Randomised controlled trial of pelvic floor muscle training during pregnancy
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《英国医生杂志》
1 Department of Obstetrics and Gynaecology, Trondheim University Hospital St. Olav, N-7006 Trondheim, Norway, 2 Department of Community Medicine and General Practice, Norwegian University of Science and Technology, N-7489 Trondheim, Norway
Correspondence to: K ? Salvesen pepes@medisin.ntnu.no
Abstract
Training the pelvic floor muscles during pregnancy can prevent urinary incontinence,1 2 and pregnant women are encouraged to do exercises for these muscles. A myth prevails among birth attendants that strong pelvic floor muscles (for example, as a result of horse riding) may obstruct labour.3 However, training of the pelvic floor muscles may produce strong and well controlled muscles that will facilitate labour.4 A prospective study with 86 women found no effect of such training on the course of delivery,5 but possible effects of pelvic floor muscle training on labour have been sparsely scientifically documented.
The primary aim of this trial was to assess if training the muscles of the pelvic floor during pregnancy could prevent urinary incontinence. Women in the study group had stronger pelvic floor muscles and reported less urinary incontinence after the training period.2 This report deals with secondary outcomes of the trial. We wanted to study any effect of pelvic floor muscle training on labour.
Methods
Women randomised to pelvic floor muscle training had a lower rate of prolonged second stage labour than women allocated to no training (table). The number needed to treat (NNT) to benefit was 8. In a survival analysis the difference between groups was 24% (95% confidence interval 16% to 33%) for the training group versus 38% (28% to 47%) for the control group.
Mean outcome variables (with standard deviations) among 224 women with a singleton fetus in cephalic position with spontaneous start of labour after 37 weeks of pregnancy. Values are numbers (percentages) of women unless otherwise indicated
The duration of the second stage of labour was not statistically different between groups (40 min v 45 min, P = 0.06). Figure 2 shows the time to delivery from the start of active pushing up to 60 minutes. The infants in the training group were slightly younger and smaller (table). A Cox regression analysis with gestational length, birth weight, and head circumference as possible confounders did not change the estimates materially.
Fig 2 Survival plot of the duration of the second stage of labour for women in the training group (n=105) and the control group (n=109). Discrepancies in numbers are due to some missing data in each group (six in the training group and four in the control group). Operative deliveries for fetal distress (n=9) and slow progress (n=3) during the first hour, and all deliveries lasting longer than 60 minutes (n=59) were censored. Log rank test, P=0.06 for comparison of the two survival plots in the Kaplan-Meier analysis
Fewer women had breech presentations (fig 1; 1 v 9, P = 0.01). The rates of operative delivery for prolonged second stage did not differ between the two groups (table 1). Fewer women had episiotomies (51% v 64%, odds ratio 0.59, 0.35 to 1.00; NNT 7), but we found no other significant differences in outcomes related to labour. Apgar scores and umbilical artery pH did not differ between groups (data not shown).
Discussion
Reilly ETC, Freeman RM, Waterfield MR, Waterfield AE, Steggles P, Pedlar F. Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises. Br J Obstet Gynaecol 2002;109: 68-76.
M?rkved S, B? K, Schei B, Salvesen K?. Pelvic floor muscle training during pregnancy to prevent urinary incontinence: A single-blind randomized controlled trial. Obstet Gynecol 2003;101: 313-9.
UK Midwifery Archives. Hannah, midwife. Does horse-riding affect the pelvic floor? www.radmid.demon.co.uk/pelvicfloor.htm (accessed 25 Jun 2004).
Baby Centre. How do pelvic floor exercises help me? www.babycentre.co.uk/refcap/536339 (accessed 25 Jun 2004).
Nielsen CA, Sigsgaard I, Olsen M, Tolstrup M, Danneskiold-Samsoee B, Bock JE. Trainability of the pelvic floor. A prospective study during pregnancy and after delivery. Acta Obstet Gynecol Scand 1988;67: 437-40.
Cunningham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC, Hankins GDV, Williams obstetrics 20th edition. Stamford, CT: Appleton and Lange, 1997.
Bergsj? P, Maltau JM, Molne K, Nesheim B-I. Obstetrikk . Oslo: Universitetsforlaget, 1987.
