Index. Springer-Verlag London 2017 S.K. Doumouchtsis (ed.), Childbirth Trauma, DOI /

Transcription

1 A AAS. See Artificial anal sphincter (AAS) Abdominal wall, 2 3 Absorbable synthetic sutures, 121, 199 Accidental bowel leakage, and episiotomy, 87 Acetaminophen, for perineal pain, 84 Acute prolonged bladder overdistension (ApBO), 154, 155 Adipose tissue, of abdominal wall, 2 Afferent nerves, of anorectal canal, Age at first birth, and LAM injury, 183 and perineal trauma, 251, 252 AI. See Anal incontinence (AI) Alcock s canal, 11 Allis tissue forceps, 123 Amenorrhoea, and obstetric fistula, 234 AMR. See Anorectal manometry (AMR) Anaesthesia. See also Epidural anaesthesia for episiotomy, 80 and pelvic floor trauma, 60 and PPUR, 155 for repair of lower genital tract trauma, 120 Anal canal, 113 distension of, 26 Anal dilation, and perineal trauma, 75 Anal fissures, during pregnancy, 28 Analgesia for episiotomy, 80 for perineal pain, 127, 203 and perineal trauma, for repair of lower genital tract trauma, 120 Analgesics, for perineal pain, 84 Anal incontinence (AI), 104, See also Urinary incontinence (UI) and anal sphincter injury, 304 and childbirth, cost of, 296 definition, 272 and episiotomy, and external anal sphincter repair, 124 following sphincter injury, 125 and forceps delivery, 186 and LAM injury, 184 management of, 125 and midline episiotomy, 186 and OASIS, 305 during pregnancy, PMFT for preventing, 274, and second vaginal delivery, treatment, Anal lock mechanisms, for continence, Anal orifice, 17 Anal reflex, 26 Anal skin, 17 Anal sling, 190 Anal sphincter complex, 10 11, 113, 114 pregnancy-related changes in, Anal sphincter injuries, 60, See also Obstetric anal sphincter injuries (OASIS) clinical examination, 187 and fecal incontinence, 36 and forceps delivery, 253, 259 functional investigation, imaging, 187 and incontinence, 304 and parity, 252 repair, 189 tears, and LAM injury, 184 treatment, Anderson s forceps, 63 Animal studies of pelvic floor disorders, 106 of pregnancy-related pelvic floor changes, Anococcygeal raphe, 19 Springer-Verlag London 2017 S.K. Doumouchtsis (ed.), Childbirth Trauma, DOI /

2 316 Anorectal anatomy/physiology afferent nerves, bowel and anorectal changes in pregnancy anal fissures, 28 constipation, hemorrhoids, 28 continence, anal lock mechanisms, rectal reservoir function, 24 defecation, innervation, intestinal disorders, 28 nerve centers of control, vascularization, Anorectal angle (ARA), 145 Anorectal canal, anatomy of, Anorectal manometry (AMR), 25, Anorectal muscles, Anorectal sensation, 26 Antenatal massage, 203 Antenatal pelvic floor muscle training, Antenatal perineal massage, 83, 258 Anterior abdominal wall, 2 Anterior episiotomy, 72 Antibiotics for perineal wound infections, 127, during suturing, 123 Antiseptics, for POP management, 221 ApBO. See Acute prolonged bladder overdistension (ApBO) Aponeurosis splits, 2 ARA. See Anorectal angle (ARA) Artificial anal sphincter (AAS), 189 Asian ethnicity, and perineal trauma, 251 Autonomic nervous system, 21 B BA. See Bulking agents (BA) Bartholin glands, 4 Bilateral uterine artery ligation, 221 Biofeedback, 188 Biological slings, 244 Biomechanical models of pregnancy-related pelvic floor changes, 51 Bird s cup (ventouse), 62 Birthing position during delivery, 259 Birthweight-related maternal complications, 255 Bladder anatomical changes, during pregnancy, hormonal effect, and PPUR, 154 injury, caesarean-related, 166 postpartum care, rupture, 168 ultrasound, 157 Bladder augmentation, 241 Bladder diary, 163 Bladder neck anatomical changes, during pregnancy, hypermobility, and stress urinary incontinence, Blood supply in abdominal wall, 2 3 in external genital organs, 3 5 in perineal muscles, 5 BMI. See Body mass index (BMI) Body mass index (BMI), and LAM injury, 183 Botulinum toxin injections, for dyspareunia, 127 Bowel disorders, Bowel hypomotility, during pregnancy, 27 Breech delivery, 65 and episiotomy, 77 Broad spectrum antibiotics for prevention of perineal wound infections, 128 for repair of tears, 123 Bulbocavernosus reflex testing, for urgency urinary incontinence, 163 Bulbospongiosus muscle, 5, 113 Bulbs of vestibule, 4 Bulking agents (BA), for fecal incontinence, 190 Buttonhole tear, 115, 122 C Caesarean hysterectomy, 221 Caesarean section (CS). See also Vaginal delivery and anal incontinence, 305 bladder rupture during, 168 elective (see (Elective caesarean section) ) mechanism of bladder injury, 166 and overactive bladder, 36 and pelvic floor disorders, and pelvic girdle syndrome, 308 and POP, 34, 221 and PPUI, protection against anal sphincter injury, 186 and second stage of labour, 254 sexual intercourse resumption after episiotomy, 85 and urinary incontinence, 35, 257 uterine injury during, Camper s fascia, 2 CART. See Classification and regression trees (CART) analysis

