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Cesarean delivery linked to lower incidence of pelvic floor disorders

Compared with spontaneous vaginal delivery, cesarean delivery was associated with a lower hazard for pelvic floor disorders, according to findings recently published in JAMA.

“Despite recent advances, the biological mechanisms underlying pelvic floor disorders remain uncertain. Epidemiologic studies suggest that pelvic floor disorders are associated with childbirth, because these conditions are strongly associated with parity and are more common after vaginal birth vs. cesarean birth,” Joan L. Blomquist, MD, department of gynecology, Greater Baltimore Medical Center, and colleagues wrote.

“Little is known, however, about the association of various obstetrical exposures with the course and progression of pelvic floor disorders during a woman's life,” they added.

Researchers followed-up annually with 1,528 women, of whom 1,092 were multiparous (median age at first delivery, 30.6 years).

Blomquist and colleagues found that after a median of 5.1 years, there were 168 cases of anal interference, 153 cases of pelvic organ prolapse, 138 cases of stress urinary incontinence, and 117 cases of overactive bladder.

In the reference group — women with spontaneous vaginal delivery — the 15-year cumulative incidences of pelvic floor disorders were: stress urinary incontinence, 34.3% (95% CI, 29.9-38.6); anal incontinence, 30.6% (95% CI, 26.4-34.9); pelvic organ prolapse, 30% (95% CI, 25.1-34.9); and overactive bladder, 21.8% (95% CI, 17.8-25.7).

Compared with spontaneous vaginal delivery, operative vaginal delivery was associated with significantly higher hazard of pelvic organ prolapse (adjusted HR= 1.88; 95% CI, 1.28-2.78) and anal incontinence (aHR = 1.75; 95% CI, 1.14-2.68). Cesarean delivery was associated with significantly lower hazard of stress urinary incontinence (aHR = 0.46; 95% CI, 0.32-0.67), overactive bladder (aHR = 0.51; 95% CI, 0.34-0.76) and pelvic organ prolapse (aHR = 0.28 95% CI, 0.19-0.42).

“Results of this study showed a substantial difference in pelvic floor disorder incidence based on a woman’s obstetrical characteristics. The cumulative incidence of each pelvic floor disorder was significantly associated with delivery mode,” Blomquist and colleagues wrote.

They added the data were drawn from a single institution, so the results would not necessarily be the same in more diverse cohorts. – by Janel Miller

Disclosures: Blomquist reports no relevant financial disclosures. Please see the study for all other authors relevant financial disclosures.