<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03041246</url>
  </required_header>
  <id_info>
    <org_study_id>3722-16-SMC</org_study_id>
    <nct_id>NCT03041246</nct_id>
  </id_info>
  <brief_title>Manual Fascial Manipulation in Pregnant Women</brief_title>
  <official_title>The Influence of Manual Fascial Manipulation on the Function of the Pelvic Floor in Pregnant Women</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Sheba Medical Center</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Sheba Medical Center</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Pregnancy and vaginal delivery are considered as the main risk factors for damage to the&#xD;
      pelvic floor. There are various ways to measure the strength of the pelvic floor and to&#xD;
      evaluate functional problems. Manual mobilization of the pelvic floor is a well-known&#xD;
      treatment modality, however, ample knowledge exists on the efficacy of physiotherapy and&#xD;
      exercise for improvement of pelvic floor function and strength. The aim of this study is to&#xD;
      analyze the influence of pelvic floor fascial mobilization (PFFM) technique on the function&#xD;
      and strength of the pelvic floor muscles as well as parameters presumed to be influenced by&#xD;
      the strength of the pelvic floor in pregnant women.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Pregnancy and vaginal delivery are considered as the main risk factors for damage to the&#xD;
      pelvic floor at various degrees, starting at mild stress incontinence and up to fool fecal&#xD;
      incontinence as well as pelvic pains or urination difficulties.&#xD;
&#xD;
      There are various ways to measure the strength of the pelvic floor and to evaluate functional&#xD;
      problems. Measured the strength of the pelvic floor muscles by physical examination according&#xD;
      to Oxford Grading Scale (scale of 0-5) as well as by using Perineometer device, were equally&#xD;
      efficient and well correlated. Other modalities such as the use of surface electro myography&#xD;
      (EMG), that presents the level of the muscle electrical activity and expiration volumes and&#xD;
      the strength of the pelvic floor muscles were also positively correlated to the strength of&#xD;
      the pelvic floor. Recent studies presented dysfunction of pelvic floor during pregnancy as&#xD;
      well as in the postpartum period by the use of pelvic floor disability index 20 (PFDI20)&#xD;
      questionnaire validated in Hebrew.&#xD;
&#xD;
      Ample knowledge exists on the efficacy of physiotherapy and exercise for improvement of&#xD;
      pelvic floor function and strength, however, prolonged and continuous exercise is needed to&#xD;
      achieve good results as well as compliance and perseverance. The long-term effect is&#xD;
      unwieldly.&#xD;
&#xD;
      Manual mobilization of the pelvic floor is a well-known treatment modality. However the&#xD;
      literature regarding the effect of this technique is sparse. A recent series of case reports&#xD;
      presented immediate and major improvement of pelvic floor dysfunction after manual&#xD;
      mobilization. The peripartum period is critical for the function of the pelvic floor however&#xD;
      the yield of manual therapy on function and strength of the pelvic floor was not evaluated in&#xD;
      pregnant women. We hypothesize that manual therapy can improve the strength and the function&#xD;
      of the pelvic floor within a short time span and this can be objectively measured by common&#xD;
      and well used parameters The aim of this study is to analyze the influence of pelvic floor&#xD;
      fascial mobilization (PFFM) on the function and strength of the pelvic floor muscles as well&#xD;
      as parameters presumed to be influenced by the strength of the pelvic floor in pregnant women&#xD;
&#xD;
      Materials and methods&#xD;
&#xD;
      The study will involve number of phases:&#xD;
&#xD;
      Phase one: Screening and enrollment of patients Women followed at the high risk pregnancy&#xD;
      clinic at the Sheba medical center, who carry singleton pregnancy at the ages of 20-45 years&#xD;
      old and about to have their 2nd to 4th delivery (primiparous and multiparous women) will be&#xD;
      examined for the following parameters: demographic and medical data, focused interview for&#xD;
      symptoms of pelvic floor dysfunction including urination and fecal function as well as pelvic&#xD;
      floor pain, manual assessment according the Oxford grading scale will be performed, and the&#xD;
      strength of the pelvic floor measured by the use of Perineometer (Peritron 'AV' Combined Anal&#xD;
      &amp; Vaginal Perineometer NEW MODEL). Other parameters that will be measured include:&#xD;
      mobilization of the pelvic-femoral joint, Forced expiratory volume 1 (FEV1) (a connection was&#xD;
      shown between FEV1, intraabdominal pressure and the strength of the pelvic floor, assessment&#xD;
      of vocal quality ( analyzed by communication clinician, repeat assessment will be performed&#xD;
      after two weeks and after 4 weeks, estimated assessment time - 20 Min) 80 women are expected&#xD;
      to be enrolled.&#xD;
&#xD;
