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Pelvic floor, prolapse and vaginal birth - A search in medical literature for anatomical repair descriptions of acute obstetrical tears and a study on primiparous women in the delivery room with focus on cysto- and/or rectoceles.

Rosberg, Camilla LU (2012) LÄKM01 20121
MD Programme
Abstract
BACKGROUND: It is well-known that pelvic organ prolapses and perineal tears can be a consequence of vaginal birth. Seven thousand women undergo surgery for pelvic organ prolapses in Sweden every year.
OBJECTIVE: To search for medical literature that describes the identification and repair of the anatomical structures present in obstetrical perineal tears. To make an attempt to understand how prolapses might originate by trying to provoke a protrusion of the rectum or the urinary bladder into the vagina thus forming an instability similar to a cysto- and/or a rectocele, in primiparas immediately after a vaginal birth and to describe their tears anatomically.
METHODS: A search in the Pub Med and in the Cochrane database was done and three... (More)
BACKGROUND: It is well-known that pelvic organ prolapses and perineal tears can be a consequence of vaginal birth. Seven thousand women undergo surgery for pelvic organ prolapses in Sweden every year.
OBJECTIVE: To search for medical literature that describes the identification and repair of the anatomical structures present in obstetrical perineal tears. To make an attempt to understand how prolapses might originate by trying to provoke a protrusion of the rectum or the urinary bladder into the vagina thus forming an instability similar to a cysto- and/or a rectocele, in primiparas immediately after a vaginal birth and to describe their tears anatomically.
METHODS: A search in the Pub Med and in the Cochrane database was done and three textbooks for different staff categories of health care professionals were penetrated. Patients were recruited by telephone and seen when they came to deliver at the labor ward. A clinical examination was done immediately postpartum and the tears were described anatomically.
RESULTS: 17 women were examined and in 6 of them an instability similar to a rectocele could be provoked. In all of them a tear in the perineal membrane and in a thick fascia in the posterior vaginal wall was noted thus enlightening the importance of other structures besides muscles for stability of the pelvic floor. The possibility to provoke an instability similar to a rectocele could exist despite an intact sphincter or only a partly torn perineum. In this small population no protrusions of the urinary bladder similar to cystoceles were found.
CONCLUSION: Rectocele-like instabilities can be provoked immediately after a vaginal birth. Anatomical structures in an obstetrical tear are possible to identify and describe despite bleeding and edema postpartum. We found no comprehensive references in the literature on how to define and repair these structures in the postpartum period. (Less)
Abstract (Swedish)
När en kvinna föder barn kan hon få skador i underlivet. Det kan göra att man senare behöver opereras för att t.ex. tarmen eller urinblåsan inte sitter helt fast på sin ursprungliga plats i magen utan istället buktar ut i slidan, något som kallas för framfall. Ca 7000 kvinnor opereras för sådana problem varje år i Sverige och det blir en stor kostnad för samhället. Även om man kan få framfall utan att ha fött barn så vet man att det är ökad risk att drabbas om man har varit med om en förlossning. Det har därför gjorts en studie där man undersökte kvinnor som inte fött barn på ”vanligt sätt” tidigare, d.v.s. där barnet kommer ut genom slidan. Man undersökte kvinnornas underliv direkt efter förlossningen och såg om man med hjälp av fingret i... (More)
