Ruth Zielinski

MRI Findings in Patients Considered High Risk for Pelvic Floor Injury Studied Serially After Vaginal Childbirth

OBJECTIVE The purpose of this article is to characterize pelvic floor injury after vaginal childbirth with serial MRI. SUBJECTS AND METHODS MR images (3-T) were obtained early (1 month) and late (7 months) after first childbirth in 19 women with risk factors for pelvic floor injury. All women underwent multiplanar intermediate-weighted sequences, and 11 women underwent fluid-sensitive sequences. MR images were evaluated for levator edema and tears and for pubic abnormalities. RESULTS Three women had unilateral high-grade tears, three had unilateral low-grade tears, and one had bilateral high- and low-grade tears of the levator ani muscles. All tears were focal at the pubis. Levator edema was present in all women on initial imaging and was resolved at follow-up. Six women had bone marrow edema, five with fracture line. None showed a pattern indicating nerve damage separate from muscle tears. CONCLUSION MRI showed focal levator ani muscle tears at the pubis with bone marrow edema and fracture in patients at risk for pelvic floor injury.

The relationship between pelvic organ prolapse, genital body image, and sexual health

Pelvic organ prolapse involves physical changes to the genitals, potentially distressing to women. We hypothesized poorer genital body image in prolapsed women versus controls and that genital body image would correlate with sexual health.

Home Birth After Hospital Birth: Women's Choices and Reflections

INTRODUCTION The number of US women choosing home birth is increasing. Little is known about women who choose home birth after having experienced hospital birth; therefore, the purpose of this research was to explore reasons why these women choose home birth and their perceptions regarding their birth experiences. METHODS Qualitative description was the research design, whereby focus groups were conducted with women who had hospital births and subsequently chose home birth. Five focus groups were conducted (N = 20), recorded, and transcribed verbatim. Qualitative content analysis was undertaken allowing themes to emerge. RESULTS Five themes emerged from the womens narratives: 1) choices and empowerment: with home birth, women felt they were given real choices rather than perceived choices, giving them feelings of empowerment; 2) interventions and interruptions: women believed things were done that were not helpful to the birth process, and there were interruptions associated with their hospital births; 3) disrespect and dismissal: participants believed that during hospital birth, providers were more focused on the laboring womans uterus, with some experiencing dismissal from their hospital provider when choosing to birth at home; 4) birth space: giving birth in their own home, surrounded by people they chose, created a peaceful and calm environment; and 5) connection: women felt connected to their providers, families, newborns, and bodies during their home birth. DISCUSSION For most participants, dissatisfaction with hospital birth influenced their subsequent decision to choose home birth. Despite experiencing challenges associated with this decision, women expressed satisfaction with their home birth.

Planned home birth: benefits, risks, and opportunities

While the number of women in developed countries who plan a home birth is low, the number has increased over the past decade in the US, and there is evidence that more women would choose this option if it were readily available. Rates of planned home birth range from 0.1% in Sweden to 20% in the Netherlands, where home birth has always been an integrated part of the maternity system. Benefits of planned home birth include lower rates of maternal morbidity, such as postpartum hemorrhage, and perineal lacerations, and lower rates of interventions such as episiotomy, instrumental vaginal birth, and cesarean birth. Women who have a planned home birth have high rates of satisfaction related to home being a more comfortable environment and feeling more in control of the experience. While maternal outcomes related to planned birth at home have been consistently positive within the literature, reported neonatal outcomes during planned home birth are more variable. While the majority of investigations of planned home birth compared with hospital birth have found no difference in intrapartum fetal deaths, neonatal deaths, low Apgar scores, or admission to the neonatal intensive care unit, there have been reports in the US, as well as a meta-analysis, that indicated more adverse neonatal outcomes associated with home birth. There are multiple challenges associated with research designs focused on planned home birth, in part because conducting randomized controlled trials is not feasible. This report will review current research studies published between 2004 and 2014 related to maternal and neonatal outcomes of planned home birth, and discuss strengths, limitations, and opportunities regarding planned home birth.

Validity and Reliability of a Scale to Measure Genital Body Image

Womens body image dissatisfaction extends to body parts usually hidden from view—their genitals. Ability to measure genital body image is limited by lack of valid and reliable questionnaires. We subjected a previously developed questionnaire, the Genital Self Image Scale (GSIS) to psychometric testing using a variety of methods. Methods: Five experts determined the content validity of the scale. Then using four participant groups, factor analysis was performed to determine construct validity and to identify factors. Further construct validity was established using the contrasting groups approach. Internal consistency and test-retest reliability was determined. Results: Twenty one of 29 items were considered content valid. Two items were added based on expert suggestions. Factor analysis was undertaken resulting in four factors, identified as Genital Confidence, Appeal, Function, and Comfort. The revised scale (GSIS-20) included 20 items explaining 59.4% of the variance. Women indicating an interest in genital cosmetic surgery exhibited significantly lower scores on the GSIS-20 than those who did not. The final 20 item scale exhibited internal reliability across all sample groups as well as test-retest reliability. Conclusions: The GSIS-20 provides a measure of genital body image demonstrating reliability and validity across several populations of women.