3 Catheterization for iatrogenic bladder injury, 167 for obstetric fistula, 239 for PPUR, 157, 158 Celecoxib, for perineal pain, 84 Cellular and matrix proliferation, and wound healing, 197 Cephalopelvic disproportion, 232 Cerebrospinal axis, 21 Cervical elongation/hypertrophy, 219 Cervical fibrosis, 220 Cervical incision, 221 Cervical prolapse. See Pelvic organ prolapse (POP) Cervical tear, 115 Cervix, 9 Chemoattractant agents, 197 Childbirth injury assessment relevant anatomy, ultrasound, Childbirth injury management in acute setting, 120 continence outcomes, follow-up care and future pregnancies, perineal pain and dyspareunia, perineal wound infection and breakdown, repair external anal sphincter, of first-or second-degree tears, 122 of third-or fourth-degree tears, suturing, Childbirth injury prevention. See Perineal trauma, prevention Chromatic catgut suture, 121 Circumferential fistula, 236, 241, 242 Classification and regression trees (CART) analysis, Clitoris, 4 adhesions, 207 dorsal artery of, 3, 4, 11 Coagulation, and wound healing, Coccygeus muscle, 8 Cold gel, for perineal pain, 84 Collagen, 51, 215 degradation, 103 fi bers, 198 and stress urinary incontinence, 162 Colon taenia, 18 Columnar epithelium, of uterus, 9 Complete/partial absent urethra, Complex obstetric fistula, 170, 236, treatment of, 172 Complicated fistula. See Complex obstetric fistula Concentric needle electromyography, 59 Connective tissue remodeling, in vaginal delivery, Constant relaxation, 26 Constipating agents, 188 Constipation, 184 during pregnancy, Continence, See also Anal incontinence (AI); Incontinence; Urinary incontinence (UI) rectal reservoir function, 24 and repair of anal sphincter injury, Continuous bladder drainage, for obstetric fistula, 238 Continuous non-locking sutures, 122, 199 for episiotomy, 80, 81 Continuous subcuticular sutures, 122 Cornua, uterine, 10 Corpora cavernosa, 4 Corpus clitoridis, 4 Cough-stress test, for urgency urinary incontinence, 163 Covert urinary retention, 153, 156 Creeping substitution, 198 CS. See Caesarean section (CS) Cystocele, 104 Cystoscopy, 168, 235 Cystotomy, 239 Cytokines, 197 D Deep circumflex iliac artery, 2 Deep perineal pouch, 8 9 Defecation neurophysiology of, reflex, Dehiscence of episiotomy, wound, Denervation injuries, 59 and PPUR, 155 Diclofenac, for perineal pain, 84, 123 Disposable ventouse cup, 62 Double fistula, 169 Douglas cul-de-sac, 4 Duhrssen s cervical incision, 221 Dye tests, for obstetric fistulas, 171, 235 Dyspareunia, , 206 after episiotomy, 85, 86 and suturing,

4 318 E EAS. See External anal sphincter (EAS) EAUS. See Endoanal ultrasound (EAUS) Ectocervix, 9 Ectopy, 9 Elastin, 103, 215 Elective caesarean section, 37, 257, 262, 263 and macrosomia, 255 Electrical stimulation, for dyspareunia, 206 Electrocautery, 239 Electromyography (EMG), of pelvic floor damage, 46 prolonged second stage of labour, 59 Electronic Personal Assessment Questionnaire-Pelvic Floor (epaq-pf), 46 EMG. See Electromyography (EMG) Endoanal ultrasound (EAUS), of anal sphincter injuries, Endocervical canal, 9 Endometrium, 9 10 Endopelvic connective tissue, 214 Endosonography, anal, 117 Endovaginal ultrasound (EVUS), 33, 147 BK Medical Flexfocus, 135, 136 of LAM, 133, 187, 218, 219 for pelvic floor biometry, 141 of pelvic floor changes, 48 for visualization of LAM, End-to end repair of external anal sphincter, , 199 Enteric nervous system, 21 Enterocele, 104 epaq-pf. See Electronic Personal Assessment Questionnaire-Pelvic Floor (epaq-pf) Epidural anaesthesia for episiotomy, 80 and fecal incontinence, 184 and perineal pain, 84 and perineal trauma, 60, and PPUR, 155 EPI-NO, 50, 261 Episiotomy, 58, 60 and anal incontinence, for breech presentation, 65 characteristics of, 73 definition, dehiscence, and epidural analgesia, 254 fetal macrosomia, historical landmarks, 70 history in previous delivery, 76 imminent perineal tear, 76 infection, 82 and instrumental deliveries, as part of complex perineal protection, and pelvic floor trauma, 305 and perineal pain, 83 prevention, treatment, 84 and perineal trauma, 61, 114, prevention, and POP, 34, 35 rate, repair, and human papilloma virus, restrictive (see (Restrictive episiotomy) ) resuturing, 82 role in instrumental deliveries, 64 role in modern obstetrics, role in pelvic floor disorders, 105 role in prevention of OASIS, of pelvic floor dysfunction, 75 self-control of woman, 77 and sexual function long term, resumption of sexual intercourse, 85 short term, 85 short perineum, 75 significance of placement of, space for interventions/maneuvers in difficult deliveries, timing of, 79 types, and urinary incontinence, 86 using continuous non-locking suture, 81 Epithelial cells, 198 Erigentes nerves. See Pelvic splanchnic nerves Ethnicity, and perineal trauma, 251 EVUS. See Endovaginal ultrasound (EVUS) External anal sphincter (EAS), 10 11, 18 19, 113 innervation of, 20 overlap vs. end-to-end repair of, reflex of, role in anal lock, 25 suturing of, 123 ultrasound of, 116 External iliac artery, 2 External urethral meatus, 4 F Fascia, loosening of, 51 Fast-absorbing sutures, for episiotomy, 80

