Putative protective effects of cesarean section on pelvic floor disorders.

Pregnancy can affect the lower genitourinary tract through physiologic changes, or traumatic injury tissue stretching and tearing, besides neurologic and vascular compression and compromise, and muscle strain are inevitable during childbirth.The levator ani complex of the pubococcygeus, puborectalis, and iliococcygeus muscles must allow passage of the fetus. The perineal body and external anal sphincter may become injured, with or without episiotomy, but sometimes as a necessary maneuver to allow passage of the fetal head or shoulders. The traumatic insults may lead to permanent damage on pelvic floor and subsequent urinary or anal incontinence.In this article we aim to review the literature regarding the impact of pregnancy or childbirth on pelvic floor changes.

Obesity and fetal-maternal outcomes.

In women Obesity has a significant impact on every aspect of female reproductive life both in terms of infertility and early pregnancy complications. It is linked to a number of adverse obstetric outcomes as well as increased maternal and neonatal morbidity and mortality. These complications include miscarriage, congenital abnormalities, pre-eclampsia, gestational diabetes mellitus, iatrogenic preterm delivery, post-dates pregangy with increased rates of induction of labour, caesarian section and complications during and following operative procedures, post-partum haemorrhage, shoulder dystocia, infection, venous thromboembolism and increased hospital day. It is important to consider obese pregnant women as a high risk group with a linear increase in risk of complications associated with their degree of obesity.

Uterine artery Doppler flow studies in obstetric practice.

In women who develop preeclampsia there is a pathological increase in placental vascular resistance should be detectable by abnormal Dopplerf low studies of the maternal uterine vessels. In women considered at low risk with abnormal early pregnancy uterine artery Doppler studies are needed. Until such time as these are available, routine uterine artery Doppler screening of women considered at low risk is not recommended. Uterine artery Doppler screening of high-risk women appears to identify those at substantially increased risk for adverse pregnancy outcomes and interventions that might improve clinical outcomes.Abnormal testing in these women could potentially lead to increased surveillance and interventions that might improve clinical outcomes.