      Phase Two Women who will fulfill one or more of the following parameters will be enrolled to&#xD;
      the second phase of the study . (n=40)&#xD;
&#xD;
        1. Oxford grading scale ≤3/5&#xD;
&#xD;
        2. Pelvic floor strength assessed by perineometer≤ 30 cm/h20&#xD;
&#xD;
        3. Clinical symptoms of urine, flatus or fecal incontinence&#xD;
&#xD;
        4. Pelvic floor, hip joint or pelvic joints pain&#xD;
&#xD;
      Randomization will be performed to one of two groups:&#xD;
&#xD;
      Group A-Control group (n=20) Group B-Study group (n=20) Guidance towards exercise for&#xD;
      strengthening of the pelvic floor will be provided for both groups. Study group will be&#xD;
      treated manually for the pelvic floor in two sessions two weeks apart. The manual&#xD;
      manipulation of the pelvic floor will involve intra vaginal superficial as well as pelvic&#xD;
      skin area pressure points. The manipulation will not involve the cervix uterus or rectum.&#xD;
      Each session will lasts one hour&#xD;
&#xD;
      Both groups will be assessed by ultrasound for blood flow in the middle cerebral artery,&#xD;
      umbilical artery and uterine artery as part of the parameters that may show benefit to the&#xD;
      fetus due to pelvic floor mobilization.&#xD;
&#xD;
      Reassessment of all the women and repeat treatment for the study group will be performed&#xD;
      after two and four weeks from the primary assessment.&#xD;
&#xD;
      The study will be performed at a high risk pregnancy clinic at the Sheba medical center.&#xD;
      Women will be enrolled voluntarily with no financial benefit.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">July 1, 2018</start_date>
  <completion_date type="Actual">June 1, 2020</completion_date>
  <primary_completion_date type="Actual">June 1, 2020</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <intervention_model_description>On enrollment, dividing the healthy ( n=40) from the pathological function of the pelvic floor ( n=40). From the second group, randomizing the groups to study group: recieving pelvic floor fascial mobilization (PFFM) treatment (n=20)compared to control group (n=20).</intervention_model_description>
    <primary_purpose>Treatment</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Contraction strength</measure>
    <time_frame>Change of contraction strength is assessed - from baseline to 2 weeks after last treatment ( up to maximum of 1 month )</time_frame>
    <description>Contraction strength assessed by Oxford grading scale</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Contraction pressure</measure>
    <time_frame>Change of contraction pressure is assessed - from baseline to 2 weeks after last treatment ( up to maximum of 1 month )</time_frame>
    <description>Contraction pressure measured by using Peritron perineometer</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Symptoms associated with pelvic dysfunction</measure>
    <time_frame>Change of pelvic dysfunction is assessed - from baseline to 2 weeks after last treatment ( up to maximum of 1 month )</time_frame>
    <description>Assessment of symptoms associated with pelvic dysfunction: urinary incontinence, fecal incontinence, frequency and urgency (by the use of pelvic floor disability index 20 - a questionaire including 20 questions on pelvic floor function)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>FEV1</measure>
    <time_frame>Change of FEV1 is assessed - from baseline to 2 weeks after last treatment ( up to maximum of 1 month )</time_frame>
    <description>Forced expiratory volume 1</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Voice Handicap Index - 10 among Hebrew speakers (VHI-10-HEB) questionaire</measure>
    <time_frame>Change of VHI-10-HEB is assessed - from baseline to 2 weeks after last treatment ( up to maximum of 1 month )</time_frame>
    <description>Evaluation of the validity of the voice handicap index that includes ten questions concerning voice usage among hebrew speakers</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">80</enrollment>
  <condition>Pelvic Floor Disorders</condition>
  <arm_group>
    <arm_group_label>Study group - Treatment with PFFM</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Manual treatment for the pelvic floor will be provided in two sessions two weeks apart as long as guidance towards exercise for strengthening of the pelvic floor</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Control group -</arm_group_label>
    <arm_group_type>No Intervention</arm_group_type>
    <description>Guidance towards exercise for strengthening of the pelvic floor with no other interventional treatment.</description>
  </arm_group>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>Pelvic floor fascial mobilization</intervention_name>
    <description>The manual manipulation of the pelvic floor involves intra vaginal superficial as well as pelvic skin area pressure points.</description>
    <arm_group_label>Study group - Treatment with PFFM</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion criteria:&#xD;
&#xD;
          1. Age 20-45 years old&#xD;
&#xD;
          2. Gestational age 24-30 weeks gestation&#xD;
&#xD;
          3. Singleton pregnancy&#xD;
&#xD;
          4. Expected second-4ourth delivery&#xD;