5 Fecal incontinence. See Anal incontinence (AI) Fecal Incontinence Quality of Life (Rockwood) score, 87 Fecal urgency (FU), after episiotomy, 87 Female Sexual Function (FSFI), 84 Femoral artery, 2 Fenton s procedure, 207 Fetal crowning, 58 damage during vaginal birth, 59 and episiotomy, 79 and perineal trauma, 73 Fetal distress during second stage of labour, 60, 61 Fetal mortality, and POP, 220 Fibroblasts, 198 Finite element method, 51 First-degree tears repair of, 122 suturing of, Flap, for obstetric fistula repair, Flatal incontinence, 304. See also Anal incontinence (AI); Urinary incontinence (UI) and childbirth, 36 and external anal sphincter repair, 124 Foley catheter, 235 Forceps delivery. See also Vacuum extraction for breech presentation, 65 and fecal incontinence, 186 and LAM injury, 183 and levator trauma, 135 and pelvic floor disorders, 105 and perineal trauma, 62 64, , 259 and POP, 221, 224 and postpartum haemorrhage, 200 use of episiotomy for, 77, 78 Fossa navicularis, 4 Fourth-degree tears, repair of, Fractures, pubic bone, 203 FSFI. See Female Sexual Function (FSFI) FU. See Fecal urgency (FU) Fundus, uterine, 9 Fusible link hypothesis, 59 G Gastrointestinal tract. See Lower gastrointestinal tract complications Genital hiatus, pregnancy-related changes in, Genital hygiene, 221 Genital organs external, 3 5 internal, 9 10 Genital prolapse, 107. See also Pelvic organ prolapse (POP) Gestational urinary incontinence, Glycerine suppositories, 188 Graciloplasty, 189 Graft, for obstetric fistula repair, H Haematomas, and wound healing, Haemostasis, and wound healing, Hand-poised childbirth approach, 186, Hands on childbirth approach, 260 Healing, effect of surgical techniques on, effect of suture material on, and haematomas, labial fusion, 207 natural wound healing in soft tissue injuries, obstetric fistula, pain LAM injuries, 203 perineal pain, pubic bone injuries, 203 perineal wound infection, and postpartum haemorrhage, 200 sexual morbidity secondary to, 206 wound dehiscence/breakdown and management, Hemorrhoidal ring, 17 Hemorrhoids, during pregnancy, 28 HPV. See Human papilloma virus (HPV) Human papilloma virus (HPV), and episiotomy repairs, Hyaluronidase, for perineal pain, 127 Hydrocortisone, for perineal pain, 127 Hymen, 4 Hypercoagulability, 197 Hysterectomy. See Caesarean hysterectomy I IAS. See Internal anal sphincter (IAS) Iatrogenic bladder injury incidence, 165 mechanism at CS, 166 risk factors for caesarean-related bladder injury, 166 treatment and prevention, Iatrogenic fistula, 169 Iatrogenic uterine injury causes, 167 treatment and prevention,

6 320 Ice packs, for perineal pain, 84 Ileal conduit, 241 Ileopectineal ligament, 47 Iliococcygeus muscle, 7, 8, 19, 33 Iliohypogastric nerve, 3 Ilioinguinal nerve, 3 Imaging. See also specifi c entries of anal sphincter injuries, 187 of pelvic floor changes, Imminent perineal tear, and episiotomy, 76 Incontinence. See also Anal incontinence (AI); Urinary incontinence (UI) cost of, and episiotomy, and PFMT, prognosis of, Indomethacin, for perineal pain, 84 Indwelling catheter, for PPUR, 158 Infection and episiotomy, 82 perineal wound, Inferior epigastric artery, 2 3 Inferior hypogastric plexus, 20 Inferior rectal nerve, 11 Inflammation, and wound healing, 197 Infralevator haematomas, and wound healing, Innervation in abdominal wall, 3 of anorectal canal, in external genital organs, 3 4 in perineal muscles, 5 re-innervation after vaginal delivery, 59 Instrumental deliveries. See also Forceps delivery; Vacuum extraction and episiotomy, and perineal trauma, 62 65, and PPUR, 155 Intercostal nerve, 3 Internal anal sphincter (IAS), 10 11, 113 injury, and fecal incontinence, 124 innervation of, 20 reflex of, 25 role in anal lock, 25 suturing of, 123 ultrasound of, 116 Intraoperative urological injury, 165 Intrauterine fetal demise, and perineal trauma, 61 Introital asymmetry, 207 Ischaemic injury, 59 Ischaemic necrosis, and obstetric fistula, 238 Ischiocavernosus muscle, 113 Isthmus, 9 J J-hook needle, 146 J-shaped episiotomy, 72 K Ketoprofen, for perineal pain, 84 KHQ. See King s Health Questionnaire (KHQ) Kielland s forceps, 63 King s Health Questionnaire (KHQ), 86 Kiwi Omnicup, 62 L Labial fusion, 207 Labia majora, 3 graft harvested from, 239 Labia minora, 3 Labour first stage of, 58 prolonged/obstructed, and obstetric fistulas, 169 second stage of (see (Second stage of labour) ) types of injury during, 105 Lacerations iatrogenic bladder laceration, and LAM injury, 187 and POP, sphincter, and fecal incontinence, 36, 37 LAD. See Levator ani deficiency (LAD) LAM. See Levator ani muscle (LAM) Laparoscopic uterine suspension, 221 Laparotomy, 239 Lateral episiotomy, 72 and OASIS, 73 75, 78 Laxatives, 203 use after suturing of tears, 123 LBPP. See Low back and pelvic pain (LBPP) L1 dermatome, 3 Levator ani deficiency (LAD), Levator ani muscle (LAM), 6 8, 19, 32 33, 132, 182, avulsion, 33, 50 51, , 203, 216 bilateral avulsion, 134, 135 detachment of, 146 EVUS for visualizing, hematomas, injuries, , 183, 203 and fecal incontinence, 184 and POP, 146, , prognosis of, risk factors, and rotational instrumental deliveries, 63

