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.

Sammanfattning: 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.