Pelvic Floor Disorders 5–10 Years After Vaginal or Cesarean Childbirth

Abstract

Objective To estimate differences in pelvic floor disorders by mode of delivery. Methods We recruited 1,011 women for a longitudinal cohort study, 5-10 years after first delivery. Using hospital records, we classified each birth as: cesarean without labor, cesarean during active labor, cesarean after complete cervical dilation, spontaneous vaginal birth, or operative vaginal birth. At enrollment, stress incontinence, overactive bladder, anal incontinence, and prolapse symptoms were assessed with a validated questionnaire. Pelvic organ support was assessed using the Pelvic Organ Prolapse Quantification system. Logistic regression analysis was used to estimate the relative odds of each pelvic floor disorder by obstetric history, adjusting for relevant confounders. Results Compared to cesarean without labor, spontaneous vaginal birth was associated with a significantly greater odds of stress incontinence (odds ratio (OR) 2.9; 95% confidence interval (CI) 1.5, 5.5) and prolapse to or beyond the hymen (OR 5.6; 95% CI 2.2, 14.7). Operative vaginal birth significantly increased the odds for all pelvic floor disorders, especially prolapse (OR 7.5; 95% CI 2.7, 20.9). These results suggest that 6.8 additional operative births or 8.9 spontaneous vaginal births, relative to cesarean births, would lead to one additional case of prolapse. Among women delivering exclusively by cesarean, neither active labor nor complete cervical dilation increased the odds for any pelvic floor disorder considered, although the study had less than 80% power to detect a doubling of the odds with these exposures. Conclusion Although spontaneous vaginal delivery was significantly associated with stress incontinence and prolapse, the most dramatic risk was associated with operative vaginal birth.

Immediate Compared With Delayed Pushing in the Second Stage of Labor

“…33,34 This is clinically relevant, because operative vaginal deliveries are associated with increased risks of neonatal and maternal morbidity. [35][36][37] Many studies did not evaluate important neonatal and maternal outcomes, and when they did, they were measured differently, making statistical synthesis impossible. The methodologic quality of studies was also variable.…”

Pelvic floor dysfunction, and effects of pregnancy and mode of delivery on pelvic floor

“…For example, the likelihood of OAB syndrome does not differ significantly in women who underwent VD or CD 5e10 years ago [46]. In another study, it has been emphasized that pregnancy state itself is a risk factor for OAB, and not the mode of delivery.…”

“…Cochrane reviews indicated that limited episiotomy should replace routine episiotomy [57e59]. Mediolateral episiotomy has been argued to be a risk factor for PFD, as it causes FI by damaging the anal sphincter [46]. Despite that, mediolateral episiotomy has not been found to increase the incidence of prolapse, UI, and FI, compared with the first-and second-degree spontaneous perineal lacerations and intact perineum [60].…”

Ultrasonographic evaluation of urethrovesical junction mobility: correlation with type of delivery and stress urinary incontinence

“…Since a number of studies did not show a significant difference in the rate of SUI between women who underwent elective CS and those who underwent non-elective CS (during labour) [23][24][25][26], we did not analyse separately the results in women undergoing CS before or during labour. During pregnancy, the RVA was significantly wider than in the control group, while there were no significant differences between the second and third examinations after either VD or CS.…”