What is it about?
Major somatic pelvic floor injuries are more common than previously realized after vaginal deliveries that involve forceps instrumentation. Research notes that 20-30 % of women can suffer from levator ani muscle avulsion that may cause long term morbidities of pelvic organ prolapse, sexual dysfunction, psychological distress and marital disharmony.
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Why is it important?
Contemporary literature usually defines somatic damage as ‘perineal trauma’ in the sense of episiotomy and perineal tears. Since the advent of translabial 3D/4D ultrasound, clinicians now classify ‘pelvic floor trauma’ differently. Major damage of this type encompasses levator ani muscle 'avulsion’ or detachment of the puborectalis component of this LAM from the pelvic sidewall. If women are given accurate information on these risk factors of vaginal delivery, along with options of caesarean section prior to delivery, severe postnatal morbidities could be decreased.
Perspectives
There is now substantial evidence from large epidemiological studies demonstrating that vaginal childbirth, especially forceps delivery, may be associated with pelvic organ prolapse and anal and urinary incontinence and sexual dysfunction. A difficult delivery with resulting somatic trauma may also have psychological consequences. Postpartum trauma symptoms can hinder mother and baby bonding and maternal adjustment; negatively affect children’s behaviour and development adversely affect relationships, diminish the quality of sexual and marital interactions.
Dr Elizabeth Mary Skinner
University of Sydney
Read the Original
This page is a summary of: Re: Caesarean section should be available on request, BJOG An International Journal of Obstetrics & Gynaecology, June 2016, Wiley,
DOI: 10.1111/1471-0528.13886.
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