LAUSR

Hypothesis Placental ischemia/hypoxia is NOT the major initiating event in the pathogenesis of preeclampsia. It is pelvic muscle pressure. Methods During my Winston Churchill Memorial Trust traveling fellowship to explore how to prevent trauma to pelvic floor muscles during birth, I conducted a review of the literature published between 1990 and 2017 investigating classification, assessment, and (physiotherapeutic) treatment of pelvic dysfunction and muscle physiology and biomechanics during pregnancy and postpartum. Expert opinions with biomedical engineers and muscle physiologists were also sought via interviews. Findings Studies revealed a conceptual model where muscles in the pelvic area become chronically tense (a high tone pelvis) because of multifactorial insults antepartum and postpartum. Pressurizing the pelvis and culminating in raised blood pressure. A triad of interrelated insults were identified which are mothers being encouraged to do Kegels with no relaxation component. The growing number of mothers with emotional stress disorders which manifest physically as tense muscles especially those in the pelvic region. And thirdly postural adaptations of pregnancy such as lumbar lordosis and anterior pelvic tilt being amplified by mothers poor lifestyle practices such as prolonged sitting, wearing heels and inadequate breathing causing shortened piriformis, quadriceps and other pelvic region muscles. Creating an unstable pelvis and compensatory spasm of antagonist muscles such as the pelvic floor to try and balance the pelvis.These tight or spasmed pelvic muscles are not just dysfunctional, but theoretically left unused their blood vessels become stiff resisting blood flow and causing volume overload at the heart, with a compensatory heart rate and blood pressure increase. Conclusion We are dealing with a pelvic pressure issue, not just a blood pressure one. A silent epidemic of tight pelvic muscles should be considered as a major initiating event in the pathogenesis of pregnancy hypertension in a significant number of mothers. Further studies are needed in this exciting area.