The role of pregnancy and childbirth on pelvic static disorders
E. Brătilă, S. Vlădăreanu, C. Berceanu, M. Cîrstoiu, C. Mehedințu, D. Comandașu, M. Mitran
Rezumat: Multiple studies emphasize the consequences of vaginal delivery on the pelvic floor, but the pregnancy itself represents a risk factor for the appearance of static pelvic disorders. Review
of specialty literature by studying the articles published
in PubMed and Cochrane databases between 1980 and
2010. The prevalence of urinary incontinence (UI) is correlated with parity and the way that vaginal delivery is assisted. Although delivery is an independent risk factor for the occurrence of UI, pregnancy plays an important role in its pathophysiology. UI during
pregnancy is considered a prediction factor for the
subsequent appearance of UI. Damage to the pelvic
nerves and muscles during childbirth increases the risk
of postpartum urinary retention, the effect of epidural
analgesia being controversial. Hormonal influences
during pregnancy cause the relaxation of utero-vaginal
support systems resulting in the emergence of uterine
prolapse, its level increasing in the third trimester.
Postpartum fecal incontinence presents as risk factors
the external and/or internal anal sphincter lacerations,
which have a maximum incidence at first vaginal delivery
and the pudendal neuropathy respectively, which is
strongly associated with multiparity. Among the prophylactic factors for the appearance of postpartum perineal disorders we mention avoiding the use of instrumental delivery by forceps application,
the correct diagnosis of fetal pelvic disproportion and
limiting the duration of the second active phase of labor.
The majority of pelvic floor disorders occur as a result of the first vaginal delivery. Although cesarean section represents a prophylactic factor for static pelvic disorders, it does not have a protective
role when performed in the second stage of labor. Cuvinte cheie: vaginal delivery, cesarean section, urinary incontinence, uterine prolapse, fecal incontinence.