7 innervation of, 20 pregnancy-related changes in humans, role in childbirth, 32 stretch, and occipitoposterior position, 65 structure and function, 8 trauma, 58 effect of epidural analgesia on, 60 fecal incontinence, POP, and second stage of labour, and stress urinary incontinence, 161 ultrasound for, urinary incontinence, Levator hiatus, 33, 182 dimensions and area, during pregnancy, 49 and stress urinary incontinence, 162 transperineal ultrasound of, 217, 218 Levator muscle thickness, 144 Levator plate descent angle, Levator pubic gap, 144 Levator tear, 105 Liberal episiotomy, and perineal trauma, Ligaments, pelvic, 47 anatomical changes of, 51 Lithotomy, 240 LMJ. See Longitudinal muscle joint (LMJ) Logistic regression analysis, 60 Longitudinal muscle joint (LMJ), 18 Loperamide, for fecal incontinence, 188 Low back and pelvic pain (LBPP) prognosis of, Lower gastrointestinal tract complications anal sphincter injuries, pelvic floor injuries, Lower genital tract trauma, 112 repair of, 120 Lower urinary tract (LUT) complications, classification of, postpartum urinary incontinence, postpartum voiding difficulty and urinary retention, urinary tract injury during childbirth, LUT. See Lower urinary tract (LUT) complications Lymphocytes, 197 M Macrophages, 197 Macrosomia, fetal 321 and perineal trauma, 255 role of episiotomy in prevention of, Magnesium (topical solution), 221 Magnetic resonance imaging (MRI). See also Ultrasound (US) of anal sphincter injuries, 187 of LAM, 32, 59, 103, 133, 216, 217, 222 of pelvic floor changes, 48 prolonged second stage of labour, 59 of pubic bone, 203 Mainz II pouch, 241 Malmstrom cup (ventouse), 62 Malpositions, and perineal trauma, 65 66, 255 Malpresentations, and perineal trauma, 65 66, 255 Manual perineal protection (MPP), for perineal pain, 83, 87 Marcaine, for perineal pain, 127 Maternal age, and perineal trauma, Maternal position during delivery, 259 Maternal pushing-related injuries, 60, McCoy Female Sexuality Questionnaire, 84 Mechanical injury, in vaginal delivery, Mechanoreceptors, 26 Median episiotomy, and perineal trauma, 256 Mediolateral episiotomy, 72 dyspareunia after, 85 and fecal incontinence, 87, 305 and OASIS, 64, 73 75, 78, 305 and pelvic floor dysfunction, 75 and perineal trauma, , 260 and shoulder dystocia, 76 timing of, 79 use in instrumental deliveries, 77, 78 Methylene blue dye test, for obstetric fistulas, 171, 235 Midline episiotomy, 71 dyspareunia after, 85 and fecal incontinence, 87, 186, 305 and OASIS, 64, 73, 74, 78, 83, 305 rate of, 78 Minimal levator hiatus (MLH), dimensions and area, Mixed urinary incontinence (MUI), 159 MLH. See Minimal levator hiatus (MLH) Modified Gilliam suspension, 221 Modified median episiotomy, 71 Mons pubis, 3 Motilin, 28 MPP. See Manual perineal protection (MPP) MRI. See Magnetic resonance imaging (MRI) MUI. See Mixed urinary incontinence (MUI)

