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Previous research showed that, compared with spontaneous vaginal delivery, cesarean delivery was associated with lower risk for pelvic floor disorders whereas operative vaginal delivery was associated with higher risk. To further examine the associations between childbirth mode and risk for various pelvic floor disorders, investigators conducted a cohort study of women enrolled 5 to 10 years after their first delivery and followed annually for up to 9 years. Among 1528 participants, 28% had 1 delivery, 56% had 2 deliveries, and 16% had ≥3 deliveries. Groups consisted of cesarean births only (778 women), spontaneous vaginal births only (SV; 565 women) and vaginal birth with at least 1 operative vaginal delivery (OV; 185 women). Pelvic floor disorders included stress urinary incontinence (SUI), overactive bladder (OAB), anal incontinence (AI), and pelvic organ prolapse (POP).
In the SV group, 15-year cumulative incidences (following the first birth) were 34% (SUI), 22% (OAB), 31% (AI), and 30% (POP). Compared with women in the SV group, those with only cesarean births had significantly lower risk for SUI (adjusted hazard ratio, 0.46), OAB (aHR, 0.51), and POP (aHR, 0.28), whereas those in the OV group had significantly higher risk for AI (aHR, 1.75) and POP (aHR, 1.88).
Blomquist JL et al. Association of delivery mode with pelvic floor disorders after childbirth. JAMA 2018 Dec 18; 320:2438. (https://doi.org/10.1001/jama.2018.18315)
Comment
The Women's Preventive Services Initiative recently recommended that all women be asked if they have urinary incontinence and whether it impacts their activities and quality of life. Given the high prevalence of pelvic floor disorders reported in this study — and the reluctance of many women to raise the issue with their clinicians — we would do well to ask our patients at regular intervals whether they are experiencing urinary or anal incontinence. Lastly, although cesarean delivery did not carry higher risks for pelvic floor disorders in this cohort, these findings should not be taken to mean that cesarean delivery represents a solution.