[Pelvic and perineal sequelae of delivery]

Vaginal delivery especially with dystocia, may result in relaxation or disruption of fascial and ligamentous supports of pelvic organs. The relationship between first childbirth and obstetric trauma is strong but additional pregnancies and deliveries are aggravating factors as well as ageing and hormonal effects of the menopause. These anatomic changes are contributing to the development of stress urinary incontinence, anal incontinence and genital prolapse. Preventing obstetric trauma needs changes in current obstetric practice: reduction in the episiotomy rate, use of vacuum extractor in preference to forceps. General practitioners can help at the time of postnatal control by making a full clinical evaluation of pelvic floor damage, referring women for further investigation and asking them about postnatal sexual difficulties. Postpartum perineal physiotherapy is indicated for women at risk: pelvic floor congenital weakness instrumental delivery, postpartum urinary and/or anal incontinence.