It is the first birth that does the damage: a cross-sectional study 20 years after delivery

Atan, Ixora Kamisan; Lin, Sylvia; Dietz, Hans Peter; Herbison, Peter; Wilson, Peter

doi:10.1007/s00192-018-3616-4

Cited by 38 publications

(30 citation statements)

References 36 publications

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“…Additionally, newborn weight is also considered a risk factor for OASIS [7, 14], and thus, women with OASIS delivered larger newborns than those without OASIS. Finally, the low rate of multiparous in the group of OVD and OASIS in the present study supports the contention that the first vaginal delivery which requires instrumentation causes the most important pelvic floor damage [15].…”

Section: Discussionsupporting

confidence: 84%

Coital resumption after delivery among OASIS patients: differences between instrumental and spontaneous delivery

et al. 2019

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BackgroundObstetric anal sphincter injuries (OASIS) are associated with sexual dysfunction and a lower likelihood of sexual activity in the postpartum period. The aim of the present study was to compare coital resumption and the variables influencing this activity after delivery in women with and without a history of obstetric anal sphincter injury (OASIS) and according to the mode of delivery.MethodsA prospective, observational, case-control study was performed at 6 months postpartum in 318 women: 140 with a history of primary repaired OASIS and 178 women without OASIS. Demographic and obstetric data, breastfeeding, and symptoms of urinary and anal incontinence were collected. Patients were asked about coital resumption and completed the validated specific Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12). Continuous and non-continuous variables were compared using ANOVA and the Fisher exact tests, respectively. A multivariate logistic regression model and a multiple regression analysis were constructed to assess the impact of demographic and clinical variables on the percentage of coital resumption and on the PISQ-12 score, respectively.ResultsAfter a spontaneous delivery (SD), patients without OASIS showed a higher percentage of coital resumption than those with OASIS (98% vs. 77%; p = 0.003), and the PISQ-12 score was also higher (p < 0.001). PISQ-12 score was better in women with SD compared to those with operative vaginal delivery (OVD)(p < 0.001), independently of the history of OASIS. Current breastfeeding, a higher Wexner score and OVD negatively influenced the PISQ-12 score.ConclusionsAfter SD, women with OASIS resumed coital activity later than women without OASIS. Women with OVD resumed coital activity later, and had a lower PISQ-12 score than women with SD.

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Section: Discussionsupporting

confidence: 84%

Coital resumption after delivery among OASIS patients: differences between instrumental and spontaneous delivery

et al. 2019

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“…found one new LAM avulsion after a second VD. Our findings show that the incidence of LAM avulsion after a second VD is low and the prevalence of LAM avulsion is similar after one or two VDs, confirming that the first VD is associated with the greatest risk of LAM trauma 15,16,18 .…”

