Call for Writing Group Members - White Paper on Expansion of Maternal Health

News

IUGA and FIUGA (Foundation for International Urogynecological Assistance) are seeking 2-5 members to join a writing group to develop a white paper advocating for the inclusion of pelvic floor care under the umbrella of maternal health.

TIMELINE
July – November/December 2023

APPLICATION DEADLINE
Applications must be received by 11:59pm CST on Tuesday, May 23, 2023.

CONTRIBUTOR EXPETATIONS

  • The white paper will be developed using a collaborative process that requires regular communication via email, possible conference calls, and completion of assignments.
  • Contributors will produce and deliver all completed assignments and required information on or before the agreed deadlines.
  • Contributors will disclose all potential conflicts of interest (see Conflict of Interest Policy).

BACKGROUND
Maternal health (in conjunction with child health) is one of the most important components of public health and forms the backbone of primary health care and referral system, especially in lower- and middle-income countries (LMICs). However, maternal morbidity data remain woeful: For every woman who dies during childbirth, 20 – 118 more suffer from sequalae that can often render life worse than death.1 A well-researched and evident sequelae of vaginal birth is pelvic floor trauma leading to pelvic floor disorders (PFDs). Vaginal delivery is strongly predictive of future development of pelvic organ prolapse with the first delivery conferring the greatest risk.2 Compared with cesarean section, vaginal delivery is associated with an almost two-fold increase in the risk of long-term SUI, with an absolute increase of 8%, and an effect that is larger in younger women.3 There is also an increased risk of UUI, with an absolute increase of approximately 3%. Lastly, perineal trauma is common during childbirth: up to 85% of delivering women can suffer from perineal injuries which may be spontaneous or secondary to an episiotomy. 60-70% of these patients may require surgical repair.4 Though obstetric anal sphincter injuries (OASIS), the most severe form of perineal trauma, are much less common (occur in 1.7 – 3% of deliveries),5,6 this can be associated with lasting sequelae such as anal incontinence, urinary incontinence, perineal pain, dyspareunia, embarrassment, and low self-esteem.7,8 13 – 46% of women who sustain OASIS will suffer from post-partum urinary incontinence.9 

Despite these disheartening numbers, only the devastating experience of vesico-vaginal fistula, resulting from vaginal or cesarean birth, among poor women in low-income countries has been increasingly recognized over the past two decades.3 The large number of women without fistula suffering from pelvic floor dysfunction has largely been neglected.3 The evidence described above clearly establish that pelvic floor disorders are integrally related to women’s reproductive history, especially history of difficult vaginal deliveries and the trauma that can occur while giving birth.4 Poor maternal and reproductive health indicators like high parity, early age at marriage and first delivery, poor nutrition, moderate and severe anemia, and levator ani muscle damage during vaginal delivery have been found to be linked to the development of PFDs.

Yet urogynecological care is not considered part of maternal health. There is a major chasm between clinical urogynecological care and preventive public health measures directed at improving maternal and reproductive health, even in the developing world.

Recognition of PFDs resulting from childbirth as a part of maternal health would result in extension of the massive international donor support for fistulas to include the other more prevalent PFDs linked to childbirth, namely prolapse, perineal tears, urinary and fecal incontinence. Development of a public health approach to urogynecological conditions would lead to incorporation of pelvic floor care within the scope of public health agendas of various countries worldwide and lead to training of healthcare workers in the care of the pelvic floor including prevention, screening, and treatment of perineal trauma. It will bring about a welcome shift of research focus globally from expensive industry driven therapies that are too expensive to implement in LMICs to development of low-cost therapies. It will also unlock major funding support from multilateral donor agencies for urogynecology research.

HOW TO APPLY

  1. Submit your letter of interest and CV to This email address is being protected from spambots. You need JavaScript enabled to view it. by May 23, 2023.
  2. Complete the online Disclosure Form by May 23, 2023

APPLICATION DEADLINE
Applications must be received by 11:59pm CST on Tuesday, May 23, 2023.

REFERENCES

  1. Samar KH, Dorgham LS, Suheir AM. Profile of High Risk Pregnancy among Saudi Women in Taif- KSA. World Journal of Medical Sciences. 2014;11(1):90-7.
  2. Deprest J, Cartright R, Dietz HP, et. al. International Urogynecological Consultation (IUC): pathophysiology of pelvic organ prolapse (POP). IUJ. 2022;33(1699-1710). https://doi.org/10.1007/s00192-022-05081-0
  3. Tahtinen RM, Cartwright R, Tsui JF, et. al. Long-term impact of mode of delivery on Stress Urinary Incontinence and Urgency Urinary Incontinence: A Systematic Review and Meta-Analysis. Eur Urol. 2016;70(1):148-158.
  4. McCandlish R, Bowler U, van Asten H, Berridge G, Winter C, Sames L, et al. A randomised controlled trial of care of the perineum during second stage of normal labour. BJOG. 1998;105(12):1262–
  5. Ampt AJ, Ford JB, Roberts CL,Morris JM. Trends in obstetric anal sphincter injuries and associated risk factors for vaginal singleton term births in New South Wales 2001–2009. Aust N Z J Obstet Gynaecol. 2013;53(1):9–16.
  6. Smith LA, Price N, Simonite V, Burns EE. Incidence of and risk factors for perineal trauma: A prospective observational study. BMC Pregnancy Childbirth. 2013;13:59.
  7. Solans-Domènech M, Sanchez E, Espuna-Pons M. Urinary and anal incontinence during pregnancy and postpartum: incidence, severity, and risk factors. Obstet Gynecol. 2010:115(3):618–628.
  8. Fitzpatrick M, O’Herlihy C. The effects of labour and delivery on the pelvic floor. Best Pract Res Clin Obstet Gynaecol. 2011;15(1):63–79.
  9. Rivard C, Award M, Leibermann M, DeJong M, Massey SM, Sincacore J, Brubaker L Bladder drainage during labor: a randomized controlled trial. J Obstet Gynaecol Res. 2012;38(8):1046–1051.