Protecting the Pelvic Floor: Obstetric Management to Prevent Incontinence and Pelvic Organ Prolapse

Department of Obstetrics and Gynecology, University of California Davis Medical Center, Sacramento, USA.
Obstetrics and Gynecology (Impact Factor: 5.18). 10/1996; 88(3):470-8. DOI: 10.1016/0029-7844(96)00151-2
Source: PubMed


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.

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    • "Stress urinary incontinence (SUI) is a disease that is defined as the involuntary leakage of urine under vesical stress conditions [1]. The primary etiological factor of SUI is vaginal delivery [2], usually due to combined muscular, nerve and connective tissue injury [3]. Although progress has been made in the treatment of SUI [4], our understanding of the molecular mechanisms underlying the condition is poor. "
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    ABSTRACT: The molecular mechanisms underlying stress urinary incontinence (SUI) are not clear. In light of the limited availability of human tissue for study, we explored the changes in the urethra of C57BL/6 mice with experimentally induced SUI. Twelve virgin female mice were randomized into two groups: one group undergoing vaginal distension (VD) for 1h with an 8-mm dilator, and a non-instrumented control group. Four days after VD, leak point pressures (LPP) and maximum urethral closure pressure (MUCP) were assessed in these mice under urethane (1g/kg, i.p.) anesthesia. After measuring LPP and MUCP, the animals were sacrificed, and the urethras were removed for proteomic analysis using 2-dimensional differential gel electrophoresis (2D DIGE) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) technology. Lastly, interaction between these proteins was further analyzed using MetaCore. LPP and MUCP values were significantly decreased in the 8-mm VD groups compared with the non-instrumented control group. Sixty-eight differentially expressed proteins of urethra from female mice with and without VD were identified. Of these, 19 proteins were up-regulated and 49 were down-regulated. The majority of the VD-induced proteins were involved in generation of precursor metabolites and energy, oxidation of reduction, regulation of apoptosis, and glycolysis. Myosin expression in the urethra was significantly decreased in the 8-mm VD group as compared with the control group. As a model of simulated birth trauma, VD can induce SUI in female mice. Under-expression of myosin plays a plausible role in the pathogenesis of SUI following vaginal trauma.
    Full-text · Article · Aug 2013 · European journal of obstetrics, gynecology, and reproductive biology
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    • "Pelvic organ prolapse and pelvic floor dysfunction are common clinical conditions affecting a large number of women [1] [2] [3] [4] [5]. For example, from 30 to 50% of women in "
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    ABSTRACT: The segmentation of pelvic structures in magnetic resonance (MR) images of the female pelvic cavity is a challenging task. This paper proposes the use of three novel geometric deformable models to segment the bladder, vagina and rectum in axial MR images. The different imaging appearances and prior shape knowledge are combined into a level set framework as segmentation cues. The movements of the contours are coupled with each other based on interactive information, and the organ boundaries can be segmented simultaneously. With the region-based external forces defined, the proposed algorithms are robust against noise and partial volume effect.
    Full-text · Article · Jan 2013 · Computers in Biology and Medicine
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    • "Child birth by vaginal delivery causes denervation in the pelvic floor musculature as a result of related straining and expulsive efforts (Farrell et al., 2001; Hvidman et al., 2002; Burgio et al., 2003; Parazzini et al., 2003; Holroyd-Leduc and Strauss, 2004). The strain on the pelvic flow muscles is even worse when a woman is giving birth to a large baby because giving birth to a large baby alone exerts more pressure and may cause more traumas to the muscles and nerves in the pelvic floor (Handa et al., 1996; Holroyd-Leduc and Strauss, 2004). In the current study, 40% of the women with UI had delivered a big baby (>4 kg). "
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    ABSTRACT: Urinary incontinence (UI) is still a common chronic health problem affecting physical, psychological and social well-being of women in developing countries. UI is a challenge to women's health because of the number affected and lack of access to affordable care that can cure or relieve associated symptoms especially in resource limited settings. This study explored the prevalence of UI and assessed effectiveness of a Video Assisted Teaching Program for Kegel's Exercises (VATPKE) in reducing severity of UI symptoms among community dwelling women. A survey was used to obtain data from a sample of 598 community dwelling Indian women in Coimbatore district in Tamilnadu State. A pre–posttest design was then used to assess effectiveness of the VATPKE in reducing UI symptom severity in affected women. Data were analysed using a paired samples t-test. Of the 598 women, 202 (34%) reported having some level of UI and most participants affected were married (78%), less educated (56%), had high BMI (52%) and lower socio-economic status. Affected women mostly reported the severity level of UI symptoms at pre-intervention as moderate (78%) or mild (22%).The mean post-intervention UI symptoms severity score (M = 21·72, SD = 3·99) was lower than pre- intervention (M = 29·91, SD = 5·12) and paired t-test results showed that the difference was highly statistically significant (p < 0·00). The VATPKE used in this study was effective in reducing the severity of self-reported UI symptoms in community dwelling Indian women.
    Full-text · Article · Oct 2012 · International Journal of Urological Nursing
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