULTS After adjusting for covariates, (i) significant differences in sexual function and desire were found between the vaginal delivery and Cesarean section groups at day 3 and week 6 postpartum (P = 0.0419 and <0.0001, respectively); (ii) differences in desire and satisfaction between the tubal ligation and not groups were significant at both time points (P = 0.0346 and 0.0338); (iii) differences in sexual function and sexual activity or intercourse between low and high CES-D scores were significant at 6 weeks postpartum (P = 0.0040 and 0.0043, respectively); and (iv) differences between pain level groups in sexual activity or intercourse and desire were significant at 6 weeks (P = 0.0493 and 0.0004). At 3 days postpartum, significant differences between educational level and ethnic groups were observed (P = 0.0002 and 0.0414). CONCLUSIONS The results showed significant differences in sexual function shortly after delivery between groups based on delivery method, tubal ligation, depression, pain, ethnicity, and educational level. This information may help health professionals to be more aware of womens perception of sexuality and may foster sensitivity in assessing their sexual function after childbirth.

A repeated measures study of changes in health‐related quality of life during pregnancy and the relationship with obstetric factors

AIMS To examine changes in health-related quality of life throughout the course of pregnancy and among three pairs of consecutive periods (pre-pregnancy to early pregnancy, early to middle pregnancy and middle to late pregnancy), as well as to identify associated obstetric factors during the entire period of pregnancy. BACKGROUND Only sparse data are available concerning the profiles of health-related quality of life throughout pregnancy. DESIGN A within-subject comparison was undertaken. METHODS In total, 358 women completed the Taiwanese version of the Medical Outcomes Study Short Form-36 Health Questionnaire and a demographic-obstetric questionnaire at three stages of pregnancy at a medical centre. The participants were recruited between 2009-2010. A generalized estimating equation regression model was employed for the repeated measures. RESULTS The scores for physical component summary decreased significantly throughout early, middle and late pregnancy. The scores for mental component summary increased. The scores for physical, mental component summary and the eight domains of health-related quality of life decreased significantly from pre-pregnancy to early pregnancy. After adjusting for demographic and clinical factors, significant factors predicting physical component summary during pregnancy included stage of pregnancy and previous infertility. The factors predicting mental component summary included stage of pregnancy, parity and medical condition. CONCLUSIONS The results revealed the dynamic pattern of perceived health status by the Taiwanese pregnant women in their surrounding socio-cultural context and identified the stage of pregnancy and obstetric factors predicting health-related quality of life.

Depressive Symptoms as a Predictor of Sexual Function during Pregnancy

INTRODUCTION Biopsychological and sociocultural factors have been reported to be associated with sexual function in pregnancy. To date, very few studies have focused on the relationship between sexual function and depression during pregnancy. AIM To determine whether depressive symptoms predict overall sexual function, desire, arousal, lubrication, orgasm, satisfaction, and pain during pregnancy by using the Female Sexual Function Index (FSFI). METHODS Pregnant women undergoing prenatal examinations were randomly selected for this cross-sectional investigation. The study included 555 pregnant women who completed the Taiwanese versions of the Center for Epidemiologic Studies Depression Scale (CES-D), FSFI, and a demographic questionnaire during pregnancy. MAIN OUTCOME MEASURES CES-D scores for depressive symptoms, scores for overall sexual function on the FSFI, and the FSFI domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. RESULTS After adjusting for demographic factors, CES-D scores during the first trimester negatively predicted overall sexual function (P=0.0004), arousal (P=0.0104), lubrication (P=0.0016), orgasm (P=0.0022), and pain (P<0.0001). Moreover, CES-D scores during the third trimester negatively predicted sexual desire (P=0.0005) and satisfaction (P<0.0001). Furthermore, gestational age negatively predicted overall sexual function, arousal, lubrication, orgasm, and pain (all P<0.0001). Parity was a positive predictor of overall sexual function, arousal, lubrication, and orgasm (all P<0.0005). Medical conditions were positive predictors of sexual desire (P=0.0023). CONCLUSIONS The present study revealed that depressive symptom scores during early and late pregnancy were significant negative predictors of sexual function during pregnancy.

