Werner Stadlmayr

Maternal adjustment five months after birth: the impact of the subjective experience of childbirth and emotional support from the partner

: Recent research suggests that negative childbirth experiences may cause maternal maladjustment. The impact of intranatal emotional distress, intranatal physical discomfort and postnatal emotional evaluation of birth on symptoms of posttraumatic stress and depression is investigated with regard to the moderating role of emotional support from the partner. Subjective childbirth experience measured with the German version of the Salmons Item List, obstetric characteristics and postnatal emotional support from the partner were assessed in 374 women six weeks after childbirth. Trauma symptoms and postnatal depression were measured five months after childbirth. Postnatal emotional partner support acts as a moderator of the effect of the subjective childbirth experience on the development of symptoms of avoidance, intrusive thoughts and depression. The direct influence of emotional partner support is stronger regarding symptoms of depression and hyperarousal than regarding avoidance and intrusive thoughts. No direct association between intranatal physical discomfort/labour pain and later maternal adjustment could be found. Women with a negative childbirth experience and poor emotional support from their partner are at increased risk for psychological maladjustment in the first five months after birth.

Effects of Female Genital Mutilation on Birth Outcomes in Switzerland

Objective  The primary aim of this study was to determine the desires and wishes of pregnant patients vis‐à‐vis their external genital anatomy after female genital mutilation (FGM) in the context of antenatal care and delivery in a teaching hospital setting in Switzerland.

Sexual and organ function in patients with symptomatic prolapse: are pessaries helpful?

OBJECTIVE To evaluate quality of life and pelvic organ and sexual function before and during pessary use in patients with symptomatic pelvic organ prolapse and to determine reasons which lead to cessation of pessary use. DESIGN Prospective observational study. SETTING Tertiary referral center. PATIENT(S) Patients with symptomatic stage II or more prolapse of the anterior, posterior, or apical vaginal wall with or without uterus were included in this study. INTERVENTION(S) We used the Female Sexual Function Index questionnaire and the Sheffield prolapse questionnaire. For quality of life we used the Kings Health Questionnaire. MAIN OUTCOME MEASURE(S) Main outcome measures were quality of life and sexual and pelvic organ function. RESULT(S) A total of 73 women participated in this study; 31 were sexually active. Desire, lubrication, and sexual satisfaction showed statistically significant improvement, and orgasm remained unchanged. Statistically significant improvement in the feeling of bulge occurred during therapy, stool outlet problems were significantly improved, overactive bladder symptoms were significantly better, and pessaries did not significantly alter incontinence. CONCLUSION(S) Pessaries have been shown to be a viable noninvasive treatment for pelvic organ prolapse improving organ and sexual function as well as general wellbeing.

Male and Female Sexual Function After Surgical Repair of Female Organ Prolapse

INTRODUCTION Few data are available referring to male and female sexual function after prolapse repair of symptomatic pelvic organ. AIM Primary aim of this study is to determine the male and female sexual function before and after surgery for pelvic organ prolapse. MAIN OUTCOME MEASURES We used the Female Sexual Function Index (FSFI) questionnaire for female patients and for their male partners the Brief Male Sexual Inventory (BMSI) as measurement of sexual function. METHODS We included sexually active heterosexual couples that were referred to the Department of Urogynaecology because of symptomatic cystocele, rectocele or vault descent. For cystoceles, anterior repair was performed, for rectoceles posterior repair, and for vault descent sacrospinous ligament fixation. FSFI and BMSI questionnaires were distributed before and after pelvic organ surgery and 4 months after. Female clinical examination assessing the degree of prolapse was performed before and 6 weeks after surgery. RESULTS A full data set of 70 female questionnaires and 64 male questionnaires could be evaluated. Two cases of female de novo dyspareunia occurred. In women, FSFI scores improved significantly in the domains desire, arousal, lubrication, overall satisfaction, and particularly pain. Orgasm remained unchanged. In men, interest, sexual drive, and overall satisfaction improved significantly. Erection, ejaculatory function, and orgasm remained unchanged. Despite remaining unchanged, erection, strength of erection, ejaculation, and orgasm were not considered problems anymore compared to preoperative BMSI scores. CONCLUSION Surgery for pelvic organ prolapse improves male and female sexual function in some domains but not in all.

Where should bulking agents for female urodynamic stress incontinence be injected

For bulking agents used for female stress urinary incontinence, the recommendation for the anatomical placement varies as some injectables are to be placed close to the bladder neck and others midurethrally. Aim of the study was to determine if there are differences concerning the outcome after transurethral collagen injections depending on the anatomical placement midurethrally or at the bladder neck. We randomly assigned 30 elderly female patients with urodynamic stress incontinence to either transurethral collagen injection midurethrally or to the bladder neck. Prior to injection and at ten month follow-up, maximum urethral closure pressure (MUCP), functional urethral length (FUL), maximum flow rate and cough test were performed and the patient was asked to estimate her bladder condition using a visual analogue scale. Postoperative contentness was 8 (median, 95% confidence interval 5–9) in the midurethral group and 8 (median, 95% confidence interval 7–10) in the bladder neck group with a p value of 0.012, 95% confidence interval –2.464 to –0.2859, in favour to midurethral injections. MUCP and FUL increased significantly in both groups and flow rate decreased in both groups. Continence was 66.6% in the midurethral group and 60% for the bladder neck group respectively. Both midurethral and bladder neck collagen injections improve patients’ satisfaction almost equally with a small advantage for midurethral injections.

