Hans P Dietz1, Peter D Wilson, Ian Milsom. 1. aDepartment of Obstetrics and Gynecology, Sydney Medical School Nepean, Penrith, Australia bDepartment of Obstetrics and Gynaecology, Otago University, Dunedin, New Zealand cDepartment of Obstetrics & Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Abstract
PURPOSE OF REVIEW: There is increasing awareness of the importance of intrapartum events for future pelvic floor morbidity in women. In this review, we summarize recent evidence and potential consequences for clinical practice. RECENT FINDINGS: Both epidemiological evidence and data from perinatal imaging studies have greatly improved our understanding of the link between childbirth and later morbidity. The main consequences of traumatic childbirth are pelvic organ prolapse (POP) and anal incontinence. In both instances the primary etiological pathways have been identified: levator trauma in the case of POP and anal sphincter tears in the case of anal incontinence. As most such trauma is occult, imaging is required for diagnosis. SUMMARY: Childbirth-related major maternal trauma is much more common than generally assumed, and it is the primary etiological factor in POP and anal incontinence. Both sphincter and levator trauma can now be identified on imaging. This is crucial not only for clinical care and audit, but also for research. Postnatally diagnosed trauma can serve as intermediate outcome measure in intervention trials, opening up multiple opportunities for clinical research aimed at primary and secondary prevention.
PURPOSE OF REVIEW: There is increasing awareness of the importance of intrapartum events for future pelvic floor morbidity in women. In this review, we summarize recent evidence and potential consequences for clinical practice. RECENT FINDINGS: Both epidemiological evidence and data from perinatal imaging studies have greatly improved our understanding of the link between childbirth and later morbidity. The main consequences of traumatic childbirth are pelvic organ prolapse (POP) and anal incontinence. In both instances the primary etiological pathways have been identified: levator trauma in the case of POP and anal sphincter tears in the case of anal incontinence. As most such trauma is occult, imaging is required for diagnosis. SUMMARY: Childbirth-related major maternal trauma is much more common than generally assumed, and it is the primary etiological factor in POP and anal incontinence. Both sphincter and levator trauma can now be identified on imaging. This is crucial not only for clinical care and audit, but also for research. Postnatally diagnosed trauma can serve as intermediate outcome measure in intervention trials, opening up multiple opportunities for clinical research aimed at primary and secondary prevention.
Authors: Hans Peter Dietz; Francesco Scoti; Nishamini Subramaniam; Talia Friedman; Ka Lai Shek Journal: Int Urogynecol J Date: 2018-03-12 Impact factor: 2.894
Authors: Hans Peter Dietz; Martyna Stankiewicz; Ixora Kamisan Atan; Caroline Wanderley Ferreira; Maciej Socha Journal: Int Urogynecol J Date: 2017-07-31 Impact factor: 2.894
Authors: Hans Peter Dietz; Leilani Chavez-Coloma; Talia Friedman; Friyan Turel Journal: Aust N Z J Obstet Gynaecol Date: 2022-01-20 Impact factor: 1.884