Episiotomy: the biomechanical impact of multiple small incisions during a normal vaginal delivery

Childbirth-related injuries are one of the main causes of pelvic floor dysfunction. To attempt to avoid serious tears during delivery, an episiotomy can be performed. In this study, we intended to investigate the biomechanical performance of the pelvic floor muscles after performing different episiotomies using a physics-based computational model which includes the pelvic floor muscles and the fetus. Previous biomechanical studies have analysed the mechanical effects of single incisions of different lengths; in this study, we intend to analyse the implications of multiple small incisions, evaluating the reaction forces, the stress on the muscles and the loss of tissue integrity sustained by the pelvic floor. The obtained results predict that an episiotomy delivery reduces the likelihood of macroscopic levator trauma by decreasing the stress on the region of insertion of the rectal area of the levator ani in the symphysis pubis . From the mechanical point of view, multiple incisions do not bring benefits compared to larger incisions. However, nothing can be ascertained about the clinical benefit of such an approach.

Avulsion of the Levator Ani at First Pregnancy

Objective: To investigate whether demographic and obstetric risk factors are associated with avulsion of the levator ani at first pregnancy. Methods: A series of case was undertaken on 4 pregnant nulliparous women seen with a gestational age of more than 37 weeks. We analyzed with 3D/4D translabial ultrasound and digital assessment data of 4 women seen in a tertiary Urogynecological clinic. The use of 3D/4D ultrasound as a means of detection of trauma to the levator ani. Result: We had 4 women who had levator ani avulsion. Diagnosis of levator trauma (avulsion) on tomographic ultrasound was correlated with predelivery demographic variables and ultrasound parameters. Conclusion: With a greater understanding on the function of pelvic floor muscles, risk factors for trauma and damage as a result of pregnancy and birth, healthcare professionals will have better ability to meet the needs of women in the childbearing year. This study utilized a scoring system that can be used to predict the occurrence of levator ani muscle damage. In the end, the decline in quality of life for women, especially after a birth, can be prevented. [Indones J Obstet Gynecol 2013; 37-1: 51-6] Keywords: 3D/4D translabial ultrasound, demographic, levator ani avulsion, obstetric risk factors