Vaginal Childbirth and Pelvic Floor Disorders

Childbirth is an important event in a woman's life. Vaginal childbirth is the most common mode of delivery and it has been associated with increased incidence of pelvic floor disorders later in life. In this article, the authors review and summarize current literature associating pelvic floor disorders with vaginal childbirth. Stress urinary incontinence and pelvic organ prolapse are strongly associated with vaginal childbirth and parity. The exact mechanism of injury associating vaginal delivery with pelvic floor disorders is not known, but is likely multifactorial, potentially including mechanical and neurovascular injury to the pelvic floor. Observational studies have identified certain obstetrical exposures as risk factors for pelvic floor disorders. These factors often coexist in clusters; hence, the isolated effect of these variables on the pelvic floor is difficult to study.

[1]  Wayne Katon,et al.  Urinary Incontinence in US Women A Population-Based Study , 2005 .

[2]  G. Wingren,et al.  Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study , 2004, Acta obstetricia et gynecologica Scandinavica.

[3]  J. Kelly,et al.  Bladder dysfunction in peripheral neuropathies , 2012, Muscle & nerve.

[4]  James A Ashton-Miller,et al.  Pudendal nerve stretch during vaginal birth: a 3D computer simulation. , 2005, American journal of obstetrics and gynecology.

[5]  D. Kuh,et al.  Urinary incontinence in middle aged women: childhood enuresis and other lifetime risk factors in a British prospective cohort. , 1999, Journal of epidemiology and community health.

[6]  J. Simpson,et al.  Does delayed child‐bearing increase the risk of levator injury in labour? , 2007, The Australian & New Zealand journal of obstetrics & gynaecology.

[7]  E. Hendriks,et al.  A systematic review of etiological factors for postpartum fecal incontinence , 2009, Acta obstetricia et gynecologica Scandinavica.

[8]  V. Bovbjerg,et al.  Risk factors for perineal injury during delivery. , 2003, American journal of obstetrics and gynecology.

[9]  R. Sakakibara,et al.  Vascular incontinence: incontinence in the elderly due to ischemic white matter changes , 2012, Neurology international.

[10]  T. Wilt,et al.  Prevention of urinary and fecal incontinence in adults. , 2007, Evidence report/technology assessment.

[11]  Bertha Chen,et al.  Alterations in connective tissue metabolism in stress incontinence and prolapse. , 2011, The Journal of urology.

[12]  A. Aldridge,et al.  Analysis of end-results of labor in primiparas after spontaneous versus prophylactic methods of delivery , 1935 .

[13]  G. Rørtveit,et al.  Urinary incontinence and age at the first and last delivery: the Norwegian HUNT/EPINCONT study. , 2006, American journal of obstetrics and gynecology.

[14]  M. Damaser,et al.  Effects of pudendal nerve injury in the female rat , 2000, Neurourology and urodynamics.

[15]  J. Warrington,et al.  Microarray analysis of differentially expressed genes in vaginal tissues from women with stress urinary incontinence compared with asymptomatic women. , 2006, Human reproduction.

[16]  R. Johanson,et al.  Maternal and child health after assisted vaginal delivery: five‐year follow up of a randomised controlled study comparing forceps and ventouse , 2014, BJOG : an international journal of obstetrics and gynaecology.

[17]  W. Katon,et al.  Urinary incontinence in US women: a population-based study. , 2006, Archives of internal medicine.

[18]  S. Ogston,et al.  Episiotomy and perineal tears in low-risk UK primigravidae. , 1998, Journal of public health medicine.

[19]  A. Muñoz,et al.  Vaginal parity and pelvic organ prolapse. , 2010, The Journal of reproductive medicine.

[20]  R. Goldberg,et al.  Risk Factors for Female Anal Incontinence: New Insight Through the Evanston-Northwestern Twin Sisters Study , 2005, Obstetrics and gynecology.

[21]  A. Elhan,et al.  Prevalence of Pelvic Floor Disorders in the Female Population and the Impact of Age, Mode of Delivery, and Parity , 2011, Diseases of the colon and rectum.

[22]  V. Sung,et al.  National trends and costs of surgical treatment for female fecal incontinence. , 2007, American journal of obstetrics and gynecology.

