Gestação e prolapso de parede vaginal anterior: uma associação inevitável?

Abstract

Pelvic organ prolapses (POP) are prevalent, multifactorial conditions, PPVA being the main one. Some of the risk factors are related to pregnancy, such as parity, vaginal and/or instrumented delivery and fetal macrosomia. This review seeks to assess this relationship, highlighting possible therapies and prevention of this condition. A literature review was carried out, with a bibliographic survey in electronic databases - (NCBI/PubMed and SciELO) - in addition to the descriptors in Portuguese "cystocele", "prolapse of the anterior vaginal wall" and "pregnancy". Of the 64 articles selected for analysis, 23 were read in full and used. PPVA are related to structural dysfunction in the support of the pelvic viscera due to changes in the pelvic floor musculature and endopelvic fascia. Intrinsic obstetric factors, such as uterine growth and physiological changes during pregnancy, can cause and/or aggravate POPs, as well as factors related to labor, such as vaginal delivery, forceps assisted delivery, multiparity, and cesarean is a protective factor. However, factors not related to obstetric care, such as age, quality of collagen and obesity may be related. One of the main forms of treatment for POP is surgery, which, in general, is not recommended in pregnancy. non-surgical ones, such as pelvic physiotherapy and the use of pessaries, can and should be discussed. Prevention strategies can be instituted, such as weight control, physical rest, smoking cessation, and light physical activities, under professional guidance. The revised data show the existence of obstetric risk factors associated with the development of VAPP, with well-established non-surgical therapeutic possibilities.