PhD defence L. (Leonie) Speksnijder

Dissertation in short:

The pelvic floor is important for several bodily functions. Pelvic floor injuries can lead to pelvic floor disorders (PFD), such as urinary or anal incontinence, pelvic organ prolapse, pelvic pain and sexual dysfunction. Although PFD are not life threatening, they can be the cause of significant social and physical restrictions, as well as impact one’s psychological well-being, and overall quality of life. Pelvic floor injury and muscle weakness are mainly caused by pregnancy and vaginal delivery.
In the first part of this thesis we examined risk factors for the development of pelvic floor (residual) injury and urogynecological complaints after a vaginal delivery with and without obstetric anal sphincter injury. This pelvic floor injury was diagnosed with perineal pelvic floor ultrasound (PFUS).
In the second part of this thesis, we compared conventional perineal PFUS with virtual reality imaging. 

Key findings

• Mediolateral episiotomy is not associated with the occurrence of levator injury or urogynecological complaints in women with a spontaneous vaginal delivery who did not obtain an anal sphincter injury. 
• Levator injury was associated with a prolonged second stage of labor and a nonocciput anterior fetal position.
• Sexual dysfunction after first vaginal delivery is not associated with levator hiatal dimensions.
• Residual defects of the external anal sphincter are associated with severity of anal incontinence symptoms. Furthermore, clinical factors such as constipation and altered stool consistency appear to influence this association and may therefore play a more important role in clinical management.
• Virtual reality currently has no added value for improving the objective assessment of the pelvic floor.