***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: It is thought that antenatal pelvic floor muscle training ( PFMT ) might produce a strong pelvic floor result ing in prolonged labour , whilst some believe it produces well-controlled muscles that facilitate rotation of the foetal head and shortens the duration of labour . This secondary analysis ( of a previously published r and omised controlled trial ) assesses the labour and delivery details of 268 primigravidae who were originally r and omised at approximately 20 weeks gestation to  supervised PFMT or a control group .  Between the two groups , there was no difference in the duration of the second stage of labour or in the need for instrumental delivery .  PFMT does not appear to facilitate or obstruct labour Epidemiological studies have postulated racial differences in the incidence and prevalence of pelvic floor disorders . There are anecdotal data from cadaver dissections suggesting that Asian women benefit from stronger pelvic support structures . A prospect i ve observational clinical study was conducted in order to test for differences in pelvic organ support in 200 nulliparous pregnant women . Assessment included  translabial ultrasound , documenting the position of the pelvic organs and mobility on Valsalva relative to the inferoposterior symphyseal margin .  The largest ethnic groups were Asian ( n=16 ) and Caucasian women ( n=161 ) . On comparing the groups , both antepartum and postpartum analyses showed significantly less pelvic organ mobility in Asians . This was true for virtually all parameters of organ mobility and both anterior ( P=0.002 antepartum , P=0.009 postpartum ) and posterior compartments ( P=0.04 antepartum , P=0.02 postpartum ) . No significant differences were detected for cervical mobility . It was concluded that Asian women seem to show less mobility of the anterior and posterior vaginal compartments than Caucasians OBJECTIVE : This study aim ed to compare the pelvic floor muscle strength of nulliparous and primiparous women . METHODS : A total of 100 women were prospect ively distributed into two groups : Group 1 ( G1 ) ( n = 50 ) included healthy nulliparous women , and Group 2 ( G2 ) ( n = 50 ) included healthy primiparous women . Pelvic floor muscle strength was subjectively evaluated using transvaginal digital palpation .  Pelvic floor muscle strength was objective ly assessed using a portable perineometer . All of the parameters were evaluated simultaneously in G1 and were evaluated in G2 during the 20th and 36th weeks of pregnancy and 45 days after delivery . RESULTS : In G2 , 14 women were excluded because they left the study before the follow-up evaluation . The median age was 23 years in G1 and 22 years in G2 ; there was no significant difference between the groups . The average body mass index was 21.7 kg/m2 in G1 and 25.0 kg/m2 in G2 ; there was a significant difference between the groups ( p = 0.0004 ) . In G2 , transvaginal digital palpation evaluation showed significant impairments of pelvic floor muscle strength at the 36th week of pregnancy ( p = 0.0006 ) and 45 days after vaginal delivery ( p = 0.0001 ) compared to G1 . Objective evaluations of pelvic floor muscle strength in G2 revealed a significant decrease 45 days after vaginal delivery compared to nulliparous patients . CONCLUSION : Pregnancy and vaginal delivery may cause weakness of the pelvic floor muscles OBJECTIVE Urinary incontinence is a chronic health complaint that severely reduces quality of life . Pregnancy and vaginal delivery are main risk factors in the development of urinary incontinence . The aim of this study was to assess whether intensive pelvic floor muscle training during pregnancy could prevent urinary incontinence . METHODS We conducted a single-blind r and omized controlled trial at Trondheim University Hospital and three outpatient physiotherapy clinics in a primary care setting . Three hundred one healthy nulliparous women were r and omly allocated to a training ( n = 148 ) or a control group ( n = 153 ) . The training group attended a 12-week intensive pelvic floor muscle training program during pregnancy , supervised by physiotherapists . The control group received the customary information . The primary outcome measure was self-reported symptoms of urinary incontinence . The secondary outcome measure was pelvic floor muscle strength . RESULTS At follow-up , significantly fewer women in the training