The purpose of this study was to evaluate prospectively the association between selected obstetric antecedents and symptoms of pelvic floor dysfunction in primiparous women up to 7 months after childbirth.
All nulliparous women who were delivered between June 1, 2000, and August 31, 2002, were eligible for a postpartum interview regarding symptoms of persistent pelvic floor dysfunction. Responses from all women who completed a survey at or before their 6-month contraceptive follow-up visit were analyzed. Obstetric antecedents to stress, urge, and anal incontinence were identified, and attributable risks for each factor were calculated.
During the study period, 3887 of 10,643 primiparous women (37%) returned within 219 days of delivery. Symptoms of stress and urge urinary incontinence, were significantly reduced (P < .01) in women who underwent a cesarean delivery. Symptoms of urge urinary incontinence doubled in women who underwent a forceps delivery (P = .04). Symptoms of anal incontinence were increased in women who were delivered of an infant who weighed >4000 g (P = .006) and more than doubled in those women who received oxytocin and had an episiotomy performed (P = .01).
The likelihood of symptoms of pelvic floor dysfunction up to 7 months after delivery was greater in women who received oxytocin, who underwent a forceps delivery, who were delivered of an infant who weighed >4000 g, or who had an episiotomy performed. Women who underwent a cesarean delivery had fewer symptoms of urge and stress urinary incontinence.
"Studies on changes in the pelvic floor induced by delivery have shown that breech insufficiencies of the bladder or of the anal sphincter can develop as late consequences of vaginal birth (Schüssler & Bäsler 1998, Casey et al. 2005). It is possible that such damages in the pelvic floor can be avoided when elective section is performed (Sultan & Stuart 1996). "
[Show abstract][Hide abstract] ABSTRACT: Percentages of cesarean section world-wide have increased substantially over the past two decades. Maternal request for abdominal delivery may have contributed to this development. The wish to be delivered by C-section for personal reasons without medical indication should be discussed from the medical point of view as well as from the legal perspectives of mother and child. Today, mortality in primarily indicated and performed cesarean section is not substantially higher than in vaginal delivery. The consequences of cesarean section are important for succeeding pregnancies. Besides the risk of scar rupture, the drastic increase in the incidences of placental detachment (placenta accreta/increta/percreta) and placenta previa in succeeding pregnancies are of relevance. However, this risk should be weighed against fetal risk in vaginal delivery, especially intrauterine death and encephalopathy caused by intrapartum hypoxia as well as cerebral palsy amounting to 1/500. Pelvic floor damage after vaginal delivery can probably be reduced but not necessarily avoided by primary cesarean section. In summary, advantages and disadvantages of vaginal and abdominal delivery have to be weighed up carefully. Cesarean section performed by an experienced team with optimal equipment is accompanied by rather low risk. The obstetrician has to consider possible unlawfulness in cases of maternal request for cesarean section.
[Show abstract][Hide abstract] ABSTRACT: Patient-choice cesarean delivery is in- creasing in the United States. The American College of Obstetricians and Gynecologists supports this option, citing ethical premises of autonomy and informed consent, despite a lack of evidence for its safety. This increase in patient-choice cesarean delivery occurs during a time when women with a breech-presenting fetus or a previous cesarean section have fewer choices as to vaginal birth. Patient-choice cesarean delivery may become widely dissemi- nated before the potential risks to women and their children have been well analyzed. The growing pressure for cesarean delivery in the absence of a medical indication may ultimately result in a decrease of women's childbirth op- tions. Advocacy of patient-choice requires preserving vaginal birth options as well as cesarean delivery.
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