TOG: pelvic floor & sphincter injuries Flashcards
what is the innervation of the pelvic floor?
S2-S4 and some from pudendal nerve
what type of muscle is internal anal sphincter and where does it end?
continuation of the circular smooth muscle of bowel. Ends above the anal margin at the junction of the superficial and submit part od EAS
what is the innervation to the IAS
sympathetic (L5) and parasympathetic nerves (S2-S4). accounts for 50-85% of resting pressure
what is the innervation of EAS?
inferior rectal branch of pudendal nerved contributed to 15-30% resting pressure
what percentage of women sustain some kind of perineal injury during vaginal delivery?
85%
what is the episiotomy rate in the UK?
8-16%
what is the rate of OASI (obs anal sphincter injuries) in centres where mediolateral episiotomies are done compared to where midline episiotomies are done?
OASI rate with mediolateral epis= 1.7% (2.9% in primips)
OASI rate with midline epic= 12% (19% in primips)
what is the UK OASI rate? What is the UK OASI rate in primips?
3%. Range of 0-8%
OASI rate in primips= 2.1%
what are the symptoms of obstetric-related pelvic floor dysfunction?
anal incontinence
urinary incontinence
pelvic organ prolapse
sexual dysfunction
which specific point of the pudendal nerve is particularly prone to injury during childbirth?
the point where it curves around the ischial spine and enters the pudendal canal enclosed in its tight fibrous sheath (Alcock’s canal)
what percentage of women suffer with anal incontinence despite primary repair?
39%
in women who had transient anal incontinence after a complete tear, what percentage have relapse symptoms after the next delivery?
What is the major long term problem in these women?
39%
Major problem is incontinence of flatus
what is the most significant risk factor in developing faecal incontinence after delivery?
full thickness anal sphincter disruption
the prevalence of OASI is predominantly associated with which 5 factors
- forceps delivery
- unassisted delivery at home
- large metal head circumference
- obesity
- increasing maternal age
what are the main risk factors for development of OASI?
- midline episiotomy
- first vag del
- shoulder dystocia
- persistent OP position
what is the only independent factor predicting a major tear, hence higher risk of faecal incontinence?
epidural analgesia
in comparing post partum women with and without stress urinary incontinence, what difference is there between the bladder neck of the 2 groups?
women with postpartum SUI have been found to have greater bladder neck mobility during straining before delivery, compared to postpartum women without SUI
if woman delivers exclusively by c/s, is she more or less likely to have urinary incontinence, in the long term, compared to women who have had all vaginal deliveries?
What if she has had combination of c/s and vaginal deliveries?
women delivered exclusively by c/s are less likely to have urinary incontinence in the long term, compared to those who only had SVD, BUT not if they had combo of c/s and SVD
what percentage of porous women have some degree of POP (pelvic organ prolapse).
What percentage of these women have symptoms?
50%
15% of these women are symptomatic
what percentage of symptomatic prolapse is found in nulliparous population?
2%
what is the most common morphologic abnormality of the elevator ani seen in 1/3 women after child birth?
avulsion injury of the pubovisceral muscle from the pubic rami
what is the most common postpartum sexual disorder.
what are the other common postpartum sexual disorders?
sexual pain.
this is followed by disorders of sexual desire, arousal, orgasm
perineal pain occurs more frequently and persists for longer after what type of delivery?
instrumental or breech vaginal delivery
when is the ideal time postnatally to see patients suffering with perineal problems? what should the setting be like?
6-8 weeks after delivery.
dedicated perineal clinic
breastfeeding and childcare facilities
