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.
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.
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.
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
Correspondence to Hans P. Dietz, MD, PhD, FRANZCOG, DDU, CU, Professor in Obstetrics and Gynaecology, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW 2750, Australia. Tel: +61 2 4734 1809; fax: +61 2 4734 3485; e-mail: firstname.lastname@example.org