Protecting the pelvic floor: obstetric management to prevent incontinence and pelvic organ prolapse.
ABSTRACT To review the literature regarding the effects of childbirth on the muscles, nerves, and connective tissue of the pelvic floor, review the evidence to support an association between childbirth and anal incontinence, urinary incontinence, and pelvic organ prolapse; and present recommendations for the prevention of these sequelae.
Sources were identified from a MEDLINE search of English-language articles published from 1984 to 1995. Additional sources were identified from references cited in relevant research articles.
We studied articles on the following topics: anatomy of the pelvic floor association of childbirth with neuromuscular injury, biomechanical and morphologic alterations in muscle function, and connective tissue structure and function; the long-term effects of childbirth on continence and pelvic organ support; and the effects of obstetric interventions on the pelvic floor.
Articles were reviewed and summarized. An overview of the structure and function of the pelvic floor was developed to provide a context for subsequent data. Childbirth was found to be associated with a variety of muscular and neuromuscular injuries of the pelvic floor that are linked to the development of anal incontinence, urinary incontinence, and pelvic organ prolapse. Risk factors for pelvic floor injury include forceps delivery, episiotomy, prolonged second-stage of labor, and increased fetal size. Cesarean delivery appears to be protective, especially if the patient does not labor before delivery.
The pelvic floor plays an important role in continence and pelvic organ support. Obstetricians may be able to reduce pelvic floor injuries by minimizing forceps deliveries and episiotomies, by allowing passive descent in the second stage, and by selectively recommending elective cesarean delivery.
BJOG An International Journal of Obstetrics & Gynaecology 07/2003; 110(7):658-663. DOI:10.1016/S1470-0328(03)02296-1 · 3.86 Impact Factor
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ABSTRACT: Pelvic floor dysfunction (PFD), although seems to be simple, is a complex process that develops secondary to multifactorial factors. The incidence of PFD is increasing with increasing life expectancy. PFD is a term that refers to a broad range of clinical scenarios, including lower urinary tract excretory and defecation disorders, such as urinary and anal incontinence, overactive bladder, and pelvic organ prolapse, as well as sexual disorders. It is a financial burden on the health care system and disrupts women's quality of life. Strategies applied to decrease PFD are focused on the course of pregnancy, mode and management of delivery, and pelvic exercise methods. Many studies in the literature define traumatic birth, usage of forceps, length of the second stage of delivery, and sphincter damage as modifiable risk factors for PFD. Maternal age, fetal position, and fetal head circumference are nonmodifiable risk factors. Although numerous studies show that vaginal delivery affects pelvic floor structures and their functions in a negative way, there is not enough scientific evidence to recommend elective cesarean delivery in order to prevent development of PFD. PFD is a heterogeneous pathological condition, and the effects of pregnancy, vaginal delivery, cesarean delivery, and possible risk factors of PFD may be different from each other. Observational studies have identified certain obstetrical exposures as risk factors for pelvic floor disorders. These factors often coexist; therefore, the isolated effects of these variables on the pelvic floor are difficult to study. The routine use of episiotomy for many years in order to prevent PFD is not recommended anymore; episiotomy should be used in selected cases, and the mediolateral procedures should be used if needed. Copyright © 2014. Published by Elsevier B.V.
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ABSTRACT: Key contentLower urinary tract infection is associated with increased maternal and fetal morbidity.There is an association between pelvic organ prolapse and increasing parity and vaginal deliveries.Lower urinary tract dysfunction and pelvic organ prolapse are common during pregnancy and the postpartum period, but often resolve.Special consideration is needed regarding the management of lower urinary tract dysfunction and pelvic organ prolapse during pregnancy and the postpartum period, with an emphasis on conservative management.Learning objectivesTo know how to manage lower urinary tract infection in pregnancy.To understand the epidemiology and management of lower urinary tract dysfunction in pregnancy.To be aware of the epidemiology and management of pelvic organ prolapse in pregnancy.Ethical issuesShould pregnant women be prescribed antimuscarinic drugs when adverse effects on the fetus have been shown in animal studies?Should women who have not completed their families be offered surgery for pelvic organ prolapse?Should elective caesarean section be offered to women who have had previous successful incontinence surgery?The Obstetrician & Gynaecologist 07/2012; 14(3). DOI:10.1111/j.1744-4667.2012.00111.x