&#xD;
        Exclusion criteria&#xD;
&#xD;
          1. First delivery&#xD;
&#xD;
          2. Gestational age at more than 30 weeks gestation at enrollment&#xD;
&#xD;
          3. Premature contractions&#xD;
&#xD;
          4. Cervical insufficiency&#xD;
&#xD;
          5. Placenta previa&#xD;
&#xD;
          6. Placenta accrete&#xD;
&#xD;
          7. Multifetal pregnancy&#xD;
&#xD;
          8. Maternal chronic illness including connective tissue disease, neurological illness&#xD;
      </textblock>
    </criteria>
    <gender>Female</gender>
    <gender_based>Yes</gender_based>
    <gender_description>Women that are pregnant</gender_description>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>42 Years</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <location>
    <facility>
      <name>Sheba Medical Center</name>
      <address>
        <city>Ramat Gan</city>
        <country>Israel</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>Israel</country>
  </location_countries>
  <reference>
    <citation>Batista EM, Conde DM, Do Amaral WN, Martinez EZ. Comparison of pelvic floor muscle strength between women undergoing vaginal delivery, cesarean section, and nulliparae using a perineometer and digital palpation. Gynecol Endocrinol. 2011 Nov;27(11):910-4. doi: 10.3109/09513590.2011.569603. Epub 2011 Apr 18.</citation>
    <PMID>21500994</PMID>
  </reference>
  <reference>
    <citation>Hallock JL, Handa VL. The Epidemiology of Pelvic Floor Disorders and Childbirth: An Update. Obstet Gynecol Clin North Am. 2016 Mar;43(1):1-13. doi: 10.1016/j.ogc.2015.10.008.</citation>
    <PMID>26880504</PMID>
  </reference>
  <reference>
    <citation>Navot S, Kalichman L. Hip and groin pain in a cyclist resolved after performing a pelvic floor fascial mobilization. J Bodyw Mov Ther. 2016 Jul;20(3):604-9. doi: 10.1016/j.jbmt.2016.04.005. Epub 2016 Apr 7.</citation>
    <PMID>27634085</PMID>
  </reference>
  <reference>
    <citation>Okido MM, Valeri FL, Martins WP, Ferreira CH, Duarte G, Cavalli RC. Assessment of foetal wellbeing in pregnant women subjected to pelvic floor muscle training: a controlled randomised study. Int Urogynecol J. 2015 Oct;26(10):1475-81. doi: 10.1007/s00192-015-2719-4. Epub 2015 Aug 21.</citation>
    <PMID>26294205</PMID>
  </reference>
  <reference>
    <citation>Petricelli CD, Resende AP, Elito Junior J, Araujo Junior E, Alexandre SM, Zanetti MR, Nakamura MU. Distensibility and strength of the pelvic floor muscles of women in the third trimester of pregnancy. Biomed Res Int. 2014;2014:437867. doi: 10.1155/2014/437867. Epub 2014 Apr 28.</citation>
    <PMID>24877094</PMID>
  </reference>
  <reference>
    <citation>Talasz H, Kofler M, Kalchschmid E, Pretterklieber M, Lechleitner M. Breathing with the pelvic floor? Correlation of pelvic floor muscle function and expiratory flows in healthy young nulliparous women. Int Urogynecol J. 2010 Apr;21(4):475-81. doi: 10.1007/s00192-009-1060-1. Epub 2009 Dec 8.</citation>
    <PMID>19997721</PMID>
  </reference>
  <reference>
    <citation>van Veelen GA, Schweitzer KJ, van der Vaart CH. Ultrasound imaging of the pelvic floor: changes in anatomy during and after first pregnancy. Ultrasound Obstet Gynecol. 2014 Oct;44(4):476-80. doi: 10.1002/uog.13301.</citation>
    <PMID>24436146</PMID>
  </reference>
  <verification_date>June 2020</verification_date>
  <study_first_submitted>January 24, 2017</study_first_submitted>
  <study_first_submitted_qc>February 1, 2017</study_first_submitted_qc>
  <study_first_posted type="Estimate">February 2, 2017</study_first_posted>
  <last_update_submitted>June 7, 2020</last_update_submitted>
  <last_update_submitted_qc>June 7, 2020</last_update_submitted_qc>
  <last_update_posted type="Actual">June 9, 2020</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Sheba Medical Center</investigator_affiliation>
    <investigator_full_name>Dr. Aya Mohr-Sasson</investigator_full_name>
    <investigator_title>Principal Investigator</investigator_title>
  </responsible_party>
  <keyword>pelvic floor</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Pelvic Floor Disorders</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03041246
org study id: 3722-16-SMC
nct id: NCT03041246
lead sponsor: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
Pregnancy and vaginal delivery are considered as the main risk factors for damage to the
      pelvic floor. There are various ways to measure the strength of the pelvic floor and to
      evaluate functional problems. Manual mobilization of the pelvic floor is a well-known
      treatment modality, however, ample knowledge exists on the efficacy of physiotherapy and
      exercise for improvement of pelvic floor function and strength. The aim of this study is to
      analyze the influence of pelvic floor fascial mobilization (PFFM) technique on the function
      and strength of the pelvic floor muscles as well as parameters presumed to be influenced by
      the strength of the pelvic floor in pregnant women.
Pregnancy and vaginal delivery are considered as the main risk factors for damage to the
      pelvic floor at various degrees, starting at mild stress incontinence and up to fool fecal
      incontinence as well as pelvic pains or urination difficulties.

