Spiteri, Margaret; (2005) The role of connective tissue in the female pelvic floor. Doctoral thesis , UCL (University College London).

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Abstract

Biomechanical studies were performed on biopsies of the rectus sheath, round and uterosacral ligaments as well as anterior and posterior vaginal walls of women with or without genital prolapse. In the second study, 96 healthy women in their fifth decade, were compared with 94 similar women with genital prolapse surgery Their clinical connective tissue markers were assessed by standardised methods and their first childbirth data were collected from hospital notes. The progress of the first labour was analysed by multiple logistic regression in the 2 groups of women. In the third study, 665 primiparous women who had their first baby during the previous 7 to 12 months, had their clinical connective tissue markers assessed as in the second study. Data from their first labour were then collected from the hospital notes and compared to the connective tissue markers by standard multiple regression analysis. Results: In-vitro biomechanical data showed that the round ligament properties were different in women with and without genital prolapse. They were also different amongst women under and over 40 years of age without genital prolapse. In women without genital prolapse, the elasticity of the rectus sheath and the round ligament differed from each other. In women with genital prolapse, the anterior vaginal wall and the uterosacral ligament were different from each other. In the second study, women with uterocervical prolapse had a shorter active first stage of labour than women without prolapse. When women with any type of genital prolapse were compared to women without prolapse, there was no difference in the duration of labour. The study is likely not to have had adequate power to detect a difference in the second stage of labour. More women in the prolapse group had knee hyperextension but there was no difference in the mobility of the upper limb joints. In the third study, primiparous women with increased joint mobility had a shorter second stage of labour. Connective tissue properties play an important role in pelvic floor function.

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