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  • 1
    Electronic Resource
    Electronic Resource
    The influence of oestrogen replacement on faecal incontinence in postmenopausal women (1997)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 104 (1997), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To assess the value of hormone replacement therapy (HRT) in postmenopausal women with faecal incontinence.Design Prospective observational study using a bowel function questionnaire and anorectal physiological testing before and after six months of standard oestrogen hormone replacement therapy.Setting Menopause and colorectal clinics of two university teaching hospitals.Participants Twenty postmenopausal women (mean age 61 years) with demonstrable faecal incontinence (mean duration 6.1 years) previously untreated with HRT.Main outcome measures Improvement in symptoms and objective alteration in anorectal physiology tests.Results All women had significant symptoms of anorectal dysfunction before treatment, whereas 5/20 (25%) were asymptomatic after six months of HRT, and a further 13/20 (65%) were symptomatically improved in terms of flatus control, urgency, and faecal staining. There was no change in bowel frequency or stool consistency following HRT, but social activity was considerably improved. Anal resting pressures and voluntary squeeze increments were significantly increased following oestrogen therapy, although no differences in anal canal vector symmetry index were observed. Insignificant changes occurred in threshold volume of rectal sensation and volume of defaecatory urge, but there was a significant change in maximum tolerated rectal volume after six months. Neither anal canal electrosensitivity nor pudendal nerve terminal motor latency was altered following HRT. Seven of the 20 women (35%) had an identifiable anal sphincter defect on anal endosonography. Statistical analysis, however, showed no significant difference in outcome in this group compared with those with an intact anal sphincter. A larger population sample may demonstrate this.Conclusion This observational study has shown a possible benefit of oestrogen replacement in postmenopausal women with symptoms of impaired faecal continence. A prospective randomised controlled trial is now advisable to test this hypothesis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1997.tb11459.x
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  • 2
    Electronic Resource
    Electronic Resource
    The value of ultrasound measurement of amniotic fluid ume in the management of prolonged pregnancies (1984)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 91 (1984), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Ultrasound assessment of amniotic fluid ume was used to monitor 335 patients with prolonged pregnancy. Reduced amniotic fluid was diagnosed when no single vertical pool of amniotic fluid measured 〉30 mm. Sixty-five patients with reduced amniotic fluid had labour induced while 270 patients with normal amniotic fluid were managed expectantly unless the cervix was favourable. Patients with reduced amniotic fluid had a statistically significant increase in meconium-stained amniotic fluid and growth-retarded babies and were more likely to require delivery by caesarean section for fetal distress. There were no perinatal deaths in the series and the perinatal outcome was satisfactory in both groups. Ultrasound measurement of amniotic fluid represents an effective discriminatory test in post-term pregnancy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1984.tb04781.x
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  • 3
    Electronic Resource
    Electronic Resource
    Chronic polyhydramnios is a syndrome with a lactogen receptor defect in the chorion laeve (1985)
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 92 (1985), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary. Human chorion laeve contains a lactogenic hormone [prolactin (PRL), growth hormone (GH) and placental lactogen (hPL)] receptor. Here, we studied binding of the potent lactogen, human GH. to this receptor in 18 normal pregnant women, in 12 patients whose pregnancies were complicated by chronic polyhydramnios and in 13 with chronic oligohydramnios. Polyhydramnios was classified clinically as idiopathic in seven patients. and secondary and associated with various disorders in the remaining five patients. Lactogenic hormone binding was lower in association with polyhydramnios (mean 1·60. SEM 0·15%)) than with normal amniotic fluid volume (mean 3·05, SEM 0·40%; P〈0·05): Scatchard analysis indicated that a reduced number of lactogen receptors within the chorion laeve was the reason. The lactogenic hormone receptor defect in the chorion laeve was present in pregnancies complicated by either idiopathic or secondary polyhydramnios. In contrast to chronic polyhydramnios, tissue from patients with chronic oligohydramnios bound lactogenic ligands in a normal fashion. Insulin binding sites were also identified in the chorion laeve, and, in contrast to the lactogens, binding parameters were equivalent in the three patient groups. PRL resistance developing subsequent to this chorion laeve receptor defect might produce the excessive amniotic fluid volume characteristic of polyhydramnios. We propose that a chorionic PRL receptor deficiency underlies the various clinical forms of chronic polyhydramnios.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-0528.1985.tb01349.x
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  • 4
    Electronic Resource
    Electronic Resource
