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

Johns Hopkins University, Baltimore, Maryland, United States
Obstetrics and Gynecology (Impact Factor: 5.18). 09/2011; 118(4):777-84. DOI: 10.1097/AOG.0b013e3182267f2f
Source: PubMed


To estimate differences in pelvic floor disorders by mode of delivery.
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.
Compared with 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.
Although spontaneous vaginal delivery was significantly associated with stress incontinence and prolapse, the most dramatic risk was associated with operative vaginal birth.

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Available from: Leise Knoepp, Oct 19, 2014
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    • "They diagnosed avulsion by ultrasound in 48 women (63.6%) and confirmed that forceps delivery is a statistically significant risk factor [12]. Forceps delivery thus seems to be associated with a significantly higher incidence of MLA avulsion injury [5] [9] [14]. "
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    ABSTRACT: Objective: We compared the incidence and type of levator ani avulsion diagnosed by translabial ultrasound evaluation in primiparous women six months after vacuum-assisted or spontaneous vaginal delivery. Material and methods: This retrospective observational study was performed between January 2011 and December 2013. Primiparous women six months after vacuum-assisted vaginal delivery and after spontaneous vaginal delivery underwent translabial ultrasound evaluation. The distance between the urethra and fibers of the musculus levator ani puborectalis (levator–urethra gap) was measured. A levator-urethra gap >25 mm was considered a musculus levator ani avulsion. Results: In total, 184 women participated in the study. Among them, 92 had vacuum extraction and 92 had uncomplicated spontaneous delivery. A longer levator–urethra gap on both sides of the pubic bone was found in women after vacuum-assisted vaginal delivery (p < 0.0001 for both sides). Musculus levator ani avulsion was identified in 20 women (unilateral in 16 cases and bilateral in four cases). No difference in an incidence of musculus levator ani avulsion was identified in women after vacuum-assisted vaginal delivery [11/92 (12%)] compared to spontaneous delivery [9/92 (10%); p = 0.81]. Conclusion: Vacuum-assisted vaginal delivery in primiparous women is associated with a longer levator–urethra gap but not with a higher frequency of avulsion of the musculus levator ani.
    Full-text · Article · Oct 2015 · Journal of Maternal-Fetal and Neonatal Medicine
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    • "They diagnosed avulsion by ultrasound in 48 women (63.6%) and confirmed that forceps delivery is a statistically significant risk factor [12]. Forceps delivery thus seems to be associated with a significantly higher incidence of MLA avulsion injury [5] [9] [14]. "
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    ABSTRACT: Objective: The evaluation of the risk and protective factors for pelvic floor trauma in relation to vaginal delivery.Design: Review.Setting: Department of Obstetrics and Gynecology, University Hospital of Ostrava.Methodology and results: The aim was to provide a comprehensive survey of studies focused on risk factors for pelvic floor trauma following vaginal delivery; and to constitute the relationship between the risk and protective factors and levator ani injury. To state the prognosis of the pelvic floor injury before a child delivery is difficult and almost impossible, but it has been assumed that an operative vaginal delivery (obstetrical forceps) represents a significant risk factor for avulsion. The change in obstetric practice can prevent the injury and thus to reduce an adverse effect.Conclusions: Pregnancy and the methods of childbirth are important factors with an impact on pelvic floor injury, potentially contributing to the development of pelvic organ prolapse, and stress and anal incontinence. The recognition of the factors, the proper training of medical staff in the management of labour, and subsequently the proper treatment of perineal tears should prevent pelvic floor injury.Keywords: labour, avulsion, perineal tears.
    Full-text · Article · Feb 2015 · Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne
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    • "In addition, with vaginal delivery there is a decreased incidence of endometrial infection, and fewer complications due to anesthesia, or placenta accreta in future pregnancies. However, vaginal delivery can cause weakness of the pelvic floor muscles resulting in problems such as urinary incontinence8, 9). "
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    ABSTRACT: [Purpose] The purpose of this study was to examine the activities of the abdominal muscles of women who had experienced vaginal delivery in comparison with those who had experienced Cesarean childbirth. [Subjects and Methods] A total of 14 subjects (7 vaginal delivery, 7 Cesarean section) performed an active straight leg raise to 20 cm above the ground, and we measured the activities of the internal oblique abdominal muscle, the external oblique abdominal muscle, and the rectus abdominal muscle on both sides using electromyography. The effort required to raise the leg was scored on a Likert scale. Then, the subjects conducted maximum isometric contraction for hip joint flexion with the leg raised at 20 cm, and maximum torque and abdominal muscle activities were measured using electromyography. [Results] During the active straight leg raise, abdominal muscle activities were higher in the Cesarean section subjects. The Likert scale did not show a significant difference. The activities of the abdominal muscles and the maximum torque of the hip joint flexion at maximum isometric contraction were higher in the vaginal delivery subjects. [Conclusion] The abdominal muscles of Cesarean section subjects showed greater recruitment for maintaining pelvic stability during the active straight leg raising, but were relatively weaker when powerful force was required. Therefore, we consider that more abdominal muscle training is necessary for maintaining pelvic stability of Cesarean section subjects.
    Full-text · Article · Aug 2014 · Journal of Physical Therapy Science
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