8 322 Multiparity and anal sphincter injuries, 252 PPUI among, 160 Multiple births, and perineal trauma, Muscle receptors, in anal canal, 21 Musculature, pelvic floor, 50 Myenteric plexus, 27 Myometrium, 10 N Neonatal morbidity, and sequential instruments, 63 Nephrectomy, 234 Nerve centers of control, Nerve injury, in vaginal delivery, 103 Neuropeptides, 21 Neutrophils, 197 Neville Barnes forceps, 63 Non-steroidal anti-inflammatory drugs (NSAID), for perineal pain, 84 NSAIDs. See Non-steroidal anti-inflammatory drugs (NSAIDs) O OASIS. See Obstetric anal sphincter injuries (OASIS) Obesity and perineal trauma, 252 and wound infections, 205 Obstetric anal sphincter injuries (OASIS), 58, 60, 112. See also Anal sphincter injuries and episiotomy, 64, 73, and fecal incontinence, 124 and fetal macrosomia, 75 and instrumental deliveries, and Kielland s forceps, 63 management of subsequent pregnancies after, 126 and occipitoposterior position, 65 pain following, 203 and perineal support, 260 prognosis of, repair, 199 role of episiotomy in prevention, and shoulder dystocia, Obstetric fistulas (OF), 231 background and definition, 232 classification, 170, clinical diagnosis assessment, 235 symptoms and signs, complex fistulas, definition, diagnosis, 171 epidemiology, 169, 232 healing, management, mechanism and pathophysiology, 169 and mental health, 235 pathogenesis, 232 postoperative care, 172, presentation, prevention, 172 repair route, 238 timing, 238 urinary incontinence after, risk factors, 170, 232 surgery, outcomes and complications, treatment, Obturator fascia, 11 Occipitoposterior position, 65, 263 and anal sphincter injuries, 186 and postpartum incontinence, 255 Octyl-2-cyanoacrilate, Oestrogen cream, 207 OF. See Obstetric fistulas (OF) Operative vaginal delivery. See also Instrumental deliveries and OASIS, 306 and pelvic floor trauma, 305 and POP, 34, 224 and sexual desire, 311 Osmotic laxatives, 188 Ovaries, 10 Overactive bladder, 104 and mode of childbirth, Overlap repair of external anal sphincter, Overt urinary retention, 153, 156 P Pain LAM (see (Levator ani muscle (LAM), trauma) ) low back and pelvic pain, perineal (see (Perineal pain) ) pubic bone injuries, 203 sexual intercourse, postpartum, 310 Paracetamol, for perineal pain, 84 Parasympathetic innervation, of anorectal canal, 20 Paraurethral glands, 4

9 Paravaginal haematomas, and wound healing, Parity and epidural analgesia use, 254 and LAM avulsion, 217 and perineal trauma, and POP, 34 and PPUI, 160 and sexual intercourse resumption after episiotomy, 85 urinary incontinence, 35 and urinary incontinence, 35 PDS. See Polydioxanone (PDS) Pelvic anatomy, female abdominal wall, 2 3 anal sphincter complex, external genital organs clitoris, 4 labia majora, 3 labia minora, 3 vagina, 4 5 vestibule and vestibular glands, 4 vulva, 3 internal genital organs ovaries, 10 uterus, 9 10 perineal muscles bulbospongiosus muscle, 5 coccygeus muscle, 8 ischiocavernosus muscle, 5 levator ani, 6 8 pelvic floor, 5 urogenital diaphragm, 8 9 pudendal nerve, Pelvic diaphragm, 214 Pelvic floor, 5, 20, 113 in childbirth, effect of pregnancy on, 43 anal sphincter, anatomical changes of ligaments, 51 bladder and functional bladder neck anatomy, clinical assessment, 45 genital hiatus, imaging techniques, Pelvic Organ Prolapse Quantification System, physiological changes, 44 effects of second stage of labour on, 58 prolonged, 59 injuries, , bowel disorders, POP, in vaginal delivery, muscle anatomy and function animal studies, biomechanical models, 51 levator ani changes in humans, with pubo-rectal sling, 24 trauma and regional anaesthesia, 60 ultrasound (see (under Ultrasound (US)) ) Pelvic floor biometry, D EVUS technique for, Pelvic floor disorders, 31 32, 304 and maternal age, 251 obstetric and maternal factors in, Pelvic floor dysfunction (PFD), incidence, 101 risk factors, 102 role of episiotomy in prevention, 75 Pelvic floor muscle (PFM), 152, 182 strength, 308 and stress urinary incontinence, 162 Pelvic floor muscle training (PFMT), 46, 107, 188 for anal incontinence postpartum, 277, during pregnancy, 274, antenatal, and incontinence, for PPUI during pregnancy and puerperium, 164 success criteria and recommendations, for urinary incontinence postpartum, , during pregnancy, , Pelvic girdle pain, 51 Pelvic girdle syndrome (PGS), 308 Pelvic organ prolapse (POP), , and childbirth, complications antepartum, 220 intrapartum, 220 postpartum, 220 definition, 214 incidence and prevalence, and LAM injuries, and LAM injury, 146 management, 221 maternal and fetal complications, 220 mode of delivery, 224 operative vaginal delivery, 224 prevalence and natural history, prolonged second stage of labour, and puerperium, 222 and vaginal parity, 32,

