Pelvic floor trauma in childbirth - myth or reality?

Area of Science:

• Obstetrics and Gynecology
• Pelvic Floor Disorders
• Childbirth Injuries

Background:

• Pelvic floor trauma during childbirth is a growing concern for healthcare providers and the public.
• Increased availability and perceived safety of elective Cesarean sections influence discussions on vaginal delivery risks.
• Emotive factors and health economics have complicated rational discourse on childbirth-related pelvic floor trauma.

Purpose of the Study:

• To evaluate the evidence regarding the reality and extent of pelvic floor trauma in childbirth.
• To determine if childbirth-related pelvic floor trauma is a myth or a clinically significant issue.
• To review established risk factors and assess the long-term clinical relevance of identified trauma.

Main Methods:

• Systematic review of 25 years of urogynaecological research.
• Analysis of evidence on potential damage to pelvic floor structures during vaginal delivery.
• Identification and review of defined risk factors associated with pelvic floor trauma.

Main Results:

• Evidence suggests vaginal delivery can damage the pudendal nerve, levator ani muscle, pelvic organ supports, and anal sphincters.
• Identified risk factors include operative vaginal delivery, prolonged second stage of labor, and fetal macrosomia.
• The clinical significance and long-term impact of this trauma on pelvic floor morbidity remain unclear.

Conclusions:

• There is sufficient evidence to support that vaginal delivery can cause significant pelvic floor trauma.
• While risk factors are established, the clinical relevance and long-term consequences of childbirth-related pelvic floor trauma need further research.
• The link between obstetric trauma and later-life pelvic floor morbidity requires more investigation.