Infant irritability: The impact of fetal alcohol exposure, maternal depressive symptoms, and low emotional support from the husband†

OBJECTIVES The aim of this study was to investigate the impact of fetal alcohol exposure, maternal depressive symptoms, and low emotional support from the husband on infant irritability in the first one and a half years of life. Four models describing the interplay of these factors were assessed: A direct effect model, an interaction or threshold model, a mediational model and a transactional model. METHOD A sample of initially 458 women was assessed in a prospective 3-wave study across the first 17 months after childbirth. Fetal alcohol exposure was questioned retrospectively six weeks after birth. Infant irritability was reported by the mothers and fathers. RESULTS Support for the direct effect model and the interaction model could be found: Fetal alcohol exposure and low emotional support from the husband were associated with increased infant irritability at 5 months. The impact of fetal alcohol exposure was moderated by postnatal depressive symptoms. More irritability was reported if both risk factors, prenatal alcohol exposure and maternal depressive symptoms, were present. Infant irritability and maternal depressive symptoms were associated cross-sectionally. At the age of 17 months only a main effect of prenatal alcohol exposure on irritability could be found. CONCLUSION Direct effects of fetal alcohol exposure, maternal depressive symptoms, and low emotional support from the husband on infant irritability as well as an interaction between fetal alcohol exposure and maternal depressive symptoms were revealed. The interaction can be understood in terms of a diathesis-stress model. However, no longitudinal associations between maternal depressive symptoms and infant irritability could be found.

A pilot study of Connexin 43 (Cx43) in human bladder tissue in patients with idiopathic detrusor overactivity

OBJECTIVE Aim of the study was to compare Connexin 43 (Cx43) in human bladder tissue of urodynamically proven idiopathic detrusor overactivity to those of urodynamically stable bladders. STUDY DESIGN We compared bladder biopsies of patients with detrusor overactivity and those with stable bladder analysing Cx43 message by RNA extraction and PCR amplification. All patients had multichannel urodynamics prior to the biopsies. RESULTS We investigated the bladder biopsies of 15 female patients with and 15 patients without detrusor overactivity. Cx43 could be detected in nine patients of the detrusor overactivity group and in eight patients of the control group which was not statistically significant. 42 cycles of PCR were necessary to demonstrate Cx43 presence in the positive specimen. The presence of Cx43 was not consistent in the samples from the bladder dome and the side walls meaning there were Cx43 positive results in the dome and negative ones in the side walls of the same patient and vice versa. CONCLUSION In conclusion, Cx43 is present in human bladder tissue both of overactive bladders and those of controls. However, it is expressed in very small amounts and is not always detectable. The role of Cx43 for the origin of detrusor overactivity remains unclear.

Labour experience and postpartum stress and depression: a quantitative and qualitative examination

Abstract Objectives: The purpose of this study was to examine the relationship between qualitatively and quantitatively assessed birth experiences and rates of post-birth distress and depressive symptoms three to four weeks postpartum. Both the rates of post-birth distress and depressive symptoms represented risk factors for subsequent mental health problems in the later postpartum period. Background: Childbirth is accompanied by various stress factors. However, little is known about the relationship between stressors occurring during birth (intrapartum) and the ways women cope with them and women’s development of depressive symptoms or acute stress reactions postpartum. Methods: One hundred and twenty-seven women from two longitudinal studies were interviewed 48–96 h after childbirth. Thirty birth interviews from both samples were additionally examined for qualitative themes related to women’s reported experience in connection with mental health adaptation (i.e. without symptoms (n = 10), symptoms of depression (n = 10) and acute stress reactions (n = 10)) at three to four weeks postpartum. Results: Women with depressive symptoms reported less intimate and helpful contact with their partners and baby during labour compared with women without symptoms or with acute stress reactions. Women with acute stress reactions had less confidence in themselves, and reported disorientation during the birth process, compared with women without symptoms or with depressive symptoms. Conclusions: Recognition of how women cope with intrapartum factors during labour could help to identify psychological distress shortly after delivery, and inform the introduction of timely and appropriate psychological support for affected women.

The net which made her wet: two unusual cases of stress incontinence.

This report describes two cases of urinary stress incontinence secondary to mesh repair of large abdominal hernias. Both patients had never experienced urinary incontinence before their hernia repair. In both cases, polypropylene nets were inserted to stabilise the abdominal wall. Immediately after the intervention, both patients became stress incontinent. Probably pressure transmission to the pelvic floor was increased due to stabilisation of the abdominal wall, which worked as a “windpipe” before surgery. After the insertion of suburethral tapes the incontinence resolved.