Pelvic floor injury during vaginal birth is life-altering and preventable: what can we do about it?

DeLancey, John O.L.; Masteling, Mariana; Pipitone, Fernanda; LaCross, Jennifer; Mastrovito, Sara; Ashton-Miller, James A.

doi:10.1016/j.ajog.2023.11.1253

Cited by 9 publications

(4 citation statements)

References 108 publications

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“…Pelvic floor muscle injuries during childbirth often lead to disorders that impair the quality of life for women [1]. Muscle damage implies macrophage and satellite cell interactions, among other cell types that regulate degeneration and regeneration processes in PFM [9].…”

Section: Discussionmentioning

confidence: 99%

“…Aging and childbirth are often reported as the main risk factors that weaken PFM. Vaginal birth is considered the leading risk factor, because the passage of the fetal head is associated with exceptional force on, and overstretching, of the PFM [1]. This may lead to their rupture or avulsion [2].…”

Section: Introductionmentioning

confidence: 99%

“…This may lead to their rupture or avulsion [2]. Therefore, childbirth-induced PFM injuries imply neuromuscular and supportive impairments that are prone to the onset of urogynecological disorders like POP or SUI [1][2][3][4][5][6]. In this regard, three-dimensional computer models and magnetic resonance imaging have been able to predict the overstretching of pelvic and perineal muscles, tendons or connective tissue, and nerves [1].…”

Section: Introductionmentioning

confidence: 99%

“…The rate of women diagnosed with puborectalis trauma increases four-fold from pregnancy to the first five days postpartum, matching the enlargement of the levator hiatus [4]. Some of the latter morphometry defects in PFM and functional outcomes coming from neurophysiological outcomes (i.e., evaluation of neuromuscular reflexes and muscle strength) are considered indicators of muscle damage [1,7]. Following metabolic and physical insults, skeletal muscle degeneration and regeneration phases, which comprise orchestrated processes involving injured myofibers, fibroblasts, satellite cells, and infiltrated immune cells, among other cell types [8], lead to muscle recovery [9].…”

Section: Introductionmentioning

confidence: 99%

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Shift from Pro- to Anti-Inflammatory Phase in Pelvic Floor Muscles at Postpartum Matches Histological Signs of Regeneration in Multiparous Rabbits

Rodríguez-Benítez,

López-García,

Xelhuantzi

et al. 2024

Medicina

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Background and Objectives: Pelvic floor muscles (PFM) play a core role in defecation and micturition. Weakening of PFM underlies urogynecological disorders such as pelvic organ prolapse and stress urinary incontinence. Vaginal delivery damages PFM. Muscle trauma implies an inflammatory response mediated by myeloid cells, essential for subsequent recovery. Molecular signaling characterizing the pro-inflammatory phase shifts M1 macrophages to M2 macrophages, which modulate muscle repair. The present study aimed to evaluate histological characteristics and the presence of M1 and M2 macrophages in bulbospongiosus (Bsm) and pubococcygeus muscles (Pcm). Materials and Methods: Muscles from young nulliparous (N) and multiparous rabbits on postpartum days three (M3) and twenty (M20) were excised and histologically processed to measure the myofiber cross-sectional area (CSA) and count the centralized myonuclei in hematoxylin-eosinstained sections. Using immunohistochemistry, M1 and M2 macrophages were estimated in muscle sections. Kruskal–Wallis or one-way ANOVA testing, followed by post hoc tests, were conducted to identify significant differences (p < 0.05). Results: The myofiber CSA of both the Bsm and Pcm of the M3 group were more extensive than those of the N and M20 groups. Centralized myonuclei estimated in sections from both muscles of M20 rabbits were higher than those of N rabbits. Such histological outcomes matched significant increases in HLA-DR immunostaining in M3 rabbits with the CD206 immunostaining in muscle sections from M20 rabbits. Conclusions: A shift from the pro- to anti-inflammatory phase in the bulbospongiosus and pubococcygeus muscles of multiparous rabbits matches with centralized myonuclei, suggesting the ongoing regeneration of muscles.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Shift from Pro- to Anti-Inflammatory Phase in Pelvic Floor Muscles at Postpartum Matches Histological Signs of Regeneration in Multiparous Rabbits

Rodríguez-Benítez,

López-García,

Xelhuantzi

et al. 2024

Medicina

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Up for the tackle? The pelvic floor and rugby. A review

Donnelly,

Bø,

Forner

et al. 2024

European Journal of Sport Science

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The pelvic floor and its associated disorders are a unique and often overlooked aspect of women's rugby. This review discusses relevant biopsychosocial considerations specific to the pelvic floor and rugby. Pelvic floor disorders can present at any time across the female lifespan but are more prevalent during pregnancy and postpartum. This is due to the substantial physiological and anatomical changes experienced during pregnancy and vaginal childbirth. Consequently, pelvic floor disorders can impact a player's ability to perform, maintain engagement with, or return to, rugby due to symptoms. Players need to be informed, supported, and guided through focused pelvic floor muscle training to condition the muscles and ‘ready’ them for the varied demands of rugby. Health and fitness professionals should understand the risk of pelvic floor disorders across the female lifespan and screen players for symptoms when supporting them to maintain or return to rugby. Rugby players who are symptomatic of pelvic floor disorders should be signposted to specialist services and/or resources to manage their symptoms. Once engaging in rugby training, ongoing evaluation of player load tolerance and implementation of individualized strategies to support managing rugby‐related loads to the pelvic floor should be considered. Finally, surveillance and research focusing specifically on rugby players and pelvic floor function are needed.

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Parturition at term: induction, second and third stages of labor, and optimal management of life-threatening complications—hemorrhage, infection, and uterine rupture

Romero,

Sabo Romero,

Kalache

et al. 2024

American Journal of Obstetrics and Gynecology

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Pelvic floor injury during vaginal birth is life-altering and preventable: what can we do about it?

Cited by 9 publications

References 108 publications

Shift from Pro- to Anti-Inflammatory Phase in Pelvic Floor Muscles at Postpartum Matches Histological Signs of Regeneration in Multiparous Rabbits

Shift from Pro- to Anti-Inflammatory Phase in Pelvic Floor Muscles at Postpartum Matches Histological Signs of Regeneration in Multiparous Rabbits

Up for the tackle? The pelvic floor and rugby. A review

Parturition at term: induction, second and third stages of labor, and optimal management of life-threatening complications—hemorrhage, infection, and uterine rupture

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