University of British Columbia

Research Spotlight

Publication Highlight

Geoffrion R, Badowski S, Gong M, Mann G, Tilak M, Koenig N, Lee T. Pelvic Floor Health Index: Initial validation of a practical postpartum tool for busy clinicians. Can Fam Physician. 2023 Nov;69(11):e229-e235. doi: 10.46747/cfp.6911e229. PMID: 37963795.

Pelvic floor disorders, including urinary incontinence, vaginal prolapse, pelvic pain and dyspareunia are commonly precipitated by pregnancy and childbirth. Despite such a common occurrence in the postpartum period, primary care providers do not have access to adequate screening tools for pelvic floor disorders. Access to such a tool would allow for primary care providers to start conversations around pelvic floor disorders, allowing for timely interventions for their patients. Geoffrion et al. developed a simple and practical, primary care clinical screening tool for pregnancy and postpartum pelvic floor symptoms called the Pelvic Floor Health Index (PFHI). The PFHI consists of a 10-item questionnaire, where each item is a yes-or-no question and increasing scores represent better pelvic health. There are 4 questions on PFDs, 3 on genital pain, 1 on genital sensation, and 2 on sense of attractiveness and avoidance of intimate activities.

They tested their screening tool in a cohort of primiparous women, aged greater than 19, in the immediate postpartum period. The PFHI was administered to the study participants at 2,4, and 6 months postpartum. To assess convergent and divergent construct validity, participants also completed the following validated questionnaires: The Female Sexual Functioning Index (FSFI), the Pelvic Floor Distress Inventory (PFDI), the 36-item Short Form Health Survey, and the Edinburgh Postnatal Depression Scale (EPDS). Overall, 74 participants completed the PFHI survey at baseline. Sixty-nine participants answered all 10 questions at baseline, while 45 participants (61%) completed the PFHI at 2 months, 32 (43%) at 4 months, and 45 (61%) at 6 months. Pelvic Floor Health Index score was inversely correlated with PFDI score at all time points. There were moderate correlations between PFHI and FSFI scores at 0, 2, and 6 months. Pelvic Floor Health Index score was positively correlated with SF-36 score— especially in the domain of physical functioning—at 2, 4, and 6 months. Similar to the main analysis, PFHI score was inversely correlated with PFDI score at all time points in both severe and minimal perineal trauma groups. Weak correlations with the EPDS suggest that physical pelvic floor symptoms may not play a large role in postpartum depression. The PFHI scores showed gradual improvement consistent with the expected natural course of disease and mirrored improvements in symptoms demonstrated with established questionnaires (convergent validity). We developed our questionnaire to address mainly physical symptoms and this was reflected in weak or inconsistent correlations with the EPDS, as well as with the mental health and emotional domains of the SF-36 (divergent validity). The authors concluded that the PFHI is a 10-item, newly validated, and psychometrically robust questionnaire that can be administered to patients in the postpartum period to screen for pelvic floor dysfunction.

Current Studies/Investigations

DEAREST II: The study aims to examine whether patients who have anxiety or depression are at greater risk of prolonged opioid use following in-patient surgeries. As opioids are commonly prescribed to help manage pain after surgical procedures, a better understanding of risk factors for long-term opioid use can help physicians manage postoperative pain for higher-risk patients more responsibly.

  • Investigators: Cundiff GW, Tigert M, Keonig N, Geoffrion R
  • Progress: REB approved, seeking data permission

Vaginal Uncomplicated Delivery Rate as a Quality Indicator Compared to Cesarean Delivery Rate: A Quantitative Analysis of a Population Database: This study proposed a better performance indicator, the Vaginal Uncomplicated Delivery rate, and assessed it as performance indicator, compared to the Cesarean Delivery rate.

  • Investigators: Cundiff GW, Kaur P, Hanley GE, Janssen P.
  • Progress: submitted for publication

Clinical Guideline for Uterine Preservation at the Time of Pelvic Organ Prolapse Repair: The study aims to inform urogynaecology providers of best practices regarding uterine preservation at the time of POP repair, towards facilitating better patient counseling, by summarizing published data and providing expert consensus on the strength of this literature.

