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prevention pelvic floor injury delivery

Xiani Yan, Jennifer A Kruger, Xinshan Li, Poul M F Nielsen, Martyn P Nash
Vaginal delivery is the primary cause of levator ani muscle injury, which is in turn the leading factor contributing to pelvic floor disorders including pelvic organ prolapse and urinary stress incontinence. Existing biomechanical models of childbirth have provided some understanding of pelvic floor function during delivery and have helped in the investigation of preventative strategies. The modeling frameworks for childbirth simulation are described with emphasis on (1) the recent advances in medical imaging quality and computational power; (2) improvements in the anatomical representation of the pelvic floor and fetal head; (3) more realistic boundary conditions for delivery; and (4) mechanical properties determined from experiments...
November 2016: Wiley Interdisciplinary Reviews. Systems Biology and Medicine
(no author information available yet)
Lacerations are common after vaginal birth. Trauma can occur on the cervix, vagina, and vulva, including the labial, periclitoral, and periurethral regions, and the perineum. Most of these lacerations do not result in adverse functional outcomes. Severe perineal lacerations, extending into or through the anal sphincter complex, although less frequent, are more commonly associated with increased risk of pelvic floor injury, fecal and urinary incontinence, pain, and sexual dysfunction with symptoms that may persist or be present many years after giving birth...
July 2016: Obstetrics and Gynecology
(no author information available yet)
Lacerations are common after vaginal birth. Trauma can occur on the cervix, vagina, and vulva, including the labial, periclitoral, and periurethral regions, and the perineum. Most of these lacerations do not result in adverse functional outcomes. Severe perineal lacerations, extending into or through the anal sphincter complex, although less frequent, are more commonly associated with increased risk of pelvic floor injury, fecal and urinary incontinence, pain, and sexual dysfunction with symptoms that may persist or be present many years after giving birth...
July 2016: Obstetrics and Gynecology
Mélodie Mathé, Guy Valancogne, Anthony Atallah, Clémentine Sciard, Muriel Doret, Pascal Gaucherand, Etienne Beaufils
OBJECTIVES: Between 0.5 and 5% of vaginal deliveries involve obstetrical anal sphincter injuries (OASIS). Thirty to forty percent of patients with OASIS will suffer from anal incontinence in the subacute postpartum period. The aim of the present study was to assess the effectiveness of early pelvic floor muscle training (PFMT) combined with standard rehabilitation on anal incontinence after vaginal deliveries complicated by OASIS. STUDY DESIGN: The present work was a retrospective quantitative study performed in a tertiary-level maternity hospital...
April 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Dan V Valsky, Sarah M Cohen, Michal Lipschuetz, Drorith Hochner-Celnikier, Hagit Daum, Itai Yagel, Simcha Yagel
OBJECTIVES: We evaluated primiparous women with clinically diagnosed third- and fourth-degree and anal sphincter tears, to evaluate the rate of levator ani muscle injury compared to primiparous women without sphincter tears. METHODS: Primiparous women delivering in our maternity ward with intrapartum diagnoses of third- or fourth-degree anal sphincter tears, repaired by the overlapping technique, were recruited to undergo 3-dimensional transperineal sonography of the pelvic floor anatomy, including the anterior and posterior compartments...
April 2016: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
I Kamisan Atan, K L Shek, S Langer, R Guzman Rojas, J Caudwell-Hall, J O Daly, H P Dietz
OBJECTIVE: Vaginal childbirth may result in levator ani injury secondary to overdistension during the second stage of labour. Other injuries include perineal and anal sphincter tears. Antepartum use of a birth trainer may prevent such injuries by altering the biomechanical properties of the pelvic floor. This study evaluates the effects of Epi-No(®) use on intrapartum pelvic floor trauma. DESIGN: Multicentre prospective randomised controlled trial. SETTING: Two tertiary obstetric units in Australia...
May 2016: BJOG: An International Journal of Obstetrics and Gynaecology
Paige V Tracy, John O DeLancey, James A Ashton-Miller
Because levator ani (LA) muscle injuries occur in approximately 13% of all vaginal births, insights are needed to better prevent them. In Part I of this paper, we conducted an analysis of the bony and soft tissue factors contributing to the geometric "capacity" of the maternal pelvis and pelvic floor to deliver a fetal head without incurring stretch injury of the maternal soft tissue. In Part II, we quantified the range in demand, represented by the variation in fetal head size and shape, placed on the maternal pelvic floor...
