There is an increasing awareness that obstetric events in a womans’ first labor may contribute to her subsequent gynaecological outcomes (1).
The initial evidence arises from studies in the 1950’s from St Louis, Missouri, which related chronic pelvic pain to difficulties in labor (2). More recent evidence offers the view that intrapartum injuries to autonomic nerves contributes to the development of endometriosis, adenomyosis and leiomyomas (3, 4). In a prospective study of 2240 nulliparous women over four years, there were
worse gynaecologic outcomes at 47 months follow-up for almost all intrapartum interventions including induction of labor. http://www.whonamedit.com/synd.cfm/1697.html
Uterosacral ligaments contain branches of the inferior hypogastric plexus that deliver autonomic nerves to the uterus and vagina. Difficult intrapartum episodes results in attenuation, or even avulsion, of the uterosacral ligaments with widespread reinnervation at the site of the injury presenting with chronic pelvic pain 5-10 years later (3-5). Uterosacral “defects” are not widely recognised in the clinical literature though vaginal, levator and neurologic injuries have been recorded as adverse consequences of vaginal delivery.
That gynaecologic outcomes may be a consequence of intrapartum events is an important question that needs urgent attention.
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