Some researchers have shown that regular and standard physical activities during pregnancy can reduce the risk of caesarean section in pregnant women (1). Despite the fact that pregnancy is associated with profound anatomical and physiological changes, exercise has minimal risks and confirmed benefits for most women. An adequate exercise program during pregnancy influences the mode of delivery, increasing the possibility of a vaginal delivery (2). Therefore, antenatal pelvic floor muscle exercises are recommended as a safety and inexpensive strategy for lowering caesarean section rates (3). Our aim is to analyze the obstetric and perinatal outcomes of those patients who received assessment and treatment in the Pelvic Floor Unit of the Rehabilitation Department during their pregnancy, comparing them with the overall results of the Obstetrics and Gynecology Department.

Retrospective descriptive study carried out from January 2017 to December 2018. Inclusion criteria were all singleton pregnant women controlled in the Pelvic Floor Unit of the Rehabilitation Department of Dr. Negrín University Hospital of Gran Canaria. Study variables collected were age, previous sport activity, smoking habit, parity, assessment indication,  duration of treatment, weight gain during pregnancy, gestational age at delivery, active expulsion period time, weight of the newborn, type of delivery, indication of cesarean section, epidural anesthesia, need for episiotomy, tears in the birth canal or sphincter, perinatal results. 
In our Department, during that two-year time period, an annual average of 4207 births were attended, with a rate of normal vaginal deliveries of 79%, 10.5% of Cesarean section and 9.6% of forceps deliveries. The  episiotomy rate was 25% (16.5% in normal vaginal deliveries and 88.7% in forceps deliveries), and epidural analgesia was administered in 54% of women with a normal vaginal delivery. Anal sphincter injury was diagnosed in 7.7% of the forceps deliveries and in 1% of the normal vaginal deliveries. The nulliparous average rate was 57.4%. Mean time of the active phase of the second stage of labor was 30 minutes.

A total of 120 patients were included. Their average age was 35 years (26-49). Mild or moderate sport activity was carried out by 82.5% of patients while 16.7% did not carry out any previous sport activity.  94.2% were non-smokers. 60.8% were nulliparous women (58.3% in their first pregnancy, 2.5% had a previous cesarean section). The main indication for referral were own request in 84.2% of patients and 15.8% due to urinary incontinence. Average number of treatment sessions were 10.2. The mean weight gained during pregnancy was11.6 kg. Mean gestational age at delivery was 39 weeks.The average duration of the active phase of the second stage of labor was 30.44 minutes. Average birthweight was 3238 g. Mode of delivery was 81.7% normal vaginal delivery, 10.8% forceps, 7.5% cesarean sections. None of the C-section performed were due to cephalopelvic disproportion or no progression of labor. 
Epidural analgesia was administered in 55.8% of patients and an episiotomy was performed in 25.9%. An anal sphincter injury occurred in 4% of the patients.  Two were forceps deliveries, 2 normal cephalic vaginal deliveries, one breech delivery and a home delivery. All anal sphincter injuries were third degree tears excepto for a fourth degree tear in a normal vaginal delivery. All newborns had an Apgar score greater than 7 and an umbilical arterial pH greater than 7.0. 4% of newborns were admitted to the Neonatal Intensive Care Unit either due to prematurity and/or low birth weight.

We found that those that received rehabilitation showed a lower C-section rate however this was not statistically significant. No  differences were found between the rehabilitation group and the general population group in terms of mean gestational age, forceps delivery, third and fourth degree tears,  time of the second stage of labor, perinatal outcome and episiotomy. 
However, the potential benefit of rehabilitation may have been underpowered in this study. Rehabilitation may not have a potential obvious effect in a Department with optimal and adjusted rates of cesarean section and forceps delivery with associated optimal perinatal outcome. Larger multicenter prospective studies are needed to study the potential effect of rehabilitation in different obstetrical practices.

No differences were in mode of delivery, episiotomy rate, perineal tears, perinatal outcome and time of second stage of labor in those pregnant women that followed a pelvic floor excercise program and those from the general population. Further study will be needed to look at wether pelvic floor exercises during pregnancy has a positive effect on postpartum recovery. Also, larger multicenter prospective studies are needed to study the potential effect of rehabilitation in patients from obstetrical practices with different C-section and instrumental delivery rates.

Rajabi A, Maharlouei N, Rezaianzadeh A, Lankarani KB, Esmaeilzadeh F, Gholami A, Mansori K. Physical activities (exercises or choreses) during pregnancy and mode of delivery in nulliparous women: A prospective cohort study. Taiwan J Obstet Gynecol. 2018 Feb;57(1):18-22.
Silveira Lílian Cristina da, Segre Conceição Aparecida de Mattos. Physical exercise during pregnancy and its influence in the type of birth. Einstein (São Paulo)  [Internet]. 2012  Dec [cited  2019  Mar  31] ;  10( 4 ): 409-414. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1679-45082012000400003&lng=en.  http://dx.doi.org/10.1590/S1679-45082012000400003.
El-Shamy F.F. • Abd El Fatah E. Effect of Antenatal Pelvic Floor Muscle Exercise on Mode of Delivery: A Randomized Controlled Trial. Integr Med Int 2017;4:187–197