Childbirth and pelvic floor dysfunction: An epidemiologic approach to the assessment of prevention opportunities at delivery

Abstract

Female pelvic floor dysfunction is integral to the woman's role in the reproductive process, largely because of the unique anatomic features that facilitate vaginal birth and also because of the trauma that can occur during that event. Interventions such as primary elective cesarean delivery have been discussed for the primary prevention of pelvic floor dysfunction; however, existing data about potentially causal factors limit our ability to evaluate such strategies critically. Here we consider the conceptual principles of epidemiologic function and the availability of data that are necessary to make informed recommendations about prevention opportunities for pelvic floor dysfunction at delivery. Available epidemiologic data on pelvic floor dysfunction suggest that there may be substantial opportunities for the primary prevention of pelvic organ prolapse at delivery. Although definitive recommendations await further epidemiologic studies of the potential risk and benefits of obstetric practice change, it is hoped that this discussion will provide a novel, quantitative framework for the assessment of pelvic floor dysfunction prevention opportunities.

Vaginal Birth and De Novo Stress Incontinence

“…But, since approximately 1 in 10 women will develop pelvic floor dysfunction, 9 women would be subjected to the risks of the preventive intervention (cesarean birth) for every one woman whose future pelvic floor dysfunction would be prevented. (28) This research, by identifying impairments in urethral function and mobility, can lead to further studies designed to evaluate the effect of delivery mode and obstetrical factors on urethral closure pressure and urethral mobility. Eventually we hope to identify risk factors that may direct targeted injury prevention strategies.…”

Relação entre a pressão muscular perineal no puerpério e o tipo de parto

“…O processo reprodutivo nas mulheres exerce papel preponderante nas disfunções do assoalho pélvico, na maioria das vezes por causa das características anatômicas originais que facilitam o nascimento por via vaginal e, também, por causa do trauma que pode ocorrer durante esse evento 3 .…”

Biomechanical properties of the vaginal wall: effect of pregnancy, elastic fiber deficiency, and pelvic organ prolapse

“…Yet, numerous epidemiologic studies suggest that many women fail to completely recover from this event; indeed, vaginal distention trauma appears to play an important role in the etiology of pelvic organ prolapse with vaginal delivery conferring a 4-to 11-fold increase in the risk of developing prolapse (1,2). In women with overt prolapse of the vaginal vault, there is pathologic distention of the vagina that fails to spontaneously recover and often progresses to a larger and more symptomatic bulge.…”