Pregnancy, Obstetric Trauma and Their Effects on the Pelvic Floor. Literature Review
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Author Biographies
Diana Catalina Jaramillo González, Pontifical Bolivarian University
Gynecology and Obstetrics Resident. Pontifical Bolivarian University, Medellín, Colombia.
Mauricio Gómez Londoño, Pontifical Bolivarian University
Gynecology and Obstetrics. Universidad Pontificia Bolivariana, Medellín, Colombia. Subspecialist in urogynecology, Universidad Chile, Santiago de Chile, Chile.
Luis Guillermo Echavarría Restrepo, Pontifical Bolivarian University
Gynecology and Obstetrics. Pontifical Bolivarian University. Master in Epidemiology. CES University. Medellin Colombia.
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Abstract
Pelvic floor disorders are a medical condition that affects 30% of women of all ages, and include a plethora of anatomical and functional pathologies that, though they do not alter patient survival, do affect their well-being to a large extent. Urinary and fecal incontinence, pelvic organ prolapse and sexual dysfunction are among these pathologies. The importance of the subject rests on the fact that pelvic floor disorders are more frequent after pregnancy and birth as a result of inherent changes to pregnancy itself and obstetric injuries that are widely known risk factors, which may be associated to severe damage to the pelvic floor. Therefore, possible labor complications that may increase the risk of pelvic floor disorders must be prevented, along with the implementation of certain preventive strategies and safe interventions that reduce damage and possible long-term consequences. Here, we present a literature review about the physiological changes in the pelvic floor during pregnancy, the most frequent dysfunctional disorders, the role of forceps delivery in the appearance of different conditions, and preventive strategies that may be implemented to reduce the effects on the pelvic floor.
References
Fialkow MF, Melville JL, Lentz GM, Miller EA, Miller J, Fenner DE. The functional and psychosocial impact of fecal incontinence on women with urinary incontinence. Am J Obstet Gynecol. 2003; 189:127-129.
Handa VL, Zyczynski HM, Burgio KL, Fitzgerald MP, Borello-France D, Janz NK, et al. The impact of fecal and urinary incontinence on quality of life 6 months after childbirth. Am J Obstet Gynecol. 2007; 197:636.e1-6.
Koc O, Duran B, Ozdemırcı S, Bakar Y, Ozengin N. Is cesarean section a real panacea to prevent pelvic organ disorders? Int Urogynecology J. 2011; 22:1135-1141.
Sung VW, Hampton BS. Epidemiology of pelvic floor dysfunction. Obstet Gynecol Clin North Am. 2009; 36:421-443.
Walker GJA, Gunasekera P. Pelvic organ prolapse and incontinence in developing countries: Review of prevalence and risk factors. Int Urogynecology J. 2011; 22:127-135.
Carrera JM, Devesa N, Chacón D, Cararach V, Fabre E, Foradada CM, et al. Mortalidad materna en África. Progresos Obstet Ginecol. 2007; 50:405-419.
Lavender T, Hofmeyr GJ, Neilson JP, Kingdon C, Gyte GM. Caesarean section for non-medical reasons at term. Cochrane Database Syst Rev. 2012 Mar 14;3:CD004660.
Ecker J. Elective cesarean delivery on maternal request. JAMA. 2013; 309:1930-1936.
MacDorman MF, Menacker F, Declercq E. Cesarean birth in the United States: Epidemiology, trends, and outcomes. Clin Perinatol. 2008; 35:293-307.
Ceriani Cernadas JM, Mariani G, Pardo A, Aguirre A, Pérez C, Brener P, et al. Nacimiento por cesárea al término en embarazos de bajo riesgo: efectos sobre la morbilidad neonatal. Arch Argent Pediatría. 2010; 108:17-23.
Van Ham MA, van Dongen PW, Mulder J. Maternal consequences of caesarean section. A retrospective study of intra-operative and postoperative maternal complications of caesarean section during a 10-year period. Eur J Obstet Gynecol Reprod Biol. 1997; 74:1-6.
Obstetricia y Ginecología. Texto integrado. 8. ed. Medellín: CIB; 2008.
Weiner S, Monge J, Mann A. Bipedalism and parturition: An evolutionary imperative for cesarean delivery? Clin Perinatol. 2008; 35:469-478.
Petros PE, Ulmsten UI. An integral theory and its method for the diagnosis and management of female urinary incontinence. Scand J Urol Nephrol Suppl. 1993; 153:1-93.
Friedman S, Blomquist JL, Nugent JM, McDermott KC, Muñoz A, Handa VL. Pelvic muscle strength after childbirth. Obstet Gynecol. 2012; 120:1021-1028.
Bump RC, Norton PA. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am. 1998; 25:723-746.
Herbert J. Pregnancy and childbirth: the effects on pelvic floor muscles. Nurs Times. 2009; 105:38-41.
Stuge B, Mørkved S, Dahl HH, Vøllestad N. Abdominal and pelvic floor muscle function in women with and without long lasting pelvic girdle pain. Man Ther. 2006; 11:287-296.
Machin SE, Mukhopadhyay S. Pelvic organ prolapse: review of the aetiology, presentation, diagnosis and management. Menopause Int. 2011; 17:132-136.
Eskandar O, Shet D. Risk factors for 3rd and 4th degree perineal tear. J Obstet Gynaecol J Inst Obstet Gynaecol. 2009; 29:119-122.
