Pelvic organ prolapse and incontinence 15–23 years after first delivery: a cross‐sectional study

Abstract

Objective To study the association between pelvic floor dysfunction (PFD) and mode of delivery and to calculate the risks of PFD comparing caesarean delivery and operative vaginal delivery to normal vaginal delivery 15-23 years after childbirth. A subgroup analysis comparing forceps and vacuum delivery was planned.Design Cross-sectional study.Setting Postal questionnaire.Population 1641 (53%) of 3115 women who delivered their first child in Trondheim, Norway, between January 1990 and December 1997.Methods A questionnaire including questions on symptomatic pelvic organ prolapse, urinary and fecal incontinence and surgery for these conditions.Main outcome measures Prevalence of PFD measured by symptomatic pelvic organ prolapse or surgery (sPOP), urinary incontinence or surgery (UI) and fecal incontinence or surgery (FI).Results When caesarean delivery was compared to normal vaginal delivery the adjusted odds ratio (aOR) for sPOP was 0.42 (95% confidence interval, CI, 0.21-0.86) and the aOR for UI was 0.65 (95% CI 0.46-0.92). Operative vaginal delivery was associated with increased risk of sPOP (aOR 1.73, 95% CI 1.21-2.48) and FI (aOR 1.96, 95% CI 1.26-3.06) when compared with normal vaginal delivery. There were no differences in sPOP, UI or FI in a subgroup analysis comparing forceps and vacuum delivery.Conclusions Caesarean delivery was associated with decreased risk and operative vaginal delivery with increased risk of pelvic floor dysfunction 15-23 years after first delivery, but there were no differences between forceps and vacuum delivery.Keywords Fecal incontinence, forceps delivery, pelvic floor dysfunction, pelvic organ prolapse, urinary incontinence, vacuum delivery.Linked article This article is commented on by R Rogers, p. 972 in this issue. To view this mini commentary visit http:// dx.doi.org/10.1111/1471-0528.13318.Please cite this paper as: Volløyhaug I, Mørkved S, Salvesen Ø, Salvesen KÅ . Pelvic organ prolapse and incontinence 15-23 years after first delivery: a crosssectional study . BJOG 2015;122:964-971.

Long-term Impact of Mode of Delivery on Stress Urinary Incontinence and Urgency Urinary Incontinence: A Systematic Review and Meta-analysis

“…Hence potentially increasing use of cesarean section may have beneficial public health consequences from the perspective of pelvic floor health, including decreased need for SUI and pelvic organ prolapse surgery [52], [53]. Our results are consistent with those of a Swedish cohort study that reported vaginal deliveries increased surgical treatment for incontinence (hazard ratio: 2.9; 95% CI, 2.4–3.6) compared with women only having cesarean deliveries.…”

Pelvic floor dysfunction in the immediate puerperium, and 1 and 3 months after vaginal or cesarean delivery

“…Hormonal and mechanical factors affect the female organism during pregnancy, delivery, and the puerperium, causing alterations of the pelvic floor that can lead to PFD . Although these changes tend to regress gradually, with a return to the pre‐pregnancy state in up to 12 months, long‐term follow‐up studies have shown that PFD may persist …”

Levator ani muscle injury and risk for urinary and fecal incontinence in parous women from a normal population, a cross‐sectional study

“…This is a secondary analysis of a cross‐sectional study of 608 women with first delivery at Trondheim University Hospital, Norway, between 1 January 1990 and 31 December 1997. The primary aim of this study was to examine differences in PFD and LAM injury after different modes of delivery, and results have been published elsewhere . Women who were still alive and had a postal address in Norway in 2013 were identified from the Hospital Patient Administrative System.…”

“…The prevalence of UI and FI increases with advancing age, but the etiology is believed to be multifactorial . Pregnancy, vaginal delivery, parity, smoking, and body mass index (BMI) are additional risk factors for developing PFD …”