Depressive symptoms, pain, and sexual dysfunction over the first year following vaginal or cesarean delivery: A prospective longitudinal study.

BACKGROUND Childbirth has a significant impact on maternal health, and the high rate of cesarean delivery is a global health concern. Few studies have used validated measures to explore depression, pain, and sexual dysfunction following vaginal or cesarean delivery over a prolonged time period. OBJECTIVE We examined the associations between vaginal and cesarean delivery and depressive symptoms, pain, and sexual function during the 1-year postpartum period. DESIGN A prospective, five-time-point longitudinal study. SETTING Maternity unit at a medical center. PARTICIPANTS A total of 351 of 736 women completed a questionnaire that described demographic characteristics, depressive symptoms, and pain levels at 3-5 days postpartum, and updated personal data, depressive symptoms, pain levels, and sexual function at 4-6 weeks and at 3, 6, and 12 months after delivery. METHODS Differences between the vaginal and cesarean groups in depressive symptoms, pain, and sexual function and trends of changes in these factors over the first postpartum year were examined. RESULTS Compared with the vaginal birth group, the cesarean birth group had a significantly higher prevalence of depressive symptoms at 3 months (p=0.03); higher scores for non-localized pain at 3-5 days (p<0.001), 4-6 weeks (p=0.03), and 3 months (p=0.046); higher scores for abdominal pain at 3-5 days (p<0.001), 4-6 weeks (p<0.001), and 6 months (p=0.01); lower perineal pain scores at 3-5 days (p <0.001); and higher sexual desire scores (p=0.04) but lower sexual satisfaction scores (p=0.02) at 4-6 weeks. Differences between the vaginal and cesarean groups were significant (p=0.01, p=0.049, respectively) in terms of the decrease in non-localized pain from 3-5 days to 4-6 weeks postpartum and the increase in sexual desire from 4-6 weeks to 3 months postpartum. CONCLUSIONS Cesarean delivery was associated with an increased prevalence of depressive symptoms at 3 months and higher pain levels that persisted at 6 months postpartum in Taiwan. We found no difference in sexual function between vaginal and cesarean delivery after 6 weeks postpartum, and no differences in the trends related to depressive symptoms or in sexual functioning (except for desire) within 1 year postpartum.

Association of mode of delivery with urinary incontinence and changes in urinary incontinence over the first year postpartum.

OBJECTIVE: To examine the association between vaginal or cesarean delivery and urinary incontinence (UI) and identify the trend in the change in UI within the first 12 months postpartum. METHODS: This was a prospective longitudinal study of 330 of 749 women who completed a UI questionnaire and a personal characteristics questionnaire over five visits in a medical center. RESULTS: The vaginal delivery group had a significant higher prevalence of any UI at 4–6 weeks and at 3, 6, and 12 months (29.1–40.2% vaginal compared with 14.2–25.5% cesarean); stress urinary incontinence (SUI) at 4–6 weeks and 3 and 12 months (15.9–25.4% vaginal compared with 6.4–15.6% cesarean); and moderate or severe UI at 3–5 days, 4–6 weeks, and 6 months (7.9–18.5% vaginal compared with 4.3–11.3% cesarean); and a significant higher score for interference in daily life at 3–5 days and 4–6 weeks (1.0, 0.7 vaginal compared with 0.7, 0.4 cesarean) compared with those in the cesarean delivery group. Prevalence increased for any UI, SUI, and slight UI (all P<.02) and daily life interference score decreased (P=.02) for women who had a vaginal delivery through 1 year postpartum. CONCLUSION: Vaginal delivery was associated with higher UI prevalence that persisted for 1 year postpartum, but there was no association with interference in daily life after 6 weeks postpartum. Variation was observed in UI changes within the first year in the vaginal delivery and cesarean delivery groups. LEVEL OF EVIDENCE: II