[23]  鮫島 浩,et al.  Population-based study からみた神経予後不良因子の検討 , 2009 .

[24]  Richardson Ac,et al.  Treatment of Stress Urinary Incontinence Due to Paravaginal Fascial Defect , 1981, Obstetrics and gynecology.

[25]  C. Raker,et al.  Costs of ambulatory care related to female pelvic floor disorders in the United States. , 2010, American journal of obstetrics and gynecology.

[26]  W. Bosch,et al.  Prevalence of urinary, fecal and double incontinence in the elderly living at home , 2004, International Urogynecology Journal.

[27]  J. Thorp,et al.  Episiotomy: can its routine use be defended? , 1989, American Journal of Obstetrics and Gynecology.

[28]  S. Donath,et al.  Effects of prolonged second stage, method of birth, timing of caesarean section and other obstetric risk factors on postnatal urinary incontinence: an Australian nulliparous cohort study , 2011, BJOG : an international journal of obstetrics and gynaecology.

[29]  I. Chalmers,et al.  West Berkshire perineal management trial. , 1984, British medical journal.

[30]  H. Koelbl,et al.  Impact of mode of delivery on levator morphology: a prospective observational study with three‐dimensional ultrasound early in the postpartum period , 2012, BJOG : an international journal of obstetrics and gynaecology.

[31]  J. Delancey Fascial and muscular abnormalities in women with urethral hypermobility and anterior vaginal wall prolapse. , 2002, American journal of obstetrics and gynecology.

[32]  F. B. Nugent The primiparous perineum after forceps delivery , 1935 .

[33]  E. Vittinghoff,et al.  Cost of Pelvic Organ Prolapse Surgery in the United States , 2001, Obstetrics and gynecology.

[34]  F. Ramezanzadeh,et al.  Postpartum evaluation of stress urinary incontinence among primiparas , 2006, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[35]  Delee The Prophylactic Forceps Operation , 1921 .

[36]  E. Lukacz,et al.  Pelvic Floor Disorders, Diabetes Mellitus, and Obesity in Women: Findings from the KP CARES Study , 2007 .

[37]  B. Howard,et al.  Risk Factors for Prolapse Development in White, Black, and Hispanic Women , 2011, Female pelvic medicine & reconstructive surgery.

[38]  Rosana Ferreira Sampaio,et al.  Pelvic floor muscle strength predicts stress urinary incontinence in primiparous women after vaginal delivery , 2012, International Urogynecology Journal.

[39]  J. Jelovsek,et al.  Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life. , 2006, American journal of obstetrics and gynecology.

[40]  E. Hodnett,et al.  Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial. , 2004, American journal of obstetrics and gynecology.

[41]  L. Troiano,et al.  Postpartum urinary symptoms: prevalence and risk factors. , 2002, European journal of obstetrics, gynecology, and reproductive biology.

[42]  M. Behan,et al.  Randomised clinical trial to assess anal sphincter function following forceps or vacuum assisted vaginal delivery , 2003, BJOG : an international journal of obstetrics and gynaecology.

[43]  C. O'Herlihy,et al.  Patterns of abnormal pudendal nerve function that are associated with postpartum fecal incontinence. , 2003, American journal of obstetrics and gynecology.

[44]  N. Perone Pelvic floor disorders 5-10 years after vaginal or cesarean childbirth. , 2012, Obstetrics and gynecology.

[45]  F. Daneshgari,et al.  Recovery of continence function following simulated birth trauma involves repair of muscle and nerves in the urethra in the female mouse. , 2010, European urology.

[46]  L. Meyn,et al.  Episiotomy Use in the United States, 1979–1997 , 2002, Obstetrics and gynecology.

[47]  M. Kamm,et al.  Anal sphincter trauma during instrumental delivery , 1993, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[48]  A. Muñoz,et al.  Pelvic Floor Disorders After Vaginal Birth: Effect of Episiotomy, Perineal Laceration, and Operative Birth , 2012, Obstetrics and gynecology.

[49]  James A. Ashton-Miller,et al.  Levator Ani Muscle Stretch Induced by Simulated Vaginal Birth , 2004, Obstetrics and gynecology.

[50]  J. B. Delee The Prophylactic Forceps Operation* , 1920, The Medicalization of Obstetrics.

