Operative vaginal delivery and pelvic floor complications

Operative vaginal delivery (OVD) is associated with injury to the pelvic floor and compromise to the urinary, genital and gastrointestinal systems. There has been significant evolution in recent years in the practice of OVD (from the use of forceps to vacuum delivery), the conduct of delivery (from routine to selective episiotomy) and the recognition and management of obstetric anal sphincter injury (OASIS). This review article considers a number of key questions from the perspective of the clinical practitioner: What effects does OVD have on the pelvic floor? How can the effects of OVD on the pelvic floor be reduced? When and how should episiotomy be performed during OVD? How should future pregnancies following OVD and OASIS be managed? The place of episiotomy during OVD, a much debated strategy to prevent injury to the obstetric anal sphincter during OVD, is considered.