[The role of pelvic outlet dystocia in the pathogenesis of pelvic floor damage cause by obstetric intervention].
BACKGROUND: Vaginal delivery may cause injury to the perineum even when it progresses normally. In the light of this, some authors have suggested that other factors besides obstetric trauma may be implicated in the pathogenesis of genito-urinary prolapse, such as maternal constitution, race, connective tissue characteristics, etc. The aim of this study was to investigate the role of mechanical factors in causing perineal injury. METHODS: We examined the clinical data of 250 women who underwent, 20 days after delivery, a clinical examination consisting of a semeiological study of micturition and a functional evaluation of the pelvic floor. RESULTS: Outlet dystocia seems to be associated with the higher prevalence of anteriormedian prolapse and seem to play an important role in the pathogenesis of post-partum pelvic floor deficiency. CONCLUSIONS: If valid prognostic indexes for the selection of patients at risk are found, it will be possible to carry out an effective prevention of pelvic floor damage and also to avoid an indiscriminante and unjustified increase of laparotomic deliveries.