10 324 Pelvic Organ Prolapse Quantification (POP-Q) system, 45 46, 215, 222, 223 Pelvic organ support, effect of pregnancy and childbirth on, 215 Pelvic pain. See Low back and pelvic pain (LBPP) Pelvic plexus. See Inferior hypogastric plexus Pelvic splanchnic nerves, 20 Pelvis muscle, 214 Perianal skin, 17 Perineal artery, 5 Perineal Clinic, 125 Perineal curvature of rectum, 16 Perineal hyaluronidase injection, 261 Perineal incisions, 239 Perineal massage, 203 antenatal, 258 during second stage, Perineal muscles, 5 9, Perineal nerves, 3, 11 Perineal pain, and episiotomy prevention, treatment, 84 healing, and suturing, 121 Perineal revision, for dyspareunia, 127 Perineal rupture, 104 Perineal tears, , 114 and epidural analgesia, 254 repair of, 120 suturing of, Perineal trauma, clinical assessment, 117 (see also (Childbirth injury assessment) ) episiotomy and its role in instrumental deliveries, 64 and instrumental delivery sequential instruments, ventouse and forceps delivery, and intrauterine fetal demise, 61 malpositions and malpresentations, and multiple births, prediction, prevention antenatal pelvic floor muscle training, elective caesarean section, 257 EPI-NO, 261 episiotomy, 260 maternal position during delivery, 259 perineal hyaluronidase injection, 261 perineal massage during second stage, perineal support, primary strategies, pushing during second stage, 260 secondary strategies, tertiary strategies, vacuum vs. forceps delivery, 259 warm compress and antenatal perineal massage, 258 whirlpool baths, 259 in previous delivery, 76 regional anaesthesia and pelvic floor trauma, 60 risk assessment Asian ethnicity, 251 epidural analgesia, episiotomy, instrumental delivery, macrosomia, 255 malpresentations and malpositions, 255 maternal age, obesity, 252 parity, prolonged second stage, 254 risk factors, 251 second stage of labour effects on pelvic floor, 58 and LAM trauma, prolonged, 59 and spontaneous vaginal delivery, Perineal wound breakdown, , dehiscence, infection, , Peritoneum, of anorectal canal, 16 Pessaries, 221 PFD. See Pelvic floor dysfunction (PFD) PFM. See Pelvic floor muscle (PFM) PFMT. See Pelvic floor muscle training (PFMT) PGS. See Pelvic girdle syndrome (PGS) Physiological changes of pelvic floor, during pregnancy, 44 Physiotherapy. See Pelvic floor muscle training (PFMT) PLURAL. See Pubic Levator plate Ultrasound Reference Assessment Line (PLURAL) PNTML. See Pudendal nerve terminal motor latency testing (PNTML) Polydioxanone (PDS), 123, 200 Polyglactin, 200 sutures, 123 Polyglactin 910, 80, , 199 Polymodal nociceptive receptors, in anal canal, 21

11 POP. See Pelvic organ prolapse (POP) POP-Q. See Pelvic Organ Prolapse Quantification (POP-Q) system Posterior wall of anorectal canal, 16 Postpartum bladder care, Postpartum fecal incontinence, 184 PMFT for, 277, Postpartum haemorrhage and second stage of labour, 254 and wound healing, 200 Postpartum perineal pain. See Perineal pain Postpartum sexual function, Postpartum urinary incontinence (PPUI), and caesarean section, definitions, 159 and parity incidence, 160 prevalence, 160 PMFT for, , predictors of, 307 role of PFMT during pregnancy and puerperium, 164 stress urinary incontinence, treatment and prevention, urgency urinary incontinence, Postpartum voiding difficulty and urinary retention (PPUR) acute prolonged bladder overdistension, 155 clinical presentation of, 156 confirmation of, 158 definition, 153 diagnosis of, discharge planning, 158 hormonal effect of bladder, 154 incidence, 154 indwelling catheter, 158 management and prevention of, 157 postpartum bladder care, prolonged labour and instrumental delivery, 155 and regional anaesthesia, 155 risk factors for, 156 Postvoid residual (PVR) volume, 153, 163 measurements, 157 PPI. See Present Pain Intensity (PPI) PPUI. See Postpartum urinary incontinence (PPUI) PPUR. See Postpartum voiding difficulty and urinary retention (PPUR) Preaortic plexus, 19 Pregnancy bowel and anorectal changes in, effect on pelvic floor, effect on pelvic organ support, 215 incontinence during anal, 274, urinary, , intestinal disorders, 28 POP in, prevalence of urinary incontinence during, 159 as risk factor of urinary incontinence, 35 role of PFMT for PPUI during, 164 Present Pain Intensity (PPI), 83 Preterm labour, and POP, 224 Prognosis of childbirth trauma incontinence, LAM injury, low back and pelvic pain, obstetric anal sphincter injury, sexual function, Prolonged labour, and PPUR, 155 Pubic bone edema, 103 Pubic bone injuries, 203 Pubic Levator plate Ultrasound Reference Assessment Line (PLURAL), 145 Pubic symphysis, 203 rupture, 104 Puboanalis muscle, 8, 33 Pubococcygeus muscle, 7, 19 damage, during vaginal birth, 59 Puboperinealis muscle, 8, 33 Puborectalis hiatus, Puborectalis muscle, 7, 8, 19, 33, 59 J-hook needle in, 146 role in anal lock, 25 Pubovaginalis muscle, 8, 33 Pubovisceral muscle, 59. See Pubococcygeus muscle damage, during vaginal birth, 59 Pudendal arteries, 3 5 Pudendal nerve, 3, 5, 11 12, 20 block/injury, and PPUR, 155 damage, during vaginal birth, 36, 59, 103 Pudendal nerve terminal motor latency testing (PNTML), 36, 188 Pudendal neuropathy, 125 Puerperium and POP, 222 role of PFMT for PPUI during, 164 PVR. See Postvoid residual (PVR) volume Q Quality of life questionnaires, of pelvic floor damage, 45 46