Hofmeyr GJ, Kulier R. Cephalic version by postural management for breech presentation Cochrane Database Syst Rev 2000;(3): CD000051.(Kjell ? Salvesen, profess)
Correspondence to: K ? Salvesen pepes@medisin.ntnu.no
Abstract
Training the pelvic floor muscles during pregnancy can prevent urinary incontinence,1 2 and pregnant women are encouraged to do exercises for these muscles. A myth prevails among birth attendants that strong pelvic floor muscles (for example, as a result of horse riding) may obstruct labour.3 However, training of the pelvic floor muscles may produce strong and well controlled muscles that will facilitate labour.4 A prospective study with 86 women found no effect of such training on the course of delivery,5 but possible effects of pelvic floor muscle training on labour have been sparsely scientifically documented.
The primary aim of this trial was to assess if training the muscles of the pelvic floor during pregnancy could prevent urinary incontinence. Women in the study group had stronger pelvic floor muscles and reported less urinary incontinence after the training period.2 This report deals with secondary outcomes of the trial. We wanted to study any effect of pelvic floor muscle training on labour.
Methods
Women randomised to pelvic floor muscle training had a lower rate of prolonged second stage labour than women allocated to no training (table). The number needed to treat (NNT) to benefit was 8. In a survival analysis the difference between groups was 24% (95% confidence interval 16% to 33%) for the training group versus 38% (28% to 47%) for the control group.
Mean outcome variables (with standard deviations) among 224 women with a singleton fetus in cephalic position with spontaneous start of labour after 37 weeks of pregnancy. Values are numbers (percentages) of women unless otherwise indicated
The duration of the second stage of labour was not statistically different between groups (40 min v 45 min, P = 0.06). Figure 2 shows the time to delivery from the start of active pushing up to 60 minutes. The infants in the training group were slightly younger and smaller (table). A Cox regression analysis with gestational length, birth weight, and head circumference as possible confounders did not change the estimates materially.
Fig 2 Survival plot of the duration of the second stage of labour for women in the training group (n=105) and the control group (n=109). Discrepancies in numbers are due to some missing data in each group (six in the training group and four in the control group). Operative deliveries for fetal distress (n=9) and slow progress (n=3) during the first hour, and all deliveries lasting longer than 60 minutes (n=59) were censored. Log rank test, P=0.06 for comparison of the two survival plots in the Kaplan-Meier analysis
Fewer women had breech presentations (fig 1; 1 v 9, P = 0.01). The rates of operative delivery for prolonged second stage did not differ between the two groups (table 1). Fewer women had episiotomies (51% v 64%, odds ratio 0.59, 0.35 to 1.00; NNT 7), but we found no other significant differences in outcomes related to labour. Apgar scores and umbilical artery pH did not differ between groups (data not shown).
Discussion
Reilly ETC, Freeman RM, Waterfield MR, Waterfield AE, Steggles P, Pedlar F. Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises. Br J Obstet Gynaecol 2002;109: 68-76.
M?rkved S, B? K, Schei B, Salvesen K?. Pelvic floor muscle training during pregnancy to prevent urinary incontinence: A single-blind randomized controlled trial. Obstet Gynecol 2003;101: 313-9.
UK Midwifery Archives. Hannah, midwife. Does horse-riding affect the pelvic floor? www.radmid.demon.co.uk/pelvicfloor.htm (accessed 25 Jun 2004).
Baby Centre. How do pelvic floor exercises help me? www.babycentre.co.uk/refcap/536339 (accessed 25 Jun 2004).
Nielsen CA, Sigsgaard I, Olsen M, Tolstrup M, Danneskiold-Samsoee B, Bock JE. Trainability of the pelvic floor. A prospective study during pregnancy and after delivery. Acta Obstet Gynecol Scand 1988;67: 437-40.
Cunningham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC, Hankins GDV, Williams obstetrics 20th edition. Stamford, CT: Appleton and Lange, 1997.
Bergsj? P, Maltau JM, Molne K, Nesheim B-I. Obstetrikk . Oslo: Universitetsforlaget, 1987.
Hofmeyr GJ, Kulier R. Cephalic version by postural management for breech presentation Cochrane Database Syst Rev 2000;(3): CD000051.(Kjell ? Salvesen, profess)