Section: Discussionsupporting

confidence: 69%

Natural history of levator ani muscle avulsion 4 years following childbirth

Gruting

Delft

Sultan

et al. 2021

Ultrasound in Obstet & Gyne

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Objectives The primary aim was to evaluate prospectively the natural history of levator ani muscle (LAM) avulsion 4 years following first delivery and its correlation with signs and symptoms of pelvic floor dysfunction (PFD). The secondary aim was to investigate the effect of a second vaginal delivery on the incidence of LAM avulsion and PFD. Methods This was a prospective longitudinal study of nulliparous women recruited antenatally, who were assessed at 36 weeks' gestation and 3 months, 1 year and 4 years postpartum for signs and symptoms of PFD and presence of LAM avulsion. Pelvic floor muscle strength was assessed by digital palpation, and pelvic organ prolapse (POP) was assessed using the POP quantification (POP‐Q) system. Validated questionnaires were used to evaluate urinary, bowel and sexual function and symptoms of POP. Transperineal ultrasound was performed to assess LAM integrity and hiatal biometry. Differences in signs and symptoms of PFD over time were evaluated using a linear mixed model, separately in women who had had one delivery and in those who had two or more deliveries during the study period. Results Of 269 women recruited, 147 (55%) attended the 4‐year follow‐up and were examined at a mean interval of 3.8 ± 0.4 years after their first delivery. Of these, 74 (50%) had a subsequent delivery. The prevalence of LAM avulsion 4 years after a first vaginal delivery was 13%, with no difference between women who had one and those who had two or more vaginal deliveries. Women with an intact LAM and one or more deliveries showed no change in signs and symptoms of PFD at 4 years compared with the previous assessments. Of women with one vaginal delivery who were diagnosed with LAM avulsion 3 months or 1 year postpartum, those in whom the LAM avulsion was no longer evident at 4 years (42%) showed worsening of POP‐Q measurements, whereas those with persistent LAM avulsion (58%) showed significant worsening in pelvic floor muscle strength and hiatal area on ultrasound. After a second vaginal delivery, no new avulsions were diagnosed, however, previous LAM avulsion became more extensive in 44% of women and hiatal area increased in women with persistent LAM avulsion. Conclusions The first vaginal delivery carries the greatest risk for LAM avulsion, with impact on signs of PFD 4 years later. A second vaginal delivery could result in deterioration of LAM avulsion, but no new avulsions were found. © 2020 International Society of Ultrasound in Obstetrics and Gynecology

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“…It is known that a majority of women obtain some degree of perineal tear during vaginal delivery [10,23], and primiparous women experience the highest risk of suffering more severe perineal tears [24,25]. Second-degree tears can in the worst cases cause problems similar to those due to anal sphincter tears.…”

Section: Discussionmentioning

confidence: 99%

“…Previously described risk factors for perineal tears include maternal age, foetal birthweight, and head circumference [6][7][8][9]. Primiparous women are at the highest risk of at least a second-degree tear [10], yet the symptoms these women display 1 year postpartum are not well described [3].…”

Section: Introductionmentioning

confidence: 99%

Posterior compartment symptoms in primiparous women 1 year after non-assisted vaginal deliveries: a Swedish cohort study

et al. 2021

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Introduction and hypothesis This is a prospective cohort follow-up study based on the hypothesis that primiparous women with non-assisted vaginal deliveries and a second-degree perineal tear have more posterior compartment symptoms 1 year after delivery than those with no or first-degree tears. Methods A follow-up questionnaire, including validated questions on pelvic floor dysfunction, was completed 1 year postpartum by 410 healthy primiparas, delivered without instrumental assistance at two maternity wards in Stockholm between 2013 and 2015. Main outcome measures were posterior compartment symptoms in women with second-degree perineal tears compared with women with no or only minor tears. Results Of 410 women, 20.9% had no or only minor tears, 75.4% had a second-degree tear, and 3.7% had a more severe tear. Of women presenting with second-degree tears, 18.9% had bowel-emptying difficulties compared with 20.0% of women with minor tears. Furthermore, almost 3% of them with second-degree tears complained of faecal incontinence (FI) of formed stool, 7.2% of FI of loose stool compared with 1.2% and 3.5% respectively in women with no or only minor tears. Conclusions Symptomatic pelvic floor dysfunction is common among primiparous women within 1 year following uncomplicated vaginal delivery, and there are no significant differences between second-degree perineal tears and minor tears. These symptoms should be addressed in all women after delivery to improve pelvic floor dysfunction and quality of life.

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It is the first birth that does the damage: a cross-sectional study 20 years after delivery

Abstract: Most LAM avulsions and EAS defects seem to be caused by the first vaginal birth. Subsequent vaginal deliveries after the first were unlikely to cause further LAM trauma.

Cited by 38 publications

References 36 publications

Coital resumption after delivery among OASIS patients: differences between instrumental and spontaneous delivery

Coital resumption after delivery among OASIS patients: differences between instrumental and spontaneous delivery

Natural history of levator ani muscle avulsion 4 years following childbirth

Posterior compartment symptoms in primiparous women 1 year after non-assisted vaginal deliveries: a Swedish cohort study

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