Up to 40% of vaginal deliveries lead to pelvic floor denervation. This has been linked causally with the later occurrence of urinary incontinence, faecal incontinence and vaginal prolapse. Pelvic floor position, anal sphincter pressures and anal electrosensitivity were evaluated in 72 volunteers as simple screening tests for detecting patients who might benefit from neurological assessment. A lower perineum and reduced voluntary sphincter pressures were found antenatally in parous women when compared with nulliparas. The tests were repeated postnatally 24 to 72 hours after delivery. When compared with antenatal readings, the perineum was lower and sphincter pressures were reduced in subjects delivered vaginally. Forty one subjects were reexamined after 6-8 weeks and partial recovery was found. Anal squeeze pressures and pelvic floor position when straining were the results most consistently changed. On the basis of this study it is suggested that 28% of multiparas seen anrenatally and between 25% to 30% of all women who deliver vaginally may be eligible for more detailed neurological study.

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Problem: Caesarean section rates have risen in high-income countries. One of the potential drivers for this is the widespread use of CTG monitoring. Background: Intrapartum cardiotocograph monitoring is considered to be indicated for women at risk for poor perinatal outcome. Aim: This systematic literature review with meta-analysis examined randomised controlled trials and non-experimental research to determine whether cardiotocograph monitoring rather than intermittent auscultation during labour was associated with changes in perinatal mortality or cerebral palsy rates for high-risk women. Methods: A systematic search for research published up to 2019 was conducted using PubMed, CINAHL, Cochrane, and Web of Science databases. Non-experimental and randomised controlled trial research in populations of women at risk which compared intrapartum cardiotocography with intermittent auscultation and reported on stillbirth, neonatal mortality, perinatal mortality and/or cerebral palsy were included. Relative risks were calculated from extracted data, and meta-analysis of randomised controlled trials was undertaken. Findings: Nine randomised controlled trials and 26 non-experimental studies were included. Metaanalysis of pooled data from RCTs in mixed-and high-risk populations found no statistically significant differences in perinatal mortality rates. The majority of non-experimental research was at critical risk of bias and should not be relied on to inform practice. Cardiotocograph monitoring during preterm labour was associated with a higher incidence of cerebral palsy. Discussion: Research evidence failed to demonstrate perinatal benefits from intrapartum cardiotocograph monitoring for women at risk for poor perinatal outcome. Conclusion: There is an urgent need for well-designed research to consider whether intrapartum cardiotocograph monitoring provides benefits.

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