Results of a personalized algorithm for managing women after childbirth in terms of preventing pelvic floor dysfunction

Background. during pregnancy and the postpartum period, anatomical and physiological changes in the structures of the pelvic floor occur. The most significant reorganization during   pregnancy is undergone by connective tissue, the transformation of which is adaptive and adaptive in nature. Symptoms of pelvic organ prolapse, urinary incontinence, sexual dysfunction first begin to appear or progress, as a rule, after the first birth. In the modern world, women pay close attention to maintaining an active and fulfilling life after childbirth. The creation of a personalized approach to the prevention of pelvic floor dysfunction symptoms in women after childbirth, including highly effective rehabilitation measures, will improve the quality of all areas of life. The purpose of the study. to reduce the incidence of pelvic dysfunctions and urodynamic disorders based on the developed algorithm for monitoring women after childbirth and implementing rehabilitation measures. Material and methods. A two-stage prospective comparative study was conducted, which included 200 women after natural childbirth. At the first stage of the study, clinical   and anamnestic predictors and instrumental markers of the development of pelvic and urodynamic dysfunctions were determined in 120 women after childbirth. Group A included 67 women who developed pelvic dysfunctions and urodynamic disorders, such as pelvic organ prolapse and urinary incontinence. Group B included 53 patients who were not found to have this pathology. A model for predicting the development of pelvic dysfunctions and urodynamic disorders in women after childbirth was created using logistic analysis methods based on clinical and anamnestic data and instrumental markers of the development of pelvic and urodynamic dysfunctions obtained at the first visit. At the second stage of the study, the clinical significance of the predictive model for the development of the risk of pelvic dysfunctions and urodynamic disorders after childbirth was tested, as well as rehabilitation measures were assessed in terms of their prevention. The examination sample of the second   stage consisted of 80 women after natural childbirth. A high risk of developing pelvic dysfunctions and urodynamic disorders after childbirth was detected in 50 women, and a low risk was found in 30 women. Using a random number generator, high-risk patients were divided into two groups. Patients in group B (n=25) underwent a course of dynamic quadripolar radiofrequency (DQRF). Women in Group G (n=25) performed only home pelvic floor muscle training using individual portable Smart trainers. Women in Group D (n=30) were given general recommendations on lifestyle and recovery after childbirth. Research results. Prognostic markers for the development of pelvic dysfunctions and urodynamic disorders after childbirth were determined. Conducting rehabilitation measures presented in the form of a course of dynamic quadripolar radiofrequency reduces the incidence of pelvic organ prolapse and urinary incontinence 6 months after childbirth. Conclusion. For patients belonging to the high-risk group after childbirth, an algorithm has been developed to reduce the incidence of pelvic dysfunctions and urodynamic disorders 6 months after childbirth.

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