Pelvic Floor Morbidity Following Vaginal Delivery versus Cesarean Delivery: Systematic Review and Meta-Analysis

Abstract

Objective: To compare pelvic floor disorders between vaginal delivery (VD) and cesarean delivery (CD). Methods: For this study, a PUBMED database search was used, utilizing a combination of relevant medical subjects’ headings (MeSH) terms, with the following keywords: “Pelvic floor disorders” or “Pelvic floor morbidity” and “Delivery”. Search limits were articles in English or Spanish, about women, published from December 2009 to December 2019. The STATA 16 package was used for meta-analysis and data heterogeneity assessment. Results: Thirteen studies meeting eligibility criteria were identified comprising 1,597,303 participants. Abstract: Pelvic floor morbidity prevalence was Urinary Incontinence (UI) 27.9% (5411 patients in 7 studies with reported cases), Pelvic Organ Prolapse (POP) 14.2% (6019 patients in 8 studies with reported cases), and Anal Incontinence (AI) 0.4% (1,589,740 patients in 5 studies with reported cases). Our meta-analyses revealed significantly higher rates of all three morbidities and overall morbidity in the VD versus CD group: UI OR = 2.17, 95% CI 1.64–2.87, p for heterogeneity ≤ 0.0001, I2 = 84%; POP OR = 3.28, 95% CI 1.91–5.63, p for heterogenicity ≤ 0.043, I2 = 63%; AI OR = 1.53, 95% CI 1.32–1.77; p for heterogeneity ≤ 0.291, I2 = 20%; and overall morbidity (OR = 2.17, 95% CI 1.64–2.87; p for heterogeneity ≤ 0.0001, I2 = 84%). Conclusion: Vaginal delivery is directly related to the appearance of pelvic floor disorders, mainly UI, POP, and AI. The risk of POP should be taken into higher consideration after vaginal delivery and postpartum follow-up should be performed, to identify and/or treat it at the earliest stages.

Pelvic floor disorder and relevant factors in Iranian women of reproductive age: a cross-sectional study

“…According to the evidence from a systematic review and a meta-analysis (2021), vaginal delivery can increase the risk of pelvic floor disorder [ 17 ]. This study introduced the increasing number of parities and the BMI as the risk factors in pelvic floor disorder [ 38 ]; however, another study reported that pelvic floor disorder had no significant correlations with the number of pregnancies and delivery [ 39 ].…”

“…Recently, a review study has introduced genes as an effective factor in the emergence of pelvic floor disorder, especially pelvic organ prolapse distress [ 16 ]. The highest rate of pelvic floor disorders reported after vaginal delivery is related to urinary incontinence (28%) and pelvic organ prolapse (14%) [ 17 ]. Nevertheless, there is no evidence regarding the role of caesarean section in protecting pelvic floor muscles to prevent the potential occurrence of pelvic floor disorder [ 18 ].…”

Fecal Incontinence and Diarrhea During Pregnancy

“…Anticipating and proactively managing FI and discussing future delivery in pregnant people with 1 or more prior obstetric anal sphincter injury (OASIS) is important because the risk of FI with prior OASIS and the risk of another OASIS in those with a history of OASIS are significantly increased (29)(30)(31). All women who have an episiotomy or a perineal tear at the time of delivery should undergo a rectal examination to evaluate for a rectal or anal sphincter injury.…”

Effects of Different Indications for Forceps Delivery on Pelvic Floor Muscle Surface Electromyography and Early Postpartum Pelvic Floor Function in Primiparas

“…Presently, PFDs are regarded as a hidden epidemic that affect approximately 21%-26% of women, with urinary incontinence (UI), having the highest incidence rates worldwide [2]. Pregnancy and delivery are independent risk factors for impaired pelvic floor function [3,4], with operative vaginal delivery (OVD) being closely associated with PFDs [5]. OVD refers to a key means of delivery in which forceps or vacuum extraction is used to apply direct traction on the fetal head during the second stage of labor to accelerate or achieve vagi-nal delivery [6].…”