När en kvinna föder barn kan hon få skador i underlivet. Det kan göra att man senare behöver opereras för att t.ex. tarmen eller urinblåsan inte sitter helt fast på sin ursprungliga plats i magen utan istället buktar ut i slidan, något som kallas för framfall. Ca 7000 kvinnor opereras för sådana problem varje år i Sverige och det blir en stor kostnad för samhället. Även om man kan få framfall utan att ha fött barn så vet man att det är ökad risk att drabbas om man har varit med om en förlossning. Det har därför gjorts en studie där man undersökte kvinnor som inte fött barn på ”vanligt sätt” tidigare, d.v.s. där barnet kommer ut genom slidan. Man undersökte kvinnornas underliv direkt efter förlossningen och såg om man med hjälp av fingret i kvinnans ändtarm kunde trycka fram ett framfall. Kvinnan fick också hålla andan och trycka på neråt för att se om det p.g.a. ökat tryck i magen då började bukta. Studien visade att när en viss del av väggen mellan slidan och ändtarmen är sönder så kan man lätt framkalla framfall av ändtarmen. Man vet inte om väggsvagheten hade funnits kvar även om man inte försökt laga den direkt som man gjorde här utan det måste undersökas vidare, men eftersom man i studien letat i diverse medicinsk litteratur och kommit fram till att det i den inte finns en enda komplett instruktion till läkaren om hur man ska sy ihop alla delar som kan gå sönder vid en förlossning så var det viktigt att hitta sambandet mellan väggsvagheten och framfallet. Det verkar dock vara svårare att få urinblåsan att bukta och man vet fortfarande inte vilka delar som går sönder när urinblåseframfall uppkommer vid en förlossning, eller hur man ska undersöka för att hitta de framfallen. (Less)
Please use this url to cite or link to this publication:
author
Rosberg, Camilla LU
supervisor
organization
alternative title
Bäckenbotten, prolaps och vaginal förlossning - En sökning i medicinsk litteratur efter anatomiska reparationsbeskrivningar av akuta obstetriska skador och en studie på förstföderskor i förlossningsrummet med fokus på cysto- och/eller rectocelen.
course
LÄKM01 20121
year
type
H2 - Master's Degree (Two Years)
subject
keywords
Pelvic floor, Prolapse, Vaginal birth, Medical, Anatomical, Repair, Obstetrical, Tears, Primiparous, Delivery room, Cystoceles, Rectoceles.
language
English
additional info
Contact: camilla.rosberg.633@student.lu.se; kokkamoj@telia.com
id
3046496
date added to LUP
2012-08-31 09:26:18
date last changed
2012-08-31 09:26:18
@misc{3046496,
  abstract     = {BACKGROUND: It is well-known that pelvic organ prolapses and perineal tears can be a consequence of vaginal birth. Seven thousand women undergo surgery for pelvic organ prolapses in Sweden every year.
OBJECTIVE: To search for medical literature that describes the identification and repair of the anatomical structures present in obstetrical perineal tears. To make an attempt to understand how prolapses might originate by trying to provoke a protrusion of the rectum or the urinary bladder into the vagina thus forming an instability similar to a cysto- and/or a rectocele, in primiparas immediately after a vaginal birth and to describe their tears anatomically.
METHODS: A search in the Pub Med and in the Cochrane database was done and three textbooks for different staff categories of health care professionals were penetrated. Patients were recruited by telephone and seen when they came to deliver at the labor ward. A clinical examination was done immediately postpartum and the tears were described anatomically.
RESULTS: 17 women were examined and in 6 of them an instability similar to a rectocele could be provoked. In all of them a tear in the perineal membrane and in a thick fascia in the posterior vaginal wall was noted thus enlightening the importance of other structures besides muscles for stability of the pelvic floor. The possibility to provoke an instability similar to a rectocele could exist despite an intact sphincter or only a partly torn perineum. In this small population no protrusions of the urinary bladder similar to cystoceles were found.
CONCLUSION: Rectocele-like instabilities can be provoked immediately after a vaginal birth. Anatomical structures in an obstetrical tear are possible to identify and describe despite bleeding and edema postpartum. We found no comprehensive references in the literature on how to define and repair these structures in the postpartum period.},
  author       = {Rosberg, Camilla},
  keyword      = {Pelvic floor,Prolapse,Vaginal birth,Medical,Anatomical,Repair,Obstetrical,Tears,Primiparous,Delivery room,Cystoceles,Rectoceles.},
  language     = {eng},
  note         = {Student Paper},
  title        = {Pelvic floor, prolapse and vaginal birth - A search in medical literature for anatomical repair descriptions of acute obstetrical tears and a study on primiparous women in the delivery room with focus on cysto- and/or rectoceles.},
  year         = {2012},
}