In the literature, only 10 specialized clinics for pelvic floor dysfunction (PFD) during pregnancy, childbirth, and postpartum are described. The objective of this work is to describe the creation of a specialized group for PFD during pregnancy, childbirth, and postpartum (GPAP) at a public university and the experience obtained in the first 25 months of care.

Cross-sectional study, clinical, not-surgical. In February 2021, the Gynecology department created the GPAP after meetings with a multidisciplinary team, to provide care for pregnant, and postpartum women up to one year after childbirth with perineal trauma, PFD and/or diastasis of the rectus abdominis muscle. The term of consent was applied in the first consultation. Pregnant patients received medical care every three months, on the 7th and 40th days of the puerperium and also every three months until one year postpartum. In addition to anamnesis and physical examination, the Australian Pelvic Floor Questionnaire (APFQ) was administered. Women up to one year after giving birth answered the APFQ, the Childbirth Experience Questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). In addition to the physical examination, they also were evaluated with perineal and abdominal ultrasound. In every appointment, there was a multidisciplinary discussion about the therapeutic and rehabilitation plan. At the first appointment with the Physiotherapy team, regardless of the patient's profile, the Self-Efficacy Scale for Practicing Pelvic Floor Exercises was applied. For the functional evaluation of the pelvic floor, bidigital palpation, surface electromyography and dynamometry were used. Pregnant women were evaluated after the 20th gestational week, and reassessed between the 37th and 38th gestational week and 40 days after delivery. These patients, from the 20th to the 32nd gestational week, performed pelvic floor muscle strengthening and some, according to randomization, from the 32nd gestational week until delivery also were included in another protocol to prepare them for the delivery. Postpartum women were evaluated 40 days after delivery, and reassessed when the proposed treatment was completed, with a follow-up of 6 and 12 months after treatment. Postpartum women with rectus abdominis muscle diastasis -confirmed by ultrasound- were randomized to one of the treatment groups, had their abdominal circumference checked and answered the Low Back Pain Questionnaire, with reassessment
at the end of the 3-month treatment. Postpartum women with 3rd and 4th degree perineal lacerations responded to the Fecal Incontinence Quality of Life Questionnaire (FIQL) and Fecal Incontinence Severity Index (FISI), with a reassessment after 3 months of the proposed treatment, according to randomization, and follow-up at 6 and 12 months.

During the 25 months, 61 patients were treated. Of these, 24% were pregnant, with 33% experiencing some type of urinary incontinence. Of the 46 postpartum patients, 69% were referred for 3rd or 4th degree laceration, 11% for urogenital fistulas, 8% had complaints of urinary incontinence, and 4% had complaints of fecal incontinence. 46% of the patients received simultaneous medical and physiotherapeutic care, 8% received only medical care, and 46% did not follow-up. The average age of the patients was 29 years old, and 46% were primiparous. 15% of the patients lived with a monthly income of up to 1 minimum wage (approximately US$260), 49% with 1 to 3 minimum wages (approximately US$260 to US$782), 24% with 3 to 6 minimum wages (approximately US$782 to US$1564), and 6% with 6 to 9 minimum wages (more than US$1564).

The treatment adherence rate during this period was around 46%, improving quality of life for many women. All of the pregnant women completed the protocol until the end, we didn’t have any drop out. Yet, for the postpartum women, we still have a difficulty related to adherence. Another important data is that the main reasons for referral to the group were 3rd and 4th degree perineal injuries during childbirth. And interestingly, we have more than half of patients living with up to 3 minimum wages (up to US$782,00).

The GPAP is a unique and the only public health service in the prevention and treatment of Pelvic Floor Dysfunction for pregnant and postpartum women in Latin America, with a specialized multidisciplinary team. More than half of the patients in this project are considered very low and low-income, patients who would not have access to this type of service if it were not for the public healthcare system. The main reasons for referral to the group were 3rd and 4th degree perineal injuries during childbirth, reinforcing the importance of initiatives that minimize lacerations, such as monitoring throughout the pregnancy and postpartum period to minimize future Pelvic Floor Dysfunction.