February 2016: Journal of Biomechanical Engineering
H B G Franz, C Erxleben, A Franz, R Hofmann
In order to avoid pelvic floor injuries a caesarean section is on the one hand often requested by the pregnant women and, on the other hand, offered by obstetric staff. For both forms of delivery, comprehensive risk-benefit analyses should be carried out before deciding in favour of the surgical procedure. The present brief review summarizes the current evidence on the avoidance of pelvic floor injuries.
September 2012: Geburtshilfe und Frauenheilkunde
Heidi F A Moossdorff-Steinhauser, Pytha Albers-Heitner, Mirjam Weemhoff, Marc E A Spaanderman, Fred H M Nieman, Bary Berghmans
OBJECTIVE: Pregnancy and delivery are the most prominent risk factors for the onset of pelvic floor injuries and - later-on - urinary incontinence. Supervised pelvic floor muscle training during and after pregnancy is proven effective for the prevention of urinary incontinence on the short term. However, only a minority of women do participate in preventive pelvic floor muscle training programs. Our aim was to analyze willingness to participate (WTP) in an intensive preventive pelvic floor muscle training (PFMT) program and influencing factors, from the perspective of postpartum women, for participation...
December 2015: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Michał Chojnacki, Dariusz Borowski, Mirosław Wielgoś, Piotr Węgrzyn
Levator ani muscle (LAM) injuries are much more frequent than trauma to sphincter ani muscles, but so far they have been omitted in obstetric handbooks. Levator ani avulsion is observed only after vaginal delivery. Forceps delivery second stage of labor ≥ 110 min., fetal head circumference ≥ 35 cm, episiotomy and coincidence of anal sphincter trauma are risk factors for levator ani avulsion. The most vital issue in that type of trauma is pelvic organ prolapse and 2-4-fold higher risk of recurrence after prolapse surgery...
January 2015: Ginekologia Polska
I Michalec, M Tomanová, M Navrátilová, O Šimetka, M Procházka
OBJECTIVE: The evaluation of the risk and protective factors for pelvic floor trauma in relation to vaginal delivery. DESIGN: Review. SETTING: Department of Obstetrics and Gynecology, University Hospital of Ostrava. METHODOLOGY AND RESULTS: The aim was to provide a comprehensive survey of studies focused on risk factors for pelvic floor trauma following vaginal delivery; and to constitute the relationship between the risk and protective factors and levator ani injury...
January 2015: Ceská Gynekologie
Guri Rørtveit, Yngvild S Hannestad
BACKGROUND: Normal vaginal delivery can cause significant strain on the pelvic floor. We present a review of the current knowledge on vaginal delivery as a risk factor for urinary incontinence and pelvic organ prolapse compared to caesarean section. MATERIAL AND METHOD: We conducted a literature search in PubMed with an emphasis on systematic review articles and meta-analyses. The search was completed in January 2014. We also included articles from our own literature archives...
October 14, 2014: Tidsskrift for Den Norske Lægeforening: Tidsskrift for Praktisk Medicin, Ny Række
Adil E Bharucha, J G Fletcher, L Joseph Melton, Alan R Zinsmeister
OBJECTIVES: Current concepts based on referral center data suggest that pelvic floor injury from obstetric trauma is a major risk factor for fecal incontinence (FI) in women. In contrast, a majority of community women only develop FI decades after vaginal delivery, and obstetric events are not independent risk factors for FI. However, obstetric events are imperfect surrogates for anal and pelvic floor injury, which is often clinically occult. Hence, the objectives of this study were to evaluate the relationship between prior obstetric events, pelvic floor injury, and FI among community women...
June 2012: American Journal of Gastroenterology
N Schwertner-Tiepelmann, R Thakar, A H Sultan, R Tunn
Levator ani muscle (LAM) injuries occur in 13-36% of women who have a vaginal delivery. Although these injuries were first described using magnetic resonance imaging, three-dimensional transperineal and endovaginal ultrasound has emerged as a more readily available and economic alternative to identify LAM morphology. Injury to the LAM is attributed to vaginal delivery resulting in reduced pelvic floor muscle strength, enlargement of the vaginal hiatus and pelvic organ prolapse. There is inconclusive evidence to support an association between LAM injuries and stress urinary incontinence and there seems to be a trend towards the development of fecal incontinence...
