Urogynaecological problems in pregnancy and postpartum sequelae

Women in pregnancy can experience lower urinary tract symptoms which are related to the pregnancy and delivery and iatrogenic, and related to use of epidural anaesthesia and urethral catheters. This article assesses the controversial relationship between pregnancy and delivery and the development of urinary incontinence and pelvic organ prolapse. Lower urinary tract symptoms are common in pregnancy and they peak in the third trimester. If women have lower urinary tract symptoms prior to pregnancy, they are more likely to persist after delivery. Vaginal delivery is the factor most strongly associated with stress urinary incontinence after delivery and elective caesarean section may be protective. Vaginal childbirth causes levator ani injury and increase in levator hiatus size, and these persist following vaginal delivery. Women with levator ani injuries may be twice as likely to develop uterovaginal prolapse. Voiding difficulties are more likely to occur after a traditional epidural than a low dose or combined spinal epidural. There is radiological evidence supporting pelvic floor injury following vaginal childbirth and epidemiological evidence for the relationship between vaginal delivery and urinary incontinence and pelvic organ prolapse. Rigorous long-term studies are needed to identify the direct relationship between these two phenomena.