  • Investigators: Cundiff GW, Carter Ramirez A, Letko J, Chill H, Woodburn K, Edwards A, Chang O.
  • Progress: Literature Search Complete

International Guideline on Obstetrical Anal Sphincter Injury Surgery

  • Investigators: Sultan A, Alarab M, Cattani L, Cundiff GW, DeLeeuw JW, Giroux M, Doumouchtsis S, Hickman L, Lozo S, Madsen A, Neels H, Okeahialam NA, Rajamahaswari N, Thakar R.
  • Progress: PICOTS developed

Pilot Study of a Digital Behavioural Therapy for Overactive Bladder in Women: The aim of the study is to investigate feasibility, acceptability, and preliminary efficacy of a digital therapeutic for overactive bladder.

  • Investigators: Cundiff GW, Sooknarine C, Farrell S, Sarma S, Salameh F, Burke N, Staunton B, Carr E, Sexton K, Agnew G, Downey A, D’Arcy F.
  • Progress: Submitted for publication

The APPROVE Trial: A randomized controlled trial evaluating the efficacy and safety of a prescription digital therapeutic for the treatment of overactive bladder in women.

  • Investigators: Dieter A, Gutman R, Carr E, Cundiff GW.
  • Progress: FDA Approved, sites recruited, ready to start enrollment.

2022-2023 Publication List

Cundiff GW, Chan V, Luo J. A Longitudinal Assessment of a Physician Performance Enhancement Program Using Health Data, to Improve Quality of Care and Facilitate Lifelong Learning. J Obstet Gynaecol Can. 2023 Dec;45(12):102187. doi: 10.1016/j.jogc.2023.07.007. Epub 2023 Aug 5.PMID: 37544380

Erekson E, Whitcomb EL, Kamdar N, Swift S, Cundiff GW, Yaklic J, Strohbehn K, Adam R, Danford J, Willis-Gray MG, Maxwell R, Edenfield A, Pulliam S, Gong M, Malek M, Hanissian P, Towers G, Guaderrama NM, Slocum P, Morgan D. Performance of Perioperative Tasks for Women Undergoing Anti-incontinence Surgery: Developed by the AUGS Quality Improvement and Outcomes Research Network. Urogynecology (Phila). 2023 Aug 1;29(8):660-669. doi: 0.1097/SPV.0000000000001392.PMID: 37490706

Chaikof M, Cundiff GW, Mohtashami F, Millman A, Larouche M, Pierce M, Brennand EA, McDermott C. Surgical sexism in Canada: structural bias in reimbursement of surgical care for women. Can J Surg. 2023 Jul 4;66(4):E341-E347. doi: 10.1503/cjs.022121. Print 2023 Jul-Aug.PMID: 37402558 Free PMC article.

Fong A, Talhouk A, Chiu D, Koenig N, Cundiff GW. Symptom and Anatomical Phenotypes Provide Insights Into Interactions of Prolapse Symptoms and Anatomy. Urogynecology (Phila). 2023 Feb 1;29(2):209-217. doi: 10.1097/SPV.0000000000001314.PMID: 36735436

Foggin HH, Albert AY, Minielly NC, Lisonkova S, Koenig NA, Jacobs EN, Cundiff GW. Labor and delivery outcomes by delivery method in term deliveries in occiput posterior position: a population-based retrospective cohort study. AJOG Glob Rep. 2022 Aug 5;2(4):100080. doi: 10.1016/j.xagr.2022.100080. eCollection 2022 Nov.PMID: 36536849 Free PMC article.

Cundiff GW. Does AUGS Still Have Quality Assurance Goals? Urogynecology (Phila). 2023 Mar 1;29(3):315-317. doi: 10.1097/SPV.0000000000001298. Epub 2022 Nov 12.PMID: 36374785

Fitzgerald JJ, Sokol ER, Rardin CR, Cundiff GW, Paraiso MFR, Chou J, Gutman RE. Long-Term Outcomes After Vaginal and Laparoscopic Mesh Hysteropexy for Uterovaginal Prolapse: A Parallel Cohort Study (eVAULT). Female Pelvic Med Reconstr Surg. 2022 Jun 1;28(6):e215-e221. doi: 10.1097/SPV.0000000000001188. Epub 2022 May 17.PMID: 35536663

Johnson GE, Kan L, Nguyen J, Campbell K, Ralph L, Koenig N, Sanaee M, Maher C, Cundiff GW. Development of patient-centered outcomes for labour and birth: a qualitative study. Clin Exp Obstet Gynecol. 2022,49(1), 1.