      There are various ways to measure the strength of the pelvic floor and to evaluate functional
      problems. Measured the strength of the pelvic floor muscles by physical examination according
      to Oxford Grading Scale (scale of 0-5) as well as by using Perineometer device, were equally
      efficient and well correlated. Other modalities such as the use of surface electro myography
      (EMG), that presents the level of the muscle electrical activity and expiration volumes and
      the strength of the pelvic floor muscles were also positively correlated to the strength of
      the pelvic floor. Recent studies presented dysfunction of pelvic floor during pregnancy as
      well as in the postpartum period by the use of pelvic floor disability index 20 (PFDI20)
      questionnaire validated in Hebrew.

      Ample knowledge exists on the efficacy of physiotherapy and exercise for improvement of
      pelvic floor function and strength, however, prolonged and continuous exercise is needed to
      achieve good results as well as compliance and perseverance. The long-term effect is
      unwieldly.

      Manual mobilization of the pelvic floor is a well-known treatment modality. However the
      literature regarding the effect of this technique is sparse. A recent series of case reports
      presented immediate and major improvement of pelvic floor dysfunction after manual
      mobilization. The peripartum period is critical for the function of the pelvic floor however
      the yield of manual therapy on function and strength of the pelvic floor was not evaluated in
      pregnant women. We hypothesize that manual therapy can improve the strength and the function
      of the pelvic floor within a short time span and this can be objectively measured by common
      and well used parameters The aim of this study is to analyze the influence of pelvic floor
      fascial mobilization (PFFM) on the function and strength of the pelvic floor muscles as well
      as parameters presumed to be influenced by the strength of the pelvic floor in pregnant women