[51]  A. C. Richardson,et al.  A new look at pelvic relaxation. , 1976, American journal of obstetrics and gynecology.

[52]  K. Connell Elastogenesis in the vaginal wall and pelvic-organ prolapse. , 2011, The New England journal of medicine.

[53]  A. Maclennan,et al.  The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery , 2000, BJOG : an international journal of obstetrics and gynaecology.

[54]  G. Maso,et al.  The Effects of Mediolateral Episiotomy on Pelvic Floor Function After Vaginal Delivery , 2004, Obstetrics and gynecology.

[55]  黄亚明 MedScape , 2009 .

[56]  G W Lam,et al.  Parity as a correlate of adult female urinary incontinence prevalence. , 1992, Journal of epidemiology and community health.

[57]  K. Lohr,et al.  Outcomes of routine episiotomy: a systematic review. , 2005, JAMA.

[58]  J. Martin,et al.  Births: final data for 2009. , 2011, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[59]  James A Ashton-Miller,et al.  On the biomechanics of vaginal birth and common sequelae. , 2009, Annual review of biomedical engineering.

[60]  Christopher R V Hoover,et al.  Dual simulated childbirth injury delays anatomic recovery. , 2009, American journal of physiology. Renal physiology.

[61]  T. Jørgensen,et al.  Urinary incontinence during pregnancy and 1 year after delivery in primiparous women compared with a control group of nulliparous women , 2012, Neurourology and urodynamics.

[62]  R. E. Allen,et al.  Pelvic floor damage and childbirth: a neurophysiological study , 1990 .

[63]  James A Ashton-Miller,et al.  Comparison of Levator Ani Muscle Defects and Function in Women With and Without Pelvic Organ Prolapse , 2007, Obstetrics and gynecology.

[64]  E. Hodnett,et al.  Outcomes at 3 months after planned cesarean vs planned vaginal delivery for breech presentation at term: the international randomized Term Breech Trial. , 2002 .

[65]  S. Herron-Marx,et al.  The prevalence of enduring postnatal perineal morbidity and its relationship to perineal trauma. , 2007, Midwifery.

[66]  A. Rempen,et al.  Pressures on the fetal head during normal labor , 1991, Journal of perinatal medicine.

[67]  P. Lichtenstein,et al.  Genetic influence on stress urinary incontinence and pelvic organ prolapse. , 2008, European urology.

[68]  G. Rørtveit,et al.  Age‐ and Type‐Dependent Effects of Parity on Urinary Incontinence: The Norwegian EPINCONT Study , 2001, Obstetrics and gynecology.

[69]  E. Mohammadi,et al.  Barriers and facilitators related to the implementation of a physiological track and trigger system: A systematic review of the qualitative evidence , 2017, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[70]  Morton B. Brown,et al.  Fecal and Urinary Incontinence in Primiparous Women , 2006, Obstetrics and gynecology.

[71]  H. Dietz,et al.  Levator trauma is associated with pelvic organ prolapse , 2008, BJOG : an international journal of obstetrics and gynaecology.

[72]  C. O'Herlihy,et al.  Combined Ischemic and Neuropathic Insult to the Anal Canal in an Animal Model of Obstetric-Related Trauma , 2012, Diseases of the colon and rectum.

[73]  S. Donath,et al.  The onset, recurrence and associated obstetric risk factors for urinary incontinence in the first 18 months after a first birth: an Australian nulliparous cohort study , 2012, BJOG : an international journal of obstetrics and gynaecology.

[74]  J. Colling,et al.  Epidemiology of Surgically Managed Pelvic Organ Prolapse and Urinary Incontinence , 1997, Obstetrics and gynecology.

[75]  A. C. Richardson,et al.  Treatment of Stress Urinary Incontinence Due to Paravaginal Fascial Defect , 1981, Obstetrics and gynecology.

[76]  D. Santini,et al.  Abnormalities of somatic peptide-containing nerves supplying the pelvic floor of women with genitourinary prolapse and stress urinary incontinence. , 2004, Urology.

[77]  M. Kusano,et al.  The effect of vaginal delivery on the pelvic floor , 1999, Surgery Today.

