FERNANDA PIPITONE RODRIGUES
Índice h a partir de 2011
4
Projetos de Pesquisa
Unidades Organizacionais
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
2 resultados
Resultados de Busca
Agora exibindo 1 - 2 de 2
- Novel 3D MRI technique to measure perineal membrane structural changes with pregnancy and childbirth: Technique development and measurement feasibility(2021) PIPITONE, Fernanda; SWENSON, Carolyn W.; DELANCEY, John O. L.; CHEN, LuyunIntroduction and hypothesis We aimed to develop and validate a new MRI-based perineal membrane reconstruction and morphological measurement technique, and test its feasibility on nulliparous and parous women to determine the effects of pregnancy and childbirth on the perineal membrane. Methods The perineal membrane was traced on high-resolution MRI using 3D Slicer (R) and analyses performed using Rhinoceros 6.0 SR23 (R). Validation was done by comparing MRI-based perineal membrane reconstruction to dissection measurements in a cadaver. Feasibility of reconstruction was assessed in the following three groups: nulliparous (NP), primiparous women who underwent cesarean delivery (CD), and primiparous women with vaginal delivery (VD). The following parameters were measured: (1) swinging door angle, (2) bony and (3) soft tissue attachment lengths, (4) separation at perineal body level, (5) surface area, and (6) hiatal area. ANOVA and post-hoc comparisons were performed, and the effect sizes (d) were reported. Results Model reconstruction was similar to cadaver dissection findings. Morphological measurements were feasible in all women (NP, n = 10; CS, n = 6; VD, n = 19). Swinging door angle was 13(o) greater in CD (p = 0.03; d = 1.15) and 16(o) greater in VD (p < 0.001; d = 1.41) compared to NP. VD showed 13% larger separation at the perineal body than NP (p = 0.097, d = 0.84) and 23% larger hiatal area than CD (p = 0.14, d = 0.94). Conclusion This novel and anatomically validated MRI-based perineal membrane reconstruction technique is feasible. Preliminary findings show that pregnancy and childbirth both influence perineal membrane morphology with VD being associated with the largest swinging door angle and perineal body separation.
- Urethral function and failure: A review of current knowledge of urethral closure mechanisms, how they vary, and how they are affected by life events(2021) PIPITONE, Fernanda; SADEGHI, Zhina; DELANCEY, John O. L.Introduction A critical appraisal of the literature regarding female urethral function and dysfunction is needed in light of recent evidence showing the urethra's role in causing stress and urge urinary incontinence. Methods An evidence assessment was conducted using selected articles from the literature that contained mechanistic data on factors affecting urethral function and failure. Results Maximal urethral closure pressure (MUCP) is 40% lower in stress urinary incontinence (SUI) than normal controls. Evidence from five women shows relatively equal contributions to MUCP from striated/smooth muscle, vascular-plexus, connective tissue. MUCP varies twofold in individuals of similar age and declines 15% per decade even in nulliparous women. Age explains 57% of the variance in MUCP. This parallels with striated/smooth muscle loss and reduced nerve density. Factors influencing pressure variation minute-to-minute and decade-to-decade are poorly understood. Connective tissue changes have not been investigated. MUCP in de novo SUI persisting 9-months postpartum is 25% less than in age and parity-matched controls. Longitudinal studies do not show significant changes in urethral function after vaginal birth suggesting that changes in urethral support from birth may unmask pre-existing sphincter weakness and precipitate SUI. Mechanisms of interaction between support injury, pre-existing urethral weakness, and neuropathy are unclear. Conclusion Urethral failure is the predominant cause of SUI and a contributing factor for UUI; potentially explaining why mixed symptoms predominate in epidemiological studies. Age-related striated muscle loss and differences between women of similar age are prominent features of poor urethral closure. Yet, connective tissue changes, vasculature function, and complex interactions among factors are poorly understood.