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True cephalopelvic disproportion is very rare, reserved in the main for women with pelvic damage and those (largely in the developing world) suffering from malnutrition.
When she was eighteen, a bus crash left her with spinal and pelvic damage that would entail many surgeries, some of them probably unnecessary.
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Indeed an extensive dissection for deep endometriosis with afterwards still pain and difficulties to elevate or cross the right leg and to walk, raises suspicion of incomplete surgery and/or pelvic nerve damage.
Pelvic floor damage has been attributed to intrapartum events by Allen [ 19], who described neurophysiologic changes in association with a long second stage and larger babies.
The few studies available mostly focused on postoperative outcomes, as abdominal surgery has the potential for structural changes or pelvic nerve damage [ 8- 10].
Many factors have influenced this change in practice including increasing consumer awareness and expectation, fear of intrauterine death, brain injury and pelvic floor damage associated with vaginal delivery, beliefs requiring a specific day and time for childbirth and physicians' consideration of financial benefits [ 10- 14].
However, pelvic exenteration damages the pelvic floor, increasing the likelihood of herniation of internal organs into the infectious wound.
So based on these data, maternal obesity seems to be associated with less serious pelvic floor damages.
Obese women had a favourable outcome compared to normal weight women concerning serious pelvic floor damages at birth.
Additionally, relatively sharp instruments in a narrow pelvic area can damage blood vessels and cause bleeding, such as damage to the pudendal vein and presacral bleeding.
One apparent reason is the type of combat: when troops on foot patrols are struck by improvised bombs, they are particularly vulnerable to pelvic injuries that damage their reproductive systems.
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