group reported urinary incontinence : 48 of 148 ( 32 % ) versus 74 of 153 ( 48 % ) at 36 weeks ' pregnancy ( P = .007 ) and 29 of 148 ( 20 % ) versus 49 of 153 ( 32 % ) 3 months after delivery ( P = .018 ) . According to numbers needed to treat , intensive pelvic floor muscle training during pregnancy prevented urinary incontinence in about one in six women during pregnancy and one in eight women after delivery . Pelvic floor muscle strength was significantly higher in the training group at 36 weeks ' pregnancy ( P = .008 ) and 3 months after delivery ( P = .048 ) . CONCLUSION Intensive pelvic floor muscle training during pregnancy prevents urinary incontinence during pregnancy and after delivery . Pelvic floor muscle strength improved significantly after intensive pelvic floor muscle training Abstract Objective : To compare the effect of pelvic floor exercises , electrical stimulation , vaginal cones , and no treatment for  genuine stress incontinence . Design : Stratified , single blind , r and omised controlled trial . Setting : Multicentre . Participants : 107 women with clinical ly and urodynamically proved genuine stress incontinence . Mean ( range ) age was 49.5 ( 24 - 70 ) years , and mean ( range ) duration of symptoms 10.8 ( 1 - 45 ) years . Interventions : Pelvic floor exercise ( n=25 ) comprised 8 - 12 contractions 3 times a day and exercise in groups with skilled physical therapists once a week . The electrical stimulation group ( n=25 ) used vaginal intermittent stimulation with the MS 106 Twin at 50 Hz 30 minutes a day . The vaginal cones group ( n=27 ) used cones for 20 minutes a day . The untreated control group ( n=30 ) was offered the use of a continence guard . Muscle strength was measured by vaginal squeeze pressure once a month . Main outcome measures : Pad test with st and ardised bladder volume , and self report of severity . Results : Improvement in muscle strength was significantly greater ( P=0.03 ) after pelvic floor exercises ( 11.0 cm H2O ( 95 % confidence interval 7.7 to 14.3 ) before v 19.2 cm H2O ( 15.3 to 23.1 ) after ) than either electrical stimulation ( 14.8 cm H2O ( 10.9 to 18.7 ) v 18.6 cm H2O ( 13.3 to 23.9 ) ) or vaginal cones ( 11.8 cm H2O ( 8.5 to 15.1 ) v 15.4 cm H2O ( 11.1 to 19.7 ) ) . Reduction in leakage on pad test was greater in the exercise group ( −30.2 g ; −43.3 to 16.9 ) than in the electrical stimulation group ( −7.4 g ; −20.9 to 6.1 ) and the vaginal cones group ( −14.7 g ; −27.6 to −1.8 ) . On completion of the trial one participant in the control group , 14 in the pelvic floor exercise group , three in the electrical stimulation group , and two in the vaginal cones group no longer considered themselves as having a problem . Conclusion : Training of the pelvic floor muscles is superior to electrical stimulation and vaginal cones in the treatment of genuine stress incontinence OBJECTIVE Prospect i ve study to objective ly evaluate the benefits of pelvic floor strengthening exercises associated to biofeedback for the treatment of stress urinary incontinence . MATERIAL S AND METHODS Fourteen patients diagnosed with stress urinary incontinence ( SUI ) were selected for this study . All patients underwent a pelvic floor training associated to biofeedback for 12 consecutive weeks . Urodynamic tests , pad test and bladder diary were analyzed at the beginning of the study , at the end and after 3 months . The King 's Health Question naire ( KHQ ) was applied before and after treatment to assess the impact in the quality of life . RESULTS There was a significant reduction in the pad weight ( from 14.21 g to 1 g ) , number of urinary leakage episodes ( from 8.14 per day to 2.57 per day ) and daytime frequency ( from 7.93 per day to 5.85 per day ) . At urodynamics the authors observed a significant increase in Valsalva leak-point pressure ( from 103.93 cm H2O to 139.14 cm H2O ) , cistometric capacity ( from 249.29 mL to 336.43 mL , p = 0.0015 ) and bladder volume at first desire to void ( from 145 mL to 215.71 mL ) . Those differences were kept during the first 3 months of follow up . The KHQ revealed significant differences except in the case of ' ' general health perception ' ' , which covers health in general and not exclusively urinary incontinence . CONCLUSION Treatment of SUI with pelvic floor exercises associated to biofeedback caused significant changes in the parameters analyzed , with maintenance of good results 3 months after treatment