Prenatal Pelvic Floor Prevention (3PN)

Urinary Postpartum Handicap Prevention: Pelvic Floor Exercises vs Control. Multicentric Randomized Trial

Objective: Compare pelvic floor disorders (urinary incontinence, anal incontinence, genital prolapse, perineal pain, sexual troubles) 12 month after a first delivery between a group of women with prenatal pelvic floor exercises and a control group. Hypothesis: Prenatal pelvic floor exercises reduce postpartum urinary incontinence.

Justification: Pelvic floor disorders lead to handicap and medical care consumption. Pregnancy and delivery are the main etiologies. Pelvic floor exercises are proposed for prevention and may reduce immediate postpartum incontinence but we do not know if this preventive effect persists at 1 year. Principal criteria: Urinary incontinence score at 12 months post-partum (ICIQ-SF) Secondary criteria: Urinary incontinence prevalence at pregnancy end, 2 and 12 months post-partum Other pelvic floor disorders at pregnancy end, 2 and 12 months post-partum: symptoms questionnaires, QOL questionnaire, Pad-test, POP-Q. Mode of delivery, length of active second phase, perineal tears, Apgar score. Number of postpartum pelvic floor session, number of medical consultations, Kegel exercises. Progress: Inclusion between 20 and 28 weeks, initial assessment, randomization. 8 sessions of pelvic floor exercises with a physiotherapist between 24 and 36 weeks versus written information only. Assessment at pregnancy end, 2 and 12 (+/-1) month post-partum Study length: For each women 18 months. For each center 30 months. Number of subjects: To show a 1 point difference on ICIQ-SF score, we need 182 subjects (sd=2,4, a=0,05, β=0,20 bilateral test). Taking in account lost of follow-up (estimated 1/3) we are going to include 280 women.

Standardized pelvic floor muscle training program with a physiotherapist in 8 sessions (20-30 minutes each) between 24 and 36 weeks of gestation AND Written instructions about personal (Kegel) pelvic floor exercises

8 sessions of 20-30 minutes each between 24 and 36 weeks of gestation with a physiotherapist or midwife

Inclusion Criteria: nulliparous aged 18 years or more pregnant between 20 and 28 weeks French language reader Exclusion Criteria: No medical insurance multiple or pathologic pregnancy Previous pelvic floor exercises with a physiotherapist less than 6 months before pregnancy

Woodley SJ, Lawrenson P, Boyle R, Cody JD, Morkved S, Kernohan A, Hay-Smith EJC. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020 May 6;5(5):CD007471. doi: 10.1002/14651858.CD007471.pub4.

Fritel X, de Tayrac R, Bader G, Savary D, Gueye A, Deffieux X, Fernandez H, Richet C, Guilhot J, Fauconnier A. Preventing Urinary Incontinence With Supervised Prenatal Pelvic Floor Exercises: A Randomized Controlled Trial. Obstet Gynecol. 2015 Aug;126(2):370-377. doi: 10.1097/AOG.0000000000000972.