Relationships between perineal pain and postpartum depressive symptoms: A prospective cohort study

BACKGROUND The relationship between concurrent or previous postnatal pain and depressive symptoms remains controversial. To the best of our knowledge, no previous study has used validated measures and multiple scales to evaluate perineal pain, or examined its relationship with depressive symptoms during the postpartum period. OBJECTIVES We investigated the association between pain and previous postnatal pain with depression during the 6-month postpartum period, and the influence of previous postnatal depressive symptoms. DESIGN A prospective cohort study design was used. SETTING Maternity unit of a medical center. PARTICIPANTS This study included 432 participants; data regarding demographic characteristics, perineal pain, and any pain and depression during the 6-month postpartum period were collected. METHODS Pain and depressive symptoms were measured using the Short Form-McGill Pain Questionnaire and Center for Epidemiologic Studies Depression Scale, respectively. A generalized estimating equation was used to examine factors associated with postpartum depression. RESULTS After adjusting for covariates, women who had perineal pain at 4-6 weeks postpartum showed an increased risk for depression at 4-6 weeks (risk ratio [RR]: 1.9, 95% confidence limits [CL]: 1.2, 3.2) and 6 months (RR: 1.9, 95% CL: 1.1, 3.3) compared to those with no perineal pain. Perineal pain severity, 4-6 weeks postpartum, also predicted depressive symptoms at 6 months postpartum (β=0.63, p=0.02). Any pain intensity score at 3-5 days postpartum predicted depression at 3 months (β=0.01, p=0.04). Women with high depression scores at 3-5 days had a two- or three-fold higher risk for depression at 4-6 weeks and 3 and 6 months, respectively, compared to those with low depression scores (RR: 3.5, 95% CL: 2.2, 5.4; RR: 2.2, 95% CL: 1.3, 3.4; and RR: 2.8, 95% CL: 1.7, 4.8, respectively). CONCLUSIONS Our study provides robust evidence that perineal pain 4-6 weeks postpartum is associated with depressive symptoms 4-6 weeks and 6 months postpartum; pain at 3-5 days postpartum predicts depressive symptoms at 3 months postpartum; and previous postnatal depressive symptoms, particularly depressive symptoms 3-5 days postpartum, predict depressive symptoms during the 6-month postpartum period.

Demand feeding for healthy premature newborns : A randomized crossover study

BACKGROUND AND PURPOSE In hospitals, preterm infants are routinely fed specified amounts of formula on a fixed schedule. This results in the babys intake volume being regular and easily confirmed, but does not consider the individual babys needs. The purpose of this study was to compare the effects of demand feeding and fixed schedule feeding for healthy premature newborn babies. METHODS A 2-feeding-type, 2-period crossover study design was employed, in which each period consisted of 2 days, the first of which was a washout period, comprising a self-comparison protocol designed to identify any differences in the feeding characteristics of premature infants on demand or scheduled bottle-feeding. Eleven preterm infants were included. The sample size was monitored during the observation period by power calculation. The mean weight at study entry was 1897.27 +/- 175.94 g and the mean postconceptional age was 35.34 +/- 1.54 weeks. RESULTS Compared with scheduled feeding, demand feeding was associated with a longer daily mean interval (4.17 vs 3.02 hours; p = 0.00), greater volume per feed for demand feeding (67.28 vs 51.11; p = 0.00), greater feeding speed (5.73 vs 4.51 mL/min; p = 0.00), but a similar daily total duration of feeding. There was no significant difference in the daily total feeding volume. CONCLUSIONS Demand feeding provides superior volume per feed, and feeding speed and shortens the duration of feeding compared to feeding on a routine schedule. It is suitable and feasible for healthy premature newborns.