12 326 R Radical lateral episiotomy, 72 RAIR. See Recto-anal inhibitory reflex (RAIR) Rectal distension, 26, 27 Rectal reservoir function, for continence, 24 Rectal tunica mucosa, 17 Rectal tunica muscularis, 18 Recto-anal inhibitory reflex (RAIR), 26 Rectocele, 104 Rectouterine pouch, 4, 9 Rectovaginal fistula (RVF), , 207, 234, 235, 242 Rectovaginal septum, 216 Rectovesical pouch, 16 Rectum, See also Anorectal anatomy/physiology Rectus sheath, 2 Recursive partitioning. See Classification and regression trees (CART) analysis REEDA scale, 80 Reflexes, role in fecal continence, Regional anaesthesia and pelvic floor trauma, 60 and PPUR, 155 Rehabilitative therapy, 188 Relaxin, 27, 51 Renin-angiotensin-aldosterone system, 27 Restrictive episiotomy and perineal trauma, 60, 64, 255 rate of, 78 timing of, 79 use in instrumental deliveries, Resuturing, in episiotomy, 82 Rotational forceps, 63 RVF. See Rectovaginal fistula (RVF) S Sacral curvature of rectum, 16 Sacral nerve stimulation (SNS), 125, 189, 190 Scarpa s fascia, 2 Schuchardt incision. See Radical lateral episiotomy SD. See Shoulder dystocia (SD) Secondary sphincter repair, 125 Second-degree tears repair of, 122 suturing of, Second stage of labour effects on pelvic floor, 58 and LAM trauma, perineal hyaluronidase injection, 260 perineal massage during, perineal stretching, 75 prolonged, 59 and anal sphincter injuries, 186 and pelvic floor disorders, 106, 183 and perineal trauma, 254 and POP, pushing during, 260 Self-catheterization, 158, 241 Self-control of woman, and episiotomy, 77 Semilunar valves of rectum, 17 Semi-rigid ventouse cup, 62 Sensory innervation of anus, 21 Sequential instruments, and perineal trauma, Serosa, uterine, 10 Sexual function and episiotomy long term, resumption of sexual intercourse, 85 short term, 85 postpartum, Sexual intercourse, resumption after episiotomy, 85 Sexual morbidity, and healing, 206 Short perineum, and episiotomy, 75 Shoulder dystocia (SD), 65 and episiotomy, 76 and perineal trauma, 255 Simple obstetric fistula, 170, 236 treatment of, 172 Skene glands, 4 Skin of abdominal wall, 2 anal, 17 Skin adhesive, SNS. See Sacral nerve stimulation (SNS) Soft tissue injuries, natural wound healing in, Soft ventouse cup, 62 Sphincteroplasty, 199 Sphincter urethrae, 9 Spinal anaesthesia, and PPUR, 155 Spontaneous vaginal delivery and incontinence, 306 and perineal trauma, spop. See Symptomatic pelvic organ prolapse (spop) Squamocolumnar junction, transformation zone of, 9 Squamous stratified epithelium, of rectum, 17 Squirrel monkeys, pelvic floor prolapse in, St. Mark s score, 87 Stool softeners, 203

13 Stress urinary incontinence (SUI), 159 bladder neck and urethral hypermobility, and caesarean section, 165 after episiotomy, 86 levator ani trauma, 161 and parity, 253 during pregnancy, prevalence of, 159 prevention of, risk factors for, 162 urethral sphincter injury, 162 and vaginal delivery, Stretching of pelvic floor muscles, 50 Subcortical fracture, Subcostal nerve, 3 Submucosa tunica, 17 SUI. See Stress urinary incontinence (SUI) Superficial epigastric artery, 2 Superficial inguinal ganglia, 4 Superficial inguinal nodes, 5 Superficial perineal artery, 3 Superficial transverse perineal muscle, 113 Superior epigastric artery, 3 Superior hypogastric plexus, Supralevator haematomas, and wound healing, Surgical techniques, effect on wound healing, Sutures in childbirth trauma management, types, for episiotomy, 80, 81 material, effect on wound healing, SWEPOP (SWEdish Pregnancy, Obesity and Pelvic floor) study, Sympathetic innervation, of anorectal canal, Symphysis pubic dysfunction, 51 Symptomatic pelvic organ prolapse (spop), Synthetic mesh sling, use in OF patients, 241 T TAE. See Transcatheter arterial embolization (TAE) Tears. See Perineal tears Terminationes nervorum, 26 Third-degree tears, repair of, Tibial nerve stimulation (TNS), 189 PTNS, 189, 191 Tissue adhesives, for episiotomy, TNS. See Tibial nerve stimulation (TNS) TOT. See Trans-obturator sling (TOT) TPUS. See Transperineal ultrasound (TPUS) Transanal bidimensional ultrasound, of anal sphincter injuries, 187 Transcatheter arterial embolization (TAE), 200 Translabial ultrasound, 216 Trans-obturator sling (TOT), 189, 190 Transperineal ultrasound (TPUS), 215 for assessing levator hiatus, 140 of LAM, , 225 of levator hiatus, 217, 218 of pelvic floor changes, 48 Transurethral urinary incontinence, 241, 244 Transverse folds of rectum, Transverse perineal muscle, 9 Trendelenburg position, 221 Tunica dartos labialis, 3 U UI. See Urinary incontinence (UI) Ultrasound (US). See also Magnetic resonance imaging (MRI) of anal canal, 187 of anal sphincter muscle, 36 37, assessment of perineal trauma, bladder ultrasound, 157 endoanal (see (Endoanal ultrasound (EAUS)) ) endovaginal (see (Endovaginal ultrasound (EVUS)) ) of genital hiatus, 53 of LAM, 59 in pregnancy, 49 pelvic floor biometry, anorectal angle, 145 3D EVUS technique, 141 levator muscle thickness, 144 levator plate descent angle, levator pubic gap, 144 minimal levator hiatus dimensions and area, puborectalis hiatus, urethral thickness, 145 of pelvic floor changes, 48 for pelvic floor trauma, EVUS technique for visualization of LAM, LAM trauma, levator ani deficiency, obstetric factors, transperineal (see (Transperineal ultrasound (TPUS)) )

