Prognosis models for pelvic floor damage compared to vaginal birth and cesarean section

More than half of the primiparae report changes in the pelvic floor one year after delivery. Symptoms are urinary or fecal incontinence, irritative sensations, laxity or bulging of the pelvic floor. Underlying injuries can be of a muscular type (levator ani or sphincter ani muscle) or of a ligament type. Risk factors for pelvic floor trauma are advanced maternal age, a prolonged second stage of labour, forceps delivery, occipitoposterior fetal position and third and fourth degree perineal tears. Apart from the maternal age, the risk factors are not known prenatally and this knowledge gap is intended to be closed by prediction models. The first prediction model is called UR-CHOICE. Based on long-term epidemiological data from the ProLong (UK and New Zealand) and the SWEPOP (Sweden) databases, risk weights are established for various parameters such as maternal age, body mass index (BMI), the number of children desired and the family history on incontinence that in combination result in a percentage of future risk for urinary and fecal incontinence and genital prolapse. The second model, the Capacity Demand Model, integrates objective data from imaging, namely the circumference of the fetal head and the levator ani muscle, in order to predict severe levator ani muscle trauma with a reliability of 0.8 in the receiver-operating characteristic (ROC) curve.