Does vaginal delivery cause more damage to the pelvic floor than cesarean section as determined by 3D ultrasound evaluation? A systematic review

Araújo, Camila Carvalho de; Coelho, Suelene Albuquerque; Stahlschmidt, Paulo; Juliato, Cássia Raquel Teatin

doi:10.1007/s00192-018-3609-3

Cited by 45 publications

(38 citation statements)

References 38 publications

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“…The influence of mode of delivery on occurrence of PFD is still uncertain, but studies in women in general show that cesarean section appears to protect against these symptoms, and vaginal delivery is highly associated with pelvic floor injury. 19 , 20…”

Section: Discussionmentioning

confidence: 99%

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Pelvic floor disorders in postpartum adolescents in the Western Amazon: a cross-sectional study

Zuchelo¹,

Santos²,

Figueiredo³

et al. 2018

IJWH

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PurposeTo analyze the postpartum pelvic floor disorders (PFD) and mode of delivery among adolescents, late adolescents, and young women from Western Amazon.Patients and methodsCross-sectional study was carried out in the urban area of Western Amazon in the city of Rio Branco, Acre, Brazil, from October 2016 to February 2017. This is a convenience sample of women up to 30 years who completed six months postpartum, separated in three groups according to maternal age: adolescents (age ≤19 years), late adolescents (20–24 years), and young women (25–30 years). Participants were home interviewed and answered Pelvic Floor Distress Inventory-20 (PFDI-20). Delivery clinical data were collected from patient’s medical records.ResultsIn total, 285 participants were interviewed: 41 adolescents, 103 late adolescents, and 141 young women. After controlling for confounding factors, prevalences of PFD were higher in the adolescents’ group compared with the young women’s group (urinary incontinence [UI], prevalence ratio [PR] = 1.75, 95% CI 1.14–2.69; urge urinary incontinence [UUI], PR = 1.88, 95% CI 1.02–3.47; stress urinary incontinence, PR = 2.00, 95% CI 1.11–3.62; fecal incontinence [FI], PR = 4.40, 95% CI 1.36–14.27). PFDI-20 scores also presented higher values in the adolescent group (Pelvic Organ Prolapse Distress Inventory [POPDI], PR = 2.02, 95% CI 1.49–2.75; urinary distress inventory [UDI], PR = 2.09, 95% CI 1.47–2.98; PFDI, PR = 2.12, 95% CI 1.47–2.98). Analyzing the influence of cesarean section, adolescents have higher prevalence of UI (PR = 1.84, 95% CI 1.04–3.26, P=0.037), UUI (PR = 2.36, 95% CI 1.03–5.40, P=0.042), and FI (PR = 4.09, 95% CI 1.21–13.81, P=0.023). In addition, POPDI (PR = 2.15, 95% CI 1.60–2.89, P<0.001), UDI (PR = 2.25, 95% CI 1.61–3.16, P<0.001), and PFDI (PR = 2.27, 95% CI 1.68–3.08, P<0.001) scores are also higher among adolescents where the baby is born by cesarean section.ConclusionAdolescents present higher prevalence and symptoms of PFD; furthermore, cesarean delivery has a greater negative influence on the pelvic floor of adolescents when compared with young women. This reinforces the importance of PFD investigation among the adolescent population, mainly in developing countries which have high rates of adolescent pregnancy and cesarean section.

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Section: Discussionmentioning

confidence: 99%

“…In women in general, vaginal delivery has been considered the main contributing factor for the development of PFD; however cesarean delivery is not shown as the best choice for the prevention of these symptoms in addition to the health risks for both fetus and mother. 19 , 20…”

Section: Introductionmentioning

confidence: 99%

Pelvic floor disorders in postpartum adolescents in the Western Amazon: a cross-sectional study

Zuchelo¹,

Santos²,

Figueiredo³

et al. 2018

IJWH

View full text Add to dashboard Cite

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“…Vaginal birth-induced pelvic floor muscle and nerve avulsion, connective tissue rupture, and nerve compression are strongly implicated in the pathogenesis, development, and progression of UI. [4][5][6][7] Failure to resolve pelvic floor injury following vaginal birth trauma/injury leads to persistent postpartum SUI often worsening with advancing age. 3 The most commonly performed surgical repair techniques for SUI are implantation of synthetic mesh midurethral slings in women.…”

Section: Impact Statementmentioning

confidence: 99%

Transcriptomic Analysis of Human Mesenchymal Stem Cell Therapy in Incontinent Rat Injured Urethra

Sadeghi

Kenyon

Richardson

et al. 2020

Tissue Engineering Part A

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Periurethral human mesenchymal stem cell (hMSC) injections are associated with functional improvement in animal models of postpartum stress urinary incontinence (SUI). However, limited data exist on the role of hMSCs in modulating gene expression in tissue repair after urethral injury. To this end, we quantified temporal gene expression modulation in hMSCs, and in injured rat urethral tissue, using RNA-seq in an animal model of SUI, over a 3-day period following urethral injury, and local hMSC injection. We injected PKH fluorescent-labeled hMSC into the periurethral space of rats following a 4 h vaginal distention (VD) (three rats per time point). Control rats underwent VD injury only, and all animals were euthanized at 12, 24, 36, 72 h postinjury. Rat urethral and vaginal tissues were frozen and sectioned. Fluorescent labeled hMSCs were distinguished from adjacent, unlabeled rat urethral tissue. RNA was prepared from hMSCs and urethral tissue obtained by laser dissection of frozen tissue sections and sequenced on an Illumina HiSeq 2500. Differentially expressed genes (DEGs) over 72 h were evaluated using a two-group t-test (p < 0.05). Our transcriptional analyses identified candidate genes involved in tissue injury that were broadly sorted by injury and exposure to hMSC throughout the first 72 h of acute phase of injury. DEGs in treated urethra, compared with untreated urethra, were functionally associated with tissue repair, angiogenesis, neurogenesis, and oxidative stress suppression. DEGs included a variety of cytokines, extracellular matrix stabilization and regeneration genes, cytokine signaling modification, cell cycle regulation, muscle differentiation, and stabilization. Moreover, our results revealed DEG changes in hMSCs (PKH-labeled) harvested from injured urethra. The expressions are related to DNA damage repair, transcription activation, stem cell regulation, cell survival, apoptosis, self-renewal, cell proliferation, migration, and injury response.

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“…However, our review article showed no difference between bladder neck hypermobility and delivery route. 15 PFDs seem to be closely related to vaginal delivery, especially cases of instrumental delivery. Cesarean section is associated with a reduction in the risk for PFDs, although the routine performance of this procedure does not eliminate the risk for dysfunctions because the pathophysiology is multifactorial.…”

mentioning

confidence: 99%

Impact of Vaginal Delivery on Pelvic Floor

Juliato

2020

Rev Bras Ginecol Obstet

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Does vaginal delivery cause more damage to the pelvic floor than cesarean section as determined by 3D ultrasound evaluation? A systematic review

Abstract: Vaginal delivery was associated with a higher number of LAM injuries, puborectalis defects, increased bladder neck mobility, and enlargement of the hiatal area.

Cited by 45 publications

References 38 publications

Pelvic floor disorders in postpartum adolescents in the Western Amazon: a cross-sectional study

Pelvic floor disorders in postpartum adolescents in the Western Amazon: a cross-sectional study

Transcriptomic Analysis of Human Mesenchymal Stem Cell Therapy in Incontinent Rat Injured Urethra

Impact of Vaginal Delivery on Pelvic Floor

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