14 328 Ureteral orifices, 244 and obstetric fistulas, 235 Ureterosigmoidostomy, 241 Uretero-vaginal fistula (UTVF), 168, 234 juxtacervical, 239 Urethra complete/partial absent, and stress urinary incontinence hypermobility, sphincter injury, 162 thickness, 145 Urethral plug, 241 Urethrocele, 104 Urethrovaginal fistula (UVF), 168, 233, 234, 236 Urethrovesical junction, during pregnancy, 52 Urgency urinary incontinence (UUI), 159, diagnosis, after episiotomy, 86 and vaginal delivery, 306 Urinary diversion, 241 Urinary incontinence (UI), See also Anal incontinence (AI) and childbirth, cost of, 296 definitions, 159, 272 and episiotomy, 86 and genital atrophy, 107 after obstetric fistula repair, , 244 pelvic floor muscle training, 46 persistence of, 307 postpartum (see (Postpartum urinary incontinence (PPUI)) ) during pregnancy, PMFT for preventing, , prevalence of, 159 risk factors for, 159 transurethral, 241, 244 and vaginal parity, 253 Urinary retention. See Postpartum voiding difficulty and urinary retention (PPUR) and POP, 220 and pregnancy, 44 Urinary tract infection (UTI). See also Lower urinary tract (LUT) complications and POP, 220 and PPUR, 158 Urinary tract injury during childbirth bladder rupture, 168 iatrogenic bladder injury, iatrogenic uterine injury, obstetric fistulas, Urine dipstick assessment, for urgency urinary incontinence, 163 Urodynamic tests, Uroflowmetry, 163 Urogenital diaphragm, 8 9 Urogenital hiatus, and POP, 216 Uroplasty, 191 US. See Ultrasound (US) Uterus, 9 10 prolapse of, 104 (see also (Pelvic organ prolapse (POP)) ) UTI. See Urinary tract infection (UTI) UTVF. See Uretero-vaginal fistula (UTVF) UUI. See Urgency urinary incontinence (UUI) UVF. See Urethrovaginal fistula (UVF) V Vacuum extraction. See also Forceps delivery and perineal trauma, 186, perineal trauma after, 259 Vagina, 4 5 Vaginal birth after caesarean section (VBAC), 252 Vaginal delivery. See also Caesarean section (CS) and incontinence, 306 anal incontinence, 36, 305 and OASIS, 306 and overactive bladder, pelvic floor muscle strength after, 308 and POP, 214, 224 and second stage of labour, 254 types of pelvic floor injury in, connective tissue remodeling, mechanical injury, nerve injury, 103 Vaginal dryness, after episiotomy, 86 Vaginal injury, 242 Vaginal packing, 244 Vaginal palpation, Vaginal parity, and POP, 32 Vaginal rest, 310 Vaginal sidewall tears, 106 Vaginal tears, suturing of, Vaginoplasty, 234, 242 VAS. See Visual Analogue Scale (VAS) Vascularization. See also Blood supply of anorectal canal, VBAC. See Vaginal birth after caesarean section (VBAC) Ventouse deliveries and perineal trauma, Verbal Rating Score (VRS), 83

15 Vesical neck position, during pregnancy, 52 Vesicouterine fistula (VUF), 168, 171 Vesicouterine pouch, 9 Vesicovaginal fistula (VVF), , 207, 236 circumferential, 242 classification systems of, 237 draining of ischaemic slough, 233 juxtacervical, 233 Vestibule/vestibular glands, 4 Visceral peritoneum, of uterus, 10 Visual Analogue Scale (VAS), 83 Voluntary pelvic floor muscle contraction (VPFMC), 272, 277, 296 VPFMC. See Voluntary pelvic floor muscle contraction (VPFMC) VRS. See Verbal Rating Score (VRS) 329 VUF. See Vesicouterine fistula (VUF) Vulva, 3 haematomas, and wound healing, VVF. See Vesicovaginal fistula (VVF) W Warm perineal packs/compresses, 83, 258 Wexner (Cleveland) score, 87 Whirlpool baths, 259 Woods screw manoeuvre, 66 Wound maturation and remodeling, 198 natural wound healing in soft tissue injuries, perineal (see (Perineal wound) ) Wrigley s forceps, 63