Anatomical and functional conditions of the pelvic floor muscles after assisted vaginal delivery

Abstract

BACKGROUND: The main function of the muscles of the perineum is to preserve the syntopy and topography of the organs of the abdominal cavity and small pelvis. Clinically, various groups of complaints that significantly worsen the patient’s quality of life manifest pelvic floor muscle failure. Currently, one of the most commonly discussed causes of pelvic organ prolapse is still considered obstetric trauma.

AIM: The aim of this study was to assess the anatomical and functional conditions of the pelvic floor muscles after normal physiologic childbirth and childbirth with the use of obstetric forceps.

MATERIALS AND METHODS: The study was conducted in Maternity Hospital No. 13 (Saint Petersburg, Russia) in 2020–2021, which involved 137 patients who delivered through the natural birth canal with the use of obstetric forceps (main group, n = 47) or without the use of delivery instruments (control group, n = 90) six months after delivery. A comprehensive assessment of the condition of the pelvic floor muscles was carried out using the validated PFDI-20 questionnaire and ultrasound examination of the pelvic floor structures at rest. A functional assessment of the condition was carried out using the Pneumatic Pelvic Muscle Trainer XFT-0010.

RESULTS: Evaluating complaints using the PFDI-20 scale revealed that the median was 6.00 ± 1.77 points in the main group and 5.50 ± 1.29 points in the control group, the differences being not significant (p = 0.8). The ultrasound examination showed no significant difference in decreases in the thickness of the tendon center of the perineum and m. bulbocavernosus between the study groups; m. puborectalis thickness in the main group did not differ significantly from the norm either. The assessment of the functional condition of the pelvic floor muscles revealed no significant differences between the patients of the study groups.

CONCLUSIONS: The data obtained demonstrate the safety of the use of obstetric forceps for the anatomical and functional viabilities of the pelvic floor muscles and do not have significant differences compared to childbirth performed without the use of delivery instruments. However, the use of obstetric forceps in the practice of obstetricians and gynecologists can be a reliable tool that does not affect the quality of life of patients in the long term.

Keywords

assisted vaginal delivery / pelvic floor insufficiency / obstetric forceps / transperineal ultrasonography

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Bezhenar V.F., Frederiks E.V., Leonova M.D., Zharuk A.D.