Zafarmand MH, Goossens SMTA, Tajik P, Bossuyt PMM, Asztalos EV, Gardener GJ, Willan AR, Roumen FJME, Mol BW, Barrett YJ. Twin Birth Study Collaborative Group. Planned Cesarean or planned vaginal delivery for twins: secondary analysis of randomized controlled trial. Ultrasound Obstet Gynecol. 2021 Apr;57(4):582-591.

Cundiff GW. Cystocele repair with fascial reinforcement using autologous fascia lata for recurrent prolapse. AJOG. 2022 Mar; 226(3) Supp S1367.

Geoffrion R, Badowski S, Gong M, Mann G, Tilak M, Koenig N, Lee T. Pelvic Floor Health Index: Initial validation of a practical postpartum tool for busy clinicians. Can Fam Physician. 2023 Nov;69(11):e229-e235.

Mann GK, Koenig NA, Lee T, Geoffrion R. Reducing urinary tract infection in female pelvic surgery: A retrospective cohort study. Int J Gynaecol Obstet. 2023 Nov;163(2):639-644. doi: 10.1002/ijgo.14892. Epub 2023 May 26.

Yang EC, Koenig NA, Gong M, Brotto LA, Barr AM, Lee T, Yong PJ, Geoffrion R. Cannabis use preferences in women with myofascial pelvic pain: A cross-sectional study. Eur J Obstet Gynecol Reprod Biol X. 2023 Mar 30;18:100192.

Geoffrion R, Badowski S. Abdominal sacrohysteropexy for large iatrogenic early postpartum vesicouterine fistula. Urol Case Rep. 2022 Sep 11;45:102217. doi: 10.1016/j.eucr.2022.102217. eCollection 2022 Nov.

Tilak M, Mann GK, Gong M, Koenig NA, Lee T, Geoffrion R. Pelvic floor healing milestones after obstetric anal sphincter injury: a prospective case control feasibility study. Int Urogynecol J. 2023 Feb;34(2):553-561. doi: 10.1007/s00192-022-05348-6. Epub 2022 Sep 13.

Tilak M, Koenig N, Albert A, Mayer U, Gipson T, Sim A, Geoffrion R. OASIS Guideline Adherence Among Canadian Maternity Care Providers. J Obstet Gynaecol Can. 2022 Aug;44(8):868-869. doi: 10.1016/j.jogc.2022.04.008. Epub 2022 Apr 26.

Holmes DR, Geoffrion R, Hunt J, Hance RC, Leon MB, Mack MJ, Kaplan AV. Regulatory strategies for early device development and approval. Catheter Cardiovasc Interv. 2022 May;99(6):1784-1788. doi: 10.1002/ccd.30151. Epub 2022 Apr 29.

Geoffrion R, Munro S, Janssen P. #Bepelvichealthaware: Sharing Clinical Best Practices on Pelvic Floor Health Through Whiteboard Animations. J Obstet Gynaecol Can. 2022 Jun;44(6):642-643. doi: 10.1016/j.jogc.2022.02.008. Epub 2022 Feb 21.

Muraca GM, Ralph LE, Christensen P, D'Souza R, Geoffrion R, Lisonkova S, Joseph KS. Maternal and neonatal trauma during forceps and vacuum delivery must not be overlooked. BMJ. 2023 Oct 19;383:e073991. doi: 10.1136/bmj-2022-073991.

Park M, Wanigaratne S, D'Souza R, Geoffrion R, Williams SA, Muraca GM. Asian-white disparities in obstetric anal sphincter injury: Protocol for a systematic review and meta-analysis. PLoS One. 2023 Sep 8;18(9):e0291174. doi: 10.1371/journal.pone.0291174. eCollection 2023.

Thompson JC, Halder GE, Jeppson PC, Alas A, Balgobin S, Dieter AA, Houlihan S, Miranne J, Sleemi A, Balk EM, Mama S, Meriwether KV, Antosh DD. Repair of Vesicovaginal Fistulae: A Systematic Review. Obstet Gynecol. 2023 Nov 30. doi: 10.1097/AOG.0000000000005468. Online ahead of print.