      Materials and methods

      The study will involve number of phases:

      Phase one: Screening and enrollment of patients Women followed at the high risk pregnancy
      clinic at the Sheba medical center, who carry singleton pregnancy at the ages of 20-45 years
      old and about to have their 2nd to 4th delivery (primiparous and multiparous women) will be
      examined for the following parameters: demographic and medical data, focused interview for
      symptoms of pelvic floor dysfunction including urination and fecal function as well as pelvic
      floor pain, manual assessment according the Oxford grading scale will be performed, and the
      strength of the pelvic floor measured by the use of Perineometer (Peritron 'AV' Combined Anal
      & Vaginal Perineometer NEW MODEL). Other parameters that will be measured include:
      mobilization of the pelvic-femoral joint, Forced expiratory volume 1 (FEV1) (a connection was
      shown between FEV1, intraabdominal pressure and the strength of the pelvic floor, assessment
      of vocal quality ( analyzed by communication clinician, repeat assessment will be performed
      after two weeks and after 4 weeks, estimated assessment time - 20 Min) 80 women are expected
      to be enrolled.

      Phase Two Women who will fulfill one or more of the following parameters will be enrolled to
      the second phase of the study . (n=40)

        1. Oxford grading scale ≤3/5

        2. Pelvic floor strength assessed by perineometer≤ 30 cm/h20

        3. Clinical symptoms of urine, flatus or fecal incontinence

        4. Pelvic floor, hip joint or pelvic joints pain

      Randomization will be performed to one of two groups:

      Group A-Control group (n=20) Group B-Study group (n=20) Guidance towards exercise for
      strengthening of the pelvic floor will be provided for both groups. Study group will be
      treated manually for the pelvic floor in two sessions two weeks apart. The manual
      manipulation of the pelvic floor will involve intra vaginal superficial as well as pelvic
      skin area pressure points. The manipulation will not involve the cervix uterus or rectum.
      Each session will lasts one hour

      Both groups will be assessed by ultrasound for blood flow in the middle cerebral artery,
      umbilical artery and uterine artery as part of the parameters that may show benefit to the
      fetus due to pelvic floor mobilization.

      Reassessment of all the women and repeat treatment for the study group will be performed
      after two and four weeks from the primary assessment.