April 2012: Ultrasound in Obstetrics & Gynecology
D Cvetkov, Sv Stoykov, Ad Lukanovic
Most women which give birth vaginally, undergo some form of perineal trauma. Although cesarean section is the only alternative for avoiding vaginal birth, it is associated with a certain percentage of morbidity and mortality. Therefore it is imperative to make every effort to minimize perineal trauma and make vaginal delivery safer. In this review we try to promote safe obstetric practices and preventive steps in the form of algorithm, established in the light of the best theoretical and practical evidence to minimize perineal lacerations and obstetrics damage the anal sphincter...
2011: Akusherstvo i Ginekologii︠a︡
Yuval Lavy, Peter K Sand, Chava I Kaniel, Drorith Hochner-Celnikier
The number of women suffering from pelvic floor disorders (PFD) is likely to grow significantly in the coming years with a growing older population. There is an urgent need to investigate factors contributing to the development of PFD and develop preventative strategies. We have reviewed the literature and analyzed results from our own study regarding the association between delivery mode, obstetrical practice and fetal measurements, and damage to the pelvic floor. Based on our findings, we have suggested a flowchart helping the obstetrician to conduct vaginal delivery with minimal pelvic floor insult...
February 2012: International Urogynecology Journal
Cetin Cam, Mehmet Resit Asoglu, Selcuk Selcuk, Turan Aran, Niyazi Tug, Ates Karateke
OBJECTIVE: This retrospective study investigates the effects of mediolateral episiotomy on the pelvic floor. METHODS: Premenopausal women suffering from urinary incontinence/genital prolapse who delivered only by vaginal route were enrolled into the study. History of diabetes, morbid obesity (BMI > 40 kg/m(2)), vacuum/forceps extraction, perineal lacerations that warranted repair during labor and any pelvic surgery were the exclusion criteria. Evaluation of the patients included pelvic organ prolapse quantification scores, presence of stress incontinence, urethral hypermobility, and questionnaires were obtained for overactive bladder and anal incontinence symptoms...
February 2012: Archives of Gynecology and Obstetrics
Pauliina Aukee, Kati Tihtonen
Pregnancy and vaginal delivery affect pelvic floor by increased intra-abdominal pressure, direct muscle trauma, nerve injury and connective tissue damage. Even if pelvic floor dysfunction is more common after vaginal delivery compared to cesarean section, the differences are less clear after long-term follow up. This implies that other factors such as age, estrogen levels, genetic factors and overweight have also a role in the pathophysiology of pelvic floor dysfunctions. It is possible to prevent some of the birth injuries by careful obstetric management...
2010: Duodecim; Lääketieteellinen Aikakauskirja
X Fritel
Congenital factor, obesity, aging, pregnancy and childbirth are the main risk factors for female pelvic floor disorders (urinary incontinence, anal incontinence, pelvic organ prolapse, dyspareunia). Vaginal delivery may cause injury to the pudendal nerve, the anal sphincter, or the anal sphincter. However the link between these injuries and pelvic floor symptoms is not always determined and we still ignore what might be the ways of prevention. Of the many obstetrical methods proposed to prevent postpartum symptoms, episiotomy, delivery in vertical position, delayed pushing, perineal massage, warm pack, pelvic floor rehabilitation, results are disappointing or limited...
May 2010: Gynécologie, Obstétrique & Fertilité
Ana Maria Hernández-González
Uterine prolapse consists of a falling or sliding of the uterus from its normal position in the pelvic cavity inside the vagina and is one of the most frequent alterations secondary to pelvic floor dysfunction in gynecology consultations. Although patients are reluctant to talk about this sensitive issue, they complain of feeling a lump in their genitals, urinary incontinence, and problems in their sexual relations. In fact, uterine prolapse is not a disease but an alteration of the elements suspending and containing the uterus, which are almost always injured by pregnancy and childbirth...
November 2008: Enfermería Clínica
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