Rortveit G, Subak LL, Thom DH, Creasman JM, Vittinghoff E, Van Den Eeden SK, et al. Urinary incontinence, fecal incontinence and pelvic organ prolapse in a population-based, racially diverse cohort: prevalence and risk factors. Female Pelvic Med Reconstr Surg. 2010; 16:278-283.
Lavy Y, Sand PK, Kaniel CI, Hochner-Celnikier D. Can pelvic floor injury secondary to delivery be prevented? Int Urogynecology J. 2012; 23:165-173.
Valsky DV, Lipschuetz M, Bord A, Eldar I, Messing B, Hochner-Celnikier D, et al. Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women. Am J Obstet Gynecol. 2009; 201:91.e1-7.
International Continence Society [sede Web]. Bristol, UK: ICS; [fecha de acceso 27 de abril de 2013]. Disponible en: http://www.ics.org/
Stothers L, Friedman B. Risk factors for the development of stress urinary incontinence in women. Curr Urol Rep. 2011; 12:363-369.
Hvidman L, Foldspang A, Mommsen S, Nielsen JB. Postpartum urinary incontinence. Acta Obstet Gynecol Scand. 2003; 82:556-563.
Press JZ, Klein MC, Kaczorowski J, Liston RM, von Dadelszen P. Does cesarean section reduce postpartum urinary incontinence? A systematic review. Birth Berkeley Calif. 2007; 34:228-237.
Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med. 2003; 348:900-907.
Wesnes SL, Hunskaar S, Bo K, Rortveit G. The effect of urinary incontinence status during pregnancy and delivery mode on incontinence postpartum. A cohort study. BJOG Int J Obstet Gynaecol. 2009; 116:700-707.
Boyles SH, Li H, Mori T, Osterweil P, Guise J-M. Effect of mode of delivery on the incidence of urinary incontinence in primiparous women. Obstet Gynecol. 2009; 113:134-141.
Baydock SA, Flood C, Schulz JA, MacDonald D, Esau D, Jones S, et al. Prevalence and risk factors for urinary and fecal incontinence four months after vaginal delivery. J Obstet Gynaecol Can. 2009; 31:36-41.
Hannah ME, Whyte H, Hannah WJ, Hewson S, Amankwah K, Cheng M, et al. Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial. Am J Obstet Gynecol. 2004; 191:917- 927.
Hannah ME, Hannah WJ, Hodnett ED, Chalmers B, Kung R, Willan A, et al. Outcomes at 3 months after planned cesarean vs planned vaginal delivery for breech presentation at term: the international randomized Term Breech Trial. JAMA. 2002; 287:1822-1831.
Mant J, Painter R, Vessey M. Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study. Br J Obstet Gynaecol. 1997; 104:579-585.
Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Initiative: Gravity and gravidity. Am J Obstet Gynecol. 2002; 186:1160-1166.
Weber AM. Elective cesarean delivery: the pelvic perspective. Clin Obstet Gynecol. 2007; 50:510- 517.
Dietz HP. Pelvic floor trauma in childbirth. Aust N Z J Obstet Gynaecol. 2013; 53:220-230.
Van Brummen HJ, Bruinse HW, van de Pol G, Heintz APM, van der Vaart CH. Defecatory symptoms during and after the first pregnancy: prevalences and associated factors. Int Urogynecol J Pelvic Floor Dysfunct. 2006; 17:224-230.
Quigley EMM. Impact of pregnancy and parturition on the anal sphincters and pelvic floor. Best Pract Res Clin Gastroenterol. 2007; 21(5):879-891.
Faltin DL, Otero M, Petignat P, Sangalli MR, Floris LA, Boulvain M, et al. Women’s health 18 years after rupture of the anal sphincter during childbirth: I. Fecal incontinence. Am J Obstet Gynecol. 2006; 194:1255-1259.
Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. N Engl J Med. 1993; 329:1905-1911.
Bansal RK, Tan WM, Ecker JL, Bishop JT, Kilpatrick SJ. Is there a benefit to episiotomy at spontaneous vaginal delivery? A natural experiment. Am J Obstet Gynecol. 1996; 175:897-901.
Zetterström J, López A, Anzén B, Norman M, Holmström B, Mellgren A. Anal sphincter tears at vaginal delivery: risk factors and clinical outcome of primary repair. Obstet Gynecol. 1999; 94:21-28.
Pelvic floor disorders associated with pregnancy and childbirth [Internet]. [fecha de acceso 28 de abril de 2013]. Disponible en: http://www.uptodate.com/contents/pelvic-floor-disordersassociated-with-pregnancy-and-childbirth
Kudish B, Blackwell S, Mcneeley SG, Bujold E, Kruger M, Hendrix SL, et al. Operative vaginal delivery and midline episiotomy: A bad combination for the perineum. Am J Obstet Gynecol. 2006; 195:749-754.
Argentine Episiotomy Trial Collaborative Group. Routine vs selective episiotomy: A randomised controlled trial. Lancet. 1993; 342:1517-1518.
Dumoulin C. Postnatal pelvic floor muscle training for preventing and treating urinary incontinence: where do we stand? Curr Opin Obstet Gynecol. 2006; 18:538-543.
Beckmann MM, Garrett AJ. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev Online. 2006; 1:CD005123.
Wheeler TL 2nd, Richter HE. Delivery method, anal sphincter tears and fecal incontinence: New information on a persistent problem. Curr Opin Obstet Gynecol. 2007; 19:474-479.
Borello-France D, Burgio KL, Richter HE, Zyczynski H, Fitzgerald MP, Whitehead W, et al. Fecal and urinary incontinence in primiparous women. Obstet Gynecol. 2006; 108:863-872.