      The study will be performed at a high risk pregnancy clinic at the Sheba medical center.
      Women will be enrolled voluntarily with no financial benefit.
allocation: Randomized
intervention model: Parallel Assignment
intervention model description: On enrollment, dividing the healthy ( n=40) from the pathological function of the pelvic floor ( n=40). From the second group, randomizing the groups to study group: recieving pelvic floor fascial mobilization (PFFM) treatment (n=20)compared to control group (n=20).
primary purpose: Treatment
masking: None (Open Label)
measure: Contraction strength
time frame: Change of contraction strength is assessed - from baseline to 2 weeks after last treatment ( up to maximum of 1 month )
description: Contraction strength assessed by Oxford grading scale
measure: Contraction pressure
time frame: Change of contraction pressure is assessed - from baseline to 2 weeks after last treatment ( up to maximum of 1 month )
description: Contraction pressure measured by using Peritron perineometer
measure: Symptoms associated with pelvic dysfunction
time frame: Change of pelvic dysfunction is assessed - from baseline to 2 weeks after last treatment ( up to maximum of 1 month )
description: Assessment of symptoms associated with pelvic dysfunction: urinary incontinence, fecal incontinence, frequency and urgency (by the use of pelvic floor disability index 20 - a questionaire including 20 questions on pelvic floor function)
measure: FEV1
time frame: Change of FEV1 is assessed - from baseline to 2 weeks after last treatment ( up to maximum of 1 month )
description: Forced expiratory volume 1
measure: Voice Handicap Index - 10 among Hebrew speakers (VHI-10-HEB) questionaire
time frame: Change of VHI-10-HEB is assessed - from baseline to 2 weeks after last treatment ( up to maximum of 1 month )
description: Evaluation of the validity of the voice handicap index that includes ten questions concerning voice usage among hebrew speakers
arm group label: Study group - Treatment with PFFM
arm group type: Experimental
description: Manual treatment for the pelvic floor will be provided in two sessions two weeks apart as long as guidance towards exercise for strengthening of the pelvic floor
arm group label: Control group -
arm group type: No Intervention
description: Guidance towards exercise for strengthening of the pelvic floor with no other interventional treatment.
intervention type: Procedure
intervention name: Pelvic floor fascial mobilization
description: The manual manipulation of the pelvic floor involves intra vaginal superficial as well as pelvic skin area pressure points.
arm group label: Study group - Treatment with PFFM
criteria: 
gender: Female
gender based: Yes
gender description: Women that are pregnant
minimum age: 18 Years
maximum age: 42 Years
healthy volunteers: Accepts Healthy Volunteers
facility: 
country: Israel
citation: Batista EM, Conde DM, Do Amaral WN, Martinez EZ. Comparison of pelvic floor muscle strength between women undergoing vaginal delivery, cesarean section, and nulliparae using a perineometer and digital palpation. Gynecol Endocrinol. 2011 Nov;27(11):910-4. doi: 10.3109/09513590.2011.569603. Epub 2011 Apr 18.
PMID: 21500994
citation: Hallock JL, Handa VL. The Epidemiology of Pelvic Floor Disorders and Childbirth: An Update. Obstet Gynecol Clin North Am. 2016 Mar;43(1):1-13. doi: 10.1016/j.ogc.2015.10.008.
PMID: 26880504
citation: Navot S, Kalichman L. Hip and groin pain in a cyclist resolved after performing a pelvic floor fascial mobilization. J Bodyw Mov Ther. 2016 Jul;20(3):604-9. doi: 10.1016/j.jbmt.2016.04.005. Epub 2016 Apr 7.
PMID: 27634085
citation: Okido MM, Valeri FL, Martins WP, Ferreira CH, Duarte G, Cavalli RC. Assessment of foetal wellbeing in pregnant women subjected to pelvic floor muscle training: a controlled randomised study. Int Urogynecol J. 2015 Oct;26(10):1475-81. doi: 10.1007/s00192-015-2719-4. Epub 2015 Aug 21.
PMID: 26294205
citation: Petricelli CD, Resende AP, Elito Junior J, Araujo Junior E, Alexandre SM, Zanetti MR, Nakamura MU. Distensibility and strength of the pelvic floor muscles of women in the third trimester of pregnancy. Biomed Res Int. 2014;2014:437867. doi: 10.1155/2014/437867. Epub 2014 Apr 28.
PMID: 24877094
citation: Talasz H, Kofler M, Kalchschmid E, Pretterklieber M, Lechleitner M. Breathing with the pelvic floor? Correlation of pelvic floor muscle function and expiratory flows in healthy young nulliparous women. Int Urogynecol J. 2010 Apr;21(4):475-81. doi: 10.1007/s00192-009-1060-1. Epub 2009 Dec 8.
PMID: 19997721
citation: van Veelen GA, Schweitzer KJ, van der Vaart CH. Ultrasound imaging of the pelvic floor: changes in anatomy during and after first pregnancy. Ultrasound Obstet Gynecol. 2014 Oct;44(4):476-80. doi: 10.1002/uog.13301.
PMID: 24436146
responsible party type: Principal Investigator
investigator affiliation: Sheba Medical Center
investigator full name: Dr. Aya Mohr-Sasson
investigator title: Principal Investigator
mesh term: Pelvic Floor Disorders
sharing ipd: No