Improved birth weight for black infants: Outcomes of a healthy start program

OBJECTIVES We determined whether participation in Healthy Babies Healthy Start (HBHS), a maternal health program emphasizing racial equity and delivering services through case management home visitation, was associated with improved birth outcomes for Black women relative to White women. METHODS We used a matched-comparison posttest-only design in which we selected the comparison group using propensity score matching. Study data were generated through secondary analysis of Michigan state- and Kalamazoo County-level birth certificate records for 2008 to 2010. We completed statistical analyses, stratified by race, using a repeated-measures generalized linear model. RESULTS Despite their smoking rate being double that of their matched counterparts, Black HBHS participants delivered higher birth-weight infants than did Black nonparticipants (P = .05). White HBHS participants had significantly more prenatal care than did White nonparticipants, but they had similar birth outcomes (P = .7 for birth weight; P = .55 for gestation). CONCLUSIONS HBHS participation is associated with increased birth weights among Black women but not among White women, suggesting differential program gains for Black women.

Feasibility of a longitudinal study of women anticipating first pregnancy and assessed by multiple pelvic exams: Recruitment and retention challenges

OBJECTIVE To better understand the relationship between childbirth and pelvic floor disorders the ideal study design would begin with data collection prior to but close in time to first pregnancy and follow participants through postpartum. We conducted a feasibility study to determine the following: a) whether women desiring to get pregnant would agree to pre-pregnancy data collection including a one-time urethral catheter measure and repeat pelvic exams to ascertain a baseline within 6 months of pregnancy; b) effectiveness of various recruitment and retention methods, c) number achieving pregnancy, and then d) number expressing willingness to continue follow-up through pregnancy and postpartum. METHODS Advertising included newspaper ads, targeted emails and flyers. Post-enrollment, four data collection visits were scheduled and occurred every 6 months or until pregnant. If pregnancy occurred, women were asked to indicate their willingness to continue assessments. RESULTS The most successful advertising strategy for both recruitment and retention was local newspaper ads. Ninety-four women inquired about the study, 30 enrolled. Post-baseline retention was 23 women at 6 months, 17 at 12 months, and 13 at 18 months. Nine of the 30 women achieved pregnancy; two remained eligible and willing to participate through pregnancy and postpartum. CONCLUSIONS This study provides data on feasibility of recruiting women to establish near-pregnancy clinical baseline measures that include pelvic exams. Close to 30% reached pregnancy within 2 years of study start and within 6 months of most recent pelvic exam measure. Of those who became pregnant, 22% expressed willingness to continue follow-up into the childbearing year.

Gastrointestinal distress in pregnancy: prevalence, assessment, and treatment of 5 common minor discomforts.

Gastrointestinal discomforts are a very common complaint in pregnancy. In fact, most pregnant women will experience at least one discomfort. This article focuses on 5 common conditions that occur in pregnancy: gastroesophageal reflux disease, diarrhea, constipation, hemorrhoids, and pica. While these conditions do occur in men and nonpregnant women, they occur more frequently in pregnancy because of the anatomic and physiologic changes associated with gestation. The type and severity of symptoms can vary from individual to individual, making treatment a challenge for healthcare providers, particularly when caring for pregnant women because the effects of medications and other treatments on the developing fetus are often not extensively studied. While these discomforts are rarely life-threatening, they can cause significant distress and impair quality of life. The goal of this article was to provide a summary of the anatomic and physiological changes during pregnancy that contribute to the increasing incidence of these discomforts and to provide information about each condition including prevalence, symptoms, and treatment modalities.

Female college students’ beliefs about cervical cancer screening

Purpose To explore female college students’ perceived benefits and barriers to cervical cancer screening and perceived vulnerability to cervical cancer. Method The study was exploratory and cross sectional. The Pap Smear Belief Questionnaire was distributed online to a sample of 267 female undergraduate baccalaureate nursing students. Findings Students who obtained routine Pap smears perceived greater benefits and fewer barriers to routine screening than the students who did not obtain routine Pap smears. Personal vulnerability to cervical cancer was not a significant finding. Students who were in a long-term relationship, non-smoking and initiated sexual intercourse at a younger age were more likely to obtain routine screening. Conclusion Stressing importance of preventive health care associated with routine cervical cancer screening is important to promote women’s health regardless of age or level of education. Further studies with a broader range of college students as participants are needed to better understand their beliefs about the benefits and barriers to obtaining routine screening, and their perceptions of vulnerability to cervical cancer.

Assessment of women's sexual health using a holistic, patient-centered approach.

Sexual health problems are common in women and have the potential to affect all aspects of their lives. These issues can include diminished or lack of desire for sex, difficulty with arousal and sexual pleasure, inability to orgasm, and pain with sex. Causes of sexual health issues can be complex and multifaceted; therefore, a holistic perspective, in which all potential factors are considered, is warranted. Despite the prevalence of womens sexual health issues, discussion by providers is often absent or limited to avoidance of sexually transmitted infections or unwanted pregnancies. Health care providers may feel they do not have the time or resources to address sexual health problems. This article provides a sexual health assessment approach using a model of sexual health whereby sociocultural factors are given priority, followed by factors related to partner and relationships, psychological factors, and finally medical factors.