POP UI FI Sexual Dysfunction PFD The pelvic floor is primarily made up of the levator ani and coccygeus muscles ie paired puborectalis pubococcygeus and iliococcygeus ID: 1044092
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2. Vaginal CHILDBIRTH PELVIC FLOOR INJURY
3. POPUIFISexual Dysfunction PFD
4. The pelvic floor is primarily made up of the levator ani and coccygeus muscles (ie, paired puborectalis, pubococcygeus, and iliococcygeus). The urethral and anal sphincter muscles are also part of the pelvic floor.
5. The endopelvic connective tissues lie superior to the pelvic floor muscles and connect to the pelvic side walls and sacrum. The perineal membrane (ie, bulbocavernosus, transverse perineal, and ischiocavernosus muscles) lies external and inferior to the pelvic floor.
6. The pudendal nerve innervates the external anal and urethral sphincter, Direct connection of S2, S3, and S4 nerve fibers (MUSCLES)The innervation
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18. paravaginal defects as separation of the endopelvic fascia from its lateral attachment to pelvic side wall .Leading to Urethral Hypermobility ,SUI, Poor Anterior Vaginal Support.Fascial injury
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21. compression, stretching, or tearing of nerve, muscle, and connective tissue ..Effect of pregnancy and childbirth:
22. During labor and vaginal deliverystretching and compression of the pelvic floor and the associated nerves Leading to demyelination and subsequent denervation .Neural injury
23. The resultant stress incontinence persists if the pudendal nerve is completely transected, but resolves after distension injury.
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25. Loss of levator function (eg, due to traumatic disruption, denervation, or atrophy) may lead to widening of the urogenital hiatus and result in pelvic organ descent.Injury to the levator ani and coccygeus muscles
26. Pelvic floor muscle strength is decreased after vaginal delivery compared with women who had only cesarean deliveries.
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28. During pregnancyPost PartumImpaired connective tissue remodeling
29. PFDs increases with increasing parityUI: nulli: 6.5 one: 9.7 2:16.3 3 or more: 23.9%POP: nulli:0.6 one : 2.5 2 births: 3.7 3 or more:3.8% PREVALENCE IN PAROUS WOMEN
30. a risk factor for PFDsPost menopauseAge
31. UI :20-39: 6.9 60-69: 23.3 POP :20-39 :1.6% 60-69 :4.1Among Premenopausal :Parous are more likely to report UIImpact of age
32. Pregnancy Urinary incontinence: 7 to 60 percent The prevalence and severity of incontinence increase during the course of pregnancy . The highest incidence (2nd tm)Highest cumulative prevalence (3rd tm)ROLE OF OBSTETRIC FACTORS
33. The prognosis :favorable(70% new onset UI :Resolve spontaneously ).In 12 months post partum :the prevalence drops to 12-23%)Also among women with persistent incontinence ,severity declines in the 1st year …
34. Vaginal >Cesarean Operative vaginal, particularly forceps delivery, increase the risk of developing pelvic organ prolapse; there are few data regarding this mode of delivery and urinary incontinence. also increases the risk of anal sphincter laceration, which increases the risk of fecal incontinence.Mode of delivery
35. Episiotomy rates have been declining, given good evidence that does not support routine use of episiotomy.Episiotomy
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37. And Its IMPORTANCE Angle of Episiotomy
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41. Perineal Care
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43. Management Post OP Care Future Pregnancies 3rd -4th degree Laceration
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45. Prophylactic pelvic floor muscle exercisesDecrease shortterm risk of UI up to 3months postpartum.Cesarean delivery????????????APPROACH TO OBSTETRIC MANAGEMENT
46. that 7 to 12 women would have to deliver only by cesarean to prevent one woman from having a PFD later in life, assuming that the observed associations are causaSome studies have calculated :
47. Birth weight Maternal BMIConstipation Other
48. The authors found that the lateral birth position hadthe highest rate of intact perineum (66.6 % intact, 28.3 % lacerations requiringsuture), whereas squatting was associated with the highest rate of lacerations(41.9 % intact perineum, 53.2 % lacerations requiring suture).
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50. Prolonged labor Selective use of operative vaginal delivery Selective use of episiotomyobesity and smoking
51. The “postpartum screening card” is intended to record the presence of pelvic dysfunctions after delivery. The card is composed of five sections: urinary incontinence,anal incontinence pelvic organ prolapse pain and dyspareunia Pelvic floor muscle dysfunction.Postpartum Screening Card
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53. We now have moderately robustepidemiological data at 12 and 20 years after delivery and objective pathophysiological data (pudendal nerve trauma andlevator defects/avulsion).
54. propose a scoring system (UR-CHOICE) to predict the risk of future PFD based on several major risk factors..
55. U UI before pregnancyR Race/ethnicityC Child bearing started at what age?H Height (mother’s height)O Overweight (weight of mother, BMI )I Inheritance (family history)C Children (number of children desired)E Estimated fetal weightUR-CHOICE
56. ProLong (PROlapse and incontinence LONG-term research) 12-year database involving just fewer than 4,000 women SWEPOP (SWEdish Pregnancy, Obesity, and Pelvicfloor) 20-year database of slightly fewer than 5,000 women.For Scoring :
57. The number of children desired will not be included in the logistic regression modelling and final score but will be used in counselling women (particularly those with a high score) who are considering an elective Caesarean section.
58. Caesarean section need to bebalanced against the potential risks associated with repeat Caesarean sections, in particular, with complications of placent praevia and accreta.
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