[78]  J. Dittmer,et al.  Changes of glycoprotein and collagen immunolocalization in the uterine artery wall of postmenopausal women with and without pelvic organ prolapse. , 2011, Acta histochemica.

[79]  E. Lukacz,et al.  Pelvic Floor Disorders, Diabetes, and Obesity in Women , 2007, Diabetes Care.

[80]  L. Viktrup,et al.  The Symptom of Stress Incontinence Caused by Pregnancy Or Delivery in Primiparas , 1992, Obstetrics and gynecology.

[81]  L. Subak,et al.  Annual Direct Cost of Urinary Incontinence , 2001, Obstetrics and gynecology.

[82]  John O L DeLancey,et al.  The Appearance of Levator Ani Muscle Abnormalities in Magnetic Resonance Images After Vaginal Delivery , 2003, Obstetrics and gynecology.

[83]  P. Miotła,et al.  Polymorphism of the gene encoding alpha-1 chain of collagen type I and a risk of pelvic organ prolapse--a preliminary study. , 2007, Ginekologia polska.

[84]  Jennifer M Wu,et al.  Prevalence of symptomatic pelvic floor disorders in US women. , 2008, JAMA.

[85]  S. Abramowitch,et al.  Repetitive Mechanical Stretch Increases Extracellular Collagenase Activity in Vaginal Fibroblasts , 2010, Female pelvic medicine & reconstructive surgery.

[86]  E. Hodnett,et al.  Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial. , 2004, American journal of obstetrics and gynecology.

[87]  H. Dietz,et al.  Intrapartum risk factors for levator trauma , 2010, BJOG : an international journal of obstetrics and gynaecology.

[88]  J. Ashton-Miller,et al.  Vaginal Birth and De Novo Stress Incontinence: Relative Contributions of Urethral Dysfunction and Mobility , 2007, Obstetrics and gynecology.

[89]  M. Vessey,et al.  Epidemiology of genital prolapse: observations from the Oxford Family Planning Association study , 1997, British journal of obstetrics and gynaecology.

[90]  C. Campagnoli,et al.  Risk factors for genital prolapse in non-hysterectomized women around menopause. Results from a large cross-sectional study in menopausal clinics in Italy. Progetto Menopausa Italia Study Group. , 2000, European journal of obstetrics, gynecology, and reproductive biology.

[91]  H. Tibbals,et al.  Biomechanical properties of the vaginal wall: effect of pregnancy, elastic fiber deficiency, and pelvic organ prolapse. , 2008, American journal of obstetrics and gynecology.

[92]  Jane T. Helwig,et al.  Does Midline Episiotomy Increase the Risk of Third- and Fourth-Degree Lacerations in Operative Vaginal Deliveries? , 1993, Obstetrics and gynecology.

[93]  H. Sutton AN EPIDEMIOLOGICAL STUDY , 1937 .

[94]  S. Cnattingius,et al.  Risks of stress urinary incontinence and pelvic organ prolapse surgery in relation to mode of childbirth. , 2011, American journal of obstetrics and gynecology.

[95]  Aaron B Caughey,et al.  How long is too long: Does a prolonged second stage of labor in nulliparous women affect maternal and neonatal outcomes? , 2004, American journal of obstetrics and gynecology.

[96]  M. Aşoglu,et al.  Does mediolateral episiotomy decrease central defects of the anterior vaginal wall? , 2012, Archives of Gynecology and Obstetrics.

[97]  L. Kozak,et al.  National Hospital Discharge Survey: 2001 annual summary with detailed diagnosis and procedure data. , 2004, Vital and health statistics. Series 13, Data from the National Health Survey.

[98]  S. Cnattingius,et al.  Risk of Surgically Managed Pelvic Floor Dysfunction in Relation to Age at First Delivery , 2013 .

[99]  James A Ashton-Miller,et al.  Obstetric Factors Associated With Levator Ani Muscle Injury After Vaginal Birth , 2006, Obstetrics and gynecology.

[100]  W. Gilbert,et al.  Obstetric Anal Sphincter Lacerations , 2001, Obstetrics and Gynecology.

[101]  Pudendal nerve damage increases the risk of fecal incontinence in women with anal sphincter rupture after childbirth , 1995, Acta obstetricia et gynecologica Scandinavica.