    A randomised clinical trial comparing the effects of delayed versus immediate pushing with epidural analgesia on mode of delivery and faecal continence (2002)
    Oxford, UK : Blackwell Science Ltd
    BJOG 109 (2002), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To assess the effects of delayed vs immediate pushing in second stage of labour with epidural analgesia on delivery outcome, postpartum faecal continence and postpartum anal sphincter and pudendal nerve function.Design Prospective, randomised, controlled trial.Setting Tertiary referral maternity teaching hospital.Population One hundred and seventy nulliparous women randomised at full dilatation to immediate or delayed pushing.Methods A total of 178 nulliparous women, all with continuous epidural analgesia, were randomised at full cervical dilatation, but before the fetal head had reached the pelvic floor, to either immediate pushing or 1 hour delayed pushing. Labour outcome was analysed and all women underwent postpartum assessment of anal sphincter function, including anal manometry. Those women who had a normal delivery underwent neurophysiology studies, while those women who had an instrumental delivery underwent endoanal ultrasound.Main outcome measures Mode of delivery; altered faecal continence.Results Ninety women were randomised to immediate pushing and 88 to delayed pushing. The spontaneous delivery rate was 56% (50/90) in the immediate pushing group and 52% (46/88) in the delayed pushing group. Mean duration of labour for the immediate pushing group was 427 minutes compared with 480 minutes for the delayed pushing group (P= 0.005). Eighty-four percent (76/90) of women in the immediate pushing group received oxytocin to augment labour, 21/76 (28%) in the second stage only. Eighty-one percent (71/88) of women in the delayed pushing group received oxytocin to augment labour, 22/71 (31%) in the second stage only. Fetal outcome did not differ between the two groups. Episiotomy rates were 73% and 69% in the immediate pushing and delayed pushing groups, respectively. 26% (23/90) of the immediate pushing group and 38% (33/88) of the delayed pushing group complained of altered faecal continence after delivery (NS). Manometry, ultrasound and neurophysiology studies did not differ significantly between the two groups. Overall, 55% of women after instrumental delivery had endosonographic evidence of damage to the external anal sphincter, while 36% of women after spontaneous delivery had abnormal neurophysiology studies.Conclusions Rates of instrumental delivery were similar following immediate and delayed pushing, in association with epidural analgesia. Delayed pushing prolonged labour by 1 hour but did not result in significantly higher rates of altered continence or anal sphincter injury, when compared with immediate pushing.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1471-0528.2002.02109.x
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  • 5
    Electronic Resource
    Electronic Resource
    Randomised clinical trial to assess anal sphincter function following forceps or vacuum assisted vaginal delivery (2003)
    Oxford, UK : Blackwell Science Ltd
    BJOG 110 (2003), S. 0 
    Details
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To compare, in a prospective, randomised controlled trial, differences in anal sphincter function following forceps or vacuum assisted vaginal delivery in an institution practising standardised management of labour.Design Prospective, randomised controlled trial.Setting Tertiary-referral maternity teaching hospital.Population One hundred and thirty women.Methods Primiparous women were recruited antenatally and if an instrumental delivery was indicated, were randomised to either a vacuum or low-cavity, non-rotational forceps assisted delivery. Follow up consisted of a symptom questionnaire, anal manometry and endoanal ultrasound at three months postpartum.Main outcome measures Faecal continence scores, anal manometry, endoanal ultrasound.Results Sixty-one women delivered with forceps assistance (40 for failure to progress in the second stage) and 69 with vacuum assistance (33 for failure to progress); 16/69 vacuum deliveries proceeded to a forceps assisted delivery (23%). There were no statistical differences in the antecedent antenatal factors between the two groups. A third degree perineal tear followed 10 (16%) forceps and 5 (7%) vacuum deliveries. Based on intention-to-treat analysis, 36 (59%) women complained of altered faecal continence after forceps delivery compared with 23 (33%) following vacuum delivery three months postpartum (RR 2.88, 95% CI 1.41–5.88). Endoanal ultrasound was reported as abnormal following 34 (56%) forceps deliveries and 34 (49%) vacuum deliveries (RR 1.3, 95% CI 0.65–258). After exclusion of ‘failed vacuum’, median anal canal resting pressure was significantly lower following forceps delivery compared with vacuum delivery alone (P= 0.004). There were no significant differences in degree of ultrasound abnormality between the two groups.Conclusions Symptoms of altered faecal continence are significantly more common following forceps assisted vaginal delivery. Based on continence outcome, when circumstances allow, vacuum should be the instrument of first choice in assisted delivery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1471-0528.2003.02173.x
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  • 6
    Electronic Resource
    Electronic Resource
    Active Management A Continuing Benefit in Nulliparous labor (1993)
    Oxford, UK : Blackwell Publishing Ltd
    Birth 20 (1993), S. 0 
    Details
