Pelvic floor muscle strength and the incidence of pelvic floor disorders after vaginal and cesarean delivery

Blomquist, Joan L.; Carroll, Matthew S.; Muñoz, Álvaro; Handa, Victoria L.

doi:10.1016/j.ajog.2019.08.003

Cited by 79 publications

(79 citation statements)

References 22 publications

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“…This observation suggests that vaginal delivery contributes to PFM damage in the recent postpartum period, which is consistent with findings of previous reports (15,16). Notably, PFM strength was found to show a marked association with a shorter time to PFD in women who had at least 1 vaginal delivery; the same association was not observed in women who delivered by cesarean section (17). However, Afshari et al (18) discovered no significant differences in the strength of the PFM with normal vaginal delivery compared to cesarean section.…”

Section: Discussionsupporting

confidence: 92%

Short-term effects of delivery methods on postpartum pelvic floor function in primiparas: a retrospective study

Zhang

Wang

et al. 2021

Ann Palliat Med

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Background: The present study sought to investigate the short-term effects of different delivery methods on postpartum pelvic floor function in Chinese primiparas. Methods: Primiparous women who delivered a full-term, cephalic, singleton infant at our hospital between January 1, 2018 and August 15, 2019 were recruited into this study. All women underwent pelvic floor function screening at 6-8 weeks postpartum. Tests included postpartum Pelvic Organ Prolapse Quantification (POP-Q) score, incidence of urinary incontinence, pelvic floor muscle (PFM) strength, and Pelvic Floor Distress Inventory Questionnaire-Short Form 20 (PFDI-20) score.Results: A total of 284 postpartum women were recruited into the study. Of the participants, 147 had undergone vaginal delivery, 37 had undergone intrapartum cesarean delivery (ICD), and 100 had undergone elective cesarean delivery (ECD). Points Aa, Ba, Ap, and Bp showed a greater degree of prolapse in the vaginal delivery group than in the ECD group (P≤0.05). UI was less prevalent in ECD group relative to the vaginal delivery group (P≤0.05). Tonic PFM contraction was weaker in the vaginal delivery group than in the ECD and ICD groups (P≤0.05). Significant differences were also observed between the vaginal delivery group and the ECD group with respect to PFDI-20 scores (P≤0.05).Conclusions: Compared with vaginal delivery, ECD was strongly linked to a lower risk of pelvic organ prolapse (POP) and UI, stronger tonic PFM strength, and lower PFDI-20 scores. ECD confers relatively better protection against pelvic floor dysfunction (PFD) than does ICD.

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Section: Discussionsupporting

confidence: 92%

Short-term effects of delivery methods on postpartum pelvic floor function in primiparas: a retrospective study

Zhang

Wang

et al. 2021

Ann Palliat Med

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“…PFM dysfunction has been consistently identified as one of the leading risk factors for the development of symptomatic pelvic floor disorders (5,6).…”

Section: Introductionmentioning

confidence: 99%

Pro-regenerative Extracellular Matrix Hydrogel Prevents and Mitigates Pathological Alterations of Pelvic Muscles Following Birth Injury

Duran

Burnett

et al. 2021

Preprint

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Pelvic floor disorders, which include pelvic organ prolapse, and urinary and fecal incontinence, affect millions of women globally and represent a major public health concern. Pelvic floor muscle (PFM) dysfunction has been identified as one of the leading risk factors for the development of these morbid conditions. Even though childbirth, specifically vaginal delivery, has been long recognized as the most important potentially modifiable risk factor for PFM injury, the precise mechanisms of PFM dysfunction following childbirth remain elusive. In this study we demonstrate that PFMs undergo atrophy and severe fibrosis in parous women with symptomatic pelvic organ prolapse compared to age-matched nulliparous cadaveric donors without history of pelvic floor disorders. These pathological alterations are recapitulated in the pre-clinical rat model of simulated birth injury. The transcriptional signature of PFMs post-injury demonstrates a sustained inflammatory response, impairment in muscle anabolism, and persistent expression of extracellular matrix (ECM) remodeling genes. Next, we evaluated the administration of acellular injectable skeletal muscle extracellular matrix hydrogel for the prevention and mitigation of these pathological alterations. Treatment of PFMs with the biomaterial either at the time of birth injury or 4 weeks post-injury reduced muscle atrophy and mitigated fibrotic degeneration. By evaluating gene expression, we demonstrate that these changes are mainly driven by the hydrogel-induced modulation of the immune response and intramuscular fibrosis, as well as enhancement of the endogenous myogenesis. This work furthers our understanding of PFM birth injury and demonstrates proof-of-concept for a new pragmatic pro-regenerative biomaterial approach for treating injured PFMs.

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“…This will form the basis of subsequent pelvic floor exercises and is how the woman will learn the different types of muscle contraction which are integral to this. [8] Observation method: This qualitative measure can detect an in drawing of the anus, lifting of the posterior vaginal wall, and narrowing of the vaginal introitus (females). [9] 3.…”

Section: Types Of Pelvic Floor Dysfunctionmentioning

confidence: 99%

“…Positioning of the X-ray camera is of paramount importance as visualization of the buttocks, rectal vault, and lower pelvis is critical. [8] 5. Uroflow test: In the uroflow test, as the mother try to void her bladder.…”

Section: Types Of Pelvic Floor Dysfunctionmentioning

confidence: 99%

Pelvic Floor Dysfunction and Management: Comprehensive Review

Manimegalai¹

2020

IJNMI

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The post-natal period refers to the 6 weeks period after childbirth. In this period, the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically are known as involution of pelvic structures. Women can experience problems during the post-natal period such as tiredness, perineal pain, breast problems, backache, hemorrhoids, constipation, depression, anemia, headache, and pelvic floor dysfunction. At present, pelvic floor dysfunction is becoming a major problem during post-natal period. Pelvic floor dysfunction is a condition where pelvic floor muscles lose its control and relax completely following childbirth which alters the normal bladder and bowel functions during the post-natal period. The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. The functions of the pelvic floor are providing support of abdominopelvic viscera (bladder, intestines, uterus, etc.) through their tonic contraction, maintaining resistance to increases in intra-pelvic/abdominal pressure during activities such as coughing or lifting heavy objects and the muscle fibers have a sphincter action on the rectum and urethra. They relax to allow urination and defecation. [1] defInItIon of PelvIc floor dysfunctIon Pelvic floor dysfunction is the inability to control the muscles of the pelvic floor. [2] causes of PelvIc floor dysfunctIon durIng PuerPerIum Multiparity, it is one of the main causes of pelvic floor disorders. A woman's risk tends to increase the more times she

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Pelvic floor muscle strength and the incidence of pelvic floor disorders after vaginal and cesarean delivery

Cited by 79 publications

References 22 publications

Short-term effects of delivery methods on postpartum pelvic floor function in primiparas: a retrospective study

Short-term effects of delivery methods on postpartum pelvic floor function in primiparas: a retrospective study

Pro-regenerative Extracellular Matrix Hydrogel Prevents and Mitigates Pathological Alterations of Pelvic Muscles Following Birth Injury

Pelvic Floor Dysfunction and Management: Comprehensive Review

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