Evaluating the Pelvic Floor in Obstetric Patients

Abstract

Up to 40% of vaginal deliveries lead to pelvic floor denervation. This has been linked causally with the later occurrence of urinary incontinence, faecal incontinence and vaginal prolapse. Pelvic floor position, anal sphincter pressures and anal electrosensitivity were evaluated in 72 volunteers as simple screening tests for detecting patients who might benefit from neurological assessment. A lower perineum and reduced voluntary sphincter pressures were found antenatally in parous women when compared with nulliparas. The tests were repeated postnatally 24 to 72 hours after delivery. When compared with antenatal readings, the perineum was lower and sphincter pressures were reduced in subjects delivered vaginally. Forty one subjects were reexamined after 6-8 weeks and partial recovery was found. Anal squeeze pressures and pelvic floor position when straining were the results most consistently changed. On the basis of this study it is suggested that 28% of multiparas seen anrenatally and between 25% to 30% of all women who deliver vaginally may be eligible for more detailed neurological study.

Development of a dynamometer for measuring the isometric force of the pelvic floor musculature

“…2. The new dynamometer is designed to take direct measurements of the pelvic £oor passive strength (baseline or passive resistance given by the PFM) at a given opening of the speculum.Introital vaginalaperture isoften increased after vaginal delivery [Small and Wynne, 1990] and is associated with a reduction in PFM strength [Schussler and Anthuber, 1994]. The evaluation of PFM passive strength at a given introital vaginal antero-posterior diameter (Fig.…”

The effects of childbirth on the pelvic-floor

“…Descent of the perineum six to eight weeks postpartum during rest or during straining was observed by several investigators [49,52,55]. Simultaneously there was a considerable decrease in strength of contraction assessed with vaginal cones [43], intravaginal squeeze pressure measurements [36,44] and with a digital muscle strength score [45].…”

Périnée et grossesse

“…Snooks et al retrouvent une descente périnéale à l'effort majorée juste après l'accouchement, avec un retour progressif aux valeurs prénatales après cinq ans [42]. Cette récupération est confirmée par d'autres [51,83].…”