    ISSN: 1523-536X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: At the Tenth Birth Conference in Boston, 1992, a randomized clinical trial of active management of labor that is being conducted at Brigham and Women's Hospital in Boston was described by principal investigator, Fredric Frigoletto, Jr., MD. The study of 1800 primiparous women will examine the effect of the active management protocol on the rate of cesarean section. Since the presentation generated such strong disagreement during the discussion that followed, a further examination of the benefits and risks of the method is presented in this two-part roundtable. Part I comprises papers by Colm O'Herlihy, from National Maternity Hospital in Dublin where the active management of labor method originated, by Michael Klein, who moderated the Boston presentation and discussion, and by Henci Goer, who was an audience participant. Part II, to be published in the September issue, will contain papers by William Fraser, a Boston conference speaker who will discuss methodologic issues, by audience participant Karyn Kaufman presenting a midwife's perspective, by sociologist Barbara Katz Rothman, and by Marc J.N.C. Keirse, with a final comment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1523-536X.1993.tb00424.x
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  • 7
    Electronic Resource
    Electronic Resource
    Postpartum fecal incontinence is more common in women with irritable bowel syndrome (1998)
    Springer
    Diseases of the colon & rectum 41 (1998), S. 586-589 
    Details
    ISSN: 1530-0358
    Keywords: Anal sphincter damage ; Childbirth ; Fecal incontinence ; Irritable bowel syndrome ; Vaginal delivery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Anal sphincter damage can occur during vaginal delivery and may lead to impairment of fecal continence. The aim of this study was to determine the influence of irritable bowel syndrome on symptoms of fecal incontinence following first vaginal delivery. METHODS: A prospective, observational study was performed before delivery, six weeks, and six months following delivery in primiparous women. A bowel function questionnaire was completed, and anal vector manometry, mucosal electrosensitivity, pudendal nerve terminal motor latency, and anal endosonography were performed. A total of 208 women were assessed before and after delivery, and 104 primigravid women were studied after delivery only. A total of 34 of 312 (11 percent) had an existing diagnosis of irritable bowel syndrome. RESULTS: The prevalence of abnormal manometry or endosonography was similar in women with and without irritable bowel syndrome. However, six weeks after delivery, women with irritable bowel syndrome had a higher incidence of defecatory urgency (64 percent) and loss of control of flatus (35 percent) compared with those without (urgency, 10 percent,P〈0.001; flatus, 13 percent,P=0.007). The incidence of frank fecal incontinence was similar in the two groups. Women with IBS had increased mucosal sensitivity to electrical stimulation of the upper anal canal both before and after delivery. CONCLUSION: Women with IBS are more likely to experience subjective alteration of fecal continence postpartum compared with the healthy primigravid population, but they are not at increased risk of anal sphincter injury.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02235263
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  • 8
    Electronic Resource
    Electronic Resource
    A prospective, randomized study comparing the effect of augmented biofeedback with sensory biofeedback alone on fecal incontinence after obstetric trauma (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 753-758 
    Details
    ISSN: 1530-0358
    Keywords: Obstetric injury ; Fecal incontinence ; Biofeedback therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study was designed to compare prospectively the effects of augmented biofeedback with those of sensory biofeedback alone on fecal incontinence and anorectal manometry after obstetric trauma. METHODS: A consecutive cohort of 40 females with impaired fecal continence after obstetric anal sphincter injury were recruited from a dedicated perineal clinic. Patients were randomly assigned to receive either augmented biofeedback or sensory biofeedback alone. All patients were assessed before and after twelve weeks of biofeedback training, using a fecal continence questionnaire and anorectal manometry. RESULTS: Thirty-nine of 40 females recruited completed the study. Continence scores improved in both treatment groups, but the results were better for those who received augmented biofeedback. Anorectal manometry was unchanged by sensory biofeedback, whereas anal resting and squeeze pressures increased with augmented biofeedback. No change in anal vector symmetry was observed in either group. CONCLUSION: Augmented biofeedback training is superior to sensory biofeedback alone in the treatment of impaired fecal continence after obstetric trauma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236930
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  • 9
    Electronic Resource
    Electronic Resource
    Invited editorial (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 758-761 
    Details
    ISSN: 1530-0358
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236931
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  • 10
    Electronic Resource
    Electronic Resource
    Postdelivery anal function in primiparous females (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 1636-1636 
    Details
    ISSN: 1530-0358
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236757
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