Peripartum pelvic floor disorder clinics inform obstetric provider practices
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ORIGINAL ARTICLE
Peripartum pelvic floor disorder clinics inform obstetric provider practices Katie Propst 1
&
Lisa C. Hickman 1
Received: 3 September 2020 / Accepted: 2 October 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis The objective of this study is to evaluate obstetric providers’ knowledge and practice patterns since the establishment of a peripartum pelvic floor disorder clinic. Methods This is a prospective, cross-sectional survey study of obstetric providers at an academic tertiary care health system. A 22-question survey was designed to collect provider demographic data, indications for and barriers to referrals, provider satisfaction, and impact of the clinic’s existence on peripartum pelvic floor dysfunction diagnosis and management. Eligibility criteria included obstetrics and gynecology trainees, attending physicians, certified nurse midwives, and advanced practice providers. Results There were 86 survey responses yielding a response rate of 72.1%. The majority of respondents were staff obstetricians (57.0%) or trainees (26.7%). Most commonly reported referral indications were third- and fourth-degree lacerations (94.9%), complex lacerations (70.5%), wound breakdown (57.7%), and urinary retention (53.8%). Regarding satisfaction with the peripartum pelvic floor disorder clinic, of referring providers, 77 (98.7%) agreed or strongly agreed that evaluations were useful for patients and 78 (100%) agreed or strongly agreed that evaluations were useful for themselves. Seventy-six (97.4%) respondents reported that they were very satisfied with the peripartum pelvic floor disorder clinic overall. The majority of respondents agreed or strongly agreed that the clinic increased their awareness of both obstetric anal sphincter injuries and their impact on maternal health (84.6%). Conclusion The introduction of a peripartum pelvic floor disorder clinic results in high obstetric provider satisfaction and positively impacts patient care through increased provider knowledge and awareness on the management of obstetric anal sphincter injuries. Keywords Pelvic floor disorders . Obstetric anal sphincter injury . Postpartum urinary retention . Obstetric laceration . Postpartum urinary incontinence . Postpartum anal incontinence
Introduction Pelvic floor health and function are significantly impacted by pregnancy and delivery. During pregnancy, the hormonal milieu affects the pelvic floor muscles and connective tissue supports, which can result in issues with bladder and bowel control, sexual function, and pelvic organ prolapse. At the time of vaginal delivery, the pelvic floor is subjected to significant pressure and stretching [1]. This can lead to muscle and nerve injury,
* Katie Propst [email protected] 1
Urogynecology and Pelvic Floor Disorders, Ob/Gyn and Women’s Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A-81, Cleveland, OH 44195, USA
which in turn can have negative effects on bowel, bladder, and sexual function [1–4]. Perineal lacerations c
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