I. Kamisan Atan

Does the Epi-No® birth trainer prevent vaginal birth-related pelvic floor trauma? A multicentre prospective randomised controlled trial

Vaginal childbirth may result in levator ani injury secondary to overdistension during the second stage of labour. Other injuries include perineal and anal sphincter tears. Antepartum use of a birth trainer may prevent such injuries by altering the biomechanical properties of the pelvic floor. This study evaluates the effects of Epi‐No® use on intrapartum pelvic floor trauma.

Anal sphincter trauma and anal incontinence in urogynecological patients

To determine the prevalence of evidence of residual obstetric anal sphincter injury, to evaluate its association with anal incontinence (AI) and to establish minimal diagnostic criteria for significant (residual) external anal sphincter (EAS) trauma.

The association between vaginal parity and hiatal dimensions: a retrospective observational study in a tertiary urogynaecological centre.

Vaginal childbirth has a substantial effect on pelvic organ supports, which may be mediated by levator ani (LA) avulsion or hiatal overdistension. Although the impact of a first vaginal delivery on the hiatus has been investigated, little is known about the effect of subsequent births. This study was designed to evaluate the association between vaginal parity and hiatal dimension.

Association between ICS POP-Q coordinates and translabial ultrasound findings: implications for definition of 'normal pelvic organ support'.

Female pelvic organ prolapse is quantified on clinical examination using the pelvic organ prolapse quantification system of the International Continence Society (ICS POP‐Q). Pelvic organ descent on ultrasound is strongly associated with symptoms of prolapse, but associations between clinical and ultrasound findings remain unclear. This study was designed to compare clinical examination and imaging findings, especially regarding cut‐offs for the distinction between normal pelvic organ support and prolapse.

Delivery mode and pelvic organ prolapse: a retrospective observational study

To analyse the associations between delivery mode and symptoms and signs of pelvic organ prolapse (POP) in a cohort of symptomatic women.

The 'bother' of obstructed defecation.

To examine the relationship of visual analog scale (VAS) ‘bother’ scores for obstructed defecation (OD) with demographic data, physical examination and sonographic findings of the posterior compartment.

Warping of the levator hiatus: How significant is it?

The levator hiatus is the largest potential hernial portal in the human body. Excessive distensibility is associated with female pelvic organ prolapse (POP). Distension occurs not just laterally but also caudally, resulting in perineal descent and hiatal deformation or ‘warping’. The aim of this study was to quantify the warping effect in symptomatic women, to validate the depth of the rendered volume used for the ‘simplified method’ of measuring hiatal dimensions and to determine predictors for the degree of warping.

OC10.06: The association between vaginal childbirth and hiatal dimensions

delivered of a second child between the first and second postnatal assessments. Results: Out of 715 participants seen at an average gestation of 36+5, 529 returned for their first postnatal assessment at a median follow-up time of 4.2 (2.3–22.1) months postpartum. Of those, 227 were again seen for a second postnatal appointment, and 94 of them seen at an average of 2.7 (1.43–4.21) years after their first delivery reported a second birth. 65 (69%) had a vaginal delivery (NVD 58 [62%], vacuum 4, [4%]; forceps 3 [3%]), and 29 (31%) a Caesarean section. There were 9 VBAC attempts, of which 6 were successful (2 NVD, 3 Vacuum, 1 FD). On imaging there was a trend towards increased bladder neck descent, with no significant change observed for cystocele descent and hiatal area on valsalva. Delivery mode of the second birth seemed to have little effect on changes observed between follow ups. On reviewing patients who were diagnosed with avulsion at their 2–3 year visit and comparing them with findings at the first follow up, we found identical normal findings in 87. In 5 there was an unchanged avulsion. In one case findings had improved from complete to partial avulsion – after a second NVD. There was one new avulsion in a patient who had delivered her first baby by emergency C/S, and her second by vacuum. Conclusions: A second pregnancy and delivery do not seem to have a major effect on pelvic organ support and/ or levator functionunless the pregnancy results in that patient’s first vaginal birth.