AIM This article is a report of a study of the effects of a pelvic floor muscle exercise programme on the severity of  stress urinary incontinence in pregnant women . BACKGROUND Pregnancy is main risk factor for the development of stress urinary incontinence . Stress urinary incontinence can be cured by pelvic floor muscle exercise which is a safe inexpensive treatment with no complications and does not require the use of instruments . METHODOLOGY A quasi-experimental study , pre-post test with control group design was used at the antenatal care unit in a tertiary care hospital between June and October of 2006 . The participants were 66 pregnant women who had stress urinary incontinence with gestational ages of 20 - 30 weeks . The main outcome measure was severity of stress urinary incontinence which comprised frequency and amount of urine leakage and perceived severity of stress urinary incontinence . RESULTS After the experimental group 's participation in the pelvic floor muscle exercise programme , the frequency and amount of urine leakage and the score of perceived stress urinary incontinence severity were significantly lower than the same scores before participation in the programme . In addition , women in the experimental group had frequency and volume of urine leakage , and score of perceived stress urinary incontinence severity after participation significantly lower than those in the control group . CONCLUSION The 6-week pelvic floor muscle exercise programme was able to decrease the severity of symptoms in pregnant women with stress urinary incontinence Introduction and hypothesisThe aim of the study was to evaluate the effect of antenatal pelvic floor muscle exercise ( PFME ) in the prevention and treatment of  urinary incontinence during pregnancy and postpartum period . Methods Three hundred women were r and omly assigned to the PFME group and control group . Urinary symptoms were measured by Urogenital Distress Inventory-6 ( UDI-6 ) , Incontinence Impact Question naire-7 ( IIQ-7 ) , and question of self-reported urinary incontinence . Question naire scores of the PFME and the control groups were compared and analyzed . Results During late pregnancy and the postpartum period , the PFME group had significantly lower total UDI-6 and IIQ-7 scores ; their self-report rate of urinary incontinence was also less than the control group . Additionally , we found whether in PFME or control , women who delivered vaginally were more likely to develop postpartum urinary leakage than women who delivered by cesarean section . Conclusions PFME applied in pregnancy is effective in the treatment and prevention of urinary incontinence during pregnancy , and this effect may persist to postpartum period Please cite this paper as : Stafne S , Salvesen K , Romundstad P , Torjusen I , Mørkved S. Does regular exercise including pelvic floor muscle training prevent  urinary and anal incontinence during pregnancy ? A r and omised controlled trial . BJOG 2012;119:1270–1280 Introduction and hypothesisTheoretically , tight or strong pelvic floor muscles may impair the progress of labor and lead to instrumental deliveries . We aim ed to investigate whether vaginal resting pressure , pelvic floor muscle strength , or endurance at midpregnancy affect delivery outcome . Methods This was a prospect i ve cohort study of women giving birth at a university hospital . Vaginal resting pressure , pelvic floor muscle strength , and endurance in 300 nulliparous pregnant women were assessed at mean gestational week 20.8 ( ±1.4 ) using a high precision pressure transducer connected to a vaginal balloon . Delivery outcome measures [ acute cesarean section , prolonged second stage of labor ( > 2 h ) , instrumental vaginal delivery ( vacuum and forceps ) , episiotomy , and third- and fourth-degree perineal tear ) were retrieved from the hospital ’s electronic birth records . Results Twenty-three women were lost to follow-up , mostly because they gave birth at another hospital . Women with prolonged second stage had significantly higher resting pressure than women with second stage less than 2 h ; the mean difference was 4.4 cmH2O [ 95 % confidence interval ( CI ) 1.2–7 
    Output:
    
Conclusions Antenatal PFMT might be effective at shortening the first and second stage of labor in the primigravida .
Antenatal PFMT may not increase the risk of episiotomy , instrumental delivery , and perineal laceration in the primigravida