Childbirth, Pregnancy and the Pelvic Floor. Obstetrical risk factors - perspectives from the obstetricians

Research on the epidemiology of prolapse has been limited: most population-based studies of pelvic organ prolapse do not use objective measures for the diagnosis. Instead, most studies have used surrogate markers. A large study based on a Questionnaire (EPIQ), underline the importance of labour as risk factor for developing prolapse. Recent studies, using a graded or quantitative physical examination, suggest that the actual mode of delivery is more critical than the process of labor. Another important aspect is that pelvic floor disorders dramatically increase among women with a history of operative vaginal birth. The role of episiotomy and spontaneous perineal laceration are also debated. A recent study suggests that women who had experienced more than one spontaneous perineal laceration, across all their deliveries were more likely to have prolapse. No increase in prolapse was observed in association with episiotomy. A Cochrane review evaluated the impact of episiotomy on other pelvic floor disorders. There is evidence to support the restrictive use of episiotomy compared with routine use of episiotomy because no difference is shown in the incidence of severe vaginal or perineal trauma or in pain, dyspareunia or urinary incontinence. A study on women who delivered at the University of Turin analyzed clinical and obstetrics risk factors for urinary incontincence. From this study we concluded that patients older than 35 years and with the baby weighing more than 3,800gr are about 5 times more likely to develop urinary incontinence. No difference is shown for the use of episiotomy.