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Today, The Visible Embryo is linked to over 600 educational institutions and is viewed by more than 1 million visitors each month. The field of early embryology has grown to include the identification of the stem cell as not only critical to organogenesis in the embryo, but equally critical to organ function and repair in the adult human. The identification and understanding of genetic malfunction, inflammatory responses, and the progression in chronic disease, begins with a grounding in primary cellular and systemic functions manifested in the study of the early embryo.

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Pregnancy Timeline by SemestersFetal liver is producing blood cellsHead may position into pelvisBrain convolutions beginFull TermWhite fat begins to be madeWhite fat begins to be madeHead may position into pelvisImmune system beginningImmune system beginningPeriod of rapid brain growthBrain convolutions beginLungs begin to produce surfactantSensory brain waves begin to activateSensory brain waves begin to activateInner Ear Bones HardenBone marrow starts making blood cellsBone marrow starts making blood cellsBrown fat surrounds lymphatic systemFetal sexual organs visibleFinger and toe prints appearFinger and toe prints appearHeartbeat can be detectedHeartbeat can be detectedBasic Brain Structure in PlaceThe Appearance of SomitesFirst Detectable Brain WavesA Four Chambered HeartBeginning Cerebral HemispheresFemale Reproductive SystemEnd of Embryonic PeriodEnd of Embryonic PeriodFirst Thin Layer of Skin AppearsThird TrimesterSecond TrimesterFirst TrimesterFertilizationDevelopmental Timeline
CLICK ON weeks 0 - 40 and follow along every 2 weeks of fetal development
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Home | Pregnancy Timeline | News Alerts |News Archive Jan 27, 2014

"This is the first study with detailed, frequent and long-term follow-up to assess associations
of dyspareunia with obstetric risk factors.
" Patrick Chien, BJOG Deputy Editor-in-chief
Image: Vintage

 






 

 

Caesarean delivery may hamper sex life

Women who have a caesarean section, forceps or vacuum extraction are more likely to experience persisting pain during sex than women who have a vaginal birth, in the year following childbirth.

Birth through operation is associated with persisting pain during or after sexual intercourse, known as dyspareunia, suggests a new study published January 21, 2015 in BJOG: An International Journal of Obstetrics and Gynaecology.

The study aimed to investigate the contribution of obstetric risk factors, including mode of delivery and perineal trauma to postpartum dyspareunia. It also examined the influences of other risk factors, including breastfeeding, maternal fatigue, maternal depression and intimate partner abuse.

A cohort [meaning: a group of subjects who have shared a particular event together during a particular time span] of 1244 first time mothers across six maternity hospitals in Melbourne, Australia participated. Data were taken from baseline and postnatal questionnaires at 3, 6, 12 and 18 months.

Of the women sampled, 49% had a spontaneous vaginal birth, two thirds of whom sustained a sutured tear and/or episiotomy. Another 10.8% had a vaginal birth assisted by vacuum extraction and 10.7% gave birth assisted by forceps. Additionally, 9.7% were delivered by elective caesarean section and 19.9% were delivered by emergency caesarean section.


Results showed that 78% of the study population had resumed sexual intercourse by 3 months, 94% by 6 months, 97% by 12 months and 98% by 18 months postpartum.


With regards to dyspareunia following childbirth, most of the women (85.7%) who had resumed sex by 12 months postpartum experienced pain during first vaginal sex after childbirth. Dyspareunia, or pain, was reported by 44.7% of women at 3 months postpartum, 43.4% at 6 months, 28.1% at 12 months and 23.4% at 18 months postpartum. Of the women who reported dyspareunia at 6 months postpartum, a third (32.7%) reported persisting dyspareunia at 18 months postpartum.


Compared to women who had a spontaneous vaginal delivery with intact perineum or unsutured tear, women who had an emergency caesarean section, vacuum extraction or elective caesarean section had double the risk of reporting dyspareunia at 18 months postpartum, adjusting for maternal age and other risk factors.


Dyspareunia at 18 months postpartum can include pre-pregnancy dyspareunia, and intimate partner abuse and maternal fatigue.

In the study, one in six women (16%) experienced abuse by an intimate partner in the first 12 months postpartum. One third of these women or (32.4%) reported dyspareunia at 18 months postpartum, compared with 20.7% of women who did not experience intimate partner abuse. The authors of the study suggest that clinicians should be alert to the possibility that intimate partner abuse as a potential underlying factor in persisting dyspareunia.


The authors conclude that greater recognition and understanding is needed of the mode of delivery and perineal trauma in contributing to postpartum maternal morbidity. Additionally, ways to prevent postpartum dyspareunia should be explored.


According to Ellie McDonald from the Murdoch Childrens Research Institute, Victoria, Australia and co-author of the study: "Almost all women experience some pain during first sexual intercourse following childbirth. However, our findings show the extent to which women report persisting dyspareunia at 6 and 18 months postpartum is influenced by events during labour and birth, in particular caesarean section and vacuum extraction delivery.

"
Not enough is known about the longer term impact of obstetric procedures on maternal health. The fact that dyspareunia is more common among women experiencing operative procedures points to the need for focusing clinical attention on ways to help women experiencing ongoing morbidity, and increased efforts to prevent postpartum morbidity where possible."


"This is the first study with detailed, frequent and long-term follow-up to assess associations of dyspareunia with obstetric risk factors.

"This study provides us with robust evidence about the extent and persistence of postpartum dyspareunia and associations with mode of delivery and perineal trauma. Future research could look into ways of preventing dyspareunia."


Patrick Chien, BJOG Deputy Editor-in-chief.


Abstract
Results
In all, 1244/1507 (83%) women completed the baseline and all four postpartum questionnaires; 1211/1237 (98%) had resumed vaginal intercourse by 18 months postpartum, with 289/1211 (24%) women reporting dyspareunia. Compared with women who had a spontaneous vaginal delivery with an intact perineum or unsutured tear, women who had an emergency caesarean section (adjusted odds ratio [aOR] 2.41, 95% confidence interval [95% CI] 1.4–4.0; P = 0.001), vacuum extraction (aOR 2.28, 95% CI 1.3–4.1; P = 0.005) or elective caesarean section (aOR 1.71, 95% CI 0.9–3.2; P = 0.087) had increased odds of reporting dyspareunia at 18 months postpartum, adjusting for maternal age and other potential confounders.

Conclusions
Obstetric intervention is associated with persisting dyspareunia. Greater recognition and increased understanding of the roles of mode of delivery and perineal trauma in contributing to postpartum maternal morbidities, and ways to